Academic corroboration

Subject: Congrats on "Overdosed"

Dear John,

I read your book today from cover to cover and found it really excellent. I have just joined Yale where I head their Global Health division and hope to focus on building a stronger global case for prevention and health promotion-I attach two recent pieces of work I have completed on this as an introduction.

For almost 10 years I have been at WHO where I headed the team that developed the Framework Convention on Tobacco Control, and more recently, the Global Strategy on Diet, Physical Activity and health. I also had responsibility forour CVD and other chronic disease programs. I experienced first hand the pharma pressures in our work you refer to on osteoporosis, hypertension guidelines, use of HRT and so on. And my main interest is highlighting why prevention does not get attention, dollars or political support.

You have exquisitely highlighted one set of pressures in the best way I have ever read. Would be keen to see if we could get you to Yale at some point both to present your findings but more importantly to see if we could plan future work...would be vaulable for example if you could globalise your findings; and I am working on the global constraints to prevention that bring in the tobacco and food companies.

Hope this gets to you and keen to interact.
With regards,
Derek YachDerek Yach
Professor of Global Public Health
Yale University School of MedicineDepartment of Epidemiology and Public Health

I RESPOND:

Dear Derek,

I read your paper today and feel the same kind of personal naivete', disappointment, and concern about health in the developing countries that I have tried to evoke about health care in the US. Congratulations to you for framing the issue so well, and for calling attention to the impending healthconsequences of what is often presumed to be the benefit of rising prosperity associated with integration into global markets.

Clearly our work fits together, each supporting the other. My contribution is to document and explain the population failure of expensive downstream approaches to treating chronic conditions in the US, including the trans-generational chronic condition of low birth-weight babies. (Though mention must be made of the instances where the most lucrative care alsohappens to be the best care--like former President Clinton's highlypublicized heart surgery--the outcomes of individual acute treatment cancertainly be beneficial.)

The adoption of this approach to chronic disease prevention and treatment in developing countries will have about the same effect as the adoption of tobacco, highly processed foods, and minimally active lifestyles. All unfortunately bring benefit to trans-national corporations and a small numberof people within the developing countries, but the overall effect on the population as a whole is harm. I don't have to tell you that, analagous to the point you make about harming the environment in your paper, what is good for economic development (and an integral part of what we in the US call economic freedom) is often not good for population health. Therein lies theenormous challenge of this work within the US and, as you taught me this morning, in the developing countries as well.

I would be honored to present my work at Yale, perhaps "Don't Do As We HaveDone: The Failure of Downstream Treatment of Chronic Disease in the UnitedStates." And even more honored to work together on these issues.

Sincerely,
John