Nicolas Hewitt

Emerson

IDMD 101

4 September 2023

The Less Fun Medical Green

          In order to combat diseases such as diabetes, obesity and hypertension, a study has given

produce vouchers to around four thousand people who struggle to afford healthy foods. The

study tracked the participant’s weight, blood pressure, and blood sugar to see if there were any

noticeable improvements in the conditions of the participants. Those with uncontrolled

diabetes were found to have a significant reduction in average blood sugar, around half as

effective as typically prescribed medications. The vast majority, around 94%, of participants

reported improvement in their heath due to taking part in the program. Produce prescriptions

are only providing assistance in the short term, but advocacy groups like the Milken Institute as

well as the Biden administration are pushing to have them as well as other nutrition based

health programs implemented more permanently.

         When considering the role of physicians in treating disease and improving health, a

standard assumption would consist of prescribing drugs that target the specific cause of the

disease and to a lesser extent mitigate unpleasant symptoms. In the biomedical model, the goal

of medicine stops with treating the disease with empirically tested drugs or therapy. Beyond

that, medicine has little it should achieve. The biopsychosocial model would extrapolate that

goal to include considerations of the patient’s personal and social condition, but whether that

should extend into treatment outside traditional understanding of what is medicine depends

on one’s philosophy regarding health. The positivist perspective, in which health goes beyond

the mereabsence of disease, is where I argue the medical issue of prescription fruits and

vegetables originates. When you view the goal of medicine as maximizing the well being of the

patient, prescription produce and other treatments that provide general health benefits

(although prescription medicine does provide some specific medical treatment as supported by

the study in the article) are as important as treatments that reduce the detriments of specific

illness, such as antibiotics. The potential benefits of providing incentives to purchase more

produce are strong, as they help solve root dietary issues that cause many diseases. Produce

ought to be considered medical in the sense that although they are not an active drug that

targets a condition, it still is used by the physician to improve patient condition. Other

treatments, such as probiotics, are also general in their use and their benefits. Additionally, the

nature of medicine as largely provided by insurance lends itself to treatments that reduce the

overall health risks of the patient, as insurance companies are encouraged to support actions

that reduce risk of paying for additional care down the line.

          The implementation of prescription produce raises the debate of whether or not medicine

ought to consider inequalities in wellbeing as something to be treated by medicine, as well as

what constitutes medical inequalities. In a broader social context, inequalities of wellbeing, such

as housing or food insecurity are considered, with relatively less controversy, to be the

responsibility of the state and society as a whole. The idea of food stamps and other

government benefits are accepted as things the state can do, even if they are not considered by

all to be something the state should do. Medicine’s role in reducing inequality is met with more

resistance, perhaps because of the wish to keep medical institutions apolitical and focused on

purely scientific perspectives. Since medicine does not exist in a perfect vacuum, inequalities

will affect well being even if medical institutions try to remain as unbiased as possible. To treat

systemic issues of food inequality, especially in quality, medicine needs to be cooperatively

involved with other institutions such as the state in order to reduce the effect of socioeconomic

inequality on the health of underprivileged patients. Prescription produce blends the medical

knowledge of diet with the societal goal of improved general wellbeing, and supports the idea

that medicine should not only consider the entirety of what affects a patient’s life, but should

also not limit itself to what it can treat.

          The average reader will likely view this topic more through the broader lens of

socioeconomics rather than the question of medicine’s role of even providing such a

prescription. A reader, regardless of their opinions on the subject, would focus on the relation

of food based prescriptions to government benefits and medical insurance. Patients would

likely be enthusiastic to the idea of prescription produce as a more holistic treatment, and their

enthusiasm would only increase the effectiveness of the treatment due to their perception.

Getting produce prescriptions from their physician would also cause patients to be more

conscious of their diet overall, improving the relationship between psychological and biological

health. One concern about prescription produce would be poor reception from patients to a

physician suggesting changes to their diet. Some patients might be sensitive to the idea of a

patronizing doctor forcing patients to eat their vegetables as if he was their parent. This patient

concern touches on a fear of paternalism by physicians, and can be remedied by ensuring the

patient retains their autonomy to choose this treatment and does not feel pressured to change

their diet because of a physician’s personal belief of what is best for the patient. Instead it

should be made clear that the patient is deciding what dietary decisions that they should be

making.

          Prescription produce lends itself well to patient autonomy because it greatly increases the

patient’s agency to choose healthier food options, both in quantity and variety. With most

treatments, such as choosing what blood pressure medication they will take, the patient is

heavily dependent on the physician to inform them on the potential benefits and risks of

different medications. Often the physician has biases about what medication would be best and

may guide a patient to choose a medication that, if they were fully and impartially informed of,

they would not choose over another. With produce prescriptions much more of the decision

making is in the hands of the patient, both in the sense that the patient gets to choose what

produce to buy and is more familiar with what kinds of produce works best for them. Physicians

would likely still give advice about what produce to eat for the patient’s specific condition, but

the risk of that preventing patient autonomy is reduced. Unlike most medications, the relevant

facts about produce, such as nutritional values and bodily reactions to certain types of fruits

and vegetables, are as readily available to the patient, if not more, as they are to the physician.

          As medicine expands and challenges the great illnesses of our day, including cancer,

autoimmune diseases, and dementia, it is beneficial to also focus on the simpler, but equally

important issues that need to be treated. Prescription produce is by no means as glamorous as

revolutionary cancer treatments or advanced biomedical technology, yet it connects to

overlooked aspects of medicine: patient agency and access to care, as well as generalized

beneficial treatments. Prescription produce indicates medicine’s growing orientation to the

needs of patients beyond the biological.

 

Reference Article

Aubrey, Allison. “Prescriptions for fresh fruits and vegetables help boost heart health.” NPR,

9 Sep. 2023, 

https://www.npr.org/sections/health-shots/2023/09/04/1197266058/prescriptions-for-fresh

-fruits-and-vegetables-help-boost-heart-health.