Medical specialist: Governments should subsidize healthy food

Halachic medical conference addresses fasting for diabetics, health basket funding, clinical testing.

By JUDY SIEGEL-ITZKOVICH
vegetables 88 (photo credit: )
vegetables 88
(photo credit: )
A senior physician at Jerusalem's Bikur Holim Hospital has called on the governments around the world, including Israel, to subsidize healthful foods such as fruits, vegetables, grains and fish and remove subsidies for cheap carbohydrates and junk food that only promote the "epidemic" of excess weight, diabetes and heart disease. Dr. Yosef Kleinman, the hospital's chief of internal medicine, said at the annual conference of the Puah Institute for Fertility and Medicine According to Halacha at Jerusalem's Nofei Yerushalayim hall that while there is a global decline in the rates of hypertension, smoking and high cholesterol, cardiovascular disease continues to kill more than any other disease, and there has been a giant growth in the rates of obesity and diabetes. Cheaper foods, such as white flour and sugar, constitute the main diet of the poor, while a diet based on fresh produce, whole grains and fish is prohibitively expensive for many. If the government wants to save money on medical costs, it should encourage people to eat right, he said. However, the Treasury has repeatedly tried to apply Value Added Tax to fruits and vegetables, which would likely deter more Israelis from eating a healthful diet. Kleinman said that fasting, as required from time to time by Jewish tradition, can be healthy. He cited a study published by the American Heart Association comparing health records of religious Mormons, who fast once a month, and non-religious ones, who do not. Kleinman, a haredi physician, said the study found that the risk of hospitalization was significantly lower among those who fasted. Many religious Jewish diabetics turn to Kleinman, asking whether they can fast as required on Yom Kippur, Tisha Be'Av and other fast days. Until recently, rabbis have ruled and doctors have advised that diabetics dependent on insulin should not fast, as doing so could be dangerous. But Kleinman said that the introduction of a new injected basal insulin called Lantus can keep sugar/insulin level balance steady and enable diabetics to fast. Those diabetics dependent on diet and oral drugs can take their pills before the fast and also avoid food and drink, he said. In addition, he noted that many other patients, especially those hospitalized, who wanted to fast but had been advised not to for various medical reasons could avoid eating if a doctor prescribed special liquid food concentrates (such as Ensure) or by hooking up to an infusion for the duration of the fast. Former Sephardi Chief Rabbi Eliahu Bakshi-Doron, who is a member of the Israel Medical Association's Public Forum For Enlarging the Basket of Health Services, spoke at the conference about the painful dilemma of having to choose which drugs and treatments were included in the health basket in the face of inadequate Treasury funding. He said that although he was pleased that the Knesset Finance Committee on Monday added NIS 150 million to the 2008 basket, in addition to the original NIS 275 million agreed upon by the Treasury, he knew that the lives of many people were endangered by inadequate funding for medicine. Bakshi-Doron described the moral and halachic problems of having to decide who would live and who would die, whether the elderly would be deprived to provide drugs to younger people, and whether drugs that alleviated great pain and suffering but did not save lives should be financed at the expense of those that extended life. Tel Aviv Chief Rabbi Yisrael Meir Lau discussed whether patients should take part in clinical experiments whose efficacy and safety had not been proven for a chance to live longer and possibly see a cure. The best way, Lau said, was to balance risks against potential benefits, call a consortium of physicians who would make a recommendation and consult a leading rabbinical expert to give his opinion. Dr. Yossi Azuri, a family physician from Maccabi Health Services, encouraged smokers to kick the habit. While nicotine is the most addictive substance in the world, one can successfully give it up, he said. Going cold turkey without help leads to a very small - three to four percent - success rate a year later. But various prescription drugs and nicotine replacement therapies can be helpful, he added. Others present suggested that if all observant girls of marriageable age refused to marry young men who smoke, it would have a major effect in bringing down the smoking rate in this population sector.