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Heart Attack City

"Now we know that a single fatty meal compromises coronary flow. This is true even in young people. Arteries are crying for oxygen; you can see it with a scan 5 minutes later; 120 minutes later, the effects are still obvious." - Dr. Caldwell Esselstyn, Chief of Surgery, Cleveland Clinic


Something amazing is happening at the Cleveland Clinic, the world's largest heart surgery hospital. More bypasses, angioplasty, heart implants, and various cardiovascular surgeries are performed at the Cleveland Clinic than anywhere else in the world, so there is great irony in the fact that the hospital's lobby contains a fast food McDonald's restaurant serving more than 500,000 meals each year.

Some refer to the Cleveland Clinic as "Heart Attack City."

More than 1,000 physicians are on staff at the Cleveland Clinic, representing 120 specialties. Imagine what their waiting room looks like. In 2004 more than 2 million patients will be seen (5,500 per day), and 50,000 admitted to this facility which contains nearly 3,000 beds. That represents plenty of sick Americans.

The following article appeared in yesterday's Washington Post (December 15, 2004)


Head of Cleveland Clinic Is Attacking Big Mac and in Hospital Lobby, McDonald's Fights Back
by Ceci Connolly

CLEVELAND -- The Pizza Hut is shuttered, its neon sign collecting dust on the floor. But knocking down the Golden Arches has proved far more difficult for Toby Cosgrove, the new head of the Cleveland Clinic.

A heart surgeon who has cleaned out a career's worth of clogged arteries, Cosgrove didn't think Big Macs, supersized fries and inch-thick, six-cheese pizzas belonged in the lobby of a hospital renowned for its cardiac care. So he decreed the fast-food joints had to go.

Pizza Hut went quietly. But McDonald's, halfway through a 20-year lease, has refused to shut down a franchise that serves 12,000 doctors, nurses, janitors, secretaries, patients and visitors each week.

"Our menu is something we're all proud of," said Marty Ranft, a McDonald's vice president. "We've got a great relationship with the Cleveland Clinic. We are not interested in closing the restaurant."

In the struggle against obesity, Americans are losing. And among the favorite targets for blame are fast-food chains such as McDonald's. Studies show that consuming large portions of high-fat, salty, sugar-laden foods has helped create a nation in which 64 percent of people are overweight or obese. They often land here at the Cleveland Clinic seeking treatment for diabetes, strokes, heart failure and crippling joint pain.

"We have to set an example with the food we serve our patients and employees," said Cosgrove, a trim 63-year-old. "In a way, McDonald's was symbolic as much as anything else. It is not associated with heart-healthy food; neither is Pizza Hut."

But Cosgrove's crusade has been met with resistance from not just McDonald's executives, who say they are being singled out for a problem that goes beyond the occasional Happy Meal, but also from staff and visitors who resent what they consider to be a paternalistic attitude from bosses who can afford pricier, more healthful food.

"What they have in the cafeteria is not a lot better, and it's certainly not affordable," said Donna Wilkison, a post-operative nurse waiting in line for her McDonald's salad with chicken. The cafeteria salad bar, priced at $4.64 a pound, "gets very expensive. They need to bring in something else that's more affordable."

On its sprawling urban campus, the clinic has a Subway sandwich shop, Au Bon Pain and Starbucks. Adjacent to the McDonald's is a cafeteria that features a large salad bar, a grill, a deli and hot entrees. The choices range include fresh fruit and homemade mashed potatoes. At Subway, salads begin at $3.99 and subs are about $5. McDonald's salads cost $4.10.

Nutritionists such as Montefiore Medical Center's Miriam Pappo said the Cleveland Clinic battle is akin to fights being waged in America's schools -- and a handful of other hospitals -- over candy, soda and fast-food sales.

She said it was "appropriate" for clinic officials to act as role models, yet Pappo sympathized with McDonald's' argument that no one forces people to eat there. "In a way, they are a scapegoat," Pappo said. "But in other ways, they are contributing for sure."

Of its 13,000 U.S. locations, about 30 McDonald's outlets are in hospitals, including children's hospitals in Los Angeles and Philadelphia. The New York City Health and Hospital Corp. does not intend to renew the McDonald's contract at its Elmhurst hospital and has not decided whether to keep the one in the Jacoby Medical Center in the Bronx, spokeswoman Kathleen McGrath said. The Harlem hospital closed its McDonald's earlier this year.

The Cleveland debate began two years ago when one of the clinic's most talented, most outspoken heart surgeons rose at a staff retreat to question how in good conscience they could tempt their patients with such unhealthful products.

"I can't tell you how many patients found this repulsive," said cardiology chairman Eric Topol. "How can the Cleveland Clinic, which prides itself on promoting health, have the audacity to have a McDonald's in the main lobby?"

Some days, the scent of cooking grease wafts up the one flight to Topol's domain, a heart center that has been ranked first in the nation by U.S. News & World Report for 10 straight years. He has heard all the wisecracks and not-so-amused comments about serving up a side of fries with that angioplasty.

"If this was a strip mall or a food court in a public place, that would be a different matter," he said in an interview. "We're supposed to be the icons for promoting good health."

Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest, said McDonald's few salads, fish sandwiches and fruit drinks do not make up for its overwhelming emphasis on fried foods.

"They announced with a lot of fanfare they were going to change the frying oil, and they never followed through," Wootan said. "There's twice as much heart-damaging fat in the french fries and nuggets and apple pies in the lard they use."

McDonald's executives accuse Topol, Cosgrove and Wootan of opportunism and demagoguery, targeting an easy villain rather than the individuals doing the eating.

"If Dr. Cosgrove wants to say McDonald's is inconsistent" with the health goals of the hospital, "he needs to take a look at the vending machines with candy bars and salty snacks, the cafeteria with deep-fried chicken, baked pies and slabs of ribs," said William Whitman, director of U.S. media relations for McDonald's.

McDonald's nutritionists point to numerous high-calorie, high-fat foods in the clinic cafeteria. But their comparison of "typical meals" tallies a cafeteria breakfast of orange juice, three scrambled eggs, two pork sausage patties, two hash browns and two slices of toast against the steak, single egg and cheese on a bagel with hash browns from McDonald's.

As the burger battle has escalated, McDonald's public relations gurus have rolled out legal, political and economic arguments. They defend their food as healthful. But they also have suggested that Cosgrove is racist for targeting Turan Strange, the African American small businessman who owns the franchise, raised the specter of unemployment for its 40 low-wage workers and said that closing down will hurt Ohio beef producers.

Phillip Wilkins, a representative of the National Black McDonald's Operators Association, warned Cosgrove: "We vigorously support one another and will not hesitate to do so with every resource available to us."

In the meantime, business is brisk at the Cleveland Clinic McDonald's, one of four owned by Strange; staff members, patients and visitors wait in line.

"I try to eat healthy, but for lunch I want something that's cheap," said Tanya Sutton, who works 5 a.m. to 1:30 p.m. in patient food service. "At 11 a.m. they're still serving breakfast in the cafeteria, but that's my lunch break." She eats at the McDonald's a few times a week.

Nudged by his wife, engineering supervisor John Moorer walks through the cafeteria salad bar, loading his plate with lettuce, onions, tomatoes, mushrooms, eggs, cucumbers, cheese cubes and diced ham, which he knows is not good for his high blood pressure. But he has also opted for McDonald's or Pizza Hut: "I can't eat salad all the time. It's rabbit food."

Near retirement age, Moorer doesn't want his boss telling him what to eat. "If it's killing me, then that's my choice," he said.

McDonald's officials said they want to work with the clinic to develop more healthful menu options. But Cosgrove did not sound interested. He suggested a financial settlement is in the offing.

[end of article]



"I try to eat healthy, but for lunch I want something that's cheap," said Tanya Sutton. But this food is expensive if you take into consideration that eating this food is going to come at the expense of your health. Mr. Moorer said, "If it's killing me, then that's my choice." Does this sound like a rational statement, or is this the thinking of someone who doesn't give a rat's rump about their health; someone who values concoctions designed to tantalize the tastebuds more than being in good physiological shape. As we have become a less healthy species, sperm counts are down, women's ability to conceive is down, and miscarriages are up; all signs that our ability to procreate the species is diminishing. Like it or not, Mother Nature has the final say, and just as natural selection selects out those who are healthiest to carry on genetic lines, it also lets the unhealthy genetic lines go bye-bye. So to assist Mother Nature in her quest to have the strong survive, maybe there should be a McDonald's in every hospital lobby, and on every street corner. It won't make a difference to those who truly care about their health, they won't eat at McDonald's no matter how many there are. As to the those folks who aren't wise enough to value good health over unhealthy Happy Meals, the sooner their genetic lines are weeded out of the human gene pool, the healthier the human species will be. And since emotional health is directly affected by physical health, maybe then people's personalities will evolve away from self-interest and move towards caring about their fellow humans. Maybe then there can be just one race, the human race, and not separate races based on hair, skin, or eye color and we won't need a National Black McDonald's Operators Association. Maybe then companies will put their customer's health before financial gain. Maybe then politicians will put their constituent's interest before self-interest. If we don't improve as a species, and we instead continue on the present path where we are nothing more than revenue generating units for corporations, seen only as mouths to shovel non-human food into, and merely bodies to fill with drugs to mask symptoms of serious disease to keep the profits of the medical/pharmaceutical industries up as our health goes down, then why bother existing? Maybe another ice age should "hit the reset button", and life on this planet should try again. If people's definition of paradise is to be able to eat whatever they want and take pills to mask the symptoms of the diseases caused by this way of eating, and to be able to sit on their larger than normal butts in front of the TV as their girth increases and their health and vitality decreases, then they probably are a big disappointment to whomever or whatever designed them in the first place. That entity's point of view? "I gave you a paradise, and look what you did with it!... Free will; not one of my better decisions."

Yes, the above is a harsh look at reality, but if present health trends continue, and if people continue to become more overweight and obese at earlier and earlier ages, and if degenerative disease continues to show itself at earlier and earlier ages, then soon there may be no reality for the human race to look at!

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