Healthcare spending and reliance on single-agent approaches to cure disease and reduce disability are spiralling out of control in the USA.1,–,5 Meanwhile, sentinel health indicators such as mortality and incidence of many diseases are stagnating or, in many population subgroups, worsening.6,–,15 With the exception of cigarette smoking, where overall rates have fallen while becoming a habit concentrated in the poor and less educated, the underlying causes of most chronic diseases that constitute the bulk of both human suffering and healthcare spending have failed to improve much, if at all, over the past couple of generations.5 14 16 17 Obesity rates, inclusive of those in children, are the highest ever recorded in human history.11 17,–,19 Sedentariness has become the norm,18 20 21 and diets are increasingly nutrient sparse,22,–,26 especially in the majority of individuals who select calorie-dense, and shun whole-grain, foods.27,–,30

What is the typical American response to this? An article by Gardiner Harris in the 23 January 2011 New York Times entitled ‘New Federal Research Center Will Help Develop Medicines’ describes a plan to create a new US$1 billion centre on Advancing Translational Sciences at the National Institutes of Health (NIH). This plan typifies the search for a ‘magic bullet’, in pill form, that will cure all diseases and health problems.1 2 31

According to the article, large drug companies have spent ∼US$400 billion on drug research over the past 15 years. We should examine the effectiveness of this huge expenditure in terms of public health …