When Dr. John Pippin, a cardiologist in Dallas, visited John Peter Smith Hospital for the first time last week, he noticed the sheer number of signs — around every corner, it seemed — forbidding the use of tobacco products. 

“I thought that was impressive,” he said. “I thought that was a statement of accountability from JPS. And I wondered why they don’t accept the same accountability regarding diet that they do regarding smoking.”

Pippin is the director of academic affairs for the Physicians Committee for Responsible Medicine, a nonprofit that encourages plant-based diets and ethical scientific research. He visited John Peter Smith Hospital to speak at the June board of managers’ meeting about a long-contested subject: the McDonald’s restaurant on the hospital’s first floor.

In his testimony, he questioned why a hospital would partner with the fast-food corporation when research links fast food with a myriad negative health outcomes, including increased risk of diabetes and death from heart disease.

“It’s incongruous, and I might say hypocritical, for institutions that are built on the prevention and remedy of diseases to simultaneously support restaurants like McDonald’s,” Pippin told the Report. “It’s like selling cigarettes in a cancer ward.”

JPS Health Network declined to be interviewed for this story and did not answer questions about why the hospital has continued to renew its contract with McDonald’s, or how the hospital has responded to previous pushback about the restaurant. However, the network is considering “all available food service options for the future” as part of its master plan, spokesperson Jessamy Brown wrote in an email. The hospital earns about $200,000 a year from McDonald’s, she wrote. JPS Health Network’s annual operating revenue is more than $1 billion. 

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Golden arches among the gurneys

The 3,000-square-foot McDonald’s restaurant opened on the John Peter Smith campus in August 1993, according to coverage by the Fort Worth Star-Telegram. For McDonald’s, the occasion marked a milestone: With the Fort Worth location, the corporation had reached 25 hospital venues nationwide. 

The McDonald’s media relations department did not respond to multiple requests for an interview. 

The grand opening predated Steve Montgomery’s appointment to the hospital’s board of managers by almost a decade, he said. But the controversy had already begun. Even in the early 2000s, the board was asking, “Why do we have this thing here? Is that really the message we want to send?” he said. 

The hospital received external pushback, too. In 2012, Boston-based Corporate Accountability International requested that John Peter Smith Hospital close the McDonald’s. The corporation watchdog nonprofit said that providing fast food in a hospital “promotes harm, not health,” according to a Star-Telegram editorial from the same year.

The Physicians Committee for Responsible Medicine, which Pippin represents, would make similar pleas before the board of managers beginning in 2017. After last week’s presentation, he’s hopeful — he feels like the hospital has been listening.

“We think, maybe, they’re ready to change,” Pippin said.

For example, the most recent contract between JPS Health Network and McDonald’s began in 2013 and was slated to expire in 2019. In 2019, the Physicians Committee requested that the hospital not renew the contract. 

The hospital did renew, but with two amendments: The lease would last only one year, and it would include a clause that allowed either party to terminate the lease for any reason with 180 days’ notice. That contract is still in place, Pippin said. He’s also hoping that the hospital’s new CEO, Dr. Karen Duncan, will sympathize as a pediatrician with the Committee’s request.

In the past several years, children’s hospitals around the country have been transitioning away from relationships with McDonald’s, he said. He thinks the trend is a harbinger for more expired contracts.

John Peter Smith Hospital is the only one in Fort Worth that contracts with a McDonald’s. Both Texas Health Harris Methodist Hospital and Medical City Fort Worth offer Subway. The former also offers Einstein Bros Bagels. Patients at Baylor Scott & White All Saints Medical Center – Fort Worth can eat at Starbucks and Which Wich. Cook Children’s has a Starbucks and a Chick-fil-A. 

Pippin calls McDonald’s the “800-pound gorilla in the fast food universe.” Still, he said, it’s not the only offender. The Physicians Committee also tracks which hospitals offer Wendy’s and Chick-fil-A. 

In 2016, as part of its “Eat More Chickpeas” campaign, the Committee placed billboards and ads around hospitals that host Chick-fil-As, including Cook Children’s. Ten pump-top ads bearing the phrase “Ask your local hospital to go #FastFoodFree!” appeared at gas stations within a 10-mile radius of the hospital.

“We don’t have an ax to grind against any business,” Pippin said, “but we do have an ax to grind against practices that contribute to ill health, serious diseases and shortened lifespans.”

In Dallas, where Pippin lives, Parkland Memorial Hospital ended its own contract with McDonald’s in 2009. 

‘Sick as a nation’

Dr. Rizwan Bukhari was a surgery resident at Parkland in the 1990s. He remembers the McDonald’s. 

He remembers removing a patient’s gallbladder and, two days later, seeing that patient in line at the restaurant — hospital gown donned and IV pole in tow.

Bukhari shared that story at the board of managers meeting last week. He’s also a member of the Physicians Committee for Responsible Medicine, and he owns his own vascular surgery practice in Dallas. 

When people come to him for care, they’ve usually experienced a significant physical event like a heart attack, gangrene or stroke — three consequences of a lack of blood flow to a particular part of the body.

Bukhari’s specialty is atherosclerosis, a disease in which plaque builds up in a person’s arteries, disabling blood flow. The food a person eats can affect their risk of atherosclerosis. 

Risk factors for atherosclerosis

Arteries harden over time. Besides aging, these factors may increase your risk:

  • High blood pressure
  • High cholesterol
  • High levels of C-reactive protein (CRP), a marker of inflammation
  • Diabetes
  • Obesity
  • Sleep apnea
  • Smoking and other tobacco use
  • A family history of early heart disease
  • Lack of exercise
  • An unhealthy diet

Source: Mayo Clinic

“I began to realize that our diet was what was making us sick as a nation,” he told the Report. 

A decade ago, nearly 50% of deaths caused by heart disease, stroke or type 2 diabetes were related to food intake, according to estimates from a 2017 study in JAMA. Specifically, high intake of sodium, processed meats and sugar-sweetened beverages and low intake of nuts and seeds, seafood omega-3 fats, fruits and vegetables. 

Bukhari has started to work on preventive, lifestyle changes with his patients to help them rely less on processed foods, including those that come from places like McDonald’s. He and his colleagues also teach people how to eat healthy on a budget. 

He realizes fast foods are inexpensive and accessible, he said. Also, he added, home-cooked meals take effort, and people don’t always know how food affects their health.

“There is the individual responsibility,” he said, “But at the same time, there is a larger societal issue at hand.” 

Bukhari hopes John Peter Smith Hospital develops a similar focus on teaching and modeling. 

“My hope would be that JPS will recognize that (the McDonald’s) is inconsistent with their mandate as a health care institution,” he said. “If they do remove the McDonald’s, that they can use that as an opportunity to educate the public as to why.”

Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.

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Alexis AllisonHealth Reporter

Alexis Allison covers health for the Fort Worth Report. When she can, she'll slip in an illustration or two. Allison is a former high school English teacher and hopes her journalism is likewise educational....