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30 January 2020

What are 'farmacy' prescriptions?

Three doctors want to write 'farmacy' prescriptions for their patients, but what are they and how would they contribute to improving health?

Doctors are used to writing prescriptions for medicine. But three Boston-area cardiologists are working on a federal programme that would focus on writing prescriptions for food.

Varanda, which stands for Veterans Administration Repurposing Agriculture for Nutrition and Diet Awareness, would create a network of sustainable food gardens at veterans' hospitals to provide fresh food – for free – to vets and their families.

Farm operation in a hospital

The work is inspired by the rooftop farm at Boston Medical Center. The farm, in place since 2017, harvests more than two tons of fresh vegetables yearly and distributes them to their preventive food pantry and hospital kitchen.

"The rooftop farm is this amazing farm operation in a hospital," said Dr Stephanie Moore, an assistant professor at Harvard Medical School and VA staff cardiologist.

"The doctors could write prescriptions for fresh vegetables and healthy foods that the patients could pick up at the on-site pantry. They would go onto their computers and, much like I would write a prescription for a medication, they would write a prescription for food. And it's free."

Moore, who first learned about the farm, told two colleagues. Dr Aruna Pradhan, a cardiologist and epidemiologist works in preventive medicine at the Brigham and Women's Hospital and in cardiovascular medicine at the VA Hospital's West Roxbury Campus. Dr Pei-Chun (Cheri) McGregor directs the ambulatory cardiology outpatient clinics for Boston Virginia. McGregor is a lieutenant colonel in the Air Force Reserves and a former 11-year active duty officer.

"We as cardiologists see a lot of diseases where we give medication instead of getting to the root of the problem, when a lot of the issues are actually lifestyle and nutrition-related," McGregor said.

Sustainable produce garden

The programme is slated to start this year in the Boston suburbs Brockton and Bedford. Funding will come from private donations, federal and foundation grants and existing VA reimbursement mechanisms.

The doctors envision Varanda as a preventive health initiative that includes a food pantry, sustainable produce garden and a farmers market for veterans and their families.

The pantry and farm will provide food to veterans in need, and the vegetables will be grown on farms at the two VA hospitals, where thousands of veterans annually receive health care. The goal is to supply over 5 000 pounds of fresh produce from April to November and be supplemented by food from the Greater Boston Food Bank for year-round distribution. Farm output will stock the in-hospital preventive health pantry, an on-campus farmers market and hospital cafeteria.

"We'll be a health care facility with a pharmacy and a 'farmacy'," said Moore. "Access to Varanda by prescription means access not only to free and nutritious and healthy protein sources, but to a host of educational resources and activities, like cooking classes."

While the three women kicked off the idea on their own, they quickly received buy-in from several VA departments, including nutritional services, social work, homelessness and more. They now have a core group of more than 60 people. Varanda also coincides with the VA's rollout of Whole Health, a plan focusing on nutritional and cultural transformation of systems of health care. VA Boston is one of 18 flagship VA sites for Whole Health.

Nutrition awareness and practice

"As a huge national single payer system, the VA has enormous potential for successful local programmes to spread more widely," Moore said.

"We're trying to write the playbook for this, not just make it a one-off. Each aspect of planning and implementation will be framed by the idea of scalability to VA medical centres nationwide."

An education imperative also drives Varanda.

"Unfortunately, nutrition is not well-taught or well-received in medical schools," Moore said.

Because training at VA medical centres is a core component of medical education for thousands of medical students yearly, Moore hopes Varanda will be an opportunity to give those trainees the needed nutrition awareness and practice.

"We strongly believe that future and current physicians should learn how to integrate lifestyle choices into their practice in a real and tangible way."

Image credit: iStock

 
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