MEDICINE VS. COMMERCE Cleveland Clinic chief wants to boot fast food

A McDonald's in St. Elizabeth Health Center in Youngstown was closed about five years ago.
STAFF/WIRE REPORTS
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, supersize 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."
What's available
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 and fruit bar, a grill, a deli and hot entrees.
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. St. Elizabeth Health Center in Youngstown had one until about five years ago.
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 & amp; 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 public relations gurus defend their food as healthful, but they also have suggested that Cosgrove is racist for targeting Turan Strange, the black 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.
Engineering supervisor John Moorer, who has high blood pressure, is loading up a plate at the cafeteria salad bar, but he also has opted for McDonald's or Pizza Hut. 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.
His next target: tobacco. He wants the Cleveland Clinic smoke-free by Independence Day.