“A study in the International Journal of Adolescent Medicine and Health assessed the basic nutrition and health knowledge of medical school graduates entering a pediatric residency program and found that, on average, they answered only 52 percent of eighteen questions correctly. In short, most mainstream doctors would fail nutrition.”
~Dr. Will Cole
That is amazing. The point is emphasized by the fact that these are doctors fresh out of medical school. If they were never taught this info in the immediate preceding years of intensive education and training, they are unlikely to pick up more knowledge later in their careers. These young doctors are among the most well educated people in the world, as few fields are as hard to enter and the drop-out rate of medical students is phenomena. These graduates entering residency programs are among the smartest of Americans, the cream of the crop, having been taught at some of the best schools in the world. They are highly trained experts in their field, but obviously this doesn’t include nutrition.
Think about this. Doctors are where most people turn to for serious health advice. They are the ultimate authority figures that the average person directly meets and talks to. If a cardiologist only got 52 percent right to answers on heart health, would you follow her advice and let her do heart surgery on you? I’d hope not. In that case, why would you listen to the dietary opinion of the typical doctor who is ill-informed? Nutrition isn’t a minor part of health, that is for sure. It is the one area where an individual has some control over their life and so isn’t a mere victim of circumstance. Research shows that simple changes in diet and nutrition, not to mention lifestyle, can have dramatic results. Yet few people have that knowledge because most doctors and other officials, to put it bluntly, are ignorant. Anyone who points out this state of affairs in mainstream thought generally isn’t received with welcoming gratitude, much less friendly dialogue and rational debate.
In reading about the paleo diet, a pattern I’ve noticed is that few critics of it know what the diet is and what is advocated by those who adhere to it. It’s not unusual to see, following a criticism of the paleo diet, a description of dietary recommendations that are basically in line with the paleo diet. Their own caricature blinds them to the reality, obfuscating the common ground of agreement or shared concern. I’ve seen the same kind of pattern in the critics of many alternative views: genetic determinists against epigenetic researchers and social scientists, climate change denialists against climatologists, Biblical apologists against Jesus mythicists, Chomskyan linguists against linguistic relativists, etc. In such cases, there is always plenty of fear toward those posing a challenge and so they are treated as the enemy to be attacked. And it is intended as a battle to which the spoils go to the victor, those in dominance assuming they will be the victor.
After debating some people on a blog post by a mainstream doctor (Paleo-suckered), it became clear to me how attractive genetic determinism and biological essentialism is to many defenders of conventional medicine, that there isn’t much you can do about your health other than to do what the doctor tells you and take your meds (these kinds of views may be on the decline, but they are far from down for the count). What bothers them isn’t limited to the paleo diet but extends seemingly to almost any diet as such, excluding official dietary recommendations. They see diet advocates as quacks, faddists, and cultists who are pushing an ideological agenda, and they feel like they are being blamed for their own ill health; from their perspective, it is unfair to tell someone they are capable of improving their diet, at least beyond the standard advice of eat your veggies and whole grains while gulping down your statins and shooting up your insulin.
As a side note, I’m reminded of how what often gets portrayed as alternative wasn’t always seen that way. Linguistic relativism was a fairly common view prior to the Chomskyan counter-revolution. Likewise, much of what gets promoted by the paleo diet was considered common sense in mainstream medical thought earlier last century and in the centuries prior (e.g., carbs are fattening, easily observed back in the day when most people lived on farms, as carbs were and still are how animals get fattened for the slaughter). In many cases, there are old debates that go in cycles. But the cycles are so long, often extending over centuries, that old views appear as if radically new and so easily dismissed as such.
Early Christians heresiologists admitted to the fact of Jesus mythicism, but their only defense was that the devil did it in planting parallels in prior religions. During the Enlightenment Age, many people kept bringing up these religious parallels and this was part of mainstream debate. Yet it was suppressed with the rise of literal-minded fundamentalism during the modern era. Then there is the battle between the Chomskyites, genetic determinists, etc and their opponents is part of a cultural conflict that goes back at least to the ancient Greeks, between the approaches of Plato and Aristotle (Daniel Everett discusses this in the Dark Matter of the Mind; see this post).
To return to the topic at hand, the notion of food as medicine, a premise of the paleo diet, also goes back to the ancient Greeks — in fact, originates with the founder of modern medicine, Hippocrates (he also is ascribed as saying that, “All disease begins in the gut,” a slight exaggeration of a common view about the importance of gut health, a key area of connection between the paleo diet and alternative medicine). What we now call functional medicine, treating people holistically, used to be standard practice of family doctors for centuries and probably millennia, going back to medicine men and women. But this caring attitude and practice went by the wayside because it took time to spend with patients and insurance companies wouldn’t pay for it. Traditional healthcare that we now think of as alternative is maybe not possible with a for-profit model, but I’d say that is more of a criticism of the for-profit model than a criticism of traditional healthcare.
The dietary denialists love to dismiss the paleo lifestyle as a ‘fad diet’. But as Timothy Noakes argues, it is the least fad diet around. It is based on the research of what humans have been eating since the Paleoithic era and what hominids have been eating for millions of years. Even as a specific diet, it is the earliest official dietary recommendations given by medical experts. Back when it was popularized, it was called the Banting diet and the only complaint the medical authorities had was not that it was wrong but that it was right and they disliked it being promoted in the popular literature, as they considered dietary advice to be their turf to be defended. Timothy Noakes wrote that,
“Their first error is to label LCHF/Banting ‘the latest fashionable diet’; in other words, a fad. This is wrong. The Banting diet takes its name from an obese 19th-century undertaker, William Banting. First described in 1863, Banting is the oldest diet included in medical texts. Perhaps the most iconic medical text of all time, Sir William Osler’s The Principles and Practice of Medicine , published in 1892, includes the Banting/Ebstein diet as the diet for the treatment of obesity (on page 1020 of that edition). 13 The reality is that the only non-fad diet is the Banting diet; all subsequent diets, and most especially the low-fat diet that the UCT academics promote, are ‘the latest fashionable diets’.”
(Lore of Nutrition, p. 131)
The dominant paradigm maintains its dominance by convincing most people that what is perceived as ‘alternative’ was always that way or was a recent invention of radical thought. The risk the dominant paradigm takes is that, in attacking other views, it unintentionally acknowledges and legitimizes them. That happened in South Africa when the government spent hundreds of thousands of dollars attempting to destroy the career of Dr. Timothy Noakes, but because he was such a knowledgeable expert he was able to defend his medical views with scientific evidence. A similar thing happened when the Chomskyites viciously attacked the linguist Daniel Everett who worked in the field with native tribes, but it turned out he was a better writer with more compelling ideas and also had the evidence on his side. What the dogmatic assailants ended up doing, in both cases, was bringing academic and public attention to these challengers to the status quo.
Even though these attacks don’t always succeed, they are successful in setting examples. Even a pyrrhic victory is highly effective in demonstrating raw power in the short term. Not many doctors would be willing to risk their career as did Timothy Noakes and even fewer would have the capacity to defend themselves to such an extent. It’s not only the government that might go after a doctor but also private litigators. And if a doctor doesn’t toe the line, that doctor can lose their job in a hospital or clinic, be denied the ability to get Medicaire reimbursement, be blacklisted from speaking at medical conferences, and many other forms of punishment. That is what many challengers found in too loudly disagreeing with Ancel Keys and gang — they were effectively silenced and were no longer able to get funding to do research, even though the strongest evidence was on their side of the argument. Being shut out and becoming pariah is not a happy place to be.
The establishment can be fearsome when they flex their muscles. And watch out when they come after you. The defenders of the status quo become even more dangerous precisely when they are the weakest, like an injured and cornered animal who growls all the louder, and most people wisely keep their distance. But without fools to risk it all in testing whether the bark really is worse than the bite, nothing would change and the world would grind to a halt, as inertia settled into full authoritarian control. We are in such a time. I remember back in the era of Bush jr and as we headed into the following time of rope-a-dope hope-and-change. There was a palpable feeling of change in the air and I could viscerally sense the gears clicking into place. Something had irrevocably changed and it wasn’t fundamentally about anything going on in the halls of power but something within society and the culture. It made me feel gleeful at the time, like scratching the exact right spot where it itches — ah, there it is! Outwardly, the world more or less appeared the same, but the public mood had clearly shifted.
The bluntness of reactionary right-wingers is caused by the very fact that the winds of change are turning against them. That is why they praise the crude ridicule of wannabe emperor Donald Trump. What in the past could have been ignored by those in the mainstream no longer can be ignored. And after being ignored, the next step toward potential victory is being attacked, which can be mistaken for loss even as it offers the hope for reversal of fortune. Attacks come in many forms, with a few examples already mentioned. Along with ridicule, there is defamation, character assassination, scapegoating, and straw man arguments; allegations of fraud, quackery, malpractice, or deviancy. These are attacks as preemptive defense, in the hope of enforcing submission and silence. This only works for so long, though. The tide can’t be held back forever.
The establishment is under siege and they know it. Their only hope is to be able hold out long enough until the worst happens and they can drop the pretense in going full authoritarian. That is a risky gamble on their part and likely not to pay off, but it is the only hope they have in maintaining power. Desperation of mind breeds desperation of action. But it’s not as if a choice is being made. The inevitable result of a dominant paradigm is that it closes itself not only to all other possibilities but, more importantly, to even the imagination that something else is possible. Ideological realism becomes a reality tunnel. And insularity leads to intellectual laziness, as those who rule and those who support them have come to depend on a presumed authority as gatekeepers of legitimacy. What they don’t notice or don’t understand is the slow erosion of authority and hence loss of what Julian Jaynes called authorization. Their need to be absolutely right is no longer matched with their capacity to enforce their increasingly rigid worldview, their fragile and fraying ideological dogmatism.
This is why challengers to the status quo are in a different position, thus making the altercation of contestants rather lopsided. There is a freedom to being outside the constraints of mainstream thought. An imbalance of power, in some ways, works in favor of those excluded from power since they have all the world to gain and little to lose, meaning less to defend; this being shown in how outsiders, more easily than insiders, often can acknowledge where the other side is right and accept where points of commonality are to be found, that is to say the challengers to power don’t have to be on the constant attack in the way that is required for defenders of the status quo (similar to how guerrilla fighters don’t have to defeat an empire, but simply not lose and wait it out). Trying to defeat ideological underdogs that have growing popular support is like the U.S. military trying to win a war in Vietnam or Afghanistan — they are on the wrong side of history. But systems of power don’t give up without a fight, and they are willing to sacrifice loads of money and many lives in fighting losing battles, if only to keep the enemies at bay for yet another day. And the zombie ideas these systems are built on are not easily eliminated. That is because they are highly infectious mind viruses that can continue to spread long after the original vector of disease disappeared.
As such, the behemoth medical-industrial complex won’t be making any quick turns toward internal reform. Changes happen over generations. And for the moment, this generation of doctors and other healthcare workers were primarily educated and trained under the old paradigm. It’s the entire world most of them know. The system is a victim of its own success and so those working within the system are victimized again and again in their own indoctrination. It’s not some evil sociopathic self-interest that keeps the whole mess slogging along; after all, even doctors are suffering the same failed healthcare system as the rest of us and are dying of the same preventable diseases. All are sacrificed equally, all are food for the system’s hunger. When my mother brought my nephew for an appointment, the doctor was not trying to be a bad person when she made the bizarre and disheartening claim that all kids eat unhealthy and are sickly; i.e., there is nothing to do about it, just the way kids are. Working within the failed system, that is all she knows. The idea that sickness isn’t or shouldn’t be the norm was beyond her imagination.
It is up to the rest of us to imagine new possibilities and, in some cases, to resurrect old possibilities long forgotten. We can’t wait for a system to change when that system is indifferent to our struggles and suffering. We can’t wait for a future time when most doctors are well-educated on treating the whole patient, when officials are well-prepared for understanding and tackling systemic problems. Change will happen, as so many have come to realize, from the bottom up. There is no other way. Until that change happens, the best we can do is to take care of ourselves and take care of our loved ones. That isn’t about blame. It’s about responsibility, that is to say the ability to respond; and more importantly, the willingness to do so.
* * *
by Dr. Will Cole
With the Hippocratic advice to “let food be thy medicine, and medicine thy food,” how far have we strayed that the words of the founder of modern medicine can actually be threatening to conventional medicine?
Today medical schools in the United States offer, on average, only about nineteen hours of nutrition education over four years of medical school.10 Only 29 percent of U.S. medical schools offer the recommended twenty-five hours of nutrition education.11 A study in the International Journal of Adolescent Medicine and Health assessed the basic nutrition and health knowledge of medical school graduates entering a pediatric residency program and found that, on average, they answered only 52 percent of eighteen questions correctly.12 In short, most mainstream doctors would fail nutrition. So if you were wondering why someone in functional medicine, outside conventional medicine, is writing a book on how to use food for optimal health, this is why.
Expecting health guidance from mainstream medicine is akin to getting gardening advice from a mechanic. You can’t expect someone who wasn’t properly trained in a field to give sound advice. Brilliant physicians in the mainstream model of care are trained to diagnose a disease and match it with a corresponding pharmaceutical drug. This medicinal matching game works sometimes, but it often leaves the patient with nothing but a growing prescription list and growing health problems.
With the strong influence that the pharmaceutical industry has on government and conventional medical policy, it’s no secret that using foods to heal the body is not a priority of mainstream medicine. You only need to eat hospital food once to know this truth. Even more, under current laws it is illegal to say that foods can heal. That’ right. The words treat, cure, and prevent are in effect owned by the Food and Drug Administration (FDA) and the pharmaceutical industry and can be used in the health care setting only when talking about medications. This is the Orwellian world we live in today; health problems are on the rise even though we spend more on health care than ever, and getting healthy is considered radical and often labeled as quackery.
10. K. Adams et al., “Nutrition Education in U.S. Medical Schools: Latest Update of a National Survey,” Academic Medicine 85, no. 9 (September 2010): 1537-1542, https://www.ncbi.nlm.nih.gov/pubmed/9555760.
11. K. Adams et al., “The State of Nutrition Education at US Medical Schools,” Journal of Biomedical Education 2015 (2015), Article ID 357627, 7 pages, http://dx.doi.org/10.1155/2015/357627.
12. M. Castillo et al., “Basic Nutrition Knowledge of Recent Medical Graduates Entering a Pediatric Reside): 357-361, doi: 10.1515/ijamh-2015-0019, https://www.ncbi.nlm.nih.gov/pubmed/26234947.
Despite Growing Burden of Diet-related Disease, Medical Education Does Not Equip Students to Provide High Quality Nutritional Care to Patients
by Millie Barnes
The reviewed studies consistently found that medical students wanted to receive nutrition education to develop their skills in nutrition care but perceived that their education did not equip them to do so. Students cited both quantity and quality of their education as reasons for this — poor quality and under prioritization of nutrition in the curriculum, lack of interest and expertise in nutrition among faculty members, and few examples of nutritional counseling during clinical years to serve as models for emerging doctors.
Furthermore, students uniformly reported having a lack of required nutrition knowledge, which was also found through testing. For instance, one study found that when nutrition knowledge was assessed in a test, half of medical students scored below the pass rate.
Five studies assessing curriculum initiatives found that they had a modest positive effect. However, most nutrition initiatives were employed opportunistically as a once-off activity, rather than being integrated in a sustained way into the medical curricula. Innovative initiatives — such as online curriculum, hands on cooking experiences, and learning from other health professionals such as dietitians — showed short-term and long-term benefits for patients and health systems. Therefore, the authors call for more funding for innovative curriculum initiatives to be developed and implemented.