AUG 2015 - THE NON-MEDICATED LIFE
The Value of Skepticism
By Paul E. Lemanski, MD, MS, FACP
Editor’s Note: This is the 66th in a series on optimal diet and lifestyle to help prevent and treat disease. Any planned change in diet, exercise or treatment should be discussed with and approved by your personal physician before implementation. The help of a registered dietitian in the implementation of dietary changes is strongly recommended.
Medicines are a mainstay of American life and the healthcare system not only because they are perceived to work by the individual taking them, but also because their benefit may be shown by the objective assessment of scientific study. Clinical research trials have shown that some of the medicines of Western science may reduce the risk of heart attacks, strokes and cardiovascular death while others may reduce certain types of cancer.
In the first 65 installments of the Non-Medicated Life, informed diet and lifestyle have been shown to accomplish naturally for the majority of individuals, many, if not most of the benefits of medications in the treatment of chronic medical conditions. Moreover, informed diet and lifestyle as a medical intervention may accomplish such benefits at lower risk for side effects and at a lower cost.
In the field of nutrition, however, what constitutes “informed” at any given time for most people seems open to interpretation and over time seems to change. Especially with the plethora of information on the internet, with multiple “experts” espousing multiple diets and exercise regimens, it’s difficult to identify what truly is informed. I would suggest that the best antidote for combating such confusion, the best means for sorting the wheat from the chaff is a healthy dose of skepticism.
Skepticism starts with our grandmothers. Grandmothers will tell you if something sounds too good to be true, it usually is too good to be true. Everyone wants to believe in a magic bullet, a way of getting a desired outcome with no work, no effort and no hassle. This is human nature but also understandable because on occasion there are “better ways” of accomplishing a given end, ways which require less effort. Grandmothers know, however, based on a long life of searching for the easiest path to an outcome, that the discovery of “better ways” are less common experiences, and generally come from personal discovery or freely shared information.
Additionally, while “better ways” may take less effort, they generally do not take no effort. Promises of getting something for nothing or nothing other than the cost of a product should be viewed skeptically. Such promises should make us pause to question the claim for evidence of credibility.
The first step in assessing the credibility of a claim is to ask: 1) who is making the claim, and 2) what do they have to gain? In the field of human nutrition, physicians and dietitians, who should generally be trusted as experts, may have unfortunately ceded authority to a host of self-proclaimed experts including celebrities, Hollywood stars, Madison Avenue style hucksters, and what I would call – for lack of a better term – snake oil salesmen.
In part, this ceding of authority has occurred because of a reluctance to question the claims of self-proclaimed experts in open forum with scientific scrutiny. And also in part, the ceding of authority has occurred because physicians and dietitians have seemed to change dietary recommendations over the last 30 years, and thereby undermined their own authority.
The fact is that perceived changes in dietary recommendations of physicians and dietitians occur, because our understanding changes with research, and an application of the scientific method. This is as it should be and should be nothing for which to apologize or become defensive. Additionally, recommendations for the health of a population are made within a certain socio-economic context, and that context can change. A recommendation for a lower fat diet substituting, for example chicken for red meat as a means to combat cardiovascular disease was appropriate and beneficial, and has contributed to a reduction in cardiovascular disease and deaths.
However, the recommendation did not foresee the response of the American food industry and consumers respectively in the development and wide use of low fat, high carbohydrate food products, which have contributed to an unprecedented increase in obesity and diabetes.
Notwithstanding changing recommendations from ongoing research, physicians and dietitians remain the experts in nutritional science on the basis of training and ongoing study in the field. Those who do not have a medical and scientific background or only limited knowledge are certainly encouraged to join in the discussion. But they must be able to bring scientific and/or epidemiological evidence to support their claims.
Consumers must remain skeptical of approaches that do not present currently available scientific evidence in support, even if future evidence may be forthcoming. The use of personal testimonial in the absence of evidence may sound compelling, but it is not science. Using the positive experiences of the few to make recommendations to the many is fraudulent. Moreover, even when not directly causing harm such practices may convince the non-skeptical to embrace a treatment that delays the use of proven and effective treatments, and thus ultimately may be harmful.
Physicians and dietitians who are practicing their profession in a responsible way do not gain financially from espousing a given approach based on any other criteria, except that it is based on the best available science. Those who practice skepticism will rightly ask if financial gain is linked to a promulgated product, and even more the skeptical will ask for the scientific evidence that a product delivers on its claims.
Scientific evidence at its best is based on clinical trials in which individuals in the studies are randomly assigned to intervention or placebo, and the investigators are blinded to the assignment process, and result until the conclusion of the study. Scientific evidence is not provided simply by the words “clinically proven,” especially when at the conclusion of the sales pitch you hear, “This product in not intended to diagnose, treat, cure or prevent any disease.” The skeptical would rightly ask: if so, what does the claim of “clinically proven” actually mean?
In summary, skepticism is perhaps the most effective approach to use when sorting through the myriad of diets, nutritional recommendations, and exercise recommendations currently available online, in the press, and in the media. Skepticism will help us identify physicians and dietitians as the most appropriate sources of information, and the active practice of skepticism will encourage those same physicians and dietitians to espouse only those approaches with the highest quality evidence. As such, a healthy dose of skepticism keeps everybody honest, and provides the most effective way to ensure that you are truly using “informed” diet and exercise in the pursuit of the Non-Medicated Life.
Paul E. Lemanski, MD, MS, FACP (firstname.lastname@example.org) is a board certified internist at the Center for Preventive Medicine, Capital Care Medical Group in Albany. He is medical director of the Department of Community Medicine and Population Health at Capital Care Medical Group. Paul has a master’s degree in human nutrition; he is an assistant clinical professor of medicine at Albany Medical College and a fellow of the American College of Physicians.