For many years, health professionals have been slowly realizing that traditional approaches to healthcare are ineffective and that some are actually harmful to patients. They have also become increasingly unhappy with how healthcare is delivered (short office visits, insurance companies and third party payers dictating practice guidelines, low reimbursement rates, etc.). This has caused great dissatisfaction, and many doctors, nurses, and dietitians have become receptive to new ideas about diet, health, and medicine. They are reading books, attending continuing education conferences, and speaking with colleagues as they search for better options.
Patients and members of the public are equally dissatisfied. They are put off by healthcare professionals who seem remote and sometimes even disrespectful; thanks to the internet and other readily available sources of information, they are aware of the side effects of commonly prescribed drugs; they are sickened by the conflicts of interest that are pervasive in the diet and health businesses; and they want better outcomes.
While the dissatisfaction is understandable and the search for alternatives is admirable, the problem is that many people tend to latch onto the first option they find that appears to be different. If the first exposure to something new is Forks Over Knives or one of the health professionals in that film, they become enthusiastic about plant-based nutrition. If the first new idea encountered is Functional Medicine, they become enamored with certain forms of diagnostic testing and the prescribing of supplements. If it’s the Paleo diet, a meat-based diet is adopted.
The tendency to latch onto organizations, beliefs, diets, and protocols that are not supported by solid research is based on many factors. The first is that even the worst of the alternative diet and health programs have positive attributes which seem appealing. Many of the diet plans, even if they are not ideal, are better than the Standard American Diet; the approaches seem patient-centered; the focus is on the whole person; and the treatments appear to be more “natural.”
Research shows that healthcare professionals, including doctors, notoriously lack skills for properly evaluating research concerning diagnostic testing, drugs, and procedures. Shannon Brownlee wrote extensively about this in her book Overtreated. One recent example is reflected in a study published in the Annals of Internal Medicine which showed that most doctors surveyed were unable to correctly evaluate the efficacy of cancer screening tests like mammography and PSA testing based on statistical evidence. This inability to interpret data is concerning, and most certainly contributes to bad decision-making when looking at diet and health programs.
Low expectations are another factor. Most patients and practitioners do not know that it is possible to stop and reverse disease, and instead think that the best that can be expected is to mitigate symptoms while diseases progress. On this basis, the idea that symptoms can be addressed with dietary supplements instead of drugs and surgery, for example, becomes an exciting concept for many patients and their doctors.
Both practitioners and patients are driven by the same dissatisfaction with the existing medical system and the American diet. They want and need to find better alternatives. And they both get excited as soon as an alternative presents itself. We can forgive a lay person for latching on to a new idea that seems to offer less potential for harm and more hope for a better outcome. But we should be able to expect better from practitioners; they need better training and also to be held to a higher standard (evidence) when making recommendations to patients.
In the meantime, we must be committed to telling the public that better outcomes are possible – that disease and obesity are food-borne conditions that can be prevented and treated with the right diet and lifestyle changes. The answer to our current healthcare mess is not to try to find alternative diagnostic tests and more natural pills; it is to throw out our existing framework and adopt a new one in which diet and lifestyle are the basis of care.
Wegwarth O, Schwartz LM, Woloshin S, Gaissmaier W, Gigerenzer G. “Do physicians understand cancer screening statistics? A national survey of primary care physicians in the United States.” Ann Intern Med. 2012 Mar 6;156(5):340-9.