American College of Physicians: Internal Medicine — Doctors for Adults ®

Tuesday, December 23, 2014

Want health? Try the truth

At a recent health conference in Boston, I was privileged to share the podium with a physician colleague who serves as senior health editor at The Atlantic, writing articles on topics in health and medicine that routinely reverberate far and wide. To protect the innocent, probably best that I not mention Dr. Hamblin by name.

On this particular occasion, my physician colleague was addressing an audience of health and nutrition experts on the topic of best-selling nonsense. His task was to explain, from the perspective of a media insider, why we have new fad diet books every week if not every day, and why the media and public alike tend to devour them.

My unnamed, high-profile, media-savvy colleague invoked the same toxic formula for success that I have oft lamented on these and other pages. The recipe is as follows:

1) Cite only those studies that support the position you held before you examined the evidence.

2) Invoke a scapegoat, silver bullet, or both.

3) Offer the moon and stars, by means of pixie dust.

4) Insinuate (or say) that everyone who addressed this topic before is a moron.

5) Proclaim absolute certainty.

If you want to write a best-seller on health, weight loss, or diet, there's your formula. It has worked for thousands before, why not you?

I hope you don't take that bait. Yes, it works for the author. But it is a calamity for the reader. Here's why:

1) Citing evidence selectively is an easy, old, and rotten trick. By citing studies at all, you can make yourself seem, to any reader less versed in the subject than you, rather erudite. Readers are unlikely to conduct a systematic review of the peer-reviewed literature to learn that for every study you cited, there are a hundred saying the opposite. As a would-be, best-selling author of dietary nonsense, you must, and alas, can, count on that.

2) No one thing is wrong with our diets or lifestyle, and no one thing will fix it all, any more than some cockamamie, get-rich-quick scheme will make you rich overnight. But people favor hope over experience in this area, and there is (lots) of money to be made exploiting that willful suspension of common sense.

3) Worthwhile things always take time, effort, and patience. Think about education, work, love, money. But somehow, health doesn't make the cut. Please make mine a magical short cut with a side of pixie dust! Fad diet and health authors do just that, and presumably laugh about us buying it, all the way to the bank.

4) To get full respect as a renegade genius, you have to point out that nobody but you ever really “got it.” You have to do that even if you are stating something entirely self-evident for decades, such as: eating too much sugar isn't a great idea. You want to look smart and sell a lot of books? Call a whole lot of perfectly reasonable, intelligent people morons and climb over them. (Case in point: how many times can someone tell us that nobody but them has ever told us that too much added sugar is bad for us, before we remember that we have, in fact, heard that somewhere before ...)

5) Bertrand Russell famously said this: “The whole problem with the world is that fools and fanatics are always so certain of themselves, and wiser people so full of doubts.” You will note that the authors of fad diet and health books speak with absolute conviction at all times. That may invite you to question the wisdom of reaching for your credit card.

Since this is what prevails in our culture, it is at the level of our culture that it all must be addressed. I have a plan.

The plan is to establish a True Health Coalition: a global group of leading experts and organizations in health, nutrition, fitness, and medicine from diverse disciplines to come together, and rally around the core truths about disease prevention, health promotion, and lifestyle as medicine. The idea is for this group to speak loudly, and often, with one voice, reaffirming that we should, indeed: not smoke; be active; eat food, not too much, mostly plants; sleep enough; manage stress; and nurture our social connections. With the relentless cadence of the percussion section, this group will tell us all, again and again and again, the truth about getting to health, until the noise and the nonsense, the static and the salesmanship, the hype and hooey, are drowned out. Until the truth prevails.

The True Health Coalition, in turn, is part of a larger plan, to propagate access to the power of lifestyle as medicine. But it does begin with the relentless propagation of the truth, the whole truth, and nothing but the truth. For the truth is what can set us free, and we are incarcerated in an endless cycle of false promises, procrastination, and missed opportunity.

Had enough hooey, profitable for its peddler, costly for the rest of us? Had enough quick-fix nonsense? Ready for a bracing dose of truth, and the freedom that comes with it?

Then join us. Put your name and preferred contact information in the comments here, or send them to me privately at When I have a tally of our strength, I will report back.

We are imprisoned by cultural inanities that favor sales over sense, profits over the promise of adding years to life, and life to years. But we can free ourselves, with the simple, solid, reliable fundamentals that make up ... the truth.

Labels: , , ,


Blogger Suzy R said...

Your comments and initiative resonate. But the flaw is that scientific "truth" is so relative. The RCT's this year contradict last year's. Take transfusions for Hb < 7; the previous shibboleth was to transfuse an actively bleeding individual to 9-10 anticipating the amount of blood loss, or the post-op patient to 10 or over, because of concern about oxygenation, ischemia, and volume status. Now, data are confirming a Hb> than 7 is sufficient, and transfusing to higher Hb's can cause harm.

OR treating to LDL's <100 or <130 in patients with ischemic heart disease, or diabetes is deemed not to be supported by the research. High intensity or moderate intensity statin treatment is the new recommendation; along with complicated algorithms

In pedaling "truth" you cast doubt because of evolving nature of research, and changing paradigms of disease and health. Call it something else and give it legroom for modification.

December 27, 2014 at 10:04 AM  

Post a Comment

Subscribe to Post Comments [Atom]

<< Home

This is a printer-friendly version of this page

Print this page  |  Close the preview




Contact ACP Internist

Send comments to ACP Internist staff at

Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

Powered by Blogger

RSS feed