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

 
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Tuesday, January 24, 2017

Feeding people, and democracy, to death

As a physician, and a specialist in disease prevention and health promotion, I have long been nothing less than sickened by the unending flow of misinformation about food. My job is protecting the health of people, and misinformation about diet and health is toxic to them. It makes me figuratively sick because it makes so many actually sick.

Diet is profoundly important to every aspect of health. When bad, diet is a major contributor to chronic disease, disability, and premature death, to say nothing of comparably ghastly impacts on every aspect of planetary health. When optimal, diet is a major contributor to both vitality and longevity, and fortuitously, to sustainable food systems, climate stabilization, preservation of aquifers, and the protection of biodiversity, too.

The prospect of such benefits, however, is perennially threatened by the unending deluge of diverting alternatives to fundamental truths about healthful, sustainable dietary patterns. The truth competes endlessly with everything from marketing hype to outright lies, false promises to propaganda.

I spend a lot of time wrestling with the forces that converge where information and misinformation about diet and health come together. Over the past 20 years or so, I have authored three editions of a nutrition textbook for medical education and practice, the principal purpose of which is to differentiate what we know and should apply to patient care from all the rest. A few years ago, I was asked to write a review article on much the same topic. Similar efforts populate these very columns.

And, of course, this very matter has been germane to the care of my patients all these years, to the health promotion programming my lab has developed, and to the basic care and feeding of my own family. Since just about everybody eats just about every day, differentiating between dietary sense and nonsense is the furthest thing from a theoretical exercise. It is practical, up close, hands on, and personal. In my family's case, thanks to my wife, we've made our own conclusions about the matter accessible to everyone else, too.

Feeding people well, in other words, depends a lot on reliable information. It depends on truth.

Lately, we've all had a reminder that exactly the same pertains to feeding democracy well. Democracy, too, thrives on truth, and sickens on propaganda.

We are all bearing witness to this now, as each day brings new revelations about fake news, social media distortions, echo chambers, and most ominously, the intercession of a foreign power in the sanctity of our election process, and thus our very sovereignty.

For reasons best expressed by Bertrand Russell, it may often be easier to sell lies than truth. However much we may value popularity, it correlates very inconsistently with credibility.

This is pretty dire, no matter our party or native preferences. We've all been told that propaganda is toxic to democracy by no lesser source than the Founding Fathers.

The Second Amendment, whatever its merits, is, inarguably, second. Something else comes before it, because something else is presumably even more important, and that something else is truth. The First Amendment protects the freedoms of speech and the press, and it's not likely to be an accident that the Founders gave it primacy.

Of course, there's a bit of a conundrum here. The unfettered flow of information allows for the unfettered flow of misinformation, too. The best defense against that is not the law, but sense the Founders may have hoped would be more common than it proves to be.

The Founders, and our Constitution, tell us just how toxic propaganda can be: it is the number one threat to the viability of our democracy. In this modern age, I believe it is the number one threat to our personal vitality as well. I am far from alone. Even the National Institutes of Health, in developing a strategic plan to guide all of its nutrition research, includes the distinction between what we know reliably from all the rest among its priorities.

The fundamentals of diet for the promotion of human health really are very clear to just about everyone not actively involved in marketing alternatives. Yes, of course calories do count. Yes, of course, an absurd excess of sugar is bad for us. No, of course added sugar isn't the ‘one thing’ wrong with our diets, any more than saturated fat ever was. No, we will never get good answers to silly questions about diet. Yes, we can beneficially customize diets for health, and weight loss, but only in the context of fundamental truths that pertain to us as a species, all but universally.

I have previously lamented that whatever the respective toxicities of bad carbs and bad fats, the ingestion of nonsense about diet by gullible masses is far worse than either. Propaganda is the real poison. As it turns out, it is now a fixture in both our diets and our politics. That leaves me worried as doctor and citizen alike. We are seemingly inclined to look on passively as both we the people, and our democracy, are fed to death on much the same diet.

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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.

Auscultation
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.

DrDialogue
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.

FutureDocs
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.

KevinMD
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).

Prescriptions
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.

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