Well, seeing as I am a physician and wrote a post awhile back exactly to answer this, here goes. It's long. Skip it if you prefer for incredibly complex societal ills to be explained in 3 sentences
Nutrition, Doctors, and the Scapegoat Effect
In my time on forums and in-person discussions over the years, I have repeatedly heard one derivation or another of the following refrain:
“Doctors don’t even talk about nutrition and know nothing about it. That is why we listen to other people to get our dieting advice. To add to this, they are full of standard-issue conventional wisdom on nutrition, and are stuck in their ways about counseling it.”
The above sentiment is both painfully true and amazingly naïve, at the same time….but it reveals one of our biggest tendencies as a culture: picking one or two groups to scapegoat our larger societal problems on, all in order to create useful public villains and divert responsibility away from the actual power brokers in any given area.
In discussions of crime, it is useful for each side to pin the blame on either the police or a given minority community, depending on your slant. In discussions of economics, it is useful to blame either ruthless corporations or “socialist” business regulation. In politics, the extreme right or left is blamed for every malady the country endures or ever has endured….We do this with nearly everything….and the goal is always the same:
The goal is to convince each side of the dangers of the other side controlling policy, to generate fear, to depict a boogey man that is out to get them or otherwise not looking out for them in the least.
The same is true with doctors and nutrition. The truth is always somewhere in the middle, with both sides being correct about certain aspects. In the case of nutritional guidance in regards to doctors, here is the reality:
What we are up against
- As in many areas of our society, given groups are pinned with the blame on what are actually HUGE, multi-factorial, societal ills. In any discussion of nutrition, it is a dishonest endeavor if money and lobbying power are not brought into the discussion….in other words, discussing food without discussing money and politics is not a real discussion. As a practicing physician that must give out nutritional advice almost daily, here are the main three monsters I am up against.
1) Multi-national corporations with huge advertising campaigns, the ability to lobby (read: bribe) Congress for laws beneficial for them financially, and immunity from lawsuit in controlling all ends of production. This includes GMO use, their ability to make heavily processed foods very cheaply due to subsidies, and their ubiquity/monopoly of almost all places where food is bought.
2) A for-profit insurance system and government-run system that rewards only treatments to disease, not prevention of disease….as a doctor, I get paid for pills, surgeries, or exams that I give you. I do not get paid for you sitting at home eating an apple and never needing a doctor. It was setup this way in the early 70s under Nixon, with his "revolutionary" HMO idea, as a means to entice private ownership of hospitals. (They lost money for the gov, so this was much preferred) The way to make them profitable was to charge for rote services, not a person's entire care.
3) Decades of research, mostly done in the 70’s and bought into for political reasons, that give very bad advice in regards to nutrition. Seeing as many of these recommendations served BOTH political and profit-driven reasons (Nixon's food prices problem as well as Agri-Business boom by selling this hyper-processed garbage), it was taken up. In the years since, both forces are essentially still at play. Money + political power = unquestioned truthiness.....that is not news
So, other than that my job is really easy.
My question when I get into these discussions is always the same: which one of those drivers up there is the fault of the medical community, and which are the fault of society?
We could live in a country with this in place for each of the problems above….
1) We COULD create patient pools, done at random, in which a given set of doctors and facilities are charged with the care of. There would be a flat rate paid to each doctor in the performance of preventing these people from poor outcomes….no more getting paid per surgery or per patient seen; incentivize health care, not disease care.
2) We COULD repeal the massive subsidies given to companies like ConAgra or Monsanto that give monopoly power to them, as well as allow them to make the worst food in the store also be the cheapest. A bag of cheetos is cheaper than a head of lettuce because of the lobbying power behind that bag. That is the ONLY reason, and it is that way because we allow it to be.
3) We COULD subsidize organic producers and small-time fruit/vegetable producers in the same fashion we do corn and wheat. (Many corn-growers sell at less than cost of production. Tax dollars alone give the processed food poisoners profit, not the market. THAT is socialism.)
My point, as in almost any big discussion, is that this kind of this does not happen in a vacuum. Everything is connected.
So in closing, here is my reply to the sentiment I wrote in italics earlier.
“Doctors are at the end of the spear in combating an epidemic of terrible health in America. For this reason, we are often blamed for a part of it….The reality is that an entire apparatus of government and corporate power serves to maintain our food system the way that it is, and is by far the biggest contributor to our health crisis. To stand against this tidal wave we are armed only with some rudimentary pills to control symptoms, a lot of paid for government-backed information, and a legal system that will spit us out the other end the second we practice in a different way. Those that do, like me, do so at their own peril, daily. Society need not look to us to blame. They need only look in the mirror. They made themselves sick and bought-off, and now they are upset that our profession cannot sufficiently save them from their own undoing.”
In other words, attacking doctors for the food system and what is recommended by it is like blaming lead producers for gunshot deaths....it is a completely tilted table we work with, and the reasons it is so toxic are the same reasons that much of our society is toxic. To blame this singularity, nutritional advice, on what it in reality a systemic, to the root problem in our country, does not accomplish anything.
Last edited by TheyCallMeLazarus; 12-23-2013 at 08:27 PM.
"The soul that does not attempt flight; does not notice its chains."