Consumers are increasingly questioning their health providers, pushing back against public health directives, and generally showing less and less respect for the scientific community. I have a few ideas why.
Just last year I received a letter in the mail telling me to follow a low fat, low cholesterol diet because a blood test showed elevated cholesterol. The low fat myth was struck down long ago, and most research today links elevated cholesterol to excessive sugar and starch intake. In addition, a basic cholesterol test doesn’t tell me nearly enough about the size and density of the molecules that could actually lend some insight into my relative risk of heart disease. Just this week we learned that the Scientific Advisory Committee for the 2015 Dietary Guidelines finally acknowledges that, “cholesterol is not considered a nutrient of concern for over-consumption,” yet I still have patients being told by their cardiologists to follow a low fat, low cholesterol diet.
Over the summer I was prescribed 80 mg of prednisone a day while in the hospital, and then was served a high carbohydrate diet. No one bothered to discuss how this drug impacts blood glucose levels, potentially creating a metabolic mess, dramatically increasing weight, and possibly causing diabetes. I found out that the doctor anticipated problems because he prescribed insulin to address the expected increase in blood sugar as I was admitted to the hospital.
Just this fall a nurse called and attempted to tell me to start taking a medication for low thyroid function. There was no discussion with the endocrinologist until I asked for one. When we did talk I heard, “this medication is the standard of care.” And that’s despite telling her that my previous experience with the medication was unsatisfactory.
DISILLUSIONED WITH SCIENCE?
Apparently I am not the only one increasingly disillusioned with medical care and the science behind it. Most recently the disassociation between what doctors say and what patients do is playing out on the stage of childhood vaccinations. With greater controversy in countless corners of the medical and scientific universe, the experts express increasing frustration at the “propaganda”, and are beginning to fight back. Hopefully, they will also consider what got them into this mess in the first place.
Health care providers, public health advocates and the scientific community in general may be merely reaping what they sow. Current medical practice and public health efforts lean heavily on authority, too often trampling all over the notion of consumer “buy in”. And it isn’t just a generational thing. Sadly, too many practitioners and scientists of all ages, both sexes, and in every discipline stumble when it comes to working with their patients.
A RECIPE FOR RESISTANCE
Broad public health pronouncements and recommendations tend to flop, with patients considered “non-compliant” and the public too preoccupied, uneducated, or confused to do the right thing. In contrast, I suspect the current science based modus operandi is a recipe for opposition and resistance. In the world of food and nutrition the examples keep piling up.
Measure the shifting science regarding: fat in the diet, calorie counting, and cholesterol. Add in controversies regarding sodium and sweeteners. Credible scientists sit on both sides of many debates, and yet too many public health authorities and health care practitioners present their position as the only one. Mix in a hefty dose of publication bias, scientific fraud, and the inherent skew of research funded by self serving entities, and you have all the fixin’s needed to fuel consumer dissent.
Stir in media coverage that churns up the masses for the most dubious of motivations. Top it off with medical care that is increasingly less about the patient and more about the insurance company, the formulary, an algorithm, or a “standard of care” that reflects what we used to think, but not what we understand today. Is anyone really surprised that health care controversies swirl around an increasingly disenchanted public?
I feel sorry for doctors that are expected to deliver good care and explain procedures in a few minutes per visit. I empathize with public health officials who are often limited to communicating in public service soundbites. I understand how challenging it is to deliver scientific information to the masses. However, I also don’t blame the public for growing increasingly frustrated and skeptical of the scientific community.
Ultimately we need to engage in more honest and open discussions with patients and join them on their journey, not just present what we want them to know or tell them what we want them to do. Would the scientific community be more credible if we considered what we don’t know as much as what we think we do?