20 August 09
Common Sense: A Plea
My brother-in-law is an opthalmologist. As far as doctors’ jobs go, it’s quite a good gig. Not the superstardom of neuroscience or surgery, not the large salaries of orthopedics, there is still the bonus of good hours and the huge reward that comes from restoring sight to people semi-blinded by cataracts. He lives in a small town (a real small town: population <4,500, unlike Davis, whose population is now >65,000 and should rightly be called a small city). In this small town, people stop him regularly in the street thanking him for saving their mother’s vision. It’s an aging population, so this happens more than you’d think.
One day, he was called in to operate on a kid who’d poked himself in the eye with a stick. (This also happens more than you’d think.) He passed out cold on the operating room floor, alarming everyone in the room. He was wheeled over for a CT scan, other tests. They called my sister.
“Can I just ask you, what was the age of his patient? Seven? Right. That’s Simon’s age. I think he just had a moment of daddy-itis. I think he’ll be fine.” D’s superabundance of common sense has, more than once, been embarrassing to medical professionals, but I’m really grateful to be related to someone who has this much. It provides perspective.
As we move into chemotherapy with my mother, a friend has recommended a book by David Servan-Schreiber, Anticancer: A New Way of Life. The book advocates a combination of good-sense nutrition loaded with antioxidants found in foods (not supplements), especially dark fruits and green tea, exercise, and a meditation or yoga practice. All of it in addition to, not instead of, the tripartite therapies used by modern medicine (surgery, radiation, chemotherapy). Sounds sensible, yes? Hardly worth writing a book over, maybe!
Yet this is not advice you’ll get from most doctors, most oncologists. Why? Because they consider it outside their brief. Oncology is all about finding the rogue cells and killing them as quickly and efficiently as possible. It’s not about boosting immune systems. Oncology conferences are full of anxious doctors whose lives are spent trying to keep up with the latest therapies, the latest research, and they probably don’t think they’d have time to keep up with all these nutrition or meditation findings, even if they thought it might be part of their work (but they don’t: medicine is very much in the thrall, still, of the palace of pharmacopia). They are busy people, and unfortunately they are getting busier. Certain cancers are now epidemic in the Western world, especially colon, breast, cervical, lung, prostate. (Esophageal cancer, which killed my father, isn’t, but it’s epidemic in Japan, where people are screened for it aggressively.)
Servan-Schreiber is himself a psychiatric doctor who, during one of his own research experiments, was discovered to have a brain tumor, putting him instantly on the other side of the doctor-patient divide. But the most astonishing thing I read last night was this:
“My knowledge of nutrition… was considerably less than that of an average reader of Cosmopolitan. With only minor exaggeration, the following sums up the extent of what I’d been taught [in medical school]:
- Foods are composed of carbohydrates, lipids, proteins, vitamins, and minerals.
- People who suffer from obesity need to eat fewer calories.
- If diabetic, people must eat less sugar; if hypertensive, less salt; with cardiac disease, less cholesterol.”
Even knowing doctors are overstressed by advances in their fields, surely we can do better than this. Demonstrably, we have, otherwise we’d still be relying on leeches and bloodletting and blue pills and black draughts. Unfortunately, it means we’re going to have to look out for ourselves while they catch up. We’re going to have to use common sense. I wonder if there’s a pill for that. Hmmm….
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This is a great post, Pica. The “x patient must eat less y” advice is especially telling, given that both weight and cardiac disease aren’t necessarily the results of eating tons of fatty food. There are fat people who exercise more and eat better and less than thin people, and people who cut out all fats and cholesterol and still have heart disease, and so on. It’s a bit like saying “don’t walk on your foot if it hurts” without taking the time to figure out why it hurts, and if there might be a better way of walking so it doesn’t hurt in the first place.
I think you’re overlooking the issue that a lot of what is touted as preventative or maintenance therapies is just plain old pseudoscience. Medically meaningless terms like ‘immune boosting’ are big red flags, and most of these claims are unsupported by good research, or are even demonstrably false. It’s not about common sense, or stressed-out, drug-pushing doctors, or even with the medical community catching up with advances in their fields. It’s about not bothering with bunk.
I’m not making the claim that good nutrition is useless — just that common sense is not always a good indicator of what’s genuinely effective. By our very natures, human beings are not particularly rational. We have a strong tendency to jump to conclusions, to assume causation when we witness correlation, to confirm our own expectations. We pick up on positive correlation easily, but just as easily we completely overlook negative correlation. This is why it took to long to develop the scientific method, and by extension, modern medicine. It may seem to be a slow process, but it works. Nothing compares to the predictive power of good science (or the effectiveness of treatments developed in this manner).
Drink green tea if you want (why not — it’s delicious!), but don’t assume that our common sense trumps good research, or that researchers and medical professionals are just over-worked, or near-sighted, or even just shills for Big Pharma. It’s entirely conceivable that the lack of nutritional advice coming from oncologists is primarily due to a lack of any good, well-supported advice to give.
(Apologies for the rant — and I realize that I’ve gone a little off target of the point you were trying to make — but the complete lack of accountability for the claims made by a lot of people pushing alternative medicine, particularly to desperate folk like cancer patients, is one of my major pet peeves. :) )
Thanks, Rana. I’ve always wondered about this, and was acutely aware of the contempt in which this kind of thing was held by the docs I worked with at the UC Davis Med Center for a few months. Actually, it wasn’t contempt so much as just completely ignored. It’s still arrogant, though, so much so that when you find a physician who actually cares about nutrition and exercise you’re taken aback. They’re an oddity.
This can change, though. Medical schools are definitely teaching new approaches to the doc-patient relationship and this wasn’t taught as recently as 10 years ago.
Jo: couldn’t agree more on the tons of stuff is bogus. But I wish the medical profession (and most of what funds it, and the "scientific research" that results from the funding which skews what gets researched in the first place) were less biased toward pharma at the expense of cancer prevention, which after all we’ve known quite a lot about for a long time. It’s just that it’s been left to the individual to take it on for themselves, rather than on the recommendations of their docs. Wouldn't it be better for this to come from sound science through respected avenues, like doctors, rather than Cosmopolitan?
I actually think docs do recommend many sensible actions people can do to improve their overall health. They’ll tell anyone who’ll listen that exercise, moderation in food intake and alcohol consumption, adequate rest, finding ways to reduce stress, all will go a long way toward achieving optimum health. But remember that phrase “anyone who’‘ll listen”? Most people (and I include myself here) don’t want these “simple” answers because they involve us, the intended recipients of the benefits, actually having to do some work, think a bit, take action. Nope, we want the quick fix, or the “scientific” solution, or both. I know I should exercise more than I do, I know I should eat less than I do, I know I should eat more green leafy vegetables than I do. And knowing that, I still exercise too little, eat more than I need, and pass over the kale for the tomatoes (not that tomatoes are bad for me, but you get the point). So, while there’s plenty of blame (or, less pejoratively, responsibility) to be shared among Big Pharma, docs, insurance companies, “alternative medicine” flaks, [insert your favorite whipping boy here], the fact is that most of us know EXACTLY what we need to be doing. Maybe Nike has give us the best medical advice of all: “Just do it!”