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Your disease, your fault

Earlier this week, my colleague Dr. Gorski explored a common theme in alternative medicine: the idea that all disease is preventable.  This implies that all disease has a discrete cause and that individual behavior can mitigate this cause.

If biology worked this way, my job as an internist would be very different.   Many people would love to believe that life is this predictable, and that they have that much control over their health, but they don’t.  Most disease represents the interaction of environment and genetics, and you can’t change your genes (with a few exceptions, of course).

It’s natural to want to be able to exert an impossible level of control over your health, but when unscrupulous charlatans (redundant redundancy alert!) play on these beliefs and fears, they can cause, rather than prevent problems.

Which brings us yet again to the Huffington Post.  Yet another Promiser of Big Promises is telling us why we’re sick and what to do about it, without the benefit of actual truth or science.  Dr. Joel Fuhrman starts by frightening us, but the reassures us:

The American diet causes disease.

[…]

You cannot escape from the biological law of cause and effect — food choices are the most significant cause of disease and premature death. We cannot win the war on these diseases by putting more money into medical interventions or drugs. We must unleash the disease-fighting artillery in our own kitchens.

Well, there is no “biological law of cause and effect”.  There is biology, there is medical science, but no “law”.  The best lies are built on truth, and contain both fear and hope.  It’s true that Americans are suffering from obesity and diseases associated with obesity.  It’s obvious that diet has something to do with this.  And as every primary care physician knows, lifestyle change are an important part of preventing and treating these diseases.

But real doctors also know that we will never “win the war on these diseases.”  Biology is indifferent to our desires.  We all get sick, we all die.  We have learned to moderate this in some cases, but we will never “win”.  Anyone who tells you otherwise is trying to sell you something.

And Joel is trying to sell you something.  Like most so-called medical writers at HuffPo, he links directly to his website, where he sells all sorts of miracles.  In the usual whirlwind of internal contradiction that is alternative medicine, he at once denigrates the progress possible with science-based medicine, while at the same time inventing his own “science”.  This is what I found particularly interesting about this particular brand of fake medicine.  Rather than appealing to unseen forces such as qi or “water memory”, Joel goes straight for what Michael Pollan calls “nutritionism”.   He invents what he calls his “health equation”: Health = Nutrients / Calories (H = N / C).

In real equations, it’s important to define ones terms, and in this case the big undefinable is “health”.  Since this can’t be quantified in any real way, this is nothing more than a parlor trick.

But like all medicine shows, this one needs more than just some fancy equations.  Joel explains that he is sharing with you a secret that “they” don’t want you to know:

Doesn’t every American have the right to know they don’t have to suffer a heart attack or a stroke? They can protect themselves. They could choose otherwise, but shouldn’t they be informed of the most effective lifestyle to protect against cancer? Should they just be given drugs for diabetes, cholesterol, blood pressure and more or should they know they have the opportunity for a complete non-drug recovery?

Or maybe people have the right to know that they cannot control every aspect of their health, and that if they cannot make necessary lifestyle changes, they should not be “punished” by being denied access to life-saving medications.  Not everyone has “the opportunity for a non-drug recovery”.  As physicians, our job is to use the best available evidence to help all of our patients.  It is not to dispense false promises, fake science, and a heaping portion of blame to those who don’t do everything we tell them to.

Posted in: Science and Medicine

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