Oh boy if I finish doing dishes in time your boy is gonna open a can of whupass on this overmedicalization Saturday night special.
nytimes.com/2018/12/05/mag…
nytimes.com/2018/12/05/mag…
First of all, I know that authors don't write their headlines, but c'mon "it's time to study [diet]"? Dietary epidemiology has been a robust literature for DECADES. And the reasons ppl are properly skeptical of it are legion.
Take the "rigorous research" that the author wants to happen regarding diet. It requires, at the very least, rigorous accounting of what people eat.
That's *really* hard. We don't do well remembering what we ate or drank even yesterday. And we tend to recall differently
That's *really* hard. We don't do well remembering what we ate or drank even yesterday. And we tend to recall differently
based on what has happened to us.
That's the "exposure" as epidemiologists call it - what we're supposed to rigorously study. But let's say somehow we do a good job of this (and tbh ppl have worked assiduously on it). What is the outcome?
That's the "exposure" as epidemiologists call it - what we're supposed to rigorously study. But let's say somehow we do a good job of this (and tbh ppl have worked assiduously on it). What is the outcome?
What is a "healthy" diet (more on this misnomer later) supposed to achieve? It's important to specify in advance just what this diet is supposed to do. Let's take a "simple" example. Salt.
The more salt, the more high blood pressure, right?
The more salt, the more high blood pressure, right?
That's true. And, to a certain extend, less salt means less high blood pressure. But - whether reducing salt intake reduces blood pressure in populations is a hard question to answer.
Let's assume for the sake of argument that we can get people to accurately record their diet, and we have a well-specified outcome.
What is our intervention supposed to be? What is this "healthy" diet that beats cancer and makes us live longer? I'm going to tell you a secret.
What is our intervention supposed to be? What is this "healthy" diet that beats cancer and makes us live longer? I'm going to tell you a secret.
You don't need to believe me - do your own research, look up the systematic reviews - but I'm going to tell you straight: there is no angel food and no devil food. THERE IS NO DEVIL FOOD.
(Except for blowfish, I guess. And hemlock. But I digress.)
(Except for blowfish, I guess. And hemlock. But I digress.)
What's really going on in the exasperating tendency of people to micromanage other people's diets is a medicalization of food into medicine.
Food isn't medicine. It's food.
Food is not reducible to constituent parts that we can nutritionally tweak, any more than we are genes.
Food isn't medicine. It's food.
Food is not reducible to constituent parts that we can nutritionally tweak, any more than we are genes.
Dietary epidemiology is exactly as promising as precision medicine.
Each is convinced that reductionism is our gateway to health.
Each is wrong even before they get out of the gate.
Each is convinced that reductionism is our gateway to health.
Each is wrong even before they get out of the gate.
That doesn't mean we shouldn't study diet. It would be really useful to know the relationship between salt and heart failure or hypertension. But the claims and the aims should be modest, with the goal of helping people make their own decisions, not finding some magic bowl.
Compare another broad and deep subfield of clinical epidemiology: pharmacological treatment for hypertension. Lots of studies, right? Lots of conflicting data.
You don't see someone write in the NYT "IT'S TIME TO STUDY TREATMENTS OF HIGH BLOOD PRESSURE."
You'd be like wtf.
You don't see someone write in the NYT "IT'S TIME TO STUDY TREATMENTS OF HIGH BLOOD PRESSURE."
You'd be like wtf.
But that field struggles on - incremental improvements, ongoing disputes. There's been real progress made there, lately. *Some* elderly might benefit from a stricter BP goal, but *on the whole* for *most* elderly, likely not.
No one is saying (or should be saying) THERE'S ONE BEST TREATMENT FOR HIGH BLOOD PRESSURE.
There's not one best diet for cancer.
There's not one best ANYTHING for cancer.
There's not one best diet for cancer.
There's not one best ANYTHING for cancer.
So. I'm gonna finish up here.
"What's the harm," you might ask, "of going for that pot of gold, of making those big claims?"
Epidemiology works with public health, or should, and public health is about prioritization.
What does it mean to eat right?
"What's the harm," you might ask, "of going for that pot of gold, of making those big claims?"
Epidemiology works with public health, or should, and public health is about prioritization.
What does it mean to eat right?
It means HAVING ENOUGH MONEY FOR FOOD, damn it.
I'm gonna say this again.
It means HAVING ENOUGH MONEY FOR FOOD.
I'm gonna say this again.
It means HAVING ENOUGH MONEY FOR FOOD.
It means having the availability, the money, the ingredients, the home space, the time, to get or make the food you want to eat when you want to eat it.
Pace Michael Pollan, the real diet advice is
"Eat food. Whatever you want."
Pace Michael Pollan, the real diet advice is
"Eat food. Whatever you want."
What do people really want to eat and why?
How can we make that available to them?
How can we get cheaper, tastier food to more people?
Can we subsidize cooking time and preparation?
Can we subsidize more food for more people?
How can we make that available to them?
How can we get cheaper, tastier food to more people?
Can we subsidize cooking time and preparation?
Can we subsidize more food for more people?
Food means so much to everyone. Particularly in the run up to Christmas, when food, sharing it, our reactions/aversions to it, occupy so much of our brains, bodies, and homes, to say that biomedical scientists are gonna tell us what to eat -- once & for all - is nauseating.
fin
fin
Blame this thread on @JoshGaroon who shared the article with me
Unroll please @threadreaderapp
