The dietary guidelines fiasco
It is now absolutely clear that the official dietary recommendations promulgated by WHO and many different nations are fundamentally flawed. The advice to limit the intake of fat, and saturated fat (SFA) in particular cannot be justified by substantiated by research. In fact many of the individual fatty acids are important nutrients in their own right. On the other hand, the advice to increase the consumption of carbohydrates has been disastrous. It has contributed to the increased incidence of obesity, Type 2 Diabetes (T2D) and most of the common chronic diseases. On top of all this, the persistence of the dogma for those diagnosed with T2D means that the health of patients continues to deteriorate. Even worse it prevents the implementation of strategies that would result in significant improvement in health.
Resistance to change
Despite the overwhelming evidence that a radical change in policy is badly needed, the “Great and the Good” in the healthcare professions fight tooth and nail to retain the status quo. It is obvious that an approach, which is based on Low Carbs and High Fat (LCHF) would have enormous benefits. First of all, those who adopt this approach would suffer much less disability and increase their life expectancy. Secondly, it would help to combat the growing incidence of T2D. Thirdly it would result in significant savings in the costs of healthcare. So if the answer is self-evident, why have we reached this impasse?
What has gone wrong?
There undoubtedly a crisis in many areas of scientific research. Within the life sciences field, much of the work is very poor quality as I discussed in a post over two years ago (1). Even worse, there is a failure to get to grips with the issues. This means that the foundations of national policies are very shaky indeed. There are numerous examples of how government committees have reached what are clearly faulty conclusions. With the passage of time, it has become clear that many reports produced by these committees have been abject failures.
Emphasis on specialists
There is undoubtedly a fundamental weakness in the approach because of the emphasis on specialist disciplines in mainstream science. Hence, the vast majority of those invited to participate in the process are specialists in their own discipline and have little or no knowledge of the other disciplines. Furthermore, the majority are unlikely to have insight and possibly even interest in the social and economic aspects that are crucial to the development of policy. Genuine progress requires relating the different specialist areas to each other. The skills and attributes to do this successfully are different from those required by the single discipline specialist.
In fact, the personality traits are probably in conflict because one is essentially “analytical” whereas the other has to weigh up evidence from a wide range of different sources and reach a balanced conclusion. There is little recognition of the need for these skills so there are few opportunities for people to develop careers in these areas. In practice, what often happens is that a few forceful personalities dominate proceedings and the rest go along. Because this is apparently the “consensus” of many of the leading relevant scientists, the conclusions have an aura of credibility that is not justified. Furthermore, any attempt to criticise or challenge the results are slapped down because “the experts” have pronounced their verdict and that is the end of the matter.
Response to criticism
In my education as a scientist, I learned that one of the fundamental tenets of science is that you set up a hypothesis that has to be tested. If the results of the investigation demonstrate that the hypothesis was not valid, you have to start again with a new hypothesis. Even a working hypothesis that has been around for years should be subject to continuous testing and may eventually fail.
Many of our so-called leading scientists appear to have forgotten the basics, or perhaps never learned them in the first place. To them, a hypothesis to which they subscribe has become a personal belief. They regard anyone who has the temerity to question this working hypothesis as an attack on their reputation. They feel compelled to defend themselves usually by denouncing those who challenge the status quo.
This is certainly not a new phenomenon. Galileo encountered similar opposition when he proposed that the earth was not the centre of the universe. In the USA, once the official policy to advocate a reduction in fat was in place, it was almost impossible to criticise it.
Money talks and conflict of interest (effectively meaning corruption) is now endemic in much of science. It has been exacerbated by the pressure to raise funds by universities and other research organisations. Professor Barry Popkin has provided valuable insight into this when he wrote:
“The major issue is that first and foremost, the food industry has paid prominent scientists to conduct studies, which blatantly are designed to give answers questioning other science that goes against the industry, and these individuals usually act as advisers and consultants with the intent of countering potentially damaging scientific evidence. But this is based on funding studies directly relevant to that industry and then having the scholars speak up for the industry. There are clear cases where the industry has bought scientists and science as noted above and the big sugar and big beverage area is absolutely filled with such scholars. “(2)
The totality of the evidence reveals an appalling state of affairs. Many aspects of the scientific world have been corrupted and are being manipulated to the financial advantage of most of those involved. Ordinary members of the public are the ones who lose out.
Although there is some limited recognition of these fundamental flaws in science, there is a reluctance to get to grips with them. It has been shown that claims from highly cited observational studies persist and continue to be supported in the medical literature despite strong contradictory evidence from RCTs (3).
Powerful interests are benefitting enormously and will fight hard to maintain the status quo. Perhaps the life sciences can learn from the example of the particle physics community that faced similar issues some years ago. As a consequence, great effort is now devoted to intensive checking and re-checking of data prior to publication. The prime objective is to get results that are reliable and the incentives have been adjusted accordingly (4).
It will not be easy to change the culture in the life sciences. On the other hand, it is not sustainable in the long term to carry on regardless.
It is axiomatic that governments have been gullible in accepting the validity of claims about the benefits to health of many procedures and treatments despite the fact that many were based on dubious evidence.
The fact remains that there are serious limitations in the quality and reliability of the available scientific information. In particular, there are many drugs and medical procedures that do not result in genuine improvements to personal health and may even do more harm than good. It is imperative that anyone trying to grapple with policy matters appreciates this.
If we are ever to make any progress, a good starting point would be for patients and their doctors to be careful and critical before recommending and agreeing to any form of treatment.
- A. Tatsioni et al (2007). Journal of the American Medical Association 298 (12) pp 2517-2526
- R. Horton (2015). The Lancet 385 (9976) pp 1380