Why the Public is Confused About Nutrition
The more I learned about WFPB, the more I wondered, "why don't more people know about WFPB?"
Market failure
National Health Care Spending in 2016
https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2017.1299
United States retail prescription drug spending grew to $328.6 billion in 2016.
Given the amount of money at stake, drug companies make sure that doctors know about their drugs. Pharmaceutical representatives disseminate information to doctors and patients benefit. That's how the market is supposed to work.
https://www.pewtrusts.org/en/research-and-analysis/fact-sheets/2013/11/11/persuading-the-prescribers-pharmaceutical-industry-marketing-and-its-influence-on-physicians-and-patients
In 2012 pharmaceutical companies spent $15 billion on face-to-face promotional activities directed toward physicians and pharmacy directors.
Pharmaceutical representatives typically visit doctors to pitch their drugs.
Compare that to the $0 vegetable farmers spent on face-to-face promotional activities directed toward physicians. The WFPB diet can't be patented, so no one can profit from promoting it. That kind of market failure is called non-excludability.
Examples of non-excludability:
- https://nutritionfacts.org/video/plants-as-intellectual-property-patently-wrong/
- https://nutritionfacts.org/video/why-is-nutrition-so-commercialized/
- https://nutritionfacts.org/video/amla-vs-drugs-for-cholesterol-inflammation-and-blood-thinning/
Most people do not change diets on their own. Five minutes of a doctor's advice and a pamphlet is not enough. Successful dietary intervention includes a series of education and support meetings. With a few exceptions, health insurance does not pay for dietary interventions. However, health insurance does pay for drugs and surgery. So there is little financial incentive for doctors to learn WFPB. Therefor medical schools focus on medical interventions and teach little to no whole-food nutrition.
Even if doctors recommended WFPB to their patients, most patients have little financial incentive to eat WFPB. Health insurance pays for their doctor visits and prescription drugs. That kind of market failure is called moral hazard.
Volunteer efforts to disseminate WFPB information are limited by financial resources.
Word of mouth, Dr. Greger and other WFPB advocates are slowly getting the word out.
Every year, more medical associations are recognizing the WFPB diet.
https://nutritionfacts.org/video/plant-based-diets-recognized-by-diabetes-associations/
Nutrition in medical education
In 2010, only a quarter of medical schools required a single course on nutrition.
- Search the Internet for: nutrition in medical school
https://www.google.com/search?q=nutrition+in+medical+school
Most of the search results describe the lack of nutrition education offered to medical school. - Nutrition Education in Medical School, Residency Training, and Practice, 2019
https://jamanetwork.com/journals/jama/article-abstract/2729245
The substantial body of evidence that supports the benefits of nutritional interventions has not adequately translated into action in medical training or practice. - https://nutritionfacts.org/video/medical-school-nutrition-education/
- https://nutritionfacts.org/video/physicians-may-be-missing-their-most-important-tool/
- https://nutritionfacts.org/video/lifestyle-medicine-treating-the-causes-of-disease/
- https://nutritionstudies.org/frustrations-of-being-a-plant-based-cardiologist/
- https://nutritionstudies.org/doctor-with-ms-makes-film-on-collapse-of-us-healthcare/
- What I Wish I Was Taught In Medical School. 2018
https://youtu.be/oDplrx6rG50?t=55
We asked 20 doctors, "What's one thing you wish you where taught in medical school? - Is There a Lack of Support for Whole-Food, Plant-Based Diets in the Medical Community? 2018
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6307547/
Adams et al found in their 2009 survey that US medical students overall received only 19.6 contact hours of nutrition instruction during their time at medical school… It seems that some US medical schools have now embarked on rigorous curricular reforms to allow nutrition to “become a mainstream component of medical education.” - https://nutritionstudies.org/dr-t-colin-campbell-responds-to-reports-on-cornell-scientist-brian-wansink/ 2018
The science of nutrition has been rejected by the medical community… It is not taught in medical schools, it is not a component of the standard of medical care and primary care practitioners are not able to obtain adequate compensation should they be qualified to use this information in their practices. Nutrition as a science is not one of the 130 or so medical specialties! Yet, nutrition is unquestionably the most productive of all medical specialties, able to create more health than all the medical specialties combined. - Why Don't Most Cardiologists Teach Their Patients To Eat A Whole Food Plant-Based Diets?
https://youtu.be/g504fUxRU8Y?t=185
Interview with Kim Williams, president of American College of Cardiology. - American College of Lifestyle Medicine
https://lifestylemedicine.org/What-is-Lifestyle-Medicine
Most medical students and physicians do not receive adequate training in even the basics of Lifestyle Medicine—nutrition and physical activity—yet we know that 85 percent of chronic disease today is caused by unhealthy lifestyle choices in these and other areas.
Follow the money
book: "The China Study" by T. Colin Campbell, Part IV: Why haven't you heard this before?
Dr. Campbell served at the top level of U.S. government nutrition advisory committees in Washington D.C..
He describes his experience with incumbent pharmaceutical and food industries gaming the system for their own benefit.
There is a lot of money in promoting unhealthy habits:
- https://nutritionfacts.org/2018/03/08/knowingly-and-secretly-deciding-to-put-the-buying-public-at-risk/
- https://nutritionfacts.org/2019/07/23/dishonest-doctors/
- https://nutritionfacts.org/2019/07/25/why-doctors-are-so-drug-happy/
- https://nutritionfacts.org/2019/09/24/how-could-there-be-such-a-disconnect-between-the-science-and-medical-practice/
- https://en.wikipedia.org/wiki/Sugar_marketing#Influence_on_health_information_and_guidelines
Science is hard
Reading a large number of scientific studies would take too long, even for science buffs. Professional researchers published in peer review journals spend years learning the science. Checking the credentials of nutrition researchers is relativity quick. But most people don't know enough about how science works to check credentials.
It's very easy for people not trained in nutrition, statistics, and science to make errors interpreting the data.
https://nutritionstudies.org/minger-critique/
Dr. Campbell outlines errors in Minger's critique on the China Project.
Scientific Literacy: How Do Americans Stack Up?
https://www.sciencedaily.com/releases/2007/02/070218134322.htm
28 percent of American adults currently qualify as scientifically literate.
To be classified as "scientifically literate," Miller said one must be able to understand approximately 20 of 31 scientific concepts and terms similar to those that would be found in articles that appear in the New York Times weekly science section and in an episode of the PBS program "NOVA."
https://www.popsci.com/what-americans-know-about-science#page-3
20% know what a "scientific study" is.
Nutrition in the popular press
Nutrition in the popular press and nutrition in the peer review literature are worlds apart.
The popular press disseminates nutrition nonsense. Here are just two examples:
- https://nutritionfacts.org/video/the-protein-combining-myth/
- http://io9.com/i-fooled-millions-into-thinking-chocolate-helps-weight-1707251800
We journalists have to feed the daily news beast, and diet science is our horn of plenty. The only problem with the diet science beat is that it’s science. You have to know how to read a scientific paper and actually bother to do it.
https://nutritionfacts.org/video/spin-doctors-how-the-media-reports-on-medicine/
In a study of the dietary advice given by newspapers in the UK, “no credible scientific basis” was found for most claims. The “misreporting of dietary advice” was found to be “widespread and may contribute to public misconceptions about food and health.” …
Reporters may only have an hour or two to put together a story; and so, they may rely on press releases.
False citations
Dr Hyman's Evidence That Eating Fat Makes You Thin
https://www.youtube.com/watch?v=RovJRlTbsgw
In this video, the reader follows a citation to the primary source.
Dr. Gundry’s The Plant Paradox Is Wrong
https://youtu.be/7NT4q_5dfLs?t=212
- 3:32 Dr. Greger checks the first citation in a diet book.
13 Kinds of Bogus Citations
https://www.painscience.com/articles/bogus-citations.php
I have checked a lot of citations, and the main WFPB health claims made by researchers always checked out.
Belief perseverance
Unhealthful eating is normalized in Western society.
https://en.wikipedia.org/wiki/Belief_perseverance
Belief perseverance is maintaining a belief despite new information that firmly contradicts it.
https://nutritionfacts.org/video/the-tomato-effect/
The tomato effect describes the rejection of highly efficacious therapies by the medical establishment because they happen to go against the prevailing conventional wisdom.
https://en.wikipedia.org/wiki/Ignaz_Semmelweis
In 1847 Semmelweis discovered that the incidence of puerperal fever could be drastically cut by the use of hand disinfection in obstetrical clinics.
Despite various publications of results where hand washing reduced mortality to below 1%, Semmelweis's observations conflicted with the established scientific and medical opinions of the time and his ideas were rejected by the medical community.
Semmelweis's practice earned widespread acceptance only years after his death when Louis Pasteur confirmed the germ theory.
A tobacco-food analogy (16-minute video segment)
https://youtu.be/d0IhZ-R1O8g?t=3382
The transcript is on https://nutritionfacts.org/video/food-as-medicine/
- 0:56:22 Smoking cigarettes as historical precedence.
- 1:02:34 In 1939, Dr. DeBakey published his opinion on tobacco smoking causing lung cancer.
- 1:04:42 In 1964, The Surgeon General’s report on tobacco smoking came out.
- 1:08:57 It took 25 years for the Surgeon General’s report to come out, and longer still for mainstream medicine to get on board.
- 1:12:21 [end of topic]