The deadly omission in your doctor’s medical training

I had the good fortune recently to hear from my colleague and friend Dr. George Lundberg. George served as Editor-in-Chief of the Journal of the American Medical Association for 20 years and then became the first Editor-in-Chief of Medscape, the best source of health information on the internet (together with the Daily Dispatch, of course!).

When George speaks, people need to listen. He’s a pathologist and also worked in forensic pathology (like me), which I find gives physicians and medical scientists a solid, sophisticated, and rational approach to investigation and interpretation of evidence that can be applied to virtually anything.

As editor of JAMA, he made it the leading U.S. journal for medical science and practice. Then, he made Medscape the leading source for medical information on the internet. Some of us are privileged to follow in his footsteps, though we cannot begin to fill them.

Dr. Lundberg also tackles the conundrum of nutrition from a doctor’s perspective. He claims he “does not know anything about nutrition as it relates to chronic illness” because, like other doctors, he learned so little about it in medical school.

This is a common sentiment among doctors.

And it was certainly the case when I attended medical school.

“No time” for nutrition in medical school

I attended the University of Pennsylvania where the professors who wrote the textbooks everyone used were also the same professors who personally taught us in the lectures and laboratories. I had the privilege to learn medical physiology with Dr. John R. Brobeck, for an entire afternoon three times per week in the Penn physiology laboratory during my first semester. Dr. Brobeck was the editor of the venerable Best’s and Taylor’s Textbook of Physiology.

I would like to say it was me who asked asked Dr. Brobeck one fine fall afternoon, “when are we going to learn about nutrition?” But at that time, the university had recently started admitting 25 percent of women to our med school class. And it was one of the women who asked that pertinent question.

Dr. Brobeck patiently explained we had a lot to cover and there really wasn’t time to study nutrition. But if anyone was interested, there was a chapter in the back of his book. (And there would not be a quiz on it next Monday!)

I eventually went on to learn about diet and nutrition as it relates to human biology, growth and development in the first class of the combined M.D./Ph.D. program created by another distinguished faculty member, Baruch S. Blumberg (1925-2011). I took his class right after he won the Nobel Prize for Medicine or Physiology in 1976.

Dr. Lundberg recounted to me how he spent a lifetime after early medical training reading articles about nutrition, before and after publication, but remains “woefully ignorant of the nutritional truth.”

It’s hard for physicians, like consumers, to find these truths among bad government guidelines, intrusive bureaucracy, and misguided nutritional policies. In addition, big pharma and big food companies drive the medical research in this country, which is rife with design and methodological flaws, and shaky statistical practices.

Plus, we have an inadequate database on human diet and nutrition to begin with.

The “Dark Ages” of nutritional research  — only 30 years ago

As a senior investigator at the National Cancer Institute (NCI), I started the diet and cancer research program along with my colleagues. But we found we didn’t even know how much of different nutrients were present in different foods (nutrient composition). Nor did we know how humans absorbed and metabolized different nutrients from foods (nutritional metabolism).

So, before we could even begin to understand Dr. Lundberg’s goal of “nutritional truth” regarding chronic diseases, we ran to the USDA with funding to do some basic nutritional studies.

All of this was in the ‘80s — the 1980s, that is. Not the 1880s, when you might expect such basic research to have taken place!

While critically important, chronic disease risk factors for diet and nutrition tend to typically exist in the realm of two to four times relative risk. In other words, people with the “worst” nutrition compared to people with the “best” nutrition may have double, triple, or quadruple the risk. By comparison, certain genetic risk factors or environmental risk factors –- such as heavy smoking, radiation, industrial chemicals, and certain occupations — can have 10 to 100 times the risk. So nutritional risks are far more subtle and difficult to detect.

But everyone has to eat. Which on the one hand, makes the ranges of possible variability limited compared to other kinds of exposures that are “all or none.” But at the same time, because everyone has to eat, the population attributable risk can be very high — that is, involving many millions of people even when relative risks are not as high.

We are finally starting to figure it all out.

Next time, I will share what Dr. Lundberg had to say during our recent exchanges about vitamin D, which I think goes a long way toward explaining the state of affairs we face today.


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