Food as Medicine, and the Pseudo-Sophistication of Doubt

A colleague and I recently had the opportunity to “pitch” what we do, what our company offers, to a convened group of potential corporate clients.  I am not a salesperson, but I am nonetheless extremely proud to pitch these wares.  What we offer makes it possible to complete a validated, comprehensive assessment of personal dietary intake in as little as a minute; identify a personalized goal diet based on health objectives, culture, and preference (and soon, reducing environmental footprint as well); and treat to the divide between baseline and destination with food-as-medicine, as precisely as GPS doles out a turn list.  The treatment offerings span micro-challenges and digital coaching, “taste bud rehab,” dietitian coaching, and expertly curated food and meals, delivered to your door.

We have deployed these assets to many tens of thousands to date, with extremely gratifying results.  In the realm of dietary assessment, where our corporate goal is to make diet quality a vital sign, we have pushed back the frontier of what’s possible- completing more dietary assessments in less time than ever before in history.

Years of developmental work; close collaboration with some of the world’s leading nutrition experts; patent-earning innovations; a bounty of published, scientific validation research; and deployment into on-going studies at dozens of leading universities, foundations, and federal agencies underlie the advanced suite of tools my colleague and I presented. 

When we were done, the first question- from someone in finance- was whether we had years-long data, showing that what we offered not only produced good outcomes in the near term (we do), but immunized people long-term against the toxicities of our food culture (which, from the way he posed the question, he did not seem to think we should fix).  The question went on to juxtapose food as medicine with GLP1 drugs, conveying the impression that (A) we should just prescribe these for everyone instead, and (B) he likely owned stock in Novo Nordisk.

As you might be discerning, there is a lot in this that provokes something nearing disgust in me- most notably, our apparent willingness to addict people to junk food on purpose, for profit, and then to fatten the coffers of Big Pharma to treat at high cost and some risk an array of health problems that need never have occurred in the first place.  But let’s leave all that alone for now, because my focus here is on another matter: the pseudo-sophistication of the “do you have long term data?” question.  Science runs on legitimate doubt; legitimate doubt is healthy, and wise.  Doubt for doubt’s sake is procrastination, disguised as trenchancy.

The answer, for any such future interrogators looking to impress their fellows with how sedulous their manner, how sagacious their mind is: of course.  We have massive, overwhelming evidence that when we genuinely enable people to eat better we can prevent and reverse disease; add years to lives and life to years; slash health care costs; and do the health of the planet a host of favors in the process. 

Do you see the logic problem in the renunciation of all this evidence?  On the chance not, I will lay it out in a brief analogy we may call the “going the distance fallacy.”

Let’s pretend that I was selling not food-as-medicine and lifestyle-as-medicine, but…a car (electric, preferably).  And let’s pretend you wanted to buy a car- or buy a fleet of cars for your workforce.  And let’s pretend that I made a particularly great car, with particularly great features, incorporating all the best practices in car-making, along with our signature enhancements.

We could talk about power and torque; acceleration and cargo space; battery capacity, fuel efficiency and climate control; electronics and the sound system; warranty and value retention; and whatever else people talk about when cars are trading hands.  And then you could ask me: “do you have evidence that THIS car will perform so well for, say, 100,000 miles?”

I reply based on our vast experience with cars in general, entirely secure in the knowledge that it would do exactly that.  But you are asking not about CARS, but about THIS CAR.  Do we have evidence that this NEW car can go/will go/has gone 100,000 miles?

I reply that this is a NEW car; of course, it has not gone 100,000 miles.  The alternative is for you and your workforce to go car-less for 5 years or so while we drive the new cars you need, now, 100,000 miles each to prove they will go that distance, at which point…you will not have gone where you needed to go these past 5 years; the new cars you could have bought 5 years ago will each have 100,000 miles on them; and we will be offering a new, upgraded model of our car.  You will then be in a position to ask if these new, updated and upgraded cars of ours have shown that THEY can go the distance- and our cycle would begin anew.

We would never sell a car; you would never own one; and both of us would be on the road to nowhere. 

Pick, by the way, any other analogy you like: “I know that candles in general will burn; but will this NEW candle burn?  I know that trees will grow for years when planted in a yard, but what’s the evidence that THIS tree will grow for years when planted in my yard?  I know that educating children, in general, helps them achieve a higher standard of living, but what’s the evidence that this specific group of teachers in this particular (new) school will produce better outcomes for MY CHILD 30 years from now?”  And so on.

The evidence that food-as-medicine and lifestyle-as-medicine work, when done right, is as clear, consistent, and decisive as the evidence that candles hold flame, cars travel miles, trees grow for years (if we don’t kill them), and education improves lives.  We also have evidence, of course, that when what we offer is too little, too late, too feeble, too poorly conceived - it doesn’t tend to accomplish much.  That's not a surprise; it's a self-fulfilling prophecy. We can’t study Dumbo’s feather to reach conclusions about parachutes; we can’t study roller skates to reach conclusions about automobiles.  And in studies of drugs, we don’t generally test willfully negligible doses to determine if they work: we study what we believe to be a therapeutic dose.  Somehow, we fail to apply that sensible standard when food or lifestyle is the medicine instead- despite the luminous promise of what they, done right, can do.

Probing for new “proof” of established effects each time an advance builds innovation on top of best practices is nihilism, disguised as perspicacity.  It is a feint by those favoring, and more often than not, profiting from, the status quo.

It is the road to nowhere.

The rest of us should reject it accordingly; move on; and actually enjoy the promise of… getting somewhere.

-fin

David L. Katz, MD, MPH is a specialist in Preventive Medicine and Public Health.  He is the founder of Diet ID, Inc, Chief Medical Officer for Tangelo, and past president of the American College of Lifestyle Medicine.