Hey, all you naturopaths, ‘nutritionists’, chiropractors, and all other unaccredited pedlars of gobshite:
Stop saying ‘diet and exercise’ are ‘alternative’. They’re not.
Stop saying that doctors don’t get to cover nutrition in their university studies. They do.
Stop characterising modern medicine as being all about ‘slashing, burning and poisoning‘. It isn’t (and there are plenty of medical organisations in Australia who are all about evidence-based plans to make prescription and screening even more conservative, which is good).
Stop poisoning the well about evidence-based medicine in order to sell your ineffective supplements and elitist food products. They don’t work and you’re just making people frightened as you rake in stacks of money.
And that is some Rachel Dolezal level trickery.
I get that as a preamble that was pretty aggressive, but I’m pretty much beyond caring about the cynical and hypocritical attempt by the pseudoscientific community to mischaracterise the nature of EBM for their own financial profit. It should go without saying that obviously exercise and diet are a core component of evidence-based care. That highly-trained allied health professionals like dieticians and physiotherapists work alongside doctors in the complex management of patient care is patently obvious for anyone who thinks about it for more than two seconds. But of late, promoters and believers in SCAM have made a number of assertions that are fallacious, narcissistic, defamatory and hypocritical:
- That doctors receive little to no training in nutrition and dietetics
- That doctors resort, in the first instance, to medical intervention rather than conservative recommendations in all medical conditions
- That doctors are motivated by personal profit to keep people on medication, rather than to try and manage them without
- That diet and exercise are the primary domain of altmed practitioners like naturopaths and unaccredited ‘nutritionists’, and that their knowledge and expertise outweighs that of people who have undergone 12+ years of tertiary training to practise medicine
True, I doubt there are many doctors who have spent as much time wanking about paleo, superfoods, green juices or spirulina to quite the same extent as self-professed wellness gurus do. I don’t think even dieticians would, despite their extensive tertiary training: far be it for them to have to add in – beyond the intricate knowledge of biochemistry, multiple organ systems, the complex relationship between culture and food intake, community intervention strategies, food science and managing complex dietary needs for severely ill patients – every piddling piece of minutiae on the benefits of raw goat semen kombucha.
It is worthwhile being mindful of claims at altmed’s ownership of healthy eating and movement and the motivations behind them. You’re going to struggle to find any general practitioner who would tell people to throw themselves headlong into an orgiastic binge on sticks of copha and stolen packets of sugar, or who isn’t aware of the devastating impact of diabetic complications or heart disease. They get it. But managing sick people of limited means with a number of competing health demands in the time available for a medical consultation is a challenge, and often conversations about diet and exercise are going to be a challenge, for whatever reason. I highly doubt that your average wellness blogger is treating patients who are facing amputations for diabetic foot pathology or heart failure (and if they are, then they’re monsters): when the patients one treats are either the worried well or people with real diseases operating under fatal delusions, it is easier to push diet and exercise above all else.
And all that would be fine if that’s all they were doing. They’re not.
Ben Goldacre has written of the schism between good nutrition and the cult of ‘nutritionism‘ before: it’s not enough to just tell people to eat a salad every so often, or to lay off the excessive alcohol; it has to be accompanied by prescriptive recommendations about ‘superfoods’ and macronutrients. Some quacks are all over paleo; others over veganism. But regardless of the flavour, it is all straight-up, hardcore, anti-intellectual rubbish which is predicated on economic privilege, sick right-wing individualism and thinly-veiled envy of the esteem in which evidence-based practitioners are held in the community. (There’s a reason why there’s no ATAR/OP requirement for most of the degrees on offer by full-fee ‘natural health’ institutions, and why courses in physiotherapy or dietetics are extremely competitive, regardless of the university.)
Claiming ownership of lifestyle management enables a number of things: firstly, it acts as an obfuscating halo around the more notably batshit insane recommendations of altmed: anti-vaccination, homeopathy, reiki and iridology seem more reasonable when the mainstay of treatment revolves around eating well and recommending the odd pilates class. Furthermore, it allows them to frame evidence-based practitioners as being out of touch (which is pretty helpful as a marketing tool, when the rest of what you have to sell doesn’t work or endangers people). Mainly, what it does is allows for the specialist niche marketing of products that might be otherwise commercially unpalatable: aesthetically unappealing produce can be upsold as being ‘organic’, and esoteric food products can be labelled as ‘superfoods’.
Because despite the claims that doctors are shills for products, I am presently struggling to find a wellness guru that doesn’t have something to sell.
It might be inca inchi protein powder, or meditations, or books, or functional ‘wellness’ annuals, or online courses, or coaching, but these bloggers all seem to be selling LOTS of stuff, for lots of money, with not a lot of evidence to back it. (Also, those B-School pimps you see at various wellness blogs? Those bloggers are making up to $1000 for every person they refer who joins the program. Just don’t even.)
You will all need to forgive me for my bluntness, but trick, please.
So next time when someone mentions how doctors don’t know enough about health and wellness just because they don’t endorse the superfood of the month, think critically: because that person may very well be shilling for Big Farma.
And you don’t need to worry about any of that.