Monday, February 10, 2014

Eat, drink, and be .... confused!

Is beer good for your health or is it a slow killer?  What about, say, bread, broccoli, wine, eggs, or (dare we say it?), sex?

Beer; Yebisu Beer Museum, Wikipedia

The answers are:
1.  Yes!  Anything we consume will keep us alive, but that just facilitates the path to our final end.  Metabolism and conjugal energy expenditure generate waste products, heat, cell division, and so on.  That leads to death!

Or 2.  Nobody knows!  After decades of huge, expensive studies by presumably the most knowledgeable investigators doing state-of-the-art science, we know relatively little with relatively little firmness, what we eat does for or to us.

In a Times article on Sunday, nutrition journalist Gary Taubes excoriates the nutrition research mill, and we think properly so, for decades of generating ever more numerous studies on nutritional epidemiology, without garnering many firm or important conclusions.
The 600,000 articles — along with several tens of thousands of diet books — are the noise generated by a dysfunctional research establishment. Because the nutrition research community has failed to establish reliable, unambiguous knowledge about the environmental triggers of obesity and diabetes, it has opened the door to a diversity of opinions on the subject, of hypotheses about cause, cure and prevention, many of which cannot be refuted by the existing evidence. Everyone has a theory. The evidence doesn’t exist to say unequivocally who’s wrong.
Even the basic questions about foods and eating are not being answered with much rigor, including even the common-wisdom recommendations related to obesity, dietary abuses, and so on, are often on quite shaky ground.  It is a huge research establishment that has its hands on funding agencies and is not being held accountable for delivering actual goods commensurate with the public investment.

Why can't we figure out the relationship of nutrition to disease in so many cases?  Largely because we've got a reductionist science that is able to find causes of disease that have large effects -- smoking, asbestos, the cause of infectious diseases -- but lousy at explaining diseases that are due to gradual exposure to multiple interacting factors that takes place over decades.  And, when some people exposed to what looks like a risk factor -- obesity, say -- develop diabetes but others don't, or when lots of sugar in the diet seems to be associated with obesity in some people but not in others, our methods really fail us.  We see the exact parallel in genetics, as we've written many times.  Indeed, does DDT cause Alzheimer's disease, a result we blogged about just last week?

Also on Sunday, the BBC reported that vitamin C is an effective treatment for cancer.  How many times for how many decades do we still have to hear more of this-finally-is true conjecture about vitamin C?  It's been going on for many decades.  The current story appeared in a journal called Science Translational Medicine.  The very phrase' translational medicine' reflects our rather bourgeois industrialization of the research system with its business and status basis.  It is a cachet self-congratulatory catch-phrase that suggests that biomedical research in the past had no interest in preventing or combating disease.  It suggests that grants were not given by NIH for such purposes (of course, NIH does fund a lot research that's irrelevant to health), which is just plain silly.  Or, rather, as we often have suggested, an establishment's typical way of making itself sound salubrious to the taxpayer we milk for our careers.  So why is there even a Science Translational Medicine journal?  Because Nature has one?  Because there might be advertising or subscription gains to be made?  Because each science publisher has to keep up with the perceived proverbial Joneses?  Because the bloated professoriate clamors for ever-more status-sounding places to publish their work?

What we're doing in the biomedical and health research establishment is to a great extent ever more of the same kinds of studies only bigger and with more costly and sophisticated hard and software.  Anyone with a computer can get SurveyMonkey software and design a questionnaire, and if you've got a degree in public health you know how to hire a bunch of nurse-interviewers, phone-callers, data-base miners and the like, and send them out on the streets to do various sorts of random samples, test and quality-check questionnaires in a standard way, then increase samples, have lots of meetings and data-enterers, and after a few years start using push-button statistical software to pour out papers (and contact the Times and BBC 'science' journalists to trumpet your work).  And, every year or so, write new grants to follow up your important 'translational' research.

Is there anything new here?
The  state of play is well known, and well known at least to the thoughtful contingent of researchers in the game.  Taubes, who has been guilty of simplistic advocacy as even he acknowledges by confessing his personal preference for sugar as the one-size-fits-all evil, clearly identifies the nature of the problem.  He doesn't really offer a solution.

We can't either, but we do say, that what is not being done is making better use of our wet ware: our brainpower.  Taubes' story was on nutrition research, and we have been harping on the same issues with respect to genomics, and have also critiqued epidemiology (including nutritional epidemiology) in past posts.

There is no magic answer for ginning up real insight and creativity.  But there may be ways of numbing or mesmerizing the part of society that might produce creativity.  A huge factory-like establishment of drone workers who need the factory to keep spewing out 'product' may have just that effect.  Our own idea that part of what is needed is to at least make the soil -- the research environment ecology -- more likely to engender innovation.  That would mean to down-size, slow down, think more and return research to being more of a profession than an industry.  There are too many professors, too pressured to grind out too many papers or hustle too many grants to keep the administrators and careerists happy.  Too many administrators who, dependent on the cream, need to keep the factory humming.  Time to think, or re-think, or be inspired creatively by odd facts is hard to come by when the pressure is get grants or lose your job.

Better synthetic rather than narrowly technical education is needed, but we haven't been generating the kinds of people who can teach it.  Instead, we have trained a body of academic professors who have been brought up and entrained in, depend on, and hence perhaps can't see or can't afford to see what is actually happening. But despite at least some people pointing the problems out, there is nothing on the horizon that seems yet able to stimulate real change.

All of this is true.  It is also true that the problems are difficult, many if not most faculty have a sincere drive to help public or individual health, high technology is at least somewhat effective and more than just expensive showy toys, and administrators are needed for big, expensive systems.  The methods are often canned in ready-made software, but that doesn't make them wrong, even if we clearly are thinking wrongly in some way.  Until we're shown better, while we do act like fad-following sheep, we do that because that's what we, collectively, know how to do.  And until our jobs and self-esteem are not constructed around the impatient, short-term factory mentality, one cannot expect us to act very differently. 

We do, after all, need to eat, drink, and try to be merry, for tomorrow we die whether or not we like to accept that.


Kirk M Maxey said...

Self-reporting is the mainstay of dietary studies, and a weaker, more rotten-to-the-core foundation could scarcely be found. Everyone knows the dogmas about good and bad foods, and subjects steadfastly under-report the bad and over-report the good in order to convince their inquisitors that they are themselves good and admirable people.

All of this focus on inputs overlooks the other 50% - the outputs, or what exactly it is people do with the nutrients they are taking in. I've written in my blog that almost all controls in hypertension/sodium studies were actually salt-stressed, because they were sedentary. They were not allowed to pour out the 2-3 liters of 150 mM NaCl solution (sweat) that would be physiologic. Likewise, fat and sugar intakes are caloric stresses, and impact the body much differently if forced into storage due to sedentary behavior. A 1000-calorie burn of whatever nature (running, chopping wood, having sex- your choice) puts the same food intake into an entirely different context.

Until dietary studies actually control the weight and composition of the experimental diet, and until they include as controls humans doing what is physiologic for humans, they will be just so much more wasted energy.

Ken Weiss said...

I didn't know about some of what you say, but it certainly sounds right. If you're a professor needing to do a study, it isn't clear what you can do (not clear to me, at least) to get around the random-sample or tiny-sample in-lab experimental or rat-based study.

And what about the 30% or so of purchased nutrients that are actually thrown away as many studies have shown. Or nibbles or restaurant meals where the content isn't knowable in detail? And given that genotypes do, in some ways, affect metabolism and storage and so on, how could one get sufficient samples to really address daily-life questions like dietary risks except in the most generic way--which, as we see, doesn't work very well either.

But if we think these are important things to know about, then what needs to be done to slow the train down til we have better ideas? Too much depends on the train keeping moving at accelerating speed.

Holly Dunsworth said...

I feel like critical thinking in science is absolutely powerless against Dr. Oz and the like.

Holly Dunsworth said...

(cont'd) That whole audience might be frustrated with the differing points of view every few months but that doesn't stop them from spending money on the products for the new plans each time one's unveiled.

Ken Weiss said...

Preachers promise salvation and pass the plate. No matter how awful the world, nor how much the personal pain and angst, the promise still leads to donations. It is, if one takes an atheistic point of view, an awful, cynical way to maintain a privileged class (preachers, bishops, et al.) at the expense of the suffering.

Maybe, of course, it's a fair trade: comforting illusion at a nominal cost.

There is more than a bit of symmetry with the way that the research establishment (us!) continues to make ever-evolving promises for salvation (no death, no disease)....if we pass the ever-growing plate.