Monday, June 9, 2008

what is the why?

i have been having long, sometimes contentious conversations with a friend of mine about health and nutrition.  She is a Nurse Practitioner here in NYC, and our conversations are stimulating and fruitful, for the most part (it is usually my fault if they go off!).  

The last was especially lively, as we argued the Fat = bad bit like two cats holed up in a 200sf studio apartment.  

My position (shared by a growing group of scientists, MD's and nutritinists) is that Dietary Fats/cholesterol should never have been pilloried.  That they are not the key element in High Blood Pressure, Heart Disease, and Obesity that the medical/dietetic establishment suggests they are.  Instead our problems are based on refined sugars/carbs.  Consumption of Corn Syrup in this country increased by 400% between 1900 and 1980.  The average person in this country consumed about 1 cup of sugar/year 100 years ago.  We now consume about 1/2 cup per day.

Gary Taubes has written a book entitled Good Calories, Bad Calories that goes into quite a bit of detail on the subject.  

But what really struck me about this whole discussion was that it forced me to think about some core beliefs.  Why do I trash the medical establishment?  The nutrition establishment?  Pretty much all authority and large organization? 

So I found myself writing to my friend, trying to determine the answer to some of these questions.  It is personal, and could be considered poor journalism.  but this is a blog.  Rules, be gone!

Here is what I told her:
I have just been dipping into his book "Good Calories, Bad Calories". It is a massively researched indictment of the "fat is bad" prevailing attitudes. His primary enemy: refined sugars and grains.
here is a quote:
"From the inception of the diet-heart hypothesis in the early 1950s, those who argued that dietary fat caused heart disease accumulated the evidential equivalent of a mythology to support their belief. These myths are still passed on faithfully to the present day."

I am not a lonely zealot that hates the western dietetic and medical establishment. I actually see myself, in contrast, as a member of a small club of folks that must look more closely at everything around them, that take nothing for granted, that trust no large organization, particularly one with complex and large scale vested interests.

Everything I know that is Good and helpful to people fits into two categories:
1. Relies most heavily on personal interactions and partnerships. i.e. - in the medical world: nursing and acupuncture. in the personal/religious world: individual self-cultivation/spirituality (i hate that word, but it is right for the concept) OR
2. Relies on a small group of reasonable people working together. the important part is "small". The moment our standards of excellence fall is the moment our organization gets too big. Perhaps you can illuminate this point: in your experience what hospitals are the most effective? Do the larger hospitals have sufficient autonomy of smaller departments to keep these smaller departments effective, or do they get bogged down in whole building beaurocracy? etc. etc.

I believe in the small, smart, responsive, flexible group. I also believe that as our population and mass-culture take hold, most people are separated from that small group. Their standards fall, their ability to parse opposing arguments is reduced to ambivalence or worse, apathy. I do not believe that the medical establishment has the market cornered on the brightest, best, most remarkably caring people in the world. I believe though it may be better then some professional communities it is prone to stumbles in judgment, standards and ethics, as all others are. I was a teacher for 8 years, and I can tell you that most teachers care deeply about the welfare of their children. The definition of what that welfare is however is a vast and confusing affair. With the confusion comes disparity in the deliverance of education to children. Some in education think that the german model of strict discipline and tacit memorization is of the greatest service to students, others think that a grade-less progressive model of collaboration is best. The definition of standards is muddied by such things.
When you tell me that your professional world is immune to such confusion of values all my skeptical bells start ringing loudly.

I also want you to know, that I cared deeply for the children i saw each day. But I never ceased in my descrying of the educational establishment where I perceived its failings. The reason I say this is that I do not descry you, or your (obviously valuable and caring and vital) work when I descry certain arms of the medical establishment. I believe that a community can be both forward looking and intelligent in one instance and blind and stupid in another. You seem to think I will always throw your baby out with the medical establishment bathwater. This is not the case. What I am trying to do is - find the good stuff, wherever it is, and combine all that i find into a new tapestry, one devoid of lines between communities, but full of lines between good sense and stupidity.

I hope this helps you understand where I come from, when I sound strident and dismissive. I am sorry for the tone at times, I assure you, it is better then it was, and will be better then it is in time.
Be Well.

Comment:  Of course now, in retrospect, so many points I was trying to make are crumbling in my mind.  Large groups can be useful, as can individuals with no major or minor affiliation.  I suppose the point of the above was my effort at continuous evaluation of my values and ethics.  

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