Appendix 4 - Food for Thought

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]


The amount of power granted to physicians in our society is obscene. From an article published in the Journal of Medicine and Philosophy, "In the case of the United States, the question of how a profession held in low esteem and mired in a complex and unwieldy competitive system, managed to create a degree of professional sovereignty and social authority unprecedented anywhere else in the world, is a fascinating one."[65] As reported in Medical Economics in 1998, doctors held on to first place in ratings of public regard for 17 occupations. Almost 5 out of 6 respondents saw physicians as having "very high prestige." Politically interesting, union leaders were held among the lowest in public esteem.[66]

Quoting from a book entitled Women and Doctors, "No other professional in America enjoys the degree of authority that physicians have managed to secure. Almost unquestioned in their judgments, they have been given the authority to exercise power in areas that extend beyond their medical are of competence."[67] Case in point, nutrition.

Physicians are cited as the source of the best, most reliable, most credible source of information about nutrition.[68]

A Dutch study of 600 consumers found that they preferred the advice about healthy eating habits from their physician over 10 other potential sources including dietitians, the government, consumer organizations, etc.[69] The sad reality, though, is that most doctors know next to nothing on the subject. A study, for example, in the American Journal of Clinical Nutrition pitted doctors against patients head-to-head in a test of nutrition knowledge. More than half the patients scored higher than the physicians![70]

This is not surprising given the amount of nutrition training doctors get. A 1993 report to Congress documented that less than a quarter of U.S. medschools require nutrition as a separate course.[71] And it shows. One 1998 study of medical student nutrition knowledge, for instance, showed that less than a quarter of students had any knowledge of the nutritional value of fruit juices and soft drinks.[72] The stats are similarly dismal in residency programs.[73] The Committee on Nutrition in Medical Education has concluded that, "Nutrition education programs in U.S. medical schools is largely inadequate to meet the present and future demands of the medical profession."[74]

 
 

[65] Pippen, RB. Medical Practice and Social Authority." Journal of Medicine and Philosophy 21(1996):417-437.

[66] "Shining Brightly Because of Public Gloom Over Managed Care." Medical Economics 1998(August 10):29.

[67] Smith, JM. Women and Doctors New York: Atlantic Monthly Press, 1992.

[68] Fowler, G. "Dietary Advice." British Medical Journal 285(1982):1321-1323.

[69] Hiddink, GJ, et al. "Consumers' Expectations about Nutritional Guidance." American Journal of Clinical Nutrition 65(1997):1974S-1979S.

[70] Lazarus, K, RL Weinsier and JR Boker. "Nutritional Knowledge and Practices of Physicians in a Family Practice Residency Program." American Journal of Clinical Nutrition 58(1997):319.

[71] Ockene, JK, et al. "Physician Training for Patient Centered Nutrition Counseling in a Lipid Intervention Trial." Preventive Medicine 24(1995):563.

[72] De Villiers, FPR and UE Macintyre. "Medical Students' Knowledge of Nutrition Still Inadequate." Education for Health 11(1998):378-390.

[73] Lazarus, K, RL Weinsier and JR Boker. "Nutritional Knowledge and Practices of Physicians in a Family Practice Residency Program." American Journal of Clinical Nutrition 58(1997):319-325.

[74] Ammerman, A, et al. "Medical Students' Knowledge, Attitudes, and Behavior Concerning Diet and Heart Disease. American Journal of Preventive Medicine 5(1989):271-278.

 
 
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