Vik,

I absolutely agree with you – “Health is not a medical product and the majority of what’s needed to remain healthy (for most people most of the time) should not require robuset interaction with the medical care system.” (-Vik Khanna) I also absolutely love the content of what you said about graduate and professional degrees not being independent validations of the opinions they produce, although I don’t consider people with such degrees clowns. Each opinion stands on its own. And most of the knowledge required to enjoy good health does not require formal education, although in the absence of being raised with an awareness of the habits that foster good health some level of education is needed.

My bias is that, having seen what is playing out in politics, healthcare, the ER, and society in general, I would like to shift the focus from healthcare to health. A part of that shift is healthcare changing to support the things that foster health, but a bigger part of it is our communities and country being clear on what those things are. Knowing is not enough, but it is a prerequisite to doing in this case.

What are those things that foster health? We could say they’re simple – leave it to intuition. I addressed that in the previous response. Or we could say it’s simple, in a way, but when it comes to explaining it things get quite complex. I like your honeycomb metaphor because it gives a nod to the conceptual complexity of health. You, me, and others who agree with and understand the honeycomb metaphor also probably don’t need a metaphor to suggest what the basics are. That leaves me at the pillars. To me it’s a balance between not saying anything and the impossible feat of explaining everything. Every point in between has its own unique audience who will subscribe to only a particular message.

Anoop

Send me an email at Vik.Khanna.Health@Gmail.com, so we can talk offline.

I agree with a lot of what you say. It is uncommonly wise.

However, please don’t talk to people about pillars of health. It’s an oft-used wellness metaphor and strikingly wrong. Pillars, like the corporate silos that business leaders complain about, lack interconnectedness and don’t conjure an image in the listener’s or reader’s mind of how apparently disparate concepts such as exercise, nutrition, stress management, etc. all connect at multiple levels. A honeycomb might be more apt.

One of my biggest concerns is that we are tipping towards making everything about healthy living dependent upon the judgments of the professions. Whether it’s physicians or the Ph.D.-adorned clowns who produced this meat and cheese dreck, we are too invested in what experts think and not what experience tells us. Health is not a medical product and the majority of what’s needed to remain healthy (for most people most of the time) should not require robuset interaction with the medical care system.

Vik,

Even when the science behind a study is good, I have a problem with accepting a study as the final verdict on a subject rather than as an informing opinion. Even the best study is an opinion within a particular context about a population. It doesn’t say anything about Vik, Anoop, or anyone else in particular. Taken out of context, they can be harmful. Considered in context, they can be life saving.

The article you linked to that questions the validity of many studies (was that a study as well? 🙂 says it well. t’s appropriate to really look at the science behind some of these studies, as you did. What we’ll find is that there’s a difference between truth, which is what studies are supposed to unearth, and reproducibility, which is what studies are designed to find. In most of these studies, if a finding is reproducible across a cohort of people, we say that it’s true. That’s a loaded leap we make. We are so quick to want certainty in the form of a truth, a verdict, a piece of hard evidence as we call it, that often times we are willing to blind ourselves to the limits of not just the study you analyzed, but studies in general.

What becomes apparent is that is the quality of a study and its stated conclusions are entirely dependent on the author’s ability and motives. Know the storyteller and you know the story. It’s human nature. And it’s true of every opinion we encounter.

It looks like we generally agree. Let’s take it to the next level then.

Do you feel that health leaders have a responsibility to articulate a clear message about the direction we need to move in as a country? I use the unusual phrase “health leaders” because the people we really need to step forward are not limited to healthcare. I also include as a health leader just about everyone involved in healthcare and allied health fields. I’m also not reserving it for managers, executives, or providers because many times such positions are dependent on the current system for income (like myself) and face a personal challenge in doing something to shift the system back to basics, as we talked about previously. After all, it doesn’t take a healthcare provider to manage pre-hypertension, pre-diabetes, or someone on their way to depression. A caring friend with a healthy lifestyle can often do it better.

I feel we have that responsibility. I feel that there’s enough confusion out there about what to eat, how much to exercise, and how much to sleep. I agree with taking the “intuitive positive steps” you mention. Each person has to own the responsibility to tap into that. If that were all that’s needed we could wash our hands of the situation and say what happens is what happens – healthcare and health leaders don’t need to make an effort. But taking intuitive positive steps is only 50% of it. The message that we produce regarding what those steps are is the other 50%. Intuition is also informed by what’s happening around us.

In fact, I’m now thinking that every opinion that we put out on health, no matter how remotely related through whatever medium of communication, should be accompanied by at least a couple lines on how we need to go back to basics so people don’t forget the big picture and the direction we need to move in. It’s easy to get lost in a compelling article or news/infotainment story. The basics, which I call the 4 pillars of health (nutrition, movement, rest, connection) ain’t sexy. It just works.

We’ve reached a point as a country where we need a clear, concise message that cuts through all the other stories. That’s what I try to do for my patients when we talk about lifestyle – keep it simple and straightforward. I emphasize taking the next step. It could be a step toward a fresh food, plant-based diet, a step out the door for a walk, stepping into bed to get more rest, or stepping out with a friend. But that next step needs to be clear.

Anoop

Anoop: thanks for your very thoughtful note. I share some of your experience, having tried my hand at vegetrarianism, no oils, etc. At the end of it all, I eat this way: modest amounts of a broad range of foods, in quantities that I can easily judge will not push me towards overweight/obesity. I am also fanatically devoted to my exercise regime, and much of my eating is designed to support that.

So, I agree with you: back to basics is the key. But studies such as the one I lampoon are not about back to basics. They are, as Al Lewis noted, thinly disguised sale pitches and, as such, they no less deserving of being lampooned than any fast food company’s advertising campaign.

There is no one best way to eat, just as there is not single best way to exercise. I’d be happy if, instead of pursuing the “best diet” or the “best exercise” Americans resolved to just do something better today than they did yesterday. People learn best not from stupid science and equally stupid media coverage of it, but from experience. By spinning tall tales of eat-this, dont’t-eat-this, all we do is confuse people and discourage them from taking intuitive positive steps.

I’m not vegetarian, but have gone through stints of being vegetarian, vegan, vegan & no oil – partly to see how it affected how I felt, but also because I have conversations about such diets with my patients in the ER sometimes.

I like what Perry said, and you supported, about “going back to basics”, but for many Americans the basics of fresh fruit and vegetables, whole grains, and many of the other things on Perry’s list are not the reality. Many don’t even agree on what the basics are.I don’t think a hard-core “this is what you must eat” nutrition plan is the way to go for any one person because one size does not fit all. But, when we’re talking about the health of the country overall, we have to be able to indicate the direction we need to move in. And that direction involves a step toward a fresh food, plant-based diet. That would be a step “back to basics.”

I love the title of @BobbyGVegas essay – “A Healing Burger.” A burger can heal – why not? But to me the question is whether that’s the direction we need to move in overall. If we’re talking about what’s best for me, you or any one person, we will have several different viewpoints. And if enough people read the post we would have thousands of people supporting each viewpoint. But does that take us where we need to go, not just as individuals, but as a country?

I can say that from my experiences in the ER, I have no doubt that a step toward a fresh food, plant-based diet (meaning more fresh veg/fruits, less canned/fried/meat) will make a big difference in the lives of my patients.

Anoop

You’ve found me out. Truth be told, a great burger has been one my guilt pleasures for as long as I can remember, which is pretty amusing considering that when my family came to the US my parents were both praticing Hindus who did not eat beef. My first burger was at a White Castle in Queens when I was about 4. Love at first bite.

Try your local health food store. It’s worth the hunt.