Food Over Medicine (21 page)

PP:
There are a few things that need to be said about the advice that people do get from doctors. The first is that doctors tell patients to reduce the fat, lose a few pounds, to try to eat less red meat. They buy into the myth that if you eat chicken and fish instead of red meat, it will help you tame your coronary artery disease, which we know is not true. The second thing is that the recommendations tend to be so general that the person has no idea what to do with them. One thing that we’ve learned at The Wellness Forum is that the specificity of the instruction has a lot to do with the outcome. If I tell you, “Hey, Glen, eat a little bit less of this,” you don’t really know what that means. If I say, “Glen, do not eat this; I want you to eat that instead,” you now have a specific directive. The likelihood that you’ll know what to do and be able to follow through on all my advice is a much greater. The information from doctors tends to be vague; in the context of the short office visit, that’s about as good as it’s going to get. The third thing is that some doctors don’t even do that much. They basically say, “Okay, you have coronary heart disease and high cholesterol, but your dad had it and your grandfather had it. It runs in families, so the earlier we treat you with meds or an angioplasty, the better.” The patient is effectively told that he or she is the helpless victim of bad genetic wiring. That victim mentality shines through and sometimes precludes any advice whatsoever about diet from being dispensed, or taken to heart if it is.

GM:
There’s also the problem of low expectations, isn’t there? Doctors may recognize that meat and cheese in the diet are harmful, but believe that it’s all but impossible for most people to change their eating habits.

PP:
Yes, that’s a problem. The idea that either people won’t try it or they won’t stick with it—that’s taken as gospel, although there are some studies out there that suggest otherwise. You know, Dr. Neal Barnard did the original compliance study on Dr. Dean Ornish’s diet and showed that patients who made bigger changes were more compliant and happier with their diets.
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He conducted a similar study with diabetic patients who converted to a plant-based diet that showed similar results.
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GM:
If doctors believe that their patients can’t possibly change their diet and they approach them with that philosophy, then that’s likely going to be self-reinforcing: patients will embrace what’s presented as the difficulty of changing one’s diet.

PP:
The more insidious aspect is getting unhelpful dietary advice. Let’s say I develop high cholesterol and high blood pressure and I go to a traditional doctor. Perhaps she is even enlightened enough to have a dietitian in the office. However, that dietitian is trained on the party line, so the dietitian says I’ve got to have skim milk on the cereal, give up hamburgers and cheeseburgers and pizza, but I can have some chicken and fish. So I really work at this, I’m trying. I’m drinking the skim milk that tastes like crap and eating a lot of salmon. I do this for six months and I show back up at my doctor’s office. My cholesterol’s actually gone up and my A1C levels, a marker for diabetes, have also gone up. I had a prediabetic condition and now it looks like it’s developing into full-blown diabetes despite my best efforts for six months and you know what I say? “This dietary change doesn’t work, give me the drugs.” And so the medical skepticism about diet becomes a self-fulfilling prophecy because the dietary advice given out has no chance of helping anybody.

On the other hand, when we put people on the type of diet that actually does work, we get a different form of reinforcement. People get better, they lose weight, they get off their medications, and they don’t want to go back. We get a great deal of compliance because they actually see results from their effort. And that’s the big missing link in what’s going on in the general medical community.

Doctors need to know, and I believe most of them do, that part of their job, if they’re going to be in practice and present themselves as doing right by people, is to continue to learn. It’s the responsibility of any physician in practice to be reading and learning all the time. Now, it would be lovely if one way they would continue their learning would be by visiting, say, Dr. McDougall’s Health and Medical Center in Santa Rosa, California, or our Wellness Forum in Columbus, Ohio. But that’s not what happens. Doctors go to continuing education conferences that are largely sponsored by drug companies. The companies have doctors make presentations about the use of their drugs, many of which are off-label applications, which the drug reps can’t recommend, but doctors and continuing medical education programs effectively can.

GM:
Now, doesn’t a lot of that additional education sponsored by drug companies take place at resorts in places like Maui?

PP:
Oh yeah, and on cruise ships. And you get to be a presenter by being a high prescriber. There are rewards for being a high prescriber. For example, you and your spouse get an all-expenses-paid vacation for making a presentation on how to prescribe for off-label uses. So even the system of continuing education for doctors is corrupt.

GM:
I didn’t know about the rewards for being a high prescriber. I’ve never seen a doctor advertise on a website, “Number-one prescriber of Fosamax.” Why is that?

PP:
Professional modesty.

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GM:
Pam, what do you see as the ideal role of doctors in people’s lives? Should people go for annual checkups? Should they do any tests to monitor their health?

PP:
No.
Newsweek
had a cover story titled “One Word Can Save Your Life: No!”
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It’s about saying no to diagnostic tests. The article doesn’t make quite as strong a statement as either I or Dr. John McDougall would, but it’s right up there. It basically pointed out that the more tests you have, the more likely you are to discover something that’s insignificant but get treatment for anyway. Most major organizations, including the U.S. Preventive Services Task Force, have said that there’s no value to the annual exam.
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One interesting point that Dr. McDougall makes when he speaks about this issue, and it had a profound effect on me, is that he grew up where you go to the doctor every year for a physical. He said during that time he gained fifty pounds, he developed an intestinal obstruction, had to have surgery, and had a stroke. Obviously, the annual physical did him no good at all. The annual exam, the way we’ve structured it, is absolutely useless, so I don’t go. I don’t think you’ll find many people who are involved in this plant-foods movement spending much time in doctors’ offices. Probably the further away you get from doctors, the better off you’re going to be, in most cases.

GM:
All right, let me play devil’s advocate here. I’ve always gone for annual checkups. For many years, my cholesterol was about 160 or so and then it started creeping up. I told you the story about how, a little bit more than a year ago, it went as high as 212. That’s when I spoke to Dr. McDougall. He told me to cut out the fructose; now I’m back down to my normal levels again. If I hadn’t gone for an annual checkup, I wouldn’t have known I was at 212. I would have thought, “Gee, I’m on a great diet. I’m fine.” I would have continued eating my few cookies in the evening and my sweetened soy yogurt and so forth. I had a significant problem brewing and I learned about it only from my annual checkup.

PP:
First of all, you’re a little more enlightened than the average person, and have been for quite some time. Second, you didn’t have a doctor, obviously, who was trying to get you to do more than just come in, check in, get a blood test, and go home. Third, you were lucky enough to be able to discuss your problem with Dr. McDougall.

You’re not the one I’m concerned about, Glen. I’m concerned about the average healthy male who shows up and the doctor says, “Let’s do a prostate-specific antigen (PSA) test because you’re getting to that age where you ought to have one.” So you get a PSA test and it’s a little bit elevated. Soon they identify a few cancer cells and you’re rushed into having a prostatectomy. Now, in all likelihood, if you had done nothing, if you had never known about those funny cells, you would die with that cancer at the age of ninety-seven—die with it, but not of it.

I’m concerned about the woman who goes to the OB/GYN’s office for her annual checkup, and the doc tells her she needs a mammogram. As a result, they discover a carcinoma in situ and next thing you know, she’s labeled a cancer patient. She has surgery, she’s taking tamoxifen, and she’s had enough radiation to increase her risk of a heart disease significantly. Those are the more typical scenarios, which is why the whole situation is so inadvisable for people. What I tell people is, first of all, learn what the research shows in terms of results from common diagnostic tests. Once you do, you’re likely to do none of this diagnostic testing that doctors want to subject you to, and I’m not talking about a blood test to get your cholesterol tested. My gosh, you can go to a drugstore and get that done now; you don’t even need to go to see a doctor.

In my books and lectures, I advise people to do none of these diagnostic tests that you’re being pushed to do when you go in, whether it’s a Dexa scan, PSA, mammogram, colonoscopy, etc.; they’re not going to save your life. All they do is lead to more tests and more treatments that don’t work. A blood panel is fine only if you are a smart consumer about medicine. Here’s what I mean by that. In your case, you go to the drugstore, get a blood test, see that your cholesterol is up—notice that you didn’t ask your doctor what do to about it, you asked Dr. McDougall what to do. What do you think would have happened if the average person asked the doctor what to do about it?

GM:
Probably a statin.

PP:
Yeah. Because it runs in your family, Glen. That’s the type of advice that you would get. So to be a smart medical consumer, you decide what steps to take on your own behalf. You may want to look for any way to do so outside of the traditional medical establishment.

Now, if I had a relentless pain in my side, I didn’t know what it was, and it didn’t go away by Monday, I would clearly go see a doctor. That’s smart medical consumerism. But showing up in this perfectly healthy state that I am in to say, “Listen, I just want you to poke and prod and tell me that I’m okay after as much poking and prodding as you can get my insurance company to pay for,” well, that’s where the problem is.

GM:
So you believe in going to doctors if you feel pain or if something unusual is going on?

PP:
Of course. A woman in her thirties misses four menstrual periods in a row and she’s not pregnant—I think she ought to check it out.

GM:
At that point, do you do whatever tests the doctor orders? How do you manage this relationship with the doctor?

PP:
You should ask a lot of questions, but don’t consent to anything until you have a complete understanding of it. You go to the doctor and say, “Look, I’ve got this pain on my side and I can’t figure out what it is.” And she says, “Well, we need to do some imaging.” Okay, well, what kind of imaging? She might say a CT scan, but if you investigate CT scans, you may decide that that’s way too much radiation and that you’ll probably be better off with an MRI. What you really want to do is gather information. If you don’t know the answers to some of these questions, go home, do some research, and then decide what you’re going to do. I’m not saying you should dillydally for another nine months—you may be on a fairly tight schedule of needing to figure out what’s wrong—but you don’t just do what you’re told. Some doctors will test you to within an inch of your life. Again, the worst thing you can have if you walk into a doctor’s office or a hospital is great insurance because they’re going to use it.

GM:
What if they find a tumor and say we need to operate immediately?

PP:
The number of times that a condition is so life-threatening that we find out about it this afternoon and we need to have surgery tomorrow morning is such a tiny percentage that it isn’t even worth talking about. You say, “Great, I’d like to have any images and any other information that you can give me so that I’m really clear on what’s going on with me.” Take notes and then say, “Thank you so much, I’m really glad we’ve gotten to the bottom of this. Please tell me what you think I ought to do and I’m going to take real careful notes here. By the way, please understand when you’re telling me what you want me to do, I would like some outcomes and expectations in absolute rather than relative terms. I want you to tell me the straight story. I’m going to go check this out with some other people, get some other opinions from people who have different tools in their toolbox, and then I’m going to make up my mind about what to do.” And that’s when you get in touch with somebody like me or Dr. Ralph Moss or Dr. McDougall, get some other points of view, and then make your best decision about what you think is right for you to do. Don’t get herded into some type of procedure without looking into it first.

GM:
Okay. What if a woman has a Pap test and they find precancerous cells on the cervix, dysplasia, and she’s told she needs a LEEP Cone biopsy? Isn’t that potentially a lifesaver?

PP:
Well, yes, but there’s also a good chance that the treatment she was getting from the OB/GYN caused it in the first place; that’s what happened to me.

GM:
Say that again? A chance that the treatment she was getting caused the dysplasia?

PP:
Yes. First of all, birth control pills are carcinogens; they’re full of hormones. We know that supplemental hormones are carcinogenic; a lot of women get these conditions by taking birth control pills.
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That’s what happened to me when I got cervical dysplasia. What added to it was the terrible diet that I was eating at the time; this episode took place about five years before my conversion. I also got the human papillomavirus, which is a minor player in the whole thing. However, all of this could have been avoided if I had been eating the right diet and hadn’t been taking those dreadful pills. Even after you’re diagnosed with dysplasia, if you get off the pills, stop drinking so much alcohol and eating dairy products, and eat the right foods, that condition will right itself most of the time.

Since it’s not immediately life-threatening, it’s one of those conditions where it’s worth it to go home, practice dietary excellence, do the right things, go back to the doctor in four months and have another Pap smear, and see if it’s gone away before you do anything about it. Keep in mind that the LEEP Cone biopsy procedure requires a general anesthetic, something that’s best to avoid whenever possible. So, in my case, not only did this doctor who did the LEEP Cone biopsy give me the birth control pills, which were a major part of why I developed the condition in the first place, but I stayed on the birth control pills because he didn’t tell me to stop taking them. I went home and continued to eat cheese and drink alcohol and eat cookies for another several years. So my risk of recurrence was huge; I’m lucky it didn’t happen to me.

GM:
But wouldn’t a woman in that situation who delays the procedure feel that she’s taking a risk that it may spread if the diet doesn’t control it?

PP:
That’s why you put a stop-loss on it. You don’t walk out the door and say, “I’m just going to go change my diet and I’m never coming back here again.” There are ways to figure out if it’s progressing, staying the same, or regressing. If it’s staying the same, you don’t do anything about it because it can’t kill you unless it progresses. Medicine does have a way of quantifying the situation. That’s why it’s so important to be knowledgeable. At The Wellness Forum, the information we provide about this type of topic is as important as how to eat the diet; if you don’t understand how to manage your relationship with your doctor, you could be just as victimized by the health care profession and end up in just as much trouble.

You have to gain enough knowledge and confidence to go in and tell the doctor, “I hear what you’re saying and I appreciate that because you have malpractice insurance and a medical license, you have to tell me certain things. Go ahead and note it in the file. I’ll even sign something saying that you told me this stuff. But I’ve learned enough about this now, having looked into it on my own, to know that there’s absolutely nothing to be lost by waiting three or four months to see if this condition clears up when I stop fertilizing it. I understand now that I’ve been fertilizing it with alcohol, cheese, sugar, and birth control pills. I’m going to try to protect myself now by eating a lot of whole foods, including lots that are rich in folate.”

GM:
I think we need to acknowledge that one reason for overtesting is the legitimate fear on the part of doctors of medical liability.

PP:
Certainly true, but on the other hand I accompanied a friend to the ER with a sinus infection, and the doc recommended an MRI—for a sinus infection. I don’t think he was worried about being sued. Consumers should be especially wary of doctors who do tests inside their own offices, because they have the strongest financial incentive to overtest, but the root of the problem is deeper than just greed.

GM:
Let’s review different types of testing and get your opinion about the harmful effects, if any, of each type. I know that you’re an opponent of mammograms. Is there ever a use for mammograms, or are they always worthless?

PP:
I would never agree to one myself. I think they’re worthless.

GM:
I would imagine that this is fairly shocking to most women who have all been told that mammography can and does save lives.

PP:
Remember, though, that these are marketing messages for mammography, not messages reporting the scientific findings.

Mammography is highly unreliable. It tends to miss aggressive tumors that grow between screenings, while detecting small, benign tumors, such as carcinoma in situ, that are usually not cancers at all and are often referred to as “pseudo-cancers.” As a reminder, the word “pseudo” means “false.” It’s a false cancer.

In spite of the fact that most of these pseudo-cancers will not develop into a cancer that will require treatment, women diagnosed with them are advised to have lumpectomies, to receive radiation treatments, and to take drugs like tamoxifen. This is overtreatment for a condition that is highly unlikely to be life-threatening. Particularly troubling is how these women are classified as “cancer survivors.” Almost all of them would be alive five years after diagnosis (the benchmark for survival for cancer patients) even with no treatment. This skews the survival statistics numbers, making it look like treatments for breast cancer are much more effective than they really are.