Paleocharlatans 2014

Peter Turchin over at the Social Evolution Forum is declaring 2014 Year of the Paleo Diet. I think his enthusiasm for the Paleo diet trend is overblown and his attempted take-down of skeptics unconvincing. (You can see my comments by clicking the link to the article.)

But I’m glad I read it, because it links to a much more interesting article in the Atlantic, This is Your Brain on Gluten. Writer James Hamblin, himself an MD, takes head-on the most recent purveyor of a revolutionary cure-all diet, one Dr. Perlmutter. The piece is well written and worth reading, because most of us are genuinely concerned with our health and well-being. We want to feel empowered to stave off all manner of illness and deficiency. We’re all set for the charlatan’s trap.

Medicine show charlatanism seems perennially appealing to most people. The majority recursively dictates the media and social discourse. So unless you retreat to a cabin in the woods, it’s always going to be in your face.

In his 2013 book Do You Believe in Magic?, University of Pennsylvania pediatrician Paul Offit wrote about the idea that there is really no such thing as alternative medicine; there is only what is proven to work and what is not. His book meticulously debunks alternative medical myths with science. Offit recounts hundreds of years of history of physicians peddling hope…

Offit’s book spent zero weeks at the top of the bestseller list.

Quoting Dr. Katz, a critic of Dr. Perlmutter’s book, Hamblin summarizes the situation

“I also find it sad that because his book is filled with a whole bunch of nonsense, that’s why it’s a bestseller; that’s why we’re talking. Because that’s how you get on the bestseller list. You promise the moon and stars, you say everything you heard before was wrong, and you blame everything on one thing. You get a scapegoat; it’s classic. Atkins made a fortune with that formula. We’ve got Rob Lustig saying it’s all fructose; we’ve got T. Colin Campbell [author ofThe China Study, a formerly bestselling book] saying it’s all animal food; we now have Perlmutter saying it’s all grain. There’s either a scapegoat or a silver bullet in almost every bestselling diet book.”

The recurring formula is apparent: Tell readers it’s not their fault. Blame an agency; typically the pharmaceutical industry or U.S. government, but also possibly the medical establishment. Alluding to the conspiracy vaguely will suffice. Offer a simple solution. Cite science and mainstream research when applicable; demonize it when it is not.

He gets to the heart of anti-science confirmation seeking, saying “The law of good science is that you can’t say ‘I’ve got an idea and I’m going to fall in love with it and selectively cite evidence to support it.'” Yet that’s exactly what Dr. Perlmutter seems to be doing with his book. We can never really know whether he truly believes what he’s peddling or if he is simply exploiting his position for fortune and fame.

Dr. Perlmutter’s claims probably contain grains of truth (yuck, yuck, yuck), but after all the dust settles we’ll almost certainly be left with just another miracle diet as we move on to the next one. There is a whole industry committed to this niche. Hamblin neatly summarizes part of the negative social impact while concluding the article with an intriguing sentence…

I hope people don’t give up on nutrition science, because there is a sense that no one agrees on anything. An outlier comes shouting along every year with a new diet bent on changing our entire perspective, and it’s all the talk. That can leave us with a sense that no one is to be believed. The scientific community on the whole is not as capricious as the bestseller list might make it seem.

When a person advocates radical change on the order of eliminating one of the three macronutrient groups from our diets, the burden of proof should be enormous. Everything you know is not wrong. [Perlmutter’s] narrative comes with the certainty that you are doing something to save yourself from cognitive decline and mental illness, which is probably the most unsettling of disease prospects.

With that belief can also come guilt and blame; an idea that something simple could’ve been done to prevent a mental illness, when actually it was bigger than us. To think that every time you eat any kind of carb or gluten, you are putting your mental health and cognitive faculties at risk is, to me, less empowering than paralyzing.

Empowerment comes in many forms. It is important to believe you’re doing what’s right.

“It is important to believe you’re doing what’s right.” That really is an interesting way to close the article. In a sometimes overwhelmingly complicated and befuddling world, it’s comforting to have some certainty, to know what’s right, in the face of the most frightening prospects. Ultimately, that is what the Dr. Perlmutter’s of the world are offering: Confidence and power against the goblins and fates. I don’t see the market for it disappearing anytime soon.

Aside: The article also got me wondering again about the way for-profit entities deftly leverage non-profit infrastructure to their advantage. Dr. Perlmutter will host a 90-minute PBS special, Brain Change, discussing the topics found in his recently released best selling book. How does this work? My understanding is that PBS and affiliates pay for the programming. But aren’t programs like this a form of advertising that combine interesting content and infomercial? Who should be paying whom? And how is this reconciled with PBS’s non-advertising model?

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