The China Study (50 page)

BIG MEDICINE: WHOSE HEALTH ARE THEY PROTECTING?                  329
and extra milk for patients who have osteoporosis. The health damage
that results from doctors' ignorance of nutrition is astounding.
Apparently, there aren't enough "nutrition-oriented physician role
models" in medical education. A recent survey found "a shortage of nu-
trition-oriented physician role models is probably the major constraint in
teaching nutrition to residents. "12 I suspect that these medical programs
lack nutrition-oriented physicians simply because they do not make it a
priority to hire them. Nobody knows this better than Dr. John McDou-
gall.
DR. MCDOUGALL'S CHALLENGE
Dr. John McDougall has been advocating a whole foods, plant-based ap-
proach to health longer than any practitioner I know. He has written ten
books, including several that have sold over a half a million copies each.
His nutrition and health knowledge is phenomenal, greater than any oth-
e r doctor I've met and greater than any of my nutrition colleagues in aca-
demia. We met recently in his Northern California home, and one of the
first things he showed me was his bank of four or five full- size metal file
cabinets lined up along the back of his study. There can't be many people
in the country with a collection of scientific literature on diet and disease
that could rivalJohn McDougall's, and, most importantly, John maintains
a high level of familiarity with all of it. It is not unusual for him to spend a
couple of hours a day on the Internet reviewing the latest journal articles.
If anybody would be a perfect "nutrition-oriented phYSician role model"
in an educational setting, it would be Dr. John McDougall.
Growing up, John ate a rich, Western diet. As he says, he had four
feasts a day: Easter during breakfast, Thanksgiving at lunch, Christmas
at dinner and a birthday party for dessert. It caught up to him, and at the
age of eighteen, a few months into college, John had a stroke. After re-
covering with a new appreciation for life, he became a straight A student
as an undergraduate and then completed medical school in Michigan
and an internship in Hawaii. He chose to practice on the Big Island of
Hawaii, where he cared for thousands of patients, some of whom had
recently migrated from China or the Philippines, and some who were
fourth generation Chinese or Filipino Americans.
It was there that John became an unhappy doctor. Many of his pa-
tients' health problems were a result of chronic illnesses, such as obesity,
diabetes, cancer, heart disease and arthritis. John would treat them as
he was taught, with the standard sets of pills and procedures, but very

330                          THE CHINA STUDY
few of them became healthy. Their chronic diseases didn't go away, and
John qUickly realized that he had severe limitations as a doctor. He also
started to learn something else from his patients: the first and second
generation Americans from Asia, the ones who ate more traditional,
Asian staple diets of rice and vegetables, were trim, fit and not afflicted
with the chronic diseases that plagued John's other patients. The third
and fourth generation Asian Americans, however, had fully adopted
America's eating habits and suffered from obesity, diabetes and the
whole host of other chronic diseases. It was from these people thatJohn
began to notice how important diet was for health.
Because John wasn't healing people, and the pills and procedures
weren't working, he decided he needed more education and entered a
graduate medical program (residency) at the Queens Medical Center in
Honolulu. It was there that he began to understand the boundaries that
the medical establishment had set and the way that medical education
molds the way doctors are supposed to think.
John went into the program hoping to find out how to perfect the
pills and procedures so that he could become a better doctor. But
after observing experienced doctors treating their patients with pills
and procedures, he realized that these authoritative doctors didn't do
any better than he did. Their patients didn't just stay Sick-they got
worse. John realized something was wrong with the system, not him,
so he began to read the scientific literature. Like Dr. Esselstyn, once
he started reading the literature, John became convinced that a whole
foods , plant-based diet had the potential not only to prevent these dis-
eases that were plaguing patients, but also the potential to treat them.
This idea, he was to find out, was not received kindly by his teachers
and colleagues.
In this environment, diet was considered quackery. John would ask,
"Doesn't diet have something to do with heart disease?" and his col-
leagues would tell him that the science was controversial. John contin-
u e d to read the scientific research and to talk to his colleagues and only
became even more baffled. "When I looked at the literature, I couldn't
find the controversy. It was absolutely clear what the literature said."
Through those years,John came to understand why so many physicians
claimed diet was controversial: "The scientist is sitting down at the
breakfast table and in the one hand he has a paper that says that cho-
lesterol will rot your arteries and kill you, and in the other hand he has
a fork shoveling bacon and eggs into his mouth, and he says, There's

BIG MEDICINE: WHOSE HEALTH ARE THEY PROTECTING?                331
something confusing here. I'm confused.' And that's the controversy.
That's all it is."
John tells a story about seeing a thirty-eight-year-old man and his
wife after the man had suffered a second heart attack. As the attending
resident (not their primary physician), he asked the patient what he
was going to do to prevent a third, fatal heart attack. "You're thirty-eight
years old with a beautiful young wife, five kids. What are you going to
do to keep your wife from being a widow and your kids from becom-
ing fatherless?" The man was despondent, frustrated and said, "There's
nothing 1 can do. 1 don't drink. 1 don't smoke. 1 exercise, 1 follow the
same diet the dietitian gave me after my last heart attack. There's noth-
ing more 1 can do."
John told the couple what he had been learning about diet. He sug-
gested that the man might reverse his disease if he ate the right way. The
patient and his wife received the news with enthusiasm. John talked
with them for quite a long time, left the room and felt great. He had
finally helped someone; he had finally done his job.
That lasted for about two hours. He was called into the Chief of Med-
icine's office. The Chief of Medicine wields absolute authority over the
residents. If he fires a resident, not only is that person out of his or her
job, that person is out of his or her career. The excited couple had told
their primary physician what they had just learned. The doctor replied
that what they had been told wasn't true, and promptly reported John to
the Chief of Medicine.
The Chief of Medicine had a serious conversation with John, who
remembers being told that "I was stepping far beyond my duties as
a resident. 1 should get serious about medicine and give up all this
nonsense about food having anything to do with disease. " The Chief
of Medicine made it clear that on this point, John's job, and his sub-
s e q u e n t career, was on the line. So John bit his tongue for the rest of
his education.
On the day of John's graduation, he and the Chief of Medicine had a
final talk. John remembers the man as being smart, with a good heart,
but he was too entrenched in the status quo. The Chief of Medicine sat
him down and said, "John, 1 think you're a good doctor. I want you to
know that. I want you to know that I like your family. That's why I'm
going to tell you this. I'm concerned that you're going to starve to death
with all your crazy ideas about food. All you're going to do is collect a
bunch of bums and hippies. "

332                         THE CHINA STUDY
John paused to gather his thoughts, and then said, "That may be the
case. Then I'll have to starve. I can't put people on drugs or surgeries
that don't work. Besides, I think you're wrong. I don't think it will be
bums and hippies. I think it will be successful people who have done
well in life. They'll ask themselves, 'I'm such a big success, so how come
I'm so fat?''' With that, John looked at the Chief's generous belly, and
continued, "They'll ask, 'If I'm such a big success, why are my health
and my future out of contro!?' They'll look at what I have to say, and
they're going to buy it."
John finished his formal medical education having had only one hour
of nutrition instruction, which involved learning which infant formulas
to use. His experience confirms every study that has found nutrition
training among physicians to be sorely inadequate.
HOOKED ON DRUGS
John touched on another important area where the medical profession
has lost credibility: its ties with the drug industry. Medical education
and drug companies are in bed together, and have been for quite some
time. John talked some about the depth of the problem and how the
educational system has been corrupted. He said:
The problem with doctors starts with our education. The whole
system is paid for by the drug industry, from education to research.
The drug industry has bought the minds of the medical profession.
It starts the day you enter medical school. All the way through
medical school everything is supported by the drug industry.
John is not alone in criticizing the way in which the medical estab-
l i s h m e n t has partnered with the drug industry. Many prominent sci-
entists have published scathing observations showing how corrupt the
system has become. Among the common observations are:
• The drug industry ingratiates itself with medical students with
free gifts, including meals, entertainment and travel; educational
events, including lectures, which are little more than drug adver-
tisements; and conferences, which include speakers who are little
more than drug spokespeople. 15- 17
• Graduate medical students (physician residents) and other physi-
cians actually change their prescribing habits because of informa-
t i o n provided by drug salespeople, 18-20 even though this information

BIG MEDICINE: WHOSE HEALTH ARE THEY PROTECTING?                333
is known to be "overly positive and prescribing habits are less ap-
p r o p r i a t e as a result."1 7, 21, 22
• Research and academic medicine merely carry out the pharmaceu-
tical industry'S bidding. This can happen because: the drug com-
panies, and not researchers, may design the research, which allows
the company to "rig" the study23, 24; the researchers may have a
direct financial stake in the drug company whose product they are
studying I5 , 25 ; the drug company may be responsible for collecting
and collating the raw data, and then only selectively allowing re-
searchers to view the data 2), 26; the drug company may retain veto
power over whether the findings are published, and may retain
editorial rights over any scientific publications resulting from the
research 2 ,25, 27; the drug company may hire a communications firm
)
to write the scientific article, and then find researchers willing to
attach their names as authors of the paper after it has already been
written.26
• The major scientific journals have turned into little more than mar-
k e t i n g vehicles for drug companies. The leading medical journals
derive their primary income from drug advertising. This advertis-
ing is not adequately reviewed by the journal, and companies often
present misleading claims about drugs. Perhaps more disconcert-
ing, the majority of clinical trial research reported in the journals is
funded by drug company money, and the financial interests of the
researchers involved are not fully acknowledged.24
In the past couple of years there have been well-publicized scandals
at major medical centers that confirm these charges. In one instance ,
a scientist's integrity was maligned in a variety of ways by both a drug
company and her university administration after she found that a drug
under study had strong side effects and it lost its effectiveness. 27 In an-
o t h e r case, a scientist speaking out about the possible side effects of
antidepressants lost a job opportunity at the University of Toronto. 26
The examples go on and on.
Dr. Marcia Angell, an ex-editor of the New England Journal oj Medicine,
wrote a scathing editorial called "Is Academic Medicine for Sale?"15:
The ties between clinical researchers and industry include not
only grant support, but also a host of other financial arrangements.
Researchers serve as consultants to companies whose products
they are studying, join adviSOry boards and speakers' bureaus,

334                         THE (HINA STUDY
enter into patent and royalty arrangements, agree to be the listed
authors of articles ghostwritten by interested companies, promote
drugs and devices at company-sponsored symposiums and allow
themselves to be plied with expensive gifts and trips to luxurious
settings. Many also have equity interest in the companies.
Dr. Angell goes on to say that these financial associations often sig-
nificantly "bias research, both the kind of work that is done and the way
it is reported."
Even more dangerous than the threat of fraudulent findings is the
fact that the only type of research that is funded and recognized is
research on drugs. Research on the causes of disease and non-drug
interventions simply doesn't occur in medical education settings. For
example, academic researchers may be furiously trying to find a pill
that will treat the symptoms of obesity, but not be devoting any time
or money to teaching people how to live a healthier life. Dr. Angell
writes 15 :
In terms of education, medical students and house officers, under
the constant tutelage of industry representatives, learn to rely on
drugs and devices more than they probably should [my emphasis].
As the critics of medicine so often charge, young physicians learn
that for every problem, there is a pill [my emphasis] (and a drug
company representative to explain it). They also become accus-
t o m e d to receiving gifts and favors from an industry that uses
these courtesies to influence their continuing education. The aca-
demic medical centers, in allowing themselves to become research
outposts for industry, contribute to the overemphasis on drugs and
devices."
In this environment, is it possible for nutrition to be given fair and
honest consideration? Despite the fact that our leading killers can be
prevented and even reversed using good nutrition, will you ever hear
about it from your doctor? Not as long as this environment persists in
our medical schools and hospitals. Not unless your doctor has decided
that standard medical practice as it is taught does not work, and decides
to spend a Significant amount of time educating himself or herself about
good nutrition. This takes a rare individual.
The situation has gotten so bad that Dr. John McDougall said, "I
don't know what to believe anymore. When I read a paper that says I