Issue 13 / 10 April 2012

IN a recent radio interview a book author was promoting the concept that sugar — and particularly fructose — is the key factor in weight gain.

An ex-lawyer, David Gillespie spoke confidently and referred to the scientific literature. Taking part in the discussion (Is our diet industry making us sick?, Nightlife with Tony Delroy, 12 March 2012) was an experienced dietitian, who was clearly frustrated by some of the author’s assertions.

Why, I wondered, was the word of an informed amateur being given equal weight to that of a trained professional? It made me think about the issue of authority and credibility in general. What is it that makes a person credible to a particular audience?

In our world of mass media, health care advice is ubiquitous. We are bombarded by the latest diets and “how to” books, radio and television stories, and a profusion of websites, blogs and discussion groups.

Influence is no longer vested in some concept of credibility or authority, but by accessibility. How, then, is credibility earned?

I have previously written in MJA InSight about the way some alternative health practitioners use a new style of paternalism by combining excellent communication skills with simple and direct advice.

It appears our human nature craves certainty and simplicity, but our current society values autonomy and individualism. The result is that many people go for messages that sell simplistic ideology under the guise of “choice” and “information”, and also go against the established mainstream.

Given the enormous popularity of alternative health care in Australia, many people suggest that orthodox medicine could learn something from that approach. Can we?

On the Radio National program Ockam’s Razor in 2010, trained nutritionist Chris Forbes-Ewan made these comments about Gillepsie’s book on fructose: “Starting with the positives, I found [the book] to be very entertaining — it contains gentle humour, plain English descriptions of complex topics, and [the author] has, at least to some extent, made an attempt to base his book on the scientific literature.

“However, [the author] is a lawyer, not a nutritionist or otherwise scientifically qualified writer, and he appears to have adopted a legal approach to his investigation of fructose — an approach that is apparently based on the adversarial nature of the profession of law. He also appears to have appointed himself counsellor for the prosecution.”

Therapists with good communication skills who provide simplistic messages that avoid personal dilemmas while giving the illusion of choice can also be very popular and successful, and can make people feel better.

However, such an approach does not respect patients’ rights to a full and frank discussion of issues involving their health — even if it makes them feel better.

Good communication is always better than poor communication, empathy is always better than lack of empathy, an apparently humble approach is better than arrogance.

Can oversimplification, though, ever be better than complete honesty?

Dr Sue Ieraci is a specialist emergency physician with 25 years’ experience in the public hospital system. Her particular interests include policy development and health system design, and she has held roles in medical regulation and management.

Posted 10 April 2012

8 thoughts on “Sue Ieraci: Honestly speaking

  1. Michelle says:

    Thanks for this post, Sue – I listened to Delroy’s broadcast (I often enjoy his hour-long discussions) and was appalled at this wrong-headed search for ‘balance’ in the attempt, apparently (?), to create some drama. I turned off in disgust around halfway through, and concluded that many other listeners may well have done likewise, out of confusion if nothing else.

    When I emailed Tony Delroy the next day to express these opinions and pointed out that, although David Gillespie had a good story to tell, anecdote was not evidence, he replied that he didn’t quite see my point and that the discussion had been very well-received by listeners.

    So there…

  2. Bryan Walpole says:

    And that is the weakness of the modern media, stuff the facts, or truth, just get a good story and stir controversy. I heard the program too, and was astonished by his fructose theory. Unfortunately for the dietitian, Gillespie had a lawyer’s smooth persuasive manner, so he seemed to be on a roll, with the dietician finding it hard to make a point.
    There are few investigative (qualified in the subject under discussion) journalists left, media can’t afford them. Leigh Dayton (Oz) and Melissa Sweet are good. Norman Swan is one of the better ones too.

  3. Anonymous says:

    The media are not interested in truth or the facts but in entertainment. What is “sensational” beats what is true. Face it! Any publisher who told the truth, all the truth and nothing but the truth would be broke in a week. It’s “boring”. In any case debate is no substitute for a balanced, factual presentation. Good luck if you can get the chance to present it!

  4. Michael Romm says:

    Sue, my experience with “trained professionals” over the last 20 years in the Australian hospital/medical system is that around 80% stopped learning when they left university. They get stuck in “this is what I learned” and never update their knowledge or practice. I’ve seen it again and again regarding infection control, drug errors, hand washing, etc.
    Did you know that the average doctor receives only 10 hours of diet/nutrition training in their 6+ years of education? No wonder they are clueless and lack credibility. The reality is that an “informed” amateur probably does know a lot more.
    Of course, there are some “trained professionals” who keep up to date and lead their profession, but unfortunately they are few and far between.

  5. Sue Ieraci says:

    Michael Romm – so many errors and fallacies in your post. Coming onto a medical website to tell a whole group of doctors what they did or didn’t learn at university shows a distinct lack of insight! What you call “diet/nutrition training” spans all the years of medical school, from the anantomy of the tongue and salivary glands, the histology of pancreatic islet cells and the vascular supply of the gut to the role of Vitamin K in the coagulation cascade. Purgatives for weight loss are a significant cause of malnutrition and hose who use them are likely to need the services of the health professionals you seem to resent.

  6. Rob.the.physician says:

    Good one Sue ………the amateurs will drown in their own ‘self-importance’!

  7. Nads says:

    Don”t shoot the messenger!
    In the US Dr Robert Lustig, a Paediatric Endocrinologist is saying exactly the same thing, and there are many many medical experts there on the bandwagon. Even the American Heart Association has set strict sugar maximum guidelines because of the proven cardiac risks.

  8. David M Driscoll says:

    Sue, to make matters worse, I try to follow up on most of David Gillespie’s errors on the relevant media outlet’s websites and never has anyone cared to correct the errors nor invite him back to clarify.

    The story has been told, the sales pitch given, the controversy stirred and audience pulled in!

    I have setup a website and am slowly working my way through the enormous amount of scientific misrepresentation and cherry-picking and plan to launch it properly next year – hopefully about the same time David Gillespie trots out the media circus for his next overstatement of the ‘facts’ on seed oils!

    Nadine (Nads) it is good to see you haven’t tried to trot out the ‘read the research’ line as you so often do in order to defend David – it obviously wouldn’t work as well here amongst scientifically literate people!

    Robert Lustig doesn’t have the research background in this specific area that you would like to suggest he has (confirm this via pubmed with his name and fructose and then look for trials vs commentaries) and looking at a recent symposia on sugar, it is obvious that Lustig doesn’t do as well amongst his peers as he does reporters or a youtube audience!) – see the Q and A video via this site http://evolvinghealthscience.blogspot.com.au/2012/06/videos-of-eb2012-su… – here is the direct link http://www.visiond.com/ASN_2012/Sun_Sym_Fructose/QandA.html

    If you read the actual paper Nadine, you would know that the sugar limits set by the AHA refer more to a percentage of discretionary calories vs an upper limit for a ‘toxic’ nutrient – one example in the paper actually allowing twice the recommendation due to the person’s age and activity level. This is David Gillespie’s new favourite piece of evidence – despite the fact that he once again – gets it wrong! I’ve spelled it out here http://davidgillespiesbigfatlies.com/17/large-advisory-bodies-dont-say-f… but I’m sure it won’t stop you nor David from misquoting it in the future

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