As I see it
Philip James writes: Philip James writes: Last month Roger Hughes and colleagues including our president Barrie Margetts rightly wrote about the general need for higher professional standards, But I sometimes wonder about the contents of undergraduate and graduate courses. Yes I know this will make me sound like a fuddy-duddy, but I worry about how much – or perhaps how little – students are trained to know about the historical and even recent foundations of our science.
For example, I gave a lecture to a postgraduate course here in London a short time ago, with graduates from many parts of the world trained in nutrition, dietetics or public health. For some reason I suddenly decided to ask about a few elementary things: had they heard of the Millennium Development Goals, of the WHO report of the Commission on the Social Determinants of Health, of the UN High-Level Meeting on prevention of non-communicable diseases last September; or more UK subjects such as the NACNE report of old, or the 2011 Foresight report on Tackling Obesities.
To my utter astonishment practically nobody had heard of any of these developments. So I suddenly sensed that we do not give our students the depth and range of understanding about the crucial nature of nutrition in our society, and how the policy and political processes depend crucially on excellent data backed by coherent analyses and then with good advocates for their policy implications. We see the lobbying going on, and we then miss the point. This is that public health is not just about shouting and making a fuss about community involvement. It is one of the most challenging scientific areas which has to tackle the complexities of individual variability and subgroups on a societal basis. My worry isn't just about what's being taught. It's also about what's being written and published.
Science and soundbites
For instance, in his column this month Geoffrey Cannon has written in his usual broad brush way, about the US endocrinologist Robert Lustig's opinion that sugar – or to be precise added fructose – is an important cause not only of obesity but also of the cluster of diseases known as the metabolic syndrome. My worry is this. You might well get the impression, from Robert Lustig's presentations with provocative titles like 'Sugar: the bitter truth', and from the way they are projected in the popular media and also scientific journals, that 40 years of work on the relationships between diet, obesity and heart disease can be tossed in the trash. At last, some will say, a brilliant scientist has come up with the truth and that it's all about sugar!
As we know, this kind of thing keeps on happening. Reports of energetically publicised scientific meetings, especially originating from the US, are headlined in ways that give the impression that beans are a cure-all for cancer, or that an African fruit protects against diabetes, or that cloudberries are a wonder-food, or that physical activity is all that's needed to stay slim, or that physical activity is useless.
Having worked as a research scientist and as a head of a large nutrition research institute, and having first been thrust into the media spotlight over 30 years ago, I think I know what happens. The television producer and presenter, like the people from the Jamie Oliver roadshow I've just been interviewed by, want crisp strong clear statements – soundbites. If you insist on saying that it's all really rather complex, you won't get on the air.
Likewise with newspapers. The journalist might write a nuanced story, but the sub-editor who invents the headlines – often without reference to the writer and with only attention-grabbing priorities – is not going to write 'Stomach cancer – green vegetables may be protective, but more supportive evidence is needed'. The only discussion in the news feature room (to revert to the Robert Lustig theory), would be between the cautious 'Is sugar toxic?' and the bolder 'Sugar is toxic'.
If I am giving the impression so far, that gross misrepresentation of science is all the fault of the media, I am misleading you. These days, research scientists and their institutions are just as culpable. As many of us know only too well, research science careers depend on frequent publication in high-impact journals. This pressure leads the researchers themselves, and their heads of department, and the hierarchy above them, to focus on work that can be projected as a big story. Many research centres, especially in the US, now also employ publicists whose job is to spin research results to make them media-friendly. Don't imagine that headlines like 'Broccoli, the new anti-cancer super-food' are always dreamed up by sub-editors. You will also see them on media releases issued by university departments.
The pressure is so enormous that when I spend some time going round different universities in the UK whose vice-chancellors are concerned about the state of nutrition in the UK (yes! the UK not Africa!) I find myself almost unable to have any discussion with scientists about what research they are doing, what problem they are attempting to solve, or whether a department needs a another stream of research to provide a suitable range of interests appropriate for a major teaching unit. No! All they want to talk about is the so-called 'Research Assessment Exercise' and how mean the assessors were about their research. These assessors clearly were thought to be part of a mafia of special interests trying to protect other universities, such as Oxford and Cambridge. So they are always downgrading the achievements of other universities.
So more and more, everything has to be new, everything has to be different, simple – even sensational. One result of all this, is that the general public gets the impression that as far as food, nutrition and health is concerned, the scientists disagree and it's anybody's guess. And that's what the policy-makers we need to influence tend to think, too.
Seeing the bigger picture
There is an answer, and this brings me back to where I started, this month. Students of nutrition science need to be taught the history of their discipline, including the origins and development of solid consensus positions such as the dietary determinants of cardiovascular disease. After graduation, nutrition professionals need to keep up with the literature, at least in their area of specialisation.
Yes, the teaching of public health nutrition needs to train students to become professionally and technically more proficient. This is vital. But what about the content of courses? Do these teach our students to see the big picture, including the foundations and development of our science and our vocation? Some do, I am sure. But how many?