Monday, November 19, 2007

I'm Still Scary?

So on Saturday I gave a lecture at the Ontario Family Physician's Conference. The lecture had been scheduled for months and the planned topic was, "Big Food: How Politics and the Food Industry Helped to Shape Canada's Food Guide" during which I had planned to discuss many of the issues I detailed roughly one year ago in my Canada's Food Guide to Unhealthy Eating series.

A few weeks before the conference I was contacted by the conference organizers. They had received a letter complaining about my talk. I hadn't planned on blogging about the letter as I didn't want to make things uncomfortable for the organizers but during the question and answer period of the lecture, one of the folks who was involved in sending this letter of concern mentioned it herself so I figure if she can talk about it, so can I.

The original letter of complaint was from the Ontario Society of Nutrition Professionals in Public Health and from the Ontario Collaborative Group for Healthy Eating and Physical Activity.

Wanna know what their concern was?

They were concerned that my presentation of nutritional evidence to physicians, a group of individuals trained to critically appraise evidence, might sway those physicians from a sacrosanct trust in Health Canada and Canada's Food Guide and heaven forbid cause them to provide evidence-based nutritional guidance to their patients (like for instance that they should minimize red meat, processed meat, refined carbohydrates and calories - messages not provided by Canada's Food Guide). They were concerned that if this were to happen, and if one of those physicians' patients might speak with someone who believes that the information that comes from Health Canada should never be questioned or critically evaluated, that there will be a conflict between the evidence-based messages provided by the physician and those of Canada's Food Guide thereby sowing confusion.

So let me ask you - if my recommendations are evidence based recommendations (and they most undoubtedly are), and if in fact Canada's Food Guide is evidence-based, how is it possible that they would be different?

I'll tell you how - Canada's Food Guide, as I've mentioned many times, is not reflective of the current state of medical evidence regarding the role of diet in chronic disease prevention.

So what did I do when I heard about their concerns? Well I immediately urged the conference organizers to invite the concerned parties to my lecture and also offered to share my speaking time with them evenly and suggested a round-table discussion afterwards.

Happily, they accepted and speaking on their behalf was Dr. Daniel Brule, currently the acting Director General of Nutrition Policy and Promotion (the folks in charge of the Food Guide).

I also immediately informed the parties involved that I would be specifically speaking about the Food Guide's nutritionally indefensible guidance on red meat, whole grains and calories.

So did they spend the 20 minutes I shared with them discussing how the Food Guide's recommendations on red meat, whole grains and calories were in fact evidence-based and that clearly I must have misunderstood the evidence?

Of course not, because the evidence clearly would support guidance on minimizing red meat, refined grains and calories. However instead of addressing the clear conflict between the evidence and the recommendations of the Food Guide, Dr. Brule spent the majority of her time detailing the rigorous process behind the Food Guide's revision.

That was a shame, because as I mentioned in my lecture - there's really not much point in talking about the process given that we've got a final product. While I certainly have major concerns with the process, we are now faced with a final product Food Guide that is anything but evidence based. Right now the only value in exploring the process would be to see where things went wrong so that next time around, perhaps the evidence can play a larger role in the final recommendations.

By the way, the Ontario Society of Nutrition Professionals in Public Health and the Ontario Collaborative Group for Healthy Eating and Physical Activity, the folks who had such great concerns never once attempted to contact me directly and did not copy me on their letter of complaint. Instead they tried to sandbag the talk directly with the conference organizers and by cc'ing pretty much everyone else (Research Monitoring and Evaluation at Health Canada, the Ontario Ministry of Health Promotion, the Ontario Public Health Association, the Council of Ontario Medical Officers of Health and the Association of Local Public Health Agencies), tried to stir up even more dissent.

So going back to their concern about the "inconsistent messages" my talk might lead physicians to make, I'll ask again - if Canada's Food Guide provided the evidence-based messages they purport, how exactly did they feel I would be able to convince physicians otherwise?

Want to know what I think is the most remarkable part about all of this? I would be willing to wager a year's salary that the folks who signed that letter, the folks who complained about my "messages", are also folks who counsel their patients to minimize red meat, to minimize refined grains and to control energy intake - the very same messages I lectured were substantiated by medical evidence and glaringly absent from our national Food Guide.

Wouldn't it be great if they would turn their clearly considerable energy and desire to advocate for nutrition towards the creation of a Food Guide that reflected our certainly shared nutritional concerns, rather than attack me, someone with no vested interest in the recommendations other than that of a physician concerned with nutrition, for attempting to advocate for Canadians by teaching physicians about the Guide's shortcomings?

More on this tomorrow.

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