What should we eat?

Answers to this simple question often appeal to science. Nutrition science, we are told, can tell us what we should or shouldn’t eat if we want to be healthy, fit and prevent disease. But are these appeals to nutrition science legitimate? We think in many cases the answer is “no”.

Some of the most egregious offenders misusing nutritional science are listicles – “10 Unbelievable Diet Rules Backed By Science,” the “14 Things You Should Never Eat,” or “10 Foods Science Says Are Healthier For Your Hair.” But even more legitimate sources of advice can be prone to misuse science and are guilty of what we label nutritional scientism.

In a recent article in the Journal of Bioethical Inquiry we critiqued three types of nutritional scientism: (1) the oversimplification of complex science (including suggesting causation from probabilistic conclusions from observational studies) to increase the persuasiveness of dietary guidance, (2) superficial and honorific references to science in order to justify cultural or ideological views about food and health, and (3) the presumption that nutritional value is the primary value of food. We discuss the first and third of these here.

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Widespread concern over diet-related chronic diseases partly explains the appeal of nutritional scientism. We want to give and receive clear dietary guidance. We want to know how diets affect our health and use that knowledge to control and prevent disease. However, the relationship among food, health and chronic disease is complex.

Diet and Causality

While scientific knowledge about the relationship between diet and chronic disease is unclear, scientific knowledge of nutrition has led to improved health dramatically with respect to nutritional deficiency diseases. For example, the relationship between dietary vitamin C and scurvy is causatively simple.  Vitamin C is an essential nutrient for all humans. If someone eats a diet that does not contain sufficient amount of Vitamin C for long enough, they will contract the deficiency disease. For nutrient deficiency, cause has a direct, non-probabilistic meaning, in the sense that if I hit my hand with a hammer, I will cause it to hurt every time.

The success of nutritional science in addressing problems of nutrient-deficiency disease might be so impressive that the aura of scientific success is extended to nutrition and chronic diseases, which are far more complex phenomena.

Chronic diseases are considered to be multifactorial.  Unlike nutrient-deficiency diseases, the meaning of causation for chronic disease is harder to understand, and thus establishment of causation is a far trickier problem.  Factors are understood in the mathematical sense, not as causes but as elements in a mathematical model.  Not everyone for whom factors are in place will get the disease, and not everyone for whom none of the factors apply can be assured of not getting the disease.  The evidence is fundamentally probabilistic, concerned with differential risk (population-level incidence) associated with the factors in the model.

Oversimplified dietary guidance may suggest that the relationship between the food and health status is more simply deterministic, an oversimplification of a highly complex situation.  Black and white dietary advice, for example to “never eat sugar” or “always avoid a particular food,” is a gross oversimplification. Invoking the science to justify oversimplified recommendations is our first form of scientism.  There are times when oversimplified recommendations are couched as a moral responsibility of the individual.

Food and diet, more than nutritional value

A second problem with nutritional scientism is that it reduces the value of food to the way it contributes to a biomedical model of health. This excludes of other values, such as pleasure, identity or culture. If we think of health more broadly, as the World Health Organization does, nutritional scientism is exposed as having a limited  understanding of the relationship between food and health.  In contrast to a focus on the biomedical model, the WHO defines health as a ‘state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity’. If health is broadly considered as social wellbeing, rather than narrowly defined as biomedical, it can be argued that an inordinate reduction of food to nutritional value is likely to be undesirable as it leads to the exclusion of values that are significant for identity, belonging, and wellbeing.

Food is central to bodily survival and nutritional health, but it is also essential for human flourishing through communal relations, religious rites, personal milestones, cultural festivals and a wide variety of everyday interactions that contribute to human well-being. When scientific understandings of food, diet, and cuisine become the dominant or exclusive mode of understanding of food and diet, the label of nutritional scientism is again warranted.

Nutrition science properly contributes to answering the question—“What should we eat?”—but its contribution should be placed in the larger context of a plurality of values that include culture, ethics, pleasure, and well-being.

By Christopher Mayes and Donald Thompson

EVENT: Symposium on Academic Publishing and the Futures of Research

Image taken from page 213 of 'Queen Mab. A novel'
The Centre for Values, Ethics and the Law in Medicine (VELiM) is hosting an event on the academic publishing industry and the commercialization of knowledge production.

In recent years there has been a lot of self-reflection about the effects of neoliberalism on the university and the practices of teaching and research. This symposium will focus on academic publishing and the impacts of paywalls on academic practices, but also democratic access to knowledge required for policy-making and informed public debate.

Speaking to The Guardian, Dr Claire Hooker outlined some of the concerns associated with current academic publishing practice, saying:

There are people out there who are worried about the effects of medicines, or who want to know more about the evidence informing the health policies that affect them, but they can’t find the answers because they hit a paywall.

Professor Paul Komesaroff (Monash), who will also be part of the symposium, argues that more open and democratic models of publishing are needed. According to Komesaroff, scholars are looking for these models. However, it appears that the current institutional arrangements and intensives make it difficult to imagine alternatives.

The symposium looks to explores some of these alternatives. For more information see the below.

Reclaiming the Knowledge Commons
The Ethics of Academic Publishing and the Futures of Research

Type: Seminar
Date: Wednesday 26 August 2015
Time: 9.00 AM to 4.00 PM
Venue: State Library, Mitchell Wing
Cost: Free
Click here to book

Speakers include: Emeritus Professor Stephen Leeder, Professor Paul Komesaroff, Associate Professor Andrew Bonnell, Dr John Byron, JoAnne Sparks, Dr Virginia Barbour, Rosalia Garcia (SAGE), and Professor Christopher Wright.
Chair: Dr Claire Hooker

The symposium will comprise four sessions:

  • 9:00-10:30 Session 1: Corporatization and the commercialization of knowledge
  • 11:00-12:00 Session 2: Democratizing knowledge or selling the farm? The emergence and challenges of ‘Open Access’
  • 12:00-1:00 Session 3:  Dissolving barriers – and boundaries: Scholars and the possibilities of the new digital knowledge commons
  • 2:00-4:00 Session 4: Taking up the challenge of ethical academic publication

Catering is provided

For more information please contact;
Centre for Values, Ethics and the Law in Medicine
T +61 410 161841 | E velim.event@sydney.edu.au

Profiting from asylum-seeker detention: Time to divest

Christopher Mayes and Ian Kerridge

On the 25th May 2015 the Royal Australasian College of Physicians (RACP) called on the Australian Government to end mandatory detention and release asylum seekers from offshore processing centres. President of the RACP, Laureate Professor Nicholas Talley outlined the College’s Refugee and Asylum Seeker Health Position Statement, which calls for:

  • more rigorous health assessments for asylum seekers on arrival;
  • better access to healthcare for asylum seekers and refugees in the community;
  • increased support services for refugees; and
  • an immediate end to mandatory detention and the release of all asylum seekers into the Australian community.

Physicians and health care professionals have witnessed first-hand the trauma of asylum-seekers in detention and have repeatedly made public the insufficient medical care available in these facilities. Professor Talley states that “Our Fellows have been inside the detention facilities. We have treated refugees and asylum seekers during their detention and after their release into the community…These people are not numbers, they are our patients.”

A time to boycott?

In September 2014 the Medical Journal of Australia published an article questioning whether the asylum-seeker policy and conditions were so bad that health professionals should boycott working in them. This article was widely reported in the mainstream media and raised awareness of the ethical and medical compromises forced upon health professionals.

Accommodation in the Nauru offshore processing facility.

Accommodation in the Nauru offshore processing facility. Source: Wikimedia Commons, licensed under the Creative Commons Attribution 2.0 Generic

As others have argued, however, while a targeted boycott campaign should be considered, refusing to provide medical care to asylum seekers would only harm the already harmed. health professionals have an ethical obligation to their patients. As Professor Talley notes “we are duty bound to speak on behalf of our patients – especially since their human rights are increasingly seen as optional.” And it may be only when health professionals see for themselves the conditions in which asylum seekers are kept, and the standards of health care they receive, that they will be motivated to speak out against injustice and advocate for better and more humane care.

Time to divest

Compounding the ethical and medical harms resulting from mandatory detention is the fact that the Australian Government spends $3.3 billion a year to maintain this policy. This money is used to pay contractors and publicly listed companies to run and operate detention facilities.

Of these, the greatest beneficiary is Transfield Services. Transfield Services’s share price spiked after it was awarded a new contract to run the detention facilities on Manus Islands. Although the share price soon declined, mandatory detention makes companies like Transfield Services appear like a good investment option.

The superannuation fund, HESTA, invests in Transfield Services. At present HESTA is a significant shareholder in Transfield Services.[1] Considering that HESTA is the superannuation for the health and community services industry it is troubling that they are using the retirement savings of physicians, nurses, allied health practitioners and social workers to invest in a company that profits from the mandatory detention of asylum seekers.

Fifteen of Australia’s peak health organisations have publicly condemned the Australian Government’s asylum-seeker policy. Yet, many of the members of these organizations may unwittingly be financially entangled with the very system they condemn. Rather than calling for health professionals to boycott working in detention centres, there is a campaign for health professionals with their super with HESTA to call on HESTA to divest from Transfield Services.

A multi-pronged strategy is needed to resist and disrupt the detention industry. Political and ethical arguments are essential to convince politicians and the public that mandatory detention should be abandoned. However, it is also important to recognize that detention is a business – that profits and financial gains are being made through the asylum seeker polices and that we may be unknowingly supporting and profiting from these businesses and policies ourselves.

It is time to divest.

[1] As of 27 February 2015, HESTA holds just under 5% of shares in Transfield Services with over 23.5 million shares. http://asxcomnewspdfs.fairfaxmedia.com.au/2015/03/02/01604569-575220267.pdf

Don’t be surprised by Abbott’s comments about ‘lifestyle choices’

Christopher Mayes, University of Sydney and Jenny Kaldor, University of Sydney

Prime Minister Tony Abbott’s claim this week that people living in remote communities were making a “lifestyle choice” that taxpayers shouldn’t be obliged to fund was not just the result of an unguarded moment. Rather, the phrase reveals an underlying view that social circumstances are the responsibility of individuals, rather than societies.

Commentators as well as Abbott’s top advisers on Indigenous affairs were quick to criticise the characterisation. Others suggested it was just another prime ministerial gaffe that shouldn’t distract us from the real issues.

Abbott is infamous for his gaffes and “dad jokes”, but this was not one of those moments. A day after he made the remark, the prime minister defended his use of the phrase on the Alan Jones Show.

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Big Food with a regional flavour: how Australia’s food lobby works

Christopher Mayes, University of Sydney and Jenny Kaldor, University of Sydney

Criticism of the food industry has itself become a niche industry. But the tendency to embrace a US-centric conception of how the industry works risks masking local variants and inhibiting a targeted response in other countries.

Since the 2001 book Fast Food Nation, a spate of books, films and documentaries on the American food industry have helped to shape the popular idea of “Big Food”.

The food industry is depicted as a highly organised set of multinational food and beverage lobbyists peddling the global diet of sugary drinks and highly processed, energy-dense salty foods – akin to tobacco industry lobbyist Nick Naylor in the 2005 film Thank You For Smoking.

But although it is highly globalised, the food industry is far from homogeneous. Big Food in Australia is not the same as the industry in the United States, where much of the popular media has come from.

Still, that doesn’t mean Australian food and beverage lobbying is benign.

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