How Can the Climate in Medical Education Be Changed?

HOW CAN THE CLIMATE IN MEDICAL EDUCATION BE CHANGED? ROGER J. WILLIAMS* A recent article in the Reader's Digest outlined "Nine Steps to a Longer Life," based on the "expert advice" obtained from interviews with ten physicians at the Mayo Clinic. There was essentially nothing wrong with the article except that watching the quality ofone's nutrition, probably the most important thing a layman can do to promote longevity, was not mentioned. If medical men were experts in this area and had discovered that the quality ofnutrition is unimportant to longevity, it would be appropriate for them to say or imply that this is so; but it is notorious that medical education does not stress nutrition and that physicians are not nutritional experts. From different prominent physicians, most ofwhom are internationally known and none ofwhom is a "nutrition enthusiast," the following comments have been received: "The fact that nutrition is no longer taught adequately in medical schools is certainly true in most cases"; "The subject of nutrition receives little more than passing attention in medical schools"; "There is very little coverage of nutrition in medical schools"; "I can recall my medical education in which nutritional education was a very small part"; "The teaching ofnutrition has been neglected in medical schools"; "When I was in medical school, they taught us nothing about nutrition"; "Most assuredly our individual medical educations have been neglected with respect to nutrition"; "There is no teaching that I know of in this important field [in medical schools]." It is conceivable that among the ten physicians interviewed at the Mayo Clinic none was competent to give expert nutritional advice to those who want to live longer. Ifthis is the case, it was probably best not to mention * Clayton Foundation Biochemical Institute, University ofTexas, Austin, Texas 78712. 608 RogerJ. Williams · Nutrition in Medical Education Perspectives in Biology and Medicine · Summer 1971 the matter. But this does not alter the fact that there should be thousands ofnutritional experts in the medical profession. In a book to be published shortly entitled Nutrition against Disease: Environmental Prevention [i], I develop the thesis that the most important cause ofnoninfective disease is the poor internal environment ofour cells and tissues. This environment is produced from the air we breathe, the water we drink, and the food we eat, and it is clear that these factors are directly related to longevity. The nutrients we furnish these tissues to promote their health includes a series ofamino acids, about fifteen minerals, and about fifteen vitamins. The names ofsome ofthese items are unfamiliar to many physicians. That the quality ofthis nutritional environment can vary through wide limits should be obvious, since all kinds of deficiencies and imbalances can exist. The environment can be poor, fair, good, or excellent on the basis of reasonable criteria. Throughout the biological world, cells commonly live in environments which are far from optimal; they respond when the nutritional environment is improved. Human cells are no exception. My thesis is that the cells in our bodies limp along, often chronically, because the nutritional environment we furnish them is inadequate. Just as the yield ofcorn from a plot ofland can vary from a few nubbins up to io, 20, 60, 120, or more bushels per acre, depending on the nutritional environment, so the functioning of our body cells and tissues can vary from merely remaining alive to maximum performance, depending on the quality of the environment. Many individuals customarily provide their bodies an internal environment of the "ten bushels to the acre" variety. Because of inadequate training in nutrition, medical men are prone to say, "A well-balanced varied diet contains all of the vitamins [minerals and other nutrients] normally needed for health." How can they know that this is so? Another way ofsaying the same thing is, "A normal healthy individual needs no more vitamins (and minerals and amino acids) than he gets from a good, usual diet." These statements are almost meaningless. How many "normal healthy individuals" are there, and how many consume a "well-balanced, varied diet"? What is meant by a "well-balanced diet"? Ifwe define it as a diet which will promote health, then the wellbalanced diet is all...