The Challenge

It would be useful if our society externally reinforced healthy habits rather than destructive ones.

Yes it would, and I have some ideas along those lines.

Yes, I'll bet you do. Another ten-point program?

I thought you'd never ask. Indeed, I have a ten-point Kurzweil Challenge to Society.

Okay, let's hear it.

The Medical Community

The first challenge is to the medical community. More than any other constituency in society, physicians need to take a leadership role in these issues. People look to their doctors for guidance. There are many doctors who have indeed provided substantial leadership in changing the views of society on the role of nutrition in health and whose pioneering research has provided the rich mosaic of scientific evidence we have today. On the other hand, most doctors in their day to-day practice do not provide this perspective to their patients. Even those patients who are in great need of this knowledge-persons with heart disease, angina pain, advanced atherosclerosis, hypertension, type II diabetes, cancer-generally receive a very watered-down set of recommendations. As I discussed in part I of this book, the public health recommendations are precompromised at 30 percent calories from fat rather than the optimal level of 10 percent. I have had numerous discussions with physicians who acknowledge that 10 percent calories from fat is the optimal level, but then they go onto say something along the lines of, "My patients would never accept..." So the optimal health recommendations are severely compromised before the patient ever hears them. And then the patient is told that if he or she follows these (watered down) recommendations, it will be helpful, but only partially so, because the genetic impact is so much greater than the impact of life-style. And of course, if one follows these highly compromised public-health recommendations on the fat and cholesterol content of food, then it is true that one had better have benevolent genes. The fact that almost everyone (with only rare exceptions) can reduce their risk of contracting these diseases by 90 percent or more is just not revealed. Indeed, most doctors are not aware of this.

The reason for this situation is that most doctors know very little about nutrition. Very little of substance is taught in medical school about this vital subject, and the vital link between what we eat and these diseases of affluence is generally not appreciated or understood.

My recommendations to the medical community are to take these nutritional issues seriously, to learn about them, and then not to pre-compromise this knowledge before disseminating it to your patients. People are quite capable of compromising on their own, if that is their proclivity.

It seems that medical schools should give this issue a higher priority.

Medical Schools

That brings me to point two, which concerns our medical schools. A survey conducted in 1984 by the Joint Liaison Committee on Medical Education of the American Medical Association and the Association of American Medical Colleges reported that only 27 percent of American medical schools offered even a single separate course in nutrition. A 1985 survey by the Committee on Nutrition in Medical Education of the Food and Nutrition Board of the National Research Council indicated that the majority of medical schools teach less than twenty hours of material related to nutrition during the four years of medical education. This results not only in the widespread ignorance of this subject that we see in the medical profession, but in the underlying message that nutrition is but an incidental health issue. This is changing in some quarters, but the surface has only been scratched.

My challenge to medical schools is to teach an orientation to medicine that emphasizes prevention through life-style alteration, where the doctor is a partner in health maintenance, not just the fix-it person that quickly repairs the "machine" when it breaks down. This would include providing an extensive and thorough background in the nutritional roots of disease and disease prevention.

The Health Insurance Industry

My third challenge is to the health insurance industry, which includes several major government programs such as Medicare and Medicaid. Having explored with numerous doctors, as well as with industry leaders and policymakers, the issue of developing a consensus on preventive medicine through nutritional and life-style counseling, I have come to realize that our entire system of third-party reimbursement for medical care makes it self-defeating for physicians to attempt to take this approach to health care seriously. It is difficult for a physician to recommend a nutritional approach to treating a disease without having some means of providing that education to his patients efficiently. Yet third-party payers will generally not provide reimbursement for nutritional counseling or education. When you consider that a change in diet is an ideal form of treatment for a type II diabetic or someone suffering from advanced atherosclerosis, this is a remarkable state of affairs, yet is almost universally the case. Given that the adage "an ounce of prevention is worth a pound of cure" certainly applies in this instance, it would make economic sense to encourage this approach to health maintenance. Indeed, the health insurance industry would find it in its economic interest to aggressively promote illness prevention through life-style alteration.

It would seem that society needs to understand what is already known about nutrition to a much greater degree.

Nutritionists

Yes, and that brings me to my fourth challenge, which is to the nutritionists. In general, there is greater awareness of these issues among this group than in the medical community.

That is hardly surprising.

One would expect nutritionists to have a greater interest in and knowledge of nutrition. But even here, there is the same issue of a quick willingness to precompromise the message. Of course, many nutritionists just pass on the public-health recommendations without a thought as to where they come from or whether or not they are truly optimal. But I know nutritionists who do understand these issues and who, themselves, follow a diet of 10 percent calories from fat yet have so little confidence in the ability of their clients to accept an optimal position on these matters that they do not share this perspective outside their profession. My challenge to this group is to provide the leadership on nutritional issues that is rightfully yours and, again, to not precompromise the truth.

Most people have little contact with nutritionists.

The Food Industry

That says something in and of itself about our society's priorities. Most of the public's education on nutritional issues comes from food advertisements, which brings me to my fifth challenge-to the food industry. On the positive side, food advertisements do deserve credit for popularizing and encouraging the public's interest in reducing fat, cholesterol, and sodium in the diet. On the other hand, many of the ads are quite misleading. For example, consider all of the foods that loudly proclaim that they are "cholesterol free," yet are high in fat, which as we have discussed is the most important factor in determining blood cholesterol levels. We see ads promoting margarine as a health food, despite the fact that it is 100 percent fat, most of which is polyunsaturated, which damages health in a variety of ways.

My challenge to the food industry is twofold. First, continue the process of developing low-fat, low-cholesterol, low-sodium foods that appeal to the American palate. Second is to avoid misleading health claims that only perpetuate common misconceptions.

That's easy for you to say, but it seems to me unavoidable that advertisers are going to put the best possible face on their products. If there is even some partial health benefit, they will tout it, and if there is a health danger, you can hardly expect advertisers to go out of their way to point that out.

The Media

Good point, which brings me to my sixth challenge-to perhaps the most influential group of all, and in many ways the sector of society in the best position to educate the American people: the media. On the program side, the news media have the opportunity to present these issues in a powerful way that is convincing and informative. The media, more than government or even the educational sector, have the ability to set the agenda of change and to focus attention on dramatic problems. One can certainly imagine some powerful documentaries on the specter of the American people eating themselves to death. On the advertising side, there is, again, a highly leveraged opportunity for influence, constructive or otherwise. Madison Avenue has mastered the means, not only to convey knowledge, but to effect deeply rooted longings and fears.

But in term of advertising, the media promotes what it is paid to promote.

For starters, there is public-service advertising, and while there are many worthwhile messages promoted in this way, the message that we can save a million lives a year through nutrition and other lifestyle factors has a deplorably low priority. I also feel that both the media, itself, and the advertising agencies that create advertisements could take a stand against some of the more egregious examples of misleading advertising.

Such as?

The most obvious example is cigarette advertising, which links the act of smoking to virility, social acceptance, good times, an almost innocent form of pleasure. But smoking poisons virtually every system in the body, and there is nothing virile, ingenuous, or fun about the health impact, short or long term.

But my primary challenge to the media is to deliver the message of the overwhelming impact of life-style on health and well-being in a way that is effective. It is difficult to deliver a message in a way that truly gets through. It is not a matter of people receiving the message and then rejecting it. It is more a matter of it simply bouncing off most people. We are so used to being bombarded with many hundreds of messages every day, that people do not even bother to evaluate most of them. But the media has the techniques and the power to change American attitudes in a fundamental way if they put their collective minds to the task.

Isn't that the purpose of this book?

Yes, and a book is part of the media. But it will take more than one book to change society.

A book can be very influential.

We shall see.

What is your seventh challenge?

Government

Challenge seven is directed at government, which also has enormous capacity to provide leadership on vital issues of health. Look at the government-led program against smoking.

As you point out, 50 million Americans still smoke.

True, but more than 100 million American adults do not smoke, which is a far better ratio than in Europe or Japan. So government leadership can make a difference.

The public enthusiasm for physical fitness started with President Kennedy's call for Americans to shape up, a prime example of presidential leadership which required no legislation. The government can also improve food labeling and encourage research to further document the benefits of a healthy diet and life-style. Most of all, the government can play the kind of leadership role on the issue of diet that it has in other areas of substance abuse.

Doesn't there need to be a public consensus first?

In a democracy the priorities of government cannot stray too far from public attitudes. On the other hand, responsible officials from the president to the surgeon general, as well as authoritative government bodies with their own influence and reputation, such as the National Institutes of Health, can help shape that consensus.

As one effective approach, I would advocate health-risk warnings on foods that are high in fat and/or cholesterol.

You mean the kind of warnings we now have on cigarettes, but for ice cream, for example?

Exactly, ice cream should lose its innocence.

Schools

Speaking of ice cream, challenge eight is directed at our schools. We should start with school lunches, which are prime examples of poor nutrition. A recent study estimated American school lunches at about 40 percent calories from fat. We do not necessarily need to go down to 10 percent calories from fat, but could still teach good nutrition by example through a more healthful lunch program.

Schools should also teach nutrition, which is, after all, a vital subject for health and happiness. If nutrition is discussed at all in today's schools, it is usually a simpleminded and misleading rendition of the four food groups.

Children are sometimes difficult to influence.

Parents

Yes and no. Children are also very impressionable and soak up their culture almost effortlessly. Perhaps of the greatest influence on children are their parents, to whom I address my ninth challenge. Education on nutrition, which is a somewhat personal and intimate aspect of life-style, is often the province of the home. Parents need to impress on their children the power and importance of what they put in their bodies. Of course, the best way to teach a subject like this is to set a good example.

And the last challenge?

Everyone

My tenth challenge is directed at everyone. As I mentioned before, the medical community is a service-providing institution that in many ways reflects the priorities of its constituency. While our medical delivery system does not constitute a perfect market, it is nonetheless difficult for doctors, hospitals, and other medical institutions to provide an orientation to health care at variance with what the public is demanding. And if people demand quick and easy solutions that do not require us to reflect on our own contribution to our health and well-being, then that is what the medical system will try to provide. The reality is that, while our medical technology can be brilliant in acute situations, true healthfulness can only be achieved and sustained through a healthful life-style.

So take the Kurzweil Challenge.

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