Saturday, May 28, 2016
In other words: Green and Jones have refused to write a medical beach read. It's a courageous choice but one that will most likely limit sales. That's too bad, because the book is a model for how to communicate science to the public, an antidote to the breathless hype and simplistic headlines that too often dominate popular scientific discourse.
The medical beach read is a straightforward genre. Like its fictional counterpart, there are clear villains: grains, toxins, malevolent corporations, the mainstream medical establishment. There are heroes: good fats, natural foods, everyday people who refuse to be sheeple, maverick doctors who write books that go against the grain. The archetypal plot is uncomplicated: For too long we have neglected the dietary root cause of our suffering, and things have never been worse than they are today. Fortunately, there's always a happy ending, and it's usually as simple as eating (or not eating) certain foods.
Medical beach reads sell like crazy because they are easy, empowering page-turners. Each chapter promises secret scientific knowledge in terms that any person can understand. The knowledge is profound, conclusive, revolutionary, and extraordinary. There's invariably a map to the holy grail of effortless weight loss. And like advertisements, the books are written for you. ("If the thought of your brain suffering over a bowl of savory pasta or plate of sweet French toast seems far-fetched, brace yourself," warns Grain Brain.)
But science is not fiction, and medical beach reads are not harmless dramas. They encourage a view of scientific knowledge as propelled by sporadic revolutions rather than incremental advancement; great scientists as lone truthseekers rather than contributors to a communal endeavor. The drama is not a fantasy: It is real, it is religious, and readers are made to believe that they are confronting a clear choice between salvation and damnation.
Gluten Exposed avoids these pitfalls with the humility and honesty that ought to be standard in any discussion of contentious medical research. The book offers expert, up-to-date summaries of the scientific consensus (or lack thereof) on gluten, grains, the gut, the microbiome, and theories about how these come together in healthy and unhealthy people. What exactly is the truth about gluten? It turns out that with the exception of celiac sufferers, who can't ever eat it, we're just not sure—though it certainly isn't as bad as popular health gurus might have you believe. Every chapter emphasizes this complexity. The mechanism of irritable bowel syndrome is "poorly understood." There is "conflicting data" on the effects of a gluten-free diet. The relationship between autism and gluten-containing grains "must be studied further."
Wednesday, May 25, 2016
Seemingly overnight, treatment of men with early-stage prostate cancer has undergone a sea change. Five years ago, nearly all opted for surgery or radiation; now, nearly half are choosing no treatment at all.
The approach is called active surveillance. It means their cancers are left alone but regularly monitored to be sure they are not growing. Just 10 percent to 15 percent of early-stage prostate cancer patients were being treated by active surveillance several years ago. Now, national data from three independent sources consistently finds that 40 percent to 50 percent of them are making that choice.
In recent years, major research organizations have begun to recommend active surveillance, which for years had been promoted mostly by academic urologists in major medical centers, but not by urologists in private practice, who treat most men. In 2011, the National Institutes of Health held a consensus conference that concluded that it should be the preferred course for men with small and innocuous-looking tumors. Last year, the American Society of Clinical Oncology issued guidelines with the same advice.
The data includes a large new national registry established by the American Urological Association involving 15,000 men nearly all treated by urologists in private practice through 2015; a national registry of 45 mostly private urology practices; and a Michigan registry of mostly private urology practices. In addition, preliminary 2016 data from the urology association indicates that the numbers are growing, with even more than 50 percent of patients choosing active surveillance.