Rationalization is a deeply ingrained defense mechanism that can cause terrible harm to people who are already suffering. When something bad happens to someone else, we are uncomfortable, thinking, truthfully, I could be next. It's much easier to identify something about that person that we can believe responsible, something they did that caused them to "deserve" their misfortune. That way we can tell ourselves that all we have to do is avoid that hot-button mistake and we can go on feeling safe from disaster. In other words, we naturally revert to victim blaming.
Cancer has always been the boogeyman of diseases, one against which we deploy every defense mechanism in our arsenal. For centuries it was implied, if not outright stated, that people got cancer because of some sin they had committed (institutionalized rationalization) and because of that, nobody admitted when they had it. One day one of your relatives just up and died and the uncles and in-laws whispered behind their hands about the cause.
We know better now. We understand that most of the time cancers start as a roll of the dice, a copymaking error that slips through the body's defenses, barely different from millions of other such mistakes that are caught and shut down before they enter our awareness. Yes, there are obvious chemicals out there in pollution and tobacco smoke that promote those mistakes, but the mistakes happen plenty without such prompts. People got tumors long before modern chemicals entered the environment, as illustrated in the image below, drawn in 1689.
Two views of Clara Jacobi, a Dutch woman who had a tumor removed from her neck in 1689. Available in the public domain in Wikimedia Commons
Yet that knowledge leaves us back in that scary territory where cancer could happen to anyone. People don't want to believe that. And so has commenced the most astonishing group confabulation of cancer causes that, when you step back and look at them, don't hold up to even the flimsiest of examinations. It's sugar! It's artificial sweeteners! It's cell phones! It's power lines, deodorant, hair dyes!
Fine, you might say, so long as the believers of these myths only change their own behavior in response to their need to believe that they are banishing the monster from under the bed. However, the folks prone to buying into these magic spells to ward off the emperor of all maladies are never content to keep their ideas to themselves. And their advice lands on fertile ground — people desperate to live will believe a lot.
So, what happens? They tell my head & neck and gastrointestinal patients, who need every last calorie they can scrape into their bodies, that they will only survive if they flush their alimentary canal like they are preparing for a colonoscopy, or live solely on kale pulverized in a blender, or in one memorable instance, try to survive on "magic" brownies. Ever hear of cannabinoid hyperemesis syndrome? Not a great way to kick off your 1.5-2 months of chemotherapy and radiation.
I could only imagine that Mark Lewis had experienced similar frustrations when he recently tweeted:
Yes, diet matters a lot in the health of your body. But a diet that consists purely of foods that don't taste good in no way ensures that the eater will not suffer from a cancer diagnosis. Nor will this penance (let's face it, that's what this is really about) make the cancer go away once it has started. How many times has someone sat in my clinic, almost yelling at me that they "did everything right: Ate all the right foods! Exercised while other people were watching TV! Cancer isn't possible!" But unfortunately somebody forgot to explain that to the cancer.
Then we have the entire massive industry of creeps who make money off of these fears by hawking nonsense advice and silly products laser-guided to hit these poor folks right in their mixed-up belief system. The American tradition of snake oil sales is alive and well.
I have a lot of good company in my disgust with this situation. Evidence that I'm not alone is a big help in getting through some hair-tearing conversations with scared patients overwhelmed with conflicting guidance. My favorite recently is a video by the inestimable Dr. Glaucomflecken in which a dietician is explaining to the shadowing medical student how to preserve sanity in this insane practice environment. In that office there is a punching bag sporting a picture of Mehmet Cengiz Öz. "Any time a patient tells us they're doing a juice cleanse or a detox or a fad diet, we come in here and punch Dr. Oz."
Inspired, I'm thinking of putting up a dart board with the cover of the latest edition of Goop.
How do you regain control of a situation in which diet advice given to your patient is harming their chances of being cured?
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Cite this: Kathryn E. Hitchcock. Please Keep Your Amateur Dietician Advice to Yourself - Medscape - Sep 30, 2021.