Tuesday, 29 October 2013

A DOCTOR WRITES

Butter, margarine, years of research...
And the future of Conductive Education

In Saturday's Times, nutritionist John Briffa wrote –

Most of us treat butter as a guilty pleasure because we are warned that it raises our risk of heart disease via an elevating effect on cholesterol. Butter has been damned by official health bodies , so we often have less tasty, lower-fat spreads instead.

This week, however, and article in the British Medical Journal went against the view. Dr Aseem Malhotra, the cardiology registrar at at Croydon University Hospital, London, said that the 'mantra that saturated fat must be removed to reduce the risk of cardiovascular disease has dominated dietary advice and guidelines for almost four decades.' He argued that evidence shows that butter and unprocessed fats may actually be good for you, lowering your blood pressure and protecting your heart. It's time, he said, to 'bust the myth if the role of saturated fat in heart disease'.

The article in the Times followed up with a page of supporting information and argument drawing upon the scientific research literature, fetching up in the confusing world of sterols –

...several studies... show sterols have the ability to damage tissue and induce worse health outcomes in animals.

While the British Heart Foundation and many doctors support the use of sterols, the National Institute of Health Excellence (NICE) explicitly advises against their routine use..

A Siren song. The author concluded with just the naughty-but-nice advice that I wanted to read –

I am a practising doctor and the author of several books on nutrition, and in more that 20 years I have not bought a single tub of margarine. Nor have I consciously limited butter in my diet. There's little doubt in my mind that butter is better, and not just in terms of how it tastes. To my mind it need nor be a guilty pleasure at all, but just a pleasure.

But should this guide my action?

More research has been needed...

...and more and more has been provided. Huge sums have been spent on it and careers built, industries have been created, academic and commercial  and lots of jobs with them. But what will I know when my present tub of marge runs out (not long now) and I next stand before the cabinet in the supermarket?

I do not have the education to judge the knowledge that research has generated on this matter, nor the money to access it if I did, and I have a sneaking suspicion that this largely nomothetic information would still not help me understand what would be better of worse for little ideographic me during the time that I should be getting through my next tub of spread. What am I to think, how am I to decide. After all, this could be life or death.

'Conductive Education needs research evidence' – I hear this again and again, and again. I go along with this mantra (though CE perhaps needs much else first) but in a qualified way. But what kind of research, what kind of evidence, for whose benefit? Where do we want 'research' to take us, what do we want actually to know, to help our decision-making, be this individual, corporate or political? What can we know?

Where is the informed a priori discussion to light and guide CE's Gadarine rush to 'research'?

References

Briffa, J. (2013) Butter and your heart: the facts, The Times, 26 October

Malhotra, A. (2013) Saturated fat is not the major issue, British Medical Journal, 347, f. 6340



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