The US medical industry has a motivation problem when it comes to the central role of food in health. Kale does not emit a flock of attractive sales people to detail doctor offices. Organics lack the financial clout to fund JAMA. Brown rice gets failure grades on inviting doctors to conferences in tropical zones. Fruits and vegetables seem to have missed out entirely on the whole marketing side of competing with the pharma-device predilections of the $3.3-trillion medical industry.
The dismal failure of medical schools and most other health professional education relative to nutrition is a returning theme over the past century. When I first began work in the integrative field in 1983 on behalf of an institution training naturopathic doctors (who distinguish themselves among physicians by their focus in food and nutrition), we came across an early 1900s government study bemoaning the lack of such training in medical schools.
The problem continues to today. When one considers the importance of food in the etiology of much that ails us, it is hard to not want to take a lesson from the China’s Cultural Revolution and send USA’s medical industry leadership out to the countryside for re-education – planting nutritional foods, hopefully, with organic methods.
A recent commentary in JACM from Harvard’s David Eisenberg, MD and some related research abstracts offer evidence that an initiative he founded over a decade ago is beginning to get them out to the countryside, with food as the incentive. Only instead of the Cultural Revolution’s compulsory sentencing, Eisenberg lures. The researcher who is famous for his survey on consumer use of “unconventional medicine” that kicked off the integrative era baits his hook with “culinary arts” and a scent of “delicious.”
The actual countryside also plays into his strategy to advance interest in nutrition in health via an appeal to the senses. The wine country of Napa Valley magnetizes participants to his annual Healthy Kitchens, Healthy Lives retreats where he partners with the Culinary Institute of America. His response to acute awareness of medicine’s failures relative to nutrition is to have drawn hundreds of healthcare thought leaders to his kitchen and table. He starts at a chakra that will engage them.
In the commentary, Eisenberg and his growing Teaching Kitchen Collaborative (TKC) introduce another strategic element in his campaign. While an N-of-1 experience in the vineyard ambience might open one to the value of elevating nutrition’s role in health, when it comes to institutional decision makers, science helps close the deal. Eisenberg, long known for trumpeting the importance of evidence for the integrative medicine movement, introduced 51 published abstracts from the TKC’s first “Research Day.” The inaugural biennial event was held prior to the February 2018 Napa retreat.
The appeal here is to the academic superego, embellishing the foodie’s id.
The TKC Research Day abstracts range across a broad set of outcomes and translational challenges. The first offers a brief portrait of the teaching kitchen movement, via results of a survey of leaders of 32 programs. Another examines the spread of such facilities in the Veteran’s Health Administration. A Northwell Hospital team reports procurement issues for healthy foods. The farm connection is highlighted via a University of Cincinnati team. Data are offered in another project on medical student perceptions on a wellness retreat. A Northwestern Osher Center for Integrative Medicine team’s submission was “Cooking up Health: Assessing the Efficacy of a Culinary Medicine Elective in Medical Students.”
A scan of the titles of the cornucopia of offerings reveal a data-driven, pleasureful, whole system, experiential, full-court press effort to put food, nutrition and lifestyle front and center in transitioning our medical industry toward what might appropriately be called a healthcare system.
Additional evidence of the success of the dozen-year-old initiative is found in the make-up of TKC membership. Anchored by the TKC’s twin bases – the Harvard TH Chan School of Public Health and the Culinary Institute of America – the growing list includes Stanford, Dartmouth, Kaiser, Princeton, nearly a dozen public academic health centers, plus funding members such as Google and additional philanthropic partners.
Eisenberg, a lifelong foodie, was recently featured on the PBS News Hour. He didn’t mince words in decrying the problem TKC is, in its way, addressing: “Today, most medical schools in the United States teach less than 25 hours of nutrition over four years. The fact that less than 20 percent of medical schools have a single required course in nutrition, it’s a scandal. It’s outrageous. It’s obscene.”
This strategy recalls an “Aha!” moment integrative medicine leader Tracy Gaudet, MD shares in her own strategy, as director of the VA Office of Patient-Centered Care and Cultural Transformation, for implanting a “whole health” approach in the Veteran’s Health Administration. Advancing health, Gaudet realized, “comes down to meaning and purpose – to discovering and rediscovering [each veteran’s] personal sense of mission and what they want to live for.”
Hopefully the pleasure of food preparation, of experiencing community in a kitchen, of planting a living center for farm-to-foods inside of academic centers and teaching hospitals and community centers and corporations of various stripes will begin to create awareness and a commitment that scores of government reports have failed to engender.
Still, one wonders what headway even the engagement of the belly chakra can make for nutrition in institutional healthcare given the base financial incentives driving doctors and members of hospital C-suites toward the sweet talk and into the arms of pharma and device partners. When doctors, medical delivery organizations and insurers can save and make money by keeping people well — some thoughtful models are emerging (examples here and here) — then TKC and its research, its models and members, will become highly valued assets and engines for an actual healthcare system.
Disclosure note: We were pleased to publish Eisenberg’s commentary and the abstracts at JACM-Paradigm, Practice and Policy Advancing Integrative Health (The Journal of Alternative and Complementary Medicine) where I serve as editor-in-chief.