The headliner for the September 27, 2019 Dr. Rogers Prize Colloquium was Alessio Fasano, MD the Harvard professor and celiac disease researcher making the global rounds as a microbiome expert. Fasano broke ranks with conventional practice when he began to assert the link between dysbiotic and disordered gut bacteria and the shocking rise of autism. He shared the stage at the Vancouver, BC event with two Canadians: fecal transplant researcher Jeremy Burton, BSc, MSc, PhD, and this year’s $250,000 Dr. Rogers Prize winner, the pioneering micro nutrient and mental health researcher Bonnie Kaplan, PhD. Perhaps because of the content, when it came to audience questions the spirit pervading the room was that of the 16-year-old Swedish climate activist Greta Thunberg. That very day outside the meeting place, Thunberg’s activism provoked a student-led march. The micro and macro met in parallel calls for disruptive change. “So the question is,” Kaplan asked, “where is our Greta Thunberg?”
Kaplan’s question came after audience impatience was provoked by deeply disquieting data. Fasano projected that autism is expected to hit one in 4 US male children in the next generation. He noted medicine’s “misses” as be guided the audience through the high-tech discoveries of intestinal permeability and the role of diet and lifestyle in the health of the microbiome. Reflecting on the trend-lines he summarized: “We made the mistakes,” he said, “we screwed this up.”
Kaplan reinforced the sour commentary. The present Canadian diet, she said, is one in which “48% of caloric intake is from the lowest level of nutrition – highly processed food.” This contribution guarantees problems for the collective Canadian microbiome. Turning to her specialty in mental health, Kaplan added that in the half century since 1960, the number of people diagnosed with mental illness has jumped from 3 in 10,000 to 2000 in 10,000. What’s worse, most conventional treatments in her view are not appropriate. There is no evidence, she said, for the claim that “taking psych medications is like insulin for diabetes – you have to take them for the rest of your life.” And yet that is what practitioners caught in the medical industrial web continue to promote.
My personal experience of the presentations was also one of mounting impatience. This had nothing to do with the quality of the presentations. They were uniformly leading edge from scientists pushing important boundaries. My impatience came from being reared into this field over 30 years ago by a naturopathic profession that taught me core values that are now seemingly “new” with the omics revolution: that health begins in the gut, that a fundamental diagnostic and learning tool is the 3-day diet-poop diary, that the mind and the body are connected, and that epidemiological evidence from around the world was already showing waves of damage from dissemination of the Standard American Diet and the lifestyle changes the SAD diet seems to inseminate. Yes, it is terrific to have confirmatory data. But where is the outrage and action? I started day-dreaming about the need for new specialties for physicians and other health care practitioners to bust our of their office confines as activists and community organizers.
Participant Badri Rickhi, MD, a prior Dr. Rogers Prize winner, brought the impatience into the room. Rickhi shared that when his pediatric medicine approach became more integrative and he began teaching different content that “I have not been able to speak to one student, or have one resident” at his base at the University of Calgary. Then he called the question that seemed to be hovering in the room: “We know what we are doing” – and by extension what needs to be done – “but how do we put it on the street?”
Armed as Fasano is with the devastating data, why so little outrage? His scientific brilliance is matched by a stereotypical Italian love of cooking, of good Mediterranean food. In response to Rickhi, he seemed to excuse inaction by alluding to the minimal awakening at Harvard and by extension the broader public health community: at Harvard’s TH Chan School of Public Health where he holds a nutrition professorship “they are only just now beginning to think of the quality and not just the quantity of nutrition.” Try pushing that river he seemed to suggest.
Burton was only slightly less tentative: “I’d like to think that people are going to start to think more holistically, wider about this – to think that it’s not just the gene, it’s the microbiome.” Fasano again distanced himself from a role of greater activism: “This is a political choice to make, not a scientific choice. This will not come from political leaders. It will only come from the grassroots.” Then he imagined a possible strategy in academia or politics – “it takes someone locking people in a room [to come up with solutions].” Then, after directly referencing Thunberg, he added: “It needs to be a grassroots movement, almost a revolution.”
Pushing the envelop of how he might, in his position, be more of an activist was clearly not something Fasano viewed as his business. I was reminded of the old joke – also stereotypical – that one of the 3 shortest books ever written is of Italian war heroes.
Burton was willing to consider that there might be a different kind of responsibility he might engage as a scientist: “I don’t know if its my role to have a political role. Perhaps it is.” The moderator, local public television media figure Stuart McNish seized the moment’s testiness to honor the Dr. Rogers Prize itself: “Isn’t that the value of the prize – it’s against the trend.” The award has routinely gone to pioneers of new ideas and practices in medicine and health.
“So the question is, where is our Greta Thunberg? We all are thinking about translation. But we can’t wait 264 years like the British government did to require citrus fruits on ships after we knew that the lack of fruits was the cause of scurvy. We need a 16 year old, or a group of 16 year olds to stand up and say, why aren’t we taught this!”
Greta’s key message, of course, is that responding dramatically and disruptively to business as usual is on us, on this present generation – on Fasano and Burton and Kaplan and McNish and those in the audience, on the supporters of the Dr. Rogers’ Prize as it is on you and me. In the expanding dialogue, audience members urged changing elementary school education. A researcher urged a much more rapid shift from scientific discovery through investing more in implementation research. As the sense of urgency’s lacing with doom filled the room, the speakers spoke of wanting to be more positive. Kaplan offered the evidence that she is being invited to speak in many places where there was no interest a few short years earlier. And there is of course the good sign that at TC Chan they are at least beginning to talk about quality of food.
I don’t think that these would pass the Greta test. As I reflected back on my 30 years since the naturopathic doctors shared their grounding in the health of the gut, and respect for the revelations of epidemiology data, Thunberg’s words at the UN seemed to speak as clearly for nutritional evidence as for climate science: “For more than 30 years the science has been crystal clear. How dare you continue to look away … The politics and solutions needed are still nowhere in sight.”
One of the favored quotes by which the insurgent holistic, integrative and naturopathic physicians of three decades ago bolstered their position was to present themselves as answers to what Thomas Edison envisioned when he urged that “the doctor of the future will give no medicine, but will instruct his patient in the care of the human frame, in diet and in the cause and prevention of disease.” A reasonable accounting of the evidence presented at the Colloquium – as elsewhere in medicine and global health these days – suggests that a more activist visioning is in order: The Doctor of the (Present and) Future will give no medicine, but will … What comes next, to meet these times?