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The Ketogenic Diet and Evidence Snobs

Posted Jun 18 2008 7:09pm

If we can believe a movie based on a true story, the doctors consulted by the family with an epileptic son in…First Do No Harmknew about the ketogenic diet but (a) didn’t tell the parents about it, (b) didn’t take it seriously, and (c) thought that irreversible brain surgery should be donebeforetrying the diet, which was of course much safer. Moreover, these doctors had an authoritative book to back up these remarkably harmful and unfortunate attitudes. The doctors in…First, as far as I can tell, reflected (and still reflect) mainstream medical practice.

Certainly the doctors were evidence snobs — treating evidence not from a double-blind study as worthless.Whywere they evidence snobs? I suppose the universal tendency toward snobbery (we love feeling superior) is one reason but that may be only part of the explanation. In the 1990s, Phillip Price, a researcher at Lawrence Berkeley Labs, and one of his colleagues were awarded a grant from the Environmental Protection Agency (EPA) to study home radon levels nationwide. They planned to look at the distribution of radon levels and make recommendations for better guidelines. After their proposal was approved, some higher-ups at EPA took a look at it and realized that the proposed research would almost surely imply that the current EPA radon guidelines could be improved. To prevent such criticism, the grant was canceled. Price was told by an EPA administrator that this was the reason for the cancellation.

This has nothing to do with evidence snobbery. But I’m afraid it may have a lot to do with how the doctors in …First Do No Harmviewed the ketogenic diet. If the ketogenic diet worked, it called into question their past, present, and future practices — namely, (a) prescribing powerful drugs with terrible side effects and (b) performing damaging and irreversible brain surgery of uncertain benefit. If something as benign as the ketogentic diet worked some of the time, you’d want to try it before doing anything else. This hadn’t happened: The diethadn’tbeen tried first, it had been ignored. Rather than allow evidence of the diet’s value to be gathered, which would open them up to considerable criticism, the doctors did their best to keep the parents from trying it. Much like canceling the radon grant.

The ketogenic diet.

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