Look for a Good Answer or Tell the Truth?
Four principles describe a common framework for healthcare ethics: autonomy, nonmaleficence, beneficence, and justice. That first one, respect for autonomy, requires telling the truth. But unfortunately, it can come into conflict with beneficence – the moral obligation to do good for others. So which comes first? Tell the truth as you find it? Or look for an answer that serves a higher purpose?
We’re spending this week at a short course on causality in obesity research at the Indiana School of Public Health in Bloomington. It’s all about statistical and research methods for figuring out important questions about cause and effect in obesity. But, it turns out that this ethical issue (of truth and beneficence) lies at the heart of many questions that obesity researchers face. Is it more important to report facts and results objectively? Or should we advocate for concepts and policies that serve a higher purpose?
Important Issues of Causality
Opening this week, David Allison and Kevin Fontaine explained the importance of faithfully answering questions about causality in obesity. We’re in the fourth decade of an obesity pandemic. Despite assurances from some, definitive solutions are escaping us. In part, the problem is that we have only suppositions about what is causing the problem and what will work to solve it.
Such a truthful assessment does not work so well for selling policies to address the problem. So instead, we hear policymakers and advocates telling the public “we’ve got this figured out.”
In his introduction, Allison recommended Get Well Soon, an entertaining book about history’s worst plagues. It turns out that finding the truth of what was causing a plague was often essential to ending it. Suppositions aren’t good enough.
Bad Guys Causing Obesity
Right now we have only suppositions about what is causing an excess of obesity in the population. It’s probably a combination of many factors acting together. But it’s very appealing to single out bad guys. Through the 80s and 90s, fatty foods were prime suspects, so low-fat diets were the answer. McDonald’s served as a perfect villain, as depicted in Super Size Me.
Now the prime suspect is refined carbs and especially sugar. Coke has taken the role of chief villain from McDonald’s and soda taxes are the answer. “It’s a no-brainer,” say some public health advocates. They point to data about soda consumption – not health outcomes – to prove their point. Perhaps, these taxes will eventually prove to have an effect on health. Or maybe not. We await real evidence.
We Need Truth Before Beneficence
To overcome obesity, we need to find the whole truth of what is causing it and what actually works to reverse it. Good intentions are only helpful when we’re armed with the truth. Curiosity and objectivity are helpful for finding it.
Click here for our presentation yesterday at this short course. You can find all of the presentations from the last edition of this short course here.
She and Eye, photograph © Robert Couse-Baker / flickr
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July 31, 2019
July 31, 2019 at 9:10 am, Mary-Jo said:
‘A combination of many factors acting together’ has been known since the 70’s when the idea of multifactorial ‘treatments’ being necessary were first proposed. Then, however, prevalence was low, so those of us who struggled were either blamed for our own problem or, even worse, ignored — by the medical profession, by society. Those with private means who were able to pay for their own multifactorial treatment probably fared better than those left to fend for themselves. As incidence and prevalence soared, not much more has changed since the 70’s re: treatments, attitudes about obesity, leaving people with obesity to fend for themselves. I feel much can be learned by tracking folks who were obese in the 70’s to ask them what they feel caused their obesity and what could have helped them successfully be treated and comparing that with folks more recently struggling with obesity and tracking any differences to what THEY feel has caused their obesity to perhaps point to most commonly mentioned factors in both groups. Certainly trying to point to any one factor, like fat or sugar consumption, and then trying to control it, is not helping.
August 07, 2019 at 7:27 am, David Brown said:
In my opinion, the experts are overlooking he obvious. The most pronounced changes in our modernized dietary are the increases in linoleic acid and arachidonic acid intake. Unfortunately, the scientists who control the narrative ignore the science that explains obesity and chronic inflammatory disease. Excerpt: “Even though the underlying biochemical mechanisms have been thoroughly studied for more than 30 years, neither the agricultural sector nor medical practitioners have shown much interest in making practical use of the abundant high-quality research data now available.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3031257/