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Will head or heart prevail in making the big decision?

by
01 April 2016, at 1:00am

The Mercury Column, in which a guest columnist takes the temperature of the profession - and the world around.

EXCEPT FOR THE LUCKY ONES AMONG US, it’s not uncommon to find oneself reaching for a Hobnob around 11 o’clock in the morning – assuming that life allows you enough free time even to register that you’re feeling a tad peckish. 

Those lucky ones may have never, or may never in the future, know what it is to feel the pounds piling on but for the rest of us, the “one minute on the lips is a lifetime on the hips” message is all too resonant.

I mention this because, fortuitously, I was reaching for said Hobnob this morning while reading the paper on one of those rare days off when, with a myriad of tasks that need doing, the temptation of sitting down with a coffee instead seemed irresistible.

Yes, I know that tolerance of the very concept of irresistibility is what creates those excess pounds in the first place and I am testament to the fact that post-rationalisation is all-powerful.

In the process of reaching over for a teeny snack, I noticed an article that caught my attention for a number of reasons: for years, creators of fad diets have told us that munching protein rather than carbohydrates will leave a longer lasting feeling of satiety and now the Journal of the Academy of Nutrition and Dietetics has published a paper demonstrating this in a properly conducted study involving more than 500 subjects. So there, it must be true because it appears in print.

After some soul-searching, I had decided to eschew the opportunity to point out the pitfalls of evidence-based medicine that, for most individuals, relies on someone more experienced than ourselves to survey everything that appears in print on a given topic and to report back their take on the most important findings – but I appear, despite my denial, to have embarked on that subject. I apologise to all those who prefer the safety of collective wisdom and let’s say no more about it.

This article tells us what we already knew, that is that a steak eaten at breakfast will keep you feeling full longer than a bowl of breakfast cereal and I’ve siphoned off a delicious quotation which I offer up as recompense for the rejection of that crunchy Hobnob.

“Feeling fuller could help to reduce food intake, an important factor when dieting.” It’s good that one of the published researchers from Purdue, Indiana, has told us that because I was in danger of failing to make the connection for myself.

I take my hat off to the person who made millions of dollars by inventing a diet that revolves around only eating when one feels hungry. Of course it could only happen where the printed word is more meaningful than the over-the-fence recommendation that once passed for communication before we embarked on the digital age, but the reality is that we are now hard- wired simply to believe what we read and ignore our gut feeling. I should apologise for that too, I suppose.

However, there is a serious point here that bears some discussion.

Information v opinion

As we approach the impending referendum on Brexit et al, our decisions will all be made on the most cogent arguments that we receive, whether in print or on TV and radio, from people who may know more about it than we may feel we do ourselves.

The problem is that it becomes increasingly difficult to know where to turn for unbiased information rather than partisan opinion. If, as many of us feel, this is one of the most important issues for us to consider, leading up to our voting decision, surely it must be possible to find unbiased information to assist us in that process?

I, for one, find it difficult to know where to find that, particularly as the advent of 24-hour news broadcasting means that simple facts don’t fill enough air time but the interpretation of facts by those with opinions they wish to share does it far better.

Many of us are agog at what we see as an unfolding pantomime in the US electoral process and eternally thankful that our own political process appears to be more credible yet, already in the run-up to our Brexit decision, we see ministers of the Government divided in their opinions and justifying their position by the use of statements that cannot possibly be taken seriously on the basis that they do not, one imagines, have a crystal ball with which to foretell the future.

Yet, millions of us will need to go to the polls poorly equipped to make such an important and far-reaching decision with little more to sustain us than the televised views of people whose political ambitions are strategically opaque.

In our professional capacity, this profession has the bene t of science to back up its recommendations and, however much I might tug at a ragged seam of EBM to prevent myself from falling into a similar trap, there is no doubt that basing our views on the proven experience of others is by far the safer position than heeding the siren calls of those who might have a parallel agenda – and history is littered with the reputations of those who believed their own PR rather too much. 

The problem is that, as a species, we need to grow and adapt, to push at the edges and to learn more about the seemingly impossible. It’s far easier to create a persuasive campaign for leaving the past behind and to reach for the stars, whether politically, socially or scientifically, and the not-so- recent Scottish referendum proved that point convincingly.

Hearts and minds

If we react with our hearts, we can almost touch the future but if we listen to our heads, caution will always prevail unless the status quo is ultimately untenable. All too soon, we’ll know whether the UK is in or out of Europe and although we’ll have made that decision based on a paucity of proper, informed understanding of the issues, it will be fascinating to see whether, in the end, head or heart prevailed.

As you have read this far, please indulge me in one last comment on EBM. While our professional standing dictates that the scientific basis of EBM is the only ethical way in which to formulate recommendations, how do we ensure that we continue to reach for the stars in our understanding if we are always focused on looking backwards?

We need others among us to maintain their stellar aspirations and we need to retain enough imagination to recognise true advances.