How Could There Be Such a Disconnect Between the Science and Medical Practice?

“Most deaths in the United States are preventable and related to nutrition.” According to the most rigorous analysis of risk factors ever published, the Global Burden of Disease study, funded by the Bill and Melinda Gates Foundation, our diet is both the number-one cause of death and the number-one cause of disability in the United States, having bumped smoking tobacco down to number two. Smoking now kills about a half million Americans every year, whereas our diet kills thousands more.

If most death and disability is preventable and related to nutrition, then, certainly, nutrition is the number-one subject taught in medical school and the number-one topic your doctor talks with you about, right? How can there be such a disconnect between the science and the practice of medicine?

Let’s do a thought experiment. Imagine you’re a smoker in the 1950s. The average per-capita cigarette consumption was about 4,000 cigarettes a year. Think about that. In the 1950s, the average American smoked half a pack a day.

My video How Smoking in 1959 Is Like Eating in 2019 shows a series of 1950s tobacco ads featuring media stars, famous athletes, and even Santa Claus telling you to smoke. The message was clear: If you wanted to keep fit and stay slender, you made sure to smoke. Magazine ads also encouraged you to eat hot dogs to keep yourself trim, as well as lots of sugar to stay both slim and trim. One ad even claimed that sugar was less fattening than apples. Apples! Though one internal tobacco industry memo stated, “Apples connote goodness and freshness and we see many possibilities for our youth-oriented cigarette with this flavor.” They wanted to make apple-flavored cigarettes for kids. Shameless!

As those 1950s ads tell us, in addition to staying “fit,” staying “slender,” and “guard[ing] against throat-scratch”, “for digestion’s sake,” you could smoke. “No curative power is claimed for Philip Morris,” read one ad, “but—an ounce of prevention is worth a pound of cure.” Heeding that advice, it’s better to be safe than sorry, so you’d better smoke.

Like eating, smoking was a family affair. Marlboro ads featured babies with comment bubbles saying, “Gee, Mommy, you sure enjoy your Marlboro,” “You’re darn tootin my dad smokes Marlboro…he knows a good thing,” and “Just one question, Mom…can you afford not to smoke Marlboro?” In another ad from the 1950s featuring a stereotypically  nuclear family, the dad is given cartons of cigarettes from his doting children—one boy and one girl, of course—and even the dog has a carton as his doting wife looks on.

“Blow in her face and she’ll follow you anywhere” was one tobacco company’s tagline, and “No woman ever says no to Winchester” was another. After all, cigarettes are “so round, so firm, so fully packed.” After all, John Wayne smoked them…until he got lung cancer and died.

Back then, even the Flintstones were smoking, and so were the doctors. This is not to say there wasn’t controversy within the medical profession. Yes, some ads showed doctors smoking Camels, but, in others, physicians preferred Lucky Strikes, so there was some disagreement. Indeed, “eminent doctors…on high and impartial medical authority…call for Philip Morris.” Even “leading nose and throat specialists” couldn’t agree which cigarette is better for your throat. Probably best to stick to the science, and, touts another ad, “more scientists…smoke Kent…” This should not be rocket science—but even the rocket scientists had their favorite Viceroys for the “man who thinks for himself.”

Can you guess why the American Medical Association (AMA) “went on record as withholding endorsement of the Surgeon General’s Report on Smoking and Health, which documented the important role of cigarettes in…lung cancer”? A “gift from the tobacco companies” of ten million dollars may have had a little something to do with that. But why weren’t more individual doctors speaking out? There were a few gallant souls ahead of their time writing in to medical journals, as there are today, standing up against industries killing millions, but why not more? Maybe it’s because “the majority of physicians themselves smoke[d] cigarettes,” just like the majority of physicians today continue to eat foods that contribute to our epidemics of dietary diseases. What was the AMA’s rallying cry back then? Everything “in moderation.” The AMA said “[e]xtensive scientific studies have proved that smoking in moderation” is okay.

Eating the Standard American Diet today is like being a smoker in the 1950s. Just as smoking was rampant back then, think about what we’re feeding even hospital patients to this day.

We don’t have to wait until society catches up with the science. Sometimes it takes a whole generation for things to change in medicine. The old guard of smoking physicians and medical school professors die off, and a new generation takes its place—but how many people need to die in the interim?


I try to answer the question that arises in the minds of pretty much anyone dipping even  a single toe into the lifestyle medicine literature: “Wait a second. If this were true, why didn’t my doctor tell me?” If, for example, our number-one killer can be reversed through diet, why isn’t it front-page news and taught to every medical student, broadcast from every mountaintop by medical organizations, and featured in our government dietary guidelines? Still confused? Check out my other videos that address these questions:

For more on the parallels between smoking then and eating today, see:

Is the risk of smoking really comparable to following the Standard American Diet, though? See Animal Protein Compared to Cigarette Smoking and Will Cannabis Turn Into Big Tobacco?.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Why a Resource Like NutritionFacts.org is So Necessary

In a study of the dietary advice given by newspapers in the United Kingdom, “no credible scientific basis” was found for most claims. Indeed, “[m]isreporting of dietary advice…is widespread and may contribute to public misconceptions about food and health”—and potentially not only the public.

Scientists like to think they are not influenced by popular media. One study decided to put it to the test. The New York Times reports on scientific research each week, and researchers found that the studies covered by the Times end up being cited in the New England Journal of Medicine more than those that don’t. Seems like the popular press does indeed have an impact on science? Not so fast. That’s just one potential explanation. Perhaps outstanding studies are more likely to be picked up by the media and, independently, more likely to be cited. It’s possible the Times was just earmarking important science and its publicizing of that research didn’t have any effect on how often it was cited in future studies.

How can we disentangle the two? In 1978, there was a three-month strike during which the Times continued to print copies but couldn’t sell them to the public. So, a natural experiment was set up. Researchers compared the number of citations of Journal articles published during the strike with the number published when the paper wasn’t on strike to “discover whether publicity in the popular press truly amplifies the transmission of scientific findings to the medical community.” If the paper were just earmarking important articles, then the strike would have no effect on the studies’ future impact, but that’s not what happened. As you can see from a graph shown in my video Spin Doctors: How the Media Reports on Medicine, the studies covered by the Times during the strike when no one could read them appeared to have no impact on the medical community.

The next question, of course, is whether the press is simply amplifying the medical information to the scientific community or distorting it as well? “[S]ystematic studies suggest that many stories about new medicines tend to overstate benefits, understate risks and costs, and fail to disclose relevant financial ties.” What’s more, “[o]verly rosy coverage of drugs may also result from the direct and indirect relations between journalists and drug companies”—that is, the financial ties between the reporters and Big Pharma with all its perks.

Scientists and physicians often blame the press for the public being “poorly served” by the media’s coverage of medical science. In fact, the famous physician William Osler was quoted as saying, “Believe nothing that you see in the newspapers…if you see anything in them that you know is true, begin to doubt it at once.” Both parties, however, share the blame. Reporters may only have an hour or two to put together a story, so they may rely on press releases. It’s not hard to imagine how drug company press releases might be biased. But, surely, press releases from the scientists themselves and their institutions would “present the facts fairly, unambiguously, and without spin,” right?

Researchers decided to put it to the test. Critics may blame the media, but where do you think the media gets its information? “One might assume” that press releases from prestigious academic medical centers would be “measured and unexaggerated,” but researchers found they suffered from the same problems: downplaying side effects, having conflicts of interest and study limitations, and “promot[ing] research that has uncertain relevance to human health…”

For example, most “animal or laboratory studies…explicitly claimed relevance to human health, yet 90% lacked caveats about extrapolating results to people.” Indeed, “a release about a study of ultrasonography [ultrasound] reducing tumors in mice, titled ‘Researchers study the use of ultrasound for treatment of cancer,’” failed to add “for your pet mouse.”

“For animal research, it is estimated that less than 10% of non-human investigations ever succeed in being translated to human clinical use. Over-selling the results of non-human [lab animal] studies as a promised cure potentially confuses readers and might contribute to disillusionment with science.”

Although it is common to blame the media for exaggerations, most times, they don’t just make it up—it is what the research institutions are sending out themselves. Researchers found that “most of the inflation detected in our study…was already present in the text of the in their own press releases produced by academics and their establishments.” Medical journals, too. Indeed, sometimes medical journal press releases do more harm than good. An analysis of press releases from some of the most prestigious medical journals found the same litany of problems. I don’t think most people realize that journals sell reprints, which are official-looking copies of the articles they print, to drug companies and others. Reprints can bring in big bucks. Drug companies may buy a million copies of a favorable article. Indeed, they “usually buy reprints of studies that they have funded themselves. Unsurprisingly, they buy them only when the results are positive for their drugs, and they use these reprints as a form of marketing.” What’s more, sometimes a company will submit an article and promise to buy a certain number of reprints if it’s accepted, which “is effectively a bribe…” A long-time editor-in-chief at the prestigious British Medical Journal recalled that a woman from a public relations company called him, offered to take him to a restaurant of his choice, “and stopped just short of saying she would go to bed with me if we took the paper.”

“Another conflict of interest for editors relates to advertising—a major source of income for many journals. Most of the advertising comes from pharmaceutical companies.” If they don’t like a study, they can threaten to withdraw their advertising if it’s published. This potentially leaves editors “faced with the stark choice of agreeing not to publish a particular piece or seeing their journal die.”

Even if journalists, as they’re writing an article, have the time to skip the press releases and go directly to the source to read the studies themselves, they may find them “incomprehensible; utter gobbledygook.” Yet even if they do understand the studies, scientific articles are not simply reports of facts. Authors have many opportunities to add spin to their scientific reports, with “spin” defined as distorting the interpretation of results and misleading readers, either unconsciously or with a willful intent to deceive.  Researchers looked at randomized controlled trials with statistically nonsignificant results, meaning, for example, a drug was compared to a sugar pill and the difference between the two was essentially nonexistent. Would the researchers just lay out the truth and report that they spent time and money, but, in terms of their primary outcome, got nothing? Or would they try to spin it? In 68 percent of cases, they spun it. There was spin in the abstract, the article summary, which is particularly alarming because the abstract is often “the only part of an article [people] actually read.”

Given all of this, it’s no wonder the media often gets it wrong. Spin in the abstracts can turn into spin in the press releases and result in spin in the news. “Therefore, even if journalists [do their due diligence and] are using the original abstract conclusion in good faith, they still run the risk of deceiving their readers.” Researchers presenting new findings can always be careful to stress how preliminary the findings may be. “But let’s be serious. Powerful and reinforcing self-interests” may prevail.

I think the biggest problem with the way the media reports on medicine, though, is the choice of which stories are covered. In 2003, for instance, SARS and bioterrorism killed less than a dozen people, yet generated over a hundred thousand media reports, which is far more than those covering the actual greatest threats to our lives and health. In fact, ironically, “the more commonplace the cause of death, the less likely it is to be covered by the mass media.” Our leading killer is heart disease, yet it can be prevented, treated, and even reversed with diet and lifestyle changes—now that’s what should be front page news.


If we can’t trust the medical literature on its face, where can we turn? We’re talking life-or-death information here. What we need is someone who will dig deep into the data and translate the gobbledygook into actionable tips on keeping us and our families healthy. If only there was a website we could trust to tell us the unbiased truth…

If you appreciate the work we do, please consider supporting us. NutritionFacts.org relies solely on individual donations from users like you!

If you think just a little spin is bad, there is a much deeper rot in the medical literature. For more on this critical topic, see:

Interested in some specific examples of the spin and conflicts of interest we’ve been discussing? See:

It’s no wonder Physicians May Be Missing Their Most Important Tool.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Why Did Doctors Keep Prescribing Cancer?

We’ve known about the role of estrogen in breast cancer going back to the 1800s, when surgical removal of the ovaries seemed to help in some cases. Ovaries were said to send out “mysterious” influences to the rest of the body, which were identified as estrogen in 1923. The medical profession jumped on this discovery and started injecting menopausal women by the thousands, and it was said that “[t]he ‘shot’ gives a ‘respectable’ hook on which to hang the visit to the doctor…” Soon, there were pills and patches, and medical journals like the Journal of the American Medical Association regaled doctors with ads I feature in my video How Did Doctors Not Know About the Risks of Hormone Therapy? on how they can “help the women to happiness by simply prescribing estrogen” and, “[w]hen women outlive their ovaries…,” there is Premarin.

As far back as the 1940s, concerns were raised that this practice might cause breast cancer, noting it would have been nice to figure this out before we started dosing women en masse. But breast cancer risk didn’t seem to matter as much, because heart disease was the number-one killer of women, reviews concluded, and because women taking hormones appeared to have lower heart attack rates, which would outweigh any additional breast cancer. However, women taking estrogen tended to be of a higher socioeconomic class, exercised more, and engaged in other healthy lifestyle changes like consuming more dietary fiber and getting their cholesterol checked. So, maybe that’s why women taking estrogen appeared to be protected from heart disease. Perhaps it had nothing to do with the drugs themselves. Despite the medical profession’s “enthusiasm for estrogen replacement therapy,” only a randomized clinical trial could really resolve this question. We would need to divide women into two groups, with half getting the hormones and half getting a placebo, and follow them out for a few years. There was no such study…until the 1990s, when the Women’s Health Initiative study was designed.

Wait a second. Why did it take the bulk of a century to decide to definitively study the safety of something prescribed to millions of women? Perhaps because there had never been a female director of the National Institutes of Health until then. “Just three weeks after being named NIH Director in 1991, [Bernadine Healy] went before Congress to announce, ‘We need a moon walk for women.’ That ‘moon walk’ took the form of the Women’s Health Initiative, the most definitive, far-reaching clinical trial of women’s health ever undertaken in the United States.”

The bombshell landed in summer 2002. There was so much more invasive breast cancer in the hormone users that they were forced to stop the study prematurely. What about heart disease? Wasn’t that supposed to balance things out? The women didn’t just have more breast cancer—they had more heart attacks, more strokes, and more blood clots to their lungs.

The news that women treated with hormone replacement therapy “experienced higher rates of breast cancer, cardiovascular disease, and overall harm has rocked women and physicians across the country.” Estrogen started out as the most prescribed drug in America before the study, but, after, the number of prescriptions dropped immediately and, within a year, so did the incidence of breast cancer in the United States.

The most important question about this story is why were we all so surprised? There had been “decades of repeated warnings” about the risks of cancer. In fact, the reason breast cancer patients had so much trouble suing the pharmaceutical company was that “the drugs have contained warning labels for decades.” And, with that disclosure, surely any reasonable physician would have included it in their risk and benefit discussions with their patients, right? It’s like the warning labels on packs of cigarettes. If you get lung cancer now, you should have known better. And, so, if you were on hormone replacement therapy and got breast cancer, don’t blame the drug company. They warned you about the risks, right there in the fine print.

Why didn’t more doctors warn their patients? Even after the study came out, millions of prescriptions continued to be dispensed. That’s a lot of cancer in our patients we caused, wrote one doctor. “How long will it take us to discard the financial gains, to admit that we are harming many of our patients, and to start changing our prescription habits?”

“Why did this practice continue in the face of mounting evidence of harm?” Well, it is a multibillion-dollar industry. “Despite an overwhelming amount of evidence to the contrary, many physicians still believe that estrogenic hormones have overall health benefits,” a “non-evidence-based perception [that] may be the result of decades of carefully orchestrated corporate influence on medical literature.” Indeed, “[d]ozens of ghostwritten reviews and commentaries published in medical journals and supplements were used to promote unproven benefits and downplay harms of menopausal hormone therapy…” PR companies were paid to write the articles that were then passed off as having been written by some expert.

What now? “Gynecologists must switch allegiance from eminence-based to evidence-based medicine.” In other words, they must consider what the science says and not just what some so-called expert says. It’s been said that the “current culture of gynecology encourages the dissemination of health advice based on advertising rather than science.”

“Women were placed in the way of harm by their physicians, who acted as unsuspecting patsies for the pharmaceutical companies.” If we really wanted to prevent heart attacks in women, simple lifestyle behaviors can eliminate more than 90 percent of heart attack risk. So, instead of being Big Pharma’s pawns, “recommending a healthful diet, increased exercise, and smoking cessation would truly benefit women’s health.”


The whole Premarin debacle speaks to the importance of putting purported therapies to the test (see, for example, Do Vitamin D Supplements Help with Diabetes, Weight Loss, and Blood Pressure?), as well as to the power of Big Pharma (Eliminating Conflicts of Interest in Medical Research), medical community collusion (American Medical Association Complicity with Big Tobacco), and my most series on mammograms.

What about Plant-Based Bioidentical Hormones and Soy Phytoestrogens for Menopause Hot Flashes? Check out the videos to find out.

In general, patients (and doctors) tend to wildly overestimate the efficacy of pills and procedures. See Why Prevention Is Worth a Ton of Cure and The Actual Benefit of Diet vs. Drugs.

Medical care, in general, may be the third leading cause of death in the United States. See How Doctors Responded to Being Named a Leading Killer.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: