HEART OF THE MATTER"
a special program of the National Emergency Medicine Association (NEMA)
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Guest: Dr. Sharon Akabas, Administrator, Institute of Human Nutrition, Columbia University College of Physicians and Surgeons
Topic: Physicians learning nutrition
Host/Producer: Steve Girard
NEMA: Ask anyone you know whether they believe there's a strong link between nutrition and disease, I'm sure you'd get..."Don't be silly, of course there is". New studies are out everyday reporting the connections between how we eat and how we feel, age, or fight off disease. So why is it so few American medical schools, less than one fourth, require students take a nutrition course? Today, we'll ask that question of Dr. Sharon Akabas, coordinator of a unique Masters in Nutrition program at Columbia University College of Physicians and Surgeons in New York.
AKABAS: It's an excellent question, first of all...and nutrition as a field has asked itself that question over time. The director of our program, Dr. Richard Deckelbaum, one of his thoughts on this question is that nutrition doesn't really sit neatly into any one system, any organ system or any particular discipline. It actually crosses all disciplines, and it's relevant through the lifespan. A friend of mine once used the analogy that if you make a layer cake, and on one level you have biochemistry, another physiology, another pharmacology, molecular biology...etc, etc... And then you cut a slice through that cake, in a sense that would represent nutrition. And as a result, it is related to every discipline, but doesn't necessarily, isn't necessarily seen as a discipline in and of itself. And I think one of the reasons there's been a change in the desire to incorporate nutrition somehow...either teach biochemistry with a nutrition focus, or as one goes through pathology, incorporate the consequences of poor nutrition into the lecture. I think one of the reasons it's changed is that it simply can't be ignored...how important nutrition is, especially with respect to chronic diseases in developed countries like the United States. And that would be heart disease, cancer, strokes, diabetes and atherosclerosis. So, those are among the top ten causes of death in this country, and of the ten...five are clearly related to nutrition.
NEMA: In the material I have on your program...which we'll get to talk about shortly...the father of medicine, Hippocrates was said to believe fervently in the closeness of nutrition and good health...but over the years, I believe we've gotten away into treating diseases, rather than preventing them or living holistically. Now, the pendulum seems to be swinging back...and the two are starting to run together again...
AKABAS: I think it's getting back on the same track also because with managed care, there are some major managed care groups who recognize the significance of preventive medicine...and nutrition is one of the strongest tools available in prevention of these chronic diseases. So, in the New York area, one of the major health groups is Oxford, and they're willing to fund nutrition related treatments and prevention, and that's been a very important piece in elevating the status of nutrition among physicians, and other health care professionals.
NEMA: Is it true that there is a very small number of schools that offer nutrition courses to developing physicians?
AKABAS: To be honest with you, I believe the percentage of those that require it is somewhere on the order of 1 in 5, or 1 in 6 medical schools...and one has to look even beyond that number and say, "...okay, they require it, what are they requiring, how substantive is it"? In general, one is happy just to get it on the agenda, and the next question is, "How rigorous is it"? So of those 1 in 5 or 1 in 6, in many instances, it's a relatively superficial view of nutrition. Beyond the places that require it, it's offered in many places as an elective course. But in general, according to one study, only 6% of the medical students took advantage of an elective course when it was offered. So, what is out there.. these are statistics as of 1996...what is out there is generally not required. When it is required, it's not necessarily of sufficient breadth or depth. And when it isn't required, a very small percentage of people are taking advantage of it. As to whether or not that's changing, I am hopeful that it is.
NEMA: Tell me about the nutrition program offered at your school, Columbia....
AKABAS: The program at Columbia is an M.S. degree in nutrition, targeted at physicians and other health professionals. And we saw a specific need for this, because in the case of physicians, there was a survey done and it suggested that physicians are the major group of health professionals to whom people go to ask nutrition advice. And frequently, the physician is faced with a dilemma: either he or she isn't sufficiently trained to answer the question, nor do they necessarily know where to go for reputable advice in the literature. And so the dilemma becomes...do they try to answer the question themselves? Can they refer the individual to a registered nutritionist, which is something we would very much encourage? Or can they go and seek some basic level of knowledge themselves, to answer rudimentary questions? And the program we're offering is hopefully addressing the latter...that we're trying to provide a strong and broad base of nutrition information, nutrition science...so the physician can at least begin to address the questions asked by his or her patients.
NEMA: Since your's is a novel idea...it's limited for now to people who have access to your campus, near the New York area...what's the chance for future outreach via video or internet?
AKABAS: We are interested in outreach...that's a longer range plan. In theory, a person can come and do this program in a one year time period...so for a practicing physician, it is generally limited to an hour and half or so from the New York City area. But beyond that, we hope to do more outreach. Some of that outreach will likely come in the form of seminars and programs that deal with nutrition related issues.
NEMA: With the rise of several areas of treatment aimed at prevention, from chiropractic to acupuncture to naturopathic practitioners...doctors can't help than be caught up in the efforts to prevent the conditions and diseases they are trying to treat...
AKABAS: I think it was Kiirkegaard who once was known to say, "...it takes a cracked mind to let a little light into the world"...and my husband, who's a scientist, responded to that by saying, "not so cracked that your brains fall out". And I think what that really speaks to is the idea that this...nutrition...is something that's been around for a long time...and for a long time it was people with a more open mind who acknowledged its potential significance. And more people have opened their minds to something like nutrition, but one of the important aspects of the program here is that we want to keep an open....but a very critical mind. Because, I believe it was Mark Twain who's quoted as saying, "I never listen to health advice, you could die from the misinformation". And so we're very careful here to analyze the basis of any clinical recommendation that might be made.
NEMA: What about some tips on how patients can get the answers they seek on nutrition related issues?
AKABAS: The first thing I would say is to recommend a nutrition counselor to a patient...a registered dietitian or certified nutrition educator. I think that would be the very first place to go...if they're unable to seek the care or advice of a nutritionist, then they probably should find out what umbrella organization, medical organization or nutrition organization includes their particular ailment...and then find out whether there have been position papers or information papers written on a nutrient and that disease. There are also sites for nutrition fraud that I would recommend for anyone who is going to be using the web.
NEMA: This awareness of nutrition...must also help the physician be more involved with a patient...in order to help in prevention...the physician has to know more about the patient....
AKABAS: The physician, I think, is becoming more aware of the individual within a system...for instance, the individual within a family system, the individual within a particular culture, the individual within a culture which has a food supply that surrounds it. An older expert in obesity, Theodore Van Itale, was once quoted as saying, "...we used to hunt for our food...now food hunts us". And I think the other piece to be aware of is that physicians are becoming more sensitive to how individuals make certain choices, and what is required to really effect behavior change.
NEMA: Our thanks to Dr. Sharon Akabas, coordinator of the Masters in Nutrition program for physicians and health care professionals at the Institute of Human Nutrition at Columbia University College of Physicians and Surgeons in New York.
SPOT: 15 years in the prevention of heart disease, stroke and trauma - The National Emergency Medicine Association. This show is just part of what NEMA does. We send out millions of pieces of prevention information to people around the country, give grants to organizations in research, public information and emergency services, and have been instrumental in the creation and expansion of the Chest Pain Emergency Room movement. To play a role, call 800-332-6362.
NEMA: Thanks for joining us for today's program. If you have any comments or suggestions, contact this station. Or visit our home page at:
...for a look at transcripts of this or past programs, or to find out more about the National Emergency Medicine Association. I'm Steve Girard at The Heart of the Matter.