Sue Ieraci: Honestly speaking

IN a recent radio interview a book author was promoting the concept that sugar — and particularly fructose — is the key factor in weight gain.

An ex-lawyer, David Gillespie spoke confidently and referred to the scientific literature. Taking part in the discussion (Is our diet industry making us sick?, Nightlife with Tony Delroy, 12 March 2012) was an experienced dietitian, who was clearly frustrated by some of the author’s assertions.

Why, I wondered, was the word of an informed amateur being given equal weight to that of a trained professional? It made me think about the issue of authority and credibility in general. What is it that makes a person credible to a particular audience?

In our world of mass media, health care advice is ubiquitous. We are bombarded by the latest diets and “how to” books, radio and television stories, and a profusion of websites, blogs and discussion groups.

Influence is no longer vested in some concept of credibility or authority, but by accessibility. How, then, is credibility earned?

I have previously written in MJA InSight about the way some alternative health practitioners use a new style of paternalism by combining excellent communication skills with simple and direct advice.

It appears our human nature craves certainty and simplicity, but our current society values autonomy and individualism. The result is that many people go for messages that sell simplistic ideology under the guise of “choice” and “information”, and also go against the established mainstream.

Given the enormous popularity of alternative health care in Australia, many people suggest that orthodox medicine could learn something from that approach. Can we?

On the Radio National program Ockam’s Razor in 2010, trained nutritionist Chris Forbes-Ewan made these comments about Gillepsie’s book on fructose: “Starting with the positives, I found [the book] to be very entertaining — it contains gentle humour, plain English descriptions of complex topics, and [the author] has, at least to some extent, made an attempt to base his book on the scientific literature.

“However, [the author] is a lawyer, not a nutritionist or otherwise scientifically qualified writer, and he appears to have adopted a legal approach to his investigation of fructose — an approach that is apparently based on the adversarial nature of the profession of law. He also appears to have appointed himself counsellor for the prosecution.”

Therapists with good communication skills who provide simplistic messages that avoid personal dilemmas while giving the illusion of choice can also be very popular and successful, and can make people feel better.

However, such an approach does not respect patients’ rights to a full and frank discussion of issues involving their health — even if it makes them feel better.

Good communication is always better than poor communication, empathy is always better than lack of empathy, an apparently humble approach is better than arrogance.

Can oversimplification, though, ever be better than complete honesty?

Dr Sue Ieraci is a specialist emergency physician with 25 years’ experience in the public hospital system. Her particular interests include policy development and health system design, and she has held roles in medical regulation and management.

Posted 10 April 2012