Should medical schools be mandated to teach nutrition?

Doctor, do you know a lot about human nutrition? You said “yes?”

Congratulations, if that is true. But I suspect that South Carolina Congressman Joe Wilson’s infamous quote “you lie” is applicable.

American medical schools traditionally have done a horrible job with their curricular treatment of clinical nutrition. University curricula are controlled by the faculty and, when the faculty don’t know or care much about a topic, it often gets short shrift.

I personally hate the notion of a legislature mandating that medical education institutions teach certain curricular topics. Yet, sometimes that seems the only way to get it done.

By current count, 15 states — including California, Connecticut, Florida, Iowa, Kentucky, Massachusetts, Nevada, New Jersey, Oklahoma, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, and West Virginia — mandate Continuing Medical Education in specific topics.

Rhode Island lists the largest number of topics, six.

The topics required by various states include pain management, geriatric medicine, domestic violence, risk management, end-of-life care, universal precautions, HIV/AIDS, ethics, cultural competence, controlled substances, bioterrorism, and prevention of medical errors.

What this means is that, at some point in time, a state legislature and governor decided that the physicians in their state, no matter what medical school or residency programs they came from, simply were not getting the job done for the people in their state in a field of particular concern at that political moment.

Now, witness the state of California on the topic of nutrition.

Senate Bill 380, approved 37-0 by the Senate, 74-0 by the Assembly, and signed into law by the governor on September 6, 2011, requires the Medical Board of California to disseminate educational materials and to discuss “nutrition and lifestyle behavior for the prevention and treatment of chronic diseases,” presumably as a preamble to more definitive actions.

Look around you on the street or in the hospital, watch TV, read a newspaper or magazine, or go online. How well is the United States medical and public health establishment getting the job done in nutrition?

Not well. More than 60% of adult Americans are overweight, obese, or morbidly obese. This sad state did not just happen overnight.

All of those overweight people have had physician encounters.

Correcting the obesity and subsequent diabesity problem starts with physician knowledge about proper clinical nutrition.

That knowledge must be converted into a positive attitude and then widespread physician behavior that can effect preventive and curative patient behavior.

SB 380 may be too little, and too late for millions, but it is a start.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

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