A 15 minute office visit cannot dispel a year’s worth of confusion

Minutes from melting in the summer heat, I dumped my stuff at a table and homed in on the hospital café’s soda display for something -cold. The gentleman at the next table glanced my way and said, “Are you in the medical field?”

“Yes sir, I’m a medical student.”

He eyed my drink and asked, “Did you hear that diet soda can increase your risk of diabetes by 70%? Even just a few cans a week.”

“No sir, I hadn’t heard that.”

“Seventy percent. Since then I’ve been drinking regular Coke. Wish I’d known ten years ago.”

Sure enough, on his table was a bottle of regular Coke. And I was drinking diet. I’m not trying to lose weight; for me they’re just an occasional treat. I also far prefer the taste of diet, doubt me as you may. I wondered whether the gentleman had diabetes and was now blaming diet soda for causing it. I wondered where he’d heard that 70% figure, and of course I wondered whether that research was actually any good. Since it wasn’t a clinical setting and he wasn’t my patient, I didn’t ask him any of those questions. But the trim, slightly disheveled gentleman in the hospital café certainly got me thinking.

From the day we medical students get our white coats, we are reminded to “do no harm” to our patients. Commonsense as it may sound, we’re about to earn the privilege to use powerful drugs, sophisticated surgery, and deeply personal questions in the service of our patients. We’re taught every day how medical interventions may backfire and cause harm. But in medical education and in society at large, we speak much less often about the potential for information to cause harm. I wonder if I was witnessing one of those cases.

I dug up the study linking diet soda to diabetes. It showed that women who regularly drink sugar-sweetened beverages or artificially-sweetened beverages are more likely to have Type II diabetes. There were more cases of diabetes among the artificially-sweetened beverage drinkers, but it’s nearly impossible to know why. As any student in statistics 101 can attest, and the authors themselves acknowledge, an association (between sweetened beverages and diabetes risk) is not the same thing as causation. Several scientists responded to the paper critiquing its methods. But no scientist, not even the authors of this study, said it means we should switch from diet soda to regular soda. In fact, the paper confirmed decades of research that showed regular soda is plain awful for anyone trying to avoid diabetes.

So what happened? I can’t say for sure, but I suspect a process something like the playground game “telephone.” As the study was translated into a press release, nuances got lost. As that press release turned into a news story, the cycle repeated. And as every viewer watched the news broadcast, a 30-second segment turned into a one-sentence takeaway: “Diet soda causes diabetes.” I imagine many, like the gentleman I met, stopped drinking diet soda and switched to regular — for the sake of their health, ironically. I’m no crusader for diet soda, and I know it may have its own risks, but regular soda is not preventive medicine.

Science is an imperfect, iterative process. One study comes up with something unusual, hundreds respond with different conclusions, and the truth is usually somewhere in the middle. Trouble, and potential harm, arise when initial anomalies are treated as if they overturn what’s been found for decades before. Something similar happened decades ago when Andrew Wakefield published a study claiming to link the MMR vaccine with autism. The study was retracted, Wakefield was disgraced, and decades of credible research subsequently established that vaccines have not led to a single case of autism. Yet since 2007, 1175 people have died from diseases preventable by vaccination. This is perhaps the best example of information causing harm – though not all cases are as stark.

If this gentleman were my patient, and that study had come up in the clinic, I certainly would’ve tried to put it in context: neither regular nor diet Coke is actually “good” for him, and he should switch to water if he wants to lower his risk of diabetes. But a 15-minute annual visit is unlikely to dispel a year’s worth of confusion. The explosion of health information available to the public needs to be matched by a stronger voice from those who can ensure it does no harm. We in medicine need to acknowledge that the clinical encounter alone is not enough to serve our patients — that the need for a medical presence in the public sphere has never been so great.

Karan Chhabra is a medical student who blogs at Project Millenial. He can be reached on Twitter @KRChhabra. This article originally appeared in the Boston Globe’s Short White Coat.

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  • Frank Lehman

    He said: ” neither regular nor diet Coke is actually ‘good’ for him, and he should switch to water if he wants to lower his risk of diabetes.”

    Does Chabbra think that there is really a good reason not to drink the diet Coke if one’s aim is to avoid diabetes?

    We all know that it is politically correct to tell everyone that they should drink plain water. But who wants someone like Chabbra giving them medical advice because it is politically correct.

    • Guest

      Your question is worded confusingly, so I’m not really sure what your point is. Coke is bad for you, and if anyone really needs scientific studies to tell you that then I encourage you to look them up.

      If you truly believe that hyperconcentrated cylinders of high fructose corn syrup won’t negatively impact your health I have a bridge to sell you.

      • Frank Lehman

        He is telling us that we should not drink Diet Coke (or regular Coke) if the objective is to avoid diabetes. That doesn’t confuse you, does it?

        He then concludes that we should drink plain water. That certain is the politically correct position.

        What is confusing is why Chandra apparently thinks that Diet Coke puts us at risk for diabetes. Even those spreading all the scare stories about aspartame don’t say it causes diabetes.

        • Guest

          Oh Frank. Poor poor Frank.

          You seem to be keen on educating yourself, so I encourage you to look up a lecture given by Dr Robert Lustig on the subject. I think you can find it on YouTube as Sugar, The Bitter Truth.

          It will require at least a rudimentary level of basic science to understand it though.

          • Frank Lehman

            I don’t know what your problem is (other than having a defective personality that makes you feel better by denigrating others), but you might start out by considering that not only legitimate sources (such as Lustig) but also the wackos who spread the scare stories, do not say that aspartame causes diabetes.

          • Guest

            You didn’t watch the video did you? You must not have watched the video. It doesn’t have anything to do with aspartame, it has to do with the way the liver processes high fructose differently than glucose, and how such large quantities of it in our diet affects the way our cells respond to insulin. But go ahead, cheers mate!

          • Frank Lehman

            I am afraid you are beyond help.

          • Guest

            I’m sure there’s a picture book somewhere that could explain it to you better. Enjoy your bliss

          • Frank Lehman

            You are beyond help.

          • Hannah

            Diet Coke doesn’t have high fructose corn syrup in it. At all. Why would it be any more likely than water to cause diabetes?

    • Mengles

      Politically correct to tell someone to drink water? Um, no. Try again.

  • http://frugalnurse.com/ Frugal Nurse

    I agree with this observation. So much of the health information delivered via TV health shows and news reports is designed to grab the viewer’s attention and tease them into watching the program. But it’s those short “take away” headlines that either emphasize harm (“Diet soda can increase your risk of diabetes by 70%!) or benefit (“Aspirin lowers colon cancer risk!”) that people remember. They aren’t always told, or don’t hear, the whole story about the study and how it was done, how many people were involved, who sponsored it, risks versus benefits, etc. In my 30-years experience as an office nurse, I’ve seen physicians and nurses spend a lot of time correcting misinformation or trying to put information into better context.

  • GT

    Speaking of water, another pseudo-medical/scientific myth that has
    been around so long that it’s very hard to dissuade people from, is the
    “you must drink 8 glasses of water a day” one.

    These things come out of nowhere and become “accepted fact” and once they do, it’s very hard to get people to budge on their beliefs.

  • Angelique

    A FIFTEEN-MINUTE annual exam? Now THAT’S scary! I’m glad my doctors spend more time than that with me.

    But thank goodness we have here a medical student who plans on advising his patients to make the healthiest choices, not the “best of the bad ones,” especially since many patients are likely to confuse the things a doctor says they CAN eat with things a doctor says they SHOULD eat.

  • azmd

    This is all great as far as it goes, but it would be helpful to see some concrete ideas for innovative ways we could educate our patients, within existing time constraints. I think it is well known already that patients need more education than they are getting.

    To me, this seems like an area in which a motivated, imaginative medical student could really provide some added value…who better to develop patient education materials and methods than someone who is also learning the material at the same time, has an interest in engaging and effective education, and has more time on his or her hands than the typical attending?

  • querywoman

    Maybe people with diabetes or those with family histories of diabetes are more likely to drink sugar-free drinks.
    Clean drinking water is a modern luxury. Our ancestors drank mildly fermented beer and wine or brewed tea because it was safer than stream water.
    There’s always some media war on our drinking flavored beverages.