Dr Attia is a surgeon who heads up a group of researchers investigating the causes of obesity and diabetes. In this TED Talk, he questions whether some of the complications we see in obesity could actually be the triggers. More importantly, because of our current assumptions about obesity, are we too quick to spot the criminal rather than the victim?
It was tempting to respond to this video with defiance and regurgitate all the scientific evidence that disputed his central theory. However, a) that wouldn’t make a particularly interesting blog post and b) it would have required digging out research papers I haven’t looked at for close to ten years, reviewing them critically, and begrudging the fact I wouldn’t be able to throw any more recent research into the proverbial hopper.
Instead, it got me thinking of Malcolm Gladwell’s TED Talk ‘Choice, Happiness and Spaghetti Sauce‘. He opens with a story about the market researcher Howard Moskowitz who was trying to find the right level of sweetness for Diet Pepsi. The data came back a mess. There was no clear trend and no obvious concentration of sweetener that would make the perfect Pepsi.
A little while later, Moskowitz realised he’d been trying to answer the wrong question. They were looking for the perfect Pepsi when they should have been looking for the perfect Pepsis – different people prefer different degrees of sweetness. Moskowitz later got to test this theory by researching pasta sauces for Campbell’s. He found that a third of consumers wanted chunky vegetables in their sauce, something no company was selling. Campbell’s duly brought out such a sauce and saw a huge growth in sales.
Just as there’s no such thing as the perfect Pepsi or spaghetti sauce, there’s no such thing as a singular cause for diabetes and obesity. There are metabolic, hormonal, biochemical, physiological and genetic triggers like there are for so many other illnesses. And that’s why it’s important to search for these triggers and to avoid being blinkered by scientific dogma.
That doesn’t mean there has to be, needs to be or can be a pill to treat every cause. No one said life is fair and people may need to make lifestyle changes as a result. In some cases, these lifestyle changes may actually be the cure. In other cases, they may be no more than palliative; obesity could indeed be masking something more sinister. And if there’s money to be made from finding new therapies based on this research, then there probably will be. For this you will need to look to the pharmaceutical companies that many seem to malign.
So the question becomes: just because you can create a drug, should you? Does it make more economic sense to help someone manage their condition than pay out thousands of dollars, pounds or euros for every patient? And what is the morally just thing to do?
Regardless of your views on NICE in the UK, or ‘death panels’ as they were described by some in the US, Dr Attia’s mission isn’t necessarily a waste of time. It is right to repeatedly question assumptions and dogma. We seem willing enough to do it in the name of religion (or atheism) so we shouldn’t be scared of doing the same for science and medicine. Indeed, it was questioning prevailing opinion that identified an increased risk from cot death from letting babies sleep on their fronts. And who knows what additional discoveries the research team may make along the way?
But while the point of the speech was about questioning scientific conclusions, there was an underlying and far more powerful point Dr Attia made: we should learn to be more compassionate. We should be especially careful of making judgements about strangers.
In his book ‘Adapt’, Tim Harford tells the story of the Scottish epidemiologist and doctor Archie Cochrane. At one stage he worked in a hospital for prisoners of war and a Russian soldier was brought to him, screaming out loud. Knowing little Russian, and lacking any suitable medicine, Cochrane could do nothing but hug his patient. This act of tenderness stopped the soldier’s screams almost instantaneously.
So what does it mean to be compassionate? In my opinion, dangernate said it best in one of his blog posts:
Being compassionate doesn’t have to mean giving the homeless guy your spare change or donating canned-goods to a food drive. In its truest form, it’s curiosity towards other people’s stories and understanding that they have value, just the same as you. Viewing the world through this lens doesn’t just help those around us, it also makes us happier, more deeply satisfied people.
If my experience as a scientist and analyst has taught me anything, it’s that we should have the humility to accept that we could be wrong. Even if we understand everything else there is to know about a subject, it only takes one bit of evidence to disprove a hypothesis. Therefore, we should reflect this same humility to the world around us. There’s a time for criticising and there’s a time for caring.
Edit: video embedded