Paradigm shift: the end of "normal science" in medicine understanding function in nutrition, health, and disease.

of the paper. Despite our focus on lipid lowering, lowfat diets and statins over the last 20 years, the incidence of cardiovascular disease is on the rise. Like many studies where the results contradict the prevailing beliefs, the abstracts and conclusions do not reflect the data in the body of the paper. In an analysis of 44 articles and their abstracts published in major medical journals during a one-year time frame, the authors concluded that “data in the abstract that are inconsistent with or absent from the article’s body are common, even in large-circulation general medical journals.” (See Figure 1.) These examples illustrate the way medicine is rooted in beliefs, not necessarily objective reality, and how current medical practice is based on “normal science,” not necessarily a newer conception of human physiology based on complex, selfregulating, higher order functioning elucidated by research in genomics, nutritional biochemistry, and molecular biology. CHRONIC DISEASE AND THE FAILURE OF THE CURRENT MEDICAL PARADIGM The current problems in medicine fall into two general categories. The first is the failure of access and universal coverage as a right for all citizens. This is the topic for another essay and a complex political problem. The second is the failure of the current model of medical diagnosis and treatment to successfully address the chronic disease burden in our society which affects 125 million Americans. Not only does our current approach fail to effectively diagnose and treat the underlying causes of chronic disease, found in the complex interaction of genes, lifestyle, and environment, it does great harm. As a nation we spend $1.6 trillion on healthcare each year. This represents 15% of our gross national product (GNP) or approximately $5,000 per person per year, or more than double the percentage of GNP spent by any other nation on healthcare. Despite this, we are 12th out of 13 industrialized nations in 16 major indicators of the health status of a population, such as life expectancy and infant mortality. In fact we are 27th in life expectancy. Cuba is 28th. Yet that is not the worst problem. Our own healthcare system has been estimated to be anywhere from the 1st to the 3rd leading cause of death from hospitalizations, hospital infections, atypical drug reactions, bedsores, medical errors, negligence, unnecessary procedures and surgery and more. The cost attributed to the harm caused by our medical system has been estimated at over $200 billion. Other problems endemic to our medical system include: the fundamental limitations of our gold standard research tool, the randomized controlled trial (RCT) to assess lifestyle and nutritional interventions and long-latency deficiency diseases; the lack of publication of negative medical trials, thus providing a positive bias in medical literature; direct to consumer pharmaceutical marketing; and heavy marketing of off-label uses of medications, including hormone replacement therapy. Other problems are inherent to the practice of funding of research by private industry, often resulting in a financial conflict of interest leading to suppression of studies or incomplete or biased conclusions. The most well known example of the latter was the comparison between generic thyroxine and Synthroid where the pharmaceutical company prevented the publication of the article, because the outcome was not favorable to the manufacturer of the trade name drug. With the exception of the National Institutes of Health and some private foundations, most of the research agenda is set by the pharmaceutical industry. Even the post-graduate education of physicians is primarily controlled and orchestrated by the pharmaceutical industry. Recent data point to the dangers of medical care and the fact that more care is not necessarily better. In areas where there are more physicians and a higher cost of care, there is less patient satisfaction and worse outcomes than areas with a lower cost of care. Even when there are agreed upon standards for care and prevention, they are not met. The frequent lack of implementation of clinical science to clinical practice is inadequate and dangerous. For example, only 40% of patients receive aspirin after myocardial infarction, and a recent study Ca rb oh yd ra te s