Diabetes, Vaccines, and Scientific Literacy

Suppose I were to tell you that most people can reverse type two diabetes by changing their diet. Now I’m not an endocrinologist; I’m not even a doctor, but I assure you that if you’d like to reverse your diabetes, I can help. So you, being a sensible person who believes in following expert advice, go to your doctor and your endocrinologist both of whom tell you not to listen to me and to continue increasing your insulin dosage year after year. “There’s nothing you can do about it,” your doctors say, “type two diabetes is a chronic, degenerative disease.” They say this knowing that most diabetics will live ten years less than the average person and are far more likely to die of a heart attack. By now they also know that a person with diabetes is far more likely to succumb to COVID-19 related complications.

These hypothetical doctors apparently don’t know that there is a mountain of evidence indicating that you can indeed reverse type two diabetes through diet. Ketogenic diets appear to be the most effective, but a google scholar search will show a fairly wide variety of diets that are associated with complete or partial reversal.

The doctors’ lack of knowledge is not trivial. Nearly half of the US population suffers from at least one chronic disease and poor blood sugar regulation and high insulin levels are connected with most of them. If the doctors are so wrong about diabetes, what else are they wrong about? Could autism be connected to gut health? Could Alzheimer’s disease be affected by the levels of sugar and insulin in the blood? Could statins, a drug that my doctor seems to give to nearly all patients, only help one in 200 people?

This is an incomplete list of the the things doctors generally get wrong about health and disease. All of the papers and studies I’ve cited are mainstream scientific studies. I would argue that they’re good studies, and they’re not hidden from doctors especially in the internet age. But reading those studies is not how the average person interacts with science. They interact through experts like their doctor who either isn’t reading those studies or isn’t changing his advice based on them. Why do doctors seem slow to learn?

In a few months of health coaching, I’ve helped about a dozen people get off their diabetes medicines. Those people all have endocrinologists and general practitioners and they share their experience with those doctors. I’m not the only one doing this, there are thousands of health coaches helping perhaps millions of people; any doctor who still believes that reversing diabetes is impossible is simply not opening their eyes.

One explanation for why a doctor may not want to open their eyes is because of perverse incentives. Doctors get paid per visit and in many countries they get paid more by insurers for seeing patients with pre-existing conditions. Fixing the underlying problem decreases profit both for the doctor and for the increasingly privatised world of health care in which we are all living. There is also something called the “standard of care”, and if a doctor doesn’t give the standard of care (insulin injections in the case of a diabetic) they may open themselves up to the risk of a lawsuit. This may seem cynical and I’m sure doctors all believe that they’re doing well by their patients, but these are the institutional realities.

What emerges here is a system within which doctors are not asking “what’s best for the patient?” Instead they are asking “What’s the standard of care for this patient, and how can I keep my employers and the insurance companies happy?” The answers to those questions will lead to increasing insulin doses for a diabetic 100% of the time.

From the patient’s point of view, especially from the point of view of the rare patient who has been able to escape this system, the experience shatters all faith in the system. For example, take a hypothetical client Radha. (This is a hypothetical example, not based on any of my real clients, though this is a fairly typical experience.) Radha is a 50-year-old mother of two who works as an executive in a high-pressure job. She developed type two diabetes five years ago and she hates injecting herself with insulin. She asked her doctors how to get off the insulin and they told her to “eat less and move more”. She followed the advice; it didn’t work. She got frustrated and, after trying a number of different approaches, came to me. After working with me for eight weeks her insulin dosage has decreased for the first time ever and her endocrinologist is shocked. After another 4 weeks, she’s off insulin completely. (Again this is a hypothetical example – for many clients the process takes less time, for others it may take more, and for yet others it may not be possible to completely stop insulin, though everyone I’ve worked with has been able to significantly reduce insulin intake.)

What does Radha take away from this experience? The doctors in five years were unable to do what she and her health coach could do in three months. Conclusion: The doctors must be complete idiots!

So when those same doctors are saying “you’d better get your vaccines”, the natural response is one of skepticism. That’s not a bad thing. We should be sceptical of what we are told to do in general. I’m skeptical too. But when I see something that seems odd, I have the training to go through the peer reviewed literature and see what other scientists think of a given conclusion. If a hypothesis is neither completely proven nor completely disproven (which is the case 99% of the time), I can at least form an educated opinion based on the quality and quantity of studies that have been published. Most people don’t have the confidence to do that; indeed most of the papers are written in a way that makes them inaccessible to the average reader.

Instead of starting their own research project, most people will stumble through a world of contrarian opinions, some of which may have merit and some of which clearly don’t, until they find something that resonates with their own world view. This often looks like the opposite of the scientific method. The scientific method involves taking a hypothesis and trying to disprove it. In this case, the individual is usually actively looking for confirmation bias. If she believes that mainstream medicine is wrong (as it was in her lived experience), she will find evidence to confirm that bias. And if she’s looking for heroes, for anti-establishment messiahs, she will find those too.

Anti-establishment experts come in a range of flavours, from those who use thorough and rigorous science to find flaws in the existing status quo to peddlers of snake oil. At the dodgy end of the spectrum are disciples of Andrew Wakefield, the doctor who first published an article (since retracted) linking autism with vaccines. Brian Deer, who’s written a whole book about Wakefield, was recently interviewed by Dr. Peter Attia and I highly recommend that podcast to anyone interested in the topic. To me what stands out from that story is Wakefield’s inability to understand the scientific method. A good scientist has a hypothesis and then tests it. Testing, as explained above, means trying to disprove one’s own hypothesis. Wakefield never tried to disprove any of his hypotheses. Rather he sought to prove that the information he was receiving from his experiments was consistent with whatever his hypothesis happened to be. The hypothesis that the moon is made out of cheese is consistent with Einstein’s theory of relativity; that doesn’t make it true.

Worse yet, when he found data that was not consistent with his hypothesis, he blamed the data collectors. “Their instruments weren’t powerful enough,” is a theme that comes up again and again. But the instruments that disproved his theories were far more powerful than the somewhat odd and outdated tools he favoured. One is tempted to say that Wakefield, like the lay person, was seeking only confirmation bias, but I don’t think that would be fair to the lay person. Wakefield knew or at least should have known exactly what he was doing, so his actions look more like deliberate fraud than if those same actions were taken by someone without his expertise.

There’s more to the Wakefield story – including what to me can only be described as the torture of children with Autism Spectrum Disorders (ASD) – but for the purposes of this discussion what’s important is that Wakefield seems to have hit a nerve. The number of people claiming – without any evidence – that vaccines are dangerous has increased at an alarming rate. It is also true, of course, that ASD has increased at an alarming rate and that conventional science doesn’t have great explanations for why that is the case. Putting the blame on vaccines at least offers a scapegoat, something humans have been using for thousands of years in the face of inexplicable tragedy. And when people are eager to hear a story, storytellers will appear.

And of course the COVID vaccines offer storytellers a host of new opportunities. At the heart of many of these stories is a universal truth – one cannot prove a negative. I can’t prove that COVID vaccines won’t turn you into a frog because those vaccines were never tested against that hypothesis. I can tell you that in the millions of people who’ve taken vaccines, nobody has turned into a frog. But of course that information will do little to soothe the fears of those who are genuinely concerned about the as-yet-unknown potential for human/amphibian transmogrification.

I don’t mean to make light of the issue – there are some known issues with the current crop of vaccines as have been widely publicised. Just to put those issues in perspective, your risk of developing a blood clot from the Johnson & Johnson vaccine is about 5 per million; the risk of developing a blood clot from COVID is 39 per million. And I suppose one can be concerned about unknown long-term risks, though history tells us that any issue with vaccines tends to come to light in the first few months. But beliefs like an mRNA vaccine will somehow merge with human DNA, or that vaccine preservatives are dangerous, or that vaccines cause sterility have no scientific basis. (A full explanation of some of the more common COVID vaccine myths is available here.)

For me as a health coach this has been somewhat depressing. As a rule I don’t pay much attention to the Great Vaccine Debate, but when my clients – and all my clients are very knowledgeable and intelligent people – start asking me whether they will get COVID from the vaccine or whether the trials were long enough, I get worried. The nature of disinformation is that it doesn’t have to convince people, it just has to confuse people. And people are certainly confused.

None of this is meant to bypass the need for a genuine public debate. When it comes to issues of public health, we should not blindly trust the experts. The case of type two diabetes proves that pretty conclusively. But in order to move beyond the need for experts, ordinary people must cultivate scientific literacy. Can we think critically about what we’re hearing? Can we try to disprove “facts” before believing them, even those that confirm our own biases? Can we distinguish transparent fraud from an as-yet-unproven-but-genuine hypothesis? If we can’t do these things, any public debate can and will be hijacked by grifters and con-artists.

The real danger to me is that while pseudo-science takes over a greater and greater proportion of humanity, the “experts” lie in wait. Their model relies on tools that are scientifically proven – insulin injections certainly lower blood sugar – but may not be the best way to address chronic disease. If they can posit a false dichotomy between themselves – the experts – and everyone else who believe that vaccines will turn people into frogs, the chances for improving our collective health are slim.

On the other hand if we, as an informed and scientifically literate community, can demand health care grounded in good quality science that prioritises human need over corporate greed, something wonderful might happen. We might just get it.