Open letter to University of Washington Medical School

To: Michael J. Ryan, M.D.
Associate Dean for Curriculum – University of Washington Medical School

Cc: Brian Seppi, MD, President, Washington State Medical Association

Kathy Lofy, MD, Interim State Health Officer, Washington State Department of Health

February 24, 2015

Dear Dr. Ryan,

We are writing to you in your capacity as Associate Dean of the UW Medicine curriculum. We have heard that you have been conducting a review of the medical curriculum.  We are writing to ask you to include the science of vegetarian nutritional medicine in the didactic portion of medical training, and its practice as a therapeutic in the clinical portion of medical school education.

Diet is the number one leading risk factor for disease burden in the United States[i] yet doesn’t have a large presence in the medical curriculum. A substantial number of high quality medical studies, published in major medical journals, now demonstrate that a healthy vegetarian diet, composed of vegetables, legumes, whole grains, fruit plus nuts and seeds, is very effective preventative medicine for most cases of the common diseases affecting many Americans, such as coronary artery disease, essential hypertension, certain forms of cancer such as prostate cancer, obesity, and type II diabetes, as well as several less common diseases. It also is often the safest and most efficacious treatment for most cases of those diseases. In many other circumstances it serves as a valuable adjunct to medication or surgery. We are aware of an emphasis in rural medicine at the University of Washington medical school, and here in particular, there is evidence that a vegetarian diet lowers the risk for many diseases and is an effective treatment for the common chronic diseases in this population[ii].

In addition to the benefit to individual patients, there are significant benefits to public health and to society at large when doctors are able to treat patients by prescribing a healthy vegetarian diet.  In particular, the problem of antibiotic-resistant bacteria would be much reduced if doctors prescribed a healthy vegetarian diet to many of their patients.  As we’re sure you know, most antibiotic-resistant bacteria result from the non-therapeutic use of antibiotics on farm animals, kept in very crowded conditions on so-called factory farms, in order to allow them to survive such harsh conditions and grow to commercial weights.[iii] It is not possible to provide the quantity of meat currently demanded by customers in this country, without using antibiotics on such farms. If the demand for meat and other animal products were to be significantly reduced, there would be less need for factory farms, and so the use of antibiotics on farms would also be reduced, and hence the development of antibiotic-resistant bacteria.

Another significant public benefit of treating patients with a healthy vegetarian diet is that in addition to being the most effective form of medicine for many common diseases, it has the advantage of being an extremely low cost method of treatment, thus saving patients and society as a whole an enormous amount of money which could be better used elsewhere. In fact, a Mutual of Omaha study determined that for every dollar spent on the Dean Ornish program, a very successful treatment for coronary artery disease utilizing vegetarian nutritional medicine, there was an immediate savings of $5.55 for every dollar spent.[iv]

Very little of this is currently being taught in most medical schools and hence it is not being put into clinical practice. Most nutrition education that students do receive is focused on the treatment in clinical situations such as postoperative care, malabsorption, renal dialysis, prenatal care, and even nutrition in developing countries.[v] [vi] This lack of education disempowers doctors from offering the best preventative and therapeutic measures to their patients, and deprives their patients from effective therapies resulting in unnecessary morbidity and mortality, while greatly increasing healthcare costs for both their patients and the entire nation.

In the course of our work, providing educational information for people interested in a healthy vegetarian diet, we hear many complaints from patients that their doctors don’t know nearly enough about nutrition. This concern prompts many physicians to complain in return that they weren’t taught enough about the science of nutrition or its applications as a therapeutic in their medical school education. This situation is hardly surprising for according to one study, over 90% of doctors feel that their training in nutrition was inadequate to meet their needs.[vii]

A growing number of patients are not waiting for their doctors to learn about the role of nutrition in human health, and so they treat themselves using information from the internet and other potentially unreliable sources, without the knowledge and experience that one would expect their physician to have.[viii]  In our experience, they would much rather be able to include their physicians on their healthcare team, but they feel they can’t because their doctors have so little knowledge in nutritional medicine.

Since doctors are not learning the science and skills necessary to treat their patients with vegetarian nutritional medicine, we feel that the solution to this problem begins in changing the University of Washington Medical School curriculum. Therefore we strongly urge you to include, as a separate subject, a comprehensive course in nutrition, emphasizing vegetarian nutritional medicine, and then to follow it up with a specific rotation in the clinical portion of the curriculum. We would like to propose the following three components be included in the curriculum:

The Science: Students need to know basic nutritional science: how different nutrients and foods function in humans.

Best Practice: They need to know how to prescribe appropriate nutritional treatments either as a monotherapy or as an adjunct for each patient.

Effective Delivery: They need to know how to guide patients through their dietary changes.

In fact, many doctors have already started to practice vegetarian nutritional medicine and integrate it into their patients’ treatments.[ix]  Even the new president of the American College of Cardiology, Dr. Ken Williams, uses this modality of treatment for his patients.

We are not advocating vegetarian nutritional medicine as a panacea for all ills – there is certainly an important role for appropriate medication and surgery. However, we believe that vegetarian nutritional medicine must be given a prominent position in the curriculum, so that doctors will be empowered to use it as a tool for clinical practice and as a background for research.

While we are aware that some improvements have been made in the curriculum recently, they are not nearly enough to meet the students’ needs. We recognize that there are always going to be some costs involved in changing the curriculum, but our proposal only requires new materials for the specific nutritional science course, plus one or two clinicians practicing lifestyle medicine for the rotations.  These costs will be minimal in comparison to the long term benefit to the public and patients.

We are willing to help in the educational process. We would be happy to provide a brief introduction to vegetarian nutritional medicine free of charge to your students. We have already given this to students at both Western University Medical School in Lebanon , OR, and at Bastyr University in Kenmore, WA, with great success. While we are not able to offer the comprehensive nutritional education your students really need, it does provide a good beginning and gives your current students a running start in a subject which is critical to their future practice of medicine. We would appreciate the opportunity to meet with you and answer any questions you may have.

Thank you for your attention to this matter. Health is important to every citizen of this state and the public is counting on you. Please feel free to contact us if we can be of any help to the students or medical school.

Very respectfully,

Amanda Strombom                                         Stewart Rose

President                                                         Vice-President

Vegetarians of Washington                            Vegetarians of Washington

Co-signatories:

Lynn Fioretti DO, Family Medicine, Okubo Family Practice Clinic -Fort Lewis (Madigan) Fort Lewis, WA

Keith Hanson, MD, Preventative Medicine, Brewster Medical Clinic, WA

Chan Hwang, MD, Physical Medicine and Rehabilitation and in Electrodiagnosis, Pacific Rehabilitation Centers, Puyallup, WA

Arun Kalyanasundaram MD, MPH, Cardiology, Highline Medical Center, Burien, WA

Chris Kozura, ND, Seattle Natural Family and Sports Medicine, Seattle, WA

Henry Kuharic, MD, (Retired) Seattle, WA

George Lee, MD, Family Medicine, Overlake Medical Center, Bellevue, WA

Patricia McEachrane-Gross, MD, MPH, Family Medicine and Preventative medicine, Ocala, FL

Esther Park Hwang, MD, Obstatrics and Gynecology, MultiCare OB/Gyn Associates, Tacoma, WA

Tim Riesenberger, MD, MPH, Emergency Medicine, Federal Way, WA

Spoorthi Velagapalli MD, Internal Medicine, Virginia Mason, Bellevue, WA

References

[i]  Christopher J. L. Murray and the US Burden of Disease Collaborators. “The State of US Health, 1990-2010 Burden of Diseases, Injuries, and Risk Factors.” JAMA. 2013;310(6):591-606

[ii] David Drozek et al. “Short-term effectiveness of a lifestyle intervention program for reducing selected chronic disease risk factors in individuals living in rural Appalachia: a pilot cohort study.” Adv Prev Med. EPub Jan 16 2014; 2014:798184.

[iii] Steve Heilig et al. “Curtailing antibiotic use in agriculture. It is time for action: this use contributes to bacterial resistance in humans.” West J Med. 2002 Jan; 176(1): 9–11.

[iv] Dr. Dean Ornish’s Program for Reversing Heart Disease. Published 2010 by Random House Publishing Group.

[v] Dimaria-Ghalili RA, et al. “Capacity building in nutrition science: revisiting the curricula for medical professionals.” Annals of the New York Academy of Sciences Vol 1306, Annals Reports pages 21–40, December 2013

[vi] Sellin J. “Dietary dilemmas, delusions, and decisions.” Clin Gastroenterol Hepatol. 2014 Oct;12(10):1601-4;

[vii] Vetter et al. “What do resident physicians know about nutrition? An evaluation of attitudes, self-perceived proficiency and knowledge.” J Am Coll Nutr.  April 2008; 27(2):297-298

[viii] Kendra L. Schwartz, MD, MSPH et. al. “Family Medicine Patients’ Use of the Internet for Health Information: A MetroNet Study.” J Am Board Fam Med January-February 2006 vol. 19 no. 1 39-45

[ix] Phillip Tuso et al. “Nutritional Update for Physicians: Plant-Based Diets” Perm J 2013 Spring; 17(2):61-66