Does Bad Medicine Drive Out Good? The Case of Eczema

In an article on weight regulation I read this:

One subject . . . developed symptoms possible related to EFA [essential fatty acid] deficiency (ie, mild eczema relieved by the addition of fat to the diet).

In other words, the subject — in a metabolic ward at Rockefeller University where everything he ate was supplied by the researchers — developed eczema when fed a zero-fat diet. When fat was added, the eczema disappeared. The researchers understood that not enough fat in your food can cause eczema. This research was done around 1960. The conclusion is supported by dozens of reports from people doing the Shangri-La Diet who said that when they started drinking oil their skin improved. Dry areas disappeared. I found the same thing myself. (And judging by the large fraction of people who have dry skin, a lot of people aren’t eating enough fat.)

The notion that eczema can be cured by eating more fat — perhaps high in omega-3 — could hardly be simpler. Around 1960, at least some doctors understood this (in a situation, I admit, where it was easy to understand). Yet here is how eczema is treated today, according to Bottom Line/Women’s Health (April 2009, p. 9):

Eczema (dry, itchy, swollen skin) usually is treated with topical anti-inflammatory cream twice daily during flare-ups. Patients who applied tacrolimus (Protopic) twice weekly to lesion-prone areas even when no lesions were visible went 142 days between flare-ups, on average . . . versus 15 days for placebo users. Tacrolimus can cause nausea and muscle pain and may increase skin cancer risk — ask your doctor about the pros and cons of preventative eczema treatment.

The information comes from a study done by Sakari Reitamo, a professor of dermatology at University of Helsinki, and others published recently in Allergy.

The surface things — the things that impress many readers — appear good: large sample, big difference between groups, peer-reviewed journal, good university. Yet once you know that eczema can be cured by eating more fat, the whole thing sounds Orwellian.

6 thoughts on “Does Bad Medicine Drive Out Good? The Case of Eczema

  1. In his book, Taubes shows that carbohydrate restriction for weight loss was the conventional wisdom for around 100 years, but with the advent of the lipid hypothesis of heart disease, the knowledge was shoved down the memory hole. When low carb diets were revived, it was almost as if no one had ever heard of such a thing. But if you had gone to a major medical center or clinic for weight loss up until the early 70s, you would have gotten a low carb diet.

  2. thehova, thanks for letting me know about the McArdle posts. Besides being pleased she mentioned me, I thought the interview with Campos was very good. He makes several good points that aren’t usually made. I disagree with him, however, that being thin isn’t important. I wished McArdle had asked him: What about people who want to be thin to look more attractive? When Campos goes on about how it doesn’t really help your health to be thinner, he’s ignoring what I thought was pretty obvious: that it does help your attractiveness.

    Perhaps any reader of this blog doesn’t need to be told that she appears to misunderstand my theory. I say that the obesity epidemic has arisen because we are eating foods that taste exactly the same each time (and have lots of quickly digested calories). Lots of factory-made food. Factories make food that’s less variable than homemade food. Such food produces stronger flavor-calorie associations, which raise our set points more. This isn’t the same as saying our food has lots of fat, sugar, and salt.

    Dennis, yes, that’s a good example.

  3. Bad money drives out good because money has two (among others) functions: store of value and means of exchange. The bad money is good enough for the exchange, while the good money is retained for it’s storage value.

    Presumably in this context we have rituals/knowledge that get used for treatments. But they have value in differing ways: short-term v.s. long-term efficacy.

    There are some narratives of the founding of professional medicine that argue that for centuries their was an unlimited demand for medical knowledge so lots of folks would volunteer to provide treatments. Such practitioners have a preference for treatments that have high short term efficacy – blood letting, caffeine, purgatives, etc. etc. Only once a monopoly was granted longer term efficacy could get a bit of seat at the table.

    No doubt all knowledge economies have analogous problems. How the split between short-term and long-term efficacy is balanced ain’t amenable to naive rule making.

  4. Thanks for responding. Yes, people truly want to lose weight. It seems like Mcardle/Campos argue that this desire to lose weight stems from a major, erroneous misconception that fat equals unhealthy.

    But I don’t think that’s right. In college, being overweight, I struggled to get to classes around campus. I was starting to feel pain in my hips and knees. I had terrible acne from the types of food I was eating. I was often directly miserable from being overweight.

    Of course, strict calorie reduction, which health care experts seem to often advocate, often makes people more miserable.

    That’s what’s great about the SLD. You lose weight in a smart way.

  5. Thanks, thehova. Not only does Campos ignore the psychological benefits of weight loss, he may not realize that weight loss certainly causes blood pressure reduction and less damage to knees and legs, as you say.

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