Long time lurker, first time poster. :) Forgive me if I don't have the format down right.

I think there are many doctors who are all for evolutionary medicine. You just have to find them. And I think as there's more demand, there will be more training.

Also, the problem isn't just about malpractice; it's about our healthcare system. Doctors have 15 minutes or so. They can't possibly go into diet in that time. In 2007, I developed vitiligo, and went to a dermatologist who was recommended to me. I felt like I was imposing on her time, which I was considering how insurance pays her. She said, "Yep, vitiligo." I asked about vitamin D levels, she said, "Oh no, you're fine, you get enough walking to your car. But I should have you checked for thyroid, go to the lab, oh and here's a prescription for Protopic. See ya!"

I was so disgusted by the whole thing that I found a naturopath. And that was a totally different experience. My initial appointment was 1.5 hours, and we went into everything.

I actually went back in yesterday, because my vitiligo has been getting worse since I've been paleo (it's really some other issues, with possible flare from diet change). And she is ALL for the diet. She took my concerns about the whole leaky gut possibly being the cause of most autoimmune diseases very seriously and ordered various genetic tests, told me I had some yeast issues and that I'm on the right diet for it. I know that if I hadn't been doing paleo, she would have recommended something close to it. In fact, she did just that a couple of years ago, and I, stupidly, didn't listen. She probably didn't push it because let's face it, people are incredibly rigid about what they will and will not give up. And that's less about doctors and more about patients.

So yeah, I think there are plenty of doctors out there. We just have to find them, and be more involved in our own health care. And we need a better healthcare system, because without it, we're all doomed. How can anyone, no matter how well-trained, properly care for a patient in 15 minutes? The answer is, they can't.

Just adding a little update here...one of my professors did sneak in a Paleo lecture in our psychiatry class (of all places), complete with some readings on evolutionary omega 3/omega 6 ratios and references to Cordain. We wound up having 2 Paleo diet questions on the psychiatry final (which I, of course, got right). We also had an expert in autism treatment lecture a while back essentially saying he was putting his patients on a Paleo-type diet (without calling it that) and having much success. They also just added two nutrition lectures to our schedule this week by a doctor I know who is very anti-processed foods, refined sugar/flour/etc. I'd say from our conversations he leans more towards the Stephen Guyenet line of thinking (more veggie heavy with starches, but no sugar). So the good news is that bits and pieces are working their way into the medical school curriculum (at least at one school). How soon it will make an impact on future docs is hard to say. But again, just opening an exam and having a couple questions directly on Paleo diet was pretty encouraging for me.

A number of challenges come to mind:

a - groupthink, as in any academic field. See Kuhn's model of scientific evolution

b - defensive medicine, which reinforces (a)

c - entrenched experts (c.f. Plank's funeral-driven science), an interacting variable on both (a) and (b)

d - self-interest of doctors (payola obviously but also greater profits from 'management' than cure). Naturally, this would generally be unconscious since most MD's are kind and conscientious.

Put it all together and I'd say it'll take a long while. What paleo needs is their Ancel Keys. Atkins might've done it, but he was isolated and beaten down by united experts. So when young internists sprout enough to create a sort of substrate, the next Keys/Atkins may get a fair hearing. If that's the process, we're talking at least a decade, maybe a generation.

Something to think about:

Rewarded behavior is repeated.

I don't fault the Drs.

I fault management's incenting behaviors and decisions inherently leading to unhealthy behaviors in their patients. Where are the incentives to create more healthy portfolios of patients? They certainly don't exist in a 3rd Party payer system where the patient is viewed as little more than body parts.

Until our government incentivizes the health industry w/r/t the AVERAGE US Citizen, there is no reason for them to change. I'd like to see BIG bonuses paid out to EVERY practicing Dr. to drop our average BF% by 10%. Wouldn't that change the focus and relationship between physicians and patients? It would also return much of the power back to primary care, where health SHOULD begin.

I want to say to this board when my first blog arrives it will have a lot to do with that question I asked. I just have sent the initial draft to my editor and I am awaiting his reply.......that question really help me frame my mindset in how I plan to deliver my content. It was very vital to my thought process. Every post I thought deeply about and I appreciated the honest feedback. Collaboration between doctor and patient takes a good doctor to a great doctor. I believed this before my question and the answers solidified my premise.

We can only guess but I doubt much change. My doctor will not even discuss nutrition. Amazing when you realize how much diet affects health.

As a current medical student who plans to recommend lifestyle changes over prescriptions, I believe that we need to start with the physicians themselves. One of a doctor's greatest attributes is (or should be) the ability to relate to their patients. If we want physicians to recommend this lifestyle, we need to get them to try it first. This way they can understand what it's all about, the science behind it, and perfect a way to get patients started. This, in my belief, is the key to change. The hard part, of course, is getting this to happen on any sort of wide scale. It has to be an organized effort, and it most definitely has to involve teaching nutrition in medical schools. We barely learn anything outside of basic biochemistry and I'd bet you'd be hard pressed to find a student who can explain to you why "saturated fat is bad for you" but you'll find many who accept that principle blindly.

In my class of 200 or so medical students, including myself, we might graduate 1 or 2 other folks I know of that will adhere to some variant of evolutionary medicine/paleo/whatever other name you want to give this. Not looking good. I mean I'll come back from the summer having attended the Ancestral Health conference armed with the latest, greatest science and I'll try to convert students and professors, but we'll see how much of an effect that has. I've given one lecture on campus to the public on evolutionary principles for health, but, again, I don't think it had much impact since most of my audience was sipping on frappuccinos and I'm telling them to not drink sugar bombs.

Anecdotally I can report that most of my colleagues are pretty resistant to change. Most of my classmates have put on non-trivial amounts of weight during the school year. Not surprising really--we study 8-12 hours a day, mostly sitting, we're constantly stressed, sleep deprived, flooded with cortisol, and we don't really have a lot of time to cook and so people resort to fast food. I think I'm the only person in the class to have lost a significant amount of weight this year and so people ask me what I'm doing because they all want to lose weight for the beach season this summer. So I tell them, but then they don't want to do it. They don't want to give up the carbs, and they sure as hell don't want to do crossfit (although I attribute most of the weight loss just to diet...Crossfit has been the icing on the cake). I started out the year fat and now I'm clearly not--my results are completely obvious. Doesn't matter. People are resistant to change. Even really smart people. I mean I'm still the kind of crazy guy who won't touch free sandwiches at lectures or buy cookies during various fundraising drives. So in the proverbial trenches I can report that it isn't terribly promising. Maybe it is different at other schools.

So, in about 7 or 8 years, there will be at least, oh, 2 or 3 more paleo friendly physicians in Southern California. Not good. I'll certainly report back after the Ancestral Health con in August if I run into more med students from around the country. Lets hope.

My guess is that nobody knows, at all. Predicting the future of healthcare is a bajillion times harder than predicting the stock market. A good bet would be entropy though-- what's the likelihood of a complex healthcare system getting simpler?