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Issue #25 (November 2016)

From the Editor

Volume 1

All the nutrition knowledge in the world won’t do any good, if you can’t convince people to change their behaviors.

This is where the life sciences start blending with the social sciences, and it can get quite messy. You see, there’s already quite a bit of research on behavior change, communication strategies, and whatnot. Being an eternal skeptic, I’m skeptical of much of this research, even after spending a while doing behavior change research.

Where does this skepticism come from? Let me illustrate with an example. There was a study published a couple years ago showing that nutritional advice bolstered with genetic testing didn’t produce much behavior change. At first glance, that may suggest that genetic testing isn’t helpful for nutrition-related issues. But the tests were mostly for things like sugar and caffeine intake, which can be quite difficult for people to change. What if the test was for something like an MTHFR mutation, which can be remedied with a simple change in folic acid supplementation?

My main point is that behavior change is EXTREMELY context specific. Not to mention that any experimental study is going to enroll people of varying behaviors and attitudes, and hence not be able to say much about any specific group. Just from the emails we get at Examine.com, I can tell you some things with certainty:

-Some people respond very poorly to detail, even at a moderate level. They would ideally want a two-sentence summary of a topic, even if it misses critical subtleties. Once you tell them something, they’re ready to take action.

-Other people research a single topic to death, until they understand all that their background will allow them to understand. They can and will attack you (ahem, I mean point out logical flaws) when discussing topics.

-A surprisingly large number of people have a nutritional Achilles heel. For example, some people know a ton about nutrition, but still binge late at night a couple times a week, and hence can’t lose weight. Others bought into some kind of dogma early on in their nutrition-research lives (low carb is essential, veganism is essential, etc etc), and can’t escape what’s baked into their systems after thousands of meals.

So while behavior change is key to translating nutritional science knowledge to practice, I’m not sure how valuable behavior change data really is. Maybe I’m wrong, and maybe it is (and has been) very helpful to practitioners … it’s hard to tell.

Regardless, some simple rules are always useful, whether research-backed or not. First, never push your diet philosophy on someone unless you’re sure they want you to. Second, it’s near impossible to change many behaviors at once, so baby steps are usually a good idea. And finally, be nice, and listen. Just because you know what the literature says, doesn’t mean that you know how someone feels or what’s going on in their particular body.

Kamal Patel,
Editor-in-chief, Nutrition Examination Research Digest

Volume 2

The term “peer” in “peer review” isn’t that easy to understand. Let’s delve into this a bit more.

First of all, academics and researchers are not paid to peer review. What happens when you assign a complex task to someone who is both unpaid and busy with a full-time (and often, more than full-time) job? The process can become extremely slow, and careless mistakes can be made.

The peer-review process isn’t even a very consistent one. Reviewer #1 may leave scant comments and give the paper a thumbs up, pending revisions, while Reviewer #2 hates the paper for wasting her time, yet comments the heck out of it then rejects it. Reviewer #3 may be in over his head, not very familiar with the topic area, and looking for a knowledgeable friend’s opinion so as to not embarrass himself.

People associate the term “peer” with “jury of your peers” or “peer pressure”. In those cases, the term doesn’t really have a sterling reputation. Yet when you attach the term peer-review to a study, suddenly that study can be cited in the media as fact. In fact, if you throw out terms like peer-reviewed randomized trial, and pair it with something like New England Journal of Medicine, then the game’s pretty much over. 95% of people will believe whatever you say.

On the flip side, many people are amused or horrified when Wikipedia is used as a citation, formally or informally. Sure, Wikipedia isn’t peer-reviewed, and hence you’ll find errors ranging from minor to laughable. But major entries on Wikipedia are viewed by many hundreds of thousands of people, sometimes millions. And there’s also public discussion in the editing pages. That doesn’t exist for peer review.

Basically, journals are stuck in the stone age, while the Internet’s free flow of information has whizzed past them. Many journals are locked behind pay walls, making the information mainly accessible to those with academic affiliations. There is little room for public commentary on studies, and that can create problems at times. If an inconsistency is caught, it might take months (or over a year) for it to be corrected, and some extremely flawed papers are never retracted. Pubmed has an option for comments on papers, but that feature is rarely used.

Most importantly, peer review remains a bit of black box. Different journals have different peer-review processes, and the overall quality and rigour of the reviewer also can drastically differ. Some journals are more likely to accept review papers, some less likely. Some aren’t likely to accept “controversial” research, while others are. If you want your paper to be published, there are enough crappy journals, including pay-to-play and predatory publishing journals, that you can eventually find someone to accept it.

None of this will change though, unless pressure mounts from both inside and outside the publishing community. So don’t accept study results just because they’re peer-reviewed. If you’re really into research, voice your opinion online and elsewhere. Academic research is broken in several different ways, but peer-review is a good place to start fixing it.

Kamal Patel,
Editor-in-chief, Nutrition Examination Research Digest

See other articles in Issue #25 (November 2016) of Study Deep Dives.