John Crown (Independent) | Oireachtas source

Yes, I should stop digging.

The issue of diet has become a much larger consideration in my professional life during the past decade. At our previous meeting I indicated that I had undergone a road-to-Damascus like conversion on the dietary front approximately 12 years ago, which resulted in my losing in the region of 25 kg. I have largely managed to keep that weight off in the intervening period. My experience gave me an appreciation of the difficulties involved, the skills necessary and what needed to be done. The more important issue, however, is the realisation that people in the profession, particularly those within my specialty, were horrifically ill-informed on the importance of diet. There was nowhere near enough education on dietary issues in the past.

I emerged from years and years of oncology training and experience to become a moderately involved breast cancer specialist on the international stage, but it is only in the past few years that the penny has been dropping with those in my profession on the importance of diet from the point of view of cancer prevention. I do not just refer to diet in this regard but also to obesity and its various causes. I will not discuss all of the details, but I can point out that almost all of the common cancers that are not caused by cigarette smoking tend to have an increased incidence in those who are obese or whose intake of calories is too great. There are even data which suggest that if one has had cancer, the chances of it returning in a lethal secondary form are higher if one is obese following one's diagnosis. As a result of this, I spend a great deal of time discussing diet with my patients. I was doing a rough estimate and reckon that I take 20 dietary histories a week and make the same number of attempts at some kind of dietary intervention for patients whom I identify as being obese. I do so without specialist support for my conclusions. If someone looks obese and I know his or her actual weight, I will discuss his or her diet with him or her.

The results of my efforts in this regard are surprising. My patients are not children; most but not all are middle-aged women. They will often wring their hands and inform me that they cannot understand their failure to lose weight. They state they eat healthily, do not consume fatty foods and only eat modest amounts of bread, etc. When one takes their histories, one comes to realise that while there are foods which are more likely to make one gain weight - a previous speaker alluded to this and I pointed it out last week - there is no food that is safe if one eats too much of it. Likewise, I really believe there is no food that is dangerous if it is eaten in strict moderation. People must understand that merely eliminating sugar and fatty foods from their diets will not prove sufficient, particularly if they are eating four spuds or a great big plate of rice or pasta every night. In many of the patients I see the latter are the principal culprits. My patients are women who, because they have had cancer, buy into the idea of avoiding extraneous chemicals. As a result, they stay away from processed foods and soft drinks. None of this probably makes that much difference to one's risk of cancer if one is consuming too many unhealthy foods - to the point where one has become obese - and one's daily calorie intake is too high. This provides some indication of the challenge we face.

The primary strategies we should adopt should focus on education and regulation. I would be grateful if Dr. O'Shea indicated whether he is of the view that we are spending enough time educating young doctors in matters of nutrition. It is my opinion that we are not doing so. Other than stopping people smoking, the single most important action we could take to decrease the death rate from cancer 30 years from now would be to curb calorie intake. This would have a greater impact than anything we do in the context of screening or treatment. I support Dr. O'Shea in his comments on the lack of treatment. I do not know what is the current position, but when I inquired a few years ago, he indicated that there was a two to three year wait for people to be seen at his clinic and that there was a corresponding wait for the minority of patients who required bariatric surgery. I commented previously that if abortion were available in this country, there would be a ten month waiting list. In that context, a health system which obliges patients to wait three to four years to be assessed and then a further three to four years to be treated is profoundly abnormal. This speaks to the need for a fundamental reform of the health system and the removal of responsibility for managing it from those who currently run it.

As we move forward, we must educate doctors, teachers and parents who need to get the message that systematically malnourishing their children - I am not referring to undernourishing them - and giving them the wrong foods is a form of neglect. In extreme cases, it is a form of child abuse. The traffic light idea has much to recommend it and if there are some foods which are utterly devoid of nutritional value and contain large amounts of calories - people may continue to consume these foods because they have a low-level addiction to them - they should be the subject of special treatment and there should be a total ban on their being advertised. A similar and complete ban should be introduced on advertising alcohol. Social pressure of this nature can work. The debate in which we engaged in respect of people smoking in cars in which children are present has had some effect. This is now something which people are reluctant to do.

In the incentivising good behaviour and disincentivising bad behaviour I intend to bring before the committee in the near future a proposal to make the entire Leinster House campus a smoke-free zone. I know Deputy Michael Colreavy who referred to this matter will support me in that regard.

I am not so certain about using taxation measures to deal with this issue. The idea of taxing people to modify their behaviour is one about which I am somewhat uncomfortable. I do not understand why poor parents who provide their children with proper nourishment six days a week and then take them out on the seventh day to see a movie and have a "Big Mac" should pay more.