RE: My previous reference to how cultural differences affect one's opinion and
judgement, the following, although not related solely to food choices, just
came across my email:


How Culture Can Affect A Doctor's Advice
March 10, 1999 03:34 PM PST

 NEW YORK, May 10 (NYT Syndicate) - Patients depend on their doctors to
give them advice based on the best scientific evidence. But often the
evidence is muddy and the best course of treatment far from clear. When
this occurs, a doctor's cultural beliefs can play an important role in
shaping his or her recommendations.

 In an article in this week's issue of the medical journal The Lancet,
three cancer researchers examined two recently published guidelines for
women who have inherited genes that put them at very high risk for
developing breast and ovarian cancer, BRCA1 and BRCA2 — for Breast Cancer
gene 1 and 2. One set of guidelines was drawn up by a panel of experts in
France, while the other by a panel in the United States.

 The two panels agreed on most points, but in areas where the evidence was
equivocal they came to very different conclusions. The differences, the
researchers write, demonstrate how cultural factors can shape medical
decision-making.

 The lead author of the paper was Dr. Francois Eisinger of the
Paoli-Calmettes Institute in Marseille, France.

 The panels diverged on three main points: whether women with these genes
should regularly perform breast self-exams, whether they should change
their lifestyles in hopes of reducing their cancer risk, and whether they
should have prophylactic surgery — operations to remove their breasts and
ovaries while they are young before a cancer has time to develop.

 In the case of breast self-exams, the U.S. guidelines recommend that these
women examine their breasts regularly starting at age 20, while the French
guidelines do not recommend breast self-examination. Such exams, the French
experts said, may induce anxiety in some women and, they argued, "It is not
desirable to shift the responsibility for screening onto the women
themselves."

 In the case of lifestyle changes, the U.S. panel admitted that the
evidence is not strong that lifestyle changes can make a difference, but,
nevertheless, recommended that women with these genes should exercise, eat
a low-fat diet and avoid smoking. The French guidelines, in contrast, make
no mention of lifestyle changes.

 Both panels concluded that prophylactic mastectomy and prophylactic
oophorectomy (the operation to remove the ovaries) are options for these
women but the panels took very different positions on the issue. The U.S.
guidelines require only that women who wish to have the operations give
informed consent to demonstrate that they understand the risks and possible
benefits of procedures.

 The French guidelines, on the other hand, say doctors should "oppose"
prophylactic mastectomy in women under 30 and oophorectomy in women under
35, and, even then, doctors should only consider the operations in women
whose breast cancer risk is more than 60 percent and whose ovarian cancer
risk is more than 20 percent.

 In addition, the French guidelines urge that women who fulfill these
requirements wait several months before considering the procedure. Such
recommendations, Reisinger and his colleagues note, carry great legal
weight in France, where, unlike the United States, doctors need more than
informed consent to perform an operation. "Under French law, a physician
cannot invade a patient's bodily integrity unless there is clear
therapeutic justification, even if previous permission for such an invasion
has been granted," the researchers write.

 In the United States, on the other hand, "valid informed consent is
sufficient for procedures to take place" and, Reisinger and his colleagues
add, the U.S. panel "does not recognize the possibility of active
opposition to a woman's intention or suggest delay."

 The different recommendations may be due in part to different cultural
attitudes toward the breast, write the researchers. They note that the
French guidelines refer to mastectomy as "a mutilation." Breast self-exam
may not be acceptable in France, they write, because "French women may feel
more sensitive than American women about touching their breasts for
clinical reasons." And the apparent reluctance of the French panel to
approve of oophorectomy may reflect long-standing concern among the French
about France's low birth rate.

 The U.S. guidelines, on the other hand, appear to reflect the American
culture of individualism in which patients are expected to assume more
responsibility for their health, such as adopting healthier lifestyles and,
in this case, performing breast self-exams, and are given more autonomy in
making health care decisions, such as whether or not to have an operation.

 "The greater emphasis on autonomy in the USA may have grown out of the
long history of individualism, whereas in France, as in much of Europe,
society is more communitarian." The French approach, Eisinger and his
co-authors argue, "would probably be viewed as paternalistic in the United
States."

 Eisinger and his colleagues conclude that just as there is a need for
better scientific evidence to guide doctors and patients in making
difficult decisions so, too, there is a need for a better understanding "of
how culture influences clinical recommendations and adherence to them.