When people do something shockingly out of character, they sometimes blame the influence of a supernatural, malevolent and irresistible force. To give the devil his due, however, it is only fair to acknowledge the existence of other forces – natural, well-intentioned, and perhaps even more irresistible.

When I was three years old, I underwent a tonsillectomy complicated by severe blood-loss. That surgery was followed by a persistent anemia that was seen as life-threatening. My pediatrician sent my mother to see a prominent specialist in the treatment of childhood anemia. He informed her that if she wanted me to recover, she would have to feed me calves’ liver and bacon.

As an observant Jew, she was in an anguishing dilemma, but preserving her child’s life left her no choice; she purchased a special set of cookware, dishes and silverware to prepare and serve me bacon. I can only imagine what it was like for her to enter a non-kosher butcher shop and buy something that had been religiously shunned all her life–something that had been– by Divine precept– forbidden for her and her ancestors for millennia. I recovered from the anemia, but the violence done to a lifestyle and the damage done to relationships within the family and the rest of the Jewish community was severe and long lasting. It became impossible to scrupulously keep the kosher and non-kosher parts of the kitchen separate, and the model of a kosher home ultimately crumbled. The physician, to be charitable, may have truly believed that there was but one remedy for the anemia. There is no uncertainty, however, that he was conscious of the fact that he obliged my mother to choose between preserving her religious values or her child’s life. Whose beliefs would be validated, whose beliefs would prevail, whose would be surrendered? Would a doctor who obeyed Jewish dietary laws have insisted on the same solution to the anemia? Would a physician who was a vegan have prescribed the same remedy?

This episode happened almost 73 years ago, but its persistent echoes of pain call attention to a problem that not only is still with us, but that has acquired importance on a much larger scale.

The issues go well beyond personal or parochial concerns. Consider the experience of Mohandas Gandhi. In 1931, Gandhi was told by his doctors that his failing health (abused by years of imprisonment, extended hunger strikes, fasting near-unto-death, etc.,) could only be restored if he would agree to drink goat’s milk. He reluctantly complied with the doctors’ orders, but he was outspoken in his remorse for having surrendered to medical advice. Calling his dependence upon goat’s milk “the tragedy of my life,” he wrote:

"I believe that in the limitless vegetable kingdom there is an effective substitute for milk, which, every medical man admits, has its drawbacks, and which is destined by Nature not for man, but for babies and young ones of lower animals. I should count no cost too dear for making a search."

As recently as 1998, the Dalai Lama, who had lived as a vegetarian all his life, was advised by his doctors that his failing health required him to eat flesh. He resolved his moral dilemma by consuming meat only on alternate days. Although the media keep us informed about world-famous people who have surrendered or compromised their vegetarianism on the advice of their doctors, there are countless people — not considered newsworthy— who face the same dilemma.

We are looking at an issue that spans generations and national borders. One has to wonder what scientific and medical sources convince physicians that good health is fundamentally, “naturally” and necessarily dependent on the consumption of flesh and other animal products.

The thrust of this essay is not to denigrate the medical profession, but rather to explore and discuss some historical, cultural and behavioral elements that contribute to the current confusion and ambiguity regarding plant-based diets.

In Voices From the Edge, John Robbins reminds us that “the average MD in four years of medical school gets two and a half hours of coursework in nutrition — and even that is wrong!” This marginalization of nutritional science in the medical school curriculum has resulted in grievously widespread misinformation. There is cause for great hope, however, in the work of physicians such as Michael Klaper and Neal Barnard—distinguished medical scientists, advocates and models for sound medical/dietary practice and compassionate living.

The physician, as a human being, does not grow up devoid of a full spectrum of values that are in harmony with the mainstream of her/his culture. Thus, although there may be no “value structure” built into medical science or clinical practice, a physician cannot fail to be a participating member of his/her culture. Since the patient cannot dispute the doctor’s medical knowledge and clinical experience, when there is a dissonance between the values of the doctor and the patient, the physician’s medical authority puts the patient’s value system at a disadvantage.

An anthropological perspective reveals that there are many strong value systems that characterize a culture. Dietary norms and customs are deeply embedded, and in many cultures they are proudly held as distinctive and defining properties... “as American as apple pie,” for example, or The Haggis as an emblem of Scottish culture. What is unhappily common is that another country’s food preferences may be seen as so bizarre as to provoke mocking and derogatory references. The use of the term “Frogs” as a disparaging term for French people, for example, derives from their consumption of frogs’ legs. Equally negative and scornful attitudes are generated by observing other cultures’ enjoyment of foods that we might consider disgusting or offensive: animals’ eyeballs, sheep’s testicles, worms and grubs, termites, hogs’ intestines, snakes, scorpions, etc.

Solidly ingrained – and unconscious — cultural dietary norms would make it highly unlikely for an American physician to prescribe - or a patient to consume - a daily bowl of earthworm soup as a rich source of B-complex vitamins.

Our culture has bestowed upon physicians a level of authority that borders on that of a deity. The examples of famous figures who have surrendered to that authority represent only the tip of a massive iceberg of prestige and power.

The phrase “medical advice” quickly becomes converted to “doctor’s orders.” Among the synonyms for “orders” we find such words as injunction, bidding, directive and commandment. Which members of society have this kind of authority? Who can “order” someone’s behavior? Judges can “order” compliance with their instructions under pain of imprisonment or fine. A judge can even send a person to the electric chair. But however much authority the judge may possess, the accused can only stand trial if a physician declares him to be adequately fit and mentally competent. And even at the last moment of barbarity, the execution might be delayed if the condemned man falls into a coma, and a physician declares him too sick to be put to death.

Generally speaking, it is the physician in our society who has the last word across the widest spectrum of contingencies: from being admitted to kindergarten, the football team, or astronauts training, to being excused from military service, jury duty or gym classes. Through most of our lives “...a note from your doctor” is the magical phrase that serves to open (or close) doors for special opportunities or to exempt us from onerous obligations.

What is especially relevant to our discussion here is the question, “Who in our society can grant absolution, pardon or the suspension of judgment? Members of the clergy, the judiciary, the government or the medical profession?” But when it comes to lowering the contingencies for accountability, the doctor has absolutely the last word.

It is a common experience for a vegan or vegetarian in a restaurant to query the server - in detail - about the ingredients of menu items. If you feel the need to explain to your companions, however, that the reason for refusing the flesh entree or the cheesecake dessert is your compassion for animals, you must be prepared for critical - sometimes aggressive – commentary. If, however, you say that you would just love to eat those foods, but your doctor has forbidden it, and you mumble something about cholesterol, coronary arteries, blood pressure or the like, your “plight” will very likely evoke a compassionate, sympathetic and supportive response; your special requests for menu alterations will be treated with respect and concern.

There has evolved a kind of culturally established and maintained set of behaviors of reverential respect for “The Doctor,” tinged with awe and flavored with fear of offending. It has become one of the protocols of the profession to maintain a posture of detached superiority to the patient, who is regularly reminded that s/he is a “layman.” There are old traditions of writing prescriptions in Latin and the use of descriptive terminology that distances the patient’s language from the physician’s: my running nose becomes rhinitis, my bruise becomes a hematoma, my headache turns into cephalgia.

There are many verbal devices that further serve to create and maintain distance on a superior/inferior dimension, e.g., addressing the patient by first name, while referring to the physician in the third person (“Just have a seat, Stanley, the doctor will see you shortly”); exclusively limiting the appellation “doctor” to a physician (Albert Einstein in the physician’s waiting room would be addressed as “Albert,” “Al,” or at best, “Mr. Einstein”); and requiring the patient to describe his complaint to the nurse in simple words (“Mr. Einstein” would be expected to talk of “itching all over,” which the doctor would subsequently “diagnose” as generalized pruritis).

The perception of the patient as “child” and the physician as “responsible adult parent” is a powerful social dynamic. It is regularly strengthened in medical journal articles about “non-compliant patients”— patients who do not take their medication, who are “defiant,” or who “do not follow the doctor’s orders.”

These abbreviated snapshots point to a pattern of social and psychological conditioning that (hopefully) enhances the effectiveness of medical treatment by characterizing the physician as a superior being, possessed of arcane knowledge. Whatever positive effects this “image creation” may yield, the extraordinary empowerment of the physician enfeebles the patient and magnifies his or her vulnerability.

There are physicians who take pains to honor the ethical or religious commitments of their patients. Our family has been served over the years by health care professionals whose attitudes have ranged from sympathetic, to amused-but-tolerant, to amused-but-scornful, to flatly annoyed and overtly hostile.

It makes a difference whether the patient’s requirements are recognized as springing from a religious source that is recognized by the doctor as a “genuine religion” or whether the doctor considers the patient’s concerns the product of a frivolity or a fad. In many quarters, ethical, philosophical or ideological interests have not yet achieved full respectability.

We have taken a cursory look at the range, depth and impact of the physician on efforts to change dietary behavior. To a growing number of thoughtful and compassionate individuals, it has become quite clear that if our planet and its inhabitants are to endure and thrive, there is a compelling need for a mass return to agricultural, economic, environmental, social and spiritual sanity. And a key component of that sanity is the acknowledgment of the urgency of a world-wide shift to a plant-based diet.

There is an old French adage – “Plus ça change, plus c’est la même chose” – “The more things change, the more they stay the same.” It may have a cynical ring to it, but it does encapsulate a genuine truth: However much circumstances or cases may change, if the basic values and attitudes of a culture continue unchanged, its responses to challenges will remain as they were.

It is our responsibility to raise the consciousness of the physicians we engage. If a physician prescribes Premarin as hormone replacement therapy, for example, it is up to us to explain why a drug derived from pregnant mares’ urine is unacceptable, and request one of the vegan alternatives.

As empowered patients, it behooves us to insist on – indeed, demand— acknowledgment and full respect for our ethical, philosophical and ideological commitments.

We need to counteract pervasive ignorance and insensitivity by working actively to disseminate the work of enlightened and compassionate physicians.

Stanley M. Sapon, Ph.D., is Professor Emeritus of Psycholinguistics at the University of Rochester (NY) and co-founder of the Maimonides Project, a national resource center for grassroots hunger-relief. He is currently writing a book on vegan renewal. Read more essays from Dr. Sapon on his website at http://www.VeganValues.org