Why controversial ideas in science shouldn’t always be dismissed

Maverick scientists often get a bad reputation among their more sober peers. Science requires evidence and consensus, and contrarianism is rarely a way forward.

But there is always an exception that proves the rule. Take the idea that the ketogenic diet – a restrictive regime most famous as a way to rapidly lose weight – could be a treatment for anorexia nervosa. Given that this is a psychiatric condition characterised by a compulsion to restrict food, the proposal sounds absurd at best, painfully irresponsible at worst.

We should take this counterintuitive idea seriously, however. As we learn in this week’s cover story, following the diet does seem to help people with the condition, albeit only in a small study. It is thought to be a result of keto correcting haywire energy release in brain cells, thereby cutting anxiety and, with it, the compulsion to restrict food. If nothing else, this is a sign that keto should be studied as a potential anorexia treatment. At present, one-third of those with the condition don’t recover from standard treatment, and anorexia has the highest mortality rate of any psychiatric condition.

Unfortunately, supporting keto as a treatment for serious mental health conditions aligns one with people such as Robert F. Kennedy Jr, the controversial US health secretary. When it comes to health advice, you can’t get much more maverick than a man who claims, without evidence, that vaccines cause autism.

But it is a mistake to think that an idea is bad simply because people who generally have bad ideas support it. Multiple lines of evidence point towards keto’s mental health benefits – as we set out in our 2 May cover story, it seems to hold promise for blunting the symptoms of conditions from severe depression to schizophrenia. Given the research is at an early stage, the diet should be used for anorexia only under medical supervision, as much larger trials are needed. But seeking solutions to debilitating conditions via careful science is vital, even if doing so carries the risk of initially being labelled absurd, irresponsible or maverick.