There are a lot of positive angles at play here.

First, one key difference between dietary interventions and pharmaceutical interventions which this article only briefly addresses might be the most important - dietary interventions have shown the potential to CURE diabetes in a way no pharmaceutical intervention (to my knowledge) has. Our pharmaceutical interventions are designed to minimize the impact of the diabetic condition on overall health, not to bring patients to a state where their metabolism would function normally in the absence of pharmacology. Dietary interventions have repeatedly been shown to return the metabolism to “normal” function, and often rapidly. A CURE represents massive savings both for the patient and society, in multiple forms.

Second, while the article rightly acknowledges the challenges associated with helping patients follow diets, these are challenges that can likely be overcome with the right resources. If diet were positioned as a tool with medical significance, and there were willingness (and incentives) across the board to invest in dietary adherence to a level justified by the cost savings that result when diets are followed, I expect we’ll find ways to dramatically improve the mean benefits attributed to diet. (Virta has done a great job showing both that this can be done and that the impacts when it is done are substantial)

Finally, the secondary effects of diet are, by my assessment, better than the secondary effects of a drug. Many diets that have the potential to reverse diabetes also have the potential to drive a wide variety of simultaneous metabolic improvements - thus improving both the health and happiness of the dieter. As we recently saw with metformin, even drugs widely considered “safe” may come out to be harmful over time. This isn’t meant to be a broad anti-pharmacology statement, but on this basis alone, I would err toward choosing diet over drug if both had the potential to yield similar outcomes.

The question, as Russ notes above, is what the best mechanism (or mechanisms) might be to best apply dietary interventions toward this public good; a top-down public program may not be it.

This is a good one to share, I really like that it contributes to pushing the conversation on subsidizing healthier produce and insurance covering fitness pursuits.