Salt & Human Health

... the biggest threat to science has been quietly occurring under the radar, even though it may be changing the very foundation of American innovation. The threat is money—specifically, the decline of government support for science and the growing dominance of private spending over American research.

In 1965, the federal government financed more than 60 percent of all R&D in the United States. By 2006, the balance had flipped, with 65 percent of R&D in this country being funded by private interests.

That's the complaint in a story by Jennifer Washburn in this month's Discover magazine on "Science's Worst Enemy: Corporate Funding."

I haven't checked her figures, but I doubt that the government ever funded two-thirds of US R&D; a more reasonable figure is the 40% today. But worse than the math is the author's implicit assumption that socializing the country's research and development investments is a good thing -- that private investments reflect a for-profit bias while government investments are "pure" and "untainted." Washburn fears that "if the balance tips too far, the 'public interest' side of the science system—known for its commitment to independence and objectivity—will atrophy."

Some would question the "commitment to independence and objectivity" of federal researchers and those enjoying their largesse. Rather than rehearse the numerous and egregious examples, I'd suggest a simple reflection on the wisdom of our Founding Fathers in setting up a government recognizing that every person and institution has self-interests. The question is how they pursue them and how we can sort through competing interests to get the truth upon which to base our decisions and public policies.

In the salt area, we badly need explicit "evidence-based" policy based not on passion and emotion, but on replicable, quality science. We need to look at evidence to answer the question: would reducing population salt intakes improve health? It turns out that virtually all the studies in this area are government-funded. While often characterized by government-convened "expert" groups, the actual research does not find a health outcomes benefit to salt reduction.

Without doubt, corporate-funded research employed to support public policy deserves to be held to the highest standard and its analysis held to the standards of the Data Quality Act. So, too, does government-funded research. There should be no comfort taken -- nor relief granted -- to conclusions of government-funded scientists because they work for "the public." Sorry, Jennifer.

Posted by Dick Hanneman at 12:26 PM | Permalink

Reading Gina Kolata’s New York Times book review of Gary Taubes’ new book, Good Calories, Bad Calories, I’m struck that the book is really two-in-one. The first “book” is the heavily-researched and compellingly-argued critique of the scientific foundation of current dietary guidance. As Kolata summarizes his argument: “nutrition and public policy research and policy have been driven by poor science and a sort of pigheaded insistence on failed hypotheses.” Sounds like the sodium and health debate to me. Kolata says “much of what Taubes relates will be eye-opening to those who have not closely followed the science, or lack of science, in this area.” The second “book” is Taubes argument favoring low-carb diets.

I fear too many may neglect the impeccable research buttressing “book one” if they don’t accept Taubes’ answer to the narrower question of the role of carbohydrate, fat and protein as causes of heart disease. That would be a great loss. “Book one” is a great stand-alone read and a devastating critique of the “consensus” method – as opposed to an “evidence-based” method – of formulating dietary recommendations.

Taubes concludes: “From the inception of the diet-heart hypothesis in the early 1950s, those who argued that dietary fat caused heart disease accumulated the evidential equivalent of a mythology to support their belief. These myths are still passed on faithfully to the present day.” Kolata adds: “The story is similar for salt and blood pressure, and for dietary fiber and cancer,” concluding “Taubes convincingly shows that much of what is believed about nutrition and health is based on the flimsiest science.”

There’s much more in Taubes’ 450-page book. Make sure you read at least “book one.”

Posted by Dick Hanneman at 11:43 AM | Permalink

Gary Taubes’ new book prompted a second article in The New York Times in which NYT science writer John Tierney explains how the science underlying our dietary guidelines departed so sharply from quality science. He attributes it to the process of soliciting “expert opinion” and declares the process an “informational cascade” where an initial error is compounded and implanted as policy as successive “experts” sign-on.

“Cascades are especially common in medicine as doctors take their cues from others, leading them to overdiagnose some faddish ailments (called bandwagon diseases) and overprescribe certain treatments (like the tonsillectomies once popular for children).” Tierney recounts several of Taubes’ examples, in particular that eating fat has produced an epidemic of heart disease. The original hypothesis was embraced by politicians (Sen. George McGovern (D-SD) and President Jimmy Carter’s USDA activist Carol Tucker Foreman leading to the Dietary Guidelines for Americans and, eventually, today, to the Food Guide Pyramid. Unconvinced scientists were intimidated by politicians and the media; Tierney quotes economist Timur Kuran’s description as “a reputational cascade, in which it becomes a career risk for dissidents to question the popular wisdom.” Taubes’ book includes the anecdote of an exchange of a prominent nutrition scientist responded to Sen. McGovern when McGovern asked him why he refused to accept the conclusions of “92% of the world’s leading doctors.” The scientist called for policy based on science, not “by anything that smacks of a Gallup poll.”

Posted by Dick Hanneman at 11:31 AM | Permalink

About 18 months ago the Center for Science in the Public Interest (CSPI) petitioned to rescind FDA's Generally Recognized as Safe (GRAS regulatory exemption), arguing that since salt was implicated in hypertension, it wasn't "safe" and should be regulated as other food ingredients. FDA was obligated to conduct a public meeting, though it delayed considerably in scheduling. Repeal of GRAS would subject salt to FDA regulatory limits -- the authority to have food manufacturers limit the amount of salt in their products.

The public hearing has been scheduled for November 29th. The Salt Institute will testify.

Posted by Dick Hanneman at 11:19 AM | Permalink

Articles in the Chicago Tribune and Washington Post suggest that the World Health Organization's efforts to remain "politically correct" will be an uphill slog.

In the Sept 23 Tribune story, Julie Deardorff equates drinking increasingly-popular "nutritionally enhanced" waters which promise to deliver not only hydration but other health benefits to taking extra vitamins that "doesn't necessarily make you healthier." In fact, she says the only proven health benefit is to the profits of the beverage industry.

Whether fortified water can deliver on all those promises is still up for debate. Critics say there's no science to show enhanced water has more health benefits than less expensive tap water, while environmental organizations, religious groups and even restaurateurs argue that all bottled water -- enhanced or not -- is a wasteful and insupportable use of fossil fuels because of the costs associated with its manufacture and transportation. From a nutritional standpoint, experts maintain that it's better to get nutrients through whole foods.

She notes that

The premise behind functional water is that the public is chronically dehydrated and short on nutrients. And because it's often hard to change a person's behavior, food companies are changing the food they're eating or drinking.

And she includes fascinating quotes:

"As a nutritionist, I may not support [functional water], but as a public-health servant, I do," said Roger Clemens, the public-health specialist for the Institute of Food Technologists. "Our goal is to provide the best possible nutrition for 300 million people in the country. In this case, it may be it takes us looking at fortified water to do that."

and

"There's not a single drink out there -- from Enviga to SmartWater -- that has any proof of impact," said nutrition professor Barry Popkin, who directs the Interdisciplinary Center for Obesity at the University of North Carolina at Chapel Hill. "Just because [a nutrient] is in the product doesn't necessarily mean it will impact you or get in your body. There are all sorts of false labels promising health benefits.

The Post story, predictably, casts the issue in Inside-the-Beltway effects. Says Jane Black:

A billion-dollar battle over selling sports drinks and "enhanced" water in public schools has spilled into Congress and threatens to derail a major attempt to cut back the sale of junk food from school vending machines and snack bars.

In an attempt to limit the sale of high-calorie sodas, candy bars and other snacks in schools, Sen. Tom Harkin (D-Iowa) has introduced a bill that would have the government set new nutritional standards for the foods and drinks that schools sell to students outside cafeterias. But just what those standards should be is the issue.

Public health advocates want the standards to ban the sale of Gatorade and Powerade, which typically contain as much as two-thirds the sugar of sodas and more sodium, as well as sweetened waters such as VitaminWater and SoBe Life Water.

Sen. Harkin hopes to add his concerns into this year's Farm Bill in the form of federal standards and claims the Grocery Manufacturers (which has "historically resisted any regulation" is open to the idea. We suspect that GMA would insist on federal pre-emption; a likely deal-breaker for Harkin.

Back in Geneva, WHO may be scratching their collective heads wondering how they ever got crosswise to their normal bedfellows who are taking stronger and stronger exception to the notion that beverages be considered a significant nutrient source. So, whether the drinking water is "artesian water," "mineral water," " purified water," "sparkling bottled water," "spring water," or just plain tapwater, the view seems to be: use it for hydration, not nutrient fortification.

Which, of course, raises a whole new set of questions never addressed by the journalists: what about fluorodated water or iodized water? Both have been used instead of using salt as the carrier.

Posted by Dick Hanneman at 04:42 PM | Permalink

Anti-salt zealots display a religious fervor for their cause, trampling scientists who remind them that actual evidence of a health benefit exists only in the end product of elaborate mathematical models extrapolating only blood pressure effects (and even those are often shrouded in withheld statistics preventing replication). There's an arrogance to their advocacy. And a familiarity.

Investigative science reporter Gary Taubes published the lead story in the New York Times Magazine on September 16, asking "Do We Really Know What Makes Us Healthy?" It's the tragic story of well-intended, plausible advocacy of hormone replacement therapy (HRT) for post-menopausal women. The bright promise, the powerful claims and the glittering possibilities all came crashing down a few years ago when it was found that for many if not most of the target audience, the "cure" was killing far more than it was helping.

Taubes called for more "self-doubt" and recommital to the discipline of scientific investigation, foregoing the passion of the righteous objective for the surer cycle of scientific advance -- proposing hypotheses, testing them to discard most of them and then repeating the cycle to refine those who pass muster.

As he pointed out:

While it is easy to find authority figures in medicine and public health who will argue that today’s version of H.R.T. wisdom is assuredly the correct one, it’s equally easy to find authorities who will say that surely we don’t know. The one thing on which they will all agree is that the kind of experimental trial necessary to determine the truth would be excessively expensive and time-consuming and so will almost assuredly never happen. Meanwhile, the question of how many women may have died prematurely or suffered strokes or breast cancer because they were taking a pill that their physicians had prescribed to protect them against heart disease lingers unanswered. A reasonable estimate would be tens of thousands.

In conclusion, Taubes cautions:

All of this suggests that the best advice is to keep in mind the law of unintended consequences. The reason clinicians test drugs with randomized trials is to establish whether the hoped-for benefits are real and, if so, whether there are unforeseen side effects that may outweigh the benefits. If the implication of an epidemiologist’s study is that some drug or diet will bring us improved prosperity and health, then wonder about the unforeseen consequences. In these cases, it’s never a bad idea to remain skeptical until somebody spends the time and the money to do a randomized trial and, contrary to much of the history of the endeavor to date, fails to refute it.

Continue reading "HRT: Model for dietary salt?" »

Posted by Dick Hanneman at 05:25 PM | Permalink

You can't discern the cankers and the warts at 30,000 feet, but taking in the big picture often helps us understand the motivations that play out as the tangled inconsistencies of daily news stories about health. There are some whose mission in life is to point in alarm at instances where individuals or society comes up short -- where problems mar perfection. These professional and persistent pessimists, in the health arena, would have us focus attention and resources on such interventions as dietary changes ostensibly to effect improved health outcomes, but based only on plausible, but unproven scientific evidence.

A blog today on JunkFoodScience hits the nail on the head:

There’s been so much good news recently about the state of our health and that of children. This has clearly distressed alarmists. To keep their gloomy myths alive, they’ve tried to: A). bury the news and B). convince us that good is really bad.

With people not buying any of that, they’ve added plan C: scream louder. As Dr Ian Campbell, medical director of Weight Concern, told the BBC news this week: “We are not making enough progress!”

Facts have such a troublesome habit of getting in the way of agendas. Let’s look at three major new health reports that all brought good news.

Author Sandy Szwarc points out that the 2006 National Health Interview Survey released recently found 88% of Americans self-report good or excellent health, new figures released this past week from the Centers for Disease Control and Prevention showing strong historic trends of lengthening life expectancies and falling rates of heart disease, and a UNCEF announcement this week that more children are surviving today than ever before in history.

We think the glass is at least half full, and filling steadily.

Posted by Dick Hanneman at 10:54 AM | Permalink