Opinion

The Great Debate

What should we eat to stay healthy? Why experts actually have no idea.

To match FOOD-GLUTENFREE/Have you ever wondered why nutrition experts so often change their minds about what constitutes a healthy diet? In the last six months, a variety of experts and nutrition organizations have issued at least as many major dietary guidelines proclaiming the next set of instructions on what to eat to prevent cancer, whether processed foods are really food, whether the type of fat you eat has any effect on developing heart disease, and how to control diabetes with diet. And the next set of U.S. Department of Agriculture (USDA) and Health and Human Services (HHS) dietary guidelines, due out next year, are already creating a buzz.

These new guidelines have, like most dietary guidelines in the past, done little to solidify our understanding of the cause and effect relationship between diet and disease. Even worse, they’re likely to discredit nutritional science. Moreover, guidelines like these tend to suggest, without proper research as proof, that people have control over whether or not they develop certain diseases, and it is therefore their fault if they become ill.

A large part of the issue comes down to funding, and a lack of resources to do the kinds of studies that would help answer some of our most pressing questions. Our insistence on making recommendations — without having the proper research to back them up — has unintended, harmful effects.

Nutrition research, like all medical research, is extremely difficult and expensive. But nutrition research is even more complex than research in other areas of medicine. First, many well-designed studies have failed simply because the subjects couldn’t adhere to the diet: asking subjects to eat a diet lower in salt, for example, can initially make food seem tasteless.

Second, changes in diets have the potential to change dozens of other variables at the same time. When trying to determine whether a low-protein diet decreases cancer, for example, a study may involve reductions in grilled or processed meat — which may contain cancer-causing substances. To control for these coincidental effects, and subtle differences between the subjects, studies of dietary changes often require tens of thousands of participants.

Why low social status can be bad for your health

Inequality is at an all-time high in America. Since the 2008 crash, recent IRS figures show, the wealth of the top 1 percent grew 31 percent while the rest of American incomes grew by less than 1 percent. But although it might appear that income disparities affect only the poor and have primarily an economic impact, dozens of studies now link extreme inequality with poor health and shorter lives, across the entire socioeconomic spectrum.

Overall, the United States has among the largest social and economic inequalities of any rich country. Japan and the Scandinavian countries have the smallest. The more equal countries also have the longest life expectancies — and the richest American men only have the life expectancy of an average Japanese man, which is 4.5 years longer than the U.S. average, according to Sir Michael Marmot, a leading researcher on inequality and professor of epidemiology at University College London. He notes that residents of affluent suburban Maryland live, on average, 17 years longer than people in inner city Washington, D.C.

Marmot’s own research focuses on the UK, where a national healthcare system provides all socioeconomic classes with quality care. He has compared low- and high- ranking British civil servants over the course of their lives on a variety of health measures, ranging from cancer to obesity to alcohol addiction. For virtually all conditions except breast and prostate cancer (it is not clear why these are exceptions), Marmot found that those at the bottom are at dramatically greater risk, with overall mortality up to three times higher, depending on the specific condition. Increased levels of unhealthy behavior among the less-affluent — like smoking — did not account for all of the differences. Also, even the lowest-ranked civil servants in Marmot’s research were employed, meaning that those on bottom rungs weren’t impoverished, simply less well-off.

New bird flu strain creates fear and surveillance

An emerging bird flu that is mysterious and deadly is haunting China. With four fresh H7N9 cases reported in Jiangsu Province and no indication as to how three Chinese adults caught the little-noted avian flu virus that killed two of them in March, the global medical community is hoping the new flu will calm down until China’s health system can determine how it spread.

“I can tell you this thing is real and definitely has the markings of being a killer,” says Jason Tetro, coordinator of the Emerging Pathogens Research Centre in Ottawa, which on Monday examined gene sequences from three of China’s H7N9 cases.

“I don’t wish to cause panic,” Tetro said in an interview, noting that if the subtype were proven to have emerged from a small farm, he wouldn’t be much alarmed. Infecting a big poultry reservoir, on the other hand, might well enable H7N9 to access Asia’s wild bird population. The upstart subtype could then become as menacing as H5N1, which since 2005 has officially taken 371 lives in 622 cases, mostly in China, Southeast Asia and Egypt, according to the World Health Organization. The additional Chinese cases have convinced Tetro that “close contact with birds” has been involved. “And I think the CAFOs [industrial chicken farms] have definitely contributed to the evolution of this virus,” he says.

The keepers of truth: Seth Mnookin on fear and the vaccine wars

Whooping cough. Measles. These diseases, once thought almost gone, are creeping back into schools and hospitals around the country. The reason? Parents are refusing to have their children vaccinated, because they’re afraid that the shots can cause autism.

This ideas stems from a 1998 study in the medical journal The Lancet, in which British doctor Andrew Wakefield suggested the MMR (measles, mumps, and rubella) vaccine may be linked to autism.

The journal has since withdrawn the study, Wakefield lost his doctor’s license, and the British Medical Journal declared it fraud. But that hasn’t stopped celebrities such as Jenny McCarthy from declaring that there’s a link.

Business must change to earn back the public’s trust

– Jeff Kindler is the chairman and CEO of Pfizer. He has agreed to reply to readers’ responses about this opinion piece. The views expressed are his own. —

While it’s encouraging that slightly more people say they trust business and government today than a year ago, surveys show more than 70 percent of Americans and Europeans fear companies and governments will return to business as usual once the recession ends. It’s easy to see why.

In just the past year, a UK accounting scandal forced out the Speaker of the House of Commons, for the first time since 1695. The Governor of Illinois was thrown out of office for influence peddling, and a Congressman was convicted of accepting bribes and storing the cash in his freezer.

Your health plan’s Toyota complex

 Ford Vox is resident physician at Washington University School of Medicine’s neurology department.

– Ford Vox is a medical journalist and a physician. The opinions expressed are his own.–

A trade group by the name of America’s Health Insurance Plans began the week with oddly revealing rhetoric against a key proposal under debate at the health care summit today – controlling insurance premium hikes. Obama’s proposal “would be like capping the prices auto makers can charge consumers, but letting the steel, rubber, and technology manufacturers charge the auto makers whatever they want,” said Karen Ignagni, AHIP’s president.

Ignagni’s analogy shifted blame onto doctors and hospitals — the rubber and whatnot — but her analogy is apt in one way – we’ve got to pay attention to where the rubber hits the road. Relying on face-to-face relationships and earned trust, doctors are better poised to control costs than any federal agency or insurance company. Family practice doctors, who wield the referral, are the key to reigning in the excessive outpatient specialist care that accounts of much of the waste in American medicine. But they need some skin in the game.

Live Debate: Breast cancer screening and mammography

cancerSweeping new U.S. breast cancer guidelines released on Monday recommend against routine mammograms for women in their 40s, and suggest women 50 to 74 only get a mammogram every other year.

The new guidelines by the U.S. Preventive Services Task Force, an influential panel of independent experts, would sharply curtail the number of breast mammograms done in the United States, sparing women the worry of false alarms and the cost and trouble of extra tests.

But U.S. cancer experts say the altered schedule may mean more women will die from breast cancer.

from Ask...:

Should junk food be taxed?

Increasingly vocal calls for taxes on sugary drinks and junk food are fueling a behind- the-scenes battle that public health officials say is reminiscent of America's war on cigarettes.

Fueling the debate are revenue-hungry federal, state and local governments officials who are eying a potential $50 billion windfall from taxes on over 10 years.

Take a look at the New York City Department of Health's ad discouraging people from drinking sugary sodas, and let us know whether you think a junk food tax would be good public policy, or an intrusive step too far by the nanny state.

Moore is less for healthcare reform

Peter PittsPeter J. Pitts is president of the Center for Medicine in the Public Interest and a former FDA associate commissioner. The views expressed are his own.

In SiCKO, Michael Moore portrayed the British National Health Service and the Canadian health system as particular exemplars of excellence. He backed it up with a lot of statistics, but statistics, as the saying goes, are like a bathing suit. What they show you is interesting, but what they conceal is essential.

And what SiCKO concealed was that systems such as those in the United Kingdom and Canada are cost-based rather than patient-centric models. Facts, no matter how inconvenient to one’s argument, must not be ignored.

from The Great Debate UK:

Confronting medical issues for women

shelley-2008

- Shelley Ross is secretary general of the Medical Women's International Association, a non-governmental organisation representing women doctors from all continents. The opinions expressed are her own. -

The Medical Women's International Association was created in 1919, not long after the first International Women's Day in 1911. MWIA's founder was an American by the name of Dr. Esther Pohl Lovejoy, who served as its first president. She was an obstetrician by training but an activist and humanitarian by action. Not only did she establish MWIA but she also founded the American Women's Hospital Service during the First World War.

The motto of the Medical Women's International Association, Matris Animo Curant, comes from Latin and translates to read, "She Heals with the Spirit of a Mother."

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