Junkfood Science: November 2006

November 30, 2006

November Diet Wackiness

This month, we’ve heard about the:

* Doggie Diet, where dogs and their owners lose weight together with a “fitness unleashed” program

* Cookie Diet creator promoting another extreme Calorie Restriction diet of 800 calories a day

* Mini Liquid Diet, that includes a liter of water a day and eliminates liquids — such as juices, low-fat milk, tea and coffee — claimed to “drive you to eat more”

* Water Diet, also called the Before, During and After diet because it advocates drinking three 8 ounces of water with each meal

* Not Dieting Diet whose author claims to have lost 235 pounds by eating all of the “good carbs, fats and proteins” he wanted

* Dr. Oz’ Diet as seen on Oprah that promises effortless weight loss to last a lifetime by just cutting 100 calories a day, eliminating “bad” fats and white ingredients (sugar, flour), eating the same few breakfast and lunch foods every day (and having regular sex helps)

* Among what I call the “It’s not a diet, it’s a lifestyle” diets, the Healthy Weight Journal Challenge and another Non-Diet Diet both promised weight loss simply by making “better eating” choices and developing “healthy lifestyles”

* And so many more!

The diet industry thrives on selling false hope and the belief that we can all be slim, but two diets took mind over matter to new heights: the Ear Staple Diet and the False Memory Diet!

Ear stapling for weight loss has been getting serious buzz on weight loss blogs. Many have received flyers about the magic of biomagnetics, seen it on television or heard about it from friends. By stapling titanium points into ears, proponents convince people that toxins are being removed from their cells — with the help of 10 glasses of water a day and using a special formula on their bodies — resulting in weight loss.

Biomagnetics claims have been around for years, accompanied by numerous products which have received disciplinary actions by the FDA, FTC and state Attorney Generals for fraud. A critical review by Quackwatch examined the scientific evidence surrounding biometrics.

Incredibly, the False Memory Diet was actually discussed on Yale University’s Rudd Center blog as an interesting, novel approach with promise. Professor Elizabeth Loftus, known for her work on false memories, spoke at Rutgers about a recent study where she and colleagues were able to convince 40% of the volunteer subjects that they had gotten sick as a child while eating strawberry ice cream. The subjects really believed that it had happened and as a result their preferences for ice cream dropped on a later questionnaire. She said it didn’t work with chocolate chips and potato chips, perhaps because people eat them more often and like them too much, and were less likely to believe the foods once made them sick. The overall idea is that people could be led to avoid “fattening” foods by suggesting a false memory. Sort of mental aversion therapy.

While it hasn’t been tested with real food, the news reported that Dr. Loftus suggested that parents try it with their own children. That’s right, try to implant false memories into innocent children to make them believe certain foods make them sick!

False memory claims have been around for years, too. Cases have surged so dramatically that it’s been called the “mental health crisis of the 1990s,” said Stephen Barrett, M.D. of Quackwatch. The False Memory Syndrome Foundation was formed in 1992 to help victims and their families and offers more information, if you’re curious.

What these diets have in common, with so many ideas surrounding our food, is that their promoters understand, more than most of us, just how incredibly powerful our beliefs are and how easily we can all be taken in. Faith is how we become convinced that one diet has something special — over every other weight loss diet that hasn’t worked — and offers “hope.” Many see diets as a way of taking charge over something (body weight) they feel they can control and that society tells us must and can fit a certain measure. “If we eat this and avoid that, then we all can have a thin figure.”

When it comes to losing or gaining weight, we can place our beliefs in almost anything, as most gimmicks will work for the short term, but in time our bodies will stubbornly return themselves to the general size we were genetically meant to be. Nature has better tricks. :)

Clinical studies have demonstrated for decades that we have limited long-term control over our naturally-diverse body weights beyond about ten pounds (excluding rare health conditions). Even extreme, unhealthful measures cannot be maintained unless we have no choice, such as famines or bariatric surgery-imposed anorexia. As Jeffrey M. Friedman, head of the Laboratory of Molecular Genetics at Rockefeller University in New York, has said: “The heritability of obesity is equivalent to that of height and greater than that of almost every other condition that has been studied.” Despite all of the dieting and exercise, or pigging out and sloth, over the long-term, “people can exert a level of control over their weight within a 10-, perhaps a 15-pound range,” he said. That’s never going to be enough to healthfully change our body types.

Although diets don’t work, we continue to flock to them and believe they are life-saving. And when each diet fails, we believe it is us who failed, not the diet. These sentiments share a surprising similarity to what professor Jonathan Waxman, professor of oncology at Imperial College in London, wrote this week in the British Medical Journal. It is worthy of its own post, which follows.

Musing:No healthful weight loss or weight control method over the past century has been shown to result in long-term, sustained weight loss for virtually anyone who tries them. How much scientific evidence will it take before everyone makes peace with their bodies and their food, and enjoys the full variety of both to the fullest?

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November 29, 2006

Keeping smart about fruits and vegetables

Mom was right about those veggies: Vegetables can help fend off age-related memory loss

Study: Vegetables May Keep Brains Young

Oh really?

The news tell us that eating our veggies can keep us sharp as we grow older but is there any evidence for that claim?

Fruits and vegetables are certainly a welcome part of all the foods we enjoy. While we want to believe that these brightly colored, crunchy treats also have special anti-aging benefits, the evidence is remarkably fuzzy. The study being reported in these news stories is a prime example of the findings of a weak study being greatly exaggerated — by both the media and scientists.

Lead researcher, Martha Clare Morris, chief of Rush University Medical Center’s Rush Center for Healthy Aging in Chicago, told reporters that the slowdown in cognitive decline among those who ate 2.8 or more servings of vegetables a day was “equivalent to about five years of younger age.”

The conclusion in the published study was considerably more conservative, and rightly so: “High vegetable but not fruit consumption may be associated with slower rate of cognitive decline with older age.”

This study was not a clinical intervention trial, carefully designed, randomized and controlled to demonstrate that fruits and vegetables were actually the reason for any differences in cognitive function among elderly people. It was looking for associations among a certain population.

At the beginning of the study, food frequency questionnaires were gathered from 3,718 retirees who were part of the Chicago Health and Aging Project. Their cognitive functions were then tested using fairly crude measures involving word recall, mini-mental state evaluations, etc. The researchers put all of this into their computers looking for associations between cognitive changes over six years and how often the older people ate fruits and vegetables. [Remember, food frequency questionnaires don’t measure how much people eat of various foods, just how many times they remember eating them.]

They found an association between less of a decline in cognitive function and a greater number of vegetable servings eaten. Compared to those eating only about one serving a day, there was a 40% lower decline among those eating almost 3 servings a day and 38% among those eating the greatest number of servings (4.1 servings). While expressed as relative risks those percentages sound impressive. But as we know, such numbers are untenable for these types of studies. And the actual differences on the cognitive test scores really bring home just how untenable those percentages are: a 0.019 standard unit difference and a 0.018 standard unit difference, respectively. Numbers so tiny that their ability to predict real-life differences is questionable, at best. In another universe, this would be considered a non-finding.

The researchers also didn’t factor for things well-known to affect mental function among the elderly, such as their living situations and degree of isolation, social support, degree of stimulation and interactions with people, depression, etc. They also didn’t consider activity levels, another indication of general physical and mental health.

Since it is popularly believed that antioxidant nutrients confer such anti-aging benefits, it is curious that the researchers couldn’t convincingly explain why they were unable to find any correlation with the number of servings of fruits eaten!

The take home message is usually to turn the page or change the channel when a study report uses words like association, link, correlation, or related. Except studies aren’t always reported accurately. Look closely at those headlines and news stories. They make several leaps of faith, based on no credible evidence:

1. vegies are associated with less mental decline

2. lack of vegies are the cause for reduced mental sharpness

3. eating more vegies can prevent a decline in mental function

Just because something sounds intuitively correct, doesn’t always make it so. And correlations can never show causation. Rolls-Royce owners enjoy greater general health, but buying a Rolls-Royce is certainly not going to make you healthier. Although you may feel better. :)

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Has being fat become illegal?

The news today illustrates just how over the top the public discourse over fat has become.

Parents across England are having to allay the fears of their children tonight. With "obesity" frenzy reaching media saturation, it is no wonder that in a study of elementary children published in the Journal of Applied Developmental Psychology, professors Phebe Cramer and Tiffany Steinwert documented that by elementary school age, girls fear looking fat more than getting cancer, a nuclear war or losing their parents.

The parents in this article face criminal charges and their nine year old was taken away from them for being too fat. Brothers on trial for overweight dog

While this story might be taken less seriously ... since the nine year old was a dog ... when it happens to fat children and their families in our country, which it does all too often, it doesn’t seem as trivial.

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Vitamin E too!

Just published in the journal Diabetes are additional results from the Women’s Health Study. This is not a trivial study, despite the media’s general apathy to this news.

The National Institutes of Health began the Women’s Health initiative in 1992 to determine if there were ways to help prevent the most common causes of death, disability and impaired quality of life among mature women. This 15-year project is one of the largest prevention studies of its kind. We all want to know how to stay healthy and youthful as we age!

The clinical intervention part of the study is a randomized, double-blind, placebo-controlled clinical trial of 39,876 healthy women followed for just over a decade. Half took vitamin E and the others a placebo (“sugar pill”). Last year, the results were released finding that vitamin E proved to be of no benefit in protecting women from cardiovascular disease, stroke or cancer. And it didn’t matter what were the women’s menopausal status, hormone use, BMI (body mass index), alcohol intake, smoking status or physical activity.

The researchers have now reported that vitamin E also failed to offer any benefits for preventing type 2 diabetes.

There has been a lot of public interest in antioxidants and what seemed like the magic bullet for preventing chronic diseases of aging. This is a terrific illustration of why careful clinical trials on real people followed for many years are so important before we jump to conclusions about the cause or benefit of something based on observational epidemiological studies on large groups of people or select populations (“cohort”); or laboratory or rat studies.

In the laboratory and in animal experiments, vitamin E appeared to work as a vigorous antioxidant against those free radicals that can lead to diabetes. And several population studies found an association between higher intakes of vitamin E in the diet and lower incidences of type 2 diabetes.

Similarly, laboratory and animal research suggested that vitamin E might prevent the accumulation of fatty deposits inside arteries and reduce clogged arteries. Large observational studies also found associations between people eating foods high in vitamin E or taking supplements and lower risks for heart disease.

But as these researchers noted, those types of studies can never indicate a cause because they cannot account for bias and measurement errors and, most importantly, isolate if the effect was actually due to the thing being measured or if that was simply a marker for something else entirely. Only a well-designed, carefully conducted clinical trial can do that.

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November 28, 2006

Headline Headtrips

In recent weeks, we’ve had headlines tell us:

Fruit juice packs pounds on preschoolers


Fruit Juice Not Linked With Children's Weight

Which one is true? You will never know from reading the news reports because both stories were taken from press releases. And sadly, as is often the case, the journalists and reporters didn’t go to the original sources — the actual studies — to give the real story.

The first clue to unsound claims is an emotional appeal. The first story made its way around the world with this and other dire warning headlines such as “Fruit juice bad news for children.” The articles themselves are equally disconcerting. Attempting to worry us, making an issue appear more complicated than it is, and creating controversy and uncertainty where there is none, are all techniques played to sell us on something when good supportive science is lacking. Anytime something makes you feel scared about your food, body or health that is your BALONEY ALERT that you are being manipulated. That’s sales, not science.

Let’s look at the foreboding story first. Most research on preschool children to date has found that excessive fruit juice leads to stunted growth because it displaces the fats and other foods that growing children need. That’s why pediatricians and other child nutritional experts have long recommended limiting preschoolers to 4 to 6 ounces of juice a day. So this new claim that too much juice leads to fatter little ones is puzzling.

It came from a study in Pediatrics looking at whether nutritional counseling messages could influence childhood weight gain and if fruit juices and restrictive eating caused preschool children to become fat. About 2,800 recipients in New York’s special nutritional supplement Women, Infants, and Children (WIC) programs were surveyed. The researchers found an association between excessive daily fruit juice and children gaining a miniscule 0.009 standard deviation more in weight each month — but only in the children who were larger to begin with. They found no association between fruit juice consumption and “excessive” weight gain among smaller children. In other words, the children with a genetic tendancy to be heavier continued to grow proportionately more and stay in their normal growth curves. Thinner children at the lower BMIs normal for them, stayed in their growth curves. Children growing appropriately and generally staying on their individual growth curves is something pediatricians have long viewed as a good thing.

Their other findings concurred with the body of evidence to date. Children whose diets were restricted were larger than children whose food intakes were not restricted. “Dieting” and restrained eating works no better for weight management in children as it does in adults. Yet, incredibly, the researchers suggested that limiting fruit juice could be a strategy for preventing “overweight” in children. They didn’t test this hypothesis, but it is popularly believed today.

They also found that nutritional educational messages to parents made no difference in the children’s weight changes; something that has been borne out in the body of research.

The study behind the headlines reassuring parents that fruit juices are nothing to fear and won’t cause their children to become fat was also published in Pediatrics. These researchers used information from the National Health and Nutrition Examination Survey 1999–2002, which is a continuous evaluation of a nationally-representative sample of the population, including dietary intakes and physical examinations. They found that most preschoolers in our country drank less than 6 ounces of fruit juice, as recommended by pediatricians.

Meaning: All of this upset about juice is really not a public health issue at all. Most parents are doing just fine feeding their children. Parents needn't fear they are hurting their children. Hopefully, parents will not react to the first story by not giving their children any juice for fear they will gain weight.

They also found:

Weight status of the child had no association with the amount of total beverages, milk, 100% fruit juice, fruit drink, or soda consumed. [This actually concurs with the body of sound evidence, epidemiological and clinical, which has shown fat and thin children’s diets do not explain their weights. If you think otherwise, look closely at those studies. Often, they will be of very short duration and unable to show any lasting weight changes. But more often, they have not actually found any weight differences at all. Countless studies find a difference in calories consumed among children and merely assume that might make a difference in their weights, when they haven’t actually been able to find that at all.]

There was no clinically significant association between the types of milk (percentage of fat) consumed and weight status. [Despite what seems intuitively correct and is certainly popular today, whole milk, 2%, low-fat or fat-free milk makes no difference in children’s weights.]

The lead researcher, Dr. Theresa Nicklas, a professor of pediatrics at Baylor College of Medicine, said: "An analysis done by the U.S. Dietary Guidelines Advisory Committee found that 100 percent fruit juices provide substantial amounts of vitamin C, potassium and folate to the diet that would otherwise not be consumed."

Take home message: Kids naturally come in all shapes and sizes. Worrying about and trying to change what kids eat and drink is never going to change that. Yet to suggest that a naturally fatter child should be denied the same enjoyment and benefits of foods and drinks that other kids enjoy, based on nothing but beliefs, is unthinkable.

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Commentary — From the “Don’t miss this story!” file

Media Distort Health Risks, Say Experts

Maia Szalavitz at STATS reported on the Foundation for American Communication’s seminar on covering health risks held at Columbia University, saying:

...the surfeit of scare stories and misleading articles cited at last week's Foundation for American Communication's seminar on covering health risks at Columbia University’s Graduate School of Journalism suggests that most media organizations have a long way to go in giving the public a true picture of which health issues should concern them and which are less worrisome.

Kimberly Thompson, Associate Professor of Risk Analysis and Decision Science at Harvard’s School of Public Health noted early in her presentation that "the good news is that we're living longer," which is something that is rarely mentioned in articles about frightening new discoveries that could present a danger to health. Coverage of risks to children, for example, rarely notes that today's kids have a far longer life expectancy than ever before — but reporters tend to take for granted the false assumption that the modern world holds more dangers for children....

Kay Dickersin, Director, Center for Clinical Trials, Johns Hopkins University, reviewed how clinical trials can be understood and covered, noting that many trials which are started remain unpublished, and that this can bias the scientific literature. She also noted that only 60% of abstracts presented at meetings—which are often given big coverage in the media—result in peer-reviewed publication.

Dickersin discussed other forms of bias and also urged reporters to include information on both absolute and relative risk.Relative risk numbers can make a story sexier and scarier: for example, while a hypothetical medication might double the risk of heart disease (the relative risk), if that means the risk goes from 1 in 100,000 to 2 in 100,000 (the absolute risk), it might not really be something for patients to fret over....

When we work from the hair-raising, overstated health risks in the media, the bad science and popular beliefs that surround us every day, it is impossible to accurately figure out what really puts us at risk and what isn’t worth worrying about.

“Obviously, a man’s judgment cannot be better than the information on which he has based it.”—Arthur Hays Sulzberger, 1891-1968

The constant bombardment of news of hypothetical dangers, and our increased intolerance of risks, contrasts with the reality that we live in a safer world and are healthier than ever. The media could be a positive influence and help us understand complex issues so that we can make health decisions that are best for ourselves. As much as we think we don’t, most of us on some level do believe the health news we see on television and printed in prominent publications. The way that a risk is depicted and how often it is repeated can make a big difference in how serious it seems. Even the most wary of us can be seized by alarming soundbytes. It is easy to scare us in a soundbyte, but impossible to really confer understanding of an issue in a few words.

The public places a lot of its trust in communication professionals to investigate and communicate the soundest information and in a conscientious way. But, sadly, those expectations are seldom realized. Adequate coverage of science is rare. The media is lured to report sensational headlines, spine-tingling scares, miracle breakthroughs and popular stories. By being unquestioning, not going to original sources, over-simplifying issues into black-and-white, and framing stories as they are presented to them, media also falls victim to powerful public relations entities representing major financial or political interests.

The responsibility is shared by both journalists and the scientific and medical community, though. As doctors Lisa M. Schwartz, M.D. and Steven Woloshin, M.D. wrote in “The Media Matter: A Call for Straightforward Medical Reporting:”

The medical community should take more responsibility to help make straightforward medical reporting a reality….Too often, medical researchers and the media focus more on getting attention for their message than on getting their message right.

As the FAC seminar highlighted, the dearth of reasoned, objective science from the media plays a major part in today’s climate of fear and distorted perceptions of the risks present in our modern life.

Yet this key point was overlooked among the sources for our misguided risk assessments written in the Times Magazine article, “How Americans are Living Dangerously.” In giving examples of how we misplace risks, the authors perfectly illustrated Professor Thompson’s points that popular assumptions are believed without question and false perceptions are common among today’s reporters. For example: believing that being overweight or obese is more deadly than smoking or not wearing your seatbelt; that french fries and salty nachos are more dangerous than food-borne illnesses; that we’re being misled to think mad cow is less of a concern than children drowning in bathtubs; that we should worry about the cholesterol in our burgers because it contributes to heart disease and kills us; and that pesticides and other toxins threaten us.

But one of their comments inadvertently illustrated an especially relevant concept. Scientists and experts are six times less likely to fear things the rest of us do, probably because they often understand the science and the actual risks better than we do. Rather than distrust scientists’ undisturbed stance, we might be better helped by embracing the science, too.

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November 27, 2006

Dare we eat fat?

A study just came out in the American Journal of Epidemiology by some of the same researchers whose research last week actually found no association between red meat and breast cancer. This one, however, isn’t receiving nearly the media fanfare.

It was another dredge through the Nurses Health Study database looking for correlations. Remember, the value of these studies is not that we can base healthcare decisions on any association, regardless of how impressive or intuitively correct it might appear. We have to wait until there’s a body of research to track down the potential cause and effect — if there even is one somewhere in the correlation — and clinical evidence to demonstrate that it is valid and biologically meaningful. Associations among data on large populations don’t mean anything, and certainly not for us as individuals, until there’s been all of the necessary follow-up research to pursue various hypotheses. More often than not, initial links prove dead ends.

But when researchers can’t even find a valid correlation among a group of people between a factor and a disease, try as they might, then we can relax and stop worrying because there’s no public health threat with that factor to even concern ourselves with.

So, sorting through twenty years of data on 80,375 women, with 3,537 cases of postmenopausal breast cancer they found no association between the fat — nor any specific type of fat — the women ate throughout their adult lives and postmenopausal breast cancer (the most common type). Nor did they find any difference in the women’s risks by the hormone receptor status of the cancers. Meaning, that popular fears about supposed hormones in fatty foods, just as in red meat, causing hormonally-driven breast cancer are insupportable.

While the results are consistent with other studies, as a Reuters Health article noted, the reluctance to dare let people think that it is okay to eat or be fat was evident. It made unsettling noises that some past studies had “suggested” an association between high fat diet and breast cancer. Few readers probably tracked down the research being referred to and found the weak meta-analysis from 1993 and data dredges that failed to come up with meaningful correlations, such as 6% to 25%, nonfindings for these types of studies.

But what you may find especially intriguing about today’s study is that women with those higher waist measurements (>35 inches) we’re all being led to fear, had significantly lower incidences breast cancer. And among women with insulin resistance, a precursor to diabetes, those who ate higher-fat diets correlated with lower breast cancer risks. There again, this association is nothing to change our diets over thinking it will prevent cancer, but perhaps it will lessen fears that eating “bad” foods is going to give us breast cancer. As oncology doctors, the American Cancer Society, the National Institutes of Health and other experts note, most women who develop breast cancer have no identifiable risks factors, other than being women over 50, and fattening foods are nowhere on their lists of potential risk factors.

If this were the only such study to come up with this, we should be skeptical. But it isn’t. For more than a decade, population studies have found no evidence of a relationship between any dietary fats and the risk for breast cancer. For example, a 1996 review of seven prospective studies in four countries, of 337,819 women published in the New England Journal of Medicine found that the total calories, total fat, cholesterol, or type of fat the women ate had no bearing on breast cancers. And the body of clinical evidence is even stronger, such as the country’s largest, longest, and most comprehensive clinical intervention trial ever conducted on low-fat eating. [Stay tuned.]

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November 26, 2006

Say it isn’t so — Part two

Nothing compares to the all-out, massive, well-organized efforts to preserve the “obesity crisis”that began last year after senior research scientists inside the CDC’s National Center for Health Statistics exposed the war on obesity — begun by their own director of the CDC, Julie Gerberding, and Secretary of Health and Human Services, Tommy Thompson — as a grossly exaggerated and fabricated scare campaign. These whistleblowers proved, as had been written about here, that the study, looking for correlations between weight and premature death that had been created to lay the foundation for billions of dollars in government and industry “obesity” initiatives, and popular with an enormous throng of marketing and political interests all using the “obesity crisis,” had been derived from poor data and had flagrant methodological flaws. How bad was it? It didn’t even account for aging, the single biggest risk factor for death, in its computer model!

This new study, led by Katherine Flegal, which the scientific community recognized as a vastly superior study and the most accurate to date, used recent and solid information that included actual measurements on real people representative of today’s population. It documented:

· “Overweight" and "obesity” is not associated with 400,000 deaths, as the special interests had (and continue to) claimed, but together perhaps 25,815 extra deaths — far fewer than the deaths attributed to motor vehicles or firearms. In fact, that links fat to 2% to 3% of all “preventable” deaths.

· Among nonsmoking people under age 60, being “overweight” (BMI 25-30) and “obese” (BMI 30-35) was actually associated with lower risks for premature death than those of "normal" weight.

· Especially troubling is that being thin is 25% more dangerous than being the government recommended “normal” weight (BMI 18.5-25).

· And being thin accounts for 37,746 premature deaths. More than even being the most extremely “obese” (BMI >35)!

· Worse, being thin is riskiest of all for those over age 60 and puts them at double the risk of “normal” weight. It’s even riskier than being the most extremely “obese.”

While the very real dangers of thinness are virtually ignored, the risks of “obesity” are greatly overstated. For adults under 60, “obesity” only reaches the same risks as being underweight at the uppermost extremes of BMI (>35). That represents a mere 8.3% of the population — a far cry from the government’s claim that 66% of us are “too fat.” [And more detailed breakdowns show health risks associated with extreme obesity actually don’t come into play until much higher BMIs.]

Within hours of the release of this potentially devastating study in the Journal of the American Medical Association, special interests — notably, doctors from Harvard School of Public Health, along with the American Cancer Society, American Heart Association and the CDC — quickly rallied press conferences and media releases to deny and spin the findings and attempt to discredit them in the minds of the credulous public. They made noises about it failing to consider smoking, of reversing causality and attributing higher deaths among thin due to the fact they are sick or old, and of not considering the long-term effects of obesity. These spin doctors assumed, correctly, that the media would simply repeat their assertions and not a single reporter would go to the actual study to realize they were nonsense.

Flegal and her associates had analyzed the data in a myriad of ways and had accounted for smoking, chronic diseases and preexisting health problems, involuntary weight loss, and long-term obesity ... and each time the results were the same.

Reporters who’d read the journals where this controversy had been raging could have learned that the “obesity is deadly” studies done by researchers from Harvard, the American Cancer Society and CDC that were being so vehemently defended, had looked at self-reported data from select groups of people that weren’t representative of the population and had excluded nearly 90 percent of the deaths in their analyses to get the results they wanted. Among other such studies, you’ll find all sorts of other shenanigans.

One of the funniest statements came from the director of the CDC who held her own press conference on June 2nd to “translate our science more effectively.” In classic doublespeak, she said: “We need to be absolutely explicitly clear about one thing: obesity and overweight are critically important health threats in this country.” She appealed to reporters to communicate this “correction.”

The media fell into lockstep and did just that. ABC News said the CDC had “pledged to get scientists and the public back on track.” A Kansas City Star editorial called the Flegal study “shoddy research” that had “stunned health advocates.” The editorial said that in the CDC’s “latest embarrassing reversal...federal health officials last week returned to the basic theme they should never have abandoned: Obesity threatens human health.”

With that inconvenience — the truth — dealt with, the war on obesity proceeded without skipping a beat. If you missed this scoop, you may want to read “Obesity Crisis? ‘Oh, Never Mind!

The whole “obesity” thing has been an easy sell because our culture has come to believe so strongly that thin is better and fat is bad, and so loves to hate fat people, that the idea of questioning it is inconceivable.

© Szwarc 2006

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November 25, 2006

Say it isn’t so — Part one

It is predictable. A flurry of press releases and articles appear everytime a major study is released that debunks “pop science” — what everyone “knows” to be true — and threatens the research or agendas of special interests. These stories attempt to confuse us, spin the science, or restate the beliefs more emphatically. Many times, they even claim to have new research supporting their position, when they don’t!

Earlier this week, the long-awaited results of the 13-year clinical trial, the Women's Antioxidant Cardiovascular Study (WACS), were released. It followed nearly 16 other major clinical trials released earlier — including the Heart Outcomes Prevention Evaluation (HOPE), Atherosclerosis Folic Acid Supplementation Trial (ASFAST), and the Norwegian Vitamin Trial (NORVIT) — all firmly demonstrating no benefit of folic acid or vitamin supplementation in heart disease, and that lowering homocysteine levels does not translate to real-life reductions in heart disease. And more importantly, has no effect on the most important end point of all: death.

As a Medscape review noted, the clinically measureable evidence is overwhelmingly consistent. According to Dr. Joseph Loscalzo of Brigham and Women’s Hospital, Harvard Medical School, Boston, “the consistency of the results of HOPE-2, NORVIT, and VISP in three similar, although not identical populations, ‘leads to the unequivocal conclusion that there is no clinical benefit of the use of folic acid and vitamin B12 (with or without the addition of vitamin B6) in patients with established vascular disease....[the] incorrect view that folic acid can decrease homocysteine levels and thus reduce the risk of atherosclerosis effectively may be an unintended consequence of oversimplifying a complicated metabolic network.’” [We'll look at even stronger, more comprehensive reviews later.] Bottom line: Believing that vitamins can prevent heart disease doesn't make it so.

On Friday, the press reported the opposite of what we heard last week:

Folic acid can cut heart attack risk: experts

Can taking folic acid supplements reduce the risk of heart disease and stroke? British researchers believe it can. After analyzing evidence from earlier studies, a team of scientists in Britain said on Friday there is enough research that shows folic acid lowers levels of the amino acid homocysteine and reduces the odds of cardiovacular [sic] disease.

David Wald is quoted as saying “The evidence is very persuasive that lowering homocysteine with folic acid will lower your risk of heart attack and stroke by about 10-20 percent.”

The source of this claim is actually a paper published in November 2002 in the British Medical Journal by David Wald. It was a meta-analysis, looking for correlations among data from a multitude of diverse population studies. Its analysis claimed to have found “significant associations between homocysteine” and the risks for heart disease and stroke.

He reported the risks as odds ratios, which were 42% and 65%, respectively. But these are not tenable numbers for these types of studies. (See: Have your steak and enjoy it too!)

Yet this researcher went on to make another fundamental error: that of thinking associations can ever show cause. He even titled his paper “Homocysteine and cardiovascular disease: evidence on causality from a meta-analysis.” He concluded the “significant” results were “strong evidence that the association between homocysteine and cardiovascular disease is causal.”

His belief in homocysteine as a risk factor for heart disease, and that alone, was the basis for his conclusion that “lowering homocysteine concentrations by 3 µmol/l from current levels (achievable by increasing folic acid intake) would reduce the risk of ischaemic heart disease by 16%... and stroke by 24%.”

Given he found untenable associations, not surprisingly actual clinical intervention trials have consistently proved them to be false.

Wald has continued to be the most outspoken proponent for folic acid in the medical literature. In a May 2003 article in BMJ with the dramatic title “Inertia on folic acid has caused thousands of unnecessary deaths,” Wald is quoted as saying: “Until public health agencies fortify our diet with sufficient folic acid, people should consider taking an 800 µg supplement each day, especially if they have coronary heart disease.”

In June of 2003, Wald and a colleague of the Wolfson Institute of Preventive Medicine in London, Malcolm Law (professor at the University of London and University of Auckland in New Zealand), authored another paper in the BMJ: “A strategy to reduce heart disease by more than 80%.”Using statistical analysis of meta-analyses to support potential effects of their new polypill, they estimated that, if taken by everyone aged 55 and older with heart disease, it could prevent nearly nine out of ten heart attacks and 4 out of 5 strokes. This cocktail of six drugs in low dosages — three blood pressure drugs, a statin, aspirin and folic acid — would address what they believed to be cardiac “risk factors.”

They even made the sensational statement that their new pill would have “a greater impact on the prevention of disease in the Western world than any other single intervention.”

In the October 2003 issue of BMJ, Wald and colleagues respondedto those skeptical of their polypill claims, saying (with no supportive evidence) that the reductions in risk factors will be greater when the drugs are used together in low doses than has been shown individually.

They used the popularity of the idea among the public to support their idea. [How many were aware that these authors all have interests in the polypill, with patents granted and pending? When the zeal of claims outpace the strength of the evidence, it is only right to note potential conflicts of interest.]

Responding to the negative feedback received from the medical community, the authors said that their critics “had not given reason or evidence against the concept of the polypill.” [Scientists and quack watchers will recognize this classic argument. In science, the burden of proof falls upon those making sensational claims to prove their claims, not on others to prove a negative.]

So today, the BMJ published an “Analysis and Comment” from David Wald and associates — not a new study with new clinical evidence or any new evidence at all, but another review with the same arguments as earlier papers. Attempting to discredit the clinical evidence was clear in the article’s title: “Folic acid, homocysteine, and cardiovascular disease—judging causality in the face of inconclusive trial evidence.” They supported their conjectures using that same earlier observational population study, reports of higher homocysteine levels in people with a rare genetic disorder and a certain genetic mutation and correlations with heart disease, and statistical interpretations of meta-analyses. While admitting these sources were not randomized controlled clinical trials and suffered from publication bias and other errors, those concerns were dismissed because of the “significance” of the effect of homocysteine on heart disease — not based on actual clinical outcomes, but again on “risks” as defined by homocysteine levels. The 7 (out of many more, some showing adverse effects) randomized clinical trials they selected to review, all showed no measureable effect on relative risks. Yet those studies were also negated, essentially because they didn’t concur with their statistical interpretations and didn't look at as large of numbers as the meta-analyses. [The size of a data base used in a data dredge does not determine soundness.] They asserted that in the clinical trials “the new maximal reduction in ischemic heart disease events” had simply not yet been “appreciated.”

But this is a minor example of science and media spinning information to support a certain belief or marketing interest…..

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Another beautiful example of body and size acceptance

Velvet D'Amour is the "plus-sized" model who made international headlines last month when she walked the runway at Jean-Paul Gaultier's fashion show in lacy black lingerie. She gave an interview shortly afterwards where she talked about her desire to help promote the diversity of beauty.

She also dispelled notions that fat people aren’t active or healthy. Fat women, however, face obstacles and ridicule when they go to a gym or appear in a swimsuit. “Come with me swimming some time [she swims 120 laps three times a week] and you’ll see that people will obviously laugh out loud when you walk right by. I can take it because I am very happy in my own body but there are so many women who can’t.”

“The reality is there’s going to be fat people... there always have been fat people, there always will be fat people.”

She appeared on Entertainment Tonight again last Monday and in her interview said: “If I’m fat or if I’m thin, I feel like I’m beautiful. I think that is more about confidence than how one looks physically.”

Her lovely body is naturally fat. It’s her genetic body type. In order to have the thin body that our culture currently believes is “healthy,” she had to starve to lose the weight and starve even more to keep it off — which is not nutritionally healthy for any body.

Velvet wasn't always so accepting of her body. When she was a teen...“In order to stay thin, one avoided eating for all necessity," she tells Kevin. “I would have jello, and I would mix it with hot water, and I would drink it before it was set so that I would feel a sensation of being full, when I was quite hungry, in fact.”

But it didn't quite work like she expected. “I was literally so hungry that I was obsessed by food," she says. “There was a time when I very much hated my body, when I started gaining weight after I had tried so very much to lose weight," she explains. “In that cycle I would starve myself to death and I would eat tons of food."

But now, Velvet has a healthier body image and confidence to spare, and it's something she exudes for photographer Pascal Boissier as she poses for a photo shoot....

Velvet has found the positive in being big instead of the negative of not being stick thin. “If you want to spend your life hating yourself and being with people who don't like you, that's an option," she says. "But certainly you have the option to love yourself and to live in the moment.”

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Healthcare industry blogging update

If you had any doubt that vested interests in healthcare are taking blogging seriously, check this out:

The First-Ever Conference on Healthcare Blogging

Whether you represent a hospital, a health plan, a pharmaceutical company or a physician organization, this event is a must-attend...

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We know the real story

The Albuquerque Tribune just reported:

Longevity affected by lifestyle, study shows

One of the largest, longest studies of aging found one more reason for people to stay trim and active: It could greatly raise your odds of living to at least age 85....

While the title is changed, the content is identical, word-for-word, to that report that appeared in papers across the country last week, claiming to offer the secrets of a long, healthy life. See: “Secrets to healthful aging?

It wasn't credible the first time we read about it, either.

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November 23, 2006

Thanksgiving Special Edition

Warmest wishes to everyone for a happy Thanksgiving!

This is one of the saddest Thanksgivings I can remember. Instead of turkey with all the trimmings, the food news is all about staying trim, the dangers lurking in our Thanksgiving dinners, and how to restrain ourselves from eating lest we get fat or diseased. Good grief. ‘If anything tastes good, it must be bad’ has become the mantra of the day.

Although countless professionals are hyping the dangers of foods to sell weight loss plans, “health and wellness” or “diabetes prevention” programs; or to badger us all to eat whatever and however they believe is best; enjoying the holiday feast is not hazardous to our health. There is simply no good science behind the scares or admonitions.

So for those who haven’t succumbed to the insanity and are still cooking today, you may want to keep this number handy: 1-800-BUTTERBALL and please don’t scrimp on the gravy! :)

No other holiday more beautifully celebrates the tradition of the family dinner. There is comfort in the rituals of Thanksgiving: setting the table with the good china and the family silver, creating a sumptuous feast with everyone’s favorite traditional dishes, smelling the heavenly aromas wafting from the kitchen for hours as anticipation builds, and gathering loved ones around the table to share in the bounty. Our children deserve the same cherished nostalgia. Memories are made and relived each year in the food; the stories told around the table; and the after-dinner parades, footballs games, naps, walks and leftovers! We give thanks for the food and the many hardworking people who have grown, harvested and brought the foods to our tables.

And we give thanks for our many blessings.

Americans give meaning to saying thanks in the spirit of Thanksgiving in truly heartwarming ways. Thanksgiving brings out the good in people. Americans exhibit creditable generosity in sharing food with those less fortunate. Our country supplies more than half of the food aid distributed by the United Nations, said UN Ambassador, Tony Hall. What we give as a country through government, business and as individuals, through churches and temples, is incredible, he said. “It’s something like $56 billion a year.”

We also feel the pain in the reality of food needs in our own country.

In America, hunger is a choice between paying for food at the end of the month and paying for rent or heating or medicine. It is skipping a few meals. It is a Sunday waiting for Monday's school breakfast program. It is eating dry cereal for three days. It is shoplifting. It is being homeless or mentally ill or old....When scientists study short-term hunger in men and women who have not eaten for 36 hours, they see the same areas of the brain light up as when people are thirsty or in pain or fighting for oxygen. — Sharman Apt Russell of Western New Mexico University

Food for thought over this Thanksgiving holiday

In Healthy People 2010, the U.S. Government set an objective of cutting the rate of food insecurity among our country’s households to 6 percent, half the 1995 level, by 2010 and “in so doing, reduce hunger.” In 1995, nationally representative food security surveys estimated that about 12% of U.S. households (11.8 million households) were food insecure, including 4% (4.2 million households) classified as food insecure with hunger.

Hunger and food insecurity mean people are suffering and it has far reaching health consequences. The health; mental, physical growth and emotional development; and futures of children are jeopardized. There are also severe health implications for the elderly. The medically-documented consequences include fatigue, functional decline and diminished mental acuity, delayed wound healing, impaired immune system and increased risks of infection, exacerbated chronic and acute illnesses, depression, loss of muscle strength, falls and increased fractures, longer hospital stays, higher rates of complications and rehospitalization, significantly higher healthcare costs and higher mortality rates. In a recent study in Academic Emergency Medicine, emergency room physicians in Minneapolis found that rates of hunger are high among emergency room patients, with 24% screening positive for hunger. These patients are often forced to make choices that result in ill-health, such forgoing medications in order to buy food.

How has hunger been defined for decades? The Government’s 2002 Food Assistance and Nutrition Research Report, Economic Research Reducing Food Insecurity in the United States: Assessing Progress Toward a National Objective said:

Hunger, as measured in food security assessments, refers to “involuntary hunger that results from not being able to afford enough food.”

According to that 2002 update examining the progress on achieving those Healthy People 2010 objectives: “Undernourishment as a result of poverty is rare within the United States, but food security — assured access by all people at all times to enough food for active healthy lives— has not yet been achieved.”

This report described notable improvements during the first 5 years of the effort, however, with food insecurity declining from 11.75 in 1995 to 10.06 in 1999; and hunger falling from 4.15 percent to 2.97 percent. “About half of the reduction ... can be accounted for by improved incomes. Economic growth, with its improvements in employment and income, is essential to improving food security

This month, the most recent update, Household Food Security in the U.S. 2005, was released. Its summary findings were boldly splashed across headlines: “The prevalence of food insecurity declined from 11.9 percent of households in 2004 to 11.0 percent in 2005, while the prevalence of very low food security (their new term for hunger) remained unchanged at 3.9 percent.” An estimated 38 million Americans, 14 million children, currently live in food insecure households.

If we didn’t know where the starting point was, this narrow look at just a one-year change might give the impression that things were moving in the right direction. [Although certainly, taking an even wider viewpoint encompassing the severe hunger of the 1930s and earlier would, too.]

Looking at the actual data in Appendix D, however, gives a different picture. Since the beginning of this initiative, the prevalence of both food insecurity and hunger (“very low food insecurity”) has increased 0.1%. Those earlier improvements have been obliterated and most Americans are slightly worse off than they were in 1995. But there were significant disparities:

Rates of food insecurity were substantially higher for households with incomes near or below the Federal poverty line, households headed by single women with children, and for Black and Hispanic households. Geographically, food insecurity was more common in large cities and rural areas than in suburbs, and in the South than in other areas of the Nation....About 22 percent of food insecure households obtained emergency food from a food pantry at some time during the year, and 3.6 percent ate one or more meals at an emergency kitchen in their community.

Looking at the prevalence by state: four states noted statistically significant declines in food insecurity, 15 states had significant increases. And when it comes to hunger, “no state registered a statistically significant decline” and 14 saw significant increases.

New Mexico (with a total population less than 2 million) now leads the nation in food insecurity and hunger, with 16.8% — one in six — suffering low or very low food security (hunger). This past May, Roadrunner Food Bank of New Mexico released the results of the Faces of Hunger in New Mexico 2005 study. Since 2001, they saw a 38% increase in people seeking emergency food assistance — more than 238,000 each year, including 81,000 children and 21,000 seniors. The numbers of seniors seeking emergency food aid had nearly doubled. Forty-one percent of those served by New Mexico’s food banks said they had to choose between paying for food or paying for utilities or heating fuel. And for 28%, it was a choice between food and medicine or medical care.

“Over one-half of the increase we see are the most vulnerable of our community – children and seniors” said Melody Wattenbarger, Executive Director of Roadrunner Food Bank. Jasmin Milz Holmstrup of the Food Bank told me “an estimated 110,000 people still need our help.”

Note: In the latest New Mexico Selected Health Statistics Annual Report by the State Center for Health Statistics, Bureau of Vital Records and Health Statistics, there is no mention of hunger. In Governor Bill Richardson’s State of the State address, which made 2006 the year of the child, among the anti-obesity initiatives targeting junk food and school PE, there was no mention of hunger.

Higher energy costs mean more hunger

The price of being poor in America is having to choose between food and necessities, such as heat and air conditioning. These are life and death tradeoffs, especially for the elderly whose bodies are less able to tolerate extremes of temperature. A study just published in the journal Nutrition looked at food insecurity among low-income households from 1995 to 2001. In hot, humid states, hunger among the elderly poor was 27% higher in the summer than winter.

In cold states, hunger was 43% higher in the winter.

As energy costs rise, many more go hungry, especially the elderly poor and disabled.

The reality of just how many Americans live this precariously was demonstrated in a 2002 study by the Economic Opportunity Research Institute of Wa­shington, D.C. which found about 30% (27.9 million) of U.S. households needed federal energy assistance. Another 7 million households had energy costs disproportionately higher than their income — as high as 30.5% of their income for an additional 2 million households.

The War on Poverty

In our passion to help, it’s easy to believe that more government spending could reduce poverty and hunger long-term. But an analysis just released by the nonpartisan Goldwater Institute made some surprising findings that offer additional considerations. Their results appear to support the recommendations of the 2002 Food Assistance and Nutrition Research Report that economic growth, with its corresponding improvements in employment and income, is essential to improving food security in any real and lasting way:

Low-tax and low-spending states enjoyed sizable decreases in poverty rates during the 1990s, while high-tax and high-spending states actually suffered increases in their levels of poverty, says Matthew Ladner of the Goldwater Institute.According to his analysis of poverty rates from 1990-2000, Ladner found:

The 10 states with the highest state spending per capita - Alaska, California, Delaware, Hawaii, Massachusetts, New Mexico, New York, Rhode Island, Vermont and Wyoming - saw an average increase of 7.3 percent of overall poverty rates and a 4.5 percent increase in childhood poverty.

The 10 states with the lowest spending - Arizona, Colorado, Florida, Georgia, Missouri, Nebraska, Nevada, South Dakota, Tennessee and Texas - saw overall poverty decline by 11.2 percent and childhood poverty fall 12.2 percent....

The dramatic declines in poverty in the "small government" states strongly confirms the hypothesis that reduced taxes and state spending encourages the emigration of people and businesses to areas where private-sector job growth is able to flourish and become a powerful and effective antipoverty program, says Ladner. And while taxes and business climate alone are not the only factors in reducing poverty rates, they certainly go a long way in helping fight the war on poverty.

Full study here.

Many are looking at the complex problem of ensuring everyone has enough to eat. Despite what would seem intuitively correct, increasing food aid doesn’t mean reducing the numbers of hungry people, according to The State of Food and Agriculture 2006 report for the Food and Agriculture Organization of the UN. It noted that the vast majority of hunger is chronic and unlike acute food insecurity which is best addressed by emergency food aid, chronic hunger requires addressing the roots of hunger: limited poor families’ purchasing power. They concluded:

Emergency food aid and safety nets to ameliorate or prevent acute food insecurity are not sufficient to address the broader problem of chronic food insecurity, hunger and poverty, which pose a far greater challenge that can only be effectively addressed as part of a broader development strategy.

Food is not the resource of choice for interventions needed to help the chronically food insecure into a more secure livelihood.

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November 22, 2006

Special science exclusive: Have your steak and enjoy it too!

When it comes to food and health news, the saturation of media coverage is usually inversely proportional to the soundness of the research. Sensational claims sell a lot of newspapers, lure viewers and listeners, and create good buzz. The trouble is, most of us don’t realize we’re getting Hitchcock-like fiction when we turn on the news. With last week’s scare du juor — “red meat increases risk for breast cancer” — no mainstream news reporter took a critical look at the study they were reporting, preferring to simply pass along the press release. No one except Steve Milloy, of course, who wrote an excellent review here.

Our first clue that there was something more afoot in this media blitz than brilliant science, is that this one study — out of the thousands of new studies released every single day — was reported in every media outlet, on the exact same day, all saying the exact same thing. This is evidence of brilliant marketing, but not much more. Like everything in media today, it deserves viewing with the same skepticism as you would any other commercial. The study wasn’t nearly as well done as its marketing...

This was another study by researchers from Brigham and Women's Hospital and Harvard Medical School mining a database, called the Nurses Health Study, compiled from answers to lifestyle questionnaires that have been collected from around 120,000 nurses since 1976. This database has been the source for more than 500 “studies” looking for correlations on everything under the sun. The findings often disagree, depending on what the researchers want to find. It’s the source for many of those media reports of scientists finding something one week and something entirely different the next.

Food frequency questionnaires sent to 90,659 premenopausal women in 1991, 1995 and 1999 were used for this study. These asked the nurses how many times they had eaten 130 different food items during the past year, and each food item had 9 possible responses, ranging from never to 6 or more times a day. It’s unimaginable that anyone has the memory, time or patience to complete such a survey, which makes the accuracy of the information going in precarious at best. Even more telling of the dubious quality of the data, the women didn’t give any information about how much they ate because they weren’t asked amounts or portion sizes. So the researchers guestimated.

The researchers then obtained self-reported cases of breast cancer, a total of 1021 cases, which were confirmed using pathology reports.

Here’s where the fun begins. The researchers put all this into their computer, created a computer model that would pull select information and put it together how they chose, and then waited....

They were unable to find any measurable correlation between red meat intake and premenopausal breast cancers. That should have ended it right there. But didn’t.

What the raw data showed was that only about 9% of the young women ate more than 11/2 servings of meat a day. Most ate less than 5 servings a week. But the highest meat eaters were also more likely to smoke, nearly two times more likely to have more than three children, and slightly less likely to be taking oral contraceptives or have a history of benign breast disease. So, the researchers made statistical adjustments to their computer model to attempt to control for these and other possible confounding factors. No one knows if they adjusted correctly or if they included all of the other possible things that might have a role in these cancers.

Despite the nonfinding, they decided to dig deeper looking for correlations among hormone receptor status of the cancers. Except they didn’t have any information on the hormone status for nearly 25% of the cancers — with more of the data missing among the women eating less than 5 servings a week than among women eating the most. Meaning, they weren’t looking at data representative of most premenopausal women.

After all that, they arrived at a finding that women eating the most red meat had a 97% greater chance of getting hormone receptor positive breast cancers than those eating the least.... Except not all red meat, only if it wasn’t eaten in a sandwich or as hotdogs and bacon — they didn’t even try to give a biological explanation for that!

Now a 97% increase sounds like a horrific amount, doesn’t it? But that refers to “relative risk,” not actual risk. Only 0.6% of the women eating more than 11/2 servings a day developed hormone receptor positive cancer as compared to a 0.45% incidence among the women eating meat 3 or less times a week.That is a difference in actual risk of only 0.15% over twelve years. This is such a small number as to be unreplicable. It could just as easily have been chance or a tiny mathematical problem in their computer model.

[And the incidence among most of the women — including those eating more than a serving of meat a day! — was only 0.5%, making any real difference even less relevant.]

Reporting the actual numbers, of course, wouldn’t have created nearly as dramatic of headlines.

Accompanying this story were scares of rising rates of hormone receptive breast cancers. The truth, according to the American Cancer Society and National Cancer Institute, however, is that incidences of breast cancer in women have been stable since around 2000 and any perceived increases have been because of increased use of mammography and hence increased diagnosis.

But let’s stop right here. You’re probably realizing that playing with statistics is a mighty problematic venture. And you would be right. These types of studies are the most susceptible to errors and bias. That’s why in these data dredges to find correlations, relative risks have to be particularly significant to even be deemed tenable. They also have to be well above what one would find by chance — more than the toss of the dice.

So scientists do not take as credible anything which isn’t at least 2 to 3 times over baseline, or a 100% to 200% difference. Ernst Wynder, MD, founder and director of the American Health Foundation and editor of Preventative Medicine prior to his death, said anything less than 200% is suspect. And Marcia Angell, MD, former editor-in-chief of the New England Journal of Medicine said they looked for 200% or more before accepting a study for publication. Yet, we frequently hear about studies finding risks of 30% or 50% reported as if that means anything. So, 97% might be considered statistically significant to these researchers, but they wouldn’t be taken as worthy of note by prudent scientists or meaningful in real life at all.

These types of studies, looking for links among large groups of people, were never meant to be used as they are today. They don’t apply to individuals and most importantly, they can never show a cause for anything because they don’t actually test anything. These studies are called epidemiological studies because they were originally meant to be used as the first step in narrowing down potential factors in infectious diseases, which would then be tested in a series of clinical studies to confirm the origin of the disease.

What that means is, if a well designed population study can’t even find a correlation, then good scientists move on and look somewhere else for the cause. So those studies finding no evidence of a significant correlation are especially valuable in today’s scare-driven climate. Yet the media failed to give us the full story and reveal that multiple population studies — even using data on far larger groups of women than this and even studies done by these same researchers — have found no evidence for a link between breast cancer and red meat. For example, a study of 351,041 women published in the International Journal of Epidemiology in February 2002 and a study of 85,000 women ages 30 - 55 published in the International Journal of Cancer in January 2003. Nor is there a body of clinical evidence to support causation.

It is the most basic fundamental principle of research that correlations do not make for a cause, no matter how strong a correlation might be. Wearing a bra has been associated with a 12,500 times greater risk for breast cancer, not because bras cause cancer, but because most breast cancer is found in women.

So while Dr. Nancy Snyderman told NBC’s Today Show viewers on November 14th that we now know that there is a cause and effect between eating red meat and breast cancer....we know nothing of the sort.

© Szwarc 2006

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November 21, 2006

Special health fraud issue

The latest issue of FDA Consumer magazine is now online and the feature story is “Cracking Down on Health Fraud.” It exposes some of the biggies that have been uncovered this year:

Diabetes health fraud

Over the past year, the Mexico, United States, Canada Health Fraud Working Group (MUCH) has focused enforcement and consumer education efforts on fraudulent products to treat diabetes. In October 2006, MUCH member agencies announced that they had taken nearly 200 compliance actions against companies promoting bogus products that provide false hope to people with diabetes….

Weight loss fraud

False and misleading claims in weight loss ads are widespread. Since 2003, the member organizations of the Mexico, United States, Canada Health Fraud Working Group (MUCH) have taken more than 700 compliance actions against companies pushing bogus and misleading weight loss schemes….[LOL! That describes every weight loss plan out there!]

Natural healing

In August 2006, a federal judge sentenced John E. Curran to 12.5 years in prison for fraud and money laundering....Curran sold bogus products called "E-water" and "Green Drink." In promotional materials, Curran claimed to have cured people of cancer. One 17-year-old girl with ovarian cancer reportedly drank only Green Drink, a powdered vegetable drink, in the last weeks of her life….

In other instances, Curran used scare diagnosis tactics so that he could prescribe the phony cures to healthy people. Curran sold about 1.4 million dollars' worth of treatment and products after making his false diagnoses. He told patients they had "live parasites" in their blood, reduced blood cell counts, and ruined immune systems.

Also: influenza scams, home genetic tests, sexual enhancement supplements and a red flags list to help consumers avoid becoming victims of health fraud and understand health-related claims.

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It’s baaaack!

An earmark of junk science is that it never dies and continually resurfaces, no matter how thoroughly it has been debunked.

“Health Tips” plastered across publications from Forbes to the Washington Post today quote the Nemours Foundation’s claims that “ a single 12-ounce soft drink with sugar per day raises a child’s risk of obesity by 60 percent.”

If this sensational claim sounds simply illogical, you would be right. The source of this oft-repeated scare is an observational study done in 2001 that has since been resoundly discredited. It was, however, the only study cited by the American Academy of Pediatrics to support their 2004 “Policy Statement Soft Drinks in Schools Committee on School Health” calling for eliminating sodas in schools.

The study published in Lancet, led by David Ludwig of Boston Children’s Hospital, was based on questionnaires asking 548 children, 11-years old, to remember what they’d eaten. The researchers then looked for correlations between sugar drinks and body weights. The children had consumed an additional 158 calories per day over the course of the 18-month study — not surprising considering children that age are growing rapidly. Even so, sweetened drinks accounted for only a small percentage of those new calories and the total incidence of obesity was statistically unchanged during the study.

Their findings also showed no difference in the BMIs of children consuming the most and the least amounts of sugar or sugary drinks. In the discussion section of the study, the researchers even noted “there is no clear evidence that consumption of sugar per se affects food intake in a unique manner or causes obesity.”

That is considerably at odds with their conclusion that “consumption of sugar-sweetened drinks could lead to obesity.” Once again, it’s imperative to look at a study’s actual findings and not simply scan the conclusions or an abstract!

The popular claim that sodas contribute to obesity were based on 37 more children in this study who met the researcher’s definition of “obese” at the end of the study, but who hadn’t at the beginning. But this ignored the 35 children who had been labeled “obese” at the beginning of the study but who weren’t at the end — demonstrating the variable nature of “obesity” determinations in growing children.

Soda had nothing to do with that.

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Take your vitamins?

Last week, while every media outlet imaginable was telling us about a study that supposedly found another danger in red meat — (stay tuned for Wednesday’s special blog exclusive!) — a momentous study remained under the radar.

The results of the long-awaited Women's Antioxidant and Folic Acid Cardiovascular Study (WAFACS) were reported at last week’s American Heart Association Scientific Sessions. This was a randomized, double-blind, placebo-controlled clinical trial — as good as it gets.

This clinical trial is a subset of the Women's Antioxidant Cardiovascular Study (WACS) which began in May 1993 and ran through February of this year. It was carefully designed to test whether antioxidant vitamins, vitamin E, vitamin C, beta-carotene; and a folic acid, vitamin B6 and B12 combination; could prevent heart disease events among 8,171 women at high risk (with preexisting cardiovascular disease or three or more risk factors). The trial also examined whether these micronutrients are useful in preventing vision problems and cognitive decline.

The study design and randomization were evaluated two years ago and found to be sound and the scientists felt reasurred that the results minimized confounding factors and would provide unbiased estimates of the balance of benefits and risks, and that there is little biological basis for supposing that any benefits found will be any different for other women.

It’s findings? [drumroll, please....]

There was NO benefit of folic acid or vitamins B6 or B12 in the prevention of heart problems. In the antioxidant part of the study, they also found no cardiovascular benefits from the antioxidants vitamin C, E or beta-carotene. There was no difference among the treatment and placebo-control groups in any of the primary end measures: heart attacks, strokes, revascularization procedures or cardiovascular death.

An early hypothesis that these vitamins lead to a reduction in homocysteine and subsequently reduce cardiovascular events has already been resoundly disproven in a series of randomized clinical trials, such as HOPE-2, NORVIT, and VISP. Likewise, this study found that while the treatment group had 18% lower homocysteine levels, it did not translate to any cardiovascular benefit. Homocysteine as a cardiac risk factor has been laid to rest.

Dr. Christine M. Albert of Brigham and Women's Hospital in Boston and her colleagues were also able to examine the effect of folic-acid fortification of foods because baseline blood samples had been taken from the women before the U.S. fortification of foods. Fortification didn’t appear to account for the null findings in their study. The doctors did voice a precaution for women of childbearing years, however, noting that folic acid supplementation has been associated with reducing birth defects of the brain and spinal cord in newborns.

This study highlights the importance of clinical studies that actually test the hypotheses gleaned from observational data. But its findings really weren’t a surprise at all. This study joins a body of similar clinical evidence (which also received little media notice) that has demonstrated so conclusively that taking vitamins doesn’t prevent heart problems, the leading cause of death, that major healthcare guidelines may actually change this time.

But please don’t worry that taking a multi-vitamin in RDA amounts will hurt you, because they didn’t find anything to support that fear, either.

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