Today's NY Times (free subscription) carries an opinion column by science editor John Tierney, "Salt Wars." It recounts the exchanges between medical experts over the advisability of asking the general population to reduce dietary salt and hits both of the key issues, which are:
- Is salt reduction even possible or is "salt appetite" a hard-wired physiological response by the body to its need for this necessary nutrient?
- If population salt reduction were achieved, would public health be improved?
The most interesting aspect of this debate among medical professionals is that those advocating for population salt reduction want to skip over these two questions. Tierney blows the whistle on them, quoting America's leading salt reductionist, Dr. Larry Appel, conceding that the data a "murky" and that there is no evidence of any change in American salt consumption, up or down, in recent decades. Said Appel: “We just don’t have great data on sodium trends over time. I wish that we did. But I can’t tell you if there’s been an increase or decrease.”
To oblige Dr. Appel, while the data on any putative benefit of salt reduction is clearly all over the map with some studies supporting a benefit but more finding no benefit or even heightened risk, the data on the immutability of salt appetite is rather consistent and compelling -- government policies do not move salt consumption among people eating normal amounts of sodium (the U.S. intake is absolutely dead center among nations around the globe).
Recognizing the volatility of the issue, Tierney invited his readers to comment:
You’re welcome to weigh in on any of these issues, especially the question of what scientists really know about the effects of restricting salt. Should Washington follow New York City’s lead in pressuring food companies to take salt out of their products? Or has New York gone beyond what the evidence warrants, as argued by Elizabeth Whelan of the American Council on Science and Health ?
We have heard a lot in the media lately about salt and health. In fact, there has been an unceasing parade of talking heads and cranks that have emerged from the woodwork to repeat the urban legends on blood pressure and cardiovascular deaths that will result from our continued consumption of salt. The fact that cardiovascular disease death rates have plummeted in the last 30 years seems to be lost on these soothsayers. Another fact they conveniently ignore is that the Mediterranean countries that have such excellent cardiovascular figures eat far more salt than we do here in America and at that countries, which consume the highest levels of salt, such as Japan and Switzerland, also have the longest life expectancies. Oh well, how can actual evidence ever compete with a good scare story?
We're beginning to hear about the importance of reducing salt in the diets of young children. Unfortunately, much of what we hear does not coincide with what is being demonstrated in the medical literature.
In particular I refer to a review paper very recently published in Pediatrics, the Journal of the American Academy of Pediatrics, in November 2009. The article is titled Hyponatremia in Preterm Neonates - Not a Benign Condition . In this paper, authors Michael Moritz and Juan Carlos Ayus state that hyponatremia, or low sodium levels in the neonates pose a significant risk for future childhood development. These risks include reduced neuromotor abilities from infancy through later years as well as impaired growth and mental development. Hyponatremia has also been found to be a significant factor for hearing loss, cerebral palsy, intracranial hemorrhage and increased mortality - all because of low sodium levels in the blood resulting from decreased salt intakes.
Furthermore, the authors quoted research carried out in Israel demonstrating that low sodium levels lead to hyponatremic neonates weighing 30% more than their peers maintained at normal sodium levels and that hyponatremia in infants was predictive of increased salt appetite in adolescence and later years. So, once again, contrary to the urban legend of salt consumption leading to obesity, the evidence is exactly the opposite – it is low salt levels in neonates that lead to obesity.
The authors then went on to stress that the emerging literature also suggests that hyponatremia in adults can have very deleterious effects and may be an independent predictor of mortality in hospital patients, those with community acquired pneumonia, with congestive heart failure and liver disease. Chronic low salt levels produces neurologic impairment that affects both balance and attention deficit conditions in the elderly - effect similar to alcohol ingestion. These data were able to explain why low-salt levels are such an important cause of falls and bone fractures in the elderly. This is clinical evidence, not urban legend.
Nutrition and nutrition-related policy initiatives are not things to be trifled with and it's certainly not anything to be left to in competent activists and minimally-trained physicians parading around as nutritionist-wannabes. Neither should they be matters of gratuitous opinion. Nutrition is a key to health and any policies regarding nutrition have to be based upon strong, clinical evidence.
The USDA's Supplemental Program for Women, Infants and Children or WIC program provides food and nutritional information to low-income people who are at nutritional risk - yet, to qualify for the program, WIC foods must contain little or no added salt . Just look at the regulatory requirements for WIC-eligible foods. In particular, there is great concern over products such as vegetables and instant preparations containing vegetables that are required to be made without salt. Not only does this increase the chances for hyponatremia, but because children are so sensitive to the natural bitterness in vegetables, it is unlikely that they will eat them without the addition of salt, thereby robbing of the natural goodness these products contain.
Here again, falling victim to anti-salt propaganda, government bureaucrats in charge of this program have backed away from their responsibilities and blindly gone along with the urban legends and myth-information regarding salt, rather than heeding the published evidence in the medical literature.
As a result, the low income women, infants and children, who are most at nutritional risk have had these risks compounded by the additional risks related to low salt intakes and hyponatremia - risks leading to poor neuromotor development, impaired growth and mental development, hearing loss, cerebral palsy, brain hemorrhage and increased mortality – now how's that for government assistance?
Click the image to see the Vlog or check out the full SaltGuru video .
The UK's Food Standards Agency has made since-disproven claims to have achieved population sodium reduction. This week FSA and the Department of Health rolled out a new National Diet and Nutrition Survey .
The NDNS promises to use 24-hour urine samples (UNaV) to measure population sodium intakes -- the approach advocated by the Salt Institute in place of the dietary recall surveys FSA used to claim an overall sodium reduction. But, surprise, the results apparently didn't confirm the rosy projections of the press office. The report is silent on sodium with the excuse that "results from the urine analysis are not included in the current report as the sample size for year one is too small to report."
Not to worry, scientists have reviewed the data already -- and published an analysis that documents no reduction in sodium intake . So, Britons are safe from their government's mindless meddling -- at least for now. Last Fall, researchers reported in the Journal of the American Society of Nephrology:
UNaV and, thus, dietary sodium intake has varied minimally in the UK over the 25 yr encompassing these surveys. The mean sodium intake over the time period 1984 to 2008 was 150 mmol/d. Second, more than 6300 subjects, many providing multiple samples, are the source of these 24 h UNaV measurements from a variety of regions of the UK and Ireland, and they fall within a relatively narrow range.
Not shown, but assessed by us, was the individually determined mean and range of UNaV for women and men where the gender breakdown was available from the survey. Sodium intake for women was 129. Likewise, male sodium intake, which included a 1982 survey of only men living in London, was constant over the same period, although, as would be expected on a caloric basis, higher than that of women, 169.4. The male and female analyses excluded the three Intersalt sites, as the published data provided only the mean for the combined cohort. This statistical analysis of all available 24 h UNaV from the UK does not support recent FSA pronouncements that their national campaign directed at sodium reduction has achieved a significant reduction in the population.
Perhaps the next NDNS will "find" the urinary data these other scientists have already reported in the peer-reviewed literature.
The Mayor Bloomberg initiative (grandiosly referred to as the National Salt Reduction Program), possibly dreamed up by activist groups and leveraged through cronies at New York's health department and their friends at health commission offices around the country, reminds me of something I wrote some time back when I did the history of “Typhoid Mary.” It concerns the abuse of power exercised by Boards of Health and Health Commissions who feel they can, without fear of repercussion, dispense with civil rights in order to execute policies, even if there is no solid evidence to support them. In doing so, these bureaucrats make the self-indulgent leap from civil servants to civil masters without any permission from those they swore to serve.
The quote I am reminded of was by Dr. Josephine Baker, the person who first managed to take 'Typhoid' Mary Mallon into custody. Everyone else looked at Mary's decades-long illegal detention with a clear conscience after her death in custody. Only Dr. Baker spoke up and soberly stated what Mary, a poor Irish immigrant, was up against.
“Typhoid Mary made me realize for the first time what sweeping powers are vested in Public Health authorities. There is very little that a Board of Health cannot do in the way of interfering with personal and property rights for the supposed protection of the public health. Boards of Health have judicial, legislative and executive powers... There have been many typhoid carriers recognized since her time, but she was the first charted case and for that distinction she paid in a life-long imprisonment.”
We see the same mindless, hob-nail boot trampling going on with salt today. C.S. Lewis once said, "Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive... those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience."
A muddle of disingenuous advocates, ambitious civil servants and politicians, operating with manipulated evidence, has chosen salt reduction as their cause célèbre. These make-believe crusaders are infused with thought, “Focus on the journey, not the destination.”
Unfortunately, for the public there is a destination, and it is their freedoms and their health.
The former president of Canada's largest science based regulatory agency, the Canadian Food Inspection Agency, cautioned the public recently: "Don't be fooled. Science is always politicized." Ronald Doering argues in the National Post that we should not expect scientists to put aside their policy biases nor confess using their scientific credentials as participants in the policy arena:
That scientists should dress up their science advice as pure neutral science is understandable. For those with scientific expertise, it makes perfect sense to wage political battles through science because it necessarily confers to scientists a privileged position in political debate.
But, does it? Must we lower our high expectations that scientific experts can give us the "straight scoop" without injecting their personal policy preferences to bias their "scientific findings"? I think we can expect more from scientists. Dumbing down our sensibilities in considering scientific studies would result in substituting our own, non-expert biases and thwart progress in embracing new understandings of the reality of the world around us. Count us pro-science.
What can be said of the charge, then, that scientists have biases and their work can only be considered as a political statement? The scientific method is value-neutral. Every scientific study recognizes that the investigator has a "bias" in that the hypothesis to be tested is proposed because the scientist thinks it may offer explanatory value. It is the method itself that will save science from the bias towards confirming the hypothesis. The key here is to get agreement on the quality standards for performing the study and analyzing the results. Those, like Dr. Doering, so insist that we prioritize our understanding of "how policy is scientized and science is politicized" suggest that there is no consensus on standards of scientific inquiry. That's just plain wrong.
A generation ago, the late Dr. Archie Cochrane at Oxford University confronted this question: that scientists seemed to be reaching differing conclusions from the same body of evidence and he devised procedures that grew into the global "evidence-based medicine" movement currently promoted by his eponymous Cochrane Collaboration .
The critical component of evidence-based science is the rigorous separation of method and data. The method must be set out first and the data then gathered and analyzed using that method. It's the opposite of choosing the analytic method after the data have been examined to "discover" that the post-hoc hypothesis is confirmed.
I'm recently returned from the India-International Salt Summit in India and so my eye caught the news that, in the wake of ClimateGate, India has withdrawn from the International Panel on Climate Change (IPCC). India's environmental minister, Jairam Ramesh, was quoted observing: "There is a fine line between climate science and climate evangelism. I am for climate science."
For more than two decades, back to at least 1988 when the Intersalt Study was published, we've seen the same "theological" threat to science in the salt and health controversy. In fact, the shenanigans of the salt reductionist advocacy groups give theology a bad name. It's just the dogmatic rejection of science showing no general health benefit from salt reduction and even the futility of the public health campaign to alter salt intake levels once they are the the range that 90+% of the world's population ingests (the U.S. is right smack in the middle of this intake range).
So, we stand with Mr. Ramesh: we're for nutrition science and not nutrition evangelism in the salt and health debate.
The debate over salt and health continues to wallow at low levels of evidence: opinion or, at best, only observational outcomes studies (with one exception: a randomized trial showing that heart failure patients put on low salt diets suffered worse outcomes).
As a result, the Salt Institute, Grocery Manufacturers Association and many leading researchers are calling for a controlled trial of the health outcomes of the current policy of promoting salt reduction for everybody.
But while the salt controversy simmers, medical scientists are "moving on," recognizing that even well-designed randomized trials (RCTs) can produce results that can mislead policy decisions. TheHeart.org recently carried Sue Hughes' admonition to insist on "clinically significant" RCTs. Hughes summarizes an article in the February 2 issue of the Journal of the American College of Cardiology by Drs. Sanjay Kaul and George Diamond. That issue of JACC also contains an instructive article by Gregg W. Stone and Stuart J. Pocock on the same subject: the clinical significance of RCTs.
So, while salt reduction advocates want us to turn a blind eye to the conceded fact that six of the eight subgroups in the DASH-Sodium trial had no statistically-significant blood pressure improvement (and those subgroups would represent the overwhelming majority of the general public), the discussion in JACC is that statistical significance is not even enough: the findings also need to make a clinical difference. We read "clinical difference" to mean improved outcomes, not simply plausible theoretical modeling results.
Something public health nutrition policy-makers should consider.
India is the country with the world's largest population of newborns who are unprotected by iodized salt from the mental impairment caused by Iodine Deficiency Disorders. At the India-International Salt Summit 2010, I was invited to share my views on whether there is any conflict between government advocacy of salt reduction and its pursuit of universal salt iodization.
Short answer: no conflict at all. As I told the international delegates (pdf 75.57 kB) :
Two public health challenges inhere in dietary salt, both with major public health implications. First, conclusive research, broad experience and consensus organizational endorsement support fortification of salt with potassium iodate or potassium iodide to protect against Iodine Deficiency Disorders. Second, inconsistent research, ineffective experience, yet broad endorsements have mired implementation of advisories for population salt intake reduction intended to improve human cardiovascular health outcomes.
I noted a series of efforts by salt reduction activists questioning whether portraying salt as a public health benefactor and the fact that the issue has been dismissed whenever it has been raised, adding:
Let’s hope this is the end of this false “debate.” We need to unite and put our energies into achieving universal salt iodization. We cannot be distracted by those who would blame their lack of success reducing dietary salt on our achievements in advancing salt iodization.
If salt reductionists want to argue in favor of reducing overall salt intakes, we should make them offer evidence, not excuses. We should remind them that while the hypothesized benefits of salt reduction may fuel contentious debate, there is global consensus that salt iodization is the most cost-effective and sustainable strategy to prevent iodine deficiency disorders. It is imperative that we promote iodized salt to help every expectant mother enjoy optimal iodine nutrition and every child be born protected from iodine deficiency. Optimal iodine nutrition will protect the entire population from the loss of intellectual and physical resources through this easily preventable cause of mental retardation.
The last week has brought a media frenzy to the debate over population-wide salt reduction thanks to the hypocritical and nonsensical campaign by NYC's Mayor Bloomberg and his administration. The Salt Institute has been in the center of the fray as we seek to get fair media coverage from folks who parrot inaccurate sound bites based on faulty science and a political agenda based on a "villain of the day" mentality. We are happy to report we have made great strides in getting out "the rest of the story" as Paul Harvey would say. SI staff appeared on CBS and Fox News, weighed in on approximately 20 interviews with print media and appeared on one national radio show and another large radio show in Miami (NYC's sixth borough).
In addition, the tide seems to be turning as the national sentiment is rejecting the nanny state mentality and seems keen on personal choice and liberty. There has been a shift in reporting on this issue since Bloomberg and company first publicly entertained the notion of population-wide sodium reduction one year ago. Perhaps our favorite editorial in the last week appeared in the Wall Street Journal. Smack is bad, but the crackdown is on salt by Eric Felten does a fine job of pointing out the lunacy of a city which teaches its residents how to properly shoot up heroin, but strong arms food producers into limiting sodium content. We, like Felten, join in a collective chorus of "huh?" John Stossel also did a fine job of making the case against government food nannies in this Fox News segment.
We are encouraged to see many rising up to fight back against nanny state public policy which ignores sound science. Fox News online ran a story "Restaurant chefs boiling over NYC Mayor's salt crackdown." And a new coalition has popped up to fight back: My Food. My Choice. is made up of businesses, restaurant owners and ethnic groups (they see the policy as an attack on ethnic cuisine) and consumers.
No, this post doesn’t concern Dan Brown’s best-selling mystery novel by this title nor even reference the seasonally-referenced celestial battle presaging the birth of Christ which celebration is quickly upon us. But, like the engaging plot of a quick-read novel or the enduring scriptural lessons about man’s struggle to live good lives resisting evil designs and temptations, the notion of “angels and demons” leapt to mind when I read the recent study in the International Journal of Obesity on “white hat bias.”
Coming on the heels of “Climategate” with its ethically-challenged but politically-correct data suppression and intimidation, the article by David B. Allison, director of the Nutrition and Obesity Research Center at the University of Alabama-Birmingham and former colleague Dr. Mark Cope, touches many of the same sensitivities. The two scientists reviewed studies of the effects of consuming sugar-based beverages and breastfeeding and found consistent “white hat bias (WHB).” Without regard to how one feels about the quality of research into global warming or the contributions of sugar-sweetened beverages or breastfeeding to consequent obesity, we hope we can all agree that the assault on scientific integrity in the name of assorted “white hat” do-good causes is, ultimately, self-defeating and something worthy of universal concern.
They define WHB as “bias leading to distortion of research-based information in the service of what may be perceived as righteous ends.” (The reference to “white hats” being to early Hollywood western films where the “good guys” wore white hats while outlaws wore black hats).
Allison and Cope conclude that obesity research “may be misrepresented by scientists operating with particular biases … sufficient to mislead readers.” Allison sounds “a warning bell,” stating: “White-hat bias is a slippery slope that science and medicine need to resist.” He continued: “Some researchers like to demonize certain products or defend practices with a kind of righteous zeal, but it’s wrong to stray from truthfulness in research reporting.”
The NIH-funded study noted that “this bias appeared in studies not funded by industry.”
As in Climategate, the parallels with the salt/health controversy are uncanny. Scientists have long been accorded vast public credibility owing to their systemic pursuit of truth. We all need vigilance to unmask those (hopefully, few) who would abuse this credibility and play fast-and-loose with the expected high standards of scientific inquiry. We all want medical researchers who are angels of truth who rigorously resist the corruption of white hat bias in pursuit of their personal “righteous” – but wrong – political preferences.
The latest new study from Oxford University says that traffic-light labelling on the front of food packages do not influence consumer choices. Technical Director Mort Satin provides his opinion on the traffic light label..and..the UK, where the label was invented...and the Food Standards Agency who are actively promoting it. Vlog on (x-ms-wmv 18.35 MB) ...
The recent revelation that some global warming scientists have fudged data to hide information that didn't suit their purposes is very similar to the process we are now witnessing in the Dietary Guidelined Advisory Process. Once you start tampering with data, you can be sure it will not stand the test of time. Click on the photo for a short VLOG on the issue.
The Wall Street Journal's on a roll on "climategate," and we recently pointed to the disturbing parallel of the parasitic relationship of government advocates and special interest groups on the global warming and salt reduction issues. Today's WSJ carries an opinion column by Daniel Henniger, "Climategate: Science Is Dying ," making another observation relevant to the salt and health debate: the use of junk science to prop up government policy goals -- whether by the Bush or Obama Administrations -- is creating, in Henniger's words, a "credibility bubble. If it pops, centuries of what we understand to be the role of science go with with it."
Henniger points out the corrosive effect on science of the environmentalists'-touted "precautionary principle" whereby objective standards of evidence are replaced by subjective judgments -- "this slippery and variable intellectual world has crossed into the hard sciences."
Henniger quotes an Obama Administration spokesperson on the "precautionary principle:"
The Obama administration's new head of policy at EPA, Lisa Heinzerling, is an advocate of turning precaution into standard policy. In a law-review article titled "Law and Economics for a Warming World," Ms. Heinzerling wrote, "Policy formation based on prediction and calculation of expected harm is no longer relevant; the only coherent response to a situation of chaotically worsening outcomes is a precautionary policy. . . ."
If the new ethos is that "close-enough" science is now sufficient to achieve political goals, serious scientists should be under no illusion that politicians will press-gang them into service for future agendas. Everyone working in science, no matter their politics, has an stake in cleaning up the mess revealed by the East Anglia emails.
The tie to salt, we hope, is obvious. In the absence of evidence from even a single controlled trial of whether salt reduction would improve health and in the absence of any evidence that physiological salt appetite can be modified as a "behavior" by either education of policy diktat, the government errs on the side of precaution. I use "err" purposefully since the current policy is erroneous both on the science and even on the question of precaution. Low-salt diets are risky for some people and may be risky for the entire population. So even advocates of the "precautionary principle" should favor our longstanding advocacy of a controlled trial to get the evidence right. Close isn't "close enough for government work."
A commentary by Bret Stephens in today's Wall Street Journal , "Climategate: Follow the Money," raises issues, believe it or not, that pertain directly to salt. Salt? Bear with me. Stephens explains:
Climategate, as readers of these pages know, concerns some of the world's leading climate scientists working in tandem to block freedom of information requests, blackball dissenting scientists, manipulate the peer-review process, and obscure, destroy or massage inconvenient temperature data—facts that were laid bare by last week's disclosure of thousands of emails from the University of East Anglia's Climate Research Unit, or CRU.
We have no direct evidence that World Action on Salt and Health (WASH) and its salt reductionist members are engaged in such nefarious activities, but Stephens goes on to explain how "follow the money" makes sense when you take off the blinders that only money coming from corporate sources may be influencing a policy debate. "Money" is why we continue to see studies of salt and blood pressure when everyone accepts a relationship and why we're seeing more observational studies of the right question: salt and health outcomes. But the reluctance of the federal government to fund a controlled trial of salt and health outcomes may be linked to the tangled web of "money" as well.
Consider that thought when reading what Stephens says about the devotion of the universities and groups advocating on global warming:
(T)hey depend on an inherently corrupting premise, namely that the hypothesis on which their livelihood depends has in fact been proved. Absent that proof, everything they represent—including the thousands of jobs they provide—vanishes. This is what's known as a vested interest, and vested interests are an enemy of sound science.
Which brings us back to the climategate scientists, the keepers of the keys to the global warming cathedral. In one of the more telling disclosures from last week, a computer programmer writes of the CRU's temperature database: "I am very sorry to report that the rest of the databases seems to be in nearly as poor a state as Australia was. . . . Aarrggghhh! There truly is no end in sight. . . . We can have a proper result, but only by including a load of garbage!"
This is not the sound of settled science, but of a cracking empirical foundation. And however many billion-dollar edifices may be built on it, sooner or later it is bound to crumble.
The American College of Physicians has weighed-in the media flap over evidence-based medical recommendations . ACP's for them. So are we. We have no expertise in the area of mammography, but we are close students of the larger question over whether "evidence" or "experts" should be the source of our public health policies. We weigh-in on the side of evidence-based recommendations.
ACP president Joseph W. Stubbs decries "the politicization of evidence-based clinical research." He calls for reliance on evidence and a transparent process. Noble words, we'd agree.
But inconsistent. ACP still carries on its website, a 2004 advisory to ignore the 2003 findings of this same US Preventive Services Task Force ; USPSTF found insufficient evidence to support a population salt-reduction strategy . We agree with that evidence-based conclusion as well and invite Dr. Stubbs to join us in advocating a "constructive and transparent" process on the salt/health controversy.
With that single caveat, we commend the ACP statement that
... critics have made unfair and unsubstantiated attacks on the expertise, motivations, and independence of the scientists and clinician experts on the USPSTF.
ACP believes that it is essential that clinicians and patients be able to make their own decisions on diagnosis and treatment informed by the best available scientific evidence on the effectiveness of different treatments and diagnostic interventions. The USPSTF is a highly regarded, credible and independent group of experts that performs this role, on a purely advisory basis, to the Department of Health and Human Services, as it relates to interventions to prevent or detect diseases. As is often the case with evidence-based reviews, the USPTF’s recommendations will not always be consistent with the guidelines established by other experts in the field, by professional medical societies, and by patient advocacy groups. Such differences of opinion, expressed in a constructive and transparent manner so that patients and their clinicians can make their own best judgment, are important and welcome. It is not constructive to make ill-founded attacks on the integrity, credibility, motivations, and expertise of the clinicians and scientists on the USPSTF.
Some critics have erroneously charged that the USPSTF’s recommendations were motivated by a desire to control costs. According to the Agency for Health Care Research and Quality, “the USPSTF does not consider economic costs in making recommendations.” The Agency continues, “it realizes that these costs are important in the decision to implement preventive services. Thus, in situations where there is likely to be some effectiveness of the service, the Task Force searches for evidence of the costs and cost-effectiveness of implementation, presenting this information separately from its recommendation” and the “recommendations are not modified to accommodate concerns about insurance coverage of preventive services, medicolegal liability, or legislation, but users of the recommendations may need to do so.” [emphasis added in bold]
Under the bills being considered by Congress, the USPSTF will have an important role in making evidence-based recommendations on preventive services that insurers will be required to cover, but the bills do not give the Task Force — or the federal government itself — any authority to put limitations on coverage, ration care, or require that insurers deny coverage. Specifically, the House and Senate bills would require health plans to cover preventive services based in large part on the evidence-based reviews by the USPSTF, but no limits are placed on health plans’ ability to offer additional preventive benefits, or in considering advice from sources other than the USPSTF in making such coverage determinations. Accordingly, patients will benefit by having a floor – not a limit – on essential preventive services that would be covered by all health insurers, usually with no out-of-pocket cost to them. Patients will also benefit from having independent research on the comparative effectiveness of different treatments, as proposed in the bills before Congress. The bills specifically prohibit use of comparative effectiveness research to limit coverage or deny care based on cost.
The controversy over the mammography guidelines illustrates the importance of communicating information on evidence-based reviews to the public in a way that facilitates an understanding of how such reviews are conducted and how they are intended to support, not supplant, individual decision-making by patients and their clinicians.
ACP urges Congress, the administration, and patient and physician advocacy groups to respect and support the importance of protecting evidence-based research by respected scientists and clinicians from being used to score political points that do not serve the public’s interest.
Let's all agree on the process: follow the science. And then let's agree that digging in to defend the current politically-correct policies -- whatever they may be, but in our area of concern, policies that try to guide salt intake levels -- should be seriously questioned when such independent policy auditors as the USPSTF point out discrepancies between policy and evidence. To paraphrase the strategy that unraveled the Watergate scandal: follow the evidence. Let's not cherry-pick the science and support only the outcomes we like.
Add comment