This week's (January 5th) National Journal cover story, "Data Bomb ," set off reverberations in my mind. The article recounts the release of grossly-misleading data immediately prior to the 2006 Congressional elections that exaggerated tenfold the number of deaths in Iraq; the study fed popular disillusionment with U.S. engagement in Iraq and contributed to capture of both houses of Congress in the elections several weeks later. The study was produced by the Johns Hopkins School of Public Health. The researchers, it turned out, were anti-war activists, though they claimed their errors didn't reflect their political views.

Bad memories. Six years earlier, researchers from the Johns Hopkins School of Public Health published misleading statistics in the DASH-Sodium trial - and refused to release further statistical calculations that would likely have unmasked their charade. Again, the Johns Hopkins researcher was an activist, a member of the lobby group World Action on Salt and Health (WASH). Again, the incompletely-reported and misleading research was instrumental in an important policy decision - to establish a Daily Recommended Intake level for sodium and a Dietary Guideline supporting reduced salt intake. Even worse, this time, despite the incontrovertible conflict represented both by his WASH lobby group membership and heavy involvement in the research itself, the researcher was installed as chair of the DRI project committee and the Dietary Guidelines subcommittee where he blocked consideration of the full data from the study.

Putting the National Journal aside, I plunged into an editorial in the journal of another advocacy organization, reading an editorial entitled "Eat your fruits and vegetables, but hold the salt ." The editorial writer acknowledged his funding support from the same federal agency that had funded DASH-Sodium for a study he has underway exploring the effects of the "DASH Diet" on individuals with isolated systolic hypertension. I expected little comfort, but hoped that, perhaps, the editorial would confess the over-interpretation of the results (as had an earlier article in 2005 where a DASH-Sodium investigator revealed that in six of the eight subgroups - subgroups that represented a large majority of the public - the reported findings were statistically insignificant even though the authors described them as valid.

All these discussions of DASH-Sodium have attempted to portray the DASH Diet as salt-reduced and demonstrating benefit from lower sodium intakes. This has been frustrating to those of us - including the salt industry - who have strongly endorsed the DASH Diet because it does not reduce salt and the blood pressure effect is produced by the fruits, vegetables and dairy products - not the salt. But the federally-funded PR juggernaut rolls on.

In the editorial, Dr. Paul Conlin of Harvard University's Brigham and Women's Hospital, indeed, endorsed salt reduction and noted a study of blood pressure in chimpanzees supported increased intakes of fruits and vegetables, two of the triumvirate of "good" foods in the DASH Diet. But note the caveats Conlin incorporates into his conclusions:

Elliott et all have provided new information, albeit in chimpanzees, showing that long-term salt restriction in the setting of a diet rich in fruits and vegetables produces sustained reductions in blood pressure. These data are relevant to humans but should be approached with caution and respect for the sample size, the lesser effects when adjusted for key factors, and the inability to add knowledge on the health and/or cardiovascular benefits of salt restriction beyond blood pressure lowering. Major next steps include …confirming that eating such a dietary pattern provides unquestioned health benefits. (emphasis added)

Last year, other WASH advocates took an important step forward in conceding the validity of health outcomes measures instead of controversial statistical extrapolations based solely on blood pressure (ignoring other metabolic changes that occur in salt reduction). As one observer sagely observed, their embrace of health outcomes in a Finnish study "backfired" when the data showed that improvements in Finns' cardiovascular health lagged their European and North American peers. Still, anti-salt advocates have claimed it would be "immoral" to ask study subjects to consume "normal" levels of salt since they "know" it is unhealthy. The Conlin editorial cedes the point, admitting that such a study is not only feasible and moral, but needed to "add knowledge on the health and/or cardiovascular benefits of salt restriction beyond blood pressure lowering" and confirm "that eating such a dietary pattern provides unquestioned health benefits." Those benefits - projected to be improved cardiovascular outcomes like less heart attacks and cardiovascular disease - have not been confirmed in the several studies that have examined them.

The Salt Institute has called for a controlled trial of whether there is any health benefit from reducing dietary sodium. Now, even those who support salt reduction for blood pressure lowering are beginning to see that this isn't the right question and are embracing our view of the need for a new study.

Perhaps those bad memories of incomplete data reporting by Johns Hopkins' researchers can, indeed, be relegated to history and not the basis of public policy.

Two child specialists issue a timely reminder in the December 22 issue of the British Medical Journal . Indianpolis-based Rachel C Vreeman, a fellow in children's health services research, and Aaron E Carroll, an assistant professor of pediatrics, remind physicians not to be taken in by myths perpetuated in medical science:

Physicians understand that practicing good medicine requires the constant acquisition of new knowledge, though they often assume their existing medical beliefs do not need re-examination. ...

Even physicians sometimes believe medical myths contradicted by scientific evidence.

The prevalence and endorsement of simple medical myths point to the need to continue to question what other falsehoods physicians endorse.

Examining why we believe myths and using evidence to dispel false beliefs can move us closer to evidence based practice.

Let's face it, doctors are busy people. Reading all the latest journals -- and, particularly, the methods sections that often contain the key statistical manipulations -- is a virtually insurmountable task for GPs or area specialists like those serving our children. Take, for example, an aricle on salt and blood pressure in children published in the Journal of Human Hypertension in September 2007 by anti-salt war chief Graham MacGregor and his associates. MacGregor et al reported that

An increase of 1g/day in salt intake was related to an increase of 0.4 mm Hg in systolic and 0.6 mm Hg in pulse pressure....The consistent finding of our present analysis of a random sample of free-living indiviudals with that from controlled salt reduction trials provides further support for a reduction in salt intake in children and adolescents.

That's the item that may have caught readers' attention and, if so, it would have perpetuated another myth -- that salt was important to the blood pressure of children. Don't blame the journal, however; the editors commissioned an editorial to attempt to keep the story straight -- and they continue to make that editorial available as their top-listed Featured Article. In that corrective editorial , fomer International Society of Hypertension president Michael H. Alderman explains:

Specifically, a difference in salt intake of 1 g was associated with a 0.4 mm Hg rise in blood pressure. However, the significance of this relationship disappeared after correction for energy intake. ...

Regrettably, the current report provides little information regarding other associations to blood pressure or variations in other characteristics that might be associated with variations in sodium intake. For example, stature and physical maturation are associated with blood pressure. Bigger children may be muscular or pudgy. Children who exercise vigorously may have large energy (and sodium) intakes, and be taller and leaner than youngsters who have the same body mass index and different life styles. Cooper et al. postulated that the strong link of creatinine to blood pressure might reflect muscle mass and perhaps be a marker of body size. This, in turn, might be the most powerful determinant of blood pressure in children-more important than age or sodium. Perhaps, the best measure of growth and development available here is mid-arm circumference. The strong arm to blood pressure correlation may reflect muscle mass and suggests that diets high in energy (and therefore, among other things, sodium) may be conducive to physical maturation, along with a slightly higher blood pressure. In short, if this were the causal pathway, then higher pressure might even be a desirable sign in children.

Dietary intake is complex, and to characterize it on the basis of one element may well oversimplify any assessment of its value. For example, given the high correlation of energy with virtually all other nutrients, it is possible that those consuming more sodium (and energy) had more satisfactory consumption of other important dietary elements-both known and unknown. In any event, blood pressure is not the only measure of the health of children. The British Survey of Young People probably includes, in addition to physical and physiological data, information on other social, economic and developmental characteristics whose explanation might well inform our understanding of the relation of blood pressure, diet, health and development in these youngsters. Of note, He et al. also provide some other interesting information. For example, they note that 18-year-old British residents, in 1997, were consuming 2.6-g of sodium per day. That was similar to levels found in Chicago a decade earlier, and falls within the range of adult sodium intake seen world-wide in most countries and suggests that, a decade and 2 ago, these near adults were within that range.

It is also interesting to note that measures of discretionary sodium use did not correlate with blood pressure. This supports the Cochrane Collaboration conclusion that there was not sufficient evidence for a general dietary recommendation to reduce sodium intake. (emphasis added)

Medical myths can cause real damage. With regard to children, it seems that once corrected for caloric intake, there is no association of blood pressure and salt intake, but there IS a strong association of calories (and salt) with healthy development of children. Perhaps the biggest myth is that diet is less important than its component nutrients. Don't let your pediatrician get duped or pass on medical mythology.

Or should we title this: "Get government out of the bedroom ... and the kitchen"?

Don't miss the "Brave New Diet" op ed piece by Sally C. Pipes in today's Washington Post . To give you a flavor, she points out that basketball superstar Kobe Bryant and undefeated New England Patriot's QB Tom Brady -- to say nothing of "Hollywood hearttrobs" Brad Pitt, Matt Damon, Tom Cruise and George Clooney" -- are all "fatties." They're overweight using today's metrics. Besides some useful facts on government games-playing on the obesity issue, the political insight about dietary guidelines is particularly timely -- and planned -- for this holiday season with its parties and feasts. Ms. Pipes notes that

"underlying this ["common political refrain that America faces a childhood obesity epidemic"] is the premise that we're helpless before gingerbread cookies and honey-roasted hams -- unable to resist these and other foods and incapable of putting down our forks. We can be cured, it seems, only by government intervention such as the banning of trans-fats and sodas from public schools.

But is it the food, or is it us? Is it a proper role of government to tell us what we can or can't eat?

She poses some questions she'd like answered "[b]efore we let Uncle Sam into our kitchens, at school or at home" and concludes:

People make choices. And government should protect -- not restrict -- the freedom to make those choices so long as we're not harming others.

While we may not always like the choices others might make, it is essential that we all have the freedom to choose for ourselves. Once we accept the idea that the Nanny State should step in when it's "for our own good," we've taken a very big step down the road to something like the scene painted in George Orwell's "1984" -- when citizens wake each day to mandatory exercise classes on the Telescreen.

Most of us would prefer to choose for ourselves whether to exercise or have an extra helping of apple pie. And if we gain an extra pound over the holidays -- so what? That's why we have New Year's resolutions.

How can it be that Americans are living longer and healthier lives than ever before and yet dying in unprecedented numbers from chronic diseases? Are we confusing risks of proxy conditions for real risks of adverse health events?

Successful people live in the present, but they think seriously about the future. They invest themselves and their resources to make tomorrow better than today and to cushion the inevitable bumps in life's road. Through learned precept or harsh experience, they know that "an ounce of prevention is worth a pound of cure." They've also learned to count their blessings along the way, to temper their worry about the future by appreciating the good fortune they've enjoyed.

We use the same thought process to fashion public health policy. As a society, we have never been healthier nor longer-lived, yet these hard-won achievements are tempered with recognition that many amongst us and elsewhere in the world live Hobbesian lives. We recognize the fragility of our personal health and the imposing shadow of chronic disease in our lives and in our families. We invest ourselves, sometimes wisely, sometimes not, in quests to improve our diet and fitness and otherwise protect our health and that of our loved ones. We crave security in matters inherently uncertain. We sacrifice to prevent potential threats, often accepting taxes and social regimentation, believing that using a seatbelt or getting a flu shot is a reasonable trade-off against injuries in car crashes or a flu pandemic.

Just as we do as individuals, as a society we accept risk trade-offs, but we do it based on our belief that these risks have been fairly described. While each of us has a unique set of risk tolerances, the entire calculus is undermined if the information fed into this vast social "brain" is compromised by poorly-understood data limitations or manipulated by unseen parties with special interest bias.

Not to say that these choices are easy. We are beset, as individuals and citizens, with media coverage of emerging science which often seems conflicting. We hear blaring warnings about health threats and advocates' impassioned appeals for action on divergent strategies based on different diagnoses. It's confusing.

Take, for example, two recent "authoritative" pronouncements. In the new publication from the Department of Health and Human Services (HHS), Health, United States, 2007, a compendium of more than 150 tables reporting data from the Centers for Disease Control and Prevention, as we reported earlier :

Life expectancy is at an all-time high. Females live longer than males, but a baby born in 1900 would live until 1948 (men) or 1951 (women) -- 48 and 51 years, respectively. Boomers born in 1950 will live, on average until 2015 (men) or 2021 (women) -- 65.5 and 71 years, respectively). The new report predicts children born in 2004 will live until 2079 (men) and 2084 (women) -- 75.2 and 80.4 years respectively. We take it for granted, but it's big news. And good news.

Children are healthier. In just the past quarter century, the number of children who died before age 14 has been cut in half -- in half! (since the mid-20th century, the rate has been cut 80%). Youth and teens are 60% less likely to be in "fair" or "poor" health. Almost as good as Ivory Soap, 98.2% of our children are healthy.

Adults are thriving, too. Despite our aging population, the percentage of all people in "fair" or "poor" health has dropped in a decade by more than 10% -- from 10.4% in 1991 to 9.2% in 2005. Physical limitations have also been dropping, from 13.3% to 11.7% over the past eight years while age-adjusted vision- and hearing-impairment, over the same period, have improved a remarkable 65% (dropping from 10% to 3.5%).

Mortality continues to decline. The new figures confirm those we reported earlier this year in comparing the U.S. with Americans' steady salt intakes with mortality figures in Finland which compromised its health improvements as it reduced its population's salt intake. Overall, age-adjusted mortality for all of the leading causes of death are in decline -- cut in half since 1950. In just the past 14 years, deaths from the leading cause, heart disease, have dropped by a third. Deaths from the second-leading cause, cancer, have fallen 14% and the third, stroke, by a whopping 72% (with no reduction in dietary salt). The key is age-adjusting. If we don't die of something in our youth or early adulthood, we reach old age where we (all, eventually) die of "old age" ailments like respiratory infections or Alzheimers's. In fact, the biggest risk of dying is getting old.

But, just as we were feeling that perhaps all the doom and gloom of rising health costs and millions without health insurance, was a manageable challenge, The Partnership to Fight Chronic Disease, a new national coalition of business and labor groups, issued its "Policy Platform" declaring that "rising rates of chronic health problems pose a significant and unsustainable burden on the U.S. health care system" and called for Americans to display "a willingness to enact policies that help Americans better prevent and manage chronic illnesses." The Platform calls on the presidential candidates to "highlight common-sense reforms." Pointing out that 77% of U.S. healthcare costs are due to chronic disease, it cites (other) CDC figures showing two-thirds of American children will develop diabetes leading to "lower life expectancy than their parents." Scary stuff. The Platform throws around a lot of numbers, too, such as alleging that obesity costs society $200 billion a year.

Head-scratching time. What about the other CDC figures that show that overweight Americans are actually healthier than their thinner fellow-citizens ( 1 2 3 4 )? You may remember: the ones CDC issued as revisions to their earlier obesity alert .

Now, let's accept that the people making these analyses are most likely fair-minded advocates for their views. The first thought in sorting this out is the correct one: consult the data; a close reading of the studies may help explain the discrepancies and where the authors of various studies may have claimed more than their data show. There is another possibility, however.

While there is general consensus that preventing cancer or heart disease is better - and likely less expensive - than caring for the victim after a malignant tumor is discovered or a heart attack occurs, the differing statistical worldviews as described in Health, United States, 2007 and the PFCD Platform may come down to how risk is defined.

Take the seat belt example. Unrestrained car drivers and passengers are clearly at greater risk of injury or death than those who "buckle up for safety." We'd never, knowingly, combine the two groups to determine the average risk when the documentation of the very different risk profiles is available.

Transfer that thinking to the question of the risk of high blood pressure. About 20% of Americans have high blood pressure, hypertension. And hypertension is responsible for about 16% of heart disease. The 20% with high blood pressure include, of course, those whose current blood pressure exceeds the defined minimum 140/90 mmHg. But the calculation also includes all those whose blood pressure would have been at the "hypertension" threshold except that they took medications or made lifestyle adjustments to lower their blood pressure. Those who managed their blood pressure (like those with seat belts), surely have a lower risk. Unlike the seat belt example, however, they are all lumped together: "once a hypertensive, always a hypertensive." The group that modified its blood pressure should be considered a separate, lower-risk group. By lumping them together, we inflate the number of people identified at risk and targeted for public health concern.

Better data would, thus, help us understand why we continue to have a large number of people with hypertension while at the same time we have achieved fantastic reductions in the rate of heart disease. Hypertension is often "sold" as a disease when it is, rather, an indicator, a marker, an intermediate variable. We are concerned about heart attacks, strokes and mortality. When it comes to treating this surrogate marker, we must never lose track of the real objective: improving health outcomes, not modifying "risk factors" - especially one that explains only one-sixth of the problem. The body is complex and its systems, redundant and interconnected. Simple solutions may make great headlines, but they don't change the "medical facts of life."

So, as we marshal our resources and prioritize our public health targets, let's keep in mind that efforts to prevent chronic disease must be assigned using real-world data. We can prevent high blood pressure, but if the side-effects (e.g. increased insulin resistance, elevated plasma renin activity, etc.) impose unanticipated costs, we need to prevent heart attacks using the best weapons we have. And those weapons are proven. They include medications. They may include lifestyle interventions like weight control and fitness. They don't include salt reduction for the general population.

The Food and Drug Administration recently asked for comments on what new reference values the agency might use to calculate the percent daily value (DV) on the Nutrition Facts and Supplement Facts labels and what factors the agency should consider in establishing such new reference values. The Salt Institute provided a comprehensive response addressing the questionable value of this type of labeling to consumers.

The Salt Institute strongly support the provision of objective scientific information to consumers in a manner that will help consumers can make informed choices. Currently, nutrients are labeled in isolation - not in reference to thief role in the whole diet. While placing the impact of individual nutrients into context with our "whole diet" is a complicated task, this is how nutrients are metabolized on an ongoing basis. Lacking a complete knowledge of how individual nutrients impact upon each other in the overall diet, the question remains as to whether the consideration of nutrients in isolation for the purposes of informing consumers is truly a functional benefit to them. While no one doubts that this data provides information, it can compromise perspective by taking nutrients out of their 'holistic diet' context.

Based upon the results of the DASH diet and the most recent results on the positive impact of vegetables on the diet, we are not certain that the establishment and dissemination of a DV is of particular benefit to consumers. Salt consumption is self limiting because of taste and despite the outcry regarding our current levels of consumption, our cardiovascular performance is significantly better than that of Finland - the only country that has significantly reduced its salt consumption by 40-50% in the last 30 years. If a DV is felt to be absolutely necessary, it is certainly not in anyone's interest to reduce it any further than its current level.

The news media's been reporting a paper in The Lancet this past week that purports to "prove" that salt produces chronic disease mortality, killing 8.5 million persons around the world. As the headline writers penned, that would be a serious condition, indeed, if it were true. But a closer look shows the authors engaged in the same statistical sleight-of-hand that was on display at the FDA hearing a couple weeks ago.

No matter how you quantify the enormous costs associated with chronic disease and, in this case, heart disease, the key to assessing the veracity of the numbers associated with salt is the linkage. Simply put, there is none. It's manufactured -- it exists only as the product of a mathematical model that assumed that lower salt diets WILL lower population blood pressure AND that lowering BP in this way WILL produce the lower incidence of CV death. GIGO's the term for it; garbage in, garbage out.

In fact, the authors cite one of two studies of salt reduction in Finland. The study they don't report is the health outcomes of Finand over the year it reduced its citzens' salt intake. Absent any control, the numbers show improvement, but compared with other countries over the years, Finland lagged behind those countries that did NOT reduce salt .

That The Lancet would choose to publish this reflects the policy preference on the author, not a substantive contribution to public health nutrition policy.

When the federal government set up its program to ensure the safety of American foods, it recognized that some ingredients had been used safely for years -- for some, for centuries and for a few, like salt, for millennia. They prioritized their resources and accorded these proven-safe ingredients recognition as Generally Recognized as Safe (GRAS). The decision was reviewed and affirmed in 1982. The process is about to be re-run.

Arguing that salt affects blood pressure, a number of advocacy groups endorse removing GRAS from salt and having FDA set food-by-food limits on salt content on the assumption that this would produce lower sodium intakes and lower blood pressure. Defenders of GRAS for salt (SI, food manufacturers, some health groups and prominent hypertension researchers, argue that blood pressure is an "surrogate" risk factor -- and not a very good surrogate at that! There are other surrogate candidates to predict chronic disease risk: insulin resistance, plasma renin activity and more. Salt affects them as well. Salt's defenders -- like the Salt Institute -- have insisted the right test isn't blood pressure, but rather actual disease outcomes like heart attack incidence or, better still, mortality rates.

FDA is conducting a hearing Nov. 29th to air the controversy with prominent proponents of both views delivering oral testimony to an FDA panel in College Park, MD.

The Salt Institute will be testifying, renewing its call for a controlled trial of the health outcomes of low-salt diets and challenging FDA to help fund the study. Read the news release or the full testimony .

For a good review of the issues, see JunkFoodScience's story "The good-bad salt debate gets a hearing at the FDA ."

We're an equal opportunity critic of cooking the books on medical studies. As an FDA panel this week will (again) examine the relationship of salt and health, JunkfoodScience reminds us of the games-playing in the "gold standard" ENHANCE trial, "Even gold can be tarnished." Don't miss it. Let's hope the FDA panel reads it too!

It's a deadly double play combining the Big Lie with the Devil in the Details. But this is no game.

We have much to be thankful for, more than a one-day holiday allows. And we all can be thankful for the myriad benefits made possible by salt. Not only will Thanksgiving tables feature "Neptune's Gift" as families gather to celebrate, but more and more holiday chefs will be brining their turkeys this year. Try a Google search yourself: 1.8 million websites offer advice on brining. While a few offer advice more practical in the months ahead , most explain how soaking your turkey in salt brine will produce the tenderist, tastiest bird you've ever had.

As the top-listed Webervirtualbullet site explains:

Today there's a surge in popularity of "flavor brining", a term coined by Bruce Aidells and Denis Kelly in the book The Complete Meat Cookbook .

While traditional brining was meant to preserve meat, the purpose of flavor brining is to improve the flavor, texture, and moisture content of lean cuts of meat. This is achieved by soaking the meat in a moderately salty solution for a few hours to a few days. Flavor brining also provides a temperature cushion during cooking--if you happen to overcook the meat a little, it will still be moist.

Enjoy your Thanksgiving.

Epidemiological studies are often used inappropriately for common illnesses like cardiovascular disease and cancer, according to British cardiologist Guy Lloyd.

Randomized controlled trials are more reliable. Epidemiology is most effective in identifying large risks in rare diseases. Just in the field of cardiology, the results of observational studies are often seriously flawed.

Observational studies of the cardioprotective effects of female sex hormones, the usefulness of antioxidants or homocysteine lowering strategies, and rhythm control for atrial fibrillation suggested a clear treatment effect and greatly influenced practice. But subsequent randomised trials refuted each hypothesis.

The main problem, he explained, is all of the interacting factors among cohorts that can't be statistically accounted for in an epidemiological study.

Concerns with the reporting of medical studies are multiplying. A recent blog on Junkfoodscience highlights the efforts of a new project, STROBE (Strengthening the Reporting of Observational Studies in Epidemiology). We wish them all success.

Since the early 1950s the health promoting qualities of the Mediterranean diet have been universally acknowledged. The Mediterranean diet "is characterized by abundant plant foods (fruit, vegetables, breads, other forms of cereals, beans, nuts and seeds), fresh fruit as the typical daily dessert, olive oil as the principal source of fat, dairy products (principally cheese and yogurt) and fish and poultry consumed in low to moderate amounts, zero to four eggs consumed weekly, red meat consumed in low amounts, and wine consumed in low to moderate amounts, normally with meals. This diet is low in saturated fat (less than or equal to 7-8% of energy) with total fat ranging from less than 25% to greater than 35% of energy throughout the region." In fact, the famous DASH diet was designed using the Mediterranean diet as the model. What is never revealed, however, is that the level of salt in the Mediterraneam diet is considerably higher than that the levels recommended for the US diet.

Drs. Leclercq and Ferro-Luzzi of the WHO Collaborating Centre for Nutrition, at the National Institute of Nutrition in Rome, Italy reported in that males consumed 4400mg sodium per day based upon 24 hr Urinary excretion, equivalent to 11grams of salt per day . It was also observed that the discretionary intake of salt for adults varied from 36% (males) to 39% (females) of the total intake. The discretionary intake alone, of salt in Italy amounts to almost 75% of the total sodium recommended in the US (2300 mg). Since many of the Mediterranean foods are naturally well salted (cheeses, olives, salted fish (cod, anchovies), fish eggs, etc., it is natural to expect that a majority of the discretionary salt is used to improve the palatability of the variety of vegetables that are such a conspicuous and essential part of the diet.

When the DASH-Sodium trial is examined, it is immediately apparent that moving to a DASH-type diet has a far greater impact on blood pressure than lowering salt consumption. Dropping from the current level of sodium consumption to the recommended dietary level dropped the systolic pressure by an average of 2.1 mm Hg. However, simply changing from a regular to the DASH diet, without any changes to sodium consumption, reduced the systolic blood pressure by 5.9 mm Hg, almost three times the drop resulting from the sodium reduction. This clearly explains why Mediterranean people enjoy an excellent cardiovascular status despite their high salt consumption. With a DASH diet, the impact of sodium on the blood pressure of hypertensives is minimal (and of no significance to normotensive people - the majority in the population).

Considering that significantly increased fruit and vegetable consumption is a key element to the DASH/Mediterranean diet models, it is entirely realistic to question whether the current recommended daily intake of sodium (2300mg/day) is realistic, given the Italian example above. Amongst the most important foods are the bitter cruciferous vegetables. While they have so much nutrition to offer, without salt, they are not palatable to adults or children (who are even more sensitive to bitterness). In addition to the benefits of the DASH/Mediterranean diet for cardiovascular disease outcomes, all other health parameters are significantly improved. Based on all the scientific evidence we have available, fruits and vegetables are the cheapest, most readily available, and most beneficial foods we can consume to give a significant degree of protection from the modern health challenges we face. Considering the hierarchy of positive health impacts, maintaining the DASH/Mediterranean diet is far more significant than reducing salt - the one safe condiment that has traditionally made this diet so agreeable.

Three weeks ago, at the GMA/FPA and CSPI Salt Conference, Michael Jacobson of CSPI categorically stated in his opening remarks, "The debate on sodium is over. There is no longer a debate whether salt is good or bad." He was followed by Steve Havas of the AMA who stated that he did not believe any additional research was necessary to prove the beneficial impacts of a dramatic sodium reduction in the diet. This attempt to stifle discussion and pronounce, as if by imperial fiat, that there was no longer any debate concerning the benefits of salt reduction in the diet backfired.

When the audience, which was composed of professional food scientists, nutritionists, dieticians, epidemiologists and policy makers split into working sessions to consider all that was said, they concluded that the benefits of salt reduction to health outcomes had yet to be proven scientifically and that that a singular focus on salt reduction was not a viable solution. Indeed, the delegates unanimously stated that a more holistic approach was needed to improve overall dietary quality.

Almost as it on cue, within two weeks of the Salt Conference, two peer-reviewed medical journal articles appeared, both demolishing Michael Jacobson's assertion that "the debate on sodium is over." In a paper published in the October issue of the European Journal of Epidemiology , prominent Dutch scientist D.E. Grobbee and colleagues in the Rotterdam Study concluded that urinary sodium is not significantly associated with myocardial infarction, stroke, or overall mortality, adding: "The absence of a relationship between salt intake and mortality in our study corroborates the findings from the large Scottish Heart Health Study among almost 12,000 middle-aged subjects with 24-h urine samples."

Shortly thereafter, in the Journal of Interactive Cardiovascular and Thoracic Surgery , Drs. Jay Walker, Alastair MacKenzie and Joel Dunning of the Department of Cardiothoracic Surgery at James Cook University Hospital, in Middlesbrough, UK reported their in-depth review of all available evidence to determine if restricting dietary salt intake would provide protection from adverse cardiovascular events or mortality. They found it impossible to find a link between salt and heart disease due to a "lack of adequately powered randomized trials or observational studies conducted with sufficient rigor." Dr Dunning went further - he dismissed the theory that salt can cause strokes and heart attacks as,

...an argument of hope over reason....

These two publications reinforce the conclusions of the recent evaluation of the health outcomes study from Finland's three decade long salt reduction program.

Today saw a scathing denunciation of the poor science that has gone into the UK's public health policies . Dr. Phil Peverley, a GP from Sunderland in Northern England is this year's Magazine Journalists and Designers Association Columnist of the Year. Last year, he won the Press and Periodical Association's columnist of the year award. In his article, "A Very Large Pinch of Salt," Dr. Peverly criticizes

those doctors and politicians who have for years promoted the nannying theory that we should be forced to eat less salt in our diets. The obvious lack of a correlation between elevated blood pressure and salt intake should have been good enough for them.

He goes on to describe Public health minister Dawn Primarolo, who was recently quoted as saying that a low salt intake was an essential part of a healthy diet.

Ms Primarolo's only qualification to spout off on this subject is a six-year pre-MP career as a 'mature student', so I would always have regarded her pontifications as profoundly suspect…

Delving deeper, he states:

However, my remit is a wider one. This is further evidence that it is us, the medical profession, who don't know what we are talking about. I never fell for the bollocks about salt, but I have been as guilty as the rest of spreading disinformation and inaccurate advice about a whole manner of other medical subjects. It is becoming embarrassing.

Bravo Phil Peverly! There are not many like you, but hopefully there will be enough to drive away the fog, so we can get back to the science.

Writing for the American Council on Science and Health , Kathleen Meister offers sound advice for medical and science writers. Available in PDF , here's the executive summary :

• Scientific studies that show an association between a factor and a health effect do not necessarily imply that the factor causes the health effect. Many such studies are preliminary reports that cannot justify any valid claim of causation without considerable additional research, experimentation, and replication.

• Randomized trials are studies in which human volunteers are randomly assigned to receive either the agent being studied or an inactive placebo, usually under double-blind conditions (where neither the participants nor the investigators know which substance each individual is receiving), and their health is then monitored for a period of time. This type of study can provide strong evidence for a causal effect, especially if its findings are replicated by other studies. Such trials, however, are often impossible for ethical, practical, or financial reasons. When they can be conducted, the use of low doses and brief durations of exposure may limit the applicability of their findings.

• The findings of animal experiments may not be directly applicable to the human situation because of genetic, anatomic, and physiologic differences between species and/or because of the use of unrealistically high doses.

• In vitro experiments are useful for defining and isolating biologic mechanisms but are not directly applicable to humans.

• Observational epidemiologic studies are studies in human populations in which researchers collect data on people's exposures to various agents and relate these data to the occurrence of diseases or other health effects among the study participants. The findings from studies of this type are directly applicable to humans, but the associations detected in such studies are not necessarily causal.

• Useful, time-tested criteria for determining whether an association is causal include:

- Temporality. For an association to be causal, the cause must precede the effect. - Strength. Scientists can be more confident in the causality of strong associations than weak ones. - Dose-response. Responses that increase in frequency as exposure increases are more convincingly supportive of causality than those that do not show this pattern. - Consistency. Relationships that are repeatedly observed by different investigators, in different places, circumstances, and times, are more likely to be causal. - Biological plausbility. Associations that are consistent with the scientific understanding of the biology of the disease or health effect under investigation are more likely to be causal.

• New research results need to be interpreted in the context of related previous research. The quality of new studies should also be assessed. Those that include appropriate statistical analysis and that have been published in peer-reviewed journals carry greater weight than those that lack statistical analysis and/or have been announced in other ways.

• Claims of causation should never be made lightly. Premature or poorly justified claims of causation can mislead people into thinking that something they are exposed to is endangering their health, when this may not be true, or that a useless or even dangerous product may produce desirable health effects.

We hope this gets to be a popular site.

Whether it's the health of the planet or of its human inhabitants, it seems we have to learn every generation about the pain and suffering inflicted when we act on improperly-understood "science" -- and, thus, the need to employ a cautionary, evidence-based approach to basing public policy on boldly-asserted scientific truth.

An article in the current American Thinker deals with global warming, but it's not my intent to explore the validity of the scientific clash on that issue, only to "steal" an anecdote to make a further point. Author James Lewis shares this story:

Trofimko Lysenko is not a household name; but it should be, because he was the model for all the Politically Correct "science" in the last hundred years. Lysenko was Stalin's favorite agricultural "scientist," peddling the myth that crops could be just trained into growing bigger and better. You didn't have to breed better plants over generations, as farmers have been doing for ages. It was a fantasy of the all-powerful Soviet State. Lysenko sold Stalin on that fraud in plant genetics, and Stalin told Soviet scientists to fall into line --- in spite of the fact that nobody really believed it. Hundreds of thousands of peasants starved during Stalin's famines, in good part because of fraudulent science.

He then provides context:

When the scientific establishment starts to peddle fraud, we get corrupt science. The Boomer Left came to power in the 1970s harboring a real hatred toward science. They called it "post-modernism," and "deconstructionism" --- and we saw all kinds of damage as a result. Scientific American magazine went so far as to hire a post-modern "journalist" to write for it. John Horgan became famous for writing a book called The End of Science, but never seemed to learn much about real science. It was a shameful episode. ....

Pathological science kills people and ruins lives. Such fake science is still peddled by the PC establishment in Europe and America. ...

Britain is even more vulnerable to politicized science than we are, because medicine is controlled by the Left. That is a huge chunk of all science in the age of biomedicine. But the British Medical Journal and even the venerable Lancet are no longer reliable sources. Their political agenda sticks out like a sore thumb. It was The Lancet that published a plainly fraudulent "survey" of Iraqi civilian casualties a few years ago --- the only "survey" ever taken in the middle of a shooting war. As if you can go around shell-shocked neighborhoods with your little clipboard and expect people to tell the truth about their dead and wounded: Saddam taught Iraqis to lie about such things, just to survive, and the internecine fighting of the last several years did not help. The whole farce was just unbelievable, but the prestigious Lancet put the fake survey into the public domain, just as if it were real science. It was a classic agitprop move, worthy of Stalin and Lysenko. But it was not worthy of one the great scientific journals. Many scientists will never trust it again.

The account continues on global warming, but my point is the broader one: politically-correct science may not be scientifically-correct science and relying on PC science (junk science) risks disasters like that engineered by Stalin. That's true for environmental science. And it's true for nutrition science.

The Pittsburgh Tribune Review just published a well deserved story about the town of Cranberry, PA. This small but progressive town of 28,000 residents was recently the recipient of the Salt Institute's Salt Storage Award. The article described Cranberry's covered public works storage facility that has a capacity to store 7,000 tons of road salt.

Peter Longini, a township spokesman said, "The facility allows us to buy when the product is cheap. Some years, depending on what the winter is like, there is a problem moving the material,"

Make's sense doesn't it?

SI president Dick Hanneman said, "This is an example of the fact that it does not take a huge agency like PennDOT to do it right,"

Congratulations once again to the town of Cranberry, which will benefit from this structure, both economically and ecologically for years to come.

The Pittsburgh Tribune Review just published a well deserved story about the town of Cranberry, PA. This small but progressive town of 28,000 residents was recently the recipient of the Salt Institute's Salt Storage Award. The article described Cranberry's covered public works storage facility that has a capacity to store 7,000 tons of road salt.

Peter Longini, a township spokesman said, "The facility allows us to buy when the product is cheap. Some years, depending on what the winter is like, there is a problem moving the material,"

Make's sense doesn't it?

SI president Dick Hanneman said, "This is an example of the fact that it does not take a huge agency like PennDOT to do it right,"

Congratulations once again to the town of Cranberry, which will benefit from this structure, both economically and ecologically for years to come.