By unhappy coincidence, today's news included two otherwise-unrelated stories: an outstanding article from Elizabeth M. Whelan, Sc.D., M.P.H., president of the American Council for Science and Health, "Public Health's Credibility Crisis " (from the Skeptical Inquirer) and a real life example confirming her worst fears.
First, Dr. Whelan:
"As society grapples with a possible avian influenza epidemic, threats of biological and chemical terrorism, AIDS, cigarette smoking, drug abuse, obesity, and more, it is vital that public health professionals present reliable scientific information and that the credibility of the public health profession be beyond reproach. In recent years, however, a worrisome trend has emerged: many in the public health community appear to be promoting politics and ideology over sound science. The slippage of public health science into pseudoscience and agenda-driven initiatives has been going on for some time."
She has her own examples offered as evidence of the threat. Let me offer my own recent disappointment.
As I reported earlier on the Salt Institute's "water conditioning" RSS feed, last week, the World Health Organization sandbagged the water treatment industry and plans to produce guidelines that would have public drinking water systems ensure that the water they provide contains at least minimum amounts of calcium and magnesium, two nutrients under-consumed in the U.S. and much of the world. No one disputes the need for calcium and magnesium, but drinking water is hardly the best delivery vehicle.
Experts in nutrition and drinking water gathered in Baltimore, MD, April 24-26 to discuss whether remineralizing drinking water with low amounts of calcium and magnesium would advance public health. I attended the symposium and participated in the discussion.
The symposium was organized by the National Sanitation Foundation and the International Life Sciences Institute on behalf WHO. WHO had been asked by its Middle East office whether water from reverse osmosis or distillation desalination plants was unhealthy because nutrients had been removed.
The experts agreed on several key points: 1) calcium and magnesium are vital nutrients and generally under-consumed and it is necessary to remineralize water from desalination plants in order to prevent it from aggressively attacking the pipes by which it is delivered to homes and businesses. They also agreed that ecologic studies (observational studies of the relationship between variables such as nutrients in drinking water and the incidence of cardiovascular (CV) events, are an inappropriate and under-powered analytic tool to use in determining public health policy.
No consensus emerged, however, on the key policy question of whether drinking water system operators should meet minimum mineral standards just as they now control for "maximum contaminant levels" (MCLs). Experts lamented the weak research in the area. Dr. Martha Sinclair from Australia, for example, noted the need for "substantial improvements on the evidence" and Dr. Richard W. Morris who directed the British Regional Heart Study said his large database offered no support for the conclusion that having calcium and magnesium in drinking water improved CV risk. Purdue University's Dr. Connie Weaver said a more effective strategy would be to increase dairy intake. Swedish professor Ragnar Rylander summed up: "We cannot prove that a small increase in calcium or magnesium consumption will have beneficial health effects." Leading opposition to the WHO initiative, Joe Harrison of the Water Quality Association (a speaker at this year's Salt Institute annual meeting), pointed out that buffering chemicals are needed to protect pipe systems, but that any health concerns about soft water pertain only to naturally soft water - as found in a quarter of U.S. cities - and water softened in an ion-exchange water softener. Softened water does not attack pipes, he noted. Other engineers pointed out that failure to ensure proper buffering to control pH would result in drinking water being contaminated with heavy metals from the pipes. WHO sequestered selected scientists on April 27-28 to draft a report on the subject. At that meeting, WHO staff pushed through a "consensus" report endorsing the staff's determination to recommend minimum amounts of calcium and magnesium for drinking water.
Much as it did in "managing" objections to its interventionist staff priorities, the World Health Organization (WHO) is on the path to establishing a guideline that all drinking water would be deemed "healthy" if it contains minimum amounts of calcium and magnesium. One quarter of U.S. cities don't have the target minimums, though federal law does not allow consideration of such minimum standards so at least Congress can protect us, right? Symposium participants were promised a look at the draft recommendations, but my personal experience testifying to WHO in Geneva is that the staff routinely ignore "public" comments inconsistent with the staff-driven policies they favor.
The scenario sounds like WHO's Report 916 all over again. Report 916 of two years ago was an attempt by WHO staff to create policy advocating salt (and other dietary) restrictions in the name of combating obesity. That report was so controversial it was not endorsed by the World Health Assembly composed of the 182 health ministers of United Nations countries. Could be a replay.
Many U.N. initiatives -- and many public health initiatives -- have foundered as they pursue objectives inconsistent with political realities or with, in this case, the science and engineering of public water supply systems. It seems such a waste of precious credibility
