You've probably read press accounts of the attack on environmentalists levied by Czech president Vaclav Klaus at his National Press Club news conference yesterday. Klaus, a renowned economist who has erected a thriving market economy on the ashes of his country's bankrupt communist system, was in town promoting his new book: Blue Planet in Green Shackles -- What is endangered: Climate or Freedom? He also renewed his challenge to former US VP Al Gore to a debate on the issues. He told the crowd:
"The largest threat to freedom, democracy, the market economy and prosperity at the beginning of the 21st century is no longer socialism. It is, instead, the ambitious, arrogant, unscrupulous ideology of environmentalism. Like their [communist] predecessors, they will be certain that they have the right to sacrifice man and his freedom to make their idea reality. In the past, it was in the name of the Marxists or of the proletariat -- this time, in the name of the planet."
Whatever your views on the arrogance or scientific credibilty of the environmental movement, it was Klaus' comments in response to media questions afterwards that caught my eye. Asked why global warming is presented to the public as the overwhelming, consensus position of scientists, Klaus responded, according to John Fund of the Wall Street Journal, explalining that
the careers and funding sources of many scientists now are dependent on 'climate alarmism' and climate alarmists have become an interest group with the power to intimidate into silence skeptical colleagues and public figures. The climate issue, he added, 'is in the hands of climatologists and other related scientists who are highly motivated to look in one direction only.'
Klaus could have been talking about the salt and health issue where anti-salt proponents have tried to convince the public that critics of their views, despite their professional prominence and unassailable credentials, should be ignored and that they, the anti-salt crowd, Not only are major voices in this group funded heavily by the government agency, but careers are enhanced by toeing the government's anti-salt line.
Perhaps Klaus should review The (Political) Science of Salt by Gary Taubes. It would be wonderful to have this courageous national leader tell truth to those in authority on salt and health.
Business speaker/coach Scott Hunter's new book, Unshackled Leadership , makes an initial demand on readers: that they recognize that they live their lives in a paradigm. Their existing beliefs determine their perspective on the world and that those beliefs are unchallenged with regard to their validity or effectiveness. When the paradigm is "truth," all is well, but our beliefs virtually always have "blind spots" or outright errors. Hunter equates the resulting problem to trying to find downtown Chicago with a street map of Detroit.
Hunter goes on, helpfully, to identify various, often "petty," personality flaws as illustrative of the mis-perceptions (my blog co-author, Mort Satin, terms them "myth-conceptions"), but the basic insight is that unless we change our personal pardigms, we cannot change our course in life. He reminds us that Albert Einstein defined insanity as doing the same thing and expecting a different result.
Remodeling a paradigm just doesn't work. It needs to be knocked down and re-built. The entire method of thinking about the events we observe must be changed. To get us started, Hunter suggests:
1. Start noticing what you believe to be "the truth." Be willing to challenge your most deeply held beliefs.
2. See if what you believe is true all of the time. Do you just ignore the facts when you encounter situations which are inconsistent with your beliefs? Maybe your deeply held beliefs are just that, beliefs.
3. Ask what life would be like for you if what you believe was not the truth? Or what would life be like if just the opposite was the truth?
4. Be willing to consider the possibility that you are living in a body of beliefs that are not only not the truth, but not even useful. Your willingness to open your mind and question everything will be an enormously valuable first step to shifting your paradigm.
Using an illustration about salt, we've locked ourselves into a paradigm about salt and health where we believe that only the blood pressure impacts of intake levels of dietary salt have heath implications. As long as we remain immobilized by this perspective, we will be forever frustrated by the evidence that is accumulating that lowering dietary salt may improve blood pressure, but actually increase the risk of heart attacks, strokes and death due to cardiovascular events. Until we reconsider and change our paradigm to accept that there may be multiple effects to reducing dietary salt, we will remain in a state of denial.
It's time to "unshackle" our public health nutrition policy leadership by replacing a flawed paradigm.
Thanks to JunkfoodScience for another gem illustrating tactics of purveyors of junk science. Dietitian Sandy Szwarc describes the case of an attorney attempting to intimidate a housewife/mother-blogger who was defending against charges that vaccinations lead to autism. The attorney's heavy-handedness prompted a New Hampshire judge to demand he account for his charges. His "priceless" response struck Szwarc as "better than a soap opera."
It's not fair and must be some big conspiracy network (with "co-conspirators"), he says (in essence), because she's just a girrrrl. A "mother and housewife" can't possible be smart enough to able to research the internet and medical journals, and write such well-researched pieces. She couldn't just be a concerned mother of an autistic child, somebody had to be helping her, he says, and she must be "either an agent of the defendant or of industry." Therefore, he wanted to find out who she was working for or with. Yes, she must be an industry shill.
The Salt Institute is familiar with this line of attack. On us it goes: Salt Institute spokespersons aren't medical doctors, so they are not capable of either quoting recognized experts or summarizing the results of the scientific studies we call to public attention. After all, they say, what's important is who they represent. Of course, they are reduced to this misdirection because (apparently like the "girrrrl" blogger somehow the messenger makes a better target than the irrefutable message.
Szwarc tells the story with more pizazz. And the blogger's post is even better.
Medical science has made enormous strides since the release of the first national Dietary Guidelines in 1980, but many would agree that the quality of the American diet appears inversely related to these health gains. We've added years to our lifespan and provided the safest, highest quality foods possible yet, as a nation, the quality of our diet has deteriorated. The Secretaries of Health and Human Services and of Agriculture will soon name the next DGAC to define the science base for the 2010 Guidelines. This is the place to fix the problem. We need to establish the new 2010 Guidelines as worthy of the trust Americans hope to place in them as an authoritative source of information about their food choices.
The Secretaries should consider carefully the critical importance of the selection criteria for Committee members. With obesity at historic levels and childhood obesity a near epidemic with grave long-term consequences for our nation, the need for policy guided by expert scientists is clear. No one could deny that the first six DGACs were composed of prominent medical and nutrition experts. There can be no quarrel with the professional, subject matter qualifications of past DGAC members. It's the paradigm that needs changing.
Committees of subject matter experts produce reports with expert opinion. That sounds better than it really is. In the hierarchy of "evidence-based" medicine, expert opinion is the lowest level of evidence. Rigorous data analysis trumps even well-informed opinion. To sort out public confusion and establish consensus authority, we need to move higher on the evidence-based hierarchy. We must do better for the nation. Evidence-based decision-making focuses less on the experts and more on the evidence. While as good they could be, because past DGACs have not followed the best discipline, their reports cannot claim the mantle of evidence-based reviews. We need to change the DGAC process, not just the people on the Committee.
Using a process like the one developed in the 1980s by the Cochrane Collaboration , inventors of "evidence-based medicine," will allow this new DGAC to take the next step in the process and set the standard and grade the evidence before considering the policy analysis. We need this different expertise on the DGAC in order to make the Guidelines reflect the science and become most relevant to Americans' health.
The federal government endorses an evidence-based approach to health policy and the U.S. Preventive Services Task Force (USPSTF) is the model for how the DGAC could adopt the discipline of evidence-based decision-making. Supported by the HHS Center for Outcomes and Evidence and a contracted Evidence-based Practice Center in Oregon which conducts systematic reviews of the evidence, the USPSF makes its recommendations on the basis of explicit criteria. The USPSTF reviews the evidence, estimates the magnitude of benefits and harms for each intervention, reaches consensus about the net benefit for each intervention, and issues a recommendation - from "A" (strongly recommends) to "I" (insufficient evidence to recommend for or against).
The USPSTF process would be the most appropriate and effective model for the DGAC. An evidence-based review will require an evidence-based process; this requires changing the concept of the DGAC which up until now has been compiling expert opinion instead of conducting an evidence-based review.
In a courtroom, judges rely on subject matter experts: witnesses attest to their observations and "expert witnesses" offer their professional opinion. Judges are not subject matter experts; they are process experts. They know what observations and opinions to admit into evidence. They discipline the process. The DGAC has been acting as an "expert witness" instead of a judge. We need a DGAC composed of "judges" - experts in the process of evidence-based decision-making. We need "judges" who have a proven dedication to dispassionate review of the evidence. And we need their report to reflect their conclusions about the quality of the evidence before the policy conclusions and recommendations.
How often have we heard the anti-salt advocates, the "so-called" experts, refer to the Intersalt study, and in particular the Yanomamo Indians of Brazil. These primitive hunter-gathering tribes are held out by these experts as prime examples of the benefits of low-salt consumption, because they do not experience any age-related increase in blood pressure.
Indeed, one of the main conclusions coming out of the study was that the Intersalt populations with low-sodium intakes had low median blood pressures, a low prevalence of hypertension and no increase in blood pressure with age. Disregarding any other factors, the experts stated that the low levels of hypertension among these tribes was the exclusive result of low-salt consumption.
Such conclusions reflects the dangers of commitment to a single focus approach to science - an approach that almost always manages to manipulate the interpretation of data in order to support a prejudged conclusion. And, not particularly surprising, all the "experts" continue to use the Yanomamo Indians as primary proof that reduced salt consumption results in an absence of hypertension.
Two out of the four low-sodium populations in the Intersalt study - the Yanomamo and Xingu Indians are of Amerindian origin. Both these populations have a complete absence or a very low frequency of the D/D genotype - a genotype that is closely associated with cardiovascular diseases and hypertension.
So, it's not low salt consumption that results in the lack of an age-related rise in blood pressure in the Yanomamo and Xingu Indians, it's their genetic makeup!
Studies in Mexican Americans suggest that diseases such as obesity, diabetes mellitus, cholesterol gall stones, and gall bladder carcinoma are more common in individuals with high Amerindian genetic background (1,2,3). On the other hand, these individuals present low risk for developing cardiovascular disease, in spite of data that show serum triglyceride concentrations to be slightly higher in this population than in Caucasians at any age (4,5). These data suggest that Amerindians are protected against developing cardiovascular diseases due to their genetic background.
An interesting fact is the different prevalence of hypertension in several states of Mexico. Thus, states with a high Amerindian genetic background, such as Puebla, Chiapas, and Oaxaca present a low prevalence of hypertension when compared to the northern states of the country Coahuila, Sonora, and Sinaloa with a low Amerindian genetic background.
These differences explain the low genetic susceptibility for cardiovascular diseases and hypertension in populations with high Amerindian background such as the Yanomamo and Xingu.
How many other myth-interpretations are the "experts" responsible for?
It is hoped the new Dietary Guidelines will not be a product of the four M's, Myth-information, Myth-interpretation, Myth-representation, and Myth-guided policies
1. Hanis, C.L., R.E. Ferrell, S.A. Barton et al., « Diabetes among Mexican Americans in Starr County, Texas," Am. J. Epidemiol, 118, 659-672, (1983). 2. Hanis, C.L., R. Chakraborty, R.E. Ferrell et al., "Individual admixture estimates: Disease associations and individual risk of diabetes and gallbladder disease among Mexican-Americans in Starr County, Texas," Am. J. Phys. Anthropol, 70, 433-441, (1986). 3. Haffner, S.M., A.K. Diehl, M.P Stern et al., "Central adiposity and gallbladder disease in Mexican Americans," Am. J. Epidemiol, 129, 587-595, (1989). 4. Weiss, K.M., R.E. Ferrell, and C.L. Hants, "A New World syndrome of metabolic diseases with a genetic and evolutionary basis," Yearbook Phys. Anthropol, 27, 153-178, (1984). 5. Mitchell, B.D., M.P. Stern, S.M. Haffner et al., "Risk factors for cardiovascular mortality in Mexican Americans and non-Hispanic whites. The San Antonio Heart Study," Am. J. Epidemlol, 131, 423-433, (1990).
Confirming two earlier studies of the U.S. population in the federal government's Nutrition and Health Examination Survey (NHANES) parts I and II, a study by Drs. Hillel W. Cohen, Susan N. Hailpern and Michael H. Alderman in the new issue of the Journal of General Internal Medicine examined the relationship of dietary sodium and mortality in NHANES III. The NHANES sample represented 99 million non-institutionalized U.S. adults aged 30 and over. Dividing the population into quartiles the researchers found an inverse relationship between sodium consumption and mortality. The lowest quartile (averaging 1,501 mg/day sodium - coincidentally, the sodium target for sodium restriction advocates - had an 87% greater cardiovascular mortality than the highest sodium quartile (which averaged a hefty 5,497 mg/day). In the NHANES I analysis, the low-salt group was 20% more likely to die. In the NHANES II group, the low-salt group was 37% more likely to die. So the trend with the recent studies has been accelerating in the opposite direction than that predicted by authors of the government's dietary guidelines.
The data seem to be giving the public health nutrition establishment a slap in the face trying to wake it up. The lowest quartile was a good surrogate for the politically-correct social elite. They were, by far, the best-educated, smoked less, consumed the least salt, added the least salt at the table and had the lowest body mass, but still had non- significantly higher systolic blood pressure and, of course, they suffered vastly higher mortality outcomes."
The authors conclude that "These data are consistent with the hypothesis that lower sodium intake is associated with increased CVD and all-cause mortality." Although many associations lacked statistical significance, they "were remarkably consistent." They added: "In contrast, no analysis of the two mortality outcomes generated (Note: CVD and all-cause)any trend supporting the competing hypothesis that the highest sodium relative to the lowest sodium is associated with increased mortality."
Bottom line: "There are no randomized trial data linking sodium intake to CVD events or mortality." In fact, the findings, they declare, affirm "that for the broad general US population, higher sodium is unlikely to be independently associated with higher all-cause or CVD mortality."
Nutritionists convened in Brussels last week in a conference organized by EuSalt, the association of European salt companies. As reported in FoodNavigator.com , a basic thrust of discussion was the inadequacy of current data sets on actual nutrient intake levels. The European Union has a program (FACET) to harmonize intake data collection and create EU-wide databases.
"We need to deliver meaningful data," said Beate Kettlitz, director of food policy, science and R&D at the CIAA, the European food and drink industry association, speaking at the event.
"There is a lot of information out there about what people are eating - national databases, regional databases, in-house databases owned by food companies - but quantity counts for little if the data is not also good quality," she said.
While cautioning that the quest of perfect data should not become an excuse to "do nothing" when consensus exists, Loek Pijls, of ILSI-Europe also pointed out the inherent complexities of the data:
"Eating is a complex thing - if you change one thing, you affect others," he said. "For example, we know that there is a link between the levels of vitamin D we consume and the ability to absorb calcium."
We agree, lowering dietary salt, for example, triggers hormone production and inhibits insulin resistance independent of any blood pressure effect. The totality of the impacts must be assessed together.
For all those who fear the impact of salt on growing crops here is interesting news. Researchers report that growing cherry tomatoes in salty water can make them tastier and richer in antioxidants. Seawater irrigation puts an environmental stress on the the tomato plants that causes them to produce more vitamin C, vitamin E, and dihydrolipoic and chlorogenic acids.in an attempt to cope with the stressful conditions.
It also improves the flavor of the tomatoes.