Information Today reported that on July 19, the US House of Representatives approved measures directing the National Institutes of Health (NIH) to provide free public access to agency-funded research findings within 12 months of their publication in a peer-reviewed journal. Of course, agency-funded research is taxpayer-funded research, so you would think that NIH would be happy to accommodate this idea. Not quite.
When first asked to do this on a voluntary basis, less than 5% of the eligible research was made available. Why is there this reluctance to make the results of publicly-funded medical research more widely available?
Most of the resistance comes from the scientific publishing companies, who would like to maintain their full rights over published materials for as long a period as possible, so that they can maximize the return on their investment into these publications, which includes the peer-review and editing infrastructures. Those opposed to this measure, such as Professional and Scholarly Publishing Division of the Association of American Publishers , and a coalition of academic and society publishers from within the DC Principles Coalition of scientific publishers, wrote a letter to members expressing strong concern with the language in the appropriations bill .
My sense is that scientists, who are constantly on top of the latest developments, will not wait 12 months to see the results of ongoing research, they will continue to buy the journals as they always have. It is highly unlikely that this development will negatively affect the current system of peer review and quality editing.
There are several benefits to having this information openly available 12 months after publication as highlighted in an open letter to Congress by a group of 26 Nobel Prize winners. Greater availability will also allow scientists in developing countries, scientists in other disciplines, industry researchers and interested lay people, most of whom could not ordinarily afford to subscribe to these journals, free access to the information. This is a very large constituency that should never be overlooked when considering the opportunity to advance medical science.
The Journal of the National Cancer Institute has just published "The U.S. Food and Drug Administration's Evidence-Based Review for Qualified Health Claims: Tomatoes, Lycopene, and Cancer" . FDA's Claudine J. Kavanaugh and colleagues found no credible evidence that lycopene, either in food or in a dietary supplement, was associated with reduced risk of cancer.
The articled prompted commentary from Sandra Szwarc at Junkfoodscience:
We've often reviewed the inferior evidence surrounding fruits and vegetables and their abilities to prevent major chronic diseases, including the 2004 comprehensive examination of the scientific literature done for the Produce for Better Health Foundation campaign, 5-A-Day, under the National Cancer Institute. That year, a study led by Walter Willet, M.D., DrPH, professor of epidemiology and nutrition at Harvard School of Public Health in Boston, MA, was also published. It had followed 71,910 women and 37,725 men for 15 years and found no relationship between fruits and vegetables and cancer, or any statistically significant associations with major chronic disease or cardiovascular disease.
But, time and again, the media makes little more than a whisper when studies are published questioning claims surrounding the "emerging" science of functional foods and supplements. For instance, how many heard about the May study in the journal Cancer Epidemiology, Biomarkers & Prevention on lycopene and prostate cancer? Researchers based at the National Cancer Institute and Fred Hutchinson Cancer Research Center had examined 692 cases of prostate cancer diagnosed among 28,000 men enrolled in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, an ongoing, randomized National Cancer Institute trial to evaluate cancer screening methods and to investigate early markers of cancer. They found no association between serum lycopene and total prostate cancers or aggressive prostate cancers.
No doubt it was a coincidence, but the recently-approved House ag appropriations bill contained language (Section 746) prohibiting FDA from authorizing qualified health claims for conventional foods. Including tomatoes.
USA Today turned 25 this week and ran a series of articles about changes in the world in the past quarter century. In their list of "25 Top Medical Events " was no mention of salt at all, not even recognition that during that time frame there's been a 50% increase in the number of infants born protected against the scourge of mental retardation. This achievement is due almost entirely to the massively successful global campaign to iodize salt.
One of the 25 was of some interest, however. Ranked 16th was the odyssey of hormone replacment therapy. USA Today says:
Hormones begone
Hormone therapy was once thought to be a fountain of youth for postmenopausal women, but a landmark study in 2002 found that estrogen plus progestin raises the risk of breast cancer, heart attacks, stroke and blood clots. Women stopped taking the hormones in droves, and today, they're prescribed only for relief of hot flashes and other symptoms.
As tragic as is the HRT story, it's important lesson is to teach us to demand high quality science on health outcomes before we launch a major population health recommendation. Before the government began to advise all Americans to reduce dietary salt, it should have looked at the health outcomes studied. Had it done so, we could have avoided the expensive delays -- and potential risks -- of having the "salt hypothesis" blow up in its face as HRT already has. Too bad.
The pernicious impact of advocates' use of junk science is to undermine public confidence in all science, argues an articulate letter in yesterday's Wall Street Journal. William Heller of Greenwood, Indiana, quotes an earlier WSJ op ed piece by Richard Grinker on claims that vaccinations cause autism. Grinker opines: "The antivaccine movement may be evidence that public confidence in science is eroding. . . ." Heller continues:
Proponents of the view that vaccines cause autism provide anecdotal trial "evidence" while the other side cites scientific study after scientific study that shows no such connection. A Gresham's Law effect of junk science and opinion debasing real science seems in evidence. The same factors are at work in the climate change debate. There are reams of scientific data that debunk the carbon dioxide theory of global warming, but the only data that seem to get media play is the junk science of the global warming alarmists.
Useful perspective. Bad science driving out good.
Two terms don't always mean what we believe they do: "research " and "evidence-based." Take the research just published in the Journal of Epidemiology Community Health entitled: "Evidence-based Public Health Policy and Practice: Could targeted food taxes improve health?"
That's the question posted by Junkfoodscience author Sandy Szwarc who attributes the authors' "yes" answer to creation of a mathematical computer model which, necessarily, includes countless "arbitrary decisions and assumptions" and, unnecessarily, introduces a false sense of certainty about relationships where none may, in fact, exist. The phrase springs to mind: figures don't lie, but liars can figure. In the case of this study, she observes:
For their model, the authors in this study attempted to predict the number of lives saved by assuming that lowering salt and saturated fats in the diet (assuming low-fat diets work by lowering blood cholesterol levels) would reduce deaths from cardiovascular disease and strokes. For example, they estimated that every 3 gram/day reduction in salt intake would lower incidence of heart disease by 9-10% and strokes by 12-14%. Their estimated health benefits for low-fat diets were based on the assumption that every 1 mg/dl reduction in low-density lipoprotein ("bad cholesterol") would reduce heart disease by 1%.
Without the need to go any further, it'a already clear these assumptions contradict and exceed the actual clinical evidence on the ability of "heart healthy" low-salt diets and low-fat diets to prevent deaths from cardiovascular disease and strokes. In fact, as we've examined , even the latest Cochrane review of 39 clinical trials conducted in multiple countries over the course of three decades on the ability of "heart healthy" dietary interventions (reducing saturated fats and salt) and lifestyle interventions found: "Contrary to expectations, these lifestyle changes had little or no impact on the risk of heart attack or death..."
You'll want to read the whole blog, but, in summary, she notes the various assumptions about several variables including food consumption, then returns to the salt example:
Most disturbingly absent from their computer model was consideration of any potential harmful effects of compelling "heart healthy" diets. (emphasis in original)
Salt reduction, for example, doesn't appear entirely benign, according to growing medical research. The European Society of Cardiology Guidelines for the Management of Arterial Hypertension, for instance, reported recent research showing low-salt diets can have negative effects: activating the rennin (sic)-angiotensin system and the sympathetic nervous system, increasing insulin resistance and hypodehydration (especially with the elderly). This, they concluded, could lead to increased risks for cardiovascular disease. Similarly, people who might benefit from salt in their diets wouldn't be helped, but weren't included in their computer model, either. Salt also improves the flavor of many nutritious foods, helping to prevent nutritional deficiencies especially among vulnerable populations, such as children and elderly.
We've blogged before ( 1 2 3 4 5 6 7 8 ) on the disturbing gap between true "evidence-based" health policy-making as defined by the Cochrane Collaboration and the damaging abuse of the term by authors or editors trying to fabricate news from the end product of computer models whose results reflect the programmer's biases more than the data of the study itself. We've seen this abuse in the Intersalt Study, the DASH-Sodium Study and in an alarming number of national dietary guidelines which seize the mantle of being "evidence-based" while ignoring the discipline inherent in proper application of that term.
A June 26 story on "Sodium Shakeout: Salt and Health " by Kimberly J. Decker in Food Product Design discussed the salt and health issue, referring to a resolution approved a year ago by the American Medical Association.
"Sodium has been in discussion for many years, and the problem is that it's a very controversial discussion," agrees Markus Eckert, technical vice president, flavors, Mastertaste, Teterboro, NJ. "There have been studies for many years already showing that it can lead to cardiovascular health issues." However, "there have been other published studies that followed subjects on low-sodium diets for several years and found that, actually, the risk for cardiovascular health issues is higher here than for regular diets."
In one such study, published in 2006 in the online version of the American Journal of Medicine (119(3): 275.e7-275.e14), researchers at the Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, studied survey data from the second National Health and Nutrition Examination Survey (NHANES II) and found that, among 7,154 survey participants, those who consumed less than 2,300 mg of sodium per day were actually 37% more likely to have died from CVD. The researchers acknowledged it wasn't a clinical trial, nor did they propose that the results dictate sodium nutrition policy. They did point out that their findings cast some doubt on across-the-board advice to lower sodium consumption.
Decker summarized for her food industry subscribers:
So, following the AMA's 2006 sodium statement, the Institute of Food Technologists, Chicago, offered a voice of reason by noting that we do not now consume substantially more (or, alas, substantially less) salt than we have over the past quarter century. Other food industry organizations, such as the Grocery Manufacturers/Food Products Association, Washington, D.C., and the Salt Institute, Alexandria, VA, issued rejoinders of their own, with the latter's president, Richard L. Hanneman, going so far as to call the AMA's recommendations "scientifically unjustified and a waste of time and money." Ouch.
Ouch, indeed. Thanks to IFT for its efforts to sort out the controversy. Actually, sodium intakes have been generally unchanged not just for the past quarter century, but for the hundred or so years that we've been able to measure intakes with some accuracy. We need a "truth squad" to prevent anti-salt zealots from trying to distract the public health policy discussion from its proper focus on whether lowering dietary sodium would provide any health benefit to the population. There's no evidence on the table that it would, just computer-generated model projections based on flawed assumptions drawn from intermediate variables. Yes, ouch. That hurts all of us.
One reason MSM journalists are losing their audience is the open secret that much of what is reported as "news" comes pre-packaged in canned stories from various advocacy groups and advertisers. Add that to the herd instinct that produces "PC"-slanted reporting and it's not difficult to poke holes in what we read in the newspapers or see on TV.
Cyber-journalism has the opposite problem. Rather than lemming-like PC stories based on pooled source information like wire services, bloggers and Web authors come in all shapes and sizes of quality and credibility. Who to believe?
When it comes to making sense of the chaos of Internet health reporting, Google is trying to intervene -- to make money and, they hope, to help seekers of quality information pertaining to their precious personal health. Query: will this be another case where the surgery is successful, but the patient dies? Will the choices of the Google censors preserve the essence of scientific inquiry where competing ideas are bombarded with data that either confirms or destroys them? Or will the desire to "help" consumers understand the meaning of medical scholarship excise aberrant findings, leaving only politically-correct interpretations?
We share the concerns of Sandra Szwarc in Junkfoodscience.com :
Search engines have inordinate abilities to censor information by simply making it invisible to searches. It is not uncommon for key documents and papers that don't support government initiatives or special interest agendas to be buried and take extraordinary effort to hunt down, or to disappear from the internet altogether, something anyone who's been researching for any length of time quickly discovers...
Google has just announced that it has created a "Google Health Advisory Council." ... Says Google : "We want to help users make more empowered and informed healthcare decisions, and have been steadily developing our ability to make our search results more medically relevant and more helpful to users."
Screening out "irrelevant" and "unhelpful" information? That sounds like a euphemism for censorship. Look at every name on their new prestigious advisory panel and the interests they represent. Most will be familiar to Junkfood Science readers, as we've examined the soundness of their consumer information RAND Corp., the Cleveland Clinic, the AMA, Robert Wood Johnson Foundation, AARP, Kaiser Foundation Health Plan, Inc., California HealthCare Foundation, and others.
Despite all of the flaws and utter garbage on the net, it's still been the primary way for most people to break through the media groupthink to learn other viewpoints and sounder information. This development could be the beginnings of the world's biggest internet information firewall.
Substituting a Google censor for the rigor of true "evidence-based" analysis would be a clear step backwards. Search engines seeking access to the Chinese market, reportedly, have agreed to censor their search results. That's unfortunate for 1.3 billion Chinese and a disturbing parallel to the new Google Health Advisory Council. What we need in public health policy is more transparency and solid information, not greater opaqueness and opinion. As we blogged recently , the quality of the process is of paramount importance. We need to be able to "lift the hood and kick the tires " of new medical studies, not have a secret censor decide for us what's relevant and what's not.
