My "in" box is filling up today with news on salt and exercise, interupting (and affecting) my final edits on a story on salt and obesity. First, CBS Radio News medical consultant Dr. Gabe Mirkin wrote calling my attention to his "August" article (all senses of the word) "Why You Need Salt During Exercise " followed closely by an article filed today by Ivana Bisaro, "See Salt: You Need More Sodium Than You Think ." The Bisaro article was perfect for hot August days, reminding us of the new guidelines presented by the American College of Sports Medicine calling for replacing 500-700 mg of sodium and 3/4 to 1 liter of fluid for every hour of exercise. ACSM warns to pay special attention to getting enough salt if your sodium intake is less than 3,000 mg day (US average = 3,500 mg, but some recomend 2,300 mg, below the ACSM warning level). The US Dietary Guidelines call for a half hour of at least moderate exercise a day beyond normal activities. When it's hot outside, you may need even more than the 250-350 mg of sodium called for by the ACSM.
House Energy and Commerce chair Joe Barton (R-TX), the committee's ranking minority member John Dingell (D-MI), oversight subcommittee chairman Ed Whitfield (R-KY) and Rep. Bart Stupak (D-MI) have called on the National Institutes of Health to come clean on conflicts of interest at the agency. The Los Angeles Times reported that the letter is focused on the activities of NIH cancer researcher Dr. Thomas J. Walsh and involves his receipt of corporate support and his appearance at regulatory hearings related to his corporate sponsors.
The effort remains the tip of the larger iceberg. Current regulations address the issues of financial conflicts with for-profit organizations, but conflicts of interest inherent in both funding and professional advancement growing from support by NIH itself is a big (perhaps, bigger) concern because its subtlety has the same effect: determining policy that may support private interests and agendas more than the public good.
In previous posts, I've noted that concern for investigator bias is a serious threat to the integrity of medical research -- and public confidence in the results. It's getting to the point of "piling on" for the Wall Street Journal and the editor-in-chief of the Journal of the American Medical Association to add their strong voices to the crescendo of the chorus.
But it's a lot like the future funding for Social Security: everyone recognizes a serious problem, but sometimes the remedies suggested are half-measures that will surely only paper-over the fundamental problem.
Last Friday, the Wall Street Journal ran a story "Simply Disclosing Funds Behind Studies May Not Erase Bias " about how researchers would likely deal with toughened disclosures of financial ties to for-profit firms. Tuesday, Catherine DeAngelis, JAMA's editor-in-chief weighed in with a powerful salvo in "The Influence of Money on Medical Science ." Of course they're both right. Bias is a cardinal sin and must be stamped out.
Unfortunately, the remedies being discussed are focused narrowly on bias from a for-profit funding source. They ignore the bias based on funding from a non-profit or government source, though that influence can be even more pernicious because the public is gulled into believing the sponsors genuinely represent the "public interest." The truth is, there are policy and bureaucratic biases fully as important as taking money from a drug company or medical device manufacturer.
Sure, let's deepen our concern -- but let's widen it as well!
The Journal of the American Dietitic Association has just published a study suggesting that low-energy-dense diets lead to lower overall calorie consumption. Evidence in both human and animal nutrition suggest that mineral-dense diets are associated with body leanness. It is the general consensus of nutrition professionals that our diet would be improved if it contained fewer calories and more more minerals, so the stars seem to be lining up for the "high quality" DASH Diet, developed for blood pressure reduction, but seemingly appropriate to solving a myriad of dietary problems. Could it be that sodium isn't just irrelevant (DASH), but actually part of that "high quality" mineral-dense diet?
