A news analysis, with this title, by Denise Grady published in yesterday's New York Times should be required reading by the nation's public health nutrition community. Grady points to public health campaigns that "have drilled that message into the national psyche." Her example: angioplasties and coronary stents. She could have been talking about salt. She continues:

Ideally, treatments, operations and diagnostic procedures should be thoroughly tested before they come into routine use. Bu that is not always the case. ...

Some treatments -- like opening a closed artery -- appeal so strongly to common sense that it becomes irrestible to go ahead and use them without waiting for scientific proof that they are effective. ...

As the treatments start to catch on, people assume they must work, and it becomes difficult or impossible to study them in the most definitive way -- by comparing treated patients with an untreated control group. If most people think a therapy works, who wants to be the control? Doctors may balk at controlled studies, too, calling it unethical to withhold the treatment from patients in the control group.

Grady recognizes that her example is just that, a single instance of a widespread phenomenon of pseudo medical advice lacking "gold standard" testing through randomized trials to prove improved health outcomes -- just as is the case now with encouragement to reduce dietary salt.

And today's news that FDA has (once again) approved silicone breast implants suggests that FDA understands the need to revisit arguments based on Chicken Little pseudo-science. Responding before controlled studies confirm the problem can compound the ultimate solution by creating controversy as medical experts learn the earlier "fix" is wrong, but the public has already been indoctrinated on the basis of the premature "solution."

Grady reminds us:

Medical history is strewn with well-intended treatments that rose and then fell when someone finally had the backbone to test them, and the scientific method trumped what doctors thought they knew.

Hormone treatment after menopause, which works for symptoms like hot flashes, was widely believed to prevent heart disease and urinary incontinence. But carefully done studies in recent years have shown that hormones can actually make those conditions worse.

Stomach ulcers were once attributed to emotional stress and too much stomach acid, and were treated with surgery, acid-blocking drugs and patronizing advice to calm down. Then, in the 1980s, two doctors who were initially ridiculed for proposing an outlandish theory proved that most ulcers are caused by bacteria and can be cured with antibiotics.

For decades, women with early-stage breast cancer were told that mastectomies offered them the best chance of survival. But in 1985, a large nationwide study showed that for many, a lumpectomy combined with radiation worked just as well.

"As a nation, we're not doing ourselves any favors by going after the next new thing without doing the studies," said Dr. James N. Weinstein, chairman of orthopedic surgery at Dartmouth and a researcher at its Center for the Evaluative Clinical Sciences, which studies how well various medical and surgical procedures work.

When established treatments turn out to be useless, or worse, harmful, Dr. Weinstein said, "everybody's going to lose trust in the system."

With regard to salt, the FDA and NHLBI may have succeeded in brainwashing the public, but, ultimately, science will prevail. Government pronouncements don't change physiology. The essence of the scientific method is that current "knowledge" is bombarded with new facts and new analytical methods as they are developed and, guess what, the old orthodoxies are often overturned or modified.

What we need to sort out the controversy among medical experts regarding dietary sodium is a controlled trial of the health outcomes of various levels of dietary sodium. We need to know if lowering the average population sodium intake will save lives or put our population at higher risk of heart attacks and cardiovascular mortality as the latest studies have found.