As we blogged when we first learned of the U.S. Preventive Services Task Force's revised recommendations on frequency of mammograms , we wished USPSTF were as influential as media coverage suggested -- and not because we wanted to express an opinion on this recommendation. Rather, we wanted to endorse the process of evidence-based public health policy.

That was two or three forests worth of coverage ago, and most of the media accounts studiously avoid the real question: is there evidence to support the recommendation? Story after story deal with the outrage on the left about damage to women's empowerment or, conversely, on the right, questions about whether the reduced use of the procedure presages the rationing of medical care alleged integral to ObamaCare.

Dr. Gilbert Ross of the American Council for Science and Health has a healthier perspective.

“I don't think this issue is a gender-related one at all,” says Dr. Ross. “It certainly shouldn't be. Actually, the emerging recommendations for PSA screening for prostate cancer are very similar to these breast cancer recommendations. The authoritative bodies weighing in on PSA screening basically say don't do it unless there is some rationale for it in terms of specific risk factors, because the potential downsides outweigh the benefits. Of course, any kind of cancer screening is always an emotional issue. For women who want a more individualized risk estimate to help guide them in this decision, the NCI has a 'tool' for figuring out one's risk for breast cancer. Some women in a higher-risk category, besides getting more frequent mammograms, may also consider discussing with their doctors the potential benefits of taking a drug to reduce risk of breast cancer -- chemoprevention.

...“We believe that politicizing this issue does no one any good and contributes to confusion among women and their doctors,” says Dr. Ross. “In fact, this is an unusual instance when we agree with a New York Times editorial, calling for the mammography screening discussion to be completely severed from the ongoing healthcare reform debate.”

ACSH quotes Dr. Arthur Caplan,director of the Center for Bioethics at the University of Pennsylvania, added his weight to the argument for reason:

“In this case, the taskforce found that screening all women in their forties led to too many false positives and too much unnecessary follow-up testing for the number of lives it saved. They did not say that no lives were being saved. They said not as many as everyone thought. And not enough to justify asking every woman under fifty to get a mammogram every year...

“There is no reason to doubt the accuracy of the scientists' finding that evidence does not support routine mammography for most women under fifty. But there is every reason to doubt that the numbers they compiled will be sufficient to overturn a medical practice that carries so much ethical weight for women.”

Let's not get hung up on how we feel on this issue. Science is evolutionary. Evidence can improve over time. Let's follow the science, not the ideologues.

Spy thriller fans have been seeking alternative heroes since Tom Clancy stopped writing about his CIA champion Jack Ryan.

But the CIA will be getting an entirely new face next summer --Angelina Jolie. Jolie's new move, Salt, centers around the efforts by her character (Evelyn A. Salt) to clear her name as a rogue CIA operative. Hollywood can be so incestuous. The role in the original screenplay was written for Tom Cruise, but he dropped out. Cruise, moviegoers will remember, starred in another thriller (plus sequels), Mission Impossible, sharing a leading role with Jolie's father, Jon Voight.

Salt suffuses our culture. Who would have pictured the Salt Queen being dethroned by Angelina Jolie? So, salt fans, get used to the new "face" for salt -- here's the poster promoting the movie and the YouTube posting of the movie "teaser" trailer .

Earlier this year a New Jersey startup "food manufacturer," Bon Vivant International , began marketing "NutraSalt an all-natural, low-sodium sea salt," claiming "66 percent less sodium than other salt products."

Well, I guess this "food manufacturer" makes other things than food. Food grade salt is required to have at least 97% sodium chloride. So NutraSalt cannot be food grade salt.

The founder claims: "The product can be sold as table salt and as an ingredient to food-service companies and food makers."

It would be interesting to know which "food-service companies and food makers" are using non-food-grade salt. Inquiring minds want to know.

It has been but a few short days since the U.S. media heralded findings by the U.S. Preventive Service Task Force (USPSTF) that there is insufficient evidence to recommend that some women get regular mammograms. The press reported that the USPSTF is "influential" in setting federal policy. We responded that we only hoped it was true , but, sadly, that hadn't been our experience. The USPSTF has been a lonely voice insisting on quality science to guide policy.

We know nothing of the quality of the science on either side of the mammogram debate, but we do know that when the evidence-based recommendations of the USPSTF come up against political correctness, PC politics wins. That's been the case with the debate over dietary salt.

Thus, it was no surprise that the White House ducked. The NY Times reported that when "the task force recommendations stirred concern among women, and came under fire from lawmakers of both parties, the White House emphasized that they were not binding...."

That's the way the federal government has dealt with the salt debate: politics trumped science. The USPSTF found insufficient evidence to recommend a general reduction in salt intakes, but the powers-that-be blithely ignored this evidence-based conclusion and redoubled its efforts to achieve the impossible: substituting federal recommendations for human physiology. Read all about it .

"(E)xcessive salt restriction is as harmful as high salt in heart failure," concludes a study in the European Journal of Pharmacology . The Osaka, Japan-based research team demonstrated that for heart failure patients low-salt diets activate plasma aldosterone and the "increased plasma aldosterone level with strict salt restriction activated the mineralocorticoid receptor signaling in volume-overloaded condition, resulting in increased myocardial fibrosis."

In short, yet another study showing the risk of low-salt diets. The authors conclude:

A recent report showed that high sodium intake rather improved cardiac performance, induced peripheral vasodilatation, and suppressed the release of vasoconstrictor hormones in patients with compensated heart failure (Damgaard et al., 2006). Indeed, our findings suggest that salt depletion, which increases the plasma aldosterone level, must be avoided in addition to salt overload in the treatment of heart failure.

There was an interesting story on the front page in the print edition of today's Wall Street Journal with an eye-catching but gratuitously offensive and grossly inaccurate headline: "Maybe Mummy Should Have Laid Off the Salt." We had to respond :

There has been exactly one clinical trial of the effect of low-salt diets on cardiovascular morality and rehospitalization for congestive heart failure. That study confirmed observational studies and showed conclusively that low salt diets produced greater mortality. See the article in Clinical Science, "Normal-sodium diet compared with low-sodium diet in compensated congestive heart failure: is sodium an old enemy or a new friend? " It concludes: "The results of the present study show that a normal-sodium diet improves outcome, and sodiumdepletion has detrimental renal and neurohormonal effects with worse clinical outcome...."

So, perhaps the mummy should have used more salt during life -- as well as the salts used in the mummification process.

It's headline writers like this that are responsible for newspapers coming in dead last in terms of consumer confidence .

Scientists generally accept that 24-hour urine samples are the most accurate means of measuring sodium intake -- the "gold standard" for dietary sodium just as randomized controlled trials are the "gold standard" in the hierarchy of levels of evidence.

With that as background, how should we understand the claim by the Heart and Stroke Foundation (Canada) which "revealed" today that "500,000 kilograms of salt have been removed from the food supply in the last four years by companies participating in the Health Check program." HSF's health policy director equated the amount to "20 dump trucks of salt."

On its surface, the claim is that the total food sold over the past four years bearing a Health Check logo contains a half million kilos less salt (that figures to 550 tons of salt). Every year, Canadians consume about 130,000 tons of salt. So over four years, Canadians consumed a half billion tons of salt (520,000). In other words, this effort is claimed to reduce Canadians' salt intake by 0.1%.

But is it true? The claim can only be evaluated if we also know the answers to these questions:

1. Compared to the baseline four years ago, what was the composition of the foods bearing the HSF label? If the quantities and/or configuration of the sales differed, what can be said about the 500,000 gram number? If people, for example, are eating less of these foods (because they don't taste good or cost more) the number is invalid. But even more:
2. Compared to baseline, what other foods are Canadians eating and in what quantities? If they are eating less salt in Health Check foods, are they simply eating that salt in other foods?

No, the entire exercise is entirely bogus.

What we need to test the proposition (and we're all for the test!) is to track the total sodium consumption for a representative sample of Canadians randomized to consume a diet including as much as possible all the Heart Check foods and compare that over a year or two, with those randomized into a control group which eats whatever they want. The outcome would be ascertained by frequent collection of 24-hour urine specimens and the analysis done in blinded fashion.

Evidence suggests that physiology determines sodium consumption, not package labels. If an individual consumes "low salt" foods, they may simply eat additional quantities of food (and extra calories) to satisfy this innate "salt craving" automatically determined by the body to reflect that individual's varying need. That's why research shows such a consistent pattern of salt intake between populations and over time .

Most visible among their food industry peers in claiming "credit" for reducing salt in their product lines, ConAgra Foods and Campbell Soup both have declining customer satisfaction scores from baseline, according to the American Customer Satisfaction Index released today. ConAgra, in fact, finished dead last among the 13 named larger companies (and below the "all others" category).

On a 0-100 point scale in the ACSI, food manufacturers averaged 83 points with Campbell Soup lagging in 12th place with 82 and ConAgra dropping 6 points to 78. Leaders were H.J. Heinz with 89 followed, at 87, by Hershey, Quaker (PepsiCo) and Mars.

ACSI produces indexes for 10 economic sectors, 44 industries, and more than 200 companies and federal or local government agencies. Among all industries , manufacturers earned 81.5. Laggards were newspapers, cable/satellite TV companies and airlines (63 and 64). They, together with telephone companies (69), were the only private sector businesses with customer satisfaction as low as the federal government at 69.

ACSI is sponsored by the American Society for Quality, the University of Michigan's Ross School of Business and Cloes Fornell International.

TheWashington Post just released a story that the U.S. Preventive Services Task Force has concluded that mammograms are unwise for younger women. Post reporter Rob Stein describes the USPSTF as "an influential federal task force" and "the federal panel that sets government policy on prevention."

We could only hope that his description was true. In fact, the USPSTF has been trying to steer the federal government away from "junk science" and towards "evidence-based" health interventions for years. This may be, as Stein sums up, a "radical change" in public health recommendations.

Perhaps now people will pay more attention to what the USPSTF concluded back in 2003 and maintains today: our present policy discouraging salt intake in the general population may be politically-correct, but it is a scientifically-flawed policy. The USPSTF has studied the question and found insufficient evidence to make a general recommendation for the public .

We'd all be better off if the US Prevention Services Task force was, indeed, the influential panel that sets government policy on prevention that the Post postulates.

William Grimes book Appetite City: A Culinary History of New York , reviews the City's rich ethnic heritage evolving out of humble beginnings as Nieuw Amsterdam. He cites the increasing popularity of "ethnic" dining as the City's greatest achievement as a "food city."

By ironic coincidence, the book appeared a year ago, when the City launched an initiative that would eviscerate the sale of ethnic foods in Big Apple grocery outlets and decimate ethnic dining in the city. The health department, basing its campaign more on political correctness than sound science, is trying to persuade grocers and restaurateurs to provide shoppers and diners only low-sodium versions of the foods they love. Imagine a low-salt salt bagel. How about a corned beef on rye or hot pastrami? No, can't have that, they're cured in saltwater. Choose your favorite ethnic cuisine and you'll find it impossible to enjoy without salt; it's the quintessential ingredient in ethnic foods.

Literally millions of immigrants entered the US through New York City and, for example, there are 3.3 million Italian-Americans in the New York metro area and extensive number who themselves or whose families emigrated from Greece or other Mediterranean countries -- whose diet is deemed the healthiest in the world (pdf 592.83 kB) . Even though newly-reelected, I doubt Mayor Bloomberg wants to tell them to turn their back on their ethnic culinary heritage -- or encourage them to dine in Hoboken, Hempstead or Yonkers.

Less than 2 years ago, China was paralyzed by a massive snowstorm resulting in $22 billion in economic losses , massive closures and disruption to transportation and travelers and significant loss of life and limb.

News this week shows the wake-up call to improve winter maintenance went unheeded.

On November 13, China Daily reported:

The country was blanketed by heavy snow and pummeled by severe weather yesterday during the third consecutive day of harsh weather.

The whiteout left several people dead and caused hundreds of injuries. It also froze traffic in many cities and grounded hundreds of flights.

Tens of thousands of people and vehicles were stuck along 21 expressways in seven provinces. Power supplies were lost in some parts of the country, the China Highway Information Service said on its website yesterday.

…

The heavy snow was the reason for at least six deaths and caused upheaval to around 630,000 people in Hebei (Province). The direct economic loss there has reached 400 million yuan ($59 million), according to the provincial civil affairs department.

…

Thousands of passengers were stranded at Beijing's two airports and its five railway stations.

Beijing Capital International Airport cancelled 59 flights and delayed hundreds of others.

Rush-hour traffic yesterday was heavily congested after several pileups and many expressways between the capital and Hebei province were closed.

Beijing's transport authority also canceled 44 bus routes from downtown to nearby destinations.

The next day, the same outlet reported worsening conditions :

The death toll rose to 21 in North China on Friday as storms continued to ravage the region.

The snowstorms left a trail of destruction that will cost more than half a billion dollars to repair, the Civil Affairs Ministry said on Friday.

Heavy snow, which has not been seen in the region for decades, left 21 people dead in seven provinces, the ministry said on its website.

The number does not include deaths came in traffic accidents that were connected to the storms that began on Nov 9, the ministry said.

China has come a long way in recent years and consumes more concrete every year than any other nation, much of it to build new, modern highways. One hopes they soon discover what developed countries well understand: operating the highways in winter weather is possible, and essential to preventing the kinds of economic disaster that unavoidable but predictable snowstorms can cause in the absence of effective winter maintenance.

Modeling losses from inadequate snowstorm response in the U.S. shows that economic losses from a single day’s snowfighting failure imposes greater costs than providing a full winter’s snowfighting service . That’s a massive “competitive advantage” for the U.S. economy.

At a Washington, D.C. panel hosted by the Pan American Health Organization (PAHO) November 3rd, panelists representing the International Council for the Control of Iodine Deficiency Disorders (ICCIDD), US Agency for International Development (US AID), Health Canada, PAHO, US Food and Drug Administration (FDA) and the International Life Sciences Institute (ILSI) affirmed unanimously that there is no conflict between the global campaign to iodize salt and efforts in many countries to moderate salt intake levels.

Representing ICCIDD Americas Regional Coordinator Eduardo Pretell, former minister of health from Peru, explained that as salt intake levels may vary, or as the iodine contribution of iodized salt changes within the overall diet, salt iodization programs have proved they can simply and easily adjust the level of iodine fortification. He emphasized the necessity of systematic monitoring of iodine sufficiency either through measuring the household use of iodized salt or, better, through regular population surveys of urinary iodine excretion.

Pretell also pointed out that there is no evidence that countries which iodize salt consume different amounts of salt from those that have inadequate iodization, nor has salt consumption changed when a country achieves salt iodization. He emphasized that special care must be taken to ensure adequate iodine intakes for pregnant and lactating women and educational efforts directed to these groups urging use of iodized salt as part of any population salt reduction effort.

He reminded the group that iodine deficiency is a perpetual threat for persons living in areas with iodine-deficient soils and that, for those areas, universal salt iodization is the consensus strategy to improve iodine nutrition because fortifying salt with iodine is the easiest and least expensive option.

Pretell’s comments were amplified by Dr. Omar Dary from US AID who spoke generally on micronutrient fortification, but chose virtually all his examples from salt iodization initiatives. Dary explained that salt is the ideal carrier for iodine and other vital nutrients because its intake is consistent and predictable. He warned that the U.S. is at risk of iodine deficiency, urged American food processors to use iodized salt and reiterated Dr. Pretell’s insistence that monitoring is the key to success in salt iodization.

The importance of Dr. Dary’s advocacy for food processors to use iodized salt was brought home by Dr. Eric Hentges, president of ILSI, who presented new data confirming that, in the U.S., about three-fourths of salt is consumed as part of processed foods (none of which is iodized).

The other speakers confined their remarks to advocacy of salt reduction, but all affirmed the importance of successful salt iodization.

This graph may be even better than the Marshall Foch quote in explaining Tuesday's election results. It's from today's Casey's Daily Dispatch . CBO is the Congressional Budget Office.

The image. The analogy. Perfect. Enjoy this blog, "Pelosi as Foch " by John Feehery featured in The Hill today. Another way to put it: the best defense is a good offense (if you can mount a good offense!).