It appears that we finally have something that we can agree upon with the Center for Science in the Public Interest (CSPI) . According to a recent article prepared by Merrill Goozner of the at CSPI, and repeated by Marion Nestle in her blog , nearly half the new 2010 Dietary Guidelines Advisory Committee's 13 members have taken funding from the food and pharmaceutical industries. Of common interest is the Chairperson of the Committee, Dr. Linda van Horn, professor of preventive medicine at the Northwestern University Feinberg School of Medicine in Chicago. We are not aware of any conflict of interest involving research funding, however, during the first public meeting of the DGAC, Dr. van Horn recalled an experiment that she had done as a graduate student, which she stated proved without doubt that children who were fed reduced salt diets ended up abhorring the typical salt levels in many foods. Thus, she revealed the personal bias she brings with her as she assumes the chair of a committee tasked with the 'objective' evaluation of all the data on salt and health to be used as a base for future recommendations.
It is interesting to note that CSPI, Marion Nestle, and the preponderance of professionals in the medical community choose to define conflict of interest almost exclusively in terms of funding received from outside (particularly industry) sources. What they seem to totally ignore is the overwhelming bias resulting from personal ego, and a lifelong investment in a particular point of view on a subject. Such an all-consuming passion usually results in a conflict of interest greater than any motivated by research funding. Clinical researchers who have promoted a particular theory for decades are very unlikely to change their minds easily. Many brazenly belong to advocacy groups that publicly espouse their positions. How can they be expected to objectively evaluate data that may make decades of their investment worthless? Yet, there they are - fully prejudiced by preconceived positions - and placed in a position of public trust to make objective evaluations.
Thus, we have one of the greatest hypocrisies in modern medicine - biased researchers sanctimoniously pointing their fingers at the 'conflicts of interest' of others.
Physician, heal thyself.
As we pointed out in an earlier article, the chairman of the sub-committee for Fluid and Electrolytes for the 2010 Guidelines is Larry Appel. Dr. Appel is one of the world's most outspoken anti-salt advocates and is listed as a member of World Action on Salt and Health (WASH) , an advocacy group whose singular aim is: "to achieve a reduction in dietary salt intake around the world." In their justification for salt reduction , WASH focuses almost exclusively on hypertension to the virtual exclusion of all other risk factors and biomarkers responsible for overall health outcomes. They systematically ignore all data (including the Cochrane review and its latest reissue - ) as well as the most recent evidence that demonstrates the net negative health outcomes from reduced salt diets. How any member of such an advocacy group could possibly be selected (much less lead) what is supposed to be an objective advisory group is quite astonishing and black mark on the Institute of Medicine as well as our National Academy of Sciences under which it operates. It is not as if the IOM were unaware of this conflict of interest. They simply choose to ignore it, confident in the belief that they can pass anything off as legitimate science.
And why not? When has the medical establishment ever been called out, no matter how egregious their behavior or advice has been? How many people marched on the IOM or the AMA offices to protest the countless deaths resulting from the hormone replacement therapy fiasco. When it comes to medicine, people suffer silently - and the establishment gets a free pass.
Such hypocrisy does not bode well for the future of objective medical science in this country.
Recently, the Department of Health and Human Services launched their first Physical Activity Guidelines for Americans . This was in direct response to the national obesity epidemic whose effects can be seen everywhere. The U.S. Centers for Disease Control have stated that adult obesity rates doubled since 1980, from 15 percent to 30 percent while childhood obesity has almost tripled during the same time period, from 6.5 percent to 16.3 percent.
While it is great that these new guidelines are here, it is fair to ask why it took so long for them to be published. The answer to that is clear. The responsibility for carrying out physical activity is almost entirely in the hands of individuals. If individuals don't make the effort to do physical exercise, then there is no one to blame but themselves. This is, of course, much more related to adults than children. For children, it is both the home and school environment that is largely responsible for the amount of exercise they do.
Because of the great degree of personal responsibility associated with physical exercise, there has been little attention paid to this issue on the part of consumer advocacy groups, whose political capital is largely the result of finding businesses and large institutions to blame for problems. With reference to the obesity epidemic, consumer advocacy groups invariably blame the food industry for producing high fat, empty calorie foods, and, to a lesser extent, they blame the government for not regulating the industry. It is a very rare occurrence when a consumer advocacy group calls on consumers to bear their share of the responsibility for managing their lifestyle and matching their food consumption with energy expenditure through physical activity.
Thus, while the Physical Activity Guidelines for Americans has just been published, the Dietary Guidelines for Americans is in the process of preparation of its sixth iteration since 1980.
It is strange that it is only since the first iteration of the Dietary Guidelines for Americans that we have experienced the obesity epidemic. This does not say much about the effectiveness of the Dietary Guidelines and the people or institutions that have developed them. Considering what has happened to our physical condition in the last quarter century, one wonders if Americans would have been better off without the Dietary Guidelines. Is it possible that this could have been corrected if the Physical Activity Guidelines were issued at the same time? Not likely.
As much as the Department of Health and Human Services (HHS) and the Department of Agriculture (USDA) assure us that the Dietary Guidelines are evidence-based, they are about the worst example of this that anyone might choose. The Dietary Guidelines are predominantly based upon opinion - the absolutely lowest level of evidence in the hierarchy of acceptable evidence. In fact, some of the evidence upon which the Guidelines are based is so subjective, there have been complaints that certain of the Guidelines should never have been issued. Unfortunately, there are certain segments of our society that have an burning desire to provide guidance, no matter how ill-advised.
If you consider both the Dietary and Physical Activity Guidelines, you will see that they don't really relate to one another. (It is interesting to note that the Physical Activity Guidelines are issued by the HHS alone, while the Dietary Guidelines are issued jointly by HHS and USDA - are there some issues at play here?) While food products carry labels that indicate the energy content (calories) of each serving, it is almost impossible for consumers to easily translate this into the amount of physical activity required to expend the energy taken. People who watch their weight and exercise regularly are an exception. They have a good idea of what extra energy will have to be burned off in order to make up for extra food consumption. If they treat themselves to a few extra chocolate chip cookies, then they put in the effort to jog for an extra half hour in order to burn the calories off.
Instead of putting calories on the food label, why don't they put the physical activity equivalent on, so that people will have an idea of what they have to do to get rid of that additional intake. That is the sort of thing that will link the Dietary and Physical Activity Guidelines together - calories by themselves simply don't convey the energy input/output message to consumers.
Getting consumers to relate their diet to physical activity and energy expenditure is not rocket science. It does, however, require a sensitivity to the needs and awareness of consumers rather than a focus on political expediency and a compulsion to give advice by a medical establishment that has still to learn what food and nutrition are all about.
