Two hundred years ago, Lewis & Clark traversed the North American continent (building a saltworks at Seaside, OR), and the U.S. government has been funding scientific research ever since. Federal dollars helped make Samuel Morse's electric telegraph a reality. After WW II, federal research spending spurted sharply and today totals about $140 billion a year ($80 billion, defense; $60 billion non-defense). Nearly $10 billion goes to basic research and the federal government picks up 60% of that, although private R&D, in total, is probably double the federally-funded share.
As has been discussed repeately in this blog, federal funding comes with strings attached. Agencies have their own policy agendas which their taxpayer-funded research advances.
An article by William N. Butos and Thomas J. McQuade, "Government and Science: A Dangerous Liaison ?" appeared in the most recent, Fall 2006, edition of The Independent Review finds, unsurprisingly, in our view, that:
Goverment funding is hardly neutral in its effects on the institutions of scientific research: it helps shape which projects are considered worthy, which departments a university will emphasize, and which professors will get promoted.
The easy acceptance of burgeoning federal research funding, Butos and McQuade argue, is undermining the independence of scientific research (and producing "politically correct" science, we'd add, to finish the thought).
All the more reason Congress should amend the Data Quality Act to ensure its judicial enforceability. Critics of the DQA like to have it both ways: they lambaste the Bush Adminstration for promoting "politicized" science and turn around and attack the same Administration for implementing the DQA whose attempt is to ensure that science used by the federal govenment be transparent enough to be replicable by independent outside scientists. The consistency seems mostly consistent hostility to the Bush Administration, not consistent concern for quality science.
When you get your Christmas presents wrapped and the kids off to bed, sometimes there's a great football game on TV. If you get beyond that, it's time to read a good book. You may want to consider astronomer Carl Sagan 's The Demon Haunted World: Science as a Candle in the Dark . Amazon.com has this to say about the book:
Carl Sagan muses on the current state of scientific thought, which offers him marvelous opportunities to entertain us with his own childhood experiences, the newspaper morgues, UFO stories, and the assorted flotsam and jetsam of pseudoscience. Along the way he debunks alien abduction, faith-healing, and channeling; refutes the arguments that science destroys spirituality, and provides a "baloney detection kit" for thinking through political, social, religious, and other issues.
Chapter 12 is the "baloney detection" part and it brought a flood of recognition illuminating the current debate on salt and health. Consider Sagan's tools for testing arguments to uncover fallacy or fraud. They include encouraging substantive debate, dismissing arguments from authority and suggesting a healthy dose of humility and openness to new perspectives. He advises seeking evidence that can rule out hypotheses even while their validity is unproven and extols high quality controlled trials. Insightful and relevant, I hope you agree.
Sagan proceeds to identify common fallacies of logic and rhetoric. See if you recognize any patterns here in the salt and health debate. These include:
Ad hominem - attacking the arguer and not the argument.
Argument from "authority".
Argument from adverse consequences (putting pressure on the decision maker by pointing out dire consequences of an "unfavorable" decision).
Appeal to ignorance (absence of evidence is not evidence of absence).
Special pleading (typically referring to god's will).
Begging the question (assuming an answer in the way the question is phrased).
Observational selection (counting the hits and forgetting the misses).
Statistics of small numbers (such as drawing conclusions from inadequate sample sizes).
Misunderstanding the nature of statistics (President Eisenhower expressing astonishment and alarm on discovering that fully half of all Americans have below average intelligence!)
Inconsistency (e.g. military expenditures based on worst case scenarios but scientific projections on environmental dangers thriftily ignored because they are not "proved").
Non sequitur - "it does not follow" - the logic falls down.
Post hoc, ergo propter hoc - "it happened after so it was caused by" - confusion of cause and effect.
Meaningless question ("what happens when an irresistible force meets an immovable object?).
Excluded middle - considering only the two extremes in a range of possibilities (making the "other side" look worse than it really is).
Short-term v. long-term - a subset of excluded middle ("why pursue fundamental science when we have so huge a budget deficit?").
Slippery slope - a subset of excluded middle - unwarranted extrapolation of the effects (give an inch and they will take a mile).
Confusion of correlation and causation.
Straw man - caricaturing (or stereotyping) a position to make it easier to attack.
Suppressed evidence or half-truths.
Weasel words - for example, use of euphemisms for war such as "police action" to get around limitations on Presidential powers. "An important art of politicians is to find new names for institutions which under old names have become odious to the public"
This is rich; a mother lode.
It would take an all-day read of this blog to offer the myriad examples of these fallacies and rhetorical tricks. Those of us who have spoken to the issue have been subjected to many; and our appeals, for example, for a controlled trial of health outcomes of dietary sodium in preference for valuing "argument from authority," is but the most glaring example.
Thanks to Michael Paine of The Planetary Society Australian Volunteers for the good advice I'm passing along.
As we move into holiday mode, substituting our normal focus on salt for visions of sugarplums, some "highly encouraging" news from this week's journal Hypertension . Drs. Kwok Leung Ong and colleagues in Hong Kong, studying the massive US federal NHANES database, report that 75.7% of Americans with hypertension know that fact (up from 68.7% four years earlier) and 36.8% have it controlled (compared with 29.2% in the earlier study).
Good news indeed. And it's siginficantly grounded in the biggest federal database. As the authors note: "The NHANES database has been valuable for the study of the trends in the health status of a population because of its large sample size, complex sampling design, good quality control, and comprehensive content."
The authors found four reasons for the improvement: 1) obesity isn't increasing (missed that in the MSM, I'll bet!), 2) "better publicity and education," 3) better use of treatment guidelines for medications (as opposed to development on new meds themselves) and 4) "an increase in the use of antihypertensive medications."
No mention of salt, by the way. An ealier NHANES analysis found that those on lower salt diets don't benefit anyway. They had 37% higher cardiovascular mortality than those on normal salt. That's some pretty good news too! Merry Christmas.
This commentary isn't about salt. But the games being played with regard to the National Business Group on Health's Guide to Clinical Preventive Services, a document likely quite familiar with salt company HR managers, are the same kinds of "ends-justify-the-means" shennanigans that plague the salt and health discussion.
Junkfoodscience points out "unenthusiastic conclusions about the evidence in support of obesity screening and interventions" by the too-often-ignored U.S. Preventive Services Task Force (part of HHS), are the tip of a dangerous iceberg. As author Sandy Szwarc elaborates:
Even so, the NBGH Guide found them sufficient to support their recommendations, stating:
"The U.S. Preventive Services Task Force recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults....There is fair to good evidence that high-intensity counseling - about diet, exercise, or both - together with behavioral interventions aimed at skill development, motivation, and support strategies produces modest, sustained weight loss (typically 3 to 5 kg for 1 year or more in adults who are obese.
"Modest weight loss maintained for a year is hardly commanding evidence of long-term effectiveness for intense interventions. In fact, the dismal failure of any type of intervention in achieving long-term success was highlighted in the acclaimed, comprehensive review of more than 500 studies on dieting and weight loss by David Garner, Ph.D., and Susan Wooley, Ph.D.. They concluded: 'It is difficult to find any scientific justification for the continued use of dietary treatments of obesity.'"
Nevertheless, the Guide left out key sentences from the actual USPSTF report:
"The evidence is insufficient to recommend the use of moderate- or low-intensity counseling together with behavioral interventions to promote sustained weight loss in obese adults...The relevant studies were of fair to good quality but showed mixed results....studies were limited by small sample sizes, high drop -out rates, potential for selection bias, and reporting the average weight change instead of the frequency of response to the intervention. As a result, the USPSTF could not determine the balance of benefits and potential harms of these types of interventions."· The USPSTF concludes that the evidence is insufficient to recommend for or against the use of counseling of any intensity and behavioral interventions to promote sustained weight loss in overweight adults."
It reminds me of when the Dietary Guidelines Advisory Committee used just half a graph from Miller et al of Indiana University showing the variable blood pressure response to salt restriction -- some people's blood pressure falling more than others. But the original graph had simply been dissected and the portion showing that some people (about a quarter of the total) had a blood pressure INCREASE on lower salt was simply dropped. It wasn't politically correct.
While lots of scientists claim to employ "evidence-based" analysis, the assertion cannot be taken at face value. The truly disturbing thing here -- besides the science and health isssues involved, about which we claim no special knowledge -- is the intentional undermining of the federal government's science watchdog, the USPSTF. We need an honest broker like USPSTF so this preversion of its cautionary conclusions is perverse.
No doubt the UK's anti-salt publicity machine was feeling pleased with their success in generating headlines for a recent piece that suggested that infants need to cut their salt in half. That is, until junkfoodscience called their bluff.
We don't know if blogger-nurse Sandy Szwarc knew anything about the multi-million pound British anti-salt ad campaign featuring "Sid, the Slug," a cartoon reminder of one of the 14,000 beneficial uses of salt -- to kill slugs. Szwarc suggests the public "pour salt on it" -- the study in question. As she laments:
Such extraordinary claims require extraordinary evidence. Does this study hold up?
This study is said to be the "first ever meta-analysis of salt reduction studies in children." And it epitomizes every caveat of these types of studies. MacGregor and He "developed a strategy" of their own design to look for words in several databases and through reference lists at the end of articles to find studies of salt reduction in children. They only used studies published in English and of the 33 they found, decided to use 10 on children for this report. The studies all had different designs, with only one being a double-blind trail and only 9 were randomized; the studies varied in length from 2 weeks to 3 years; compliance with salt reductions appeared poor in two of the studies; we have no information on the racial/ethnic mix of the children and if it is representative of the general population; and only 3 measured 24-hour urinary sodium levels - which the researchers admitted is "the only accurate way to assess dietary salt intake." Simplifying what they did next, they pooled the data on blood pressures and net changes in salt intake, and used statistics to estimate the changes as needed to fill in missing data. Then, they applied two computer models to plot the results and more statistical analyses to reach their findings.
What they reported was that cutting salt intake by 42% reduced systolic blood pressures in the children by 1.17 mmHg. Most parents and children would consider such a salt reduction - nearly in half - to be extreme; while most doctors would debate the clinical significance of a mere 1 point reduction in blood pressure. Taking blood pressures in young children is an imprecise task at best and the children in these different studies were also at varying stages of development, with corresponding variable changes in blood pressures over the study durations, according to their growth and size.
The researchers stated that the "physiological need for salt intake in children has not been studied," but concluded anyway that "current salt intake in children is unnecessarily high and is very likely to predispose children to develop hypertension later."
They went on to declare that these results "provide strong support for a reduction in salt intake for children. [And] if continued, may well lessen the subsequent rise in BP with age and prevent the development of hypertension. This would result in major reductions in cardiovascular disease."
Their press release promised possible "massive population health gains."
·But this study did not examine a single child.
·It conducted no clinical research to learn how much salt is needed or might be harmful for children.
·It offered no clinical evidence to know if a lower blood pressure reading of 1 point means anything for children's health or is maintained as a child grows.
·It offered no proof that a blood pressure reading during childhood has any bearing on adult blood pressures or heart disease.
·And worse, it didn't follow a single child to see if there were any health effects from the salt restrictions they are recommending.
In other words, this study offered no clinically meaningful evidence, only speculations. ...
Shouldn't we have something tenable to go on before experimenting on an entire generation of children? I suspect most parents would think so.
She notes approvingly the award-winning expose of games-playing by the anti-salt crowd as documented in Science magazine and recent research showing that low-salt diets may be creating additional risk .
Beginning in 2007, the American Journal of Hypertension will have a new Editor-in-Chief, replacing its founder, Dr. John Laragh, a Time magazine cover story subject for his breakthrough work on blood pressure and heart disease. Laragh will be succeeded by Dr. Michael Alderman who has just completed his stint as president of the International Society of Hypertension.
In his parting editorial, Dr. Laragh says:
It is a pleasure for me to announce that Dr. Michael Alderman will replace me as Editor-in-Chief of the American Journal of Hypertension effective January 1, 2007. Dr. Alderman is a world-renowned epidemiologist who is unique among his peers because he has been especially interested in asking pathophysiologic questions in performing his population trials. This penchant led him to demonstrate, in a classic eight-year trial of 1717 hypertensive worksite employees, that the height of the entry ambulatory plasma renin level was directly related to the subsequent occurrence of a myocardial infarction (MI). At the same time, he found that no MI's occurred in the 251 patients who had low entry plasma renin levels. This led Alderman to do a confirming follow up study showing that dietary salt-depleted hypertensives with consequent higher renin values and lower urinary sodium values had proportionally higher heart attack rates than did those who ate more salt, and therefore had progressively lower renin values.
Dr. Alderman's research rightly questions the popular wisdom of unselectively advising salt avoidance for all hypertensives, and for all normotensive people, - a popular public health strategy which will surely chronically raise all of their plasma renin values and may have other unintended adverse consequences. Furthermore, this research has clearly reaffirmed the existence of only two mechanistically different types of long-term hypertension, each one of which is caused and sustained by either a body sodium (plasma and ECF fluid-volume) excess or instead by a plasma renin-angiotensin excess. This construction is supported by evidence that the hypertensive states caused by a body salt excess or a plasma renin excess are each quite selectively correctable respectively by giving a natriuretic drug or instead an antirenin antihypertensive drug.
The American Council for Science and Health (ACSH) has struck another blow for science and sanity. ACSH president Elizabeth Whelan's column yesterday, "Are Foods 'Addictive' ?" laments the tactic of critics of "Big Food" who try to make customers the victim of a conspiracy -- unable to protect their interests (in this case, their health) and, unstated but implied, requiring protection through more government intervention. Not so fast, Whelan says.
The word "addiction" is used very loosely today -- as when people claim they are "addicted" to exercise, chocolate, or the Internet. But addiction is a medical term referring to compulsive, habitual use of a substance that has physiological effects but is not necessary for survival. Addictive substances produce tolerance (meaning that it takes an increasing amount of the substance to produce the desired effect) and physical dependence -- and unpleasant symptoms of withdrawal if use is discontinued. The nicotine in cigarettes fits all these criteria. Food does not.
There have been claims that eating high-fat or high-sugar foods overactivates drug-like substances in the brain called endogenous opioid peptides, leading to food cravings, overeating, and obesity. Food, it is argued, causes an increase in neurotransmitter levels just as addicting drugs do. Some animal experiments may support this idea, but other animal data and human observations do not. If overeating were induced through an opioid-like mechanism, one might expect that opioid-antagonists would be useful in treating overeating, but they are not.
If this sounds familiar to salt-interested readers, it should. More than 20 years ago the Center for Science in the Public Interest (CSPI) conflated salt with cocaine -- "another white powder we snort" -- and labeled salt addictive. This past summer, critics accused "Big Salt" of heading a "conspiracy" as we tried to mobilize resources for a definitive controlled trial of the question of whether the amount of salt in a person's diet is related to their health outcomes, particularly to cardiovascular mortality. We have only observational studies addressing this question to date and they tend to suggest just the opposite of our current policy. Existing studies show no health benefits for reducing dietary sodium and several have identified heightened risk.
Fortunately, over these past 20 years, we've seen serious scientists express revulsion and reject this fear-mongering. The Cochrane Collaboration grew from a core of concerned research scientists at Oxford University to become first the inventor and then a worldwide force for "evidence-based" medicine (now everybody claims their product is "evidence-based" even when they stray from the Cochrane Collaboration's evidentiary rules). Now groups like ACSH and blogs like JunkScience and Junkfoodscience have taken up the watchdog role protecting the public against those who would pervert science to advance their policy objectives.
