One role played by the Salt Institute is to try to correct the misstatements, inaccuracies and outright distortions put forward by some advocates of universal salt reduction. Debate can be a healthy way to get facts on the table, identify policy options and reach reasonable policies, but our opponents frequently try to "change the subject" by attributing all defense of salt to self-interested parties or engaging in scare tactics like overstating the amount of salt in our diets or extrapolating data to claim fantastic numbers of needless deaths that they attribute to this "high" salt intake.
An example of one exchange is Bob Messenger's The Morning Cup which today leads with an "action" photo of yours truly and the headline: "Salt Institute boss miffed; his industry's under fire!" He notes my objection to items posted on his site and adds:
I sympathize with Mr. Hanneman - he's in a nasty war trying to defend against the onslaught of anti-salt hysteria emanating from some government sources, the media and the wellness community, three very powerful adversaries. But the man is just doing his job, and what a tough, grinding job it must be these days. The truth is, and I've said this before, what's going on out there has little to do with facts as much as it has to do with an agenda-filled, fear-mongering, hysteria-driven consensus among activist-minded wellness nannies who've tagged salt with the curse of their criticisms. I have said to the industry, "Heads-up! Salt's under the gun and consumers are being bludgeoned with information, a lot of it misleading." But my bottom line, I guess, is I would tend to believe Mr. Hanneman's numbers over those of his industry's opponents.
And he concludes:
So, please ... count me among those who do not look at salt as the enemy, but as another wonderful ingredient that, like all ingredients, needs to be consumed in moderation. That said, Mr. Hanneman and the Salt Institute need to toughen up even more because the onslaught is hardly over. All one has to do is look at the UK to see what happens when idiot zealots get behind the wheel!
That's the word from the trenches in the salt wars.
A Cal-Berkeley journalism professor, writing in yesterday's New York Times Magazine, has crafted a devastating critique of political correctness in dietary guidance. Michael Pollan's "Unhappy Meals " argues that replacement of advice to select a politically-correct (though ever-changing) balance of nutrients in lieu of basing a healthy diet on food choices has led to "cognitive dissonance" among shoppers and a deterioration of food choices -- all in the name of good science. It may be the best analysis of nutrition policy since Gary Taubes, whom Pollan cites reverently.
He laments "the rise of nutritionism":
The first thing to understand about nutritionism -- I first encountered the terms in the work of an Australian sociologist of science names Gyorgy Scrinis -- is that it is not quite the same as nutrition. As the "ism" suggests, it is not a scientific subject but an ideology. Ideologies are ways of organizing large swaths of life and experience under a set of shared but unexamined assumptions. This quality makes an ideology particularly hard to see, at least while it's exerting its hold on your culture.
But the problem is not confined to the consumer: "... if nutritionism leads to a kind of false consciousness in the mind of the eater, the ideology can just as easily mislead the scientist," says Pollan crediting anti-agribusiness activist and New York University nutrition professor Marion Nestle with the insight that "The problem with nutrient-by-nutrient nutrition science is that it takes the nutrient out of the context of food, the food out of the context of the diet and the diet out of the context of lifestyle."
Why? Because what is the the "soul" of a particular food -- even if one head of broccoli is presumed identical to all others of its genus -- is unknown, perhaps unknowable. Looking where the light is brightest, scientists study nutrients, substances they can isolate and measure. The process of considering them in isolation, however, Pollan faults with producing dangerously misleading science. He offers this example: societies that eat a lot of meat have more coronary heart disease and cancers. Perhaps that's because their substitution of lots of fruits and vegetables leaves little room in their diet for meats rather than the nutritionism conclusion that there is something inherently unsafe about the meat itself. That, he posits, is why the Women's Health Initiative failed to discover a relationship between reducing fat intake and reducing heart disease and cancer. He also lambasts use of dietary recall as garbage-in, garbage-out data.
No one likes to admit that his or her best efforts at understanding and solving a problem have actually made the problem worse, but that's exactly what has happened in the case of nutritionism. Scientists operating with the best of intentions, using the best tools at their disposal, have taught us to look at food in a way that has diminished our pleasure in eating it while doing little or nothing to improve our health. Perhaps what we need now is a broader, less reductive view of what food is, one that is at once more ecological and cultural. (emphasis added)
Moving towards a prescriptive conclusion, Pollan continues:
Looking at eating through this ecological lens opens a whole new perspective on exactly what the Western diet is: a radical and rapid change not just in our foodstuffs over the course of the 20th century but also in our food relationships, all the way from the soil to the meal. the ideology of nutritionism it itself part of that change.
He identifies four large-scale changes: 1) moving from whole foods to refined, 2) simplification of the food chain through standardization of seeds and fertilizers, 3) shifting from eating leaves to seeds, and 4) the shift caused by agri-business industrialization which has displaced "traditional food cultures."
Moving "beyond nutritionism," Pollan observes that "To medicalize the diet problem is of course perfectly consistent with nutritionism." He misses a great opportunity to identify government-mandated nutrition labels on food as a prime culprit (with one exception -- stay tuned). His nine rules of better eating: 1) "Don't eat anything your great-great-grandmother wouldn't recognize as food" (moms are hopelessly contaminated), 2) "Avoid even those food products that come bearing health claims" (there, the exception!) -- here he notes disapprovingly that "The American Heart Association charges food makers for their endorsement", 3) "Especially avoid food products containing ingredietns that are a) unfamiliar, b) unpronounceable c) more htan five in number -- or that contain high-fructose corn syrup", 4) shop at farmers' markets, not supermarkets, 5) "Pay more, eat less," 6) "Eat mostly plants, especially leaves," 7) "Eat more like the French. Or the Japanese. Or the Italians. Or the Greeks. Confounding factors aside, people who eat according to the rules of a traditional food culture are generally healthier than we are. Any traditional diet will do....", 8) Cook and, if possible, plant a garden, and 9) "Eat like an omnivore" by adding new foods for a more varied diet.
Regular consumers of McDonald's Happy Meals won't find a lot of comfort, but, then, that's part of our problem in making nutrition policy: to allow nutritionism's ideologists to define as good science anything that takes an easy shot at popular whipping boys like fast food. We deserve better. We need to demand more rigorous and encompassing dietary guidelines. We need to eat what our grandmothers told us was healthy. They were right.
Pollan's article should be required reading for every member of the next Dietary Guidelines Advisory Committee.
Nothing in nutrition is more politically correct today than a preoccupying focus on the "obesity epidemic." Predictably, anti-salt zealots have chimed-in that one step towards eliminating overweight is to curtail salt consumption. Of course, salt is non-caloric, but few question lumping out-of-favor nutrients in the ukase to remove salt from the diet. The Salt Institute has just published the latest issue of its e-newsletter, Salt and Health, examining the question: "Is salt implicated in our obesity epidemic? " The article documents its conclusion that:
"... the evidence exhonerates salt and even assigns it a postive role in encouraging an increase in pursuit of healthy physical fitness. In the vast majority of cases, overweight and obesity result from energy input exceeding energy output."
Let's not take these scurrilous attacks lying down; exercise your opportunities to insist on sound science!
The global anti-obesity frenzy accelerates as politically-correct legislators from city councils (New York City and Chicago, for example) to the European Parliament weigh into the "consensus" that some foods are bad and governments should discourage (or even ban, e.g. trans fat) them.
Good nutrition is in danger of being converted from a worthy health objective to a food safety imperative like e coli or mad cow disease.
This rhetorical esacalation has an eerie similarity to the US-led multi-national effort to overthrow Saddam Hussein and erect stable self-government in Iraq. People understand that food choices influence good health; they understood that Saddam had butchered his people and thumbed his nose at UN resolutions condemning his actions. Unleashing massive efforts of public awareness has produced dietary changes, but the underlying problem of diet-related chronic disease continues, forcing consideration of a "surge" of government intervention into food processing decisions to "protect" the public from making wrong food choices. Whether improved food choices can be compared to peace and freedom in Iraq, the similarity is that failure of largely voluntary measures (food labeling or UN resolutions) is followed by more draconian interventions that invite the observation that policy-makers may have "bitten off more than they can chew" and risk not only failure, but undermine the credibility of their sponsors.
No one doubts the validity of the objectives of healthy diets or Mideast peace. The consensus breaks down in interpreting the intelligence (medical studies of health outcomes of dietary interventions or whether Saddam's government in fact trained, encouraged and exported terrorists to supplement his internal barbarities) and developing effective strategies (improving overall dietary quality versus "good food/bad food" demonization or the role of the US and its allies in preventing inter-factional blood-letting among Iraq's Kurds, Sunnis and Shiites).
In February, the European Parliament expects to vote on an anti-obesity measure that declares excess body weight a "chronic disease" and would call on the European Commission to push for rules to end the promotion of foods high in fat, salt and sugar to children. Whether you believe Saddam ever had weapons of mass destruction, you should be concerned about the "intelligence" linking non-caloric salt to obesity; there's no science behind this. And whether expanded food nanny interventionism will be more successful than "boots on the ground" along the Tigres and Euphrates should give strategists pause.
Increasing speed if you're on the wrong road won't get you where you want to go.
The (British) Salt Manufacturers' Association (SMA) has developed a questionnaire on its Salt Sense website, seeking individuals whose health has been affected by consuming either too much or too little salt. SMA wants to use this information in 's effort to persuade the UK Government to undertake much-needed research and risk assessments.
SMA has been concerned for some time that the dangers of dietary salt reduction have not been given due attention. Medical and nutrition experts from around the world have come forward over recent years to warn that older people, pregnant women and those who exercise, in particular, could be at risk from following blanket advice to reduce salt, SMA has called for balance.
Want to contribute your experience ?
Stephen Daniells , the Food Science Reporter for NutraIngredients.com, writing for AP-Food Technology.com echoes a theme often voiced in our blog: that a proper concern is with the science in studies of nutrtition and health, not whether they are funded by governments or private parties. Says Daniells:
It is important to have an independent watchdog for both industry and academia, but the statements of subtle bias, or insinuations of industry meddling merely serve to undermine scientific integrity, industrial sponsors, and consumer confidence.
He goes on with regard to a recent example:
After starting with 538 articles, the reviewers, from the Children's Hospital Boston and the Center for Science in the Public Interest (CSPI), whittled this down to 206 according to their specific inclusion/ exclusion criteria. Of these, only 111 declared financial sponsorship - 22 per cent were funded entirely by industry, 47 per cent had no industry funding, and 32 per cent had mixed funding.
They then calculated that the 22 per cent declaring an industry-only source of funding were four to eight times likely to report favourable conclusions for the sponsors than studies with no industry funding.
And this led to the researchers to imply: Bias! Industry meddling! Company heavyweights leaning on the little academic!
Let's just think about this for a moment.
First of all, the studies used in the review were all published in peer-review journals, meaning independent and anonymous reviewers had already passed their expert eyes over the studies.
Undoubtedly, the studies fitted in with other results - in vitro research, and in vivo animal studies, as well as other human studies. I have never seen an article published without supporting references - have you? Some of the studies were clinical interventions.
Everything looks ok, so far…
Next up is the role of industry in funding a study. As was stated in an insightful, balanced, and levelheaded editorial by Martijn Katan from the Vrije Universiteit in Amsterdam that accompanied the review, when industry plans to fund a study, it is natural that it would select a product with a potentially favourable nutritional profile.
Finally, some sense!
You'll want to read it all .
Stephen Daniells , the Food Science Reporter for NutraIngredients.com, writing for AP-Food Technology.com echoes a theme often voiced in our blog: that a proper concern is with the science in studies of nutrtiion and health, not whether they are funded by governments or private parties. Says Daniells:
It is important to have an independent watchdog for both industry and academia, but the statements of subtle bias, or insinuations of industry meddling merely serve to undermine scientific integrity, industrial sponsors, and consumer confidence.
He goes on with regard to a recent example:
After starting with 538 articles, the reviewers, from the Children's Hospital Boston and the Center for Science in the Public Interest (CSPI), whittled this down to 206 according to their specific inclusion/ exclusion criteria. Of these, only 111 declared financial sponsorship - 22 per cent were funded entirely by industry, 47 per cent had no industry funding, and 32 per cent had mixed funding.
They then calculated that the 22 per cent declaring an industry-only source of funding were four to eight times likely to report favourable conclusions for the sponsors than studies with no industry funding.
And this led to the researchers to imply: Bias! Industry meddling! Company heavyweights leaning on the little academic!
Let's just think about this for a moment.
First of all, the studies used in the review were all published in peer-review journals, meaning independent and anonymous reviewers had already passed their expert eyes over the studies.
Undoubtedly, the studies fitted in with other results - in vitro research, and in vivo animal studies, as well as other human studies. I have never seen an article published without supporting references - have you? Some of the studies were clinical interventions.
Everything looks ok, so far…
Next up is the role of industry in funding a study. As was stated in an insightful, balanced, and levelheaded editorial by Martijn Katan from the Vrije Universiteit in Amsterdam that accompanied the review, when industry plans to fund a study, it is natural that it would select a product with a potentially favourable nutritional profile.
Finally, some sense!
You'll want to read it all .
According to the latest research at the University of Haifa , low birth weight babies born with low sodium (salt) in their blood serum are likely to consume large quantities of dietary sodium later in life. Taken together with other recent findings, this information confirms that very low serum sodium in pre-term and new born infants may be a significant contributing factor for long-term sodium intake.
The researchers reported that dietary sodium consumption in childhood (ages 8-15) was predicted by neonatal lowest serum sodium (NLS). The children with the most severe NLS serum sodium ate double the number of salty snacks and their dietary sodium intake was substantially higher than their peers. It was as if they were trying to make up for their previous history of salt deprivation. There was no relationship found between NLS and a preference for salt per se, but rather for the foods that contained salt.
This work provides a good deal of food for thought regarding our innate preference and requirements for salt and should give expectant mothers and parents of newborns pause to think before they severely limit their child's salt intake.
As with everything else in life, balance is the byword.
On January 15, 2007, a 28-year-old mother of three died from water intoxication (hyponatremia) hours after competing in a Sacramento radio station contest to see which contestant could drink the most water without urinating. The winner of the contest reportedly won a new video game system - the Nintendo Wii. The contest organizers obviously thought it very clever to have a contest called "Hold Your Wee for a Wii."
They may have been clever in thinking up contest names, but were not quite as clever in knowing the consequences of excess consumption of anything - including water.
Water intoxication - also known as hyponatremia - is more commonly seen among athletes, usually extreme athletes, although it can happen to anyone who consumes too much water, causing a critical loss of sodium. Dick Hanneman made a point of blogging this issue back in September, 2006 .
The young Sacramento mother was simply trying to secure the Wii game console for her children.
Contestants were asked to sign a waiver before taking part in the competition, but the winner of the game said participants were never alerted to the dangers.
A listener - apparently a nurse - called the show and warned the deejays of the risks of the game, but to no avail.
Yesterday, the radio station fired the morning disc jockeys and seven other employees involved in setting up the contest
Hyponatremia is a disorder of fluid and electrolyte balance characterized by an excess of body water relative to body sodium content (specifically a serum sodium concentration less than 135 mEq/L). It is the most common electrolyte disorder encountered in clinical medicine and is associated with negative outcomes in many chronic diseases. Yet, most people don't understand the significance of drinking water to excess without taking supplementary electrolytes, such as salt.
Although most hyponatremia victims may appear to be asymptomatic, severe hyponatremia is a medical emergency that calls for immediate treatment. Complications can include seizures, coma, brain-stem herniation, respiratory arrest, permanent brain damage, and death.
Two years ago, a 21-year-old student died of water intoxication during a hazing incident at Chico State University. He had been forced to drink from a five-gallon jug of water that was repeatedly refilled. He soon collapsed and had a seizure. Fraternity members didn't initially call an ambulance. By the time they did, it was too late. He was pronounced dead a few hours later.
It difficult to understand why we mindlessly continue to amuse ourselves with challenges that subject our bodies to physiological extremes, but if we do so, everyone should know the risks and consequences.
There's been a lot of chatter in the U.S. and the U.K. in recent weeks about food labels.
In the U.K., European Food Information Council (EUFIC) director general Josephine Wills presented her views to the CIAA on research on consumer response to nutrition information on food labels in Europe. She noted that although nutrition labeling has been a major instrument for consumer health and nutrition education, research shows consumers don't understand the information and likely misuse it in actual consumer purchasing decisions. The UK labeling debate divides consumer activists advocating a stoplight (red-yellow-green) "good food/bad food" label from the Food and Drink Federation (FDF) and many food manufacturers who advocate "Guideline Daily Amounts" (GDAs) for four key nutrients (calories, protein, carbohydrates and fats). Including salt is optional. FDF launched a 4m pound campaign last week to promote GDAs. The food industry effort has prompted two government agencies to proclaim a joint "independent" panel to provide an evidence-based resolution of the issues. For their side, perhaps the food companies can also agree on their own "independent" panel.
The same issues separate U.S. food manufacturers and "consumer" groups like the Center for Science in the Public Interest (CSPI). CSPI has agitated for many years for a "good food/bad food" stoplight label while the GMA/FPA and Food Marketing Institute announced last week its "Take a Peak" promotion campaign for the government's Food Guide Pyramid. The food manufacturers' campaign is the largest of a series of "private" label/education efforts which include commercial endorsement logos sold by the American Heart Association and grocers like Hanaford Brothers with their own "stars" labels. Predictably, CSPI objected to the new GMA/FPA-FMI promotion, having earlier sued FDA to require its preferred red-yellow-green stoplight. CSPI president Michael Jacbson complained to the Washington Post : "What's a consumer to do if one product has the Take a Peak logo and right next to it is a product that gets the American Heart Association logo for being a healthy food?"
Our suggestion: use evidence-based procedures to evaluate both the relationship of the claimed health benefits to quantities of nutrients ingested as well as objective measures of how consumers use food labels. There's a lot more heat than light on these issues at present.
The media is generating a mountain of coverage alleging bias based on the funding source for scientific studies, most particularly, recently, when that funding source is "industry." Presumably disinterested funding partners like the federal government, universities and even, in one recent case, the "consumer" interest group the Center for Science in the Public Interest (CSPI), get a free pass. That study , released earlier this week alleged that food industry funding biased conclusions of research studies on the healthfulness of fruit juice, milk and soft drinks. All the authors claimed they were free from bias -- including CSPI. CSPI is an advocacy group whose primary mantra is that the food industry is trying to poison its customers. Unbiased? Still, it's not an "industry" group (unless fear-mongering is an industry), so no one thinks to ask if having an author who is part and parcel of an advocacy group with a dog in this fight might somehow bias the study.
Worse, the matter of potential author bias entirely escaped media attention (or at least my monitoring of the coverage which focused on pointing with alarm to "industry money.")
Let's face it: every research project has a funding source and that funding source has a theory of what they hope science will confirm. Every funding agency has a "bias;" they want to confirm their hypothesis. That doesn't invalidate the study. The key thing is the quality of the science itself.
The ludicrous extreme of the current uncritical condemnation of industry-funded research and equally uncritical endorsement of studies funded by universities, "public interest" groups and governments is that the "white hat" scientists are credible while the "black hat" researchers employed or funded by industry find their motives examined more than the science they produce.
There's a name for the clear political agenda at play here: socialism. If socialism is government ownership of the means of production, then de-legitimizing privately-funded research is outright socialism. It is destroying the private production of science in favor of government-funded studies because only government can "protect" citizens from the rapacious, unconscionable private sector.
Medical research can be an expensive undertaking. None of the published studies at the heart of the salt and health debate have had salt industry funding support. Most are studies of government data. Most of the analysts are government-funded. Having the government gathering the data and then interpreting it weakens individual citizens. And when government goes that still-further step of denying independent scientists access to its own data, the problem moves from concern to alarm (a problem supposedly addressed by the Data Quality Act).
A good start to redress this disturbing imbalance and dangerous trend is to insist on more rigorous examination of the science itself -- study design and conformance with transparent, replicable analytic techniques. After all, if we play political games with the "evidence," it really doesn't change anything physiologically -- neither politicians nor bureaucrats can amend the laws of nature. If we head down the wrong road we don't just waste tax dollars, we "kill" people who would survive if we'd had an accurate read on the science.
The Salt Institute tries to correct the subtle distortions of our defense of the healthfulness of dietary salt. One common slander is that the Institute sued the federal government challenging the validity of the DASH-Sodium study. Regular readers will recall that the government claimed that the study proved that "every American" would be healthier if they reduced salt intake. While we strongly dispute this conclusion, we don't actually challenge the study; it seems of high quality -- only the interpretation of the findings. This is a small distinction with an important difference. Let me illustrate the way the case was put today by unbossed.com by repeating our response (also posted on unbossed.com):
As the president of the Salt Institute, which you mention as the plaintiff for the DQA test case, I feel I must correct an error incorporated into your blog. You repeat Chris Mooney's erroneous statement that the lawsuit challenges "a National Institutes of Health study on diet" that is "state-of-the-art scientific work."
Actually, we agree that the study is "state of the art" -- and vitally important. But our lawsuit did not challenge the study at all. The lawsuit challenged the fact that the government had not made the data available for independent experts to validate its "insider" interpretation of the data as required by the DQA. We asked, specifically, that the beginning blood pressure and the standard deviations of the subgroup analyses be disclosed; they have not been published and it is impossible to determine the accuracy of the conclusions being drawn without these statistics that could be provided in a millisecond from the data of the study's authors. The data are fine, but incompletely divulged and we asked only a tiny bit of information. As it is, published data by the authors have already confirmed that the agency has mischaracterized the findings. The government says the health of "all Americans" would be helped by cutting back on salt. Not only does this study not address that question at all (it is confined to blood pressure, not the net health effects of salt reduction) but in six of the eight reported subgroups -- representing the vast majority of Americans -- even blood pressure lowering is not statistically significant. This says nothing of the adverse impacts on glucose metabolism and the heart attack-stimulating production of the kidney hormone renin.
So, to set the record straight: we challenged the agency's application of its own DQA guidelines, not the study which seems to be first-rate (if not fully understood).
Dick HannemanPresidentSalt Institute
The half-truth allegation (we DID, after all, sue the government), if unchallenged, would have the effect of undermining the credibility of our argument; if people believe the DASH-Sodium study is a quality study, they would be less willing to listen to our complaint about the twisting of its findings. And if you're in the knowledge business as we are, your credibility is a huge factor in your effectiveness. Ignore the little things and you lose the ability to influence the big things. It's like the policing strategy adopted in New York City by "America's mayor," Rudy Giuliani. Mayor Giuliani started enforcing against breaking windows and painting grafitti on buildings and it helped unravel the hopelessness the public felt about obeying the law and led quickly to a dramatic fall in violent street crime. Same principle.
Sometimes we all get so busy that challenging the distortions pales in importance with the urgent priorities we all face, but responding not only preserves our credibility as salt industry advocates, but helps erode less-informed or even malicious distorters of the facts. Take time to become informed and speak out!
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.
