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March 28, 2008

Another health outcomes study finds no benefit for salt reduction

A Swedish-led group of European researchers set off to document the relationship between dietary electrolytes (magnesium calcium, potassium and sodium) and stroke risk. The ended up documenting the lack of an association of sodium and risk of stroke, adding to the lengthening list of "health outcomes" studies which are remarkably consistent in their conclusion: reducing dietary salt won't improve health.

Published in the March 10 issue of the Archives of Internal Medicine, the researchers studied 26,556 older Swedes; all were smokers. Over the 13.6 years of the study, the group recorded 579 stroke events. The population had extemely high salt intakes; the average sodium intakes for the five quintiles of sodium ranged from 3,909 mg/day to 5,848 mg/day (the U.S., by comparison averages about 3,500 mg/day -- lower than the lowest 20% of the Swedes in the study).

The findings: stroke incidence was nearly identical in all five quintiles and not only was there no trend in the pattern, but of the 30 separate analyses performed, not a single subgroup had a significant relationship between sodium and stroke incidence. Add this study to the list.

March 24, 2008

Not worth refuting?

A long plane ride today afforded the opportunity to read an Anthony Daniels review of Ibn Warraq's new book, Defending the West: A Critique of Edward Said's Orientalism. Daniels uses what Benjamin Franklin in the play 1776 said of Thomas Jefferson's writing skills: "a peculiar felicity of expression."

That expression, offered in the context of refuting Said's famous book, was offered as printed:

Some might say that Ibn Warraq has picked an easy target: Said's work would not have been worth refuting had it not been so phenomenally successful in creating what Auden called, with regard to Freud, "a whole climate of opinion."

Whatever you think about the Said/IWarraq contention, our attention was captured by the strong parallel of Said's conventional wisdom versus Warraq's critique to the Salt Institute's recurrent attempts to engage federal public health nutrition leaders in a discussion of the weakness of the scientific data offered in support of the contention that lowering dietary salt will improve health.

To paraphrase: if the federal anti-salt advocacy campaign hadn't been "so phenomenally successful" in creating a "climate of opinion" condemning salt, it would, in Warraq's appropriate words "would not have been worth refuting." Of the fifteen studies of health outcomes of salt-reduced diets, nearly every one has found no benefit and many have found additional risk.

We need a controlled trial to sort out the issues raised in these studies; all of them are merely observational. But the lack of any likelihood that a controlled trial would validate the notion of a health risk of current levels of dietary salt is trumped by the obvious fact that this unsubstantiated policy is already in place. So, even though the "hypothesis generating" studies would suggest the negative hypothesis, that lowering dietary salt would NOT improve health outcomes, the existence of the current policy based on the contrary assumption, though ostensibly "not worth refuting" is actually well worth examining.

Let's let the science guide our policy, not the momentum of obsolete assumptions. Secretary Leavitt, fund a health outcomes study of salt-reduced diets. Please.

March 21, 2008

Is lower better? Don't "treat the numbers" regarding dietary salt

NPR (National Public Radio) hit the nail on the head with this just-out story: "Doctors' 'Treat the Numbers' Approach Challenged." As correspondent Richard Knox explains:

It can take scientists a decade or more to determine whether a drug actually works. In the meantime, doctors rely on other measures, like testing blood pressure and cholesterol levels, to determine whether a drug is having positive effects. But recent studies challenge the practice of prescribing medicine based on certain test results.

Doctors call it "treating the numbers" — trying to get a patient's test results to a certain target, which they assume will treat — or prevent — disease.

Knox quotes Dr. Steve Atlas of Mass General hospital: "It's a big deal because it reminds us of something that we often forget: the number isn't the outcome. And this raises concerns that just lowering the number doesn't get you where you want to be," (emphasis added)

This is, of course, exactly what our public health nutrition policy on salt is doing: treating the number. We need to look at outcomes (see numerous earlier posts to this blog).

Knox also quotes Dr. Ned Calonge on cholesterol-lowering drugs based on the recent diabetes trial disaster, saying:

"Now, what's open is — is lower better? And I think a lot of people believed it would be, and there are many of us that were saying, 'You're going to need to show me,' " he says.

Lately, studies have also challenged other cherished assumptions — like lowering blood sugar. For a long time, doctors have believed that getting diabetic patients' blood sugar as close to normal as possible would prevent heart attacks. A drug called Avandia lowers blood sugar very well.

It was approved in 1999 and was heralded as "one of the newer and greater drugs for the treatment of diabetes," says Dr. Cliff Rosen. Rosen is the chairman of a Food and Drug Administration advisory panel that concluded unanimously last year that patients taking Avandia actually had more heart attacks and strokes.

Rosen says the Avandia story is a caution against treating millions of patients on unproven assumptions.

It's the same story for salt -- but, so far, a largely-untold story. Still, just as public health policy cannot change human physiology, neither can news coverage. But it can slow down our quest for the truth and our ability to base policy on evidence rather than opinion. Please, someone tell HHS! Outcomes matter.

March 19, 2008

New Zealand food fight

The New Zealand Bakery Association has blasted FSANZ, warning that its new requirement of iodized salt in bread "will be expensive, claiming there are not a lot of facilities to process iodised salt in the country." The bakers apparently duped foodnavigator.com writer Charlotte Eyre on that point and another: that "iodine is a nutrient commonly found in salt."

Noting that "half truths are the most insidious," the Salt Institute responded, defending the FSANZ decision and pointing out that:

  • 1. Plain salt has 1/100th the amount of iodine of iodine-fortified salt; it may be detectable in a lab, but it's insignificant nutritionally.

    2. Salt iodization is not expensive; it costs pennies per year per person.

    3. New Zealand may not have "a lot of facilities to process iodised salt," but it's a small country, well-served by Salt Institute member companies Dominion Salt of New Zealand and Cheetham Salt of Australia whose few plants make virtually all the food salt in the country and which can easily accomplish the required iodization virtually with the flip of a switch.

  • Surely the bakers have better fights to fight.

    March 17, 2008

    Kids’ salt craving is hard-wired

    USA Today published a story today echoing the CASH/WASH mantra that children eat too much salt. Our reply:

    Kim Painter’s article ignores two important points of science. First, salt reduction in children and adults may be related to blood pressure, but because salt reduction triggers other reactions, it has not been shown to lower the rate of heart attacks or cardiovascular mortality. That cherished assumption has been demolished by evidence over the past 13 years. Second, humans and other animal species eat salt in predictable amounts when they can get it; our salt intake is unchanged over the past century. Research published in the February issue of Experimental Physiology explains that the brain’s neural system system provides multiple, redundant systems to make sure our salt appetite ensures we get enough salt. Salt is an essential nutrient. We die unless we eat salt.

    Let's let the science guide this policy. The U.S. Preventive Services Task Force, the government's in-house advocate for evidence-based policy, has found evidence insufficient to advise the general population to reduce dietary salt. Ditto the Cochrane Collaboration, the global inventor of "evidence-based" decision-making in medical science.

    For more information, check the Salt Institute website, http://www.saltinstitute.org/28.html..

    Dick Hanneman
    President, Salt Institute

    March 15, 2008

    Unintended, ironic introspection by FSA

    Britain's Food Standards Agency asks: "Are we 'bad science' junkies?" Well, yes you are. The regulators, of course, aimed their barbed inquiry at what they perceive is an insufficiently alert public that can't separate fact from fiction with regard to the scientific basis for dietary recommendations. In their mind, salt is the exception; they aver: "There was good awareness of the risks associated with eating too much salt."

    Well, no there isn't "good (public) awareness of the risks associated with eating too much salt." The public has followed FSA down the "bad science" pathway and been convinced that science supports general salt reduction. Wrong. Any fair-minded reading of the literature addressing the question "will reducing dietary salt improve health" shows scant evidence for a health benefit and far more data suggesting actual increased risks.

    FSA conducted the survey for the launch of the first meeting of the independent General Advisory Committee on Science (GACS) which will open its proceedings with a panel debate to look at the question 'Should we trust what scientists say about food?'.

    Our suggestion: let's query the data, not the scientists. Good science is empirical, not expert opinion. Evidence-based medicine considers expert opinion only a Class D level of evidence.


    Climate change to impact transportation, salt usage

    Significant impacts on U.S. transportation planning are forecast in a new report about to be released by the Transportation Research Board, an arm of the National Academies of Science. TRB Special Report 290: Potential Impacts of Climate Change on U.S. Transportation concedes that "Little consensus exists among transportation professionals that climate change is occurring or warrants action now." But the report identifies "plausible future scenarios" which represent "significant challenges for transportation professionals." The committee "finds compelling scientific evidence that climate change is occurring, and that it will trigger new, extreme weather events."

    Special Report 290 identifies "five climate changes of particular importance to transportation and estimatedsthe probability of their occurrence during the twenty-first century." Included, as #4, is "Increases in intense precipitation events. It is highly likely (greater than 90 percent probability of occurrence) that intense precipitation events will continue to become more frequent in widespread areas of the United States."

    Louisiana being America's largest salt-producing state, the salt industry will be particularly interested in the report's prediction of increased coastal flooding, particularly of the Gulf coast and drier conditions in the upper Midwest "resulting in lower water levels and reduced capactiy to ship agricultural and other bulk commodities."

    Among the adaptive operational responses, the first example identified is "Snow and ice control accounts for about 40 percent of annual highway operating budgets in the northern U.S. states" and "operational responses are likely to become more routine and proactive than today's approach of treating severe weather on an ad hoc emergency basis." Roadway designers are encouraged to recognize the likelihood of more freeze-thaw cycles. In this, of course, snowfighting professionals are already well advanced in their "adaptation." The committee speculates that there will be "benefits for safety and reduced interruptions if frozen precipitation shifts to rainfall."

    Canadian discussions and studies are more advanced than in the U.S. and also predict impacts on use of road salt for winter maintenance. In "Climate Change and Ontarios's Winter Roads: Trends and Impacts on Ontario Winter Road Maintainence Ops" and "Climate Change Impacts and Adaptation: A Canadian Perspective," experts agreed that salt usage in southern and western Ontario would be unchanged by global warming, but that salt usage would increase in northern and eastern parts of the province.

    March 14, 2008

    Traffic safety AND mobility: dual imperatives, not trade-offs

    The American Automobile Association last week released The AAA Crashes vs. Congestion Report arguing that societal costs from traffic fatalities and injuries is more than double the costs of congestion. Good reminder. We object only to the "versus" separating the twin concerns. We must insist on roads that are safe and congestion-free.

    The study by Cambridge Systematics estimates that traffic crashes cost each American $1,051 for a total economic burden on the economy of $164.2 billion. Data from the Texas Transportation Institute put the tab for congestion at $67.6 billion or $430 per person. With Congress readying itself to tackle reauthorization of the federal surface transportation program next year and with the federal Highway Trust Fund approaching insolvency, these measures should be front-and-center in the public policy discussion.

    For years, the anti-highway lobby has inveighed against "paving over America" and the highway lobby has foolishly cast the argument in terms of the deteriorating condition of the nation's roads and bridges. Too true. And when the I-35W bridge plunged into the Mississippi, the poignancy of the roadbuilders' lament was manifest. The thought of an aging and inadequate roadway infrastructure contributing to the 42,642 people killed last year on American roads is totally unacceptable. We know most of those deaths are avoidable and now we know the cost of under-funding highway improvments.

    The quality of the policy debate, however, would be improved if we move beyond contesting the number of "structurally deficient" bridges or pothole-pocked or rutted roadway surfaces. Nor should we accept the notion that we need to starve investments in congestion relief to pay for safer roads. The two go hand in hand. Non-recurring congestion (the kind not caused by "rush hour") is associated with clearing traffic crashes and combatting weather conditions like snow & ice storms that contribute so much to those crashes. Simply applying salt as part of a professional winter operations program cuts 88.3% of the injury crashes and keeps the roads reliably available for our mobile society. In fact, in most states, the cost of failing to keep winter roads open through winter maintenance operations generally costs more for each day of failure than the annual cost of snowfighting (data by Global Insight, Inc.).

    As Congress sets up the debate on highway spending, let's focus attention on the outcomes we can expect our roads to deliver. We shouldn't be building roads to create jobs (or re-elect politicos) nor should we endanger drivers' lives and our national economic competitiveness by short-sightedly opposing transportation improvements due to suspicion over the self-interested motivation of construction companies. Let's measure transportation outcomes -- the service we driver are paying for through our gas taxes -- and invest to reduce the tragic waste of more than 40,000 lives every year and reverse the corrosive erosion of reliable highway mobility caused by congestion.

    And let's let the engineers and the Federal Highway Administration's Office of Operations help us define the choices rather than jury-rig our national highway priorities through Congressional earmarks.

    It's not AAA versus AASHTO (the American Association of State Highway and Transportation Officials). Both AAA and AASHTO care deeply about BOTH safety and mobility. Let's not make this mountain tougher to scale than it already is.

    March 11, 2008

    Further notice for BizCentral.org highlights Salt Institute

    ABC News' The Blotter noted the launch of BizCentral.org and the high-flying lobbying groups participating, including the Salt Institute. Enjoy. Justin Rood reported:

    Blogging: It's not just for the little guy anymore.

    Big business has officially moved into the blogosphere, a territory once claimed by radicals, grassroots organizers and armchair political philosophers.

    Bizcentral.org is a new group blog authored by lobbyists for some of the biggest industries in America. The petroleum industry is represented, as well as nuclear power, chain drug stores, the American Trucking Association – even the Salt Institute, "the world's foremost source of authoritative information about salt (sodium chloride) and its more than 14,000 known uses."

    March 03, 2008

    Focus transportation funding on priority projects

    Congressional earmarks for transportation projects are distorting spending priorities and delaying improvments to America's air and surface transportation infrastructure and those delays impose huge costs on national productivity and competitiveness, according to an analysis by Bruce Katz and Robert Puentes in the March issue of The Atlantic, aptly titled "Clogged arteries." Katz and Puentes equate the unfocused investment to thickly-spread peanut butter.

    A better approach, they argue would be to allocate the $50 billion in annual surface transportation spending where the probems are. Cities are being shortchanged, they say.

    The nation’s 100 largest metropolitan regions generate 75 percent of its economic output. They also handle 75 percent of its foreign sea cargo, 79 percent of its air cargo, and 92 percent of its air-passenger traffic. Yet of the 6,373 earmarked projects that dominate the current federal transportation law, only half are targeted at these metro areas.

    And infrastructure investment is critical to jobs creation, they explain:

    In the past, strategic investments in the nation’s connective tissue—to develop railroads in the 19th century and the highway system in the 20th—turbocharged growth and transformed the country. But more recently, America’s transportation infrastructure has not kept pace with the growth and evolution of the economy. As earmarks have proliferated, the government’s infrastructure investment has lost focus. A recent academic study shows that public investment in transportation in the 1970s generated a return approaching 20 percent, mostly in the form of higher productivity. Investments in the 1980s generated only a 5 percent return; in the 1990s, the return was just 1 percent.

    Check out their interactive map estimating road-traffic congestion in 2010. The cost of congestion, including added freight cost and lost productivity for commuters, reached $78 billion in 2005. Half of that occurred in just 10 metro areas.

    Salt Institute, industry associations launch BizCentral.org

    logo-bizcentral.gif
    Business needs a stronger voice in the blogosphere and so the Salt Institute joined today with ten other associations – representing sectors as diverse as energy, transportation, telecomm, manufacturing, retail and consumer goods – to launch BizCentral.org, a community blog for business associations, the Salt Institute announced today.

    The charter members of BizCentral.org may represent very different industries, but they support common pro-growth economic principles like free markets, free trade, and low taxes. But, while each of the industries has a unique story, the collective story of how business and industry satisfy basic consumer needs and what public policies can deliver sustainable economic security is a message that will interest and inform the influentials who we expect to participate in the blog discussion.

    March 01, 2008

    Signaling the end of China's snowstorm emergency

    shanghai_lights.jpg
    Shanghai ended a month of snowstorm-induced energy conservation Leap Year night, turning on its nightime landscaping lights, above (photo: Shanghai Daily). The first months of 2008 provided an expensive ($22 billion) lesson in the critical need to keep winter highways reliably available in winter weather to maintain economic performance in modern economies.