The newest diet “science”

As noted yesterday, there is one diet fad that has misled so many people to believe is credible and scientific, that the Wellcome Trust, a biomedical research charity based in London, has made it the subject of an ethical inquiry. It’s The DNA Diet, which claims you can lose weight and even live longer and healthier by eating based on an analysis of your DNA. In a Guardian article last week, scientists warned consumers about companies marketing these “nutrigenomic” diets on the internet. These companies are charging about $2,000 for a genetic test and personalized diet plan claimed to counter someone’s genetic predisposition to certain cancers, diabetes, heart disease or obesity.

There is no science to support these “pie in the sky claims.” They stem from the Human Genome Project, according to Dr. Alison Stewart, chief officer of Cambridge Genetics Knowledge Park. Over the last couple of years, new terms have emerged to describe and legitimize these fields: nutrigenetics and nutrigenomics. Their exact definitions vary, “but most seem to use nutrigenomics to describe the ‘functional’ interactions of food with the genome at the molecular, cellular and systemic levels; while nutrigenetics refers to genetically-determined differences in how individuals react to specific foods,” she said.

The problem is, said Stewart, genetics is much more complicated than single genes. Our health is, too. Professors at Wageningen University, Netherlands, outlined the scientific uncertainties and complexities of nutrigenomics, and went on to describe the ethical implications, which they said overshadow potential health benefits.

In a comprehensive review of the evidence for Quackwatch, doctors Stephen Barrett and Harriet Hall concluded that companies “offering genetic testing with guidance on diet, supplement strategies, lifestyle changes and/or drug usage they claim can improve health outcomes,” are dubious, have potentially serious harmful implications and should be avoided.

According to Helen Wallace, Ph.D., Deputy Director of GeneWatch UK: “For most people, tailoring your diet to your genetic make-up is about as scientific as tailoring your diet to your star sign.” Dr. Serge Jabbour, endocrinologist at Thomas Jefferson University in Philadelphia, told Ivanhoe Broadcast News last month that he thinks DNA diets are just a way to make money and that he “really doubt[s] that at some point in the future, we’re going to discover that a certain gene is going to be responsible for weight gain based on certain foods....or that genetics is going to help with weight loss.”

Nutrigenomics takes nutritional science beyond what can be soundly demonstrated in preventing nutritional deficiencies, to unsupportable beliefs in special health-promoting or preventive qualities of certain foods and supplements, or specific evils of others. It plays on the most zealous beliefs in good and bad foods. The human species is also 99.9 percent the same genetically; with the remaining 0.1% of variation accounting for physical differences that are visible and invisible, such as disease-risk. This lends doubt to the efficacy of pharmaceutical and biomedical treatments based on genetics or race/ethnicity. But both the food and medical industries recognize the huge profit potential of nutrigenomics and nutrigenetics. By testing people for their genetics and identifying people that may have markers for vulnerability to certain health problems, they hope to market foods and medicines targeting specific genotypes.

This past February, 88 researchers joined in a global initiative to establish nutrigenomics as a new “multidisciplinary science” and set up a genomics databank. The new National Center of Excellence in Nutritional Genomics at UC Davis is leading this initiative, supported in part by the National Institutes of Health. Other nutrigenomic ventures include WellGen, Inc., spun from Rutgers University, New Brunswick, NJ, which notes that the nutrition industry is a $182 Billion industry with a huge potential for growth and profit. In February, it completed a $3 million Series B financing and its website said it raised about $8 million in investor financing in 2004-2006. Jeffrey Bland, president of Metagenics, another nutrigenomic company, spoke last year at the Second Annual World Obesity & Weight Loss Congress about the potential for nutrigenomics. Metagenics already holds multiple patents and “produces over 400 all-natural, research-based products to ‘optimize health.’”

But concerns are growing about genetic testing being used to evaluate individuals and how this information might be abused by insurance companies, healthcare organizations, employers and the government to compel compliance with certain lifestyle or medical interventions. The Council for Responsible Genetics based in Cambridge, Massachusetts wrote of hundreds of cases where genetic information has already been misused to discriminate against people with undesirable genetic findings.

Commentary: As the diet season begins and the obesity hype is sure to go into high gear, remember that no weight loss method has ever been shown to be effective long-term, and none are benign. The soundest New Year’s resolution of all may be to ignore the weight loss tomfoolery and find something more valuable to do with your time, money and energies.

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December Diet Wackiness

We were inundated by diets this month — and it’s not even January! Some diets were variations on oldies, others took eccentricity and whimsy to entirely new dimensions. But they all demonstrated what Shmuley Boteach wrote in the Jerusalem Post:

If you want to make a quick buck, just pen a book about a new diet you’ve conjured up, give it a sexy name and presto, you’ll be an instant millionaire. No previous writing experience needed. You might try and call it something like The Emaciated Scarecrow Look or Thin is In. Better still, name-associate the book with something really chic like The Rodeo Drive Diet or The Fifth Avenue Starvation Plan and you'll be retiring in six months. [Maybe, that’s my mistake. :)]

The Compliment Diet is a creative plan that directs husbands to give their wives a daily compliment telling her how slim and beautiful she is (being sure to turn off the TV first). Within weeks, it promises, women who’ve been “letting themselves go,” or compensating for lack of affection by eating, will start working out and go on a diet.

The SOS Desperation Diet promises you’ll lose a dress size in a week, just in time for your holiday party. It also promises better skin and sparkly eyes, that you’ll feel more energetic, “and all the things you want when you are going to a party.” It assures prospective customers that it was devised by a naturopath so “it’s perfectly safe...and has been very carefully thought out.” It’s secret is “just good, healthy food, a little light exercise and some herbal tonics to help kick-start your metabolism and flush out any toxins.”

The Wine Diet is not about drinking any old wine, it’s about being selective and choosing wines from older vines grown at high altitudes which are claimed to have more beneficial compounds. The idea is to combine wine with a “healthy lifestyle” and a 1400-calorie diet which includes wine, dark chocolate and fruit.

The Nasal Spray Diet promises to treat obesity by eliminating the sense of smell and taste. The company already has a patent on its nasal spray which they say works to reduce food intake. This is called a “forward looking statement.” Don’t look for their spray until 2010, as clinical trials won’t begin until 2007 and then it has to get FDA approval. But the developer expects to raise $50 million with an initial public stock offering.

The George Orwell Diet describes “newspeak, doublethink, thoughtcrime and now, coming to a city near you, dietcontrol where the ‘thought police’ decide your every move and your diet.” The idea is to ban foods that Big Brother of Oceania thinks might be fattening or bad for you. This diet is for people who “believe government is looking out for our good.”

The All-Beer Diet is essentially a low-carb diet geared for guys who drink beer. For “real,” there’s a book. The author says he did his own research for 25 years of trial and error, losing and gaining back 593 pounds, and says he now has “conclusive proof” of what worked to lose 114 pounds.

The Hypnosis Diet promises to teach you a simple hypnotic technique that will eliminate cravings for “junk” foods and make you exercise more.

The Beauty and the Beast Diet claims that Candida yeast causes cravings for sugar and starch, depletes your body of nutrients and releases toxins that make you fat. It offers a yeast test and promises that with anti-fungals and natural supplements, you too can lose 180 pounds, 125 without exercise. This diet isn’t new, as beliefs of yeast-related sensitivities, allergies and health problems have been around for years, along with that candida questionnaire.

The Master Cleanse Diet is so risky and ridiculous I hesitate to even describe it. By living for ten or more days on nothing but a concoction of lemon juice, cayenne pepper, maple syrup and water — up to 12 glasses a day — along with salt water in the morning and laxatives in the evening, it says you’ll wake up thinner and no longer grumpy. This 650-calorie diet actually isn’t new and was created in the 1940s but given new life recently on the Oprah Show. The Internet is filled with claims it fights disease, clears the mind and skin, and increases energy. Dieters are warned that it’s best to stay close to a restroom.

The Oomph Diet includes an online “Rollover Calories” tool to help dieters track their unused calories throughout the week, sort of like rolling over minutes on your phone service. It’s for calorie theory believers only.

The Diet Detective’s Count Down Diet is another one for calorie theory believers who think calories are like money and can be balanced like a checkbook. It lists 7500 foods and tells what will be needed to burn the calories in those foods.

The Ultimate Sex Diet is also along those lines, promoting weight loss through “sexercise,” since it says that a half-hour romp under the sheets burns the same number of calories as a 30-minute brisk walk.

The Idiot Proof Diet promotes itself as a revolutionary web-based diet that computes everything for a dieter in seconds and “creates a personal daily menu that ensures ideal calorie shifting” to guarantee weight loss. Its guiding principle is that people are fat because they eat the wrong foods, the wrong types of calories and at the wrong times of the day. Its solution is a new “shifting calories theory” that promises by constantly shifting from one type of calorie to another, the scales will keep dropping.

The Skinny Me with Green Tea Diet creator claims that by simply drinking green tea and eating a “healthy, whole food diet” she lost 170 pounds in about a year. Her secrets include eliminating processed foods, pastas, breads, meats, fried foods and drinking lots of water. She sells an assortment of weight loss products, including a special cream she claims eliminates stretch marks and wrinkles, and a greener green tea (Uji Gyokuro “Gyoku-Hou”).

The Grapefruit Diet which prescribes a grapefruit before every meal to lose weight is still going strong after 40 years. The most amazing thing about this diet’s longevity is that its mythology continues to be believed, even by registered dietitians, and that they are actually getting funding for research.

The Purina Diet is the funniest diet circulating the internet this month. It is well worth a read! Believe it or not. :)

But there is one wacky diet that so many people are being taken in by, and believe is credible and scientific, that it has become the subject of a major ethical inquiry. We’ll reveal that tomorrow in “The newest diet ‘science.’”

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Pediatric Grand Rounds 2006

Pediatric Grand Rounds has just been posted at Breath Spa for Kids. Perhaps in response to the general zeitgeist or because it’s the last Pediatric Grand Rounds of the year, the articles written by these medical professionals are exceptionally thoughtful, inspiring and fascinating to read. The host, Shinga, writes: “Most of us are fortunate enough to live in societies where we have fortified the banks of paediatric health against the erosive forces of disease, morbidity and mortality. We live in good housing, we have clean water, standards for air quality, good nutrition, safety standards, improvements in medical science and public health measures such as vaccination. Most of us can be confident that children will survive through to adulthood.”

Dr. Flea’s excellent series on childhood vaccinations, recommended here last week when I wrote about the most common fears and myths surrounding vaccines, is the highlighted feature and deserves a second read by medical professionals, parents and everyone working with children. As Shinga noted: “It is sobering to recall what a comparatively recent privilege it is that children survive through to adulthood.”

Also deservedly mentioned is Nobel laureate Robert Fogel’s book The Escape from Hunger and Premature Death, 1700-2100, which chronicles the good news about our health and larger sizes, explaining that until fairly recently, most people battled a series of infections almost all the time, and that people (particularly children) expended a substantial amount of their calorie intake on fighting infection. It is a relatively recent development that we are so secure in our access to adequate calories that children can become larger and healthier. This realization may help people understand that the “childhood obesity epidemic” is not the crisis it’s being portrayed.

This is the best Pediatric Grand Rounds yet and includes sex, drugs, issues of life, death, morality; ethical dilemmas that reflect religious and cultural values, as well as the challenges posed by advances in medicine. Thank you, Shinga, for a great job and for including this blog in this memorable edition.

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Salt’s pedigree

They come in an array of sparkling shades and shapes with exotic names like Black Kala Namak from India; Fleur del Sel from Guerande, France; Himalayan Pink Gos Sel; Hawaiian red clay salt; Maldon sea salt; and Korean bamboo sea salt. Salt tastings are all the rage, salt samplers are among the choicest holiday gifts, and chefs tell us each salt has a different flavor and has to be used to its best advantage in cooking. Sea salt tastes a lot better than mined salt, Rocco DeSpirito told the New York Times. “It’s got a real saline, ocean character that comes across in the food.”

Thanks to celebrity chefs, popular cookbook authors and gourmet catalogs, entire mythologies have developed about salts and their healthful virtues. Culinary gurus talk passionately of various salts and continually try to outdo each other for the most alluring, exotic and lavish offerings. And salt fads are born. Gourmet salts can now sell for more than 100 times the price of plain table salt. For most of us, following these food fads seem harmless fun. It never occurs to us it might not be.

Often taken as gospel are claims that sea salt is unrefined, more natural and more healthful than ordinary table salt because it comes from the sea and is high in minerals. Sea salt has been praised for tasting pure, fresh, bright, delicate, sweet, sharp, refined, balanced and well-rounded. Everyday table salt is condemned as tasting bitter, tinny, metallic, acrid, characterless, and chemical-like, because it’s said to be cheap and highly refined.

In actuality, all edible salt sold is about 99% pure sodium chloride. The remaining 1% — negligible traces in a dish — are far too minute to make a difference nutritionally. Scientists tell us that those minuscule amounts of minerals are also undetectable by our taste buds, but it’s easy to convince ourselves otherwise when we’re paying so much for them. :)

Salts do not differ in their saltiness or tastes. What we confuse with a bright salty flavor has nothing to do with the exotic origin of the salt, but more with the size and shape of the grains. When we bite into a big, crunchy crystal, we get a burst of salty flavor on our tongue. But when a fancy salt is dissolved in a moist or cooked dish, its special taste attributes dissolve too, leaving food tasting indistinguishable from that salted using a salt shaker.

Despite popular beliefs, sea salt is not rich in the minerals found in sea water because those are left behind when the sodium chloride crystallizes out as sea water evaporates. It is Mother Nature’s natural refining. Sea salt is ten times freer of minerals than sea water.

Some of the most amusing claims surround salt’s freshness. Salt doesn’t change when it’s exposed to oxygen and it doesn’t contain volatile, aromatic oils that can be released by grinding. So “fresh”-ground is an oxymoron.

We don’t dare admit that we can’t taste any difference among salts, though. We might appear to have an “insensitive palate!” So we choose to ignore the scientific reality or let ourselves get swept up in the fun of the popular fad. But when we forget our food history, we can find ourselves having to relearn the same hard lessons of our great grandparents.

Old fashioned, salt shaker salt differs from most gourmet varieties in one very important way. Since the 1920s, most table salts have had iodine added. Today’s trendiest salts haven’t. Sea salt contains less than 2% of the iodine in iodized salt, despite beliefs that it is naturally iodized (perhaps because some associate it with iodine-rich seaweeds).

Iodized salt was the first “functional” food. Chicken feed was also supplemented with iodine, it was given to milk cows and cattle to prevent hoof rot and reduce fertility problems, and was used to sanitize milking teats (now a waning practice), so eggs and milk products can also provide some iodine. What led up to iodized salt isn’t widely known anymore. Prior to iodized salt, Americans in many areas of the country were deficient in iodine. It was not uncommon for children in some regions to be considered “dull” or “dim-witted” with IQs 15 points below children from areas where iodine deficiency was less common. During World War I, goiter (from severe iodine deficiency) ran as high as 64% in some areas, and it was the biggest single cause of medical disqualification for military service!

By 1955, about 76% of American homes used only iodized salt. Where salt is adequately iodized and people are not limiting their food choices, deficiencies are rare.

Iodine is a natural element needed by the body to make thyroid hormones and is essential for normal growth and development of our nervous system (brain), sexual development, to maintain fertility, regulate our metabolism and maintain our body temperature. Adults with insufficient iodine in their diet show signs of hypothyroidism and women have higher rates of miscarriage; infant mortality is higher in babies; and children are at risk for reduced intelligence and can suffer permanent mental retardation, neurological defects and growth abnormalities.

The U.S. Institute of Medicine’s recommended dietary allowance (RDA) for iodine is 150 mcg for adults and adolescents, 220 mcg for pregnant women, 290 mcg/d for lactating women, and 90-120 mcg for children aged 1-11 years.

But over recent decades, Americans are increasingly shunning ordinary table salt; and commercial restaurants, food processors and chefs have abandoned iodized salt in response to consumer concerns it could affect the taste of foods; preferring “natural” sea salts, kosher salts and noniodized salts. Last month, Food Technology reported that this fad, along with attempts to reduce salt intakes, may be the most significant factor leading us to deficiencies again. The National Health and Nutrition Examination Surveys found that from the 1971-1974 to 2001-2002 examinations, iodine excretion in adults dropped from 320 mcg/L to 168 mcg/L — by nearly half — and the frequency of iodine deficiencies in pregnant women jumped from 1% to 7%.

These are astounding changes. While iodine levels are not yet low enough to declare a public health emergency (remember, RDAs are not minimum requirements and are set higher than most people need to prevent deficiencies to allow for a safety margin), they indicate a trend of serious concern to health professionals.

This summer, researchers at the Conway Institute of Biomolecular & Biomedical Research at the University College Dublin reported that the iodine intakes among Irish women of childbearing age were significantly below World Health Organization recommendations. They reported that a mere 3.3% of all salt sold in Ireland and UK was iodized. This past spring researchers reported in the Medical Journal of Australia that iodine deficiencies were re-emerging in Australia.

A week ago, the New York Times reported that about one-third of the world’s population eating only locally produced foods is short on iodine, contributing to stunted growth among the children and “even a moderate deficiency lowers intelligence by 10 to 15 IQ points, shaving incalculable potential off a nation’s development.” Multiple international iodizing efforts are underway, just as the United States did in the 1920s. Meanwhile, we might be poised to having to relearn our own history lessons.

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Do fat people have fat germs?

The Washington Post reported “a startling discovery that could lead to new ways to fight the obesity epidemic.” The Associated Press suggested: “Maybe it’s germs that are making you fat.” A Nature magazine Op-ed written by Matej Bajzer and Randy J. Seeley of the University of Cincinnati said: “This is a potentially revolutionary idea that could change our views of what causes obesity and how we depend on the bacteria that inhabit our gut.” And Jeffrey Gordon of Gordeon Lab, recently renamed the Center for Genome Sciences, at Washington University in St. Louis said: “For the first time, we see that there is a correlation between the microbial gut ecology and the obese state...That’s part of the pathology of obesity.”

Now, before you think that science has shown fat to be indicative of yet another diseased state, or that popping microbe-containing pills or special “probiotic” foods will make you slim, or that you might “catch” obesity, you’ll want to know what the research being reported actually found.

These news stories were based on a nine paragraph “Brief Communication” in this month’s Nature magazine. Researchers at Gordeon Lab wrote that when they tested the stool of ten people, the bacterial flora were different after the people had been dieting for a year and had lost weight, than their flora were before starting their diets. Of the trillions of bacteria and other minute bugs in the intestinal track that helps break down food and fight off infections, the proportions of two groups of bacteria, Firmicutes and Bacteroidetes, had changed after dieting. Bacteroidetes had increased from 3% to nearly 15% of the gut bacteria. So the people’s flora while they were fat were different than when they were thinner. It was also different from 5 thin people, although when asked, the researchers didn’t reveal the dieting status of these thin counterparts.

In their paper, the researchers concluded that this association between body weight and bacterial flora “indicates that manipulation of gut microbial communities could be another approach in the treatment of obesity.” They speculated that perhaps the bacteria were able to extract more energy from food, causing obesity, althought they didn’t know how many calories the microbes might account for and admitted it would be small.

Professor Boyd Swinburn, president of the Australian Society for the Study of Obesity in Melbourne, pointed out what is probably clear to you, too. This correlation between body weight and bacterial counts does not mean the bacteria caused the change in body weights, or caused obesity in the first place. “I think it’s totally wrong,” Professor Swinburn told the Australian News. “Gordon’s group showed only that dieting changed the balance of gut bugs, not the opposite as they claimed.”

The Center for Genome Sciences researchers will continue their Human Genome Project under a $1.45 million grant from W.M. Keck Foundation awarded them in February, 2005 to “develop new approaches to isolating, sequencing and analyzing the genomes of friendly bacteria that inhabit the intestine and identifying the natural metabolic products that they synthesize.”

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The green slim diet regimen

The green slim being poured into glasses in this story’s lead photo is probably enough to make most people doubt the wisdom of this diet! But good science also cast doubts on detox diets and the fears behind them.

In Pursuit of a Body That’s Pure

...A spa where the rich and beautiful flock to purify their bodies of the chemical excesses of 21st-century existence. “Between the stresses of everyday life (deadlines, relationship struggles, traffic) and the impurities found in processed foods, the body is full of toxins and the mind, tension,” declares the Website... Guests go without solid food for anywhere from three to eight days, subsisting on a liquid diet that supposedly helps flush their systems of pollutants and preservatives while still providing vital nutrients.

They gulp down 14 individually formulated drinks daily to boost their energy and loosen stuck matter in their colons. They imbibe endless cups of fresh vegetable juice, gallons of blood-purifying tea and enough water to grow a tree in the desert. Then, packed to the gills with fiber and herbal laxatives, they receive colonics, lymphatic massages and Korean skin scrubs to help flush the toxins....these enthusiasts hope to purge themselves of accumulated metabolic waste and man-made poisons....

Most people who do detox regimens speak of them with the zeal of religious converts. They can’t wait to detox again. But medical professionals urge caution. They say detox diets can be extreme and potentially dangerous. They also say there’s no evidence that these diets do any good.

“The idea that foods are poisonous, or that we need detoxification, or a cleansing regimen to improve our health is without scientific merit,” says Roger Clemens, a nutritional biochemist at the School of Pharmacy at the University of Southern California. “We have wonderful organs, great enzymes, a great system for eliminating toxins naturally.”

...Detoxing is based on the idea that people take in or absorb toxic chemicals such as pesticides, mercury, dioxins, polychlorinated biphenyls (PCBs) and food additives through the food they eat, air they breathe and water they drink. When these chemicals build up to a certain level, the theory further goes, they can overpower the body’s natural detoxification system — causing fatigue, mental sluggishness and various “allergy-like symptoms.”

...Claims vary depending on the diet, but testimonials generally suggest that these regimens will boost energy, increase mental clarity and make skin glow.

Such diets seem to resonate with an often-affluent urban psyche that seeks to cure all through health and nutrition, and to fit neatly into this age of instant gratification and pervasive fears about environmental pollution.

...In fact, most scientists say there is no evidence to support the notion that these often extreme cleansing methods do anything except perhaps dehydrate you and throw off your electrolyte balance. When people do the regimens to excess, they can get muscle cramps or pass out, sometimes even push their kidneys to begin to shut down. “It is fraud,” Cedar-Sinai’s Pressman says. “It is a distortion and misapplication of science and medicine. Kidneys and livers don’t need rest. They don’t need water in huge quantities. What they need is to be used. Our body’s own capacity to detoxify itself is beyond anything we can design.”

Susana Belen, the 68-year-old founder of [the] Spa, is not swayed by the lack of science. “Just because it hasn’t been scientifically certified does not mean benefits do not exist.... One woman bounces on a tiny trampoline in the shade. She’s preparing for her colonic: five minutes of jumping to loosen things up. “I think the body stores toxins up in the body. It gets clogged...And here, you can get that out.”

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Medical record privacy update

Health Care Renewal just reported on “Another Electronic Medical Record Horror Story.”

According to a Wall Street Journal article, medical information about her psychotherapy that patient, Patricia Galvin thought was confidential was released to an insurance company. Health Care Renewal writes:

[C]omplaints to HHS about breaches of medical privacy have exceeded 23,000 [and] HHS presently receives about 700 new complaints monthly, while enforcement of "guarantees" such as in the HIPAA act are basically non-existent. I'd bet a large proportion of these breaches were facilitated by electronic legerdemain.

Ms. Galvin’s fears that her most private thoughts and secrets are “mere data of a transaction, like a grocery receipt” are well-founded and truly give life to an observation I made several years ago while leading electronic medical records (EMR) implementation at a large hospital....Unfortunately, as Ms. Galvin discovered to her horror, good things do not come from treating twenty-first century medical “transactions” as nineteenth century accounting data.

We’re not alone in the United States. In the UK, the ambitious Connecting for Health national EMR project and plans for a central clinical database have been met with stiff resistance from patient advocacy groups. Plans to upload medical records onto the central clinical database will put patient confidentiality at risk, the UK program has been told by its own consultants....

A similar advocacy movement is needed in the U.S., for there has been an idealistic and almost reckless push in the US to put any and all healthcare information into EMR’s and other electronic databases, even when the financial and clinical benefits are unproven....

In a decade when conflict of interest and mismanagement in healthcare is common, break-ins to supposedly secure databases appear in the news almost weekly, and dominant computer operating systems are barely able to keep ahead of hackers’ attempts to circumvent security, the dream of patient confidentiality is increasingly utopian. The reality is that the HIPAA act lacks teeth, enforcement initiatives non-existent (as the Journal reports), and stated exceptions to the HIPAA rules are prone to misuse by the powerful and those with financial incentives. These factors make it likely that the HIPAA “guarantees” are not worth the weight of the paper they’re written on.

In reality, if you want to keep information secure, don’t put it on a computer; and if you have to put it on a computer, and the computer is to be put on a network, then the information by definition is no longer secure.

These harsh realities call for a critical rethinking of the types of clinical data that should be put into electronic databases, and on governance of privacy, security and confidentiality....

Healthcare professionals quickly come to know that patients’ records are not really confidential, but when they become electronic, the numbers of people and interests with potential access explodes. The public would be astounded to learn that HIPAA gives virtually anyone remotely connected to their healthcare, third-party reimbursement or regulatory surveillance, access to their most private information, as explained by Patient Privacy Rights Foundation (and was recently written about here).

Given the unsoundness, conflicts of interest and potential for misuse of employer, government and health insurer clinical guidelines, health screenings, “health risk assessments” and “wellness” programs (as written here), the public would be wise to avoid volunteering information about their private lives to their employer or insurer. But many do, lulled perhaps by assurances the information they provide is “confidential” and will help them, and that their privacy is protected under HIPAA.

In a related story, the Chicago Sun Times just reported on an online Personal Health Records database being created by one of the country’s largest health management companies, Blue Cross and Blue Shield Association, which has partnered with America’s Health Insurance Plans, the main lobbying organization for 1,300 health insurance companies. The newspaper reports:

The two groups have developed and pilot tested standards on what should be included in the records and that make them portable, enabling consumers to transfer the records when they change insurers or doctors.

The groups, whose members cover more than 200 million people, said the goal is to have insurers include in every personal health record core data such as records of visits to doctors' offices and hospitals; medical conditions and illnesses; treatment plans, including medications; immunizations; allergies; health risks, and health insurance information....

An estimated 70 million people have personal health records through their health insurers, and millions more are scheduled for the service next year, the groups note. But, until now, the information contained in them has been inconsistent. Physician groups have urged the industry to work to standardize the information....

Association spokesman John Parker, said, "There could be many different bells and whistles to distinguish [the records] in a unique way, but core elements would be shared."

Patient Privacy Rights, a national consumer watchdog organization based in Austin, Texas, denounced this plan. “This is a wolf in sheep’s clothing,” said Deborah Peel, MD, founder and chair of Patient Privacy Rights. “Insurer-provided electronic personal health records held in a data bank that the insurers control will be used primarily to benefit insurers, not patients.” Her organization reports that insurers will get:

· An immensely lucrative database they control completely.

· A rich compilation of patient data with no state or federal laws to prevent them from using the information any way they please.

· The opportunity to data mine the new information consumers add to their PHRs for medical underwriting.

· A great new business opportunity they can sell the PHR data of millions of enrollees to employers, drug companies, and data brokers.

“The last place on Earth where patients want to keep their complete medical records is in the hands of their insurers. But that is exactly what AHIP and BCBSA are proposing. By giving plan enrollees a Personal Health Record and asking them to fill in the blanks, we’re basically being asked to spy on ourselves for the financial benefit of the insurance industry,” said Dr. Peel. “Will these companies guarantee that patients’ personal health information will never be used against them or disclosed without informed consent?”

In a press release, Patient Privacy Rights described the research showing consumers do not want their insurers to have their complete electronic medical records and feel the privacy risks outweight any benefits. They “strongly advise all Americans not to participate in any personal health record databases or data banks until Congress passes a law saying that consumers own their health records and gives them the right to control who can access their health records.”

Also in electronic medical record news, National Business Group on Health founding board member, Thomson Medstat, was just awarded a three-year $14.9 million contract to build and support the Healthcare Cost and Utilization Project (HCUP) databases of patient- healthcare information (written about here). It will be the largest and most complex electronic database to date. The contract is from the Agency for Healthcare Quality and Research under the U.S. Department of Health and Human Services. Medstat is part of Thomson Corporation, which provides electronic software and applications, including business intelligence and decision solutions, “to help employers, government agencies, health plans, hospitals and pharmaceutical companies manage the cost and quality of healthcare,” according to their press release.

Click here for complete article (and single page version).

The fabled links between weight and prostate cancer

The media is getting a jump start on the traditional New Year’s kick-off to the dieting season. News reports are telling men that losing weight can lower their risk for prostate cancer. “Here's another reason for men to avoid packing on extra pounds over the holidays,” according to the Associated Press.

“This study is the first to link weight loss to a reduced risk of this disease...and adds to increasing evidence of the importance of maintaining a healthy weight throughout adult life,” said the American Cancer Society.

The study behind these news stories was by researchers with the American Cancer Society and Duke University School of Medicine who examined data on 5,232 men diagnosed with prostate cancer between 1992 and June 20, 2003. They were looking for associations between prostate cancer and weight status.

Oh, you heard it was a study of nearly 70,000 men? That’s the Trojan Number — named after the mythical ploy of the Greeks who infiltrated the city of Troy inside a giant wooden horse. As Dr. John Brignell, author of Sorry, Wrong Number! explains, it’s one of the strategies used by researchers to inflate the size of a study so it sounds more impressive when the actual number of people with the condition being studied is significantly less. In this case, only 7% of the men actually had prostate cancer and the remaining 64,759 men were “mere bystanders.” When you find a Trojan Number, cautions Dr. Brignell, “these studies are often part of a large data dredge, in which many combinations of condition and potential cause are covered, so that the inevitable coincidental excesses can be identified and claimed as significant.”

In this case, the data was culled from the Cancer Prevention Study II Nutrition Cohort, a subgroup of the Cancer Prevention Study II. This controversial database on 1.2 million Americans was created by American Cancer Society volunteers who recruited friends, neighbors and family members to complete lifestyle questionnaires in 1982. Another questionnaire asking them their height, weight, diet, and lifestyle factors was mailed to more than 84,000 men and 97,000 women living in states with cancer registries in 1992, when they were enrolled in this subgroup.

The actual findings of this study were decidedly different from what we’re hearing:

The researchers found no association between the men’s body mass index (BMI), or the men’s change in weight, and their overall risk for prostate cancer.

In fact, looking at the data, the obese men had about 10% lower overall incidence of prostate cancers and the risk steadily dropped as BMIs increased.

These held true even after the researchers tried in their statistical analyses to control for a number of differences between the "obese" men and “normal” weight men that could point to other possible factors:

·Black men were two times more likely to be obese than slim. (African Americans have a two-fold higher mortality rate from prostate cancers than white men, according to the U.S. Preventive Services Task Force.)

·Former smokers were 24% more likely to be obese than slim.

·The obese men in this cohort exercised 4 times less than the thinner men.

Most prostate cancers do not kill men diagnosed with them — while American men have a 15% lifetime risk of being diagnosed with prostate cancer, they have only a 3% lifetime risk of dying from the disease and 90% of deaths are in men over 65 years of age, according to the USPSTF. Most of the men in this study, about 90%, had PSA screening tests which can detect cancers four or more years before they would be picked up symptomatically. According to the USPSTF’s review of the medical evidence, “screening may detect cancers that appear clinically significant based on size and tumor grade, but which would not have progressed to clinical symptoms during the patient’s lifetime.”

Closely conforming to these facts, only about 5% of the prostate cancers in this study were metastatic, fatal cancers; 80% were nonmetastatic, low-grade. The remaining 662 cases were nonmetastatic high grade cancers, which they called “aggressive.”

If being fat played a role in prostate cancers, as is being suggested, risks should increase as body weights increase. They don’t. Even risks for metastatic and the nonmetastatic high grade cancers did not increase with increasing body weights. In fact, all of the statistically-derived relative risk numbers for associations between prostate cancers and body weight were so nominal they have no practical relevance. [See Have your steak and enjoy it too! for an explanation of tenable relative risks.]

With that caveat in mind, even the trivial changes in relative risks (remember these numbers are not a man’s actual risk, it is the percentage change of their actual 3% lifetime risk) reported in this study show that being fat is irrelevant and losing weight is unwarranted.

The news focused on the higher risk among “obese” men as compared to “normal” weight men for “aggressive” forms of prostate cancers, so let’s look at those numbers. There was no correlation with body weights. The 17% increased relative risk for “obese” men was actually lower than less heavy men in the “overweight” category with BMIs 27.5 to 30. And the slightly “overweight” men with BMIs of 25 to 27.5 had a 13% lower risk than the “normal” weight men!

And losing weight was even less related to lower risks for prostate cancers. The men losing 11 or more pounds had a 10% lower risk — and losing more (> 21 pounds) didn’t reduce their risks any further. That was the same reduced risk seen in men gaining more than 21 pounds! There were no differences in risks among the men who’d gained 6 to 20 pounds, were weight stable, or who’d lost 6-10 pounds.

And while the news accurately reported that the men who lost 6 to 20 pounds was associated with a 17% lower risk for the most deadly, metastatic forms of cancer — what wasn’t reported is that the men who gained 10 pounds had a 20% lower risk! And the men were gained 20 pounds still had a lower risk than the men who had "watched their weight" and not gained an ounce.

But this study’s findings are not surprising in light of the body of evidence, especially the evidence on real people. Any lingering concerns that being fat could increase risks for prostate cancer will be allayed by simply looking at the latest cancer statistics from the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Cancer Institute, and the Surveillance, Epidemiology, and End Results Program. While obesity rates are apparently rising, prostate cancer deaths have dramatically dropped over the past ten years by one-third.

So, this study actually provided no evidence for any of the things being attributed to it: It didn’t show that being fat raised a man’s risk for prostate cancer. It didn’t show that losing weight lowered a man’s risk for prostate cancer. It didn’t show that maintaining a “healthy” weight imparted any benefits. You may be surprised by how radically different the actual findings in this study are from the spin and speculations coming from the American Cancer Society. But those familiar with this special interest group and its history of going to any length to hype obesity fears won’t be. Its corporate sponsors include the largest pharmaceutical companies with drugs for weight loss and treating “obesity-related” conditions. And Weight Watchers is the founding sponsor of the American Cancer Society’s annual Great American Weigh-In held in cities across the nation, “whose primary goal is," according to WW, "to make people aware of the link between being overweight and the risk for many diseases, especially several forms of cancer.”

© Sandy Szwarc 2006

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There's more to childhood

Another parental call for sanity by Jose Appleton:

There’s more to childhood than counting calories

The obsession with expanding waistlines is narrowing horizons for children — and replacing adult guidance with health tips. Politicians, companies and charities are lining up together in the trenches in the war against childhood obesity....

Increasingly everything that children do is assessed with reference to body mass index...Good now equals active, low fat, and smaller waistline; bad equals inactive, full-fat and bulging belly.

Childhood obesity has become the bottom line justification for children’s activity....The need to combat obesity apparently also means that they should eat good food, and eat with their family at mealtimes. This signifies a profound narrowing of vision....Children’s activity is judged in terms of narrow goals and ends, the numbers of calories that it burns, rather than being seen as simply a normal party of everyday life, or as useful as an end in itself....

Increasingly children are encouraged to engage in ‘active lifestyle programmes’. The Department of Heath gave some children pedometers to measure the numbers of steps that they take in a day. Schoolchildren in Denver received similar pedometers back in 2002, and have been counting their steps ever since. Experts try to work out what is an acceptable pedometer reading....In Minnesota, an obesity researcher designed a classroom that encouraged children to fidget.... The children are adorned with sensors to measure their every movement....

Although obesity is now the number one sin with which to scare children, it’s seen in peculiarly pragmatic terms. There is an obsession with measurement....Researchers are busily working out all the various ‘factors’ that influence childhood obesity....

These policies are in danger of breeding a new nation of self-obsessed gym goers, who are forever counting their steps and calorie intake. Kids shouldn’t be thinking about their weight, even - or perhaps especially - if they are fat...

There is more to childhood than not being fat....

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Merry Christmas!

Whatever holiday you are celebrating this winter season, I hope it finds you surrounded by love, laughter and lots of wonderful things to eat. Safe travels to all of those traveling over the river and through the woods to visit loved ones.

Some accuse Santa of being a bad role model because he’s fat, 350 pounds by some estimates. He’s a fine role model: he’s friendly, kind, generous, makes people happy everywhere he goes, and is a brilliant scientist and project manager. How else could he figure out how to travel 1,000 miles per second to deliver a gift to every one of the 775 million children celebrating Christmas? And that’s after coordinating the elves to make the toys and wrap them all, using 650,000 miles of wrapping paper, according to Carnegie Mellon University. And Santa is in terrific shape. The Pittsburgh Tribune Review reports today that Santa will burn 52 billion calories just climbing chimneys tonight. That’s quite a workout. In fact, his doctor is probably worrying he’s overdoing this exercise thing. He’ll need all of those holiday cookies and glasses of milk to keep up his energy. And despite loving holiday goodies, he is living to a ripe old age of several thousand years, I hear, although I couldn’t find evidence to confirm that. :)

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“Science” works on Christmas Eve to track Santa

Since it’s Christmastime, we’re taking a departure from serious topics to something fun to share with your little ones. Of course, this information will also help you have Santa’s cookies and milk ready for his arrival! :)

In 1958, Canada and the United States created a bi-national air defense command for the North American continent called the North American Air Defense Command (NORAD). Since then, NORAD has used four high-tech systems — radar, satellites, Santa Cams and jet fighter aircraft — to track Santa travels as he delivers gifts to boys and girls around the world. Hundreds of volunteers spend part of their Christmas Eve at the Santa Tracking Operations Center at Peterson Air Force Base in Colorado taking calls and emails from children around the world and providing them with up-to-the-minute information on Santa’s whereabouts.

Kids can track Santa online at the NORAD website: http://www.noradsanta.org or call NORAD at 877/446-6723. The information is available in six languages.

According to NORAD, their radar system is called the North Warning System. It is especially powerful and has 47 installations across the northern border of North America, all checking closely for signs Santa Claus is leaving the North Pole on Christmas Eve.

The moment our radar tells us that Santa has lifted off, we use our second mode of detection, the same satellites that we use in providing warning of possible missile launches aimed at North America. These satellites are located in a geo-synchronous orbit (that's a cool phrase meaning that the satellite is always fixed over the same spot on the Earth) at 22,300 miles above the Earth. The satellites have infrared sensors, meaning they can detect heat. When a rocket or missile is launched, a tremendous amount of heat is produced - enough for the satellites to detect. Rudolph's nose gives off an infrared signature similar to a missile launch. The satellites can detect Rudolph's bright red nose with practically no problem. With so many years of experience, NORAD has become good at tracking aircraft entering North America, detecting worldwide missile launches and tracking the progress of Santa, thanks to Rudolph.

The third detection system we use is the Santa Cam. We began using it in 1998 - the year we put our Santa Tracking program on the Internet. NORAD Santa Cams are ultra-cool high-tech high-speed digital cameras that are pre-positioned at many places around the world. NORAD only uses these cameras once a year - Christmas Eve. The cameras capture images of Santa and the Reindeer as they make their journey around the world. We immediately download the images on to our web site for people around the world to see. Santa Cams produce both video and still images.

The fourth detection system we use is the NORAD jet fighter. Canadian NORAD fighter pilots, flying the CF-18, take off out of Newfoundland to intercept and welcome Santa to North America. Then at numerous locations in Canada other CF-18 fighter pilots escort Santa. While in the United States, American NORAD fighter pilots in either the F-15 or F-16 get the thrill of flying with Santa and the famous Reindeer Dasher, Dancer, Prancer, Vixen, Comet, Cupid, Donner, Blitzen and Rudolph. About a dozen NORAD fighters in Canada and the United States are equipped with Santa Cams.

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Eat, drink and be merry!

It is nearly impossible to find that sentiment in the media today. It’s all about eat, drink and be ... moderate, healthy, watch what you eat and stick to your diet. Humbug! In the Telegraph, Tom Hodgkinson asks ‘what’s stopping us from being merry’?

What does ‘merry’ mean? It’s a word that, these days, is used only in conjunction with Christmas or to describe Robin Hood’s men. We have a vague notion that being merry is something to do with the red beaming face of Father Christmas and hearty laughter, but otherwise the idea of merriment seems an archaic irrelevance.

The word ‘merry’ actually captures an old-fashioned, fun-loving, medieval approach to life, and it’s a word and a concept that we might do well to resurrect in these grey bureaucratic days. The word reminds us that, in the Middle Ages, the light-hearted inhabitants of ‘Merry England’ really did think it was important to have fun and to limit the amount of work we did.

In the old days,Christmas lasted a full 12 days, during which time you were not allowed to work. It was a whole 12 days given over to feasting and having fun. And the fun and indulgence were not indulged in guilty fashion, as is the case today.

The medieval merry-makers did not admonish themselves when the party was over and condemn themselves to self-torturing diets and new schemes for an improved life. On the contrary, to be merry was practically a social duty. Merriment was built into the ethical codes of the time. And the Church itself actually encouraged merriment, drinking and conviviality – not just at Christmas, but all year round.

Why was it so important to be merry for medieval England? According to Professor Ronald Hutton, of Bristol University, the big difference in the medieval approach to life was that they were intensely community-minded. ‘The medieval emphasis on community meant that there was a need to cultivate virtues that made communal life better,’ says Hutton. ‘Merriment, which we would today call conviviality, was one of these.’

And rather in the same way that Robin Hood’s outlawism was intimately bound up with his detached, devil-may-care attitude to life, the Christmas festival was a time when we could release our wild sides. The writer Jay Griffiths argues that the drunken Oxford Street reveller, clutching the lamppost, his reindeer antlers hanging on his head at a skewed angle, represents the real Christmas spirit: ‘The spirit of Christmas is not restrained or well-heeled, but excessive and vulgar in its original sense: of the common people.’

Christmas is therefore anti-authoritarian, and its real purpose is not so much to sit piously and remember the birth of Christ, but to dance and sing and drink ale and spiced wine to excess. The medieval spirit and the spirit of Christmas were about taking your pleasures now and damn the consequences. ‘Eat, drink and be merry, for tomorrow we may die,’ was the line from Ecclesiasticus that was used to give biblical approval to living in the moment....

The rest of his article is here.

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Mythinformation

The Philadelphia Inquirer reports:

Myths about health and holidays abound

There are more health-related myths about the holiday season than about any other time of year. We just made that up, but it has the kernel of reasonableness that helps such untruths endure. After all, the holidays coincide with that other font of mythinformation — the cold and flu season....

1. Americans gain several pounds over the holidays

Not true - or at least it wasn't six years ago. The average weight gain between Thanksgiving and New Year's was less than a pound, based on a study of 195 adults who were repeatedly weighed from September to mid-January by researchers at the National Institutes of Health.

It has been confirmed, however, that Americans think they gain more. In a 2004 survey of 1,000 adults by the Kaiser Permanente health plan, 43 percent of men and 49 percent of women said they tended to gain "a few pounds" during the holiday season....

Throughout time, the body weights of humans have had natural seasonal fluctuations, gaining a little during the winter which comes off naturally during the summer. And overall, we naturally get a bit larger with age, all without us having much say in the matter. A quarter of a century ago in The Dieter’s Dilemma, William Bennett, MD and Joel Gurin documented that our bodies’ natural setpoints are maintained within a genetically-determined range. Dieting and controlled eating isn’t going to change that in the long-run. Research has continued to show us that. Our body types and the amount of fat our bodies carry “is automatically regulated and some people are naturally fatter than others,” they wrote. “It is a biological fact of life, an aspect of the human species’ inherent variability.”

All of the hand wringing over holiday weight gain and the need to count calories and watch what we eat isn’t grounded in good science. “The standard, ‘sensible’ recommendations to change eating habits and diligently use calorie charts are also no more than elaborate folklore, expressions of faith in a world that ought to exist, but in fact does not,” said Bennett and Gurin.

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Fear is terribly catching, bird flu isn’t

Fears of another impending health crisis were accentuated today as news stories threaten “Flu virus could kill 81 million.”

These latest death threat statistics, reported from the same press release, appear to have been created for the greatest scare value, according to Steve Milloy. In a Fox News article, he reviewed the flaws in how those numbers were derived, along with some valuable cautionary science:

...First, the researchers’ estimate of 62 million deaths has far more shock-value than credibility....The 62 million-death sound-bite is the product of statistical modeling that uses worst-case death rate estimates from the 1918-1920 pandemic influenza – an epidemic that medical historians believe killed somewhere between 20 million to 100 million people.

[T]he researchers ignored several key (not to mention glaring) differences between 1918 and 2006. First...modern medical care and public health practices have dramatically improved since 1918. So any flu epidemic is likely to be far less severe....Next, a great proportion of the deaths in 1918 was probably due to secondary bacterial infections that followed the initial viral infections. Today, antibiotics would be used to treat bacterial infections.

And let’s not forget that during 1918-1920, much of the world was still recovering from the strains of World War I. Poverty, hunger, unsanitary living conditions and stress likely made much of the global population ripe for a killer flu pandemic.

None of these considerations were factored into the researchers’ estimate.

But perhaps the researchers’ choice that most reveals their apparent desire to come up with a scary – rather than a realistic – death toll from pandemic flu is their decision to use the 1918 pandemic flu data in the first place. There were, after all, two other more recent and, in all likelihood, more relevant pandemic flu outbreaks in the 20th century....

While scares about a global bird flu pandemic have been brewing for years, the “shock we are seeing is way out of proportion to the risk,” said Anni McLeod, a senior officer of livestock policy for the U.N. Food and Agriculture Organization. “Consumers are not very much at risk from this disease,” she said at a World Poultry conference in May.

Infectious disease and agricultural scientists have been presenting science that tempers concerns for years, but it’s been underplayed in the media. Fostering fears of a crisis is too irresistible for a host of interests, from public health officials creating new emergency management programs, activists trying to frighten consumers away from animal products and modern farming, pharmaceutical companies and researchers seeking funding for vaccines, and media garnering readership and viewers with sensational headlines.

We rely upon our public health agencies to have prudent precautions in place to detect and prevent the spread of public health disasters and protect us from bioterrorism and other threats to us, which we also hope are based on objective risk analyses. But the calm, careful statements of the evidence are not reflected in the messages most consumers are hearing or the responses they are seeing.

American Council on Science and Health president Dr. Elizabeth Whelan said “given what history teaches us about the potential magnitude of such a pandemic...this is one case where the consequences might be devastating enough to make a heavy investment now reasonable.”

Congress allocated $3.8 billion last year to create a massive governmental bureaucracy to address avian bird flu under the Department of Health and Human Services and asked all state and local health departments to develop pandemic plans. According to the HHS, “the Homeland Security Department will be in charge of a national response to a possible bird flu pandemic, relying on the department’s National Response Plan and National Incident Management System.” The plan included forecasts of “a pandemic affecting 88 million people...with illness rates highest for school-age children... as many as 10 percent of all employees being unable to work...Prioritize the distribution of vaccines and antiviral medication... Calls for closure of schools, offices, and malls and possible communitywide quarantines in the event of a severe pandemic....” The government has ordered 2.7 million doses of flu vaccine from three pharmaceutical companies, enough to vaccinate first responders, although the drugs have not yet been approved.

When U.S. Centers for Disease Control and Prevention scientists presented the evidence showing limited transmissibility of the avian flu virus, CDC director Dr. Julie Gerberding cautioned that the data didn’t mean the virus might not develop into a pandemic strain. As Peggy Jordan, a New Mexico state coordinator told reporters, while “the avian flu virus has not mutated to humans yet, it is just a matter of time.”

A recent article published by the Organic Consumers Association cited an editorial concluding: “In view of the mortality of human influenza associated with this strain, the prospect of a worldwide pandemic is massively frightening.” It ended with the dire statement: “Humanity’s lust for flesh not only kills billions of animals every year directly, but threatens the health of our planet and may threaten our health in more ways than we know.”

Such terrifying claims certainly play on our emotions. But the value of exaggerating the dangers and scaring people half to death is questionable. Most consumers just want a balanced presentation of the facts. As in the case with so many scary things in the news today, the evidence and the work being done by capable scientists in this field offer reassurance, not fear.

Bird flu, avian influenza, is just that. An infection in birds which occurs naturally from flu viruses that have been recognized in poultry since 1901. There are two forms: “low” and “high” pathogenic. The low type can make birds sick but poses no serious threat to people, whereas the high type spreads more easily among birds and is often fatal to birds. The high pathogenic type, known as HPAI, can infect people after extensive contact with infected birds. Most consumers don’t know that HPAI has been detected three times in the United States — in 1924, 1988 and 2004 — but it never caused significant health problems for people, according to the U.S. Department of Agriculture. That’s because, like other veterinary issues, this disease was quickly eradicated as a result of close surveillance of bird populations (live bird markets, commercial flocks, backyard and small growers, and migratory bird populations); import restrictions; and coordination between USDA, state, local and industry which act quickly to prevent the spread and vaccinate healthy birds outside an infected area. But it is important to know that there is no evidence that the particular strain in Asia, Europe and Africa over recent years currently exists here in the United States and it is unlikely to be introduced, given the “multi-firewall” strategy in place.

According to the U.S. Department of Agriculture, the chance of infected poultry entering the processing system is extremely low. “Infected birds are typically too ill to be transported to processing plants. Federal veterinarians also check the health of all birds before they are processed to ensure that only healthy poultry enter the U.S. processing system.” American commercial poultry farms also prevent poultry from coming in contact with migratory wild birds that can introduce infections. While fears have raged that people can get bird flu from eating chicken and poultry, they are not based on the evidence. Simply using the same safe food handling and cooking that you use for poultry anyway is effective in destroying the virus, in the unlikely event it were to be present, says the USDA and CDC. You can enjoy your fried chicken or holiday turkey without fear.

Of course, the main concern is if bird virus could randomly mutate to become a flu dangerous to people. It would have to become more transmissible from birds to humans and more transmissible between people to create another pandemic. The evidence is showing that’s much less worrisome than we’re being led to believe. Recent CDC research, such as that published this summer in the Proceedings of the National Academy of Sciences, was unable to pass the virus that can cause human infections between birds, using the main pathways for transmissibility, “demonstrating that a pandemic may be harder to develop than originally thought.” They even tried unsuccessfully to make the viruses more transmissible by gene-altering them to cause mutations.

And in October, the CDC’s Emerging Infectious Diseases Journal published a study that investigated all the households within a 1 kilometer radius of the human cases of bird flu in Cambodia. They found that “even when human-poultry interactions were regular and intense” and where infected poultry outbreaks had been confirmed, the transmission of bird flu viruses to humans is low. They also learned that simple hygienic animal handling practices greatly reduced risks and pointed out that educating rural farmers about those might prove most beneficial. They noted that their findings were consistent with other studies since 2004.

People are not birds. “We are protected by a species barrier,” said Dr. Marc Siegel, associate professor of medicine at New York University School of Medicine and author of False Alarm: The Truth About the Epidemic of Fear. “Serological surveys conducted in 1997 in Hong Kong and since have detected antibodies in thousands of humans who never got sick, showing that bird flu isn’t as deadly to the few who come in contact with it as has been reported,” he said. Paul A. Offit, a virologist at the Children’s Hospital of Philadelphia, said that the evidence “should make us feel safe that there’s a substantial barrier.”

Two groups of researchers, in Japan and Holland, reported earlier this year that the while the avian flu virus can on rare occasions infect people, it’s not like other respiratory viruses. Avian flu viruses settle deep in the lower lungs, keeping them from being spread by coughing and sneezing. They don’t spread easily between people because they don’t infect the nose, sinuses and throat, meaning a flu pandemic is unlikely. “The avian virus would need to accumulate many mutations in its genetic material before it could become a pandemic strain,” said virologist Yoshihiro Kawaoka at the University of Wisconsin and the University of Tokyo.

The bottom line: While the word “pandemic” strikes fear in the hearts of most of us, we have also lived through a pandemic and were probably not even aware of it. The last flu pandemic was in 1968 and killed 33,800 Americans — about the number who die from the flu in an average year. There is no evidence we need to panic about another flu pandemic based on the millions who died a century ago. Flu is worthy of our attention and prudent precautions, but panic can be far more virulent and costly than the bird flu itself.

© Sandy Szwarc 2006

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Fat people burdens on healthcare? Not so fast!

If we believe the news, “Hospital stays of obese Americans have doubled in the past decade, according to new federal data.”

This story and its corresponding press release are from a new report from the Healthcare Cost and Utilization Project (HCUP): Statistical Brief #20: Obese Patients n U.S. Hospitals, 2004. It is sponsored by the Agency for Healthcare Research and Quality (AHRQ), whose role it is to support government public health initiatives, including the war on obesity. [See The Scientific Evidence…]

According to its website, “HCUP databases bring together the data collection efforts of State data organizations, hospital associations, private data organizations, and the Federal government...[and] includes the largest collection of longitudinal hospital care data in the United States, with all-payer, encounter-level information beginning in 1988.”

First off, a note of caution. The HCUP report is not actually reporting hospital stays of obese people. It is a tally of the numbers of times “obesity” was checked off on the billing codes on the hospital records. These codes are currently known as ICD-9 codes, taken from the International Classification of Diseases, Ninth Revision. This is an enormous, complicated and continually changing system which gives a number to every disease and medical procedure, and currently has about 12,000 codes. The medical literature is filled with documentations of their inaccuracies in reflecting actual patient disease rates. But over recent years, healthcare providers are being increasingly educated on using these codes in order to receive reimbursements ... including coding for obesity. The weight loss and bariatric industry has been especially intense in marketing the usage of the obesity code, in particular.

Not surprisingly, more providers are.

So that 112% increase in hospitalizations for “obesity”since 1996 actually reflects increased usage of the coding, but whether or not it means there are actually more obese patients is arguable. But with the heightened stringency and surveillance by third party payers in compelling providers to accurately note ICD-9 codes in order to receive reimbursements, the current figures are certainly more complete than in past years.

This report is being presented as proof that “‘obesity’ has become a major public health problem.” That was even its opening sentence. But the media’s failure to give us the full story is demonstrated in the most significant fact in the report: 94.3% of all hospitalizations made no mention of obesity!

Fat people are not flooding into hospitals with health problems more than anyone else.

“Obesity” is the primary diagnosis in only 0.4% of all hospitalizations and virtually all of those (95%) were for bariatric surgery! Not the result of fat people succumbing to life-threatening health problems, but a profit-making elective surgery targeting them.

Interestingly, while fatness for women is especially benign, 82% of patients hospitalized for “obesity” and receiving bariatric surgeries were women, and most of those as healthy young adults (ages 18-44).

Concerning the rest of the story about hospitalized patients with “secondary diagnoses” of “obesity,” it goes without saying. With 30% of the population now labeled “obese,” considering all medical care done them as related to their weight is, frankly, nonsense.

© Sandy Szwarc 2006

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