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The Healthy Skeptic

Posted by medconsumers on December 31, 2008

The Healthy Skeptic (University of California Press: 2008)

Sometimes it’s the opening anecdote that draws you into a book. In the introduction of The Healthy Skeptic: Cutting through the HYPE about your Health, author Robert J. Davis describes a youthful encounter that jump-started his own quest for truth. It was the early years of the low-fat-diet-for-all heart disease prevention message to the public. A college student at the time, Davis bragged to friends that his “highly enlightened family” (father a physician) shunned whole milk and drank only 2%, the type that is low in fat.

Another student challenged him saying, “2% milk is not really low in fat.” Incredulous, Davis cited the claim on the milk carton to support his contention. “Well, the carton lies; the fat content in 2% is closer to whole milk than to skim milk,” countered his challenger. “If you want low fat, you need to drink skim or 1%.” A trip to the library to consult a nutrition textbook led Davis to the conclusion that the other student was correct. “A glass of 2% milk has about five grams of fat, compared with eight grams of fat in whole milk and nearly zero in skim.”

Thus, the stage is set for the message of The Healthy Skeptic. Do your own searching for the evidence to support health claims. Davis, a health journalist and teacher at Emory University’s Rollins School of Public Health, makes a clear distinction between skepticism and cynicism. The former demands much more of us. He cites this quote from Marcia Angell, former editor-in-chief of The New England Journal of Medicine:

Cynicism is much easier than skepticism because it requires no distinctions. We needn’t distinguish between reliable evidence and unreliable evidence, between big dangers and small ones, between likely effects and unlikely ones, between the reasonable and the bizarre. Yielding to cynicism over skepticism is therefore an easy way out.

Thanks to the Internet, searching for reliable evidence is much easier today. The Healthy Skeptic does much of the research for you, taking on some of the most common health messages about foods, beverages, drugs, vitamins, herbal remedies, sunscreen and other products that bombard the public, mostly by way of the news media. Sometimes the hype is obvious; for example, the selling of yet-another exercise gadget in one of those middle-of-the-night infomercials.

Too often, however, it’s not so obvious that you are viewing a sales pitch. Exhibit A is the notorious video news releases, or VNRs, used for years by TV stations large and small. The VNR can look like an objective news item; for example, a reporter interviewing a physician who comes across as an independent expert about a new superfood or drug. VNRs are, in fact, what Davis calls “propaganda disguised as news,” bought and paid for by the company that makes the product. Sometimes that fact is mentioned briefly at the end of the VNR; sometimes it isn’t.

Celebrity pill-pushing can be mistaken for morning show chitchat. Years ago, actress Kathleen Turner did a round of TV and print interviews, discussing her “battle” with rheumatoid arthritis. Her mention of a helpful Web site in each interview came across as information-sharing—that is, until it was revealed in 2002 that Turner was a well-paid spokeswoman for Immunex, a bio-pharmaceutical company, which along with Wyeth, makes the RA drug Enbrel. The recommended Web site was theirs.

There was a backlash in the media after Turner was outed as an industry-funded shill. Now such financial arrangements are usually disclosed during the “interview,” but as The Healthy Skeptic notes, it can be acknowledged so quickly and offhand that the disclosure can go unnoticed.

In a section entitled, “Sunscreen Science,” we learn that sunscreens have become a $500 million-a-year business since these products were introduced in the early 1970s. But increased sunscreen use has not reduced the rate of melanoma, the deadliest form of skin cancer. In fact, studies have produced conflicting results about their most important protective benefit.

Some studies found sunscreen use decreases the rate of melanoma; some found usage increases the rate of melanoma; and others showed no effect either way. On the other hand, there is clear evidence that sunscreens protect against squamous cell carcinoma, which can be disfiguring but rarely fatal. As for basal cell carcinoma, the least dangerous and most common type of skin cancer, there is little solid evidence that sunscreens reduce its risk.

You are not likely to hear these uncertainties from your doctor. The leading supplier of information about sunscreens to the public as well as health professionals is the Skin Cancer Foundation. Despite its seemingly non-commercial name, Davis says the Foundation’s list of corporate benefactors reads like a “who’s who of sunscreen manufacturers”.

This small book does not simply expose such things as the “iffy assertions” of doctors who practice anti-aging medicine; the lack of definitive evidence about calcium’s benefit to bone health; the overselling of prevention and the exaggerated dangers of high cholesterol. It also provides a way of assessing public-health messages, their funding sources, and most important, the quality (or absence) of the supporting evidence.

(Disclosure: The Center for Medical Consumers is described as a “trustworthy source of information” in the chapter about cholesterol.)

Whether you choose to be a cynic or a skeptic is entirely up to you.

Maryann Napoli, Center for Medical Consumers© 2008

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Our Daily Meds: A book review

Posted by medconsumers on August 29, 2008

Yes, we knew that the pharmaceutical industry has been creating new diseases for at least four decades (recall how menopause became a hormone-deficiency disease curable by taking estrogen for the rest of your life). But the author of Our Daily Meds, a new book by journalist Melody Petersen, shows that one drug company, Pharmacia, was not shy about acknowledging it publicly.

Overactive bladder was created by Pharmacia in the mid-1990s in order to sell its new drug Detrol. (See TV ads with this obnoxious voice-over: “Gotta go, gotta go, gotta go right now.”) Petersen, then a business reporter for The New York Times, describes how she covered the 2003 Pharmaceutical Marketing Global Summit in Philadelphia, where Neil Wolfe, Pharmacia’s vice president, outlined the steps taken to make Detrol into the $3 billion a-year-product it is today. The first slide of his presentation: “Positioning Detrol (Creating a Disease).”

Detrol was initially intended as a treatment for urinary incontinence, but the market for this condition was too small, and a cheap alternative drug was already available. Besides, doctors weren’t keen on prescribing drugs for what was seen as a normal part of aging. Pharmacia’s first step in overcoming these obstacles was to hire doctors judged to be knowledgeable opinion leaders (KOLs) as “consultants,” fly them to medical meetings, including two symposia in London, where they were expected to come to a consensus about the definition and treatment of this new disease called overactive bladder. While being expensively wined and dined, the doctors heard from other doctors hired by Pharmacia about the disabling consequences of having to go to the bathroom more than eight times in a 24-hour period. If any KOLs objected to such an absurd notion, no such comments made it into the dozens of articles that Pharmacia paid to have written for medical and lay publications about the benefits of Detrol, writes Peterson. “And another disease was born.”
After a new disease is identified, the next step is creating buzz in the media. Of course, there’s no story unless the disease is perceived as extremely prevalent. No problem, the necessary statistics are generated by Pharmacia-financed surveys and passed on by a credulous media, including publications that should know better. (Consumer Reports lists Detrol as one of its “Best Medicines for Less 2008” along with this statistic: “overactive bladder affects some 15 to 20 million people in the U.S.”)

The standard formula for disease creation is complete once the drug maker saturates the airways, print media and medical journals with ads for Detrol. (Pfizer took over this role when it bought Pharmacia in 2002.)

Fast forward to the fall-out now that Detrol has been on the market for nearly a decade. New adverse effects have come to light—hallucinations and memory impairment, severe enough to be mistaken for Alzheimer’s disease. Oh, and there’s that question hardly anyone seems to ask (and not addressed in this book): How good is Detrol at reducing the number of trips to the toilet? The 12-week trial that won FDA approval showed that people taking Detrol LA (long-acting) had one less “episode” a week than those taking a placebo. Detrol costs $4 to $6 a day, depending upon where it is purchased.

The story of Detrol is but one of many jaw-dropping nuggets of information from Our Daily Meds. Here are a few more:

-Prescription medicine is one of the leading causes of death in the U.S., estimated to kill 270 people a day.
-Americans spent $197 billion on prescription drugs in 2003—up from $12 billion in 1980.

-It can take a hundred years before all the risks of a medicine are known, said FDA’s Janet Woodcock, in a 2005 presentation to a panel of experts reviewing the safety of the nation’s drugs.

-Once, the most successful pharmaceutical companies were those with the brightest scientists searching for cures. Now the most profitable and powerful drugmakers are those with the most creative and aggressive marketers.

-The pharmaceutical industry spent more on lobbying between 1998 and 2004 than any other industry. It has won new laws that have allowed the companies to profit from medical discoveries made by taxpayer-funded scientists. And when these new measures boosted the drug companies’ profits, other laws gave them tax credits so lucrative that as a group they pay far lower taxes on average than other major industries.

-The public is told that high profits are needed due to the high cost of innovation, but in fact the true cost of developing a new medicine is actually a closely guarded secret. What’s more, the industry hasn’t come up with many innovative drugs in the last 20 or so years.

-“Copycat drugs” are the money-makers. It’s much easier to cash in on a competitor’s blockbuster with a “new” drug that is virtually the same, simply by making doctors and consumers think it is better or has fewer annoying side effects.

The most troubling aspect of the industry’s marketing practices is the extent to which they have corrupted medical research. Over the course of the last 25 years, drug companies have been using clinical trials and medical journals to market their products. This trend was described as “the marketing approach to research” by Richard Daly, senior VP , Takeda Pharmaceuticals, at a 2002 breakfast meeting in Manhattan of executives from the largest pharmaceutical companies and advertising companies that work with them. The marketers aren’t working with test tubes and injecting patients, Petersen explained, “Instead they are standing besides the scientists, telling them what studies to do, what research questions to ask, what data to gather.”

Withholding data about serious adverse reactions from drug trials has become so common that there’s a medical term for it—“selective reporting” of trial results, also known as cherry-picking only the results the drug company wants made public. No one knows how many pharmaceutical studies have been kept secret after they showed a drug does not work or caused harms, writes Petersen, but several reviews have found that at least 50% of pharmaceutical trials were never published. Thus, a complete picture of a drug’s harms is unknown.

Prescribing physicians can no longer trust the information published in medical journals. And the doctor-patient relationship itself has become severely compromised by drug marketing. It is nearly impossible for most people to know whether their doctors are prescribing on the basis of the best available scientific evidence or the best available marketing scheme.

Petersen put it this way: “The pharmaceutical companies have become so wealthy and powerful that the whole medical system has become unbalanced. Inside hospitals and medical offices, corporate marketers are now calling the shots. They decide how patients will be treated and the doctors follow along. How else can you describe a system where doctors now prescribe a pill called Detrol for a disease called overactive bladder.”


Reviewed by Maryann Napoli, Center for Medical Consumers© August 2008

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Overtreated—Why too much medicine is making us sicker and poorer

Posted by medconsumers on March 1, 2008

New Book:  Overtreated  by Shannon Brownlee (NY: Bloomsbury, 2007)

In a nutshell, overtreatment is unnecessary treatment. It’s treatment that has no positive impact on health or longevity, and in many cases, causes harm. It’s the coronary-artery opening procedures given yearly to more than one million Americans for whom drug therapy has been proven to be the better choice. It’s the long-term drug regimens recommended to people at low-risk for hip fracture, heart attack or stroke. It’s the PSA blood test for finding prostate cancer at its earliest stage, despite the fact that studies have yet to prove immediate treatment is better than no treatment at all. Just to name a few.

About one-third of the medicine we receive is unnecessary, according to “Overtreated” by journalist Shannon Brownlee. “We spend between one fifth and one third of our health care dollars, between $500 and $700 billion, on care that does nothing to improve our health.” Central to this excellent book is the work of John Wennberg, MD, whose pioneering research spans four decades.

Wennberg was the first to detect wide geographic variations in medical care, first within his home state of Vermont and later in the country at large. Wennberg recalls that he embarked on this research project in the late 1960s with a notion shared by many doctors of that era: The most serious problem in American health care was that many citizens were not getting enough of it. Still, it was startling to find, for example, that in Middlebury, VT, 7% of children under the age of 16 had their tonsils removed, and in Stowe, VT, 70% of children had the operation. Similar variations were shown for other procedures like hysterectomy, hernia operations and hospitalizations for heart attacks.

Extensive interviews of 4,000 people living in this most homogeneous of states ruled out the obvious explanations like patient demand and the possibility that people were sicker in some areas of Vermont. The high rates of surgery were, in fact, driven by doctors not patients. Findings like these ultimately led Wennberg to conclude, “Medicine had wrapped itself in the mantle of science, yet much of what doctors were doing was based more on hunches than good research.” Wennberg’s work drew hostile reactions from fellow physicians, and medical journals turned down publication of his findings. When they were finally published in Science magazine in 1973, they drew no attention. More medical care was still considered to be better care.

Cost Becomes an Issue

In time Medicare provided Wennberg, who had moved on to Dartmouth Medical School, with a treasure trove of patient records to learn not only about regional variations in care for everyone over age 65 but also the cost of treatment. Cost had become a major issue for Medicare by 1995 due to the huge 6000% increase in spending over the 30 years following its launch. With Dartmouth colleagues, Wennberg spent the next three years combing through the Medicare data. One example of what they found: Medicare spent an average of $8,414 for an enrollee living in Miami compared with $3,341 for an enrollee in Minneapolis.

The price of major treatments, as it turns out, played an insignificant role in explaining the differences. The cost of a hip replacement, for example, was only slightly more in Miami than in Minneapolis. Another obvious possibility—elderly people are sicker in some areas of the country than in others—also accounted for only a small difference in cost.

Findings like these began to get national media attention, but the Dartmouth researchers still had to determine whether more care means better care. In 2000 Wennberg’s colleague Elliott Fisher, MD, conducted another study that showed Medicare recipients living in high-cost regions were no healthier and no less disabled than those in regions that got less medical care. The big shocker, however, was this: More care sometimes led to more deaths.

Ultimately, Fisher showed that the people in high-spending regions were not getting more major surgery. Rather they were getting more tests, drugs and procedures that were likely to be done even when it didn’t make sense in frail elderly people with a short life expectancy. An excess of specialists was a major part of the problem. “Patients with heart attack, hip fracture or colon cancer got more care—but not better care—in hospitals where there were more specialists,” concluded Fisher.

Eventually Fisher determined that the 2-6% increase in deaths among Medicare recipients living in high-cost regions was due to the fact that they spent more time in the hospital. Patients are exposed to all the risks that include hospital-borne infections, medical errors and the complications and side effects that come with any treatment.

The results of the Wennberg and Fisher studies have been known for years and have long been available to all in the Dartmouth Atlas of Health Care (www.dartmouthatlas.org). The author of the new book “Overtreated,” Shannon Brownlee, a senior fellow at the New America Foundation, provides a public service by calling attention to this important research which is even more relevant today when the newest costliest imaging, cardiac and other high-tech procedures receive almost instant uncritical acceptance.

Brownlee brings us up to speed on the few surgical procedures and drugs that are well studied and proven to be of value…but to a much smaller proportion of current recipients. One outstanding example is the coronary-artery-opening procedure called angioplasty, which, by the way, was shown to have wide regional variations by West coast researchers building on the Dartmouth researchers’ work.

Each year two million Americans receive an angioplasty, but studies show that only 800,000 of them who are in the midst of a heart attack are likely to benefit. The majority have other cardiac-related conditions like stable angina or shortness of breath, which can be more safely and effectively treated with the same drugs that will be given after an angioplasty. In a 2006 federally funded trial, the rate of death and heart attack was lower in those treated with multiple-drug therapy alone than in those given angioplasty plus multiple-drug therapy. Angioplasty with a stent costs insurers $10-15,000.

While angioplasty is an example of doctors ignoring scientific evidence that clearly shows who should get this treatment and who should not, there is no definitive information one way or another about the vast majority of tests and treatments. The Institute of Medicine estimates that only 4% are backed up by strong scientific evidence, more than half have very weak evidence or none.

Malpractice fears cause doctors to order more tests, but to Brownlee the more powerful reason doctors and hospitals overtreat is they are paid more for doing more. She calls for an overhaul of malpractice laws because they fail to punish and weed out incompetent doctors and to compensate patients for injuries that result from medical errors.

Brownlee takes consumers to task for contributing to overtreatment by making irrational demands for drugs advertised on TV or over-the-top diagnostic tests like an MRI for a sprained ankle. She calls for more independent sources of information like the federal Agency for Healthcare Policy and Research so that consumers can be better informed. Studies show that when they are given high-quality decision aids describing the benefits, risks and unknowns about treatment options, many will make an informed decision not to be treated.

The last chapter called “Less is More” presents solutions that will go a long way toward fixing our dysfunctional system. The ideal medical care system Brownlee envisions is one that rewards doctors for using evidence to improve quality; keeps specialist care to a minimum; coordinates care in ways that will reduce errors and overtreatment—among other ideas. Pie in the sky? Brownlee says that several U.S. health care systems have already implemented these ideas—Kaiser Permanente, Veterans Health Administration (VHA), Group Health of Puget Sound and the Mayo Clinic where doctors are on salary.

The VHA is especially interesting because it managed to turn around a failed medical care delivery system in less than a decade. The VHA decentralized its health care; put doctors on salary; makes sure every veteran has a primary care doctor at a local VHA clinic; rewards hospitals that hit performance measures set by Washington; negotiates discounts for drugs; and computerizes patient records to reduce medical errors and repeat testing. In 2003 The New England Journal of Medicine published a study that compared veterans’ health facilities with traditional Medicare. The quality of the care delivered at VHA health facilities proved to be significantly better on nearly all 11 performance measures.

Yet-another kudo for the VHA came from the independent National Committee for Quality Assurance which ranks health-care plans according to 17 performance measures, such as prescribing beta blockers for patients after a heart attack. By every measure, the VHA system outperformed the highest rated non-VHA hospitals, including those widely perceived to be the best in the country.

If the VHA can do it….

Maryann Napoli, Center for Medical Consumers©March 2008

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Gary Taubes Challenges Conventional Wisdom on Diet, Weight Control and Disease

Posted by medconsumers on January 1, 2008

Good Calories, Bad Calories – Challenging the Conventional Wisdom on Diet, Weight Control, and Disease by Gary Taubes

If your doctor has ever told you to go on a low-fat diet, read this book. For 50 years the public has been told that dietary fat and excess calories are the cause of obesity, heart disease and other chronic illnesses. Journalist Gary Taubes, a correspondent for Science magazine, has spent years tracking down the scientific underpinnings for both assertions and found little to support them.

In “Good Calories, Bad Calories,” Taubes shows how the low-fat recommendation has steered Americans to higher consumption of refined carbohydrates, especially processed foods, sugar and white flour. It is the quantity and poor quality of the carbohydrates consumed today, he says, that are making us sick and overweight.

Initially, the low-fat guidelines were aimed solely at people who had suffered heart attacks. By the 1980s, the entire nation was advised to keep their cholesterol down and that meant a major reduction in saturated fats, which was, and still is, recommended to prevent heart disease. Taubes writes, “Though women were clearly meant to adhere to the low-fat guidelines, they had not been included in any of the clinical trials. The evidence suggested that high cholesterol in women is not associated with more heart disease, as it might be in men, with the possible exception of women under fifty, in whom heart disease is exceedingly rare.”

Taubes first presented his case against the low-fat diet in a 2001 Science magazine article entitled, “The Soft Science of Dietary Fat,” and one year later, in a New York Times Magazine article entitled, “What if it’s all been a Big Fat Lie?” With 115 pages of references and bibliography, his new book, “Good Calories, Bad Calories,” is clearly aimed at research scientists and physicians.

The book documents a big change that occurred in U.S. dietary recommendations. For well over a century, carbohydrates (white bread, potatoes, noodles, beer, etc.) were widely believed to be fattening. That conventional wisdom was displaced by the dietary fat/heart disease hypothesis promoted by two influential people of the 1950s.

One is Dr. Paul Dudley White, President Dwight D. Eisenhower’s cardiologist, who asserted that America’s heart disease epidemic began after World War II when the country started to eat more fat and red meat and less cereal and grains. The other is Ancel Keys, a University of Minnesota physiologist, who compared the diets of seven countries and found that those with high-fat intake also had a high rate of heart disease. He was also the first to promote the familiar message that dietary fat makes us fat.

Taubes found that the facts do not support the claims of these two early proponents of the low-fat diet. The American diet was high in fat and red meat prior to World War II, according to government food surveys. Drawing on the Bureau of Census records, Taubes argues that heart disease was not all that rare in the first half of the 20th century when better diagnostic technology became available (primarily the electrocardiogram).

By the 1950s, premature deaths from infectious disease and nutritional deficiencies were mostly eliminated, thereby moving heart disease up the list of common causes of death. And lastly, changes in classification of heart-disease deaths in 1965 account for the increase that began that year.

As for Keys’s study, the seven countries were selectively chosen to support his high-saturated fat/heart disease hypothesis. Had he randomly chosen France and Switzerland, for example, rather than Japan and Finland, Keys would likely have seen no heart-damaging effect from a diet high in saturated fat. (And Taubes wryly observes, there might be no such thing as the “French paradox,” referring to the country’s storied high intake of saturated fat and comparatively low rate of heart disease.) This criticism was leveled at Keys’s work when it was first published. Still the American Heart Association eventually approved his low-saturated fat hypothesis as if it were backed by strong evidence and word went out to the public at large when Keys made the cover of Time magazine in 1961.

The fat-restriction recommendation has been kept alive in the last three decades by a small, select group of obesity researchers with university affiliations. The most striking fact about the evolution of the low-fat diet consensus, says Taubes, is that it has been tested in only two trials—on a few hundred middle-aged men who had already suffered a heart attack. Results of these trials were contradictory. The diets tested thereafter were cholesterol-lowering diets that replaced saturated fats with unsaturated fats.

Big Test Fails

By the 1970s, the National Heart, Lung, and Blood Institute decided it was time to test the low-fat, low-cholesterol diet hypothesis with a large, expensive trial. The MRFIT, or the Multiple Risk Factor Intervention Trial, randomly assigned 12,000 men either to a treatment group or a control group. All were healthy middle-aged American men with cholesterol so high (over 290 mg/ml) they were thought to be at imminent risk of heart attack.

The men assigned to the treatment group were counseled to quit smoking, take drugs to lower high blood pressure and eat a low-fat, low-cholesterol diet. They were told to substitute margarine for butter; eat no more than two eggs a week, drink skim milk; and avoid red meat, cakes, puddings, and pastries. The men assigned to the control group were left to their own devices about eating and seeking medical care. All were followed for seven years.

When MRFIT was published in 1982, the disappointing results were summarized nicely in one Wall Street Journal headline, “Heart Attacks: A Test Collapses.” Though slightly more deaths occurred in the treatment group, Taubes shows how heart disease researchers did not let go of the dietary fat/heart disease hypothesis, even when proven wrong. In a subsequent large U.S. trial, all the participants were instructed to go on a cholesterol-lowering diet because it was considered unethical not to. Cholesterol-lowering drugs became the distinguishing feature of the treatment groups in subsequent trials.

While researchers continued to explore the idea that restricting dietary fat reduces the risk of premature death in population studies, some found that the opposite was true. The 1985 Honolulu Heart Program, for example, found that high-fat diets are significantly associated with a lower risk of total mortality, cancer mortality and stroke mortality. Questionnaires filed periodically by participants of another study called the Nurses Health Study showed that the less fat consumed, the more likely they would get breast cancer.

Finally, in 2001, the Cochrane Collaboration sought to answer the low-fat diet question once and for all when it published a systematic review of the world’s best quality trials that had randomly assigned healthy adults to go on a “reduced or modified dietary fat” diet or continue eating as usual. The 27 trials that met the predetermined high-quality criteria had a combined total of about 10,000 participants. The trials lasted an average of three years. The Cochrane reviewers found that the low-fat or cholesterol-lowering diets had no effect on longevity and “no significant effect on cardiovascular events.”

The topic of weight control takes up about half the book. Though weight loss has long been promoted as the additional advantage of going on a low-fat diet, studies failed to prove this purported benefit as well. A 2002 Cochrane review of all relevant clinical trials (28 in all) concluded, “Low-fat diets induced no more weight loss than calorie-restricted diets, and in both cases the weight loss achieved was so small as to be clinically insignificant.” Conversely, Taubes cites trials showing that the high-fat diet, most notably the Atkins diet, results in more weight loss.

Total immersion in the last two centuries’ worth of research has convinced Taubes that dietary fat, including saturated fat, is not a cause of obesity, heart disease or any other chronic disease of civilization. Instead: “Through their direct effect on insulin and blood sugar, refined carbohydrates, starches and sugars are the dietary causes of heart disease and diabetes. They are the most likely dietary causes of cancer, Alzheimer’s disease and other chronic disease of civilization.” And contrary to conventional wisdom, obesity is not a disorder of overeating. Rather it is a disorder of fat accumulation due to too much insulin. (See related interview below.) What’s more, Taubes concludes that exercise is highly overrated as a means of weight control.

Taubes found enough evidence to warrant a clinical trial that tests his carbohydrates-make-you-fat-and-sick hypothesis. But he has no faith in the carbohydrate-restricted diet trials planned by the U.S. National Institutes of Health and the Dr. Robert C. Atkins Foundation because they will include only obese or overweight participants and are designed to test only weight loss.

What Taubes would like instead is a trial with healthy lean and normal-weight participants followed long enough to see whether an excess of refined carbohydrates will make them fat and develop chronic diseases. Another suggested trial would include a spectrum of participants—lean to obese—including many who have metabolic syndrome and/or type 2 diabetes.

Trials like these are not likely to take place—at least not in the near future—because a carbohydrate-restricted diet is by definition a fat-rich diet, and the medical community has been telling the public for the last half century that such a diet is dangerous. In the meantime, read this book and make up your own mind about which hypothesis has the most merit.

Maryann Napoli, Center for Medical Consumers © January 2008

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Selling Sickness

Posted by medconsumers on January 1, 2006

BOOKS WE LIKE

Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients (New York: Nation Books, 2005)

We are being manipulated by the pharmaceutical industry. The we in this case includes the general public, doctors, researchers, consumer advocacy groups, federal health officials, and politicians. The pharmaceutical industry exerts its influence over virtually all aspects of the medical care system. It sets a lion’s share of the research agenda; has a strong say in the ever-changing definitions of normal; controls most of the average doctor’s postgraduate pharmacological education; and is changing the way we think about illness in order to sell more drugs. Just to name a few.

With predictable regularity, one “silent epidemic” after another—high blood pressure, high cholesterol, bone loss, depression—is promoted either directly with “educational” advertising or indirectly through media stories inspired by the press releases of multi-national pharmaceutical giants that stand to profit from our fears. And the industry isn’t above creating a few diseases of its own. Shyness is now a social anxiety disorder; whereas menopause has long been a hormone-deficiency disease. Both, of course, have prolonged drug therapy as the solution.

More often the pharmaceutical industry has a hand in broadening the definition of illness so that more and more people can be funneled into long-term drug therapy. In the not-so-distant past, for example, one did not have osteoporosis until a fracture had occurred; now the diagnosis can be applied to anyone who shows more bone loss than the average 35-year-old (on a bone density test). How this particular diagnostic change occurred can be traced to a World Health Organization meeting funded by producers of drugs that stop bone loss.

In “Selling Sickness,” Ray Moynihan, a journalist, and Alan Cassels, a pharmaceutical policy researcher at the University of Victoria, British Columbia, carefully document pharmaceutical industry tactics in hyping awareness of and selling drugs for ten common conditions. Moynihan and Cassels do not dispute the fact that conditions like hypertension and osteoporosis can in fact lead to heart attacks and hip fractures, respectively, in some people. And others like depression and irritable bowel syndrome cause undeniable suffering.

Moynihan and Cassels object to industry-influenced expanding definitions of illness that turn millions of healthy people into lifelong patients. Too often thresholds for normal blood pressure and cholesterol are lowered, resulting in the same effect. Too often the normal travails of life or afflictions of aging are “medicalized.” Moynihan and Cassels found that 90% of the experts who sit on committees that set disease definitions and treatment guidelines for their peers have a conflict of interest because of financial ties to the drug industry.

For many doctors, the bulk of their information about new drugs comes from the materials supplied by the ubiquitous drug salespeople who regularly visit doctors at their offices armed with gifts and detailed information about their prescribing practices. (The Wall Street Journal once reported that there are 7,000 salespeople in the U.S. solely selling the cholesterol-lowering drug, Lipitor.) Moynihan and Cassels report how two Canadian health professionals are working to counter industry tactics by bringing unbiased information directly to doctors as well as the general public.

Bob Rangno, a physician, and James McCormick, a doctor of pharmacy—both members of Therapeutics Initiative at the University of British Columbia—travel the province delivering the same lecture. As recounted in “Selling Sickness,” they explain to a group of retirees that high blood pressure is not a disease in itself. Rather, it is one factor that can raise their risk of a future heart attack or stroke. Then Rangno and McCormick go on to demonstrate how easy it is to mislead with statistics, a common drug industry tactic. Their powerpoint slide shows the following questions based on study results:

Would you take a drug every day for five years if it…

A) lowered your chance of having a heart attack by 33%?

B) lowered your chances of having a heart attack from 3% down to 2%, a difference of 1%?

C) saved one person in a hundred from having a heart attack but there is no way to know in advance who that one person will be?

Rangno and McCormick ask the audience how many would take the drug based on question A, and about 80-90% raised their hands. Only about 20% indicated that they would take the drug based on questions B and C.

Then Rangno and McCormick reveal that all three questions are based on exactly the same study results. They explain that if a person’s risk of having a heart attack is 3% to start with, taking an antihypertensive drug to reduce that by 33% would bring that risk down to 2%. The 1% difference explains the one in a hundred who will benefit from the drug. “Advertisements to doctors and patients will claim, for example, that a drug offers a 33% reduction in the risk of heart attack without explaining that in actual fact you may have to take the medicine for five years in order to lower risks from 3% to 2%.” The surprised reactions they elicited from this audience of senior citizens, say Rangno and McCormick who have given this lecture numerous times, is no different from those expressed by an audience of physicians.

Industry’s marketing strategies are illustrated aptly in the chapter on female sexual dysfunction. To show how “new disease markets” are created, Moynihan and Cassels cite a business report, intended only for drug company marketing executives and potential investors, that “outlines how companies are ‘expanding the patient pool’ by using marketing campaigns to change public perceptions about what used to be considered normal life.”

Companies that make erectile dysfunction drugs are expanding their market to include women. But activists are fighting back. Chief among them is psychologist Dr. Leonore Tiefer, New York University School of Medicine, who is said to have documented the fact that for almost every key meeting where this new condition was being defined, the funding came directly from the pharmaceutical companies. She attends many of these meetings objecting to the narrow focus on genitalia and voicing another view of women’s sexual difficulties, which she acknowledges are widespread. “Women’s sexual problems and satisfactions have far more to do with relationship difficulties, life stress, and cultural expectations than with clitoral blood flow or testosterone levels.”

Tiefer’s five-year campaign of activism, which has had a strong impact on public debate via the media, merits imitation, say Moynihan and Cassel, “Her colorful campaign could well become a guide for others looking to expose and combat corporate attempts to inappropriately widen the boundaries of human illness.”±

Maryann Napoli, Center for Medical Consumers © January 2006

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Critical Condition—How Health Care in America Became Big Business & Bad Medicine

Posted by medconsumers on June 1, 2005

New Book: Critical Condition—How Health Care in America Became Big Business & Bad Medicine

The U.S. spends more on health care than other countries. In 2003, it accounted for 15.3% of the gross domestic product, a greater percentage than Germany, France, Japan, Italy, Canada, and other developed countries spend to cover all their citizens. What we are getting in return is a second rate health care system, according to Donald L. Barlett and James B. Steele, investigative reporters, formerly at the Philadelphia Inquirer and now editors at large for Time magazine. What kind of a health care system, they ask, leaves 44 million people without health insurance and tens of millions more underinsured?

One of America ‘s cherished myths is that uninsured people eventually get health care when necessary. Yes, if they are sick enough, say Barlett and Steele, but they will be discharged from the hospital sooner than insured people, often over their doctors’ protests. Shockingly, hospitals typically charge non-insured people five to ten times what an insured person would pay for the same services. With people who don’t earn enough to pay an astronomical bill, hospitals can play hardball. Non-profit and for-profit hospitals alike have been known to sue, garnish wages, and take away assets, such as a house. A catastrophic accident or illness can bankrupt even the insured. Almost no one knows what their health insurance pays until it’s too late. Unlike citizens in countries with universal health care, insured Americans spend countless hours filling out forms and questioning incomprehensible bills.

For the last two decades, politicians have sold the American public on the idea that the free market system is the best way to deliver health care. But health care has always proven to be remarkably resistant to a free market system that thrives on selling more and more. That’s the last thing a medical care system needs, wrote the authors, who see the goal as fewer hospitalizations, fewer consultations with specialists, fewer diagnostic tests, and fewer prescription drugs.

Managing health care as a business hasn’t reined in costs. On the contrary, it rewards for overmedicating and overtesting. Government is widely perceived as inefficient, and information to the contrary rarely penetrates the public’s consciousness. Medicare, for example, has an overhead that averages about 2% a year; whereas the administrative costs of private insurers is about 33%.

Quality control is practically non-existent in a health care system so fragmented. The 100,000 hospitalized patients who die each year of medical errors and the additional 106,000 who die of adverse drug reactions probably represent an undercount. No independent authority examines the records of hospitals, doctors, and drug companies to detect such deaths. Successful lawsuits often end in sealed documents under secrecy agreements, thereby ensuring the mistakes will be repeated.

Over the last few decades, American health care has changed radically from a system that was largely not-for-profit. Now, the profit motive and market forces affect every decision. Conflicts of interest are rampant. Fraud thrives in such a system, so much so that authors think the U.S. has not only the most expensive health care but also the most fraudulent.

Barlett and Steele have a remedy. It is the establishment of a taxpayer-supported independent agency that is loosely based on the Federal Reserve System. Like the FRS, the proposed health agency would be run by 14 board members appointed by the president with the consent of the Senate. It would set an overall policy for health care and influence its direction by controlling federal spending. This would encompasses everything from research grants to providing basic care for every American, as well as catastrophic care. It would be financed by a tax on the total earnings of all businesses and a flat tax like the Medicare tax on people’s income, not just their wages. The proposed agency would radically reduce medical errors with the establishment of a single information technology system that links all hospitals, doctors’ offices, pharmacies, and nursing homes.

Barlett and Steele believe that change is inevitable. More and more working Americans are dissatisfied with the ever-rising costs and U.S. companies are unable to compete in the global market with countries that have government-funded health care. The authors cite surveys of doctors, insurers, and other professionals that show a marked shift in opinion even among groups traditionally against government involvement in health care.

Reviewed by Maryann Napoli, Center for Medical Consumers © June 2005

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The Obesity Myth

Posted by medconsumers on December 1, 2004

The Obesity Myth: Why America’s Obsession with Weight is Hazardous to Your Health (Penguin Group New York: 2004) by Paul Campos

The obesity myth, according to author Paul Campos, is based on three claims: that excess weight causes illness and early death; that losing weight improves health and extends life; and that we know how to make fat people thin. The book is well armed with footnotes to support his argument that the public has gotten a skewed view of the research from the media and from obesity specialists, who are largely funded by the $50 billion a year weight loss industry.

The author is not saying that weight is entirely irrelevant to good health. (It is, he says, unhealthy to be at each extreme, morbidly obese and extremely thin.) Instead, he lays out a convincing case for how the adverse health effects of excess weight have been grossly exaggerated. Take heart disease, for example. Most cardiologists will tell you that excess weight is right up there after smoking as a major risk factor for heart attack.

Yet the nation’s heart disease death rate has been steadily declining since the 1960s and continues to decline even after the upsurge in the number of overweight and obese Americans that began in the 1980s. Contrary to conventional medical wisdom, many fat people have none of the risk factors—-high blood sugar levels, high blood pressure and high cholesterol—-associated with illness and early death. Excess weight increases the risk of heart disease, at most, by 1-5%, says Campos, and some studies even suggest obesity is a protection against vascular disease.

By now, the extremely high failure rate of all diets is well known, and Campos, a professor of law at the University of Colorado and a syndicated columnist, reminds us of the well publicized deaths and injuries associated with diet drugs. One popular over-the-counter weight loss drug, for example, had a now withdrawn ingredient proven to cause strokes in young women.

Still, the “get thin, live longer” message drives many people to diet and drugs with the idea that the benefits of losing weight clearly outweigh the risks. Unfortunately, numerous studies suggest otherwise. For example, The New York Times reported this in 2002: “Dr. Jules Hirsch, an obesity researcher at Rockefeller University [in New York City] provided evidence from studies conducted by others that followed thousands of people for years, keeping track of who lost weight, who kept it off, who become ill and who died. Repeatedly, investigators reported that fat people who lost weight and kept it off had more heart disease and a higher death rate than people whose weight never changed.”

Campos’s book is filled with references to this type of research that is largely overlooked because of its inconvenient findings. And why don’t we hear about the health risks of yo-yo dieting (weight cycling)? Could it be that there are industries from—-women’s magazines to weight loss clinics—that would go down the tubes if word gets out? One reason why the public gets a distorted view of the adverse health effects of obesity, says Campos, is the focus on weight by most researchers who ignore other factors that create ill health in fat people, such as sedentary lifestyle, poor diet, dieting-induced weight fluctuations, diet drug use, poverty, lack of access to and discrimination in health care, and social discrimination.

That a fat person can be healthy and physically fit has been demonstrated in the work of Steven Blair and colleagues at the Cooper Institute in Dallas, who have conducted a study of over 70,000 people and followed them for more than 20 years. Unlike other researchers who either ignore the role of physical activity or allow study participants to self-report activity levels, the Cooper Institute conducted regular treadmill testing throughout their study. Campos says that this study showed that obese, not merely overweight, people who engage in at least moderate levels of physical activity show half the death rate of sedentary people of ideal weight.

America is on the verge of an obesity-induced Type 2 diabetes epidemic, we are told, but Campos pokes holes in this contention. Here, he relies on the work of Paul Ernsberger, professor at the Case Western Reserve University School of Medicine, who is well versed in the obesity research and a critic of how the findings are portrayed to the public. “Actually, there is no hard data that says blood sugar levels are rising,” according to Dr. Ernsberger, who points to telephone surveys as the source for this purported rising incidence of Type 2 diabetes. Aggressive educational programs aimed at testing are one reason why many people report themselves as diabetics in telephone surveys, according to Dr. Ernsberger, who explained that doctors often tell people they are “borderline diabetics” or to “watch out for diabetes,” and this has led some people to think they already have the condition. Not incidentally, the definition of Type 2 diabetes was changed from a fasting blood sugar of 140 to a blood sugar of 126. Overnight, millions of Americans became diabetics.

The book’s parting words of advice–stop obsessing about weight. “The prosecutors in the case against fat aren’t completely wrong: They’ve just indicted the wrong parties. Americans are too sedentary. We do eat too much junk that isn’t good for us, because it’s quick and cheap and easier than the alternative of spending the time and money to prepare food that is both good for us and satisfies our cravings. A rational public health policy would focus on those issues, not on weight, which isn’t the problem, any more than diets and diet drugs would be the solution, even if they actually made people thin (thin people with bad health habits are no healthier than fat people with the same habits).”

Reviewed by Maryann Napoli, Center for Medical Consumers © 2004

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Overdosed America

Posted by medconsumers on December 1, 2004

New Book: Overdosed America-the Broken Promise of American Medicine

No, this isn’t another book about Americans popping too many pills and paying exorbitant prices for them. Its far more worrisome premise is summed up in the long subtitle: How the Pharmaceutical Companies Distort Medical Knowledge, Mislead Doctors, and Compromise Your Health. Author John Abramson, MD, is troubled by the commercial influences that pervade all aspects of American medical care. The pharmaceutical industry’s influence can be seen in everything from the sponsoring of continuing medical education to the latest treatment guidelines that make an ever-expanding number of Americans candidates for life-long drug therapy.

A Harvard Medical School faculty member, Dr. Abramson writes that he thoroughly enjoyed practicing family medicine for over 20 years. But he had become increasingly disturbed by the new brand of medical consumerism, typified by the middle-aged male patient who came in demanding an expensive, widely advertised prescription drug (Celebrex). No amount of explaining about cheaper, safer and equally effective alternatives could change his patient’s mind.

It is not only his patients who get a skewed view of new drugs, observed Dr. Abramson, his fellow physicians were influenced by the same promotional campaigns, often masquerading as education. Whereas taxpayers once funded most medical research, the pharmaceutical industry now pays the lion’s share. By now, many Americans know that the pharmaceutical industry has one of the highest profit margins of the Fortune 500 companies. How many know that the industry spends more money on marketing (from advertising to free drug samples for doctors) than on research?

Dr. Abramson left his practice to spend the next two and a half years doing what most practicing doctors have little time to do—“researching the research.” He found that drug companies have been known to: design clinical trials in such a way that ensures their products will come out on top; withhold the trials that show negative results; focus attention on the benefits while giving short shrift to the harms; and ‘spin’ equivocal results in a way that puts their drugs in a favorable light.

What’s more, the people selected for clinical trials are often unrepresentative of the majority for whom the drug will ultimately be prescribed. Cancer drugs are offered as an example. “Nearly two-thirds of all cancer patients are 65 or older,” observes Dr. Abramson, “but only one-quarter of the people in cancer studies have reached 65.” Many of the articles published in medical journals, even the most prestigious ones, he found, are little more than infomercials for the drug.

In time, Dr. Abramson began to detect the frequent use of overblown statistics guaranteed to scare people into a life-long drug regimen. Two years ago, The New England Journal of Medicine published a study about a new, inexpensive blood test that measures blood levels of inflammation in the body called C-reactive protein, or CRP, which supposedly can predict a person’s risk of heart disease. The study followed 28,000 women over eight years and found that those with the highest CRP levels were more than twice as likely to develop heart disease. The study’s authors concluded that identifying people with elevated CRP would allow “optimal targeting of statin therapy.” In other words, a way to identify future customers for cholesterol-lowering drugs.

What’s wrong with this picture? asks Dr. Abramson after the largely uncritical media picked up the CRP story and ran with it as “ground-breaking” and “extremely important.” A closer look at the statistics from this study showed that the 28,000 female participants were less than 55 years old and healthy. Their risk of heart attack, stroke, etc. was quite small. For “every 1000 women with the highest CRP levels, there was only slightly more than one (1.3) additional episode of cardiovascular disease each year than among the 1000 women with the lowest CRP levels.” In other words, the twice-as-likely-to-develop-heart-disease statistic boiled down to a doubling of odds that were tiny to begin with.

With the relentless focus on drugs, Dr. Abramson suggests that doctors and the general public tend to overlook the considerable body of research showing that regular exercise, smoking cessation, and a healthy diet trump nearly every medical intervention as the best way to keep heart disease at bay.

Americans tend to have faith in the latest high-tech medical care, but a large Medicare study challenged some common assumptions. Areas of the country with higher concentrations of specialists have both higher health care costs and worse health care outcomes.

“The public needs access to independent expert opinion that can counterbalance the enormous influence that the medical industry wields over our beliefs about the best approach to health and medical care,” writes Dr. Abramson. (Full disclosure: The Center for Medical Consumers is mentioned twice in this book as one of the rare sources of unbiased information.) A new national public body with the independence and expertise of the Institute of Medicine , he suggests, is the only way that will ever be accomplished.

Maryann Napoli December 2004

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Should I be Tested for Cancer? Maybe Not and Here’s Why

Posted by medconsumers on June 10, 2004

New Book by H. Gilbert Welch: Should I be Tested for Cancer

Americans are keen on cancer screening. In fact a recent survey showed that most would rather have a free whole-body scan than $1,000 in cash. 32% thought that an 80-year-old man who chose not to undergo a colonoscopy was irresponsible. And 74% believe that finding cancer early saves lives “most or all of the time.” Even the common occurrence of an anxiety-producing false alarm, experienced by 38% of those surveyed, did not blunt enthusiasm for cancer screening. Nearly all who had this experience acknowledged its terror-inducing aspect, but were glad they had been tested.

Cancer testing for symptom-free people is accepted as a must-do health maintenance ritual by most Americans, but are they undergoing screening with eyes wide open? How many women, for example, have ever had the pros and cons of Pap testing explained to them? How many even know there is a downside to a Pap test? But screening for any disease is a two-edged sword carrying risks as well as benefits. And sometimes the former cancels out the latter.

One of the authors of the above-mentioned survey, which was published early this year in the Journal of the American Medical Association, is H. Gilbert Welch, MD, MPH, Professor in the Departments of Medicine and Community and Family Medicine at Dartmouth Medical School. Dr. Welch’s new book entitled, Should I be Tested for Cancer? Maybe not and here’s why, serves as a counterbalance to the one-sided information the public receives from their physicians and organizations like the American Cancer Society. (“Your life will be saved.” “Your treatment will be less drastic.”) In fact, his book is downright subversive, as its title suggests consumers can make an informed decision not to be screened.

Dr. Welch writes that his book is for people who “are open to questioning the wisdom of these testing efforts.” It is not for people who need to have simple answers. “None of us likes uncertainty–but this book is full of it.” He describes cancer as a disease that is not inevitably fatal, or even inevitably invasive. Before screening, it helps to know your odds of getting the target cancer. Typically, people are told a given test reduces the odds of dying of cancer by 30%. Dr. Welch says such statistics mean nothing unless you know your odds of getting the target cancer. As an example, he provides a graph based on the mammography screening trials. In the next ten years, of 1,000 American women age 50, six will die of breast cancer without mammography; four will die of breast cancer despite having had mammograms. Therefore, only two out of 1,000 will avoid a breast cancer death because of mammography. His explanation provides not only a realistic expectation of mammography’s benefit but it also illustrates the low odds of dying of breast cancer. News flash: Most women will never get it!

The colon cancer screening trials show a puzzling finding that is rarely conveyed to the public. The people who were randomly assigned to be screened showed a modest drop in colon cancer deaths, compared to the people who were not screened. However, the same trials showed that this benefit was canceled by an inexplicable increase in deaths from other causes, chiefly heart disease.

Screening tests are good at finding something Dr. Welch calls pseudodisease, and unnecessary treatment is the usual consequence. It is the PSA-detected prostate cancer that would have remained dormant, but is usually treated with radical prostatectomy; it is the nodule found during a lung scan that demands a biopsy to rule out cancer; it is the mammography-detected ductal carcinoma of the breast that automatically means breast removal in some areas of the country.

Some high-tech screening procedures are so sensitive that they identify lumps in nearby organs. Dr. Welch relates a written account of a doctor who underwent a virtual colonoscopy, which can “see” beyond the colon. It turned up a kidney mass, a 2 cm liver mass and multiple non-calcified nodules in the lung. After several CAT scans, a liver biopsy, removal of three small sections of his lung, four days of potent painkillers, he began to feel “nearly normal” five weeks later, except for the rib pain caused by the surgical interruption of the nerves during the lung biopsies. “No cancer” was the outcome. The doctor/patient may have been relieved, observed Dr. Welch, but he was also motivated to start asking hard questions about radiologists and their remarkably sensitive imaging tests. “His story certainly makes one wonder whether they are seeing too much.”

Maryann Napoli, Center for Medical Consumers© June, 2004

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The Good Fat Cookbook by Fran McCullough

Posted by medconsumers on December 30, 2003

(Paperback — Scribner: New York, 2004)

This book is organized around a simple premise: “Foods that are really good for you taste really good.” And believe or not, science has begun to back up this appealing idea. In the last few years, foods once thought to be unhealthy were judged to be good for us. Among those that have made a comeback are: eggs (rich in two essential nutrients–choline and lutein), butter (healthier than margarine which usually contains trans-fatty acids), avocados (contain protein, fiber, antioxidants, monounsaturated fat), nuts (protect against heart disease and cancer), beef (see below), and alcohol (moderate daily drinking is good for the heart). If this trend sounds good to you, this book will make you even happier. Part I deals with the scientific evidence; part II provides the recipes.

The low-fat diet has been promoted to the public for over 30 years by government officials and the American Heart Association. It is considered the ideal way to prevent heart disease and obesity. Yet despite the proliferation of reduced-fat products (over 15,000) and a small drop in the nation’s fat intake (34% down from 40%), Americans have become the fattest people on earth. 

Now the low-fat diet is undergoing a major rethink, and the tide of scientific evidence is changing in favor of those who have challenged the conventional medical wisdom. Two population groups are frequently cited to support the contention that certain fats are so healthy that they should be consumed in high quantities: The Greenland Eskimos with their high consumption of fatty fish (rich in heart-healthy omega-3 oil) and people living in Mediterranean regions where the diet is high in olive oil, a healthy monounsaturated fat. Both groups have a total fat intake that is just as high or higher than that of the average American, but the Eskimos have virtually no heart disease and the Mediterranean people have low rates of heart disease and some cancers. Citing studies of such populations, a 1998 international conference convened by the Harvard School of Public Health, reached a consensus that a healthy diet need not be restricted in total fat. 

In The Good Fat Cookbook, Fran McCullough gathers the latest scientific evidence to show there are healthy and unhealthy fats. Her findings are likely to surprise. “The best fat of all is coconut and the worst fat of all is soy,” she writes. Canola and soy oils are so highly processed that the good nutrients are lost and trans-fatty acids develop (80% of cooking oil used in the U.S. is soy oil). The biggest surprise comes in the section on the health benefits of coconut. As anyone who has tried to keep up with the latest nutrition information knows, tropical fats (coconut and palm oil) are extremely unhealthy and should be banished from the diet. Not so, says McCullough. Coconut has numerous health virtues: It protects against heart disease and cancer; stimulates metabolic activity and gives you a burst of energy; provides high levels of antioxidants; contains lauric acid, the protective substances in mother’s milk; and has strong antiviral, antimicrobial, antibacterial, antifungal, and anti-inflammatory activity. 

Coconut oil used to be the predominant fat used in cookies, crackers, and most baked goods. In 1986, writes McCullough, the soy industry mounted a campaign to discredit coconut oil and warn the public of its dangers. The campaign was successful, according to McCullough, because “there is no Coconut Council to fund research and send out press kits, take journalists on junkets, and lobby Washington for favorable treatment in the way other elements in the agribusiness food industry cooked up the Dietary Guidelines.”

Some foods are innately healthy but become much less so due to human interference. When cattle and sheep are allowed to slowly fatten on grasses, as they are meant to, their meat has a healthy ratio of omega-3 to omega-6 fats. But that has changed with the mass production feedlots that supply most of America’s meat. The animals are fed corn that disrupts their digestive systems because they weren’t meant to eat grain, which, in turn, creates major health problems that necessitates antibiotics. Furthermore, their meat often undergoes irradiation to be sure that infections are not passed on to us. 

The book has a resource section with web sites and 800 #s for finding high quality products, such as meat from grass-fed animals, high quality oils, and omega-3 supplements. 

Maryann Napoli, Center for Medical Consumers©2003

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