1-1banner
 
medpundit
 

 
Commentary on medical news by a practicing physician.
 

 
Google
  • Epocrates MedSearch Drug Lookup




  • MASTER BLOGS





    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov




    ''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.''
    -Robert Ehrlich, drug advertising executive.




    "Opinions are like sphincters, everyone has one." - Chris Rangel



    email: medpundit-at-ameritech.net

    or if that doesn't work try:

    medpundit-at-en.com



    Medpundit RSS


    Quirky Museums and Fun Stuff


    Who is medpundit?


    Tech Central Station Columns



    Book Reviews:
    Read the Review

    Read the Review

    Read the Review

    More Reviews

    Second Hand Book Reviews

    Review


    Medical Blogs

    rangelMD

    DB's Medical Rants

    Family Medicine Notes

    Grunt Doc

    richard[WINTERS]

    code:theWebSocket

    Psychscape

    Code Blog: Tales of a Nurse

    Feet First

    Tales of Hoffman

    The Eyes Have It

    medmusings

    SOAP Notes

    Obels

    Cut-to -Cure

    Black Triangle

    CodeBlueBlog

    Medlogs

    Kevin, M.D

    The Lingual Nerve

    Galen's Log

    EchoJournal

    Shrinkette

    Doctor Mental

    Blogborygmi

    JournalClub

    Finestkind Clinic and Fish Market

    The Examining Room of Dr. Charles

    Chronicles of a Medical Mad House

    .PARALLEL UNIVERSES.

    SoundPractice

    Medgadget
    Health Facts and Fears

    Health Policy Blogs

    The Health Care Blog

    HealthLawProf Blog

    Facts & Fears

    Personal Favorites

    The Glittering Eye

    Day by Day

    BioEdge

    The Business Word Inc.

    Point of Law

    In the Pipeline

    Cronaca

    Tim Blair

    Jane Galt

    The Truth Laid Bear

    Jim Miller

    No Watermelons Allowed

    Winds of Change

    Science Blog

    A Chequer-Board of Night and Days

    Arts & Letters Daily

    Tech Central Station

    Blogcritics

    Overlawyered.com

    Quackwatch

    Junkscience

    The Skeptic's Dictionary



    Recommended Reading

    The Doctor Stories by William Carlos Williams


    Pox Americana: The Great Smallpox Epidemic of 1775-82 by Elizabeth Fenn


    Intoxicated by My Illness by Anatole Broyard


    Raising the Dead by Richard Selzer


    Autobiography of a Face by Lucy Grealy


    The Man Who Mistook His Wife for a Hat by Oliver Sacks


    The Sea and Poison by Shusaku Endo


    A Midwife's Tale by Laurel Thatcher Ulrich




    MEDICAL LINKS

    familydoctor.org

    American Academy of Pediatrics

    General Health Info

    Travel Advice from the CDC

    NIH Medical Library Info

     



    button

    Wednesday, September 27, 2006

    A Step Too Far: Not content with tracking down non-compliant diabetics, the New York City health department has decided to dictate what kind of oils restaurants can use. Marginal benefits at great cost. That's American healthcare!
     

    posted by Sydney on 9/27/2006 02:24:00 PM 10 comments

    10 Comments:

    Marginal? The Nurses' Health Study found, for instance, that increasing trans fatty acid intake by 2% of total calories doubled the risk of MI! That's equivalent to a 9-11 every year, just from one teaspoonful a day of trans fats per person. Even if the data are optimistic, it's still hundreds of lives saved a year in NYC.

    And "great cost"? Go to a big box store and compare the cost of trans versus non-trans fats. It's a few pennies a meal.

    By Anonymous Rational Thinking Fairy, at 3:09 PM  

    By "cost" I was referring to the loss of the freedom to choose.

    By Blogger sydney, at 5:01 PM  

    Sadly, consumers are not hearing about the actual evidence, only that from activists. Trans fat-containing shortening has been used for nearly a century in both home baking and cooking and by the food industry. As David Klurfeld, chairman of the Department of Nutrition and Food Science at Wayne State University, editor-in-chief of the Journal of the American College of Nutrition noted in a special series of articles in Nutrition News Focus examining the evidence on trans fats, any association between trans fats and health problems are weak. The Nurses Health Study of 90,000 nurses over 20 years, he exampled, has failed to find a link between trans fats or any other dietary fats and heart disease. He concluded: "The recommendation that any amount is unhealthy is not justified by strong evidence."

    A critical examination of the scientific evidence on trans fats done by Steven Milloy, adjunct scholar at Cato Institute and publisher of Junkscience.com (www.junkscience.com/nov99/transfat.htm), concurred. In a column for Fox News he wrote: "None of eight human population studies comes close to linking trans fat with heart disease... [merely that it] temporarily increased cholesterol levels." Even trans fatty acids are not all the same; some are natural in milk and appear to have no detrimental health effects and may be actually healthful, according to a study in the March 10, 2001, issue of Lancet.

    Led by the Center for Science in the Public Interest (CSPI), a political campaign to ban "this stealth fat lurking in our foods" ensued. "In part to a citizen petition from CSPI on Feb 14, 1994" and the subsequent 1,720 letters it received, the FDA issued a ruling on the labeling of trans fats on July 9, 2003. The FDA capitulated to activistis when it decided to require listing trans fats on food labels, but it's noteworthy that deep in the 260-page ruling, the agency noted: "[I]nformation on trans fat content in foods is limited ... information on trans fat intake is limited, ... but average saturated fat intake in the United States is about 5 times greater than average trans fat intake ... and the rate of heart disease mortality and morbidity in the United States has been decreasing for several decades."

    Even assuming there is truth to the claims, the FDA estimates that by three years after implementation of a nationwide trans fat labeling, it will prevent 250 to 500 deaths per year. So, multiple millions of dollars will be spent on preventing less than 1/100th of a percent of heart disease deaths.

    By Anonymous Anonymous, at 10:09 PM  

    I'm with Sydney on this one, people should have the right to choose. I hate when policy is dicated by soft numbers. If anything I've learned in reading medical studies over the years "doubling the risk of..." means little without explaining exactly how many people are ACTUALLY affected. 250 people is nothing compared to cancer, heart attacks, auto accidents, etc deaths. The occasional recipe is going to call for shortening or margerine. And for my mom's flaky warm biscuits that means that once a month or two I'm going to be having a teaspoon of margarine.

    By Anonymous Dara, at 9:51 AM  

    Well Comrade - of course the State knows what is best for you. We will be paying for your health care after 65 so we will dictate what you will eat. Next - forced public weighing prior to entering a restaurant.

    Seriously, at what point does government intervention stop. Many activities are not healthy in excess. The need to balance this is personal. The general numbers I have seen show no real difference in life time health cost between the health nut and a person who indulges in a less than prefect life style. The longer life cancels out any savings from the person who dies at a younger age. This would exclude the chronically ill.

    I think we have real health issues that we need to focus on, not some hyped topic of the day.

    Steve Lucas

    By Anonymous Anonymous, at 2:48 PM  

    Rational Thinking Fairy,
    perhaps I can be of help here. In this meta-analysis (otherwise known as a data dredge), they found relative risks of 0.81 to 1.17 -- those are not considered credible, relevant or significant numbers. For these types of studies, relative risks of 3.0 and less are not reliable and are considered a negative or non finding (except by junk scientists and those using "science" for various agendas).
    Still, it is important to remember that finding associations like this can never point to causation, no matter how large the RR. Wearing a bra and breast cancer relative risk: 12,500.

    By Anonymous Anonymous, at 3:34 PM  

    Re. freedom to choose, I consider banning trans fats in restaurants to be like requiring the dishes be sterilized. It's hard to tell the difference without a laboratory, most people don't care, and those who do care can trivially restore their lost liberty by carrying a personal supply of trans fats.

    Moreover, if it turns out to have been a silly crusade, the epidemiological data will give scientific proof in a few years. At that point the ban can be rationally continued or stopped. This is the beauty of doing an actual experiment instead of a retrospective correlation analysis.

    "250 people is nothing compared to cancer, heart attacks, auto accidents, etc deaths."

    So? The relative rarity of a mode of death is no consolation to those needlessly struck down by it.

    By Anonymous Rational Thinking Fairy, at 5:21 PM  

    Rational thinking fairy, you said "Moreover, if it turns out to have been a silly crusade, the epidemiological data will give scientific proof in a few years."

    It already has. In fact, any real public health concerns over trans fats have been disproven repeatedly over the past 50 years, as have the benefits of dietary interventions. I would urge you to do your own research and realize that not all sources of the scaremongering you're hearing are credible.

    By Anonymous Anonymous, at 10:47 AM  

    Looking at the New York proposed trans fat ban alongside Chicago's ban on foie gras, we see how big brother is encroaching on our individual freedoms.

    Healthcare Economist blog

    By Anonymous Healthcare Economist, at 4:49 PM  

    Life is about choice, about risk, about the right to take risk. If you want to take a look at things we sacrifice x number of lives for each year let's look at some numbers. Like how many people DIE each year from childbirth 1/2 million world wide, almost 400 in the united states in 2000, a fairly average year: http://mchb.hrsa.gov/chusa03/pages/status.htm, http://www.safemotherhood.org/facts_and_figures/maternal_mortality.htm, see also: http://www.unfpa.org/swp/2005/presskit/factsheets/facts_rh.htm. I mean if we limited risk 100% women would never have children because it increases their risks for a number of illnesses. From a health standpoint, women are better off not having kids, you weight less on average, get more sleep, live longer, etc. Especially not married. You could save half a million lives EVERY year, 50 million health related problems, and overall a quarter of the female population would have an improvement in their health. Yet, I've never spoken to one mom who (although you might catch them on a sleepless week when everyone in the house has the flu and they haven't slept in 3 days) would ever willingly not have kids simply to reduce their risk. But let's look at the big numbers: http://www.drugwarfacts.org/causes.htm. You want to advocate everyone give up: tobacco? poor diet? alcohol? toxic agents? how about we just don't drive any more? save over 26,000 deaths a year right? or look...adverse reaction to prescription drugs. We could just not have doctors prescribe drugs any more. I think that this is the point Sydney is making. That sometimes it's not just about controlling choices, it's about people being free to make them. We can't dictate others lives to them. We can try, but we rarely suceed. Every year thousands of women give up an average of 5 years off their life expentancy to do one thing: marry. Yet you don't see people lining up to stop them.

    By Anonymous Dara, at 12:46 PM  

    Post a Comment

    This page is powered by Blogger, the easy way to update your web site.

    Main Page

    Ads

    Home   |   Archives

    Copyright 2006