Tuesday, February 14, 2006

When the facts contravene conventional wisdom, go with the anecdotes?

I loved this quote from Gina Kolata's news analysis column in today's New York Times entitled "Maybe You're Not What You Eat":
"Whatever is happening to evidence-based treatment?" Dr. Arthur Yeager, a retired dentist in Edison, N.J., wrote in an e-mail message. "When the facts contravene conventional wisdom, go with the anecdotes?"
The furious reaction to last week's JAMA report that low-fat diets don't lead to improved health outcomes reminds me of the current level of civility in Congressional discourse. "Partisan" anti-fat researchers opine in outrage reminiscent of Howard Dean. The situation reminds me of the hysterical rejection of the 1995 study in the American Heart Association's journal Hypertension showing that hypertensive patients classified as "low-sodium" consumers had vastly higher risk of heart attacks. Critics flayed the methodology, yet all eight subsequent studies of health outcomes in populations with salt intakes typical of those in the U.S. have confirmed either no health benefit or an increased risk of lower salt intakes and the author subsequently was elected president of the American Society of Hypertension and, more recently, elected president of the International Society of Hypertension, a post he currently holds. Hopefully, our next Dietary Guidelines Advisory Committee will not ignore this powerful new evidence -- our only controlled trial of the health outcomes of low-fat diets -- in favor of mindless regurgitation of politically-correct policy pronouncements, as they greeted the new evidence on salt. Thank you Dr. Yeager (and Ms. Kolata) for spotlighting our options: follow the evidence or the "experts." We need to insist on evidence-based public health nutrition policies, not the anecdotally-consistent Guidelines being so loudly defended.


At 1:40 AM, Blogger Medicare Sentinel said...

I just got back from a major national seminar of the American Society for Parenteral and Enteral Nutrition in Dallas, Texas. [Web site: http://www.nutritioncare.org/]

So many of the ‘route causes’ related to metabolic intervention and treatment are being discussed and investigated. This fine organization is making quantum contributions to patient health and welfare. There is open discussion and research being done by many great minds in our healthcare field The expertise in scientific research and intervention is being address by all levels.

In my many years of practice I have seen so many cyclical events and investigations. It is clear that one cannot look at one causative factor to explain why things happen.

In the scientific community I have witnessed so many theories and ideas. There are hundreds of studies that show the need to intervene, not intervene or even selectively intervene with patients. All one need due is look at the diet industry. High carbohydrate, low carbohydrate, low fat, moderate fat, modified fat, high protein, etc.

Our understanding of so many aspects of metabolism, nutrition and true problems related to them is only in its infancy. The route cause of so much of what is happening will eventually be addressed on a genetic/molecular level. We can only manipulate so many factors from the environment and other outside forces to make long lasting changes. The incidence of obesity in this country points out the need for something beyond the surface. Life style change is very important, but we must address may more factors as well. Today, notice of a new drug close to FDA approval (Rimonabant) will be added to the increasing arsenal of ideas and tools available. Let us not forget the many predecessor medications/drugs/homepathic remedies that have already been tried.

As we progress, we need to look at the total picture. A provincial attitude will accomplish nothing. You cannot take an aspirin to cure the root cause of pain. A band aid only covers the problem; it does not prevent it nor does solve a recurrence.

Let us always focus on the total picture so that we accomplish our greatest work.

Frank R. Wojtylak, RD/CDN
Registered Nutritionist


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