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« Rose-Colored Glasses and Economists | Main | Elsewhere »

October 10, 2007

Bad Health Advice

Michael Blowhard writes:

Dear Blowhards --

I wrote back here wondering what might be done about it when public-health types, docs, and other health officials hand out bad advice. After all, when bad health advice comes from trustworthy-seeming -- and especially official and scientific -- sources, it can prove anything but harmless. People develop worse health than they'd otherwise have had; some people may even die.

In The New York Times, John Tierney visits with Gary Taubes, the author whose new book about the low-fat craze set my own musings off. Tierney doesn't attempt an answer to my question, but he does a first-class job of showing both how flagrantly the public-health sector screwed up in this case, and of how that screwup came to be.

Fact of the matter #1: No reputable study has ever shown that diets high in fat cause heart disease.

Fact of the matter #2: For almost 50 years, the American health establishment touted low-fat diets as a good way to fight heart disease.

It's like watching dominos knock each other over. Basing their judgment on a single, poorly-done study from the early 1950s, the American Heart Association announced in 1960 that people at risk for heart disease should eat a low-fat diet. Time magazine featured the researcher behind the lousy study on its cover. In the 1970s, a committee led by Sen. George McGovern urged Americans to eat low-fat. By 1980, the Dept. of Agriculture had adopted the advice and incorporated it into the Food Pyramid.

Let me repeat that in a condensed version for emphasis: By 1980, the American Heart Association, Time magazine, a Senate Committee, and the U.S.D.A. were urging Americans to fight heart disease by eating a low-fat diet. Meanwhile, zero good scientific evidence supported their advice. But how were Mr. and Ms. Routine American to know that?

And it didn't stop there. The "scientific" and public-health consensus continued to snowball. The National Institutes of Health and the American Cancer Society endorsed low-fat eating. Although the truth of the matter appears to be that fat in the diet has no significant impact on mortality whatsoever, the U.S. Surgeon General himself announced in 1988 that fat in the American diet was a health concern on a par with tobacco-smoking.

Meanwhile, millions of Mr. and Ms. Americans were abandoning fat, were gobbling down carbs like they were going out of style, and were packing on weight at a rate never before seen.

Aesthete that I am, I feel the moment may have come to remind visitors of what every good cook knows: "Fat is flavor." Our waistlines were expanding, our life-pleasure was on the decline -- and it was all for nothing.

Gary Taubes of course deserves a lot of credit for his research. And John Tierney does an excellent job of describing how this mistaken public-health consensus cascaded into something that may well have done real damage to American health.

If you're a sly, inside-the-media-beltway dog like me, you can't help but wonder how certain other Times staffers are reacting to Tierney's column. During the nutty years, after all, The Times' own health writers (for example) didn't exactly shy away from urging people to eat low-fat and high-carb.

Thanks to Dave Lull, who has steered me to some links to interviews with Gary Taubes: audio and video. Jimmy Moore interviews Taube at his low-carb blog. Here's a Frontline text interview with Taubes. A fun passage, especially for those in a mood to bash the '60s:

Taubes: Diet became a religion. The whole low-fat idea ... came out of the counterculture and Berkeley and San Francisco in the '60s, this idea that eating fatty meat, in effect, is the dietary equivalent of conspicuous consumption. There were famines going on around the world, people were starving, and here in America we were eating eggs and bacon for breakfast and huge steaks for dinner. This was just unacceptable politically, sociologically, ideologically. It merged with this idea that fat might cause heart disease, and then blossomed in the '70s.

Don't miss this Amazon review by a reader who began to take off the weight she'd gained during the low-carb years only when she started following what she wittily calls the "Julia Child Diet":

Lots of protein and green veggies, along with whole-milk cheeses and some cream and butter, but very little pasta, bread, rice or potatoes. Also, no canned or prepared foods, most of which, I've since learned, contain corn syrup or other simple sugars.

But my initial question remains open: What can or should be done about it when public-health types screw up -- and when that screwup isn't a matter of, for example, failing to respond adequately to an emergency but instead involves handing out harmful advice to people who were otherwise doing just fine, thank you very much.

It seems to me fair to say that we have on our hands here a real scandal. Perhaps a lawsuit or two might not go awry? After all, if the story Gary Taubes tells is accurate, where eating fat goes, the public health of America -- not to mention the pleasure-level of America -- would be far higher had our public-health sector simply refrained from handing out any advice at all.

Come to think of it: What on earth is the federal government doing handing out eating advice anyway? Have I overlooked something in the Constitution, or in some Amendment or other, where the government was sanctioned to tell Americans how to eat? Do we have here a classic example of the way government will tend to keep expanding until it's forcefully stopped from expanding any further?



UPDATE: Wrestling with her own diabetes challenge, Mary Scriver takes a look at the Gary Taubes book too.

posted by Michael at October 10, 2007


Michael, the last time you brought this up it seemed that the most controversial part was when you said we might sue the Diet Book Authors. Whereas, here, you are emphasizing some sort of action toward Government Officials and those Organizations that are supported by those Gov't Agencies and receive Tax support in general.

My guess is that most people are just fine with the idea of bureaucrats getting their come-uppance, but not the Authors.

Posted by: Ian Lewis on October 10, 2007 5:32 PM

A friend of mine who spent his career teaching Chemistry at Cambridge advances the simple rule "All medical research is rubbish". It is, he admits, only an approximation, but it's far more accurate than almost any body of medical research he's ever looked into. Personally, I doubt that the last fifty years of evidence takes us much beyond "Don't smoke. Avoid asbestos. Eat in variety. Enjoy alcohol, but not so much that you get drunk. Take a bit of exercise."

Posted by: dearieme on October 10, 2007 5:35 PM

Today I blogged about this same thing, after sitting over tea with a friend trying to understand what on EARTH we should do. We both have Diabetes 2 and the other markers for metabolic syndrome. Our doctors are cranky and sneering. Her husband is Blackfeet and taking 15 different pills, all of them vaguely described and none with explained interactions.

What makes it worth talking about is that though there is much overlap between us, we have utterly opposite reactions to the meds we take for the same conditions. And our lifestyles are totally different. They make their wheels roll and eat out. I stay home and do my same boring oatmeal, beans, steak and greens meals. NO ONE will listen to us. We do not necessarily respond to meds the way their pharm salesman said we would. All assume that we sneak sweets. They are correct when they assume we don't exercise unless desperate.

I think we're missing something BIG and that it will come out of the studies of proteomics that everyone suddenly realized would be necessary once the genome was figured out. Food is not a one-size-fits-all deal.

My plan, I keep saying, it to live long enough for them to get the answers and -- in the meantime -- to resist all that incredible and fascistic entwinement of government and pharm corps. It's beyond what doctors can defend against now. Over half don't even belong to the AMA. I think I should avoid MD's and go to PhD's if there were any who ran clinics.

Prairie Mary

Posted by: Mary Scriver on October 10, 2007 6:17 PM

The notion that this was all a "cascade" is fair enough, but it does miss one point: the Joy of Puritanism. Telling people that they ought to eat something unfamiliar runs the risk of introducing people to a new pleasure. Whereas trying to bully them out of a pleasure they already enjoy is just so much more satisfying. "Cascades" and Puritanism: puts me in mind of Göbels Warning.

Posted by: dearieme on October 11, 2007 2:14 AM

"Have I overlooked something in the Constitution, or in some Amendment or other, where the government was sanctioned to tell Americans how to eat?"

I have no dispute with the eating end of this issue. But I take great exception to the argument of the form, "If right {x} isn't in the Constitution, it doesn't exist." The problem with that position is summed up by a question I'd love to ask Justice Scalia: "What if the original intent of the Founders was that the Constitution shouldn't be interpreted by original intent?"

For Exhibit A, I submit the entire text of Amendment IX: "The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people."

I've often said to states' rights types, "I'll give you Amendment X if you give me Amendment IX." One hobby horse for another.

Almost as if the Founders were smart cookies, and exactly just such a piece of horse trading took place passing the Bill of Rights, eh?

The Founders anticipated the overly literal argument, and in the Ninth Amendment cut the legs right out from under it. If you wish to have it repealed, there a process for that under the rule of law. Mazeltov and good luck. But that doesn't change the fact that it's there.

Posted by: Hal O'Brien on October 11, 2007 6:25 AM

"A friend of mine who spent his career teaching Chemistry at Cambridge advances the simple rule 'All medical research is rubbish.'"

I'd agree with this, at least for clinical research. Medical researchers have two problems, one they can't control and one they can, but don't. The first is their inability to run a controlled experiment. They can try with mice and the like, but all that seems to prove is that mice will get cancer when fed any number of products in absurdly large quantities. The second is the chronic over-interpretation of data. I assume that this is sociological, driven by a need for funding, publicity, etc. The reason that one year the egg is evil and another it's the best food ever is because medical researchers routinely publish two-sigma or even one-sigma results as significant. (A one-sigma result is a 68% confidence level, meaning that about 1/3 of their measured data points fell outside this range.) They also tend to under-estimate their systematic uncertainties (from the aformentioned inability to isolate individual factors) and routinely blur the line between correlation and causation.

When you have the Brits giving in and now instructing doctors to tell pregnant women to avoid all alcohol, you know the nattering nabobs have won.

Posted by: CyndiF on October 11, 2007 9:35 AM

What's to be done? Listen to yourself instead of to distant non-persons.

The simple fact is that your body is, at least the vast majority of the time, well tuned to taking care of itself, and will tell you if it needs something.

A lot of the publicity about medical research seems to be aimed specifically at disrupting this self-trust.

Specifically talking about me and fat; when I eat a low fat diet, I start to get fat cravings. Coffee creamers suddenly look very tempting. Even pure bacon drippings looks mouthwatering.

I can easily tell when I've had enough, because the craving stop more or less instantly.

Posted by: Alan on October 11, 2007 10:04 AM

Are cats high in fat?

I hope so, because I just ate one.

Posted by: Ibod Catooga on October 11, 2007 11:18 AM

This sort of thing would be funny if it wasn't killing people.

I've been looking at a parallel but related issue: serum cholesterol. Turns out, for women of any age, and men over 50, low cholestorol is associated with both higher mortality and increased risk of cognitive decline. Men under 50 are the only group who should worry about high serum cholesterol levels.

Another one: the "sunlight is deadly" cascade, which is exposing people to risks associated with sub-optimal Vit. D levels.

I hope this is all going to come a head soon. The cascade effect is bad enough without a political class too stupid to resist legislating based on erroneous medical/scientific "consensus." We need to wake up . . .

Posted by: Kirsten on October 11, 2007 11:30 AM

It's fun to read this and pretend, as best as possible, that you're reading about global warming instead. It's common for a consensus to be formed on a subject and slowly convince everyone to believe, correct or not. That's why so many are sceptical of the climate change scientists.

Posted by: Mike Hester on October 11, 2007 5:42 PM

If you want to loose or gain weight, pretend you are animal - cow, guinea pig, show turtle - and read the lit about how to put on/take off weight for that livestock/pet.

You and me baby, ain't nothing but mammals.

Posted by: j.c. on October 13, 2007 9:28 PM

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