trans fat kills, but smoking massacres

Monday, June 22, 2015

In sports, fans get to boo and cheer because they have an emotional connection to their team and are invested in the outcome of the game. If only the same were true in the real world, where decisions made by the courts, elected officials and others have an impact on individual lives and society as a whole. For that reason, it would be very appropriate to take the FDA to task and boo loud and long. Given the responsibility for protecting the public by regulating food and drugs, those in charge of the Food and Drug Administration have forgotten their mission. Instead, they have allowed politicians to misshape their mission and in the process, allow millions of people to die.

Why the diatribe now? It’s about the announcement that trans fats (partially hydrogenated oils) will be an effectively banned substance in the food supply. It only took 14 years for that decision to occur, since transfats were found to be a health risk by the National Academy of Science Institute of medicine in 2002. That led to the 2006 requirement that trans fat be labeled and 2013 FDA determination that transfats were no longer generally recognized as safe. FDA Commissioner, Margaret Hamburg, was quoted: “Further reduction in the amount of trans fat in the American diet could prevent an additional 20,000 heart attacks and 7,000 deaths from heart disease each year – a critical step in the protection of Americans’ health.”

That’s a lot of deaths to prevent, but in the scheme of things, there is a bigger fish and the FDA, the Surgeon General, the President and Congress have turned a blind eye to the tragedy of tobacco because it might be too hard work to mount a war against tobacco companies and their lobby. Plus, it would be extremely expensive, since the huge government income derived from taxes on tobacco would need to be replaced.

The numbers are compelling:

  • The American Heart Association estimates that cigarettes cause a quarter of all preventable deaths in the US each year, a total of 440,000 deaths. (The math says that is 60 times the expected numbers of lives to be saved by removing trans fat from the American diet.
  • In 2012, the Brooking Institute reports that federal and state governments collected 17.6 billion dollars in tobacco tax.
  • In 2012, the Federal government spent $231 million for lung cancer research.
  • The vast majority of lung cancers, more than 80% are attributed to tobacco use and second hand smoke.

There is no positive medical use for tobacco products. It is addictive and significant efforts are made to treat that addiction and stop people from smoking. New smokers are created day, though not as many as in past years. The high school smoking rate is 15.7% and that beats the 2020 US government goal of 16%. That rate should be zero or as close to zero as possible. More than 2,000 youths become regular smokers every day. Those new smokers are more than enough to replace the people who die every year from tobacco use and continue the demand for a product whose recognized side effect is disease and death.

Tobacco is a tough battle and government workers and elected officials have chosen not to take the high road because it is tough. Their lack of fortitude can be seen in their battle against trans fat that took so many years and their less forceful, politically expedient than approach. For a food product that is generally recognized as unsafe, food manufacturers can still apply for waivers for its use and are being given a three-year window to alter their product. Knowing that research showed their product to be unsafe in 2002 presumably did not give them enough time to do the right thing.

Saving 7,000 lives is a big deal ,but it is not time to cheer the FDA. It is time to boo them loudly, for the more than 400,000 people it allows to die each year.



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what the research says

Monday, June 2, 2014

While California Chrome prepares for the Belmont Stakes and a run at the Triple Crown, there may already be a winner crossing the finish line in the advertising derby. Who knew that the nasal strips that are marketed to help control snoring in people were also being marketed to help horses run faster. Flair equine nasal strips made news when CC had to get permission from the New York racing authority to wear them in the upcoming race. No such permission was required at the Kentucky Derby or the Preakness. Those who make the decisions allowed the strips because there was no evidence that they improved performance and therefore felt they were a non-issue. The makers of the strips disagreed, touting their performance enhancement benefits, plus the owners of the horse believe that they work. But why should we care? It’s all about science, research and spinning the data to make a point.

In people medicine, the introduction of new medication or a new technique requires experiments to be done to decide whether the new is better than the old. And sometimes, research is needed to prove that the old wasn’t as good as we thought it was. Much of what medicine presumes to know as dogma, may actually be wrong and potentially harmful. For generations, certain medications were thought to be lifesaving when it came to resuscitating the heart, but the data to prove their worth was lacking. When re-examined, it changed the protocols that the American Heart Association had taught for decades. Some treatments have a fad like status, lasting only a few years while they are tweaked and refined. Whether it is the depth of cooling of patients resuscitated from sudden death, to how much fluid to give to a trauma patient who is bleeding, or how quickly to breathe for a patient who is in coma from a head injury, the standard care pathways are in constant flux depending upon the latest research.

So back to California Chrome. It seems that horses can be research subjects just like humans with experiments set up to learn about physiology and disease and veterinary labs are ready and willing to put horses on treadmills and study their heart, lung and muscle function. When horses run, their hearts generate significant cardiac output, meaning that lots of blood can be pumped through the lungs to pick up oxygen to be delivered to their muscles. This pressure within the lung tissue can damage the tiniest of blood vessels, the capillaries, and cause them to leak blood. Exercise induced pulmonary hemorrhage occurs in most racehorses during high intensity running. Blood leaking into the lung requires the horse to rest longer between races and training, it negatively affects performance and on occasion causes death. Furosemide is a common drug used to prevent or minimize the bleeding but the drug is sometimes used as a masking agent to hide performance enhancing drugs in horses (and in humans).

It’s tough to study exercising horses but researchers found a way. They compared the amount of bleeding (a tube has to be placed into the trachea and the lungs washed out to see how much blood can be collected) in a racehorse during exercise with no treatment as a control, with the nasal strips and with furosemide. In some studies, the nasal strips helped decrease bleeding but furosemide was more than twice as effective. In other studies, the nasal strips were not found to be effective. And in some studies, the nasal strips improved performance negligibly and in others there was not improvement at all.

Imagine a human study where the benefit of a drug or a procedure was too small to measure. Would people be willing to ask for such a treatment? The answer is not always rational but depends upon the situation. Parents often bring their infant to the hospital or clinic because of a fever and the worry about an ear infection. As it turns out, most are caused by viruses and but many health care providers still prescribed antibiotics, even though they are likely not useful in the first few days. The latest treatment strategy is to write the antibiotic prescription but ask the parents not to fill it for at least 48 hours, presuming that most viral infections will resolve in that time frame and the infant will get better with the tincture of time. But how many doctors are willing to have a long conversation with the parents and how many parents are willing to wait, when there is a medication that might work. The downside to prescribing too many antibiotics…bacteria develop resistance to commonly used antibiotics and infections in the future may be harder to treat.

Imagine cancer patients whose treatment options have come to an end and search for alternatives that have not been proven to work but yet may offer hope. From laetrile to macrobiotics to oxidative therapies, there are dozens of cancer treatments that beckon those who have failed conventional medical treatment. Science doesn’t matter when hope has been lost.

California Chrome may win at Belmont because he is faster and stronger, but not necessarily because of what he wears across his nose. But don’t tell that to his owner or the makers of the Flair equine nasal strips.

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