Campbell, Government, Big Food, Big Medicine, and Nutrition

In The China Study, T. Colin Campbell provides substantial insight as to the conflicts between science, government, the medical establishment, and the food industry in the fight over what constitutes proper nutrition. While he does a wonderful job articulating the mess we currently have, what he fails to understand is that this is exactly why we need to get government out of the business of recommending nutritional guidelines.

Right now, we have a system in which Big Food and Big Medicine–two establishments that wield the big money–pretty much dominate the ear of Big Government.

Big Food–which includes the meat and dairy industry, the fast food industry and related restaurant chains, as well as food companies that make products from meat and dairy–has a vested interest in protecting the status quo. They have hired guns in science and academia who wield a large degree of influence over government agencies, lawmakers, and their staffs.

Big Medicine–which includes physicians, insurance companies, medical services, and Big Pharma–is a similar opponent. While the medical world is increasingly aiming in the direction of prevention of disease, they place the emphasis on prevention that involves the work of medical professionals. Heart scans, angioplasties, bypass surgeries, radiological procedures, colonoscopies, pills, and injections–those are things that bring in the bucks for Big Medicine.

If you go vegan, you may reduce your chances of a heart attack to zero, but it makes no money for your cardiologist or your primary care doc. You’ll also hit many players in the Big Food industry in the pocketbook.

Unfortunately, Campbell seems to think that getting government on the side of the vegans is the answer to all of this. In fact, the better answer is to get government completely out of the business of nutritional guidelines and recommendations.

Ultimately, it’s not the government’s place to control what doctors learn, what doctors discuss with their patients, what citizens wish to eat, or what products Big Pharma and Big Food market to us.

Fact is, in the Internet, we have the best free market of information ever known to the world. And nutrition is not rocket science.

    If you have heart disease, a vegan diet may save your life.
    If you have naturally high cholesterol, an Atkins or South Beach diet is tantamount to pouring gasoline on a fire.
    If you have a high diabetes risk, getting your weight down will go far toward preventing Type 2 Diabetes. If you have Type 2 Diabetes, getting your weight down–and keeping it down–may eliminate your diabetes.

Do we need government to tell us any of those things? Of course not. We don’t know the “causation”, but let’s not kid ourselves: if you’re at risk, the actionable intelligence is there, and it’s on you to decide what to do with it.

People can choose to make their own decisions about nutrition. Dr. Esselstyn found that patients–once they realized the control they had over their disease via diet–were very willing to make the changes they needed to make.

The medical establishment needs to start deciding which team they are on: the side of the patients or the side of their pocketbook. Docs need not advise all patients to go vegan, but if I’m a cardiologist and I have a patient who has heart disease, you can bet that I’m going to be telling him that going vegan may save his life. If I don’t do this, then shame on me.

If I’m a primary care doc and I have a patient with diabetes (Type 1 or 2), you can bet that I’m going to be telling him that going vegan and getting weight control will cut the amount of insulin needed (for Type 1) and possibly even eliminate the (Type 2) diabetes altogether. If I don’t do this, then shame on me.

If I’m a primary care doc and I have a patient that is showing some signs of Alzheimer’s or related dementia, you can bet that I’m going to be telling him that he has nothing to lose by going vegan. (While we have not determined the efficacy of this approach with respect to dementia, it’s not like other therapies are working worth a rat’s posterior.)

If I’m a neurologist and I have a patient with MS, you can bet that I’m going to be telling him that going vegan may improve his overall quality of life by mitigating his complications. The science is unmistakable here.

You can also bet that if I have a patient that has found weight control to be elusive, I’ll be telling him that going vegan may succeed where other attempts have failed. The science may not be perfect here, but the pointers are strong enough.

You can also bet that if I have a patient that is in otherwise good health, but who eats a “standard” diet, and he asks me about proper nutrition, I’ll be telling him that at least cutting back the proportion of animal based products–and replacing that with plant-based products–will provide a foundation for long-term health.

On a different take, the patient is going to need to start taking responsibility for knowing what is best and what is not. This information is not restricted from you; it is readily available and is but a mouseclick or two away. You need not spend thousands of dollars on specialists to learn what is available at your library, or via the Internet. I don’t need government to do this for me.

Moreover, by getting the government out of the business of making nutritional recommendations, we will make the landscape more of a true free market. As more people cut back on animal-based products, Big Food will invest more capital in developing plant-based products that are healthier and taste good.

We may also see a driving down of health care costs without costly legislation. Fewer heart procedures, fewer chemo treatments, fewer surgeries…all of that means less strain on insurance costs. It also makes medical pricing for routine services more competitive. Traditional physicians (MDs) may see more competition from osteopaths (DOs) and even chiropractors and nutritionists over basic prevention of disease.

The critics will complain–with some merit–that we will see a lot of quacks emerge. At the same time, we have plenty of quacks now. They exist in the medical establishment, government, and all levels of industry. In the current setup, they are protected by government.

By getting government out of the business of nutrition, we might see a badly-needed shakeup in this area.

Re-Assessing Nutrition, Part 2 (“Correlation does not equal causation” only goes so far)

At times, nutrition can seem like economics: get 3 nutritionists in a room, and you’re going to get 6 different opinions.

Anyone with an opinion can cite one or more studies that give them credibility. If you want to eat a high-fat/high protein diet, there are studies that appear to support you. If you want a low-fat/high-carb diet, there are plenty of studies that appear to support you. If you want something in between, there are studies that appear to support you.

The problem is that when we assess the question–“what is the best dietary regimen”–we often don’t qualify it appropriately. The proper question is, “What is the best dietary regimen for my given activity level and health situation?

We also have to qualify it–as economists do–by indicating ceteris paribus (all things being equal). This is because some people have food allergies, others have metabolic issues, others have Type 1 Diabetes, and so forth. Dietary needs can vary. This is perhaps the main factor that makes the field of nutrition a difficult one.

Given that a third of Americans are obese, the common question is, “What is the best dietary regimen for getting off these #$%! pounds???”

If you have heart ailments, a better question may be, “What is the best dietary regimen for keeping my ticker tocking?”

If you are an athlete, the question might be, “What dietary regimen puts me in the best position to get my best performance?”

For me, the proper question is, “What is the best dietary regimen that minimizes my risks of cancer, heart disease, and dementia?”

In the world of sports–especially those that require high endurance–the science is indicative of high complex carbs/low-moderate protein/low-moderate fat. In the endurance world, vegans are not uncommon. While weightlifters and bodybuilders are still steeped in protein-mania–and science appears to support that approach in those sports that are dependent on strength–the rest of the sports world is not as big on steak and eggs as was the case 30 years ago.

But what if you are not a full-time athlete? What if you don’t run marathons? What if you’re only getting a couple hours of cardio per week? What if you just want to stay healthy, keep the excess pounds off, keep autoimmune diseases in check (i.e. arthritis) and mitigate your risk of cancer?

What if you’re like me: you want to do all those things, but still do the occasional 100-mile bike ride, or half-marathon, or half-Ironman?

It’s fair to ask what the science says about all of this.

Enter two excellent reads–Prevent and Reverse Heart Disease, by Caldwell Esselstyn, MD and The China Study, by T. Colin Campbell.

Esselstyn did his own 20-year study while he was a surgeon at the Cleveland Clinic. He took a set of patients with advanced heart disease–many of them had already had bypass surgery and/or angoplasty–and put them on a strict vegan diet. He monitored the results over a 20 year period. The results were breathtaking: those patients overwhelmingly were able to avoid further cardiac incidents, and in many cases the heart disease was even reversed.

The skeptics, however, can look at Esselstyn’s work and punch holes in it: (a) there was no “control” group, (b) it’s only one isolated study, (c) perhaps Esselstyn was personally biased.

Even then, the results are what they are. It’s a Cleveland Clinic study. Esselstyn’s credentials are impeccable. Any bias-centered criticism of Esselstyn would have to be balanced against his record of intellectual integrity as a physician.

Verdicts:

(a) Esselstyn has provided ACTIONABLE INTELLIGENCE for those who have heart disease and wish to avoid future surgeries and/or premature death.
(b) Esselstyn has provided ACTIONABLE INTELLIGENCE for those who wish to mitigate their risks of heart disease and complications thereof.

And that’s what we’re all about here: ACTIONABLE INTELLIGENCE.

And that brings me to Campbell and The China Study (TCS).

In TCS, Campbell makes a more comprehensive case for a vegan nutritional regimen. He begins by highlighting his scientific work, analyzing carcinogens (aflatoxin), and nutritional approaches in various undeveloped nations. It was in the course of studying the dynamics of aflatoxin that Campbell stumbled into the dilemmas between plant versus animal proteins. His first two chapters are foundational in this respect.

As Campbell made his case for the vegan approach–highlighting links between animal-based diets and a myriad of ailments–the skeptic in me often screamed, “Correlation does not equal causation!” Everyone with a bare-bones-basic knowledge of statistics knows that.

Unfortunately, while that statement is indeed true, it only goes so far. And every physician worth a penny knows that.

Want an example? Type 2 Diabetes.

While we have a plethora of scientific evidence correlating obesity with Type 2 Diabetes, we still have not verified conclusively that obesity causes Type 2 Diabetes. At the same time, (a) every good physician in America will tell diabetes patients to get their weight down and keep it down; and (b) when a Type 2 Diabetic drops the pounds, the diabetes usually goes away.

Correlation does not equal causation, but–if the correlation is strong enough, that constitutes ACTIONABLE INTELLIGENCE.

If dropping the pounds eliminates the diabetes, does it really matter–for your own health–if causation has not been established?

If you have the choice between eating a vegan diet or enduring painful, costly, and debilitating heart surgery, does it matter if causation has not been established?

Now some of Campbell’s proposals are controversial. For example, we have not determined that a vegan diet will keep you from getting Alzheimer’s, or Rheumatoid Arthritis, or Multiple Sclerosis.

Still, given that medical treatments for those diseases have not shown much promise, if eating less meat and jacking up the veggie intake might mitigate that risk–assuming it is a risk that you feel passionate about–then Campbell has given you ACTIONABLE INTELLIGENCE.

Correlation isn’t causation, but it is useful in forming testable hypotheses. At the very least, Campbell provides a nice basis for a myriad of such hypotheses.

Another aspect of TCS that is refreshing is the way Campbell provides insight into how the government has influenced nutrition education in ways that are harmful to Americans. While Campbell strikes me as a left-of-center type, his analysis is without respect for political parties and is more centered on the fascistic, incestuous relationship between lobbyists for the food industry, government agencies, and lawmakers. Campbell also provides a stark picture of how government influences nutrition: from the Department of Agriculture to the Department of Education, and how the food lobby has fought to stack the advisory panels with their own hired guns.

One does not have to be a vegan to appreciate the fact that the government’s recommended daily allowances are too fat-heavy and do not include enough fruits, whole grains, and vegetables. And Campbell provides an honest assessment as to why those recommendations are what they are.

At the end of the day, Campbell is no hack. He’s an honest scientist who has gone where the evidence took him. That evidence has led to many correlations, some of which have statistical significance.

We don’t have causation established, but we have the same smoking guns that appear to be showing up whenever a malady gets studied. You can decide, “Correlation does not equal causation, so I don’t care.” And that is your business. Or you can decide that you have enough inherent risk that this intel is worth acting on. That is also your business.

I would argue that it is not the government’s place to tell you what you must do, but it is on you to decide for yourself if Campbell and Esselstyn are on the money.

Maybe there’s a risk that is important to you; perhaps not. Does everyone need to go vegan? Not by a long shot. Is a total vegan approach required to mitigate the risks highlighted by Campbell? No (although Esselstyn insists on it himself.) Do we need government telling us to go vegan? No.

But if mitigating your risks of cancer, heart disease, stroke, autoimmune disorders, Type 2 Diabetes, and perhaps dementia is important, then it’s worth a look.

My only gripe with TCS: Campbell provides no vegan recipes. He does a wonderful job extolling the virtues of the vegan approach, but does a crappy job of providing a portrait of how appealing and enjoyable it can be. (Esselstyn, however, devotes a large part of his book to providing recipes.)

Campbell, however, has started a larger discussion: to what extent ought government be involved in the promotion of nutrition?

I’ll try to tackle that one next week.

Re-Assessing Nutrition, Part 1

I had the privilege of growing up during a period in which many sacred cows of nutrition became the focus of much scrutiny.

Many people may not remember, but not too long ago, (a) world-class athletes were sold on high protein/low carbohydrate diets; (b) coaches almost universally gave out salt tablets to athletes before games and practice; (c) it was not uncommon for professional teams to drink beer after games to rehydrate; (e) marathon runners–in order to “carbo load”–ate lots of sugary foods for the carbo-boost.

Today, those practices are sacrilege. While protein still gets a lot of hype–largely due to Atkins-mania–athletes are re-discovering the benefits of complex carbs. Salt tablets have given way to electrolyte replacers that go lighter on salt and provide more balance. Beer is now understood to be a DEHYDRATING agent. And marathon runners are looking more at gels (Hammer Gel, GU) and other products that provide complex carbohydrates prior to competition.

It is arguable that tennis stars Martina Navratilova and Ivan Lendl–and 6-time Ironman champion Dave Scott–provided the impetus for that nutrition revolution.

Lendl and Navratilova embraced the high complex carbohydrate/low protein approach of Robert Haas, and became the most dominant players in their sports. Navratilova–once an overweight underachiever–became the fittest player in the history of women’s tennis; Lendl held the #1 spot on the men’s tour for a record 270 weeks; Scott was similar in his approach–although he was a strict vegetarian. He would win six Ironman World Championships. (An Ironman triathlon consists of a 2.4-mile swim AND a 112-mile bike ride AND a full marathon of 26.2-miles.)

I followed a lot of that, and–after letting my fitness slip for a few years in the 1990s–embraced that path as I reached fitness levels I had not even realized in my high school days. I know many other athletes–especially marathoners and ultrarunners–who have taken this approach. For serious endurance athletes, it’s darn close to standard.

A couple months ago, an acquaintance of mine who is in the same spin class gave me a book to read that challenged him: Prevent and Reverse Heart Disease, by Caldwell Esselstyn, MD. In it, Esselstyn–a renowned former Cleveland Clinic surgeon, combat surgeon in Vietnam, and Olympic Gold Medalist (rowing, 1958)–makes the case that, with a vegan approach, heart disease can be prevented and even reversed. The thrust of his book was his own study–during his Cleveland Clinic days–of a set of cardiac patients who had advanced heart disease. He put them on a total plant-based (vegan) diet, and the success was overwhelming.

The study wasn’t perfect–there was no “control” group. But still, his results are nothing to sneeze at. He had my attention.

I also noticed that the forward for his book was written by T. Colin Campbell, author of The China Study. A friend of mine–KM, who is a physician–recommended that I read that book as it is one of her favorites. So I read it, too.

I’ve had many conversations with KM over the years. And she, like Campbell, lamented that physicians do not get a lot of nutrition training. While she is not a vegan, she appreciates the principles that Campbell provides, and has adopted many of them.

Personally, I loathe most vegetarians, especially the envirowackos who are out to castigate anyone who eats chicken, fish, beef, or pork. I have no use for those types.

Still, I’m all about mitigating my controllable risks, and Campbell and Esselstyn provide a good case for anyone with known heart disease/cancer risks who wants to control those risks without medical approaches.

In part 2, I’ll discuss why I agree with Campbell and Esselstyn. (Hint: The “correlation does not equal causation” argument only goes so far.)

They Paid Money to Reach THIS Conclusion?

Anyone with at least a double-digit IQ knows that heavier women tend to be disadvantaged in the romance department. (This is not a putdown of anyone; just a statement of the obvious.)

I say that because it does not seem that we needed experts to tell us this much.

And yes, I know that they are saying that heavier men don’t have the same difficulties. This is not really news either. While women can be choosy when it comes to male obesity, the men tend to be more finicky in that department.

Like I said, I did not post this to start any fights, but rather to point out the lunacy of the research world, in terms of wasting assets to prove what anyone with half a brain already knows.

Ouch! Doc Supposed to Remove Cyst, Cuts off Right Nut

HT: Vox Day

Thomas Sowell, in his books Basic Economics and Applied Economics: Thinking Beyond Stage One, provides a critical review of government interference in health care.

Putting things in simple terms,

(1) If government imposes a price ceiling on anything, then you still do not address the fundamental issue of the cost of the product; the cost merely gets distributed in other arenas.

(2) If the amount of demand (surgery) stays the same and price is not allowed to rise, then there will be a shortage of product available (surgeons to deliver the surgery).

(3) That shortage gets addressed through one (or more) of several options:
(a) rationing — government deciding that a patient does not “need” a particular product
(b) delay — management of a que that is subject to bureaucratic bias and little accountability
(c) increasing the available supply of the product, in ways that adversely impact the quality of the goods and services delivered.

Looks like this was the latter.

Dr Sulieman Al Hourani was only supposed to cut out a cyst, but removed the whole right testicle instead.

Why would this be a big deal, given that American doctors have done exactly this?

I’ll answer in one word: accountability. Yes, there are quacks who make it through American medical schools, make it through residency, manage to pass their boards, and go on to inflict damage on patients. But the system here is far more transparent than, say, importing a doc from BFE.

It’s not so easy to vet a doc, who comes in from Jordan, as government–given a supply-demand management problem–has no compelling reason to do things that would crimp the supply. And it’s an order of magnitude harder to sue a regulator who fails to regulate–when was the last time the SEC or the OTS faced, let alone lost, a lawsuit–than a doc who fails to practice.

(Even with the latter, it’s like locking the house after the burglar arrives, and this adversely impacts supply, as raises the cost for the good docs to stay in business.)

As for Vox’s take on Obamacare, I’m not so sure that it will end as badly. This is because Obamacare–if Americans take advantage of it–will destroy the insurance industry without providing a public option. This will return health care back to doctors negotiating with patients, minus the middleman.

(Denninger says this will pave the way for a government-run single-payer system. I disagree, because–if the insurance industry implodes, then government credibility will be zilch, and no President will have the political capital to pursue such a system in such a case. Besides, government will be out of money.)

The wildcard: if that happens, look for Blue Cross/Blue Shield, Aetna, Humana, HealthSouth, etc. to clamor for bailouts. The Federal Reserve and Treasury Department will get behind them and perhaps even make the pitch. But it won’t happen. Not with borrowing costs up several percentage points…

Mohler Weighs in on “Health Care Reform”

Southern Baptist Theological Seminary President Al Mohler provides what ought to be a no-brainer regarding the Christian obligation to pay taxes, even as we are facing the specter of government-funded abortion.

(And yes, that is where this is headed, as Obama’s Executive Order is worth a used roll of toilet paper. A court challenge to the EO will almost certainly lead to a “Landmark Decision” that requires not only government, but all health insurance providers, to fund abortion services.)

But Mohler is not speaking to anything new, as tax-funded abortions are hardly a novelty. Republican Presidents (Reagan, Bush 41, Bush 43) have made such funding more difficult–while not eliminating it–whereas Democrat Presidents (Clinton, Obama) have opened the door for more subsidizing. The United Nations–funded in part by the American taxpayer–actively provides abortion services to “developing” nations.

OTOH, there are ways that the taxpayer can work within the system.

Keep in mind that:

(a) The “health care reform” is now a health insurance mandate.

(b) The cost of health insurance is already high, in the neighborhood of at least $10,000 for a plan that will provide decent coverage.

(c) Even a bare-bones-basic plan will not protect you from financial disaster if you suffer a catastrophic event, or need any form of major surgery.

(d) the fine for not having coverage is only $750.

(e) insurance providers can no longer deny you on the basis of “pre-existing conditions”.

So, as my wife and I have noticed, the time is not far away, in which it will be more economically advantageous to forego health insurance, pay the $750, and then take our chances.

Moreover, as Denninger has pointed out, you can always sign up for insurance after you suffer your event.

Besides the fact that this approach will bring down the insurance system altogether, you have the advantage of keeping more cash on hand to mitigate your own risks.

If having insurance doesn’t mitigate your risks, then why pay through the nose for it?