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258 thoughts on “Diagnosis, Therapy and Evidence

  1. Harriet Hall says:

    Fifi, your first comment was “Could you provide some evidence for your assertion that diet, environmental carcinogens and behavior (or exercise) don’t play into the development (or non-development) of some cancers?”

    Since I had never asserted any such thing, I hardly knew what to say.

    It was as if I had suggested that something was partly white and you had challenged me to explain why I had asserted that it was all black. Maybe it was more frustration than anger: it was like that other unanswerable question “When did you stop beating your wife?” :-)

  2. micheleinmichigan says:

    Me “To be honest, I don’t get the prevention/not prevention debate.”

    weing “I don’t like lying to patients. If I put them on a statin and tell them it will prevent a heart attack I am telling them a lie. ”

    Oh, not you weing. :)

    You were talking about using precise language when presenting medication to a patient. I get that and appreciate the attention to detail.

    I didn’t state it clearly enough. But I meant only the debate of “Was Dr. H. adequately advocating for preventative measures such as exercise, diet and veggies”

    I personally don’t feel I need someone to advocate that to me, having heard it so many times before, so I don’t get THAT debate.

  3. daedalus2u says:

    The Medicinenet article is (I think) very misleading. I think they way they come up with the number of what percentage of cancers can be avoided is (in part) to observe differences in cancer incidence between different regions in ethnicity matched subjects (i.e. urban vs. rural), and then assume all of the difference is due to environment, and that all of that difference can be eliminated if the two environments are made “the same”. Then they assume that the most important environmental differences are diet, exercise, and exposure to xenobiotics in the non-rural environment.

    If we look yet again at what Harriet wrote;

    “A popular concept today is that cancer is largely a preventable illness linked to diet, environmental carcinogens and behavior. This is rooted largely in belief and hope rather than fact. Smoking is the one notable exception.”

    Harriet is correct, with the exception of smoking, the environmental difference(s) that lead to the urban vs. rural cancer gradient remain unknown. People think those differences are due to diet, exercise and exposure to xenobiotic compounds, but there is as yet no good evidence that these are the actual differences that lead to the differences in cancer, or if it something different. No one is saying that a crappy diet is good for you, or that not exercising is good for you, or that xenobiotic compounds are good for you, just that none of these things have been shown to cause cancer.

    Her article is very nice in pointing out that current medical practice is to treat risk factors as if reducing the risk factors will reduce the diseases the risk factors seem to predict, but without understanding the causal basis by which the risk factors are associated with the disease.

    Diet is especially difficult to do research on because diet is virtually always self-selected. How do we know that people who self-select a healthy diet did not do so because they are healthy? We don’t, and I think that is the major confound in diet research.

    We know that animals in the wild self-select a diet that provides all of their nutritional needs. We know this because animals live and reproduce in the wild, eating only a self-selected diet. We know that human ancestors have done this too, but the “diet causes disease” hypothesis posits that humans have lost this ability. Usually the explanation is that modern food production practices are so good at producing foods that are so appealing that humans are powerless to resist eating them to harmful excess.

    What is the prior plausibility of this hypothesis? What is the likelihood that the human appetite control mechanism(s) that evolved and worked for every human ancestor to prevent every dietary deficiency and every dietary excess in every ancestor of every human (before that human ancestor reproduced), has suddenly and irreversibly failed because of the preternatural skill of the makers of crappy fast food?

  4. micheleinmichigan says:

    Continuation. – I think the article is much more interesting as it stands, as a discussion of handling the unknowns in medicine and being able to switch direction in response to new discoveries, than it would have been had it incorporated a pitch for healthy lifestyles.

    I’m all for healthy lifestyle, but I don’t think it needs to be in every article that mentions looking for causes for cancer or heart disease.

    IMO, of course.

  5. JMB says:

    I’d like to offer an analogy for the discussion about prevention of cancer.

    Imagine a camel herder, trying to protect some camels in the hot desert sun. The camels are carrying some burdens, some very heavy, some not so heavy. A cargo plane flies overhead, opens the cargo door, and pushes out some provisions in one ton packages. At the same time, a lot of straw flies out of the cargo hold of the airplane, and begins to fall to the ground. The camel herder sees the heavy packages descending by parachute, and tries to push, pull, and cajole the camels out from under the descending heavy packages so that they don’t have their backs broken. Some camels the herder saves, some have their backs broken. Now comes the straw. The straw doesn’t seem like much to worry about, but some of the camels are carrying such a heavy burden, their backs break when a straw lands on them. So the herder starts to run around trying to catch the straw before it lands on the camels backs. But the herder doesn’t know the weight of the straw, or the weight of the camels’ burdens. After catching some of the straws, the herder realizes that there are too many other straws falling, and in spite of catching some of the straws, some of the camels still have their backs broken.

    Another person is sitting on a hill under a nice gazebo with lots of ivy providing shade from the sun. The person on the hill calls down to the herder and says, “I’ve been watching and counting straws and broken backs, and I can tell you that if you can catch those straws, you will prevent more backs from being broken!” The camel herder replies, “Well you better give me a better measure of the camels’ burdens, and a better measure of the weight of the different straws, or I’ll just be grasping at straws trying to prevent the straw from breaking the camel’s back.”

    Sorry about that. Don’t worry, I won’t quit my day job. Will I now be banned?

    The one ton packages are the carcinogens in cigarette smoke and exposure to sunlight (and a few other things, like HPV). We don’t have to have precise measures of their carcinogenicty, the strength of a person’s immune resistance, or the burden of genetic mutations they already carry, because people will be exposed to so much on a daily basis. For many of the other carcinogens, there is so much information lacking that it is hard to predict what effect avoiding them will have on the incidence and mortality of the many different diseases we group together as cancer. We would expect that by avoiding those carcinogens you can minimize your risk of cancer, but we cannot give a reliable estimate of the risk reduction. As noted in Dr Hall’s article, Ionannidis showed convincing evidence that without accurate a priori probability estimates (fits into the concept of plausibility), most of the conclusions that are drawn from data that show weak correlations, are likely to be wrong.

  6. squirrelelite says:

    Michelleinmichigan,

    You’re welcome.

    I try to recognize that the people who write these blogs to entertain and, I hope, inform us are doing this on their own time and have to do their own editing and proofreading and still get the article posted in time. And, the many enthusiastic commenters are trying to write something interesting and/or useful in a hurry with software that thinks many of the technical terms being used are misspelled. It doesn’t even like “commenters” (sp).

    So, I usually read around typos, mistaken word choices, etc. except for the extremely rare cases where actual meaning of the sentence is confused.

    In this case, the word just fit in with what I wanted to say, so I used it.

    daedalus2u,

    Your comment on the medicinenet link has piqued my curiosity, so I’ll have to see what I can find.

    I still think it was a useful list to post because it clearly shows that for the 12 most common cancers (excluding lung cancer) which we think can be reduced or mitigated (i.e. prevented) by diet, exercise, etc.; for 9 of the 12 most cancers still cannot be prevented!

    But, I will keep looking for better data and sources.

    So, I think you and Harriet and I are all heading towards the same point that even if making these changes is useful, they won’t eliminate all cancers and are not the miracle cure that is commonly touted in the popular media.

    As for loosing the ability to make good dietary choices, I don’t think we have lost that and I really don’t want to revisit the whole hunter-gatherer diet brouhaha that we slogged through a few weeks ago. However, I do think that a series of changes that have happened in our general food delivery system and the lifestyle of most of our society (at least here in North America) have removed most people from making the direct choices about what food they eat and how it is prepared that might be evolutionarily selected in favor of more healthy and survivable choices.

    About 50 years ago, it was still fairly common for people to drive a short distance to a small local grocery store (or even just walk a block or two) to purchase fresh produce and whatever meat, poultry,etc. was on sale to use to prepare their meal(s). Many people supplemented this with gardening (probably not “organically”; DDT was still in use.) to raise their own produce, berries and even fruits. Canned foods and frozen foods were also available and commonly used, but I don’t remember seeing grapes imported from South America available in the winter.

    Gradually, these “traditional” foods were supplemented and partly replaced with other choices which had a longer shelf life and were less likely to be degraded in appearance or even contaminated. An apple is actually a pretty robust fruit, but its shelf life doesn’t match a bag of potato chips.

    And, as more second parents entered the work place, more single parents were trying to work and raise children, society in general became more mobile and busy. Many people ate more fast food, restaurant food, and pre-prepared frozen food because that was all they had time for. (Been there, done that.)

    You can still make good food choices under those circumstances, but it requires good information, awareness of the trade-offs involved, and willingness to spend the time to think!

    Which leads me back to the point I think Dr. Hall was trying to make that until science achieves a deeper, clearer understanding of the underlying mechanisms that connect our diet and lifestyle choices to our general health (and preventing cancer), any choices we make are likely to have unintended, negative consequences.

    And, as long as we are awash in a flood of simplistic, absolutist pronouncements that food X is good for you, food Y is bad for you, food Z will prevent cancer, it is even harder to figure out what our good choices are.

  7. micheleinmichigan says:

    It’s good to know that SBM is important to the Russian community as well.

  8. micheleinmichigan says:

    It’s good to know that SBM is important to the Russian speaking community as well.

  9. JMB on cancer prevention:
    “So, I think you and Harriet and I are all heading towards the same point that even if making these changes is useful, they won’t eliminate all cancers and are not the miracle cure that is commonly touted in the popular media.”

    You and Harriet Hall have both suggested that it is common to believe (or say) that all (or most) cancer can be easily prevented – even cured! – with lifestyle changes.

    You guys talk to a lot more people about cancer than I ever will, and I don’t have television, so you must know what you’re talking about. But these statements do not correspond with my experience.

    The only miracle prevention strategy (not cure) that I have seen touted in the popular media is a starvation diet, and journalists don’t usually talk this one up as appropriate for anyone but the most dedicated anti-cancer extremist trying to make a point. And I personally don’t think I know anyone who thinks broccoli and a daily brisk walk is a miracle cure for cancer.

    Interesting.

    Unless by “popular concepts” and “popular media” you’re talking about websites like naturalnews.com and whale.to? That would make sense. Not mainstream, but we’ve all heard of them.

  10. BillyJoe says:

    micheleinmichigan,

    “It’s good to know that SBM is important to the Russian community as well”

    :D

    In fact, he is inviting SBM over to the Russian community:

    “I can propose to you to visit the site, on which there are much information on the theme interesting you”

    I’d be wary though. I suspect Boris has something very unattractive waiting for you.

  11. micheleinmichigan says:

    Alison – “You and Harriet Hall have both suggested that it is common to believe (or say) that all (or most) cancer can be easily prevented – even cured! – with lifestyle changes.”

    Alison, When I read these references I have been relating them to conversations that I have had regarding a friend or family member’s cancer. I don’t think that I have ever known someone with cancer without hearing someone else suggest, if that person had just done something different, they may not have cancer.

    Sometimes there is an obvious connection, like a smoker or ex-smoker with lung cancer. This would be my dad who smoked from the time he was twelve until he was forty.

    But, sometimes there has not been a known preventative measure.
    For instance my SIL died of esophageal cancer in her early 40s. She did have a risk factor, GERD. But she did everything advisable to control the GERD. People often would say, if she just had done this or that, seen the doctor more or maybe it was the GERD medication or something in the environment or her diet. They are working on the assumption that there must have been something that could have been done to prevent this. I’m not blaming people, No one did it heartlessly or meanly. I do this myself. It’s what we humans do, look for ways to control our life.

    To me, this is what Dr. H. was talking about when she said these assumptions are rooted in hope and belief rather than evidence. But, that is just how I related the phrase to my life. I’m sure other people’s experiences may be different.

  12. micheleinmichigan says:

    After I’m done sending the Nigerian Prince money, I’m going to check out Boris’ link.

  13. Alison Cummins on popular media:
    “[W]ebsites like naturalnews.com and whale.to? … Not mainstream, but we’ve all heard of them.”

    Rethinking this: I had actually never heard of naturalnews.com before starting to read Respectful Insolence. I think I had heard of whale.to previously, but I’m not sure. So “we” readers of sciencebasedmedicine.org have all heard of them, but I’m not sure most people have.

    Everyone, of course, can name someone with wackier ideas than their own.

  14. apteryx says:

    JMB – you list sunlight as one of the “one ton weights” causing cancer, but there is increasing evidence that lack of sunlight exposure and concomitant vitamin D deficiency raises the risk of cancers that cause far more deaths than skin cancer. So it really is wise to be careful before we panic about a single isolated risk factor!

    daedalus2u – You are demonstrating that the words “prior plausibility” often really mean “Did I already believe this?” It is to me very plausible indeed that humans have a biological inclination to like sugary, salty, and fatty foods, which in nature are scarce high-quality nutrients. And if you do not think it plausible that a diet loaded year-round with hyper-sugary and hyper-salty foods can be harmful, you have not been paying attention for the past forty years.

  15. micheleinmichigan says:

    “Everyone, of course, can name someone with wackier ideas than their own. -”

    Yes, but you’re not living unless you can name at least twenty. :)

  16. squirrelelite says:

    I don’t know what the percentages are, but I do know several people who think that eating the right foods will help prevent, treat, or cure cancer.

    I haven’t heard about broccoli yet, but there is a sort of urban legend/e-mail chain letter going around about the asparagus treatment for cancer. (Someone knows someone who heard about someone who ate asparagus and got better! Yeah, right!)

    Just google it.

  17. micheleinmichigan on belief in control:
    “I don’t think that I have ever known someone with cancer without hearing someone else suggest, if that person had just done something different, they may not have cancer.”

    Yes, I’d been thinking about that. But I think it’s a little different.

    When something bad happens there’s an automatic reflex to figure out why it wouldn’t happen to me (or why it won’t happen to me again). For instance, my friend is dying of esophageal cancer. When I heard about his diagnosis, I immediately thought, “he had GERD, I don’t, I’m safe.” But GERD or not, 33 is young for cancer. It’s definitely in the random-shit category, and I know that. But I still get comfort from thinking I don’t have GERD.

    I think a lot of the reactions to someone’s cancer diagnosis are like that. They smoked/didn’t eat their vegetables/drank too much/had a bad attitude. I’m not like them in that particular way, therefore I’m safe.

    It’s superstitious. I know it about myself, and I think most people are aware of it at some level. It doesn’t really fall into the category of belief. If you ask someone if they believe that because they eat cruciferous vegetables twice a week they will live cancer-free for eternity, very few people would say yes. But if their neighbour gets a cancer diagnosis, they will think Aha! Neighbour doesn’t eat broccoli! I do, and I will be safe.

    Another way of looking at it. People would like to think there are easy answers, but they also know that answers aren’t usually easy. You have probably had the experience of people helpfully suggesting easy fixes to make your child’s hearing/ speaking/ eating/ breathing difficulties just go away. Certainly when you were trying to conceive you must have gotten lots of advice. But when you explain that you are quite familiar with this tip already and that you are working with professionals, they shut up. They don’t argue with you that they are right. It was more hoping that the problem could be easy, rather than actually believing it was.

    And then when someone is actually ill or dying there’s the need to make sure that you’ve “done everything,” that the person isn’t dying needlessly. If the person is getting good medical care, then you cover all the bases by making sure they also get vegetable juice. They die anyway, and you know they are going to die anyway, but it’s a way of not going gently into that good night.

    I don’t know if this would be a distinction without a difference from the perspective of someone who counsels patients, but it feels different to me.

  18. Alison Cummins in a comment still in moderation upthread:
    But when you explain that you are quite familiar with this tip already and that you are working with professionals, they shut up. They don’t argue with you that they are right. It was more hoping that the problem could be easy, rather than actually believing it was.

    Well, that’s most people. There are also the really tiresome people who keep pestering you. Fortunately they aren’t the majority, but yes, many of them probably do really believe.

  19. edgar says:

    I think this is a great article, but it (and many) of the comments touch on a beef of mine.
    We are very imprecise and sloppy when it comes to who ‘They’ are. Strikes me as ironic. Perhaps we can define who we talk about a bit better.

  20. Harriet Hall says:

    Alison said,

    “You and Harriet Hall have both suggested that it is common to believe (or say) that all (or most) cancer can be easily prevented – even cured! – with lifestyle changes.”

    Not true! I didn’t say anything about “easily” or about “curing” cancer with lifestyle changes. What I said was “A popular concept today is that cancer is largely a preventable illness linked to diet, environmental carcinogens and behavior.”

    I’m sure you are capable of understanding the difference if you read carefully.

    Please stop misquoting me.

  21. Harriet Hall says:

    For those who still doubt that the preventability of most cancer is a common belief, here’s an article from HuffPo entitled “Cancer is a Preventable Disease: Why Don’t We Prevent It?”
    http://www.huffingtonpost.com/thomas-goetz/cancer-is-a-preventable-d_b_501990.html

  22. Harriet Hall on being misquoted:
    “Not true! I didn’t say anything about “easily” or about “curing” cancer with lifestyle changes.”

    No, you didn’t say anything about curing. JMB did.

    JMB on diet and exercise:
    “So, I think you and Harriet and I are all heading towards the same point that even if making these changes is useful, they won’t eliminate all cancers and are not the miracle cure that is commonly touted in the popular media.”

    That’s why I said “prevented – even cured!” to give both your version and JMB’s version.

    It’s true, you didn’t use the word “easily.” I inferred it, and if you didn’t mean it, I apologise.

    “A popular concept today is that cancer is largely a preventable illness linked to diet, environmental carcinogens and behavior. This is rooted largely in belief and hope rather than fact.” (You must be getting really fed up with seeing this over and over again; I’m sorry!)

    My interpretation of this statement was that people hope that they can largely prevent cancer by attention to diet, exposure to carcinogens, and behaviour.

    I went further and thought that people don’t hope for difficult things. People don’t hope that they can prevent cancer by following a strict 900 kcal/day diet for the rest of their lives. They hope that they can prevent cancer by eating broccoli (or asparagus) every week, or by taking antioxidant pills. This is how I came to “easily.”

    “Easily” may not be the right word. Nobody who coaches people on lifestyle modifications (which is what doctors do) can think that giving up smoking, losing weight or getting regular exercise are easy things to do. I meant “easily” as compared to a starvation diet, which is out of reach of most people who have the choice (and is not what people hope to be able to do to prevent cancer).

    To go back to my comment, I was simply interested that you and JMB both perceive that beliefs about strong effects of diet and exercise are “popular” or “commonly touted in the popular media.” You are both smart, respected, and as I specifically mentioned in my comment, experienced with the general public.

    You are not wrong and I am not arguing.

    However, your perceptions are different from my perception. That gap is interesting to me, and I’m wondering out loud why our perceptions seem to be different — or if they even are different.

    One obvious explanation of the gap is that I’m wrong. As I said, I don’t have a televison, so I am not familiar with a lot of popular culture. The people I know well may not be typical. Perhaps people who think I might not agree with them don’t care to share their ideas with me, so I don’t have a true picture of their beliefs. If I’m wrong about common beliefs then I should change my mind.

    Another possible explanation is that we are using words to refer to different things. To me, “commonly touted in the popular media” means an idea that I am likely to see in the lifestyle pages of my newspaper. To JMB, perhaps it means one that is not too hard to find on the internet. If I’m interpreting words like “common” and “popular” using pre-internet reference points, I probably need to update my reference points.

    It’s important to me to be able to understand people. If I don’t understand why someone is saying something, or what they mean by it, I want to figure it out. That way I learn something and I can get more out of their communication.

    I apologize for misquoting you and for anything else I’ve said that made you feel attacked. I’ve tried to be careful in my wording but I obviously have been unsuccessful. I’m sorry.

  23. lillym says:

    I think diet as cancer prevention is belief held by many people.

    It’s defintely something that is on television as well as in magazines and on the internet.

    I’ve seen claims that high fiber diets can help prevent colon cancer and antioxients help protect against and prevent cancer. There is all the hype about super foods. On television it’s in various places – scammy looking infomericals, talk shows, lifestyle news programs, I’ve even seen some claims on the shopping network when they are hawking various products.

    But it’s also in magazines — go to the book store and look at women’s magazines, healty lifestyle magazines, and things like that.

    You’ll see claims about antioxidents and super foods and high fiber diets to protect against/prevent colon cancer.

    Not to mention various websites that make these claims.

    Antioxidents and superfoods have been linked (rightly or not) to cancer prevention so a product can just have “now with antioxidents” and they don’t have to make the exact claim. They just have to tout antioxidents. And people will buy their products thinking it’s good for them and part of a diet that will be healthy and protect against/prevent cancer.

    And people will think that because they read something in a magazine or saw it on the news or on a health related website.

    Companies will make all kinds of claims to sell their products. A local tanning salon had commercials talking about how people need sunshine to get vitamin D and how using tanning beds was a great way to get the necessary sunshine to be healthy.

  24. Harriet Hall on common beliefs:
    “[H]ere’s an article from HuffPo entitled “Cancer is a Preventable Disease: Why Don’t We Prevent It?””

    Ironically, this article starts off claiming that the most common belief is that cancer is not preventable! ;>)

    The article discusses both primary (Gardasil) and secondary prevention (colonoscopies, Pap smears) and includes chemoprevention (tamoxifen). It quotes the 30-35% of cancers being diet-related, explaining that this figure includes cancers related to alcohol and that alcohol has been linked to many forms of cancer. It doesn’t mention exercise at all.

    Ironically again, the conclusion of the article seems to be that we all know we aren’t going to give up meat and wine or use sunscreen appropriately, so we should look to medicine to step up and do the prevention for us. “Screening rates are typically low, and effective treatments [like tamoxifen] for prevention are underused.” “[T]his news … should steel us to take on cancer like we’ve taken on heart disease — the number one killer in the US (cancer is the steady number two). After all, we already talk about heart disease in terms of risk, and reducing risk. We take huge amounts of baby aspirin and statins in order to reduce that risk. And it’s worked: deaths from heart disease have dropped steeply over the last few decades.”

    If I don’t know what people commonly believe, I couldn’t begin to guess what most people will get out of the HuffPo article!

  25. Harriet Hall says:

    Alison,

    Apology accepted!

    Did you see the HuffPo article I cited?

  26. edgar says:

    Why thank you Harriet. that is exactly what is needed when we speak about ‘they.’

  27. Weing asked: “While miscarriage is a reason for interrpupted pregnancies, the vast majority of such ended pregancies, while the breast tissue has these “lobules” in the “type 2″ and “type 3″ phase, are by choice.”

    Do you have any data to back up this claim? Do you know how many miscarriages occur without the woman even knowing she was pregnant?”

    The issue of loss of a pregnancy by miscarriage: It looks like 25% of conceptions is a rough number (see below, and other such studies). For my point, that it is probable that most of the abortions that happen in the transition period when milk-producing tissue of developing from non-pregnant state to milk-producing state, a lot of tese spontaneous abortions will probably happen before that development has really progressed. It is very easy to figure out that the majority of voluntary abortions, approx 1 out of 5 detected pregnancies here in the U.S., are in that critical transitional state between “type 1″ and “type 4.” “Less than one of four” seems a decent ballpark for spontaneous abortions that might put a woman at risk of this etiology of breast cancer, and “one out of five” seems a pretty firm ballpark statement for voluntary abortions.

    “Fertil Steril. 2003 Mar;79(3):577-84.

    Conception, early pregnancy loss, and time to clinical pregnancy: a population-based prospective study.
    Wang X, Chen C, Wang L, Chen D, Guang W, French J.

    Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Massachusetts, USA. xbwang@bu.edu

    OBJECTIVE: To examine rates of conception and pregnancy loss and their relations with time to clinical pregnancy and reproductive outcomes. DESIGN: A prospective observational study. SETTING: Population-based cohort in China. PATIENT(S): Five hundred eighteen healthy newly married women who intended to conceive. Upon stopping contraception, daily records of vaginal bleeding and daily first-morning urine specimens were obtained for < or =1 year or until a clinical pregnancy was achieved. Daily urinary hCG was assayed to detect early pregnancy loss (EPL). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Conception, pregnancy loss, and time to clinical pregnancy. RESULT(S): The conception rate per cycle was 40% over the first 12 months. Of the 618 detectable conceptions, 49 (7.9%) ended in clinical spontaneous abortion, and 152 (24.6%) in EPL. Early pregnancy loss was detected in 14% of all the cycles without clinically recognized pregnancy, but the frequencies were lower among women with delayed time to clinical pregnancy. Early pregnancy loss in the preceding cycle was associated with increased odds of conception (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.8-3.9), clinical pregnancy (OR, 2.0; 95% CI, 1.3-3.0), and EPL (OR, 2.4; 95% CI, 1.4-4.2) but was not associated with spontaneous abortion, low birth weight, or preterm birth in the subsequent cycle. CONCLUSION(S): We demonstrated substantial EPL in the non-clinically pregnant cycles and a positive relation between EPL and subsequent fertility.

    PMID: 12620443 [PubMed - indexed for MEDLINE]"

    Additionally…some evidence indicates that spontaneous abortins happen in a context of non-normal hormone levesl….so the hormone-cancer issue is less of a plausible phenomenon in spontaneous abortions….

    "Br J Obstet Gynaecol. 1976 Aug;83(8):640-4.

    HCG, HPL, oestradiol, progesterone and AFP in serum in patients with threatened abortion.
    Kunz J, Keller PJ.

    The predictive value of various biochemical methods for monitoring early risk pregnancies has been compared in 65 cases of threatened abortion. Estimation of human chorionic gonadotropin (HCG), human placental lactogen (HPL), progesterone, oestradiol and alpha-fetoprotein (AFP) in serum were made by radioimmunoassays. Values below the normal range predicted abortion in 79, 81, 89, 92 and 38 per cent of patients, while normal values confirmed continuation of pregnancy with an accuracy of 71, 61, 60, 68 and 30 per cent respectively. Thus predictions from oestradiol and progesterone were at least as reliable as those from the protein hormones, while AFP proved to be unsuitable for this purpose. Combination of two variables gave even more reliable results. Due to individual and diurnal variation, however, abortion in the third and fourth month could not be definitely assumed at values above 5 IU HCG/ml, 5 ng progesterone/ml or 200 pg oestradiol/ml."

    So, in sum, if abortions do contribute to breast cancer to some degree by this developmental phenomenon, it is likely the case for voluntary abortions, and not much of a case for spontaneous abortions, where the hormone profile is different.

  28. micheleinmichigan says:

    Alison, I am sorry about you friend, 33 is too young.

    I think that we are talking about the same tendency but looking at it from different perspectives. Glass half empty, glass half full. I will say that most people don’t seem to have the perception that cancer is 100% preventable today. But, sometimes I get the sense that they think, if we knew more about environment, prevention, etc that we wouldn’t get cancer. Which was enough to make me relate to Dr. H.’s comment.

    I actually don’t think I’ve pressed anybody on the issue, though, so I’m not sure what they’d say in the end. And I do have some pretty odd friends and family, so I’m not sure that their response would be representative of the general public anyway. :)

    As an off topic aside- “You have probably had the experience of people helpfully suggesting easy fixes to make your child’s hearing/ speaking/ eating/ breathing difficulties just go away.”

    I know what you mean, but I can’t recall getting recommendations from lay people. They sometimes like to say “Oh, they can fix those sort of things so easily these days.” Which sometimes feels a little dismissive of my sons experience. I mean, define easy. But actually, it’s the most appropriate comment that I can think of without getting into a long conversation about surgical procedures, therapies, etc. So the lesson is, if you’re going to have a congenital difference, make sure it’s one with good press like cleft lip and palate. That way no lay people will bother you with advice. :)

  29. Apteryx said: “If you respect the claim of this website to be about SCIENCE-based medicine, you had better back up your allegation by citing an epidemiological study in a peer-reviewed mainstream journal.”

    Just one?

  30. rosemary says:

    Edgar, “that is exactly what is needed when we speak about ‘they.’”

    Were you referring to the HuffPo article? If so, did the define “they”? I didn’t see it. I did see this though, “in fact, a newly emerging consensus holds that 90 percent of cancers are rooted in environmental or behavioral causes.” But I admit that I didn’t read the article. A glance was too disturbing.

    There is an entire industry, the alt. med. industry, built on the concept or belief that the right lifestyle prevents disease and promotes health. Yes, I know that is a very broad generalization. And no I don’t have a reference. Neither have I done a study, but IMO, the evidence is as obvious as the nose on my face. Lillyum mentioned some of it.

    Visit a health fraud store. Notice all the customers. Look at all the products they promote and sell because they are supposed to offer health benefits – organic, whole and local food. Vegetarian diets, whole grains, “natural” everything, different kinds of exercise like yoga and Pilates. Supplements. Avoidance of “chemicals”. All of which are to be incorporated into a “healthy” lifestyle.

    Visit a gym. Listen to the runners in the park as they rest and sip their bottled water.

    Look at a newsstand and notice that there is an entire class of magazines called “lifestyle magazines” which promote diets, exercise, organics, naturals and supplements. I assume Prevention magazine is still out there although I haven’t looked for ages. It used to always be in waiting rooms in hospitals, doctors’ and dentists’ offices. I always thought that if they all pulled them and the other “lifestyle” and “women’s” magazines that they could have substantially improved the education, if not the health, of their patients.

    While those who practice scientific medicine, public health agencies and reputable health organizations state and promote many of the same things about diet and exercise, things based on available evidence, alt. medders, their organizations and the mainstream media go way beyond the evidence.

    While most people in western societies believe that “healthy” lifestyles prevent disease and promote health to varying degrees, many go way beyond what scientists believe the evidence shows although most don’t actually go to extremes in their practices, even though many do feel guilty about that and think that they will suffer later as a result. So they pop a supplement to get the vitamins and magic ingredients they missed when they had a Big Mac instead of a salad for lunch.

  31. JMB says:

    Alison,

    It was squirrelelite that posted the comment about miracle cure, not me. I was the one responsible for the lame story about grasping at straws falling on camels’ backs.

  32. BillyJoe says:

    BillyJoe: “I’d be wary though. I suspect Boris has something very unattractive waiting for you.”

    micheleinmichigan: “After I’m done sending the Nigerian Prince money, I’m going to check out Boris’ link.”

    I’ve never heard it called a link before.
    …and SHAME ON YOU!

  33. Rosemary, you are completely correct, IMHO.

    FWIW, here’s how another SBMer thinks about this issue:

    1. Cancer is many different diseases in the clinical and pathologic senses, but all cancers share this trait: they are clones. What this means is that they each consist of a population of cells descended from a single progenitor, itself characterized by a stable genetic difference (change) from its own progenitors, and thus from all the other cells in the body. (Note to David Gorski: yes, I realize that some cancers, such as cancer of the breast, are frequently ‘multifocal,’ meaning that there is likely to be more than one clone of cancerous cells in a breast that has cancer; that is beside the point here, for reasons that I hope are apparent).

    2. Therefore, every cancer results from a series of somatic mutations. We have known for decades that this must be true (based on the genetic stability of cancer cells even when transferred from animals to tissue cultures and back to animals, and the finding that carcinogens are mutagens); what is relatively new is that we are starting to discover just what genes those mutations affect.

    3. Genetic predispositions to certain cancers almost certainly are due to familial genes that already have mutations that are part of a “series” for certain cancers: thus if it takes, say, 6 mutations in a cell line for most people to develop a certain cancer, in some families it may take only 3-4, because 2-3 are already there (note that I have only a vague idea how many mutations are required for a particular cancer, but I’m guessing it must be more than 1 or 2—or everyone would get cancer at an early age, because somatic mutations aren’t particularly rare (don’t ask)—but not 10-15, because then no one would—remember, they must occur in the same cell line, and that would be prohibitively unlikely (again, don’t ask, ’cause I can’t prove it with data, but think of multiplying probabilities and consider that many, perhaps most mutations—although these are somatic, remember, not germ cell—are lethal)).

    3. The nature/nurture thing here is this: Nature is explained above. Nurture figures in that some mutations are caused by carcinogens (mutagens), but others are just random; so it ought to be possible, in theory, to improve one’s chances of not getting cancer by avoiding carcinogens, but never to the point of no chance at all.

    4. We know something, but by no means everything, about what those carcinogens are. Tobacco, asbestos, HPV, UV radiation, ionizing radiation, AIDS (Kaposi’s sarcoma) and a few others are epidemiologically compelling; only tobacco is associated with a common, usually deadly cancer. Some other environmental “toxins” are clearly mutagenic, and even at low concentrations undoubtedly cause a few mutations here and there in human cells. Whether those are causing excess cancers is still open to question, and not merely because of statistical noise. Part of the issue involves DNA repair: thus the occasional “bad” mutation caused by mutagens at low concentrations may be repaired promptly, whereas a flood of mutagen may overwhelm repair mechanisms. DNA repair itself, of course, is genetically programmed and thus subject to disrepair caused by…mutations. It is also complex, involving more than a single gene.

    5. In principle, there is no reason that there couldn’t be lifestyle interventions that would dramatically reduce the risk of cancers of any kind, by eliminating mutations other than those due to chance. This could be done (in principle) by avoiding carcinogens, by ingesting substances that render carcinogens non-carcinogenic, or both. Such substances might sequester carcinogens so that they are denied access to cell nuclei, for example, or change the chemical characteristics of carcinogens (or other molecules that are generated because of their presence) such as to render them no longer carcinogenic. That was the big hope for anti-oxidants such as vitamins E and C: they are free-radical “scavengers” (free radicals=highly mutagenic tiny molecules that are generated in the body from a variety of triggering sources, including radiation and many substances in the environment). That is why anti-oxidants were quite plausible a few years ago. The trouble is that studies so far have failed to reveal any that are useful, and some appear to do more harm than good.

    6. Conclusion: while in principle there ought to be lifestyle changes that could make a huge difference in the risk of getting any kind of cancer, even for genetically susceptible people, at this point we still don’t know what those lifestyle changes might be, other than the few implied above, a few recent innovations in “chemoprevention” (e.g., Tamoxifen to reduce the risk of breast cancer in some high-risk women), a few very difficult choices (prophylactic mastectomy in some highly susceptible women), and a few other risks, mainly occupational exposures, that are associated with very rare cancers.

    That’s because for most other common cancers we don’t know what substances in the environment, if any, are the culprits, nor have we yet found preventatives—food, supplements, medicine, or anything else—that convincingly work. It’s possible that within a few years there will be breakthroughs in prevention; it’s possible that within a few years it will become a non-issue, because there is also no reason, in principle, that we should not eventually figure out how to cure cancer after it has begun, and that might happen first. It’s also possible that neither of these things will happen for a long time.

    7. My advice: push hard for cancer research, especially at the most basic levels, and follow the news. Live your own life in moderation but don’t get obsessed about it: at this point there are a few simple precautions that you can take, you know what most of them are, a competent physician knows the rest (Tamoxifen, for example), and anything beyond them is speculation.

  34. BillyJoe says:

    Alison Cummins,

    “The article discusses both primary (Gardasil) and secondary prevention (colonoscopies, Pap smears)”

    Colonoscopies are usually primary prevention. If you have a family history of colon cancer you have regular colonoscopies to detect and remove the polyps which are a precursor of cancer.

    It could arguably be said that pap smears are also primary prevention, though it is “carcinoma in situ” that you are detecting (and treating before it becomes invasive) rather than a precancerous lesion.

  35. micheleinmichigan says:

    BillyJoe -

    LOL – What can I say, I’m married, not dead.

  36. Zoe237 says:

    I admit, I am fully convinced by Dr. Hall’s further evidence that “it is a popular belief that cancer is largely preventable.” What I am not convinced of is that cancer is NOT largely preventable (which is what I thought Dr. Hall was originally saying).

    I think that at this point, we just don’t know. Dr. Atwood’s comment was helpful. What I would like is some kind of roadmap for determining what is reasonable precautions and what is just woo. For example, antioxidants, BPA, BPDEs, vitamin D, and a long list of media reports that this or that is good for preventing cancer, or that arsenic is bad on swing sets, or flame retardant pajamas are bad for kids. It’s almost impossible to sort through everything we hear in the media, and pretty much everyday we hear some new way of preventing cancer. Obviously, a lot of it is unproven, but some may be reasonable precautions. I wish I had time to sort through it all. A lot of people just take a ton of supplements and think they are protected, but that’s not really my style.

  37. lkregula says:

    I’d like to point out, since organic and local foods were brought up, that not everyone buys organic or local for health benefits. Most people that I am aware of buy local and/or organic for the environment. Humans aren’t the only organisms that matter. As for whole grains, show me a study that concludes that whole grains and processed grains have the same nutrient content.

  38. weing says:

    “So, in sum, if abortions do contribute to breast cancer to some degree by this developmental phenomenon, it is likely the case for voluntary abortions, and not much of a case for spontaneous abortions, where the hormone profile is different.”

    I really don’t see how you came to this conclusion from those articles. Anyway, if your hypothesis is correct, your advice to teenage girls should be to get pregnant as early as possible or make sure they use the morning after pill.

  39. micheleinmichigan says:

    “As for whole grains, show me a study that concludes that whole grains and processed grains have the same nutrient content.”

    And show me a GI tract that doesn’t run smoother with whole grains. Well, don’t show me. But you know what I mean.

  40. JMB says:

    @weing

    Anyway, if your hypothesis is correct, your advice to teenage girls should be to get pregnant as early as possible or make sure they use the morning after pill.

    Another consequence of the research is that possibly we should evaluate hormonal therapy to simulate the changes in the breast that occur with the pregnancy/breast feeding cycle as a possible preventive measure of breast cancer. Such an intervention would be difficult to test because of the length of time required for an RCT (40 years). Acceptance of such intervention may also be low because of discomfort and cosmetic concerns in teenagers. Such an intervention might be more acceptable at age 30 and above.

  41. JMB says:

    IMHO, FWIW I would also like to add to Kimball Atwood’s model of cancer the following.

    1. Genetic mutations are far more common than we originally thought.
    2. Many are repaired and have no consequence.
    3. Many occur in genes that are not expressed (are in an inactive state) and are of no consequence unless something changes the cell’s activity.
    4. Many cancers we observe are the consequence of a typical pattern of mutations in certain genes in certain cells. The pattern emerges largely because of accumulation of random mutations, so many thousand mutations may occur before one occurs in the important codon of the gene. However, more active cell growth may be associated with greater occurrence of mutations, and more active expression of a gene may be associated with greater occurrence of mutations in that gene. We also know one nucleotide pair is more likely to result in replication errors, which is one type of mutation. I forgot which one.

    By the way, I thought my model of disease using the cargo plane and the camels was a pretty close approximation of the model. So I sacrificed good humor for the accuracy of the model.

  42. Wallace Sampson says:

    Zoe 237: Yes, credit Dr. Atwood for his clarifying analysis. But then why return to tryng to make sense out of conflicting third party press reports? The primary results are inaccurate enough as Dr. Hall and others pointed out.
    Reminds me of Bob Newhart’s SNL takeoff on his own TV psychologist show, but in which he now answers each patient conflict with the answer, “Then just stop it!” Funny, but rings true because despite rational reassurances, we still return to prior habits of thinking.

  43. rosemary says:

    lkregula, “I’d like to point out, since organic and local foods were brought up, that not everyone buys organic or local for health benefits. Most people that I am aware of buy local and/or organic for the environment.”

    I brought it up. Your statement doesn’t negate the fact that organic and locally grown foods are also promoted and bought for health benefits.

    Ikregula, “Humans aren’t the only organisms that matter.”

    I didn’t say that they were. I happen to be an animal lover who hasn’t eaten meat for about 30 years, because I love animals, not because I believe there are health benefits. I am not disturbed by others eating meat as long as animals are raised humanely. However, I also live in farm country, a lot of which is organic farm country, and I don’t think that animals raised on organic farms are always treated humanelyl either. I also like to have the poisons in my food identified. Organic farmers may abhor and avoid “chemicals”, but many use supplements and homeo remedies, not all of which are free of biologically active ingredients, completely unaware that some of the most toxic substances on earth were made by Old Mother Nature Herself.

    Iregula, “As for whole grains, show me a study that concludes that whole grains and processed grains have the same nutrient content.”

    That is exactly the way purveyors of a “healthy lifestyle” want us to think. They market whole grains as having health benefits superior to processed grains knowing that promoting health benefits or the prevention of disease will get a lot of consumers to buy them and that as a result of their marketing claims some consumers will decide that processed grains are bad for them and avoid them entirely or greatly limit the amount that they consume.

    I know very little about nutrition. From what I know, I believe that you are correct and that whole grains are the more nutritious. I’m also rather certain that the FDA advises including some whole grains in one’s daily diet although I have no idea how solid the evidence for the recommendation is. However, the point I am trying to make is that you have to look at one’s whole diet to see if one is getting the nutrients he requires in the correct amounts while consuming the correct number of calories to maintain but not exceed his ideal weight. I suspect that most or at least many people can easily do that while including processed grains in their diets.

    I also suspect that lots of people would be happier and feel much less stressed if they didn’t worry about how safe and nutritious each morsel they put in their mouths was supposed to be and simply enjoyed the taste as they followed the general guidelines recommended by reputable scientific bodies.

  44. By the way, I thought my model of disease using the cargo plane and the camels was a pretty close approximation of the model.

    JMB, you are absolutely correct, and I thought the same thing when I read your comment. I had intended to cite you but by the time I finished my own rather verbose comment I plum forgot. Sorry about that. :-)

    KA

  45. micheleinmichigan says:

    Rosemary – just my two cents on the whole grains issue.

    The fda recommendation for fiber is 25g.

    http://www.fda.gov/Food/LabelingNutrition/ConsumerInformation/UCM078889.htm#dvs

    Mayo clinic website says – “A slice of commercially prepared white bread has 66 calories, 1.9 grams protein and 0.6 grams fiber. A slice of whole-wheat bread has 69 calories and provides 3.6 grams protein and 1.9 grams fiber. It isn’t hard to see which one is the better nutritional bet.”
    http://www.mayoclinic.com/health/whole-grains/NU00204

    Caloriewise I think that’s very low. Bread I usual buy is about 90 to 120 calories. Whole grain bread is often 2 to 3 (or more) grams fiber vs white 1gm or less. If you are eating a diet of about 1400 – 1900 calories. It is going to be very difficult to get adequate fiber without whole grains unless you are eating LOTS of veggies, beans and fiber rich fruits. Of course some people do this, other’s not so much.

    Replacing (not adding) your grains with whole grain versions is a very good way to get the recommended fiber intake. A side benefit for people who have to watch their calorie intake (Like me) is that higher fiber is often more filling, so you are satisfied with less.

    This is what both my daughter’s pediatrician and my husbands doctor have told us.

    For me, it’s not something I have to worry about. I just buy %100 whole wheat pasta, crackers, bread, and grains. The products I buy cost the same as the white version, but I’m getting more fiber for my money. Brown rice is a drag. (too long to cook). But whole wheat coucous is a good substitute. If I have a yen for white rice, pizza or a nice brioche, I don’t get bent that it’s white grain, flour, either.

    Of course, I’m sure people have other tastes and have perfectly good approaches too, but I am happy that most grain products in stores now do have whole grain options these days. Otherwise it would be very difficult for me to shop for my daughter and husband’s dietary needs.

    only IMO of course.

  46. lkregula says:

    Rosemary, I was simply trying to point out that environmental reasons for buying organic/local are a factor as well, and I’ve seen far too many people on this site lumping organic/local food in with CAM, when I just don’t think it’s an appropriate categorization. Not saying that you were doing that, it’s just a pattern that I’ve noticed. To be completely honest, I can’t remember the last time I bought something organic/local thinking “Hey, this is going to be so much better for me than conventional” and that’s how most of the people I know think of the subject- in terms of ecology not medicine. Of course their are some hypocrites in organic/local food circles, but I bet there are also people that are big advocates of SBM that religiously use anti-microbial products. Every group has their hypocrites; humans aren’t 100% rational 100% of the time.

  47. micheleinmichigan says:

    “I’ve seen far too many people on this site lumping organic/local food in with CAM,”

    Yes, I have noticed the same. I’m happy, I haven’t seen it in the articles, only the comments, though.

  48. squirrelelite says:

    Alison and JMB,

    It’s OK. It’s good to know that someone is reading what I wrote.

    Also, JMB, I liked your version of the camel and straw story. Not exactly tradtional, but it did illustrate the point.

    On the fiber question, I try to slip a little extra fiber in wherever I can. For instance, I try to eat bran flakes for breakfast, used some whole wheat flour to make the Irish Soda Bread a few days ago and have used whole wheat pastas for a few pasta dishes we made recently. Overall, we liked the results and they seemed satisfactory for my wife, who is diabetic.

    Since she is diabetic, we look closely at the sugar content of most foods we buy (one reason we generally avoid “lite” products) and try for a little more fiber with less sugar at not too much extra cost.

    I suppose we could try the approach of a popular high fiber cereal which touts in its ads that it doesn’t have cellulose (wood fiber) in it! Well, yes. When I checked they had changed the cellulose to cellulose gum! OK, it’s different but is it better?!?!?

    Our approach is more pragmatic and workable so we stick with it.

    On the calories in bread question, I remember from some of my recent shopping expeditions that some of the specialty breads that have more fiber are also cut into more massive (denser or bigger or both) slices, so they also have more calories. Calories per gram is the key.

    A quick check in my kitchen showed that whole wheat and regular bread flour both have 30g in a 1/4 cup serving for 100 cal. But, the whole wheat flour also had 3 g of fiber. That is 3.3 cal per gram. The soy flour we have only had 23 g in a 1/4 cup, but it 4 g of fiber and 3 more g of protein. But, those 23 g had 100 cal (just over 4 cal per g), so if you eat the same mass of soy flour, you’ll get more calories along with the extra flour.

    A slice of wheat bread we have had 26 g for 70 cal. I suspect the drop in calories was because the number 2 ingredient was water!

    In general, I second Rosemary’s advice and try to be aware of the general guidelines, at least those of the more reputable scientific bodies, but not worry too much about how safe and nutritious each morsel I put in my mouth is (provided it’s safe enough for my wife) and enjoy the taste! I do like food.

  49. rosemary says:

    lkregul, “I was simply trying to point out that environmental reasons for buying organic/local are a factor as well, and I’ve seen far too many people on this site lumping organic/local food in with CAM, when I just don’t think it’s an appropriate categorization.

    Ikregul, you have noticed that pattern because organic food and dietary supplements are both components of the “natural product” industry. They are represented by the same trade group, have the same lobbyists, use the same marketing techniques, sell products from the same market places. They are all usually sold or at the very least promoted by those who practice, sell and use CAM.

    http://www.npainfo.org/index.php?src=gendocs&ref=AboutNPA&category=About
    QUOTE:
    What are natural products?
Natural products are represented by a wide array of consumer goods that continue to grow in popularity each year. These products include natural and organic foods, dietary supplements, pet foods, health and beauty products, “green” cleaning supplies and more. Generally, natural products are considered those formulated without artificial ingredients and that are minimally processed.
    snip
    Natural products consumers are often motivated not only by their own health, but making buying choices that lead to sustainability of the environment
    END QUOTE.

    Do you know what they are doing with pet food? One of the vets could write an article on that. Heard about the natural, raw, frozen organic diet for dogs? They are trying to promote it for cats but having some difficulty since cats won’t eat it. Now they are freeze drying raw organic for dogs because some finicky owners don’t like handling the other kind. (I’ve seen this first hand and read about it with statistics in pet trade magazines. It is CAM.)

    Andrew Weil has opened a restaurant that serves organic fruits and vegetables.
    http://www.drweil.com/drw/u/ART03004/True-Food-Kitchen.html

    Look at the organic food he promotes on his website.
    http://www.drweilproducts.com/drw/ecs/healthy_foods/index.html

    Am I saying that because alts and the alt industry promote and sell organic food that it is bad or doesn’t offer benefits? Of course not. I am saying that I haven’t investigated it myself, but I am very suspicious about the claims and will not believe them until I see solid evidence demonstrating that they are correct.

    A quick google came up with this:
    http://www.nature.com/nature/journal/v428/n6985/full/428796a.html
    (Daedalus2u, it mentions NO.)
    If it is correct, the evidence available now doesn’t sound as if it demonstrates that organics offer substanital benefits to humans who eat them or to the environment. However, without actually reviewing the entire body of evidence, I have no idea if that is true. The site does state,
    “At the core of the organic philosophy lies a ban on the use of synthetic fertilizers, pesticides and herbicides.” That is exactly how alts I know promote it implying that “chemicals” are bad for you and the environment. Even Nestle who sounds very reliable to me says that more pesticides are found in the bodies of people who eat conventional foods than organics and she thinks that is a good reason to eat organics. I don’t because toxins are species specific and dose related and I’m not aware of harm to humans caused by “chemicals” that fall within accepted government standards and I’m not sure how much other creatures are harmed or how easy that harm is to eliminate while using conventional farming techniques.

  50. rosemary says:

    micheleinmichigan, “Mayo clinic website says – “A slice of commercially prepared white bread has 66 calories, 1.9 grams protein and 0.6 grams fiber. A slice of whole-wheat bread has 69 calories and provides 3.6 grams protein and 1.9 grams fiber. It isn’t hard to see which one is the better nutritional bet.”
http://www.mayoclinic.com/health/whole-grains/NU00204

    Michele, I don’t think they are recommending whole grain for fiber content. A quick look in the fridge showed that 3/4 c green beans (always called string beans where I grew up) contains 20 cal and 3 g dietary fiber. I think it is the minerals in the whole grain that they are recommending, but I don’t have a clue how strong the evidence is.

    First, let me stress that this is not intended to be a scientific discourse. Admittedly I know little about nutrition but one of the things I do know is that it is exceedingly difficult to do good studies on the value of nutrients in the human diet because it is impossible to control all the variables sufficiently. Regarding label claims, how health claims sell food and how the food industry has repeatedly sued and won cases against the FDA that let them put claims on labels that the FDA rejected see What To Eat by Marion Nestle p. 342. Also look at what she says about the labels on “whole grain” products.

    I like the taste of bread, but not the supermarket kind. Many years ago when I lived in Spain, I went looking for whole grain bread and finally found a bakery or bread shop in Barcelona that sold it. As far as I remember, the Spanish diet didn’t include whole grains. It was based on vegetables, fruits, fish, some white rice maybe. People ate bread for breakfast and always with meals, but it was the kind of bread Americans call “French” or “Italian” bread and they never put anything on it. They ate it dry. That is the way I remember the diet in northern Italy too where I went to school also many years ago. The staple there was white rice, not pasta. I never noticed any ill effects. (Let me repeat this is not a scientific discussion just observations from a very old memory. However, I think they are relevant.)

  51. rosemary says:

    lkregula, regarding locally grown food, from a practical point of view alone, what does it imply? I live in Vermont on the Canadian border. The variety of food that can be grown outdoors here is limited. What are we supposed to give up? Oranges? Can we get all our nutritional requirements consuming just locally grown food and beverages? Or is that going to a ridiculous extreme? If so, what portion of our diet should we find locally? My guess is that it would be small and not have a big impact on the environment.

    In the summer lots of people, even those who aren’t farmers, grow their own food. In fact they usually grow too much and have trouble giving it away. In winter because it is such a rural area the variety of fresh fruits and vegetables in the grocery stores is limited.

  52. lkregula says:

    Rosemary, there’s extremes either way, local or imported. I’ve always taken local to be what you personally are comfortably with, and being a bit more reasonable than grocery stores are. Being in Ohio, I don’t buy strawberries in winter because they’re all from California or farther. Instead, I freeze some from our farmer’s market when they’re in season, and grab those frozen bags in December when I want a treat. When I’m shopping for salad greens, I go to the local co-op where they carry greens grown locally instead of getting the boxes of greens from the Giant Eagle that come from Mexico. The flour I get all comes from a mill less than fifty miles away. For sweetener, I’ve switched to maple syrup and honey instead of cane sugar because I can get those items from my back yard (essentially). If you calculate differences, it actually does make a big difference. I wrote up a brochure about local food for the Kent Environmental Council last year, and for one day eating all local (defined as within 100 miles) as compared with regular grocery products, the total food miles went from 761 miles for the entire day’s foods locally produced to over 10,000 miles for the grocery items. I’d say that’s a big difference.

  53. lkregula says:

    Rosemary, other than Nature, the sites that you linked to are not ones that I would consider reputable, so take what they say with a grain of salt. Or a pound might be more appropriate. I do take issue with Nature’s assertion that “At the core of the organic philosophy lies a ban on the use of synthetic fertilizers, pesticides and herbicides.” I’d say that at the heart of the organic philosophy lies the goal of moving food resources in the direction of less detrimental to the environment and more suitable for long-term sustainability. Bans aren’t always effective (look at Prohibition), and aren’t always necessary if there’s no market for a product anymore.
    I’ll admit it’s a biased sample (I’m an ecologist and active in environmental organizations), but I’ll repeat- I don’t know many people who actually think that conventional food is poison or something along those lines, they look at it as an environmental issue. Many of the chemicals used in farming have significant problems for organisms in the environment. Atrazine (common conventional farming chemical) is linked with malformations in tadpoles, not directly, but through larger scale community interactions. DDT caused all kinds of problems for predatory birds. Pesticide-resistant invasive plants have started showing up thanks to the agricultural use rate providing a selective pressure.

  54. micheleinmichigan says:

    Rosemary – I see where you are coming from. I think there are a huge variety of healthy diets. I’m guessing Mediterranean diets are so healthy because of the number of beans and veggies involved.

    With our doctors’ recommendations the primary reason for whole grains was to increase the fiber intake. It’s either replacing a good amount of processed with whole grain OR drink even more Metamucil type stuff. Since I general buy store bread, crackers, pastas, the whole grain was the obvious way to go, easier. For me, I find the taste better. I like the nutty quality.

    My only point is that just because a brand is touting some current health trend, does not automatically make it useless. It may not be the only necessary route, but it’s a good route for us and I appreciate that it’s available.

  55. Rosemary – “you have noticed that pattern because organic food and dietary supplements are both components of the “natural product” industry. They are represented by the same trade group, have the same lobbyists, use the same marketing techniques, sell products from the same market places. They are all usually sold or at the very least promoted by those who practice, sell and use CAM.”

    This is like saying that every business is represented by the Chamber of Commerce, or every doctor agrees with and is controlled by the AMA. I just don’t believe that you can discount a whole industry because of their association with a particular lobbying group.

    “but I am very suspicious about the claims and will not believe them until I see solid evidence demonstrating that they are correct.”

    This sounds better to me. I’m generally suspicious of ALL claims, whether it be the organic, natural or traditional food industry. I mean, is it really “New and Improved”?

    But I do not think that it is accurate to group a farmer who is interested in preserving heirloom tomato species, using compost instead of industrial fertilizer and cutting back on pesticide use with a CAM practitioner who encourages alternative cancer therapies or energy healing.

    I think SBM encourages the use of discrete, precise thinking. I do not think that such a big generalization is useful in my decision making.

  56. squirrelelite – thanks for the fiber, calorie, gram run down.

    I will admit that I am much sloppier than that. For bread, I generally go by slice (if that info is available) since I know I will eat the whole slice. Pastas, Grains, etc I go by a loose, 8 oz = 1 cup. I know it’s not the best, but it seems to work for me.

    I also agree with both you and Rosemary. Primary importance for me is to eat the foods I can really relish. My MIL is endlessly experimenting with no-fat/low fat muffins. They are completely flavorless. I’d rather have a little muffin with a big flavor than vice versa.

  57. rosemary says:

    Michele, “My only point is that just because a brand is touting some current health trend, does not automatically make it useless.”

    I didn’t say that it did. I was trying to explain that health claims sell products and that they cannot simply be believed because it is assumed that if they were not accurate that the FDA would prohibit them. I referred you to Marion Nestle’s book, What To Eat. Since you probably don’t have a copy, let me quote. On p 343 she explains how in 1984 Kellogg got around FDA health claim restrictions for All-Bran cereal by working directly with the National Cancer Institute and that by stating, “The National Cancer Institute believes eating the right foods may reduce your risk of cancer. Here are their recommendations: Eat high fiber foods. A growing body of evidence says high fiber foods are important to good health. That’s why a healthy diet includes high fiber foods like bran cereals.” Nestle goes on to say that that claim, which IMO is very nebulous and wouldn’t lead me to any conclusion about the benefits of the product, resulted in a 47% increase All-Bran’s market share within six months. I believe that that evidence very clearly indicates that health claims most definitely sell products which, if I remember correctly, is a point commenters claimed that Dr. Hall stated without presenting evidence to substantiate it.

    Nestle goes on to explain how the industry challenged the FDA by filing lawsuits whenever the agency rejected their claims and the industry usually won. IMO, that is further evidence that the industry knows very well that health claims sell products.

  58. rosemary says:

    Michele, “But I do not think that it is accurate to group a farmer who is interested in preserving heirloom tomato species, using compost instead of industrial fertilizer and cutting back on pesticide use with a CAM practitioner who encourages alternative cancer therapies or energy healing.”

    Not only did I not group that farmer with CAM practitioners, but based on how you describe him in that paragraph I would not necessarily even consider him an organic farmer.

    Michele, “I just don’t believe that you can discount a whole industry because of their association with a particular lobbying group.”

    Perhaps I have a more intimate knowledge of the supplement and natural/organic food industry than you do. IMO, it is as bad as the tobacco industry ever was. And yes, I have the evidence. For starters check my webpage, not just the part on silver and argyria.
    http://rosemaryjacobs.com

  59. rosemary says:

    lkregula, “Rosemary, other than Nature, the sites that you linked to are not ones that I would consider reputable, so take what they say with a grain of salt.”

    Ikregula, the Nature site is the only site that looked scientific and IMO it did not present conclusive evidence showing that organic farming offers benefits to individuals who consume organic products or to the environment. I realize that doesn’t mean that convincing evidence will not eventually be produced or that one article alone accurately presents the entire body of the evidence.

    While you may not consider the other sites I linked to reputable, they are industry sites which, whether or not you consider them reputable or not, demonstrate that the same industry, the natural products industry, and the same people who promote CAM, Weil, promote and sell natural and organic food and that they do so by making claims of health benefits to individuals as well as to the environment. Actually, can anyone imagine Weil opening a restaurant that didn’t serve organic? I can’t simply because so many consumers equate organic food with healthy and safe (as opposed to dangerous or containing chemicals) and Weil is trying to brand himself as Dr. Wellness.

    While you may take issue with the Nature statement, “At the core of the organic philosophy lies a ban on the use of synthetic fertilizers, pesticides and herbicides,” I think it goes a long way in showing that all the people and publications that I’ve told you about who promote organic food for those reasons are not necessarily exceptions to the rule, but rather that those beliefs are at the very least held by a great many proponents of natural and organic.

    Ever heard of “functional food”? That is sold along with natural, organic and supplements and also promoted with health claims. Many contain supplements. According to Nestle, p. 478, “If you routinely buy such foods, you are among that select group of customers the health food business calls LOHAS (Lifestyles of Health and Sustainability). If you are LOHAS, you buy…practically anything with a health claim. This makes you part of the health food industry’s cherished demographic base. You may be choosing these foods for reasons of health, but this industry views your health concerns as a business opportunity.”

    If you still have doubts about the fact that there is a big industry out there pushing natural and organic and CAM all at the same time to the same customer, look at the “holistic” pet food market. Unlike humans, it is relatively easy to do good studies on nutrition in animals, but as far as I know, the industry hasn’t done them yet with these products although that hasn’t prevented them from making claims about how well their products benefit dogs and cats or how bad conventional pet food is.

  60. yeahsurewhatever says:

    Again I have to go on record and state that it is absolutely not the case that the data are always right. To believe so is a serious epistemological mistake. If the data were always right then it would be trivial to accrue it all generations beforehand and never bother to conduct another experiment again.

    The process of science is the optimal matching of model to data, but the extent to which data match reality is only ever imperfect. Data have a quality associated with them. Determining the reliability of data — particularly in aggregate — is at least as much an art as a science. This is why people are generally so bad at it, and why Cochrane has such a high reputation. It is a non-trivial task, and is currently the rate-limiting step in quite a lot of otherwise unrelated human endeavors.

    What you mean the say is that the data are the final arbiter, not that the data are always right. Huge difference. To equate the two statements is to believe in a sort of omnipotence among scientists, and to propagate the myth that science is free of error, methodological flaws, half-baked logic, or fraud. The endeavor of science is to be increasingly more accurate in describing facets of empirical reality. To say that the data are always right essentially is to state that this job is already done.

  61. lkregula says:

    “Not only did I not group that farmer with CAM practitioners, but based on how you describe him in that paragraph I would not necessarily even consider him an organic farmer.”

    “IMO, it is as bad as the tobacco industry ever was. ”

    I would argue that you’re defining “organic” in such a way as to justify lumping organic farming and the supplement industry. The supplement industry definitely deserves serious scrutiny and better regulation; organic farming is actually suffering from too much bad regulation (e.g. the prohibitive cost of certification means many small family farms that practice organic farming can’t become certified and benefit from the added cost of organic food, while organic certification for meat/dairy is almost meaningless thanks to the 2004 amendments allowing the feeding of conventional feed without risk of loosing certification). When you make categorizations to suit your own preconceptions, you discredit yourself as much or more than you do the groups you’re speaking against. Can you point to a part of your website that speaks about organic not in conjunction with supplements? I thought that you’re seemed well informed on supplements, but the way you insist on lumping organics and supplements is starting to make you seem much more one sided and looking to justify your own conclusions.

  62. lkregula says:

    “I think it goes a long way in showing that all the people and publications that I’ve told you about who promote organic food for those reasons are not necessarily exceptions to the rule, but rather that those beliefs are at the very least held by a great many proponents of natural and organic.”

    Yes, all the people and publications you’ve pointed out hold those beliefs, but that hasn’t been my experience. I’m not quite sure 1) why you’re so hung up on organic as this monolithic, heterogeneous group, when in fact it’s far from that, and 2) why you insist on throwing an industry that is concerned with food production methods in the same pot as an industry based on pill sales. I fail to see the connection.

  63. lkregula says:

    Gah, meant “homogeneous group” not “heterogeneous group” in the above post. Four year old is winning today.

  64. JMB says:

    A note of thanks to Kimball Atwood. To really complete my analogy, and address some other comments, I should add that some of those falling straws will prove to be heavier (when we get better measures), some of those falling straws will combine with other straws (interactions) to form hay bales or even 1 ton packages, and if the camels dodge those 1 ton packages when they land, they might find some provisions in those packages that will strengthen them. The only one I know of that combines to a 1 ton package is asbestos exposure and cigarette smoking. The only other thing to complete the analogy is that the guy on the hill sitting under the shade of ivy writes a book, and moves away from the desert to the coast on the profits from selling the book.

    To yeahsurewhatever, I would agree with you wholeheartedly, with one small exception. I think the Cochrane Collaboration accepts the implied model from experimental design and statistical inference too blindly. This is where SBM can improve on EBM. By focusing more on what the experimental design is testing, based on our scientific concepts of disease, and by focusing more on the strength of the statistical analysis, the frequency of revision of our scientific consensus in medical science will decrease. It is embarrassing to have 50% of what we hold as a scientific consensus turned over every 10 years (although nowadays, it may have improved to 15 years).

  65. rosemary

    IMO, it is as bad as the tobacco industry ever was. And yes, I have the evidence…

    So calcium supplements = cigarettes? hm.

    Well, for me, I think this is a discussion for another thread where organic foods or nutritional supplements are more on topic. I think I will bow out.

  66. squirrelelite says:

    I agree with michelleinmichigan that when this thread has completely shifted from a discussion of the interplay between our underlying scientific understanding of the causes and mechanisms of disease and the way in which we diagnose and treat those diseases into a back and forth discussion of the pros and cons of organic farming, it may be best to just drop it and wait for a more germane subject.

    Nevertheless, since I was thinking about talking about it in my last comment but deliberately restrained myself and the subject goes on, I guess I will put my two bits worth in for the benefit of our surviving readers.

    For a short summary of the benefits or lack thereof of organic agriculture, I suggest Brian Dunning’s Skeptoid podcast from last year:

    http://skeptoid.com/episodes/4166#

    As Brian says a few paragraphs down,

    “I want to stress that I am not opposed to organic food. It is generally a perfectly fine product. I do have objections to the way it’s marketed: It’s an identical product, sold at a premium, justified by baseless alarmism about standard food.”

    That pretty well mirrors my own thoughts. I used organic whole wheat spaghetti to make our lunch last Sunday. I bought it because I was looking for whole wheat spaghetti and it was on sale. It just happened to be organic as well.

    Organic food is marketed and sold as if it were a certified guarantee that the food is more nutritious, safer or at least more free from contaminants, and better for the environment. Unfortunately, I have yet to see or even read about any good studies that really support any of those claims.

    So, without convincing evidence to the contrary, it seems unlikely that organically grown plants or animals are nutritionally different from their conventional cousins.

    Also, since organic agriculture typically uses an extremely complex mixture of organic chemicals, both dead and alive ones, for fertilizer instead the two or three purified chemicals that the plants will extract for themselves and really need, it is unlikely that organic produce has a contamination advantage over conventional produce.

    On the environment/energy issue (I treat them as one because they are so intertwined), you need the answers to many questions to do the analysis to get an answer and that answer will vary from place to place and year to year.

    For instance, on the energy side, how much fuel did you burn to run the tractor(s) to work your farm? How much energy did it take to transport the crude oil to the refinery, refine it into a usable fuel, and transport that fuel to your farm for your tractor?

    On the fertilizer side, is it better to raise cows (which are a methane producer) to get your fertilizer or to use a chemical process to combine nitrogen from the atmosphere with hydrogen and then add that to rock phosphate and potassium?

    Also on the environmental point, since organic farming typically produces less yield per acre than conventional farming and many of those acres are made available by cutting down forests in Latin America, Africa and Asia; organic farming will require cutting down more acres of forest to raise the same amount of food to feed the same people.

    I don’t know if there are definitive answers to these questions and don’t expect that we will come up with them soon. I think Harry Potter’s comment to Hermione Granger in The Order of the Phoenix sums it up pretty well: “whatever this is, it’s not simple!”

    I prefer to keep my concerns and evaluations of organic food separate from my concerns and evaluations of most CAM modalities because the questions, issues, and sources of information for the two are different.

    But, the uncritical thought process which leads one group of people to accept the claims for organic food at face value without thinking about the tricky questions or the real evidence are the same uncritical thought processes used by the group of people who accept the claims for natural medicines, wellness promoting supplements, and many other CAM treatments.

    And, I think, just based on my personal observations, that there is significant overlap among the people in those two groups.

  67. lkregula says:

    Squirrelelite, thanks for the link to that podcast. The actual podcast has quite a few flaws (like the ocean as the ultimate destination in a cycle discussion) but the comments address many of those very well. As you can guess, I agree more with his commenters than his post.

  68. rosemary says:

    yeahsurewhatever, “Again I have to go on record and state that it is absolutely not the case that the data are always right.”

    If you are speaking to me, I don’t know what you are talking about. I’ve never maintained that data, which I presume you mean to be results from tests, are always right.

    Michele, “So calcium supplements = cigarettes? hm.”

    No. Lying to sell dangerous products which rob, injure and kill people is what I had in mind.”

    lkregul, “I would argue that you’re defining “organic” in such a way as to justify lumping organic farming and the supplement industry.”
    I’m sorry. I don’t understand. This is your field not mine. Doesn’t the USDA set the rules and have an Organic Certification program?
    Does that program accept people who in Michele’s example want to “cut back on pesticide use”? In other words will they certify someone who intends to use some pesticides? Are there any organic organizations you know of that permit that? How about unaffiliated individuals who consider themselves organic farmers? Of course, I assume that Michele meant synthetic pesticides, but perhaps I was mistaken.

    I do not mention organic farming on my website. I address the widely held erroneous belief that “natural” is good and “synthetic”is bad, mantras used to market supplements and organic food and which target the same consumers.

    Here,
    http://www.webanstrich.de/rosemary/comment_cdsl.html
    “What does concern me is the big marketing campaign aimed at convincing people that natural is safe and synthetic is dangerous.”
    http://www.webanstrich.de/rosemary/naturaldyes.html
    “Contrary to the popular current belief that all things natural are safe and marvelous, many natural dyes are toxic and cannot be safely produced by craftspeople where food is prepared or disposed of near a source of drinking water.”
    http://www.webanstrich.de/rosemary/grannysmeds.html

    lkregula, “Yes, all the people and publications you’ve pointed out hold those beliefs, but that hasn’t been my experience.”

    I have obviously hit a nerve. Sorry about that. However, you have repeated several times that the people you know who promote organic farming do not hold the same beliefs as those that I know or the ones whose links I have provided. If you want to convince me that your experience is typical and that those I speak of are the exceptions, you will have to provide more than your personal experience. You also seem to be saying that those who hold the USDA’s organic certificate are only a small part of those who are organic farmers. Is that true? Is that what you believe?

    Ikregula, “why you insist on throwing an industry that is concerned with food production methods in the same pot as an industry based on pill sales. I fail to see the connection.”

    I suggest you start reading trade magazines or at least Marion Nestle. If you do, you might just come to the same conclusions that I have that both industries are big businesses in the business of making money any legal way they can and that if they can get away with making false health claims that they will, even if those claims wind up hurting people and animals.

    I suspect that the natural products industry including supplements, naturals and organics started out with little people who believed in the benefits of their products and who were really altruistic and concerned about the environment and human beings, but I think that MBAs and marketing gurus noticed what a goldmine they had created, grabbed onto their beliefs and products and repackaged and sold them in the mainstream market. I have no good evidence for that. It is just my opinion.

  69. Zoe237 says:

    Wallace Sampson:


    Zoe237: Yes, credit Dr. Atwood for his clarifying analysis. But then why return to tryng to make sense out of conflicting third party press reports? The primary results are inaccurate enough as Dr. Hall and others pointed out.
    Reminds me of Bob Newhart’s SNL takeoff on his own TV psychologist show, but in which he now answers each patient conflict with the answer, “Then just stop it!” Funny, but rings true because despite rational reassurances, we
    still return to prior habits of thinking.

    Um, not sure where you’re going with this. Dr. Atwood mentioned that there were reasonable precautions that can be taken. What are those precautions or how can I figure them out? How about a road map? Or a balanced secondary website? I do sometimes go to the primary source… the medical journal in question, but I can’t do that for every subject that gets reported on. I also listen to NPR/BBC a lot and read several national/world newspapers, and I refuse to just stop reading the news (as many friends have done) to avoid intellectual conflict!

    As for the organic/whole grains/locavore debate, I wish it was one I had time to get into. No, organic food MAY not be more nutritious, and natural, possibly dangerous pesticides are used in some organic farming, but assuredly organic farming it better, for example, the migrant farm worker and the local water supply.

    One of the Union of Concerned Scientists top rules for environmentally conscious people was to avoid or reduce meat consumption, but the farming lobby hates that. The Michigan governor recently got in a load of trouble for declaring last saturday “meatout” day.

    I do have a hard time with the typical organic “Whole Foods” shopper who buys organic blueberries in December shipped from South America as opposed to the shopper who buys conventional blueberries from a local small farmer in August and freezes them for the winter. As for whole grains, my middle daughter has no trouble with constipation as long as she gets a piece of whole wheat bread every day and we avoid supplements for this problem. ;-) If anybody has read Michael Pollan, even though big Ag loves to hate him, one of his “food rules” is to avoid any product that makes health claims.

  70. lkregula says:

    “Doesn’t the USDA set the rules and have an Organic Certification program?”

    Yes, the USDA has a certification program, which is extremely costly and many people just simply choose not to participate in because they can’t afford to. You live in a rural area, have you talked to the farmers about what it would cost them to become certified? Here’s a start- $3K for the testing alone, more fees for the application process, and a minimum three year wash out period during which no chemicals can be used but you can’t use the organic label. If during testing, any of the unapproved chemicals show up, you have to do another three years of wash out before you can retest, at another $3K in cost and however much in application fees, assuming those costs don’t go up in the interim. For a small family farm, that’s a big cost for a chance at a benefit, so many farmers are going the “know your farmer” route and abiding by the organic standards, being open with their customers, and trying to make a go of it. There’s almost no regulation on the supplement industry, as I’m sure you’re aware- so long as they have the “claim has not been evaluated by the FDA” statement, a supplement manufacturer can put frog-piss in a gel cap and say it cures cancer. I don’t think those two extremes belong in the same group. There are some chemicals that are allowed under the organic acts, but not many; mostly a reliance on integrated pest management and similar techniques.

    “I do not mention organic farming on my website. I address the widely held erroneous belief that “natural” is good and “synthetic”is bad, mantras used to market supplements and organic food and which target the same consumers.”

    That’s what I thought. If you’re talking about the big, huge, Kraft-organic types when you say “organic” then, sure, they’re going after the same customers as supplement sales people. That’s only one branch of organic. There’s the population of people that just want to use fewer chemicals and try to be a little less hard on the environment, and I think that’s a larger portion than you realize. Check out your county extension office or master gardener association and ask them how many inquiries they have about “organic” or “sustainable” agriculture/gardening techniques from individuals. I’m betting it’s a decent number. Those people are trying to live by the tenets of “organic” as well and they may even self-identify as “organic”.

    I think a big problem that we’re having has to do with organic practices versus the organic industry. Organic practices (what I’m talking about when I say “organic”) have been around since the seventies or earlier, and include agricultural, horticultural, economic (cost-savings by reducing chemicals used and bought), social justice (farm workers rights), conservation (biodiversity) and traditional/heritage foods influences. Somewhere along the line, marketing people deciding that they could easily say organic=healthy, and started the industry that is what you talk about when you say “organic”.

    I don’t focus on the health claims because I think they’re crap and I try to avoid marketing generally. You don’t focus on the rest of it because no one says that, for example, multi-level tropical crops produce better-for-you food.

    I will agree with you that it’s a gross over-simplification to say that natural=safe, synthetic=harmful, but again I look at a broader scope of organic, and just wish you would admit that the scope is broader than the limit you’ve imposed. Not everyone is concerned with organic practices because they’re scared that a conventionally grown tomato will give them cancer. You seem to insist that the only part of organic that exists is the part that you define as organic, the part that is concerned with natural=healthy.

    To start delving into non-health related organic issues, check out http://www.oeffa.org/12.php. Nutrition is listed as #3, and they don’t state that organic=more nutritious, they state that fresher=more nutritious. They do discuss the “purity” of food- or lack of chemicals that people are concerned about, but they simply state that “Eighty percent of American adults say they are concerned about the safety of the food they eat. They worry about residues of pesticides and fungicides. These materials are not permitted in an organic production system either before or after harvest.” OEFFA doesn’t say those chemicals are a hazard, simply stating if you want to avoid these chemicals, they’re not allowed in organic systems. The other ten reasons to buy local/organic don’t even address nutrition or safety concerns.

    “I suspect that the natural products industry including supplements, naturals and organics started out with little people who believed in the benefits of their products and who were really altruistic and concerned about the environment and human beings, but I think that MBAs and marketing gurus noticed what a goldmine they had created, grabbed onto their beliefs and products and repackaged and sold them in the mainstream market. I have no good evidence for that. It is just my opinion.”

    The last part I can totally agree with, although I don’t think the MBA’s have completely or even mostly taken over the idea; it’s more of a chimps and humans paradigm than an Ardi and us paradigm- one branch split off from the other and they both now exist, rather than one replaced the other. And yes, the MBA’s are the chimps.

  71. lkregula says:

    “If anybody has read Michael Pollan, even though big Ag loves to hate him, one of his “food rules” is to avoid any product that makes health claims.”

    Love Michael Pollan!

  72. I’m breaking my promise to bow out. :)

    Rosemary – “No. Lying to sell dangerous products which rob, injure and kill people is what I had in mind.”

    I think that most people can think of examples of drug companies, conventional food producers, automotive companies, chemical, petrol, etc that have lied to sell a dangerous products or lied about a harmful incident to protect their profit margin. Is this bad? sure. Does it mean that I can’t buy any of the above products? That would be very difficult.

    It’s difficult to believe that I’m being deceived by organic marketers because they are alarmist about chemical use, but then trust the commenter who is being alarmist about organic products.

    Actually, I buy very few organic products. But I have a problem with some of the arguments here presented as a con for organics.

    That people who use CAM often buy organic. – Guilt by association. If people who use CAM tend to ride their bike more, does that make bike riding questionable?

    squirrelelite said- “Also on the environmental point, since organic farming typically produces less yield per acre than conventional farming and many of those acres are made available by cutting down forests in Latin America, Africa and Asia; organic farming will require cutting down more acres of forest to raise the same amount of food to feed the same people.”

    Thanks for the link – Actually when I think of a good discussion of the pros or cons of organic food, your quote is what I think of. Just a discussion of the pros and cons without a bunch of rhetoric. And, like you, I do not see it as a primarily medical issue. It is agriculture, environment, econ and social all wrapped up in one.

    I’m interested, partly because I have a friend who works as a scientist for state agricultural and disease testing. So I see some of the downsides of conventional agriculture and wonder if organic products have any answers.

    For instance I wonder about the use of antibiotics in livestock (particularly to promote growth or as a prophylactic) and it’s effects on antibiotic efficiency in the human population. Here’s an article talking about a proposed ban on antibiotic use for livestock. http://www.reuters.com/article/idUSTRE52N4OH20090324

    I also wonder about the safety of workers, particularly since most of them are in no position to make demands regarding worker safety.

    I wonder about education and efficiency in farm/manufacturing process. A while back I read a study of rice farms in a particular region of China showed that a large percentage of farmers routinely used chemicals far over the label recommended levels. Not only was this a waste of money but it was a definite risk to their health.

    I wonder about local water table and watershed issues.

    I wonder about diversity of species and disease risks.

    I wonder if organic farms make good test farms for species or methods that may have enough benefits to be used in the conventional ag industry.

    As someone who used to work with a lot of marketing (Rosemary – oh, yeah Nestle was one of my clients briefly and I can assure you that their marketing methods for their organic line are not distinctly less honest than the others.) I am personally not too concerned with the “marketing claims”. I will judge the organic industry on the same scale as all the other industries that make “claims”. Like pharma for instance. :)

  73. oh, I forgot my last wonder. I wonder how much the feed of livestock alters it’s affect on health (and repercussion on environment, economy, etc). I have heard interesting assertions regarding grass fed and cholesterol although, I don’t actually purchase grass fed beef, due to cost.

  74. Zoe237 says:

    Thanks JMB. I saw that when I posted my other cancer.org link. They give the impression that there is quite a lot we can do to prevent cancer, which is again what I honestly thought until started reading this blog. Now I kind of waiver between “it’s all a crapshoot anyway” and “prevention is key.” Obviously, somewhere in between lies the answer.

    I’ll try to find a link I’ve used in the past concerning the actual yield per acre for organic food production.

  75. apteryx says:

    lkregula: “There’s almost no regulation on the supplement industry, as I’m sure you’re aware- so long as they have the “claim has not been evaluated by the FDA” statement, a supplement manufacturer can put frog-piss in a gel cap and say it cures cancer.”

    That’s not correct. Supplements may make “structure-function” claims regarding their alleged benefits for healthy people, but may not legally claim to cure, treat, or reduce the risk of any disease. A supplement with a laxative effect cannot even state truthfully that it alleviates constipation, because that is considered to be a disease. Falsely claim to cure cancer, and sooner or later, the FDA will come down on you hard. (If it has been later rather than sooner in the case of certain sleazy internet vendors, that is evidence that FDA needs more manpower, not that Americans need more regulations.)

  76. edgar says:

    Rosemary,
    I was not referring to the Hufpo article, I was referring to this blog.
    And I have no doubt that what you cite exists, as I do see it as well. I mean, I love the fresh ground peanut butter at Whole Foods, but across the street, at Whole Body? Not so much.

    But to not specifically define something is just sloppy writing, and not scientific at all.

    Take the statement, cancer is 100% preventable.

    What a meaningless statement. Cervical cancer falls into this category, as does mesothelioma. Many,many others do not.

    While I appreciate Harriet’s link, I resent her snarky “for those who don’t believe” comment. It smacks of ‘get on board and just believe what I say without questioning’ , just as your smacks of condescension that we do not need to define ‘a broad generalazation’ because we can just go to the gym and see for ourselves is just stunning to me. Aren’t these the very antithesis of SBM? it is just as silly to paint alt-med folks with as broad a brush as they paint the allopathic/western medicine/big pharma industrial complex.

    Funny, I thought actually defining what your were speaking about was not only good journalism but good science.

  77. Fifi says:

    Of course “natural” doesn’t mean safe. Neither does “synthetic”. There are just as many people who have unrealistic beliefs regarding the safety of synthetic products and technology (cars are a good example) as there are about “organic” or “natural” products. And there’s really not much difference between Big Pharma and Big Supplement and Big Food and Big Chemical – in fact, they’re often owned by some of the same interests (generally speaking, internationally owned and distributed interests). They’re all industries that act the same (and Big Food and Big Pharma have been using the “mom and pop” meme to sell products forever, it’s hardly new or specific to organic products, neither is using pseudoscience or people in lab coats).

    Big Food saw that people are willing to pay more for food that they believe is grown under certain conditions that are potentially better in terms of sustainability and use less synthetic chemicals, and that don’t exploit others (if we’re talking Fair Trade as well). Why? Because some people care about others and the world – and think about the chain of production and consumption and choose to invest in a product that they believe makes a difference. (And undoubtedly there are other motivations that range from the narcissistic to peer pressure.) So Big Food picked up on the trend – trend watching is a huge part of Big Food’s development and marketing arm – then bought up some independent organic/fair trade companies and started trying to weaken and control organic certification so that they could brand themselves organic without doing the actual work. (The lobbyists for Big Food have been successful overall, including in keeping GMOs unidentifiable to shoppers.)

    This doesn’t mean that ethical businesses don’t exist, it just means that they’re the exception and not the rule and you’re much less likely to find them in your supermarket or to see national advertising campaigns promoting their products.

    While people who buy organic foods generally do have an interest in health and nature, they’re also not usually anti-technology or anti-science in my experience. Questioning industrial practices isn’t tantamount to rejecting science. It’s not even tantamount to rejecting technology. It’s simply questioning the traditional values and practices of industry and business that put profit before people and the environment we live in. This is hardly unreasonable considering the massive amounts of evidence regarding how industry and business operate, including trying to use marketing to manipulate people into thinking they’re buying something other than they are and trying to avoid having to be accountable for the shared resources they use and the consequences of their actions (particularly if it gets in the way of profit).

    So, it’s perfectly valid to critique industry, it’s just silly to believe that it’s only CAM or organic food that gets marketed in this way!

  78. I think it’s legal to sell frog piss in a gel-cap and books about the cancer-curing benefits of frog piss in gel caps in the same store or from the same venue. Books being protected by the first amendment, they aren’t subject to the FDA.

  79. lkregula says:

    Apteryx- thanks for the clarification, and Allison, thanks for the laugh.

  80. Fifi says:

    I find it kind of ironic that a book about the unethical practices of the food industry – particularly Big Food – is being used to try to disparage organic farming by someone who says they don’t actually know much about organic (or industrial) farming, or food marketing and development (apart from a superficial from reading stuff online from sites that are known to be bad sources of information). That all kinds of starts to add up to an uneducated prejudice rather than an informed critique. And personally I find it kind of hilarious since many of the marketing practices being critiqued come from Big Food and mainstream advertising techniques used by all of industry – they’re certainly not isolated to the mass commercialization of organic as a brand (as opposed to denoting a specific approach to farming). After all Marion Nestle is more anti-corporate/industry and critiques industry practices – and how they create the illusion of “mom and pop” – than she is actually critical of small farmers that run CSAs and so on (and she recommends buying organic for certain produce).

    (Btw, Marion Nestle isn’t related to the food giant and is an interesting source of information and opinions regarding food policy and the practices of Big Food in the US.)
    http://www.foodpolitics.com/

    And an interview with Nestle from HuffPo that recommends “While waiting for all this to sort out, here’s what to do: buy local from someone you know personally and think is worth trusting.” This is what most people I know who are genuinely interested in sustainability do – it supports local business/farmers and good agricultural practices. It also supports crop diversity (CSAs don’t grow just one crop) and encourages habitat conservation (depending on the farmer and farm, of course). But, best of all, it means getting a wide variety of freshly picked produce you’d never see in a supermarket because CSAs usually grow heirloom varieties that don’t travel or keep (or pack) well but are much more flavorful. It’s quite surprising how many people don’t actually know what a tomato really tastes like!

    http://www.huffingtonpost.com/kerry-trueman/lets-ask-marion-are-the-u_b_153831.html

  81. Fifi says:

    Rosemary, I totally agree that Big Food’s practices are very much like those of Big Tobacco or any other big corporate interest (or conglomerate of corporate interests that try to manipulate both government policy and public perception for monetary gain). I believe Marion Nestle made that comparison and it’s a bit of a rallying cry for her. However, Big Food does this for all their products so merely linking these practices to their attempts to brand unsustainable practices and products as “organic” makes no sense. All kinds of non-organic products have labels and commercials that pretend some kind of old fashioned and romantic farming is behind the product (it’s not like factory farms feature on the labels, they’re pretty unappetizing). The Big Food strategy as related to “organic” is entirely in contrast to small organic farmers that run CSAs who want stronger and not weaker regulations because that’s what actually differentiates them from Big Food (and their Big Organic divisions that are about profit and not sustainable practices). That’s why most people genuinely interested in sustainability who think critically don’t just buy products branded organic at the big box supermarkets – including places like Whole Foods – that favor image over substance and profit over ethical practices.

  82. Alison Cummins

    “I think it’s legal to sell frog piss in a gel-cap and books about the cancer-curing benefits of frog piss in gel caps in the same store or from the same venue. Books being protected by the first amendment, they aren’t subject to the FDA.”

    All I can say is that I know I’m too old when I stop wondering if toad licking is a good source hallucinations and start contemplating the legality of frog piss as a cancer cure.

    But, I’m pretty sure it’s all bad for the froggies.

  83. rosemary says:

    lkregula, I appreciate your taking the time to discuss the topic with me since it is something that I want to understand and an area in which you have expertise.

    Here are some of the problems I am having. You tell me that, “You seem to insist that the only part of organic that exists is the part that you define as organic, the part that is concerned with natural=healthy.”

    I understand that you are saying that my belief that organic farming and organic food are based on the concept that natural is good and that synthetic is bad is incorrect, but the only evidence I have seen you present are your personal observations and a link to the oeffa site which includes this statement, ““Eighty percent of American adults say they are concerned about the safety of the food they eat. They worry about residues of pesticides and fungicides. These materials are not permitted in an organic production system either before or after harvest.” You point out that oeffa is not saying those chemicals are hazardous. They are just letting those who want to avoid them know that they aren’t in their products.

    Do you really think it is unreasonable for me to conclude that oeffa knows that the reason people would want to avoid them is because they believe that they are hazardous and that they are the very reasons why 80% are concerned about food safety? Do you think it is unreasonable of me to think that if oeffa didn’t either share those views or realize they were good concepts to use to market their products that they would explain that there are valuable uses for both natural and synthetic chemicals and that when to use which must be decided based on available evidence for each?

    Pulling up several sites on google, I find they all state basically the same thing about organics being “chemical” free. The message in all of them is that natural is good and synthetic is bad which is exactly what I hear from the organic proponents I know personally and proponents of CAM. It is the underlying link that unites them all. The foundation upon which their systems of belief are build. They reject science and make an artificial distinction between chemicals calling some natural (good) and others synthetic (bad) and often go even further trying to deny that natural chemicals are even chemicals.

    Please understand that when I hear you repeat, without presenting any evidence to substantiate your claim, that I am wrong about organic proponents believing that natural is good and synthetic is bad, and when all that I see, knowing and admitting that it is anything but conclusive, shows that you are incorrect, you sound to me like the chiro who says, “No. We don’t believe in subluxations.” The acupuncturists who says, “Ha, ha, ha. You’re wrong! We don’t believe in meridians and energy.” The antivaxer who says, “Who me against vaccines? Oh no. You got it wrong.”

    The site which I found which best explains what I understand by “organic” is berkeley.edu,
    http://www.ocf.berkeley.edu/~lhom/organictext.html

    The material that I see there seems to me to correctly explain the topic. As I have repeated often, I know little about the subject. If anyone has solid evidence showing that what is stated on the berkely site is incorrect, that will convince me. However, allegations about my sins, ignorance or sloppy scholarship will not.

  84. rosemary says:

    Alison was joking?

  85. As someone who actively prefers organic:

    1) People who say the “organic” market is heterogeneous are correct. I really don’t care about whether it’s better for me or tastes better or whatever. It might be, it might not be. I just want it to be lower impact, easier on the animals, whatever.

    2) I believe that people who choose organic because they think it’s better for them are probably misguided. However, I recognize that they exist. Since most people are more interested in themselves than in soil flora and fauna, I assume that most of the market is people who care only about the “purity” of what they are putting in their bodies. I suspect most people do not know or care much about organic: they just feel the label refers to some higher standard of general goodness and purity, and is therefore to be preferred. Supporting evidence for this interpretation is the subset of parents who buy organic specifically for their children. If they were interested in the ecological implications (as opposed to concepts of purity) they would make more impact by buying organic for themselves.

    3) Even if we agree that that many people choose organic for vague “ritual purity” type feelings that they relate to their own health, we have not established that they therefore believe that their purchase of organic baby lettuce at Whole Foods is a guarantee against cancer. Perhaps it is just something that they can do, so that when they do get cancer they will know they were not to blame. Maybe they are more worried about chemicals feminizing their boys than they are about getting cancer.

  86. rosemary says:

    Edgar, “Funny, I thought actually defining what your were speaking about was not only good journalism but good science.”

    Whatever happened to simply expressing an opinion?

    My definition of alt. med. is the practice, promotion and belief in the preventive and healing powers of unproven and disproven “remedies” and therapies. AM maintains that the best way to evaluate drugs and therapies is by personal experience alone whereas scientific medicine maintains that objective, consistently reproducible evidence is required.

    Eating peanut butter that you love is delightful and has nothing to do with AM. Eating anything because the manufacturer or salesman tells you that it offers health benefits when there is no evidence that it does is a different matter.

  87. Fifi says:

    Rosemary – It’s not just the Food Industry that perpetuates ideas about natural/organic vs unnatural/synthetic, or that is the cause of semantic confusion regarding “organic”. The very term “organic chemistry” reinforces the idea that there’s an inorganic chemistry!

    http://library.thinkquest.org/3659/orgchem/

    Nor is merely “pro natural” propaganda that has led people to be suspicious of industry – it’s partly the chemical and food industries’ own propaganda regarding how safe their products are (and better than whatever other product was being consumed before). Of course, reality keeps contradicting those claims by industry (largely due to the actions and inactions of those industries themselves).

    Of course, the very roots of the natural vs unnatural binary kind of thinking goes back to religious ideas about what is “natural” and what is immoral and unnatural. To understand how the human propensity to divide things into binary good/bad categories works, cognitive science is the best resource. The universe doesn’t care about good or evil, or curative vs deadly, but it’s pretty important to us humans for a variety of reasons (evolutionary ones as well as social ones today).

    So, while marketing by Big Food certainly harnesses (and reinforces) a certain aspect of how our brains work, they’re not responsible for how our brains function or even for the tendency to see things as natural vs unnatural or good vs evil.

  88. No, Rosemary, I wasn’t joking. The frog piss example came from lkregula, but it could be anything. (Grape-seed oil, or whatever.)

    Yes, the supplement labelling issue is a concern. But I’m not sure the labelling is that big a deal, given that published information that isn’t a label can say anything it wants.

    Can someone correct me?

  89. Fifi says:

    michele – “Even if we agree that that many people choose organic for vague “ritual purity” type feelings that they relate to their own health, we have not established that they therefore believe that their purchase of organic baby lettuce at Whole Foods is a guarantee against cancer.”

    People use non-organic products for reasons of “ritual purity” as well. No More Tears and many other baby products use the same purity ploy, as do many hygiene products for adults. We’re not even scratching the surface of the plethora of totally useless (and even harmful) household cleaning products that use the purity gambit. There are plenty of parents out there creating chemical bubbles for their kids, at least the kids eating organic are likely to ingest a bit of dirt ;-) And, really, where did the idea of that kind of purity come from? Certainly there’s the role religion plays in the natural/unnatural pure/impure meme, but there’s also the role that science has played. The idea that an entirely sterile environment is desirable (outside of surgery) emerged from science and medicine in the first place…as did the unrealistic idea that we could create this totally safe and sterile environment and that science and medicine could protect us from the dangers of nature.

    It’s much more interesting to understand where ideas really come from than to simply try to point to people we don’t agree with and (incorrectly) blaming them. Both science and religion have contributed to the ideas about purity that industry uses to move their products, but more fundamentally these ideas are a reflection of how human cognition works and, if we understand this, we can understand why these strategies are effective.

  90. Fifi,

    That was me! Oh goody, so it’s not just me who does that (attributing quotes to michele instead of Calli Arcale, or JMB instead of squirrelelite). Sorry folks, and thanks Fifi for keeping me company!

  91. Fifi, right, so the quote could be rewritten as:

    “Even if we agree that that many people choose antimicrobial plastic for vague “ritual purity” type feelings that they relate to their own health, we have not established that they therefore believe that their purchase of antimicrobial plastic spatulas at Target is a guarantee against cancer.”

    or

    “Even if we agree that that many people shave their body hair for vague “ritual purity” type feelings that they relate to their own health, we have not established that they therefore believe that their shaving of body hair is a guarantee against cancer.”

    Which makes my point even more strongly.

  92. Fifi says:

    Alison and Michele – Sorry for the wrong attribution!

    “Even if we agree that that many people choose antibacterial dish soap for vague “ritual purity” type feelings that they relate to their own health, we have not established that they therefore believe that their purchase of antibacterial soap at Target is a guarantee against contracting a disease.”

    Well, actually, my point was more that even if some people do buy organic because of “ritual purity” beliefs that these beliefs are just as prevalent amongst people who use products that aren’t labeled as being organic and they’re seeking the same kind of protection against disease. And that this kind of purity marketing exists across the spectrum and has no particularly special relationship to organic products since it’s equally used to sell non-organic products. In fact, nowhere is “purity” marketing more extensive than in non-organic beauty products (many that are directly targeting eradicating normal and functional human stuff and equate “natural” with bad or try to market the idea that natural parts of being human are undesirable). To expect to find reality in marketing isn’t particularly reasonable though, it’s a bit like expecting propaganda to deliver the truth….after all, marketing and advertising are all about manipulating people using any means possible.

  93. Well, I was joking, I thinking Alison was serious, using real information albeit with somewhat humorous content.

    FiFi, yup, looks like Alison’s quote. It’s much too well written to be me. :) and I’m sure we all do it, – damn the scrolling, full speed ahead.

    Alison – “Yes, the supplement labeling issue is a concern. But I’m not sure the labeling is that big a deal, given that published information that isn’t a label can say anything it wants.”

    I do think it’s helpful to not have “Cures Cancer!” on the label. That as least makes the deception a bit harder, increases deception overhead.

    “Maybe they are more worried about chemicals feminizing their boys than they are about getting cancer.”

    Actually, maybe. The one organic product I buy, milk for the kids, was because I was concerned about the use of hormones and antibiotics in diary. Somewhere I read a postulation that the use of hormones in cows was a possible cause of more cases of early puberty.

    Recently, I found the time to take an afternoon to google this and it now appears to me that this could not be the case. The hormones used can not be digested/absorbed by humans when eating. I still have to reserve another google afternoon for the impact of the use of antibiotics.

    Also, I used to love Whole Foods. They had a small store here and the bakery was great and all the cashiers were very friendly and chatty. They built a big superstore which is not as nice. Now I use Trader Joes, which is small, friendly, cheaper and doesn’t have the awful magazines at the counter that our regular grocery store does. I’m pretty sure that involuntarily reading BradGelina gossip once a week causes cancer.

  94. FiFi “And that this kind of purity marketing exists across the spectrum and has no particularly special relationship to organic products since it’s equally used to sell non-organic products.”

    Yes. Dove, Ivory, Lots of non-organic baby products…although not having perfumes and dyes are good attributes in baby products, the “purity” marketing is still remarkable.

  95. lkregula says:

    Rosemary, go ahead and keep pretending that all organic everything is based simply on a hope for better health. You’ve obviously made up your mind that marketing organic as healthy is the only thing that drives the sale of organic products or the desire for fewer chemicals than conventional agriculture. You prefer to ignore any other reason that anyone might buy organic or local. My argument this whole time has been simply that the issue of organic is not as simple as you seem to believe, but obviously I was wrong. One can put on blinders to anything other than their conclusion and it’s a really simple issue.

    Tell me what evidence you want to see. That some conventional ag chemicals are harmful? That buying from small farms helps the local economy? That farm workers can be and are harmed by pesticides? That biodiversity is next to nil in conventional ag systems? At this point, I don’t know what you’re looking for, all you want to do is demonize something, anything, everything, and throw everything you dislike for whatever reason in the same bin as alt med. How about tattooed people- are they just like anti-vaxers? Maybe bikers are like the cigarette industry? All you seem to be doing is making big, broad, sweeping generalizations about how the world is.

  96. Fifi says:

    Most people genuinely interested in sustainable, ethical practices are quite aware of the politics of food and the food industry, including the watering down of organic standards, etc. Of course, there are people that choose to buy organic products for vanity reasons and narcissism – or because they think it makes them somehow more pure (they’d be the men and women who drive SUVs to Whole Foods to buy organic, fair trade coffee who happily inject botox into their faces and treat the WF cashier that isn’t allowed to unionize like dirt for not being servile enough). They’re the same people who buy SUVs purely out of narcissism. All this means is that some wealthy and narcissistic people buy organic food for narcissistic and social status reasons, just like they buy SUVs for the same reason (and get botox injections for the same reason)…it really doesn’t have anything to do with natural vs synthetic in any real sense, only in a marketing one.

  97. rosemary says:

    lkregula, I wrote the following above. “The site which I found which best explains what I understand by “organic” is berkeley.edu,
    http://www.ocf.berkeley.edu/~lhom/organictext.html
    The material that I see there seems to me to correctly explain the topic. As I have repeated often, I know little about the subject. If anyone has solid evidence showing that what is stated on the berkely site is incorrect, that will convince me. However, allegations about my sins, ignorance or sloppy scholarship will not.”

    You did not address it in your response.

  98. rosemary says:

    Alison, I didn’t think you were joking about the frog piss and thought that what you said was correct and elegantly expressed.

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