Mar 16 2010
Diagnosis, Therapy and Evidence
When Dr. Novella recently wrote about plausibility in science-based medicine, one of our most assiduous commenters, Daedalus2u, added a very important point. The data are always right, but the explanations may be wrong. The idea of treating ulcers with antibiotics was not incompatible with any of the data about ulcers; it was only incompatible with the idea that ulcers were caused by too much acid. Even scientists tend to think on the level of the explanations rather than on the level of the data that led to those explanations.
A valuable new book elaborates on this concept: Diagnosis, Therapy and Evidence: Conundrums in Modern American Medicine, by medical historian Gerald N. Grob and sociologist Allan V. Horwitz. They point out that
many claims about the causes of disease, therapeutic practices, and even diagnoses are shaped by beliefs that are unscientific, unproven, or completely wrong.
While we try to be science-based, we are not always as scientific or as logical as we would like to think. We form hypotheses that are compatible with existing data, and then our assumptions guide our thinking and future research and sometimes interfere with our reception of new data. We must recognize those assumptions and constantly re-evaluate them. It’s important that we look the imperfections of science-based medicine squarely in the face if we are going to have any hope of overcoming them.
Of the therapies recommended in a 1927 textbook only 23 were later validated as effective or preventive. The other 211 were subsequently found to be either harmful, useless, of questionable value, or simply symptomatic.
Medical treatment has had a big impact on human health, but there’s more to the story. We developed effective treatments for ulcers, but the incidence of ulcers was already declining before those treatments had any impact. The decline of rheumatic heart disease is probably not due to antibiotics but may be due to decreased virulence of the causal bacteria. We have no idea why the incidence of stomach cancer has decreased in the US, or why it is so high in Japan.
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. Genetic factors and the many physiologic changes of aging may contribute more than we would like to think. To some extent, disease is an unavoidable consequence of life: the idea that science can eventually provide perfect health may be a chimera.
In our efforts to prevent heart attacks we are essentially treating risk factors, without a clear understanding of how they relate to pathophysiology. We are treating hypertension, hyperlipidemia and other risk factors rather than directly treating the cause(s) of cardiovascular disease. We offer behavioral prescriptions based on assumptions derived from inadequate epidemiologic evidence, and this kind of thinking can lead us astray. Recommending a low fat diet helped fuel an epidemic of obesity as people replaced the fat in their diet with extra carbohydrates.
Once we have formed a belief we are slow to respond to new evidence that refutes it. The book covers the history of tonsillectomy. Tonsillectomies remained fashionable long after the evidence showed most of them were useless.
The most interesting question they ask is
How do diagnoses come into existence and why do many disappear with the passage of time?
What ever happened to chlorosis and neurasthenia? The same patient presenting with the same symptoms in 1890 and 2010 would get entirely different diagnoses. The ailments that afflict humans don’t change much; our diagnostic categories do.
Autism, CFS and fibromyalgia are all relatively new diagnoses for conditions that undoubtedly existed long before the diagnostic name was coined. “Their pathobiology remains unknown, and there is little agreement on their diagnostic boundaries. Once given a name, however, the numbers given to each diagnosis have expanded exponentially.”
Psychiatric diagnoses are particularly slippery. Where exactly do you draw the line between normal sadness and depression? Disease occurs on a continuum and we try to fit it into discrete boxes. We organize the data differently at different times as influenced by historical circumstances. The Diagnostic and Statistical Manual of Mental Disorders (in its many iterations, now up to DSM-5) changes as it reflects not only new data but cultural, social, and political forces. There is no evidence that the new DSM categories of anxiety have improved the diagnosis, treatment, or understanding of anxiety disorders. The popularity of the diagnosis of post traumatic stress disorder (PTSD) raises issues about the connection between external causes, individual responses, and resulting symptoms. Broadened criteria for PTSD have made it possible for almost everyone to be diagnosed or considered at risk.
We differentiate between science-based medicine and belief-based medicine, but we mustn’t forget that scientists form beliefs too. Our interpretation of the evidence is influenced by our working hypotheses. We must remember to constantly guard against overinterpretation and to concentrate only on what the evidence actually shows. When we use a diagnosis, we must remember that it is not definitive, but only an artificial category we have imposed on nature to help us understand our patients’ symptoms and provide a framework for treatment decisions. When we have an explanation, we must keep re-evaluating the data to make sure another explanation doesn’t fit the data just as well.
Ionannidis showed that most published studies are wrong. Grob and Horwitz show that many of our current diagnoses, treatments, and ideas about disease may be wrong too.
I suggest that we all repeat the mantra: “I could be wrong” and keep asking “Could any other explanation fit the data?”
258 Responses to “Diagnosis, Therapy and Evidence”
“…CFS and fibromyalgia are all relatively new diagnoses for conditions that undoubtedly existed long before the diagnostic name was coined.”
CFS, FM -and MCS- are really valid diagnoses?
I never heard of Ionannidis but here’s the reference if others are interested too: http://www.sciencebasedmedicine.org/?p=4204
“I’m a man.
But I can change.
If I have too.
I guess.” -Red Green
“The Diagnostic and Statistical Manual of Mental Disorders (in its many iterations, now up to DSM-5)”
DSM-5 is not yet a reality.
Due out in 2013 I think.
The idea of treating ulcers with antibiotics was not incompatible with any of the data about ulcers; it was only incompatible with the idea that ulcers were caused by too much acid. >>>>
I suggest that we all repeat the mantra: “I could be wrong” and keep asking “Could any other explanation fit the data?”>>>>
What were we measuring when doctors had the explanation ulcers were caused by too much acid? The quacks on TV selling all natural cures for ulcers now tell people to treat their ulcers with acid to cure them.
There is really good saying among researchers which goes along with this post:” The greatest sin a scientist can commit is to believe in his hypothesis”
This post is a perfect example of why I have beome a fan of SBM. Thanks.
I think part of the problem is that patients put a great deal of pressure on physicians to give them a diagnosis. They want a label for their symptoms and want to hand the problem over to the physician to “fix.” I don’t have good evidence for this hypothesis, just anecdotal evidence from many conversations with physicians.
If a real physician can’t figure out the problem, there are many faux physicians who will step into the breach. Alt med practitioners seem never at a loss for a diagnosis and treatment — thus making the real physican look like a dummy in the patient’s eyes.
Anarres, I’m told I have fibromyalgia. It’s intriguing. After being rear-ended yet again last summer, I started having bizarre unexplained pain, and even light contact on parts of my body is painful. The pain management doctor who started me on meds for “neuralgic pain” told me that he’s often seen this happen when someone has had a lot of different chronic pain over a period of time, especially with repeated physical trauma.
I’m not in the medical field; I don’t have access to studies, so I don’t know how to find the references that were mentioned to me. But the doc at Mayo who diagnosed me tells me that there are studies showing something that they think is fibromyalgia in animals too. If I understand correctly, there are a number of correlations with FM in both people and animals: things like lack of proper sleep, which might be associated with the cause of the pain, or might be an effect, or it might just happen a lot in similar circumstances. Another seems to be over-sensitivity to medication and medication side effects. This is all filtered through my non-doctor understanding (so I may have it wrong), and again I don’t know how to find sources; I’m simply repeating what the doctor told me.
FM is not a major problem for me most of the time; it’s just inexplicably THERE. I’m not hiding behind it, not using it as some kind of excuse, not trying to wave it around and go, “Oh, man, I’m so abuuuused, look at me!” which it seems is what most people think of in people who say they have. I tend not discuss it, because a lot of people do seem to think that it’s an invention. All it means to me is yet another kind of pain, tolerable most of the time, an annoyance a lot of the time, and something else to consider when putting together treatment programs.
Perhaps this annoyance in my life can be explained by something else. Perhaps “fibromyalgia” will eventually be replaced by something else as a diagnosis, if they understand it better or find better treatments. In the meantime, I’m just trying to follow the advice of the doc who thinks that he can help me get yet another aggravating variety of pain under control.
“Autism, CFS and fibromyalgia are all relatively new diagnoses for conditions that undoubtedly existed long before the diagnostic name was coined. Their pathobiology remains unknown, and there is little agreement on their diagnostic boundaries. Once given a name, however, the numbers given to each diagnosis have expanded exponentially.”
AND
“When we use a diagnosis, we must remember that it is not definitive, but only an artificial category we have imposed on nature to help us understand our patients’ symptoms and provide a framework for treatment decisions. ”
I’m a CFS patient. Defining it has been a huge issue.
There are a few diagnostics that appear over and over in a subset of patients: natural killer cell dysfunction, increased inflammatory cytokines, upregulation of RNASEL pathway, evidence of chronic herpes infections (EBV, CMV, HHV-6) dysautonomia/POTS. The fatigue is better described as post-exertional morbidity, or poor, slow and painful recovery after exertion.
Fatigue is a diffuse symptom that can have many many causes. Unless the most strict criteria are used in research, it’s difficult to ensure that clinically “same” CFS patients are included. This has been very controversial as researchers in the UK, and formerly at the CDC have expanded their research definitions to include almost 1% of the population, or anyone feeling chronically “unwell”. It makes a lot of their research essentially meaningless.
Until there is more of a careful consensus about what CFS is, or a categorizing of patients into subsets based on diagnostics, the pathology will surely remain unknown.
Ioannidis’s point, in a nutshell — which is perhaps slightly distorting — is essentially a profound application of Bayes Theorem; it is heavily influenced by his experience with genome wide association studies. Essentially, if you test hypotheses at random, with no initial theory to raise the prior probability, you can imagine almost anything; and all but an infinitesimal proportion of what you imagine will be false. Under those conditions, a p value of < .05 is like a screening test with a prior probability close to zero. Even specificity of .95 means that a positive test is probably false — assuming of course that you are selecting the positive tests from a large number of tested hypotheses.
This is why in order to conduct any sort of quantitative investigation, we have to start with a plausible theory, and our chances of a correct finding depend almost entirely on establishing a substantial prior probability. It doesn't have to be very large, but the point is, the prior probability of a random hypothesis is so low that we're going to get lots of statistically significant findings which are just noise. So the "stickiness" of paradigms is actually essential to scientific progress, even though it also slows us down quite often.
It's a difficult balance to strike.
From the book:
Fibromyalgia was given its name by a committee of the American College of Rheumatology in 1990. The lead author of the paper, Fredrick Wolfe, has all but recanted the diagnosis and considers the condition to be a response to stress, depression, and anxiety. “Some of us in those days thought that we had actually identified a disease, which this is clearly not. To make people ill, to give them an illness, was the wrong thing.”
“patients put a great deal of pressure on physicians to give them a diagnosis. They want a label for their symptoms”
Three thoughts about this:
(1) There’s an old story about a patient who was delighted with her doctor because he had diagnosed her with cephalalgia after all the other doctors had told her she only had headaches.
(2) I have inflammatory polyarthritis. This is a description of the signs and symptoms, not a diagnosis. One rheumatologist thought I probably had early rheumatoid arthritis that wasn’t showing up on the tests yet, then he decided I had Still’s disease. My current rheumatologist just says I have some kind of inflammatory arthritis that doesn’t happen to fit into any of the neat diagnostic categories, but who cares? since my symptoms have completely resolved with treatment. She and I are perfectly happy with not having a label.
(3) My favorite diagnosis is IBTHOOM. It Beats The Hell Out Of Me. I’ve seen a lot of cases of that.
I’m perplexed by Harriet Hall’s quote, above. “The condition”–whatever the cause–is apparently still a condition, no? It may not be a *disease* (I certainly don’t know) but neither are a lot of conditions that are given names and have treatment programs. I mean, allergies aren’t a disease, but there are treatments for them.
(And if fibromyalgia is a response to stress, depression, and anxiety, I’d like to know what’s going on with me, please. Stress I have, mainly due to chronic pain of various kinds, but surprisingly I don’t have much in the way of depression or anxiety. Perhaps this is something else?)
I think by “condition” Wolfe meant a constellation of symptoms. When different constellations of symptoms overlap, attaching a diagnostic label to one of them may not be meaningful. Before we can look for the “causes” of fibromyalgia we have to make sure we are dealing with a discrete diagnosable entity rather than an artificially limited segment of a continuum. I think he meant that there is a continuum of patients who respond to stress, depression and anxiety with a variety of symptoms and that the committee was not justified in cutting the pie the way they did.
What a fabulous post. This is the meat and potatoes of what I love about SBM!
I had a stiff big toe so I got referred to a podiatrist. He told me I had hallux rigidus. I asked what’s that? He said it means a “stiff big toe.” So this guy is getting paid $150/hour to translate it into Latin.
I mention this to a colleague who is an MD. He said oh yeah, when he was a resident this guy came in with an itchy bump and the attending diagnosed pruritis nodularis. I’m sure you can guess what that means.
great post Harriet. In my opinion Grob is well worth reading. I recommend these items
http://jhmas.oxfordjournals.org/cgi/content/abstract/62/4/383
http://www.amazon.com/Deadly-Truth-History-Disease-America/dp/0674008812
As much as I agree with Versus and Harriet about patients being happier when given a diagnosis almost to the point of demanding their diagnosis come with a catchy TLA. It is also worth pointing out that insurance companies are more likely to pay out for a condition which can be categorized on the DSM. For example, I have heard anecdotes of parents getting various speech/behavioral therapies payed for by insurance companies only when an official “autism” diagnosis was made. The diagnosis was only made in order to enable the needed therapy.
# Versus
“I think part of the problem is that patients put a great deal of pressure on physicians to give them a diagnosis.”
And Dr. H’s response.
As a patient I prefer a diagnoses (when possible). Why? First it makes it easier when I talk to another doctor or if my doctor leaves or I have to switch. I have Hashimoto’s Thyroiditis is so much easier to communicate than…well you can imagine. Computerized records have helped with this. As long as the diagnosing doctor keeps good records and other doctors can easily assess those, having a label to give another doctor is not as important.
The second reason I like the diagnoses is that it makes it easier to understand my health. For instance, I have a variety of silly little allergy and inflammation things. Knowing that I have the auto-immune thyroid disease and that people who have it are a bit more prone to allergies or inflammation puts things in perspective and I don’t get too bent out of shape about it.
Other the other hand I do understand that a diagnoses is not always accurate or desirable. My sister has a rather severe skin disorder that has never been diagnoses beyond maybe being an atypical presentation of one of the auto-immune skin diseases.
The doctors work with her to find her triggers and find what works for her. It doesn’t appear that a diagnoses would be helpful and if inaccurate it could be unhelpful.
Just my two cents.
Great Article Dr. H. really enjoyed it!
In the very unlikely event that I ever get to host Saturday Night Live, the sketch I want to do is an infomercial for Miracle KiddieGrow. I’d have a mother saying how short her kid was (visuals of a toddler, well, toddling) and then what happened after she started feeding him the supplement (visuals of same kid taking a jump ball in an eighth-grade basketball game). She says “I saw it work with my own eyes!”
The question, of course, is what that “it” was. The whole point of the joke is that the only thing she actually saw with her own eyes was that her son is taller at fourteen than he was at two. That’s not a very remarkable observation: the only parents who don’t see that are ones whose kids die tragically young or are forced to separate from their kids. Everything else isn’t an observation, it’s an attribution. But from her point of view, questioning her attribution is the same thing as questioning her observation.
There was an elderly couple who had a dog and a cat and spoiled them both rotten. One day someone with the ability to talk to animals asked them about their lives. They both talked about how wonderful they were, with the dog concluding “they must be really powerful and important if they treat me like that” and the cat concluding “I must be really powerful and important if they treat me like that.” Same observation, different attributions.
The problem is that a lot of people don’t seem to understand the difference between “I think you’ve jumped to an incorrect conclusion” and “you’re lying.”
One of the dangers of diagnosis is that once we fix on a diagnosis we tend to stop thinking. Groopman talks about this in his book “How Doctors Think.” We try to fit everything into the framework of that diagnosis rather than remembering old findings that didn’t quite fit or looking seriously at new findings that might point to a different diagnosis. A good diagnostician will not even want to hear what other doctors have said, but will start from scratch and listen to the patient’s story in her own words and try to form a truly independent opinion.
“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.”
Not disagreeing but, at least here in Australia, a couple more environmental carcinogens are fairly notable: the role of asbestos particles in mesothelioma and the sun, re skin cancer.
Excellent article, btw.
.
“I have heard anecdotes of parents getting various speech/behavioral therapies payed for by insurance companies only when an official “autism” diagnosis was made.”
This can go both ways. I have heard of insurance companies refusing to pay for SP or other therapies with a diagnoses of autism. Their rational is they don’t pay for developmental delays. That it is an educational need (not medical.)
Otherwise, do you need a diagnoses for insurance payment or is it just the all powerful “code”? (U.S. reference.)
“a couple more environmental carcinogens are fairly notable: the role of asbestos particles in mesothelioma and the sun, re skin cancer.”
Yes, and benzene, and others. But I suppose you could still argue that lung cancer was more “notable.” It certainly overwhelms the others in numbers.
One other important factor: the normal process of DNA replication involves a certain number of copying errors and some of these lead to cancers. Probably no way to avoid that, although we can hope for treatments to improve error correction and/or elimination of faulty cells.
Bottom line: the idea that most cancers can be avoided by diet and lifestyle changes and avoidance of environmental carcinogens is most likely a false hope.
Excellent article. I’ve been looking at the DSM5 draft recently, and wondering exactly how long it is before my profession goes the way of the dodo.
In psychiatry we appear to have forgotten that these categories are artificial constructs created in an attempt to bring some order and reliability, to lump patients into sets to possibly aid in our understanding of what is really going wrong. Rather we have reified the constructs – and the Book in which they are held – and have largely stopped questioning them (well, many of us might as individuals, but the profession doesn’t seem to do so in any meaningful way).
You make a really good distinction between data and explanations, and I think we would all do well to remember it
@Sir Eccles, re: insurance paying only for diagnoses – that’s one of the factors cited by the DSM5 working group when discussing the proposal of childhood “temper dysregulation with dysphoria”; the suggestion is that many kids have been diagnosed with bipolar disorder in order to gain them access to a higher level of input than they would otherwise be offered. >_<
“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.”
Any evidence for this? That one, it’s true, and two, there are people out there (besides alt medders) who believe the “largely preventable” part? Might your impression be because those are the only things we can control, at least somewhat? It seems every week there are more possible carcinogens added to the list, at least according to the EPA. I was under the impression that scientists weren’t quite sure what causes cancer, or DNA mutations. Not that I live my life in fear, but I’m genuinely curious about this issue.
I’ll just post through C, out of hundreds listed:
http://www.cancer.org/docroot/PED/content/PED_1_3x_Known_and_Probable_Carcinogens.asp
4-Aminobiphenyl
Arsenic and arsenic compounds (Note: This evaluation applies to the group of compounds as a whole and not necessarily to all individual compounds within the group)
Asbestos
Azathioprine
Benzene
Benzidine
Benzo[a]pyrene
Beryllium and beryllium compounds
N,N-Bis(2-chloroethyl)-2-naphthylamine (Chlornaphazine)
Bis(chloromethyl)ether and chloromethyl methyl ether (technical-grade)
1,3-Butadiene
1,4-Butanediol dimethanesulfonate (Busulphan; Myleran)
Cadmium and cadmium compounds
Chlorambucil
1-(2-Chloroethyl)-3-(4-methylcyclohexyl)-1-nitrosourea (Methyl-CCNU; Semustine)
Chromium[VI]
Ciclosporin
Cyclophosphamide
“Cancer is caused by changes (mutations) in a cell’s DNA — its genetic “blueprint”. Some of these changes may be inherited from our parents, while others may be caused by outside exposures, which are often referred to as environmental factors. Environmental factors can include a wide range of exposures, such as lifestyle factors (nutrition, tobacco use, physical activity, etc.), naturally occurring exposures (ultraviolet light, radon, infectious agents, etc.), medical treatments (chemotherapy, radiation, and immune system-suppressing drugs used after organ transplants, etc.), workplace and household exposures, and pollution. “
“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.”
Any evidence for this? That one, it’s true, and two, there are people out there (besides alt medders) who believe the “largely preventable” part? Might your impression be because those are the only things we can control, at least somewhat? It seems every week there are more possible carcinogens added to the list, at least according to the EPA. I was under the impression that scientists weren’t quite sure what causes cancer, or DNA mutations. Not that I live my life in fear, but I’m genuinely curious about this issue.
I’ll just post through C, out of hundreds listed:
http://www.cancer.org/docroot/PED/content/PED_1_3x_Known_and_Probable_Carcinogens.asp
4-Aminobiphenyl
Arsenic and arsenic compounds (Note: This evaluation applies to the group of compounds as a whole and not necessarily to all individual compounds within the group)
Asbestos
Azathioprine
Benzene
Benzidine
Benzo[a]pyrene
Beryllium and beryllium compounds
N,N-Bis(2-chloroethyl)-2-naphthylamine (Chlornaphazine)
Bis(chloromethyl)ether and chloromethyl methyl ether (technical-grade)
1,3-Butadiene
1,4-Butanediol dimethanesulfonate (Busulphan; Myleran)
Cadmium and cadmium compounds
Chlorambucil
1-(2-Chloroethyl)-3-(4-methylcyclohexyl)-1-nitrosourea (Methyl-CCNU; Semustine)
Chromium[VI]
Ciclosporin
Cyclophosphamide
“Cancer is caused by changes (mutations) in a cell’s DNA — its genetic “blueprint”. Some of these changes may be inherited from our parents, while others may be caused by outside exposures, which are often referred to as environmental factors. Environmental factors can include a wide range of exposures, such as lifestyle factors (nutrition, tobacco use, physical activity, etc.), naturally occurring exposures (ultraviolet light, radon, infectious agents, etc.), medical treatments (chemotherapy, radiation, and immune system-suppressing drugs used after organ transplants, etc.), workplace and household exposures, and pollution. “
Zoe237,
Yes, there’s plenty of evidence that it is commonly believed that cancer is largely preventable (while there’s no convincing evidence to support that belief). And no, it’s not just alt-medders who believe that. The book cites numerous references. For instance:
Scientists at the Harvard School of Public Health estimate that up to 75% of American cancer deaths can be prevented. They list these risk factors:
Smoking and tobacco use 30%
Obesity and diet (red meat vs. fruits and vegetables) 30%
Lack of exercise 5%
Carcinogens in the workplace 5%
Viruses (hepatitis, human papillomavirus) 5%
Family history of cancer 5%
Body size (taller, bigger people get more cancer) 5%
Women’s reproductive factors (late or no childbearing, late menopause, early periods) 3%
Excessive alcohol consumption 3%
Poverty (aside from bad diet) 3%
Environmental pollution 2%
Excessive exposure to sun 2%
Medical procedures, drugs 1%
Salt, food additives, contaminants 1%
http://www.health.harvard.edu/newsletters/Harvard_Mens_Health_Watch/2009/April/The-10-commandments-of-cancer-prevention
Estimates like these have been criticized in the literature by other scientists who are not convinced that most cancers are preventable.
There are lots of known carcinogens such as the ones you listed, but all added together they explain only a very small percentage of all cancer cases.
I think there are certain concepts shared by doctors that may not always be evident in discussions. I think those things left unsaid may be the source of some differences in opinion.
To doctors, cancer is a broad category of diseases. Just like infectious disease, there are many different etiologies, but a few shared features. If you wish to discuss factors in the development of cancer, you must specify not only the category of cancer, but even the cell type (there are different forms of lung cancer, breast cancer, bone marrow cancer, etc.). Blanket statements about cancer usually refer to an average of the most common lethal cancers.
Toxins are another subject that I think there is a conceptual difference. To a doctor, the main concern is the concentration of the toxin in the body, and the toxicity of the substance. The oxygen and water you are dependent on, can become toxic at certain concentrations, or in certain scenarios (and I don’t mean drowning). There are a few substances that are toxic in trace quantities. Those lists of carcinogenic substances don’t usually specify the concentrations at which they become carcinogenic. Although there may be test tube tests to compare the likelyhood of damage to DNA, there is a big lack of information in most cases about what concentrations may be carcinogenic.
I think a shift is currently occurring in medicine as advances in genetics become fully understood. The rate of mutation of our DNA is probably much greater than we ever understood, and the bodies compensation for damage to DNA is also much greater than we have previously understood. Changes in the bodies capacity to compensate for DNA damage may be a bigger factor in the development of cancer than we have given it credit for. The timing of exposure to carcinogens based on the number of stem cells present may also be a factor (when women become pregnant, deliver, and breast feed, the stem cells of the breast may be stimulated to differentiate, reducing the sensitivity of the breast to carcinogenic factors because of the reduction of stem cell populations). Again, when I refer to cancer, I’m talking about the average of the more common lethal forms of cancer.
That may be some of the background that may lead to some disagreements.
@cervantes “I had a stiff big toe so I got referred to a podiatrist. He told me I had hallux rigidus. I asked what’s that? He said it means a “stiff big toe.” So this guy is getting paid $150/hour to translate it into Latin.
I mention this to a colleague who is an MD. He said oh yeah, when he was a resident this guy came in with an itchy bump and the attending diagnosed pruritis nodularis. I’m sure you can guess what that means.”
You might just be joking about it, but I’ll address it for those who would take it seriously.
There are different types of diagnosis. Pruritis nodularis is more of a classification of physical findings and symptoms, what the government used to call a provisional diagnosis. The Latin terminology implies that some observer with experience in classifying skin physical exam features has observed it. Pruritis nodularis doesn’t mean much more because there are so many different etiologies that have to be considered.
Hallux rigidus is a more involved diagnosis that usually involves both the history and physical, and the xray findings (although the physical exam may suffice in many instances). It has implications about what caused it (a mechanical degenerative process), the prognosis (unlikely to improve by physical therapy, pain may be controlled by medication, but such treatment will have to be continued indefinitely), and the treatment (usually requires surgery for permanent relief when the symptoms become debilitating). Orthopedists and podiatrists may come down pretty hard on me for my oversimplification of hallux rigidus.
The use of Latin was a tradition in medicine, but did allow more specific information to be communicated between doctors. Compare, “stiff big toe that hurts” to hallux rigidus. A “stiff big toe” could be due to many things, such as gout.
Diagnosis is really an abbreviated summary of medical findings, the findings may consist of history, physical exam, laboratory or imaging findings, or pathology findings from microscopic or macroscopic examination of tissues. The diagnosis may also include the patient’s response to the disease process, or simply the pattern of behavioral responses. You can describe a diagnosis as being a provisional diagnosis, a final diagnosis, a laboratory or imaging diagnosis, a medical diagnosis, a surgical diagnosis, a psychological diagnosis, and on and on.
You’re paying for more than just the Latin, you’re paying for the educational background and the determination of what may need to be done to relieve the patient’s complaints, or what further tests may be needed to determine the cause.
cervantes,
“I had a stiff big toe so I got referred to a podiatrist. He told me I had hallux rigidus. I asked what’s that? He said it means a “stiff big toe.” So this guy is getting paid $150/hour to translate it into Latin.
I mention this to a colleague who is an MD. He said oh yeah, when he was a resident this guy came in with an itchy bump and the attending diagnosed pruritis nodularis. I’m sure you can guess what that means.”
Here’s another one:
A doctor friend of mine (I’m making this up, I don’t have a doctor friend) complained bitterly about a patient who came in every week with a list of minor, self-limiting, innocuous symptoms demanding his diagnosis. Imagine his delight when one day he was able to write in her history: diagnosis “Proctalgia”!
Women’s reproductive factors (late or no childbearing, late menopause, early periods) 3%
I don’t want to address the other factors, but this one jumped out. How is this preventable?
I don’t think Dr. Hall’s list was about preventable factors solely, since family history was on there too. But 75% is definitely a big number.
Okay, so the Harvard School of Public Health link answers my second question, so how about some evidence that cancer is NOT largely preventable? Sounds like there is some legitimate scientific debate on boths sides and that categorical statements about the root causes of cancer, whether genetics or environmental, are not yet justified by the evidence. But that’s merely my general impression as a layperson.
Harriet Halls list of the Harvard School of Public Health’s risk factors adds up to 100%. Presumably these are the “preventable” ones, and the “unpreventable” causes are on another list.
It’s not clear why age (not on the list) is presumably considered “unpreventable” while “family history” is considered “preventable.” Perhaps because family history can be prevented by not having biological children?
Or is this a list of all causes, and age is not an independent risk factor after all?
A lot of my patients are getting over asteatotic eczema now that it’s warming up. It sounds much better than winter itch.
Actually, I get it now. Dr. H is a list of risk factors. Some of those risk factors may be preventable, others not so much…like tallness, family history, etc.
I guess I was bottom up reading again. Bad habit.
“Women’s reproductive factors (late or no childbearing, late menopause, early periods) 3%
I don’t want to address the other factors, but this one jumped out. How is this preventable?”
When women get pregnant, the breast tissue begins changing to get ready for nursing. “Lobules” that will eventually produce milk develop from “type 1″ to “type 4″ across the pregnancy. If the pregnancy ends somehow before delivery, you have tissue that has been provoked into a growth mode, then interrupted before the natural course of this growth. In the “type 2″ or “type 3″ phase.
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. So, if a woman chooses to not voluntarily end any pregnancy she has up to the age of 40, then she is at lower risk of breast cancer.
There is an impressive body of evidence regarding this phenomenon. For political reasons, it is generally discounted.
There are a lot of web sites with this info, like this site:
http://www.abortionbreastcancer.com/
Additionally, it is more politically correct to acknowledge that the length of time a woman’s body is exposed to estrogen increases the likelihood of breast cancer. So, these are risk factors for breast cancer: earlier onset of menses; later onset of menopause, having fewer children or no children (pregnancy interrupts the otherwise normal estrogen exposure cycle).
There are well over a million voluntary abortions per year. So, obviously, there is some missed opportunity to prevent some breast cancer cases in women. To realize this, you have to be willing to dispassionately review evidence outside of the echo chamber.
Uterine cancer is virtually 100% preventable by hysterectomy.
Unfortunately it is well documented that rates of certain common cancers vary dramatically among cultures; for example, Americans have much higher age-adjusted rates of breast and colon cancer than people in many other countries. Please, everyone, note that those are age-adjusted rates and do not suggest that it’s because foreigners don’t live long enough to get cancer. There is no evidence to support a hypothesis that this is due to a uniquely high rate of genetic flaws in Americans, and considerable epidemiological evidence that environmental factors are involved: when people from the low-incidence cultures move here and adopt our diet and lifestyle, their risk rises.
MedsVsTherapy – That is simply not true. Though women who do bear children are at less risk of breast cancer than those who do not, the best, largest epidemiological studies show zero increased risk in women who have had either voluntary or involuntary pregnancy terminations. Falsely threatening women with cancer to try to keep them from aborting has the negative side effect of creating needless cancerphobia in women who have miscarried through no fault of their own. 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.
# MedsVsTherapy – I think Dr. Gorski discussed that topic of Breast Cancer and Abortion in the article “Abortion and breast cancer: The manufactroversy that won’t die” once already. http://www.sciencebasedmedicine.org/?p=2749
I was actually more focused on the early periods, late menopause aspect of the comment. I do not see a way to change those without Lupron or hormone treatment that would have it’s own risks.
Oh well, malnutrition can delay puberty also. I guess you could try that instead of lupron.
MedsVsTherapyon
“Additionally, it is more politically correct to acknowledge that the length of time a woman’s body is exposed to estrogen increases the likelihood of breast cancer. So, these are risk factors for breast cancer: earlier onset of menses; later onset of menopause, having fewer children or no children (pregnancy interrupts the otherwise normal estrogen exposure cycle).”
Hmm, so you’re addressing me (the commentor who just told the story about her infertility in another thread) tell me that breast cancer is “preventable” by bearing children. Shouldn’t “preventable” be, oh I don’t know, something that people have control over?
See, that only confirms in my mind “Politically Correct” to some people = NOT being a jerk in my book.
MedsVsTherapy on abortion as a cause of breast cancer:
“So, if a woman chooses to not voluntarily end any pregnancy she has up to the age of 40, then she is at lower risk of breast cancer.
“There is an impressive body of evidence regarding this phenomenon. For political reasons, it is generally discounted.”
Amy Tuteur is “eagerly awaiting the new ‘right to life’ campaign aimed at high school girls, tentative slogan: ‘Sleep with your boyfriend, get pregnant, stop breast cancer!’”
http://skepticalob.blogspot.com/2010/01/sleep-with-your-boyfriend-get-pregnant.html
Actually, I think that rather than blaming abortion for breast cancer we should acknowledge that the real problem is that we aren’t having babies early enough. At 45 I’ve never been pregnant, so my risk of breast cancer is significantly higher than it would have been if I’d had a child at 15. (Of course, in that case my risk of obtaining higher education would have dropped significantly, but that’s not that important. I’m only a woman, after all.) As a public health measure we could encourage all fifteen year old girls to give birth and give their babies up for adoption to older parents. That way we kill two birds with one stone, because the older mothers will have the health benefits of not having to go through the stresses of childbearing and/or fertility interventions in middle age.
Clearly the only reason we aren’t promoting teen pregnancy as a good thing is fear of being thought politically incorrect by foofy liberals. Since only unscientific sissies are afraid of foofy liberals, I expect to hear more from MedsVsTherapy on how sex education should fully inform teenagers of the benefits of having chilren early for the prevention of breast cancer.
Argh! Post above unreadable due to html error. Trying again.
MedsVsTherapy on abortion as a cause of breast cancer:
“So, if a woman chooses to not voluntarily end any pregnancy she has up to the age of 40, then she is at lower risk of breast cancer.
“There is an impressive body of evidence regarding this phenomenon. For political reasons, it is generally discounted.”
Amy Tuteur is “eagerly awaiting the new ‘right to life’ campaign aimed at high school girls, tentative slogan: ‘Sleep with your boyfriend, get pregnant, stop breast cancer!’”
http://skepticalob.blogspot.com/2010/01/sleep-with-your-boyfriend-get-pregnant.html
Actually, I think that rather than blaming abortion for breast cancer we should acknowledge that the real problem is that we aren’t having babies early enough. At 45 I’ve never been pregnant, so my risk of breast cancer is significantly higher than it would have been if I’d had a child at 15. (Of course, in that case my risk of obtaining higher education would have dropped significantly, but that’s not that important. I’m only a woman, after all.) As a public health measure we could encourage all fifteen year old girls to give birth and give their babies up for adoption to older parents. That way we kill two birds with one stone, because the older mothers will have the health benefits of not having to go through the stresses of childbearing and/or fertility interventions in middle age.
Clearly the only reason we aren’t promoting teen pregnancy as a good thing is fear of being thought politically incorrect by foofy liberals. Since only unscientific sissies are afraid of foofy liberals, I expect to hear more from MedsVsTherapy on how sex education should fully inform teenagers of the benefits of having chilren early for the prevention of breast cancer.
Dr Hall – “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. Genetic factors and the many physiologic changes of aging may contribute more than we would like to think. To some extent, disease is an unavoidable consequence of life: the idea that science can eventually provide perfect health may be a chimera.”
The very idea of “perfect health” is a chimera really. 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? After all, it’s popular amongst certain factions to deny the importance of diet, exercise and behavior on health for personal or ideological reasons. This doesn’t make one non-evidence based conclusion (aka an opinion) any more scientific or unbiased by political/economic/ideological beliefs than the other side.
I’d love to read an actual SBM oncologist’s perspective on cancer prevention since Dr Hall’s assertions seem to be personal opinion about cancer prevention rather than being evidence-based or saying “we don’t know”. After all, a whole, rather expensive, vaccination campaign has been based on the idea that a certain kind of cancer can be prevented by vaccinating against HPV.
Medical science is there to provide informed choice – not to force people to eat healthily, exercise or have lots of babies. We all have the freedom to choose to engage in dangerous or unhealthy behaviors – and most of us do on a daily basis and many of us get great pleasure from doing so (and some behaviors we just like to pretend aren’t dangerous because they’re so mundane). Everyone’s personal cost/benefit analysis is going to be informed by their own values and desires, and their personal situation.
It’s good to know if not having children or having an abortion or miscarriage contributes to the possibility of developing breast cancer. Science is about uncovering these kinds of correlations and then chasing down the facts and/or causation. Reality is reality, it’s not a moral judgment (as much as the god-botherers like to believe it is). Knowing one has an increased risk of developing any disease or condition – through genetic heritability, behavior or exposure – simply means that one can be a bit more aware and get properly tested so, if anything can be done, it can be an early intervention. Or, if there are preventative measures that can be taken, the person can choose to do so.
Fifi asks,
“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?”
No, of course I can’t, since I never asserted any such thing!
Your comments made me very angry. If you can’t read carefully, please don’t comment on what you imagined you read!!
“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?
Fifi said, “Dr Hall’s assertions seem to be personal opinion about cancer prevention”
I wasn’t asserting anything and I didn’t express a personal opinion. I was explaining what Grob and Horwitz said in their book and I was reporting some of the evidence they cited. My personal opinion is that many cancers are caused by environmental and preventable factors but that many are not, and that we don’t yet have reliable numbers and that the idea that cancer is mostly a preventable illness is not supported by convincing evidence.
And where is your evidence for your statement that “it’s popular amongst certain factions to deny the importance of diet, exercise and behavior on health”? What factions are those? Certainly no one on SBM has ever denied that! In fact, I don’t remember ever hearing anyone anywhere say that those factors were not important to health.
Okay, for those who haven’t read all the Dr Bios. Here is part of Dr. H.
“She received her BA and MD from the University of Washington, did her internship in the Air Force (the second female ever to do so), and was the first female graduate of the Air Force family practice residency at Eglin Air Force Base. During a long career as an Air Force physician, she held various positions from flight surgeon to DBMS (Director of Base Medical Services) and did everything from delivering babies to taking the controls of a B-52.”
Now, I worked with the military (as a civilian contractor) for about 5 years. Although it was Army and Marines, I think I can slightly generalize that knowledge to reinterpret this bio to read.
“She is not a woman who is going to take alot of guff.”
Which is why I enjoy your comments Dr. H. (As long as your sternness is not directed at me, of course.)
Dr. Hal, if I remember correctly this issue — whether or not cancer and certain other disease are preventable by diet and execise — was one of the (many) things that Fifi disagreed with Dr. Amy about. (and I think maybe that’s who she is refering to when she says “factions”).
Fifi made the same accusation of “ideological” reasons against Dr. Amy.
I’m not sure why Fifi is reacting in such an irrational way and attacking you but maybe it’s touched off a sore point and so she attacked out of some automatic reflex as if you were Dr. Amy.
Some factions think that certain diets and behaviors prevent cancer. I prefer to think that they lower the risk of getting the cancer except for prophylactic orchiectomies, hysterectomies, etc.
weing – If you consistently use “prevention” to mean avoidance of all risk, that’s fair enough; if lifetime adoption of a particular diet and lifestyle would cut your risk of colon cancer in half, there’s still that other half that wasn’t prevented. Should we be equally careful to say that statins don’t “prevent” second heart attacks, but “lower the risk” of having one?
apteryx
That would definitely be more accurate.
Dr Hall, there are many popular beliefs about cancer that aren’t evidence based and, to this reader at least, you seem to have dismissed what seem like valid and evidence-based concerns about environmental toxins and the contribution of lifestyle to some conditions and diseases. You do seem, to me at least, to promote the idea that cancer is merely a natural result of aging and/or genes and that behavior makes no difference. (But perhaps your alignment with Dr Tuteur and views on global warming have led me to read your posts and comments with a certain cynicism.)
There certainly seems to be enough evidence – gathered via scientific research – to indicate that diet, exercise and behavior probably influence the development and progression of some kinds of cancer. (I’m not even sure why you’d make sweeping generalizations about cancer considering how many different kinds we know about.) The link between sun exposure/burning and skin cancer, and certain substances like asbestos and lung cancer seem quite well supported by research (though I, as always, remain open to the possibility that the science is wrong, particularly since we’re still really at the early stages of understanding cancer – despite how far along we’ve come). Interestingly, in the case of Dr Wigand who blew the whistle on Big Tobacco, it was a cancer causing additive – coumarin – and not tobacco in and of itself that caused him to speak up. While Dr Wigand is to be commended as a person of conscience, I’m not sure if we can claim this as a victory for medical science since science was being abused by industry to sell more cigarettes and the whistle blowing was a matter of conscience rather than a scientific discovery. It’s pretty clear that industry has a big stake in promoting the idea that their practices, products or by-products (pollution) don’t cause cancer or any other disease (or global warming) so, ultimately, I’ll trust the oncologists and cancer researchers’ take on it (which, at the moment, seems to be that diet, exercise, behavior and genetics can play a role in who gets cancer – depending on the cancer being discussed, of course, and acknowledging that there are a diversity of opinions amongst the expert scientists).
I am curious as to where you stand regarding the HPV vaccine in light of your views on cancer, causation and prevention. Some people obviously believe that there’s good enough evidence for a viral cause for certain kinds of cancer to think it’s good preventative medicine to promote vaccination against HPV. Do you?
I’m sorry if my bringing this up or commenting on your posts makes you angry – but please don’t try to make me responsible for your emotional reactions. I may well be reading more into what you’ve written here based of the entirety of your writing that I’ve read, however you seem to bring your own baggage to my comments so we seem to be pretty much doing the same thing in that regard.
weing – “I prefer to think that they lower the risk of getting the cancer except for prophylactic orchiectomies, hysterectomies, etc.”
More or less my own take on it – depending on the type of cancer of course. I haven’t met that many people who think that being active and eating well will actually eliminate the risk of cancer, most people seem to believe the general concept promoted by cancer organizations – that eating well and exercising lowers cancer risk. And most people I know consider themselves at increased risk if there’s cancer in their family (that there’s a genetic risk).
apteryx – “Should we be equally careful to say that statins don’t “prevent” second heart attacks, but “lower the risk” of having one?”
I know you comment was addressed to weing not me. But to mention a something your comment illuminated for me.
To say that second heart attacks are preventable, because we have stantins available, is quite different than saying statins prevent second heart attacks. This is assuming that there are a group of people who can not take statins.
So, to me this is more about being factual than as another poster (FiFi, I think) suggested, blame, guilt, etc.
Fifi,
Arrgh!! you say “you seem to have dismissed what seem like valid and evidence-based concerns about environmental toxins and the contribution of lifestyle to some conditions and diseases.” when I just got through saying “My personal opinion is that many cancers are caused by environmental and preventable factors…” Your response is positively surreal!
It is as if I said something was black and you asked me for evidence for why I thought it was white. And then I said again that it was black and you persisted in questioning why I thought it was white. How many times do I have to say I think cancer IS frequently caused by environmental and preventable causes before you will hear what I am saying? You are making yourself look ridiculous, and I don’t need to waste any more time trying to answer your straw man nonsense. Other readers of this blog have already read and understood what I wrote despite your attempts to misrepresent it as just the opposite.
Once and for all: I believe that diet, exercise, and behavior not only “can” but DO play a role in who gets cancer. I just don’t believe that the existing evidence is sufficient to support the assertion that MOST cancer is preventable with diet and lifestyle changes. Is that straightforward and simple enough for you to get the message?
I will answer your question about HPV. I think the virus causes cancer. I think the vaccine prevents cancer. I persuaded both of my 20-something daughters to get the vaccine, and I even paid for their shots.
If you continue as before, your next step may be to ask me why I don’t accept the evidence that a virus can cause cancer and why I reject the HPV vaccine.
“To say that second heart attacks are preventable, because we have stantins available, is quite different than saying statins prevent second heart attacks. This is assuming that there are a group of people who can not take statins.”
Statins have been shown to lower the risk of a second MI by 20-30%. In combination with Niacin that risk can be lowered by 70%.
Fifi: “There certainly seems to be enough evidence – gathered via scientific research – to indicate that diet, exercise and behavior probably influence the development and progression of some kinds of cancer.”
Yes, to “the development” of cancer, but I have never seen any good evidence that the course of cancer is significantly influenced by lifestyle once it has developed. That appplies to extreme multimodal regimes often advocated within alt.med.
micheleinmichigan: “To say that second heart attacks are preventable, because we have stantins available, is quite different than saying statins prevent second heart attacks. This is assuming that there are a group of people who can not take statins.”
I’m not sure what distinction you are making there. Of course there are people who cannot take statins – those who develop liver damage or rhabdomyolysis when they do take them.
My question referred to the fact that prospective controlled trials suggest that statins are a causal factor for a reduced risk of heart attacks (and very possibly an increased risk of cancer). I, and probably most lay English speakers, would therefore say that “statins prevent heart attacks,” even though many people who take statins have heart attacks anyway. There’s a difference between “prevent heart attacks” and “prevent ALL heart attacks.” Weing prefers to avoid using the word “prevent” unless the latter is meant. Perhaps this is a more technical usage, which I am happy to accept once it’s explained to me. (Although I note that we don’t pussyfoot around saying that cigarettes “increase the risk of cancer” just because they don’t “cause” cancer in ALL smokers.)
Dr Hall – My response may seem surreal to you but it seems surreal to me that you make broad generalizations – that aren’t evidence based – then get upset when they’re questioned! As I said, I may be attributing some of the things that Dr Tuteur promoted here to you since you aligned yourself with her so closely, and be somewhat cynical about your skepticism and beliefs in general because of your position regarding global warming. I get the impression that you’re still pissed that Dr Tuteur wasn’t ultimately seen as being fit to be an SBM blogger.
Thanks for clarifying what you believe about diet/exercise/behavior and cancer, it wasn’t at all evident from you blog post (which made it seem as if you only considered smoking to be relevant and that anyone who believes in diet/exercise/behavior as a preventative measure is being silly). It still seems that you’re still dealing more in the realms of beliefs/opinions than evidence though since you’re still talking in generalities. It seems to me that cancer requires a more specific discussion that takes into consideration the type of cancer being discussed (and I still would be interested in an SBM oncologist’s take on prevention and specific cancers). My main point in posting is that you’re making generalizations and assertions that aren’t evidence based yourself while critiquing others for making non-evidence based assertions.
You made a generalization about people believing that diet/exercise/behavior can prevent cancer but we clearly hang around in different circles since few people I know or run across believe this (most are quite aware of the genetic link and whether there’s cancer in their family history, they may hope diet and exercise prevents them getting cancer but they don’t believe it’s absolute). I’ve run across some exceptions, people into fringe diets and CAM who have extreme beliefs, but they’re the exception. Just as people who believe that industrial toxins and pollution, and diet and exercise, don’t play any role in the development of cancer are the exceptions.
If you continue like before…oh, never mind, I’ll leave you to play that game by yourself
Fifi says my blog post made it seem as if I only considered smoking to be relevant and that anyone who believes in diet/exercise/behavior as a preventative measure is being silly.
I would like to hear the opinions of other commenters. Did anyone other than Fifi interpret my words that way?
pmoran – “Yes, to “the development” of cancer, but I have never seen any good evidence that the course of cancer is significantly influenced by lifestyle once it has developed. That applies to extreme multimodal regimes often advocated within alt.med.”
Agreed but the discussion wasn’t about “curing” or changing the course of cancer once it developed, it was about prevention and preventing the development of cancer. (Or at least that’s what I understood was being discussed.) I’ve never seen any good evidence that the course of cancer is influenced by lifestyle once it had developed – though there do seem to be some interesting studies around the role exercise plays in the prevention of recurrence of breast cancer, but that’s a different thing all together. I’m no fan of cancer quackery – and I fully believe that some people will develop some cancers entirely independent of lifestyle – it just seems that there’s some pretty good evidence for the contribution of dietary and exercise habits, and exposure to certain materials and chemicals (be it the many carcinogens in cigarettes or asbestos), in the development of cancer.
Dr Hall – “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.”
Fifi says “people who believe that industrial toxins and pollution, and diet and exercise, don’t play any role in the development of cancer are the exceptions.”
Who are those peole who are the exceptions? Are they real “meat” people or are they made of straw and your imagination? I’ve never even heard of anyone who said those factors don’t play any role. Name one. Show us the evidence.
Dr Hall – You make generalizations about beliefs based upon no evidence but I’m not allowed to offer up anecdotal evidence about beliefs I’ve encountered myself? Really, you have a rather unreasonable double standard and expectations regarding evidence and making generalizations for yourself and others. Do you truly doubt that people who believe that cancer is entirely genetic and unavoidable exist? (I mean, you seem to believe that prevention makes no difference for most cancers! – Dr Hall “I just don’t believe that the existing evidence is sufficient to support the assertion that MOST cancer is preventable with diet and lifestyle changes.” – or at least that there’s no evidence so both your and other’s beliefs about prevention aren’t evidence based.) Do you doubt the existence of those who simply believe that cancer is an act of God? Some people in the alt med community think cancer is caused by “bad thoughts” or a disruption in the aura, do you doubt these people exist even though this blog discusses them with some regularity?
Dr. Hall- Not at all. I thought you were quite clear when you said: “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.”
I, too, would like to know Fifi’s disagreement with that statement, but it seems she’s not one for citing examples, or even organizing an argument. Her latest post makes things even more muddled; she shoots down her own argument that cancer can be prevented through lifestyle changes.
I wonder if she’s confusing “prevention” with “lowering risk”?
Hmm. I see I was a bit slow in posting. My previous comment was responding to Dr. Hall @17 Mar 2010 at 6:21 pm.
Fifi, it’s nice to see that you’re so fired up about your strawmen, but let’s focus on the issue at hand. First off, how about naming a preventable cancer, and how that cancer is preventable?
pmoran – I can see how you might get the impression that I believe that diet and exercise can influence, prevent or even cure cancer once it’s developed (because I said “progression of cancer”) – that was a miscommunication on my part and sloppy writing that meant I said something I didn’t actually mean. Sorry about that and thanks for making me aware of it (and my apologies for initially responding to you as if I hadn’t actually written it!).
Harriet Hall on (mis)interpretation:
“I would like to hear the opinions of other commenters. Did anyone other than Fifi interpret my words that way?”
_______
“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.”
_______
I admit, I found this statement confusing. There are two parts to it: one about how preventable cancer is through ordinary lifestyle modifications, and another about how popular the belief in preventability is.
If the concept under discussion is that cancer is very easily preventable (this interpretation is supported by your comment that it is rooted in “belief and hope rather than fact”) then in my limited experience, no, not many people believe that. So it’s strange that you would say it is a “popular” belief. Maybe by “popular” you mean “not that uncommon,” which, sure, I can go with.
If the concept under discussion is that many cancers could be at least partly preventable then yes, I think a lot of people believe that. But then it’s surprising to me that you state that it is rooted in “belief and hope rather than fact,” because I thought that there was some basis for thinking that.
I read those two sentences and was puzzled. Then I moved on to:
“Genetic factors and the many physiologic changes of aging may contribute more than we would like to think.”
Then I remembered that this was a book review, and you were probably just telling us that there is a chapter in the book that would explain in more detail why cancer is less preventable than we would like to think.
I also thought that when I think about the preventability of cancer, I’m thinking of not getting cancer before the age of, say, 80. I’m not thinking of not getting cancer ever, even by the age of 200. So the puzzling opening sentences of the paragraph had too many levels to parse easily.
I moved on. Yes, the juxtaposition of “largely preventable” and “popular” was unclear to me. But precisely because it was unclear, I couldn’t take away any particular conclusion about your “ideology.” If I have more questions I can read the book you are recommending.
Does that help?
OK, you have a point. I will admit that there is a tiny minority of people who have unsupportable ideas about cancer causation and who deny all the evidence. They fall in the same category as AIDS denialists and germ theory denialists. They were not on my radar.
There is no double standard here. I did not offer beliefs based on no evidence. You questioned my description of what the book said and I offered some of the evidence cited in the book (there is more in the book). When I say that I don’t believe that the current evidence supports the idea that “most” cancers are preventable with lifestyle changes, that doesn’t mean that I believe prevention makes no difference for most cancers. It means just what it says: that I believe that the current evidence doesn’t support the idea that most cancers are preventable with lifestyle changes. I have explained that I hold no beliefs about what percentage of cancers are due to what causes or what percentage can be prevented by lifestyle changes. I don’t think the evidence is sufficient to support any such beliefs. My belief is about the state of the evidence. It is evidence-based: it’s based on the evidence that there’s no credible evidence to support the idea that most cancers are preventable with lifestyle changes.
If you believe that most cancers are preventable with lifestyle changes, why don’t you just say so and explain why you believe it? Instead, you are quibbling about what you thought I said. And this whole discussion of cancer is distracting from the message of the book. The point of the cancer business was to illustrate that if we prematurely accept one explanation it can handicap us in an objective search for the truth. Do you have any problem with that idea?
Yes, I said “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.”
Lung cancer is largely (around 90%) preventable by not smoking. That’s an established fact. It is not established that other cancers are largely preventable by diet, avoidance of environmental carcinogens, and behavior. That IS a popular concept. I did not say HOW popular it was or even suggest that the majority of the public believed it. And I cited one of several studies that prove that it is accepted in some scientific circles, and you can find a fuller exposition in the book I was reviewing. My statement is perfectly compatible with your statement that people you know “don’t believe it’s absolute.”
You are not going to get away with twisting my words. I don’t understand why you are doing this and I find it reprehensible.
Dr. H. said “Other readers of this blog have already read and understood what I wrote despite your attempts to misrepresent it as just the opposite.”
My interpretation-
To begin the phrase in question “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.”
Although you are talking about the book, to me it sounds like this is one of your take aways from the book.
It appears that you are saying we do not have evidence that cancer is LARGELY preventable. I always assume “largely” is somewhere in the 70 – 100% range, maybe 65% to stretch it. That might be just me.
“Smoking is the one notable exception.
This would be the one line that I questioned. I thought “What THE one?” It seemed a bit of a throw away line. Perhaps “Smoking is one OF THE notable exceptions” would be more accurate. (I don’t know, though.)
“Genetic factors and the many physiologic changes of aging may contribute more than we would like to think.”
This line suggests only that we don’t understand the roles of genetic and other factors, so we can not accurately determine the interplay of environment and genetics and other factors.
” To some extent, disease is an unavoidable consequence of life: the idea that science can eventually provide perfect health may be a chimera.”
Probably we are all still going to die, no matter what we eat or don’t.
“Fifi says my blog post made it seem as if I only considered smoking to be relevant and that anyone who believes in diet/exercise/behavior as a preventative measure is being silly.”
No, I did not read it that way. I would say that I read, “we’re not really sure of the role of a lot of factors in cancer, although we do know smoking’s bad. But we are probably not ever going to be able to prevent 100% of cancers through environmental or lifestyle choices.”
IMO that is.
Dr Hall – “If you believe that most cancers are preventable with lifestyle changes, why don’t you just say so and explain why you believe it?”
If I believed that I would have said it (it gets a bit tedious that you seem to assume that anyone who has a different perspective than you or that questions a generalization you’ve made must hold the beliefs you so clearly disdain). What I believe at the moment – and this could easily change as new evidence emerges – is that SOME cancers seem to be preventable via lifestyle measures, this is based on research I’ve read and what appears to be a consensus amongst cancer researchers. (If it’s not, I’d love to hear from an SBM oncologist about prevention.)
That doesn’t mean that I believe MOST are – I have no opinion about “most” cancers – you’re the one hung up on “most” and so on. I’ve stated quite clearly that I believe that one can’t generalize about cancer and that some people seem to develop some cancers entirely independent of lifestyle and some cancers seem to have very clear links to certain behaviors (smoking, working in an asbestos mine, etc) while others seem to be almost entirely genetic. I don’t have any hard and fast beliefs about most cancer, though I do see eating a healthy diet and exercising as being a sensible way to generally stay healthy in the here and now (and likely to promote good health as I age). Do I think being obsessive about diet and exercise will hold death at bay? Not at all. One can get hit by a bus, contract a fatal virus or discover they have advanced pancreatic cancer at any time (and extreme diets and exercise can come with their own risks). Do I think diet or exercise can cure cancer? No. I just think constantly belittling diet and exercise – and the role it plays in health – is weird.
# Harriet Hallon 17 Mar 2010 at 7:27 pm
OK, you have a point. I will admit that there is a tiny minority of people who have unsupportable ideas about cancer causation and who deny all the evidence. They fall in the same category as AIDS denialists and germ theory denialists.
Actually, I think they work for Phillip Morris or at least still smoke. It’s the river thing again.
Oh, and it seems to me that there’s some evidence that viruses may end up playing quite an important role in some cancers (so it’s not aging or genetics in these cases). We contract viruses – particularly HPV – through behaviors (though obviously some of these behaviors are simply going about our daily activities, they don’t involve explicit behaviors such as sex, smoking or working in an asbestos mine). Of course, that doesn’t discount there being an interaction between various factors such as a viral infection, genetics and exercise or any other number of potential factors. I’m much more curious about cancer than I am married to any particular belief about causation, and it looks like there are possibly are variety of causes or cofactors for the development of different cancers.
Fifi,
So you agree with me! No matter what you think I wrote in the post, can we now agree to agree that diet and exercise are important for health, that there are lots of different causes of cancer, and that there isn’t any hard evidence to support beliefs about how many cancers are caused by what?
I also agree with you that constantly belittling diet and exercise is weird; that’s why I have never done so. If you think I have, you are reading something into my words that I never put there.
Harriet,
Since you said:
“I would like to hear the opinions of other commenters. Did anyone other than Fifi interpret my words that way?”
I’ll try for a short and quick answer here. As Alison quoted, you said:
_______
“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.”
_______
A lot of the confusion, misunderstanding or disagreement here hinges on the interpretation of general descriptive words like largely and popular.
I don’t think anyone on this comment thread falls into that category, but it does remind me of some of the back-and-forth’s we have had with lizkat/pec.
She seemed to go on and on quibbling about whether disease X or cause Y should best be described by some or a lot or many or most or mostly or almost all or all.
Personally, when I read “popular”, I take it mean that a lot of people but not necessarily more than 50% support it or like it.
Similarly with “largely”, although I am more inclined to place that in the category of more than 50%, depending on what else is said about it.
However, in the absence of specific numbers to compare with I don’t think it helps the discussion much to argue which side of 50% is “correct”.
If we ask if the concept that “cancer is a largely preventable disease” is popular, we only have to check a few of our “favorite” healthy living sites to get plenty of confirmation. We don’t exactly need a nationwide Gallup Poll.
Placed in the context of the overall theme of your blog, this is only an example introduced to illustrate the interplay between the raw scientific data and our beliefs, understanding and interpretation of those data and how those affect the treatment and prevention choices we make as patients or doctors.
That is an important issue and one which was touched on or hinted at in previous posts on plausibility and facts, but not really tackled head-on.
I think your blog did a fairly good job of describing this issue and discussing how these factors interplay.
Well, I asked the original question, and I’m still not sure there has been any actual evidence presented. For example, why is the Harvard School of Public Health wrong? I’m not trying to argue so much as understand… how much exactly is cancer preventable? Will the trend continue that we seem to find more and more environmental causes of cancer? Obviously even lung cancer must involve interplay with different factors, as not smoking doesn’t prevent cancer as much as reduce its likelihood (dramatically).
I will say that the same kind of people who are AGW denialists also deny any environmental causes of cancer. They tend to be libertarians or industry apologists. I don’t think Dr. Hall falls into this category, however.
“Ionannidis showed that most published studies are wrong. Grob and Horwitz show that many of our current diagnoses, treatments, and ideas about disease may be wrong too.”
I also have to offer kudos for this entire post, btw. The book sounds very interesting. And the post does exactly what I’ve been begging for on this site: address the shortfalls of conventional medicine. I’m asking because I’m curious, not to derail the discussion.
Zoe237 asks,
“For example, why is the Harvard School of Public Health wrong?” It has been critiqued by other scientists for various reasons; the book mentions some of their objections. You could look up those critiques to learn exactly what they thought Harvard did wrong.
“how much exactly is cancer preventable?”
As I’ve been saying, we don’t know. All we have so far are a few isolated facts: about 95% of lung cancer can be prevented by never smoking, HPV vaccines can prevent many but not all cervical cancers, etc. And we know lots of risk factors, but we don’t have good data on what happens in the real world if we try to eliminate those risk factors.
“Will the trend continue that we seem to find more and more environmental causes of cancer?” Now you want me to get out my crystal ball and put on my turban? OK, my crystal ball predicts that more and more carcinogens will be identified but that the total number of cancers due to environmental causes will turn out to be small compared to the number due to all the other causes, and will be a smaller and smaller fraction as we learn how to avoid those carcinogens.
“It has been critiqued by other scientists for various reasons; the book mentions some of their objections. You could look up those critiques to learn exactly what they thought Harvard did wrong.”
I certainly will, and I have done some reading in the past. The problem is that each “side” is so wrapped up in their own ideology that it is hard to get at the truth. It seems like public health officials, epidemiologists, toxicologists, environmental health scientists are firmly on one side, with many doctors on another. And most doctors are not scientists… so I wonder. I do however agree that the mainstream media (not to mention human nature) love to overstate the amount of control we have over our lives.
Fifi, Dr. T would have made 20 irrelevant comments and 3 personal attacks and declared her post explained. Not the same at all lol.
Reproducible observations by independent unbiased observers can force a paradigm shift. If reproducible observations by independent unbiased observers is your definition of data, then I would agree it is for practical purposes always right.
What many will call data, the reported observations from a single experiment, still requires some skeptical assessment, just as the explanations require skeptical analysis.
Some will apply a different label to independently reproducible observations, and call it verifiable data.
If we use a more exact definition of data, we might avoid some of the confusion that may occur when we say, “I don’t accept their data” (after saying data is always right). Then the phrase “I don’t accept their data”, could be more clearly stated as, “There has not been sufficient verification of their data”.
Zoe, It occures to me that it’s possible that neither Harvard Public Health or Dr. H. are wrong. The are just looking at the issue from a different perspective. (the blind guys and the elephant)
It is the duty of Public Health to seek out possible health concerns, investigate and control them, sometimes even when there are no current illness associated, the risk is sufficient to block a substance.
From a practicing doctor’s perspective, they are looking at known causes and/or risks and need to use evidence to help an individual patient makes the best lifestyle or treatments decisions for them.
I’m pretty sure I’m saying this badly, I didn’t sleep well last night and there is not enough coffee in the world right now. But it’s possible someone will get the just of what I’m saying.
Dr Hall: “Did anyone other than Fifi interpret my words that way?””
Yes, to an extent. There may not be evidence to prove that cancer is “largely” preventable by lifestyle changes, if “largely” is defined as “over 50%.” However, when you seem to deride people who hold similar opinions as irrational or ill-informed (“rooted in belief and hope rather than fact”), without acknowledging that a substantial fraction of cancer really is preventable*, it sounds very much like you are implying: “Don’t alter your lifestyle to try to reduce your risk, it will do you little or no good.” That’s not a good message to send. It also could be argued that restricting the discussion only to whether cancer is “largely preventable” is a straw man, because most of your apparent targets might agree that cancer was less than 50% preventable, while arguing that, say, 40% prevention would still be a good thing.
*For men, the most common [potentially] life-threatening cancers are prostate, lung, and colorectal; for women, breast cancer is by far the most common, followed by lung and colorectal cancer. It is pretty well determined that all of these are influenced by environmental factors. Other cultures have dramatically lower rates of breast, colorectal, and prostate cancer – so long as they don’t adopt the Western lifestyle – and there are a number of plausible, data-supported hypotheses as to why that might be.
Many of the somewhat less frequent cancers in the U.S. also are linked to environment. For example, we know that getting sunburned increases melanoma risk. And when, as for bladder and oral cancer, you see enormous racial and sexual differences in incidence within the U.S., it suggests that behavior or exposure to environmental toxins might play a role (which indeed has been backed up by epidemiological studies, e.g., that show that tobacco use increases risk for both).
michelleinmichigan,
I think I get the gist of your message. The story of the seven blind men and the elephant is probably a good analogy.
What question we choose to ask ourselves and how we define the terms that go into it can affect the answer(s) that we get.
The Harvard School of Public Health report referenced earlier says that up to 75% of cancers may be prevented and cites a slightly less sanguine number from the ACS of 60% that might be prevented. But, those are top end, idealized estimates that might be achieved under perfect conditions.
However, when the Harvard report lists causes of cancers, at least as I read it, they are now talking about all cancers, not just preventable ones. So, that 100% of causes are not all preventable.
I found an interestng report by Miranda Hitti and Louise Chang on
medicinenet:
http://www.medicinenet.com/script/main/art.asp?articlekey=98100
It says:
“Feb. 26, 2009 — About a third of common adult cancers may be preventable in the U.S. — and that doesn’t even count cancers that could be prevented by not smoking.
That’s according to a new report from the World Cancer Research Fund (WCRF) and its sister organization, the American Institute for Cancer Research (AICR).
In the new report, the WCRF and AICR estimate that in the U.S., eating a nutritious diet, being physically active, and keeping body fat under control may prevent:
* 38% of breast cancers
* 45% of colorectal cancers
* 36% of lung cancers
* 39% of pancreatic cancers
* 47% of stomach cancers
* 69% of esophageal cancers
* 63% of cancers of the mouth, pharynx, or larynx
* 70% of endometrial cancers
* 24% of kidney cancers
* 21% of gallbladder cancers
* 15% of liver cancers
* 11% of prostate cancers
Diet, physical activity, and limited body fat could prevent 34% of those 12 cancers overall in the U.S., and 24% of all cancers, according to the report.”
If we somehow get no one in the U.S. to smoke at all
we might avoid the 30% of cancers that are lung cancers and manage to prevent 54% of all cancers. Possible, maybe achievable, but still pretty idealistic. I notice that only 3 of the 12 common adult cancers listed have more than 50% noted as preventable.
In conclusion, I liked this little tidbit from the medicinenet page on lung cancer prevention:
“Prevention means avoiding the risk factors and increasing the protective factors that can be controlled so that the chance of developing cancer decreases.
Although many risk factors can be avoided, it is important to keep in mind that avoiding risk factors does not guarantee that you will not get cancer.”
Dr Hall – “So you agree with me! No matter what you think I wrote in the post, can we now agree to agree that diet and exercise are important for health, that there are lots of different causes of cancer, and that there isn’t any hard evidence to support beliefs about how many cancers are caused by what?”
Hmmm, maybe you haven’t actually been reading what I wrote…. But I’m glad that you can agree that diet and exercise are important for supporting general health, even if you can’t agree that diet and exercise may be a factor in preventing the development of certain types of cancer (despite the fact that you’ve provided no evidence and there is quite a bit of evidence by cancer researchers in this area that you haven’t actually challenged in any meaningful or scientific way). So, no, I don’t agree with you for a couple of reasons. The main one being simply that I try to stay away from making sweeping generalizations about cancer and you’re doing this yet again. Clearly there IS some hard evidence to support various beliefs about the different causes of cancer. For instance, there seems to be good evidence that the HPV virus is linked to developing a certain cancer. And you’ve already agreed there’s good evidence that smoking is linked to developing lung cancer…and perhaps you also acknowledge the link between smoking and HPV and other cancers too? There seems to be good evidence for the link between sunburn and skin cancer, and asbestos and lung cancer as well.
All in all, you seem to be making generalizations as a means to make an argument that doesn’t really seem to hold up when you consider that there are, on one side the cancers caused by unknown factors and on the other side the cancers which have known factors (ingesting/inhaling known carcinogens, a virus, genetic susceptibility). While I’m quite open to the idea that certain cancers can be purely genetic in origin, and there seems to be a well established genetic susceptibility to certain types of cancer, you haven’t proven that purely genes or aging are the main factors in most cancers developing. In fact, the more recent discovery that there may well be a viral component to some cancers – which you acknowledge when it was brought up but ignored in your original blog post – kind of blows your “it’s all just a matter of genes and aging” hypothesis out of the water.
Dr Hall, you seem to want to make cancer more mysterious than it actually is because what we do know doesn’t support your hypothesis (which is not to dismiss the great deal we still don’t know about cancer). All in all, this is why I’d love to see the topic of prevention and cancer tackled by an SBM oncologist who can talk specifics rather than using generalizations to make the case for a non-evidence based speculation about what causes cancer. It may need to be a series since generalizing about different cancers doesn’t seem to make sense but I suspect I’m not the only person who’d find it interesting and informative. After all, if there’s really evidence that diet and exercise (and environment and behavior) aren’t relevant when it comes to most forms of cancer then surely that should be discussed by SBM since even cancer societies and oncologists seem to be recommending people pay attention to diet and exercise. Or are you (obliquely) making the claim that they’re just part of a cancer industry promoting their own agenda for personal reasons and profit and aren’t really science based in practice?
Harriet Hall on cancer prevention:
“HPV vaccines can prevent many but not all cervical cancers, etc. And we know lots of risk factors, but we don’t have good data on what happens in the real world if we try to eliminate those risk factors.”
Fifi on Harriet Hall:
“In fact, the more recent discovery that there may well be a viral component to some cancers … kind of blows your “it’s all just a matter of genes and aging” hypothesis out of the water.”
Fifi,
I’m not getting an “it’s all just a matter of genes and aging” vibe from Dr Hall. I’m getting an “it’s complicated” vibe.
You know, from the current research it seems to me (with full acknowledgment that I’m not an expert on cancer) like there isn’t going to be “one true cause” for all cancers since we’ve so far uncovered a variety of causes for different cancers (and potential cofactors and interaction between genes and environment/behavior). It seems to me that epigenetics is showing us that the interaction between genes and environment/behavior is actually quite complex and intense. (And that we also still have a lot to learn about genes and how they function.)
Alison – Yes, she’s certainly expressing that now but what I got from the initial paragraph in the blog wasn’t “it’s complicated”. What I got – and I admit I may be sensitized to this due to Dr Hall’s alliance with Dr Tuteur and her views on climate change – was yet another oblique (perhaps even unconscious) attempt to make out that people who pay attention to diet and exercise and think it may have some preventative effect against developing cancer are engaged in woo and unsubstantiated beliefs (despite the fact that most people are quite keenly aware of the genetic component to cancer in my experience) but that her speculation (a speculation I recognized because she’s made it before) that most cancers are caused by genes and aging is somehow different despite not being evidence based. (Certainly she used some qualifying and precautionary words when proposing her own position but so do cancer societies and oncologists generally.)
Combine that with the fact that we now vaccinate against HPV specifically to prevent cervical cancer – I thought due to evidence that there’s a relationship between contracting HPV and cervical cancer if it’s to be promoted as SBM – and Dr Hall’s speculative assertion seems not to be particularly supported by the science. Pointing this out doesn’t mean I believe diet and exercise are magical, it merely means that there does seem to be evidence that behaviors (including diet, exercise, smoking cigarettes, and safe sexual activity or vaccines to prevent infection with HPV) play some role in preventing or causing some cancers. I guess the problem I run up against is that Dr Hall is saying it’s too complex to speculate and then speculates herself and offers her beliefs/opinion (while dismissing other’s beliefs). That’s what seemed uneven to me.
In this whole discussion there’s also the element of “staying on message” when talking to patients.
Doctors want to communicate that patients should quit smoking, lose weight, get more exercise and eat lots of fruits and vegetables. If they do this they will feel better and probably stay healthier. These are the really critical elements. They don’t want smokers obsessing about whether their carpets are outgassing. They want them to focus on the important stuff. Eating organic? Taking vitamin supplements? Installing an air purifier? Sure, if they feel like it, once the big things are in place.
Still, doctors can’t promise patients that they won’t get cancer or ever have a stroke even if they do eat right and exercise. So they have to be careful.
And then there’s all the “theoretically interesting” stuff. I remember listening to a science show once (twenty years ago?) and a researcher was talking about using some sort of magnetic resonance or something to distinguish between the fatty acid profiles of blood samples of people with and without a particular type of cancer. I was fascinated: at the time I thought of cancer tumors as just fast-growing lumps, and the idea that a lump in, say, the pancreas could have effects on another organ, say the blood, was novel to me. I mentioned it to a doctor I knew socially, who practically shrieked at me: “NO! There is no blood test for cancer!” Which I hadn’t thought there was. I hadn’t thought there was a current test (the researcher on the radio show was talking about strictly lab work). And I hadn’t thought the theoretical test was something that would be useful in the real world (it sounded awfully expensive and was only 85% accurate). I just thought it was cool as a concept.
The doctor, however, was upset about irrelevant information distracting the patient base. Or something. The theoretical possibility of a blood test for cancer was not something he wanted his patients thinking about, and by extension he didn’t want anyone else’s patients thinking about it either. And until it had a practical application in his daily practice, he probably didn’t want to think about it — the stuff that really is applicable is plenty to keep a practitioner busy, thankyouverymuch.
When docs talk about not having enough information to make recommendations for cancer prevention, they aren’t thinking about things that are probably true, or that are true in the lab. They are thinking about what do they really know will make a real difference to the real person in front of them — what should they spend effort convincing someone to do, and when should they try to redirect the focus of someone’s health behaviours.
This is a blog about science-based medicine, so most of the emphasis is going to be on the take-home message — which will be more pared-down than the totality of the research.
(Have I got this right?)
Even when I agree with her, Fifi still wants to fight!
She says, “even if you can’t agree that diet and exercise may be a factor in preventing the development of certain types of cancer”
I DO AGREE with that. I never said I didn’t. Although I didn’t specify in so many words, when I said they were important for health I meant that they were important for cancer prevention, heart disease and many other aspects of health.
“There seems to be good evidence that the HPV virus is linked to developing a certain cancer”
Yes, and I already said that. Why are you trying to convince me of something I already said I believe?
“kind of blows your “it’s all just a matter of genes and aging” hypothesis out of the water.” “you haven’t proven that purely genes or aging are the main factors in most cancers developing”
Of course I haven’t. I do not have a hypothesis that it’s all just a matter of genes and aging. I never suggested that genes and aging were the main factors in most cancers developing. I made it clear that there are many different causes of cancer, and now you are arguing with me that there are many different causes of cancer.
I don’t think “straw man” quite covers what Fifi is doing.
Dr Hall – I’m just knocking down the strawman that you set up in your initial blog post regarding diet and exercise, not erecting another one. I don’t see much evidence that people who modify their behaviors to try to lesson their risk of developing cancer believe there are no genetic factors (barring some fringe types who believe that diet and exercise is a panacea) – in fact most people I’ve encountered who do modify their behaviors to try to lessen their risk of developing cancer seem to do so because someone in their family has had cancer. If you truly believe that it’s too complicated to speculate about, why speculate yourself? And why talk in generalities when clearly cancer risk and prevention is something that requires speaking about the specific types of cancer?
Fifi,
Any straw man you saw in my original post is a figment of your imagination.
Dr Hall – I understand that you are (or were) angry and annoyed that I commented on one of your blogs. I’m not angry about your regarding your blog post – and we do agree on many things regarding cancer upon further discussion – I just noticed that you set up what appeared to be a strawman about popular beliefs regarding cancer in your initial post. I don’t even have an issue with you speculating, just with doing so based on almost meaningless generalities and in opposition to a strawman about what others believe.
It seems to me that some folks are responding to Dr. H’s article as if it was a piece on how to stay health and prevent cancer. Perhaps if it were, some of the critiques would be quite apt.
To me, this was an article talking about how medicine should step back and take a look at the many things that they don’t know. How should doctors account for the fact that sometime the theory they are working with is wrong? How do we prevent ourself from settling for the convenient but inaccurate diagnoses that will lead us down the garden path to a wrong conclusion?
Within this context, I think it is appropriate to highlight what we DON’T know about cancer and it’s prevention. I didn’t get any hint that she thought we should all stop exercising and eat chocolate cake washed down with vodka for breakfast*. I only got the idea that perhaps some of the measures that are held out as reliable today may have unknown consequences tomorrow.
Thus this quote, “We offer behavioral prescriptions based on assumptions derived from inadequate epidemiologic evidence, and this kind of thinking can lead us astray. Recommending a low fat diet helped fuel an epidemic of obesity as people replaced the fat in their diet with extra carbohydrates.”
To me this is an article that extols doctors and patients to consider what they don’t know as well as what they do know when making health decisions. That is not an easy place to be, but I think it’s a valuable message.
It reminds me of a quote by Ralph Waldo Emerson “A foolish consistency is the hobgoblin of little minds”
*as much as we all would love to do so.
# squirrelelite – thanks for posting those statistics. Quite interesting.
I also have to point out my error of “just” which you smartly recognized as “gist”
I might add that this mistake is not as bad as the time I went on vacation and emailed my friends that I was “on the lamb”…
To be honest, I don’t get the prevention/not prevention debate. I think most people have gotten the exercise, loss weight, eat veggies message.
It’s putting the advice into action that is problematic for some people. Whether because they are rationalizing and indulgent (like me) or because they work 50 hours a week at a desk or standing and get home and still have to do homework with the kids, get dinner, etc (like my sister).
But like you said, maybe achievable, maybe idealistic.
Fifi says
” I understand that you are (or were) angry and annoyed that I commented on one of your blogs”
No, Fifi, I was not annoyed that you commented. I was only annoyed that your comments attacked me for something I did not say and did not believe.
“set up what appeared to be a strawman about popular beliefs regarding cancer”? What I actually said was “A popular concept today is that cancer is largely a preventable illness.” I still think that is a true statement that can be confirmed by various sources of evidence. You chose to interpret the words “popular concept” and “largely” in a different sense than I intended them. I don’t think I was “speculating based on almost meaningless generalities.” I think you were speculating about my beliefs based on your own preconceptions and your idiosyncratic interpretation of my words. You didn’t ask me what I meant; and when I explained my position, it turned out you agreed with me. Your assumption that I didn’t think exercise and diet had anything to do with cancer causation and that I thought it was all genes and aging was spectacularly unwarranted. Next time, instead of immediately attacking me, you might ask questions first and give me a chance to clarify.
Dr Hall – Um, actually you were the one that was immediately angry and attacking – in your first post to me you said “your comments make me very angry” (when I’d only addressed one comment to you in this thread!). I wasn’t the only one that got the impression that you were being dismissive of everything but smoking as a behavior that increases the risk of developing cancer, nor was I even the first to bring it up. Thanks for clarifying what you really meant.
“To be honest, I don’t get the prevention/not prevention debate.”
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. What will happen if the patient takes the statin but still gets a heart attack? Can he get so upset that he sues me for breach of contract? I don’t know, and I don’t want to learn the hard way.
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?”
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.
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?
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.
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.
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.
Мде …
Могу предложить Вам посетить сайт, на котором есть много информации на интересующую Вас тему….
It’s good to know that SBM is important to the Russian community as well.
It’s good to know that SBM is important to the Russian speaking community as well.
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.
micheleinmichigan,
“It’s good to know that SBM is important to the Russian community as well”
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.
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.
After I’m done sending the Nigerian Prince money, I’m going to check out Boris’ link.
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.
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.
“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.
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.
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.
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.
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.
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.
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
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.
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.
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!
Alison,
Apology accepted!
Did you see the HuffPo article I cited?
Why thank you Harriet. that is exactly what is needed when we speak about ‘they.’
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.
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.
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?
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.
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.
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!
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.
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.
BillyJoe -
LOL – What can I say, I’m married, not dead.
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.
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.
“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.
“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.
@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.
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.
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.
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.
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
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.
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.
“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.
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.
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.
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.)
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
“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.
“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.
Gah, meant “homogeneous group” not “heterogeneous group” in the above post. Four year old is winning today.
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).
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.
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.
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.
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.
Wallace Sampson:
“
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.
“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.
“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!
@Zoe237 try this,
http://www.cancer.org/docroot/PED/content/PED_3_2X_Diet_and_Activity_Factors_That_Affect_Risks.asp?sitearea=PED
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.
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.
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.
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.)
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.
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!
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.
Apteryx- thanks for the clarification, and Allison, thanks for the laugh.
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
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.
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.
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.
Alison was joking?
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.
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.
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.
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?
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.
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!
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.
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.
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.
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.
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.
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.
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.
Alison, I didn’t think you were joking about the frog piss and thought that what you said was correct and elegantly expressed.
Rosemary, when a university address has a tilda in it such as
http://www.ocf.berkeley.edu/~lhom/organictext.html that means it is usually a student or employee personal page hosted by the university. These pages are not approved or condoned by the university.
I do not understand why you are presenting a grad student’s personal page as evidence. He has interesting observations and seems knowledgeable, but he does not site his sources at all.
I’m sure he is a nice guy, but why should we trust what he has to say about organic farming? What is there to disprove, when he doesn’t show the sources that he is referring to?
Fifi, “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”.”
Yes. I know that. Actually, I have a friend who grew up on a farm and loves to cook who always says, “Show me a food that isn’t organic!”
Fifif, “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.”
That is one of the points I was trying to make. Businesses are in business to make money. They do market analysis to determine how people feel and then structure their claims to them. Health and disease prevention sell.
I never intended to suggest that everyone who uses a supplement, eats food certified organic, goes to a gym, shops in a health fraud store, etc. is being irrational or practicing CAM. There are medical reasons which require some people to take supplements. Some people like the taste of specific foods which happen to be organic. Others like the variety of spices in a health fraud store. Some people love to exercise or go to a gym to keep their weight down. There are all kinds of reasons for doing things. However, IMO, a lot of people in our society are obsessed with health and wellness and many of them get carried away with the obsession, some far more so than others. You will find many of the obsessed in health fraud stores, gyms, etc. Many if not most of them do practice CAM to varying degrees. Most are not sick. They are just looking for insurance which CAM claims to sell.
Another point that I was trying to make was that when one does something because he believes it offers health benefits, he should verify that there is solid evidence substantiating those claims especially nowadays since there are a whole lot of people out there using health claims to sell goods and services because they know how obsessed so many people are with optimizing health and preventing disease.
Also I know many people who eat organic because they believe it offers health benefits. They believe that it is natural and good and free of bad synthetics. I’ve been told here that they are exceptions and that most people who eat organic do so for the health of the environment, but I haven’t seen evidence organic helps the environment. In fact from my reading of the site I posted above, http://www.ocf.berkeley.edu/~lhom/organictext.html, which I assume is a reputable site, it doesn’t sound as if the evidence on environmental benefits is in yet. If anyone knows that it is, please give me a reference.
I’ve also quoted Marian Nestle, a food scientist, who sounds very reliable to me. Although she believes that organic food is safer for people than conventional, she clearly states that the reason is that studies show that people who eat organic have fewer pesticides in their bodies than those who eat conventional. I have also stated that I disagree with her conclusion because poisons are species specific and dose dependent and I am not aware of any evidence indicating that people who eat conventional foods are harmed by the amount of pesticides in them although I can certainly understand that many people would decide to err on the side of safety and respect their decision to do so. What concerns me personally is that a “natural remedy” used on an organic farm may have gotten into my food.
Michele, “I do not understand why you are presenting a grad student’s personal page as evidence.”
Because what he writes sounds credible to me. I’ve heard similar things from several scientists that I know personally. No one who knows anything about the subject has given me a reference to a good scientific article or review, and I’d rather trust a grad student, or someone who claims that he is a grad student who sounds like he knows the topic, than anonymous commenters on the web.
“under the laws of most states”
States don’t write the laws for USDA certification, the federal government does, and no state law can supersede the federal requirements, they can only further restrict. See http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?type=simple;c=ecfr;cc=ecfr;sid=4163ddc3518c1ffdc539675aed8efe33;region=DIV1;q1=national%20organic%20program;rgn=div5;view=text;idno=7;node=7%3A3.1.1.9.31 for the full legislation of the organic acts as they currently stand.
“wide variety of chemical sprays and powders on their crops.”
Of course there’s a wide variety of chemical sprays and powders allowed- almost everything is a “chemical”, including water. If there’s a particular pet chemical that you love to hate, you can search the database at http://www.ams.usda.gov/AMSv1.0/ams.fetchTemplateData.do?template=TemplateJ&navID=NationalOrganicProgram&leftNav=NationalOrganicProgram&page=NOPPetitionedSubstancesDatabase&description=Petitioned%20Substances%20Database&acct=nopgeninfo and http://www.ams.usda.gov/AMSv1.0/getfile?dDocName=STELDEV3100278&acct=nopgeninfo to see if anyone has petitioned to use this chemical in organic farming/food production and what the status of their petition is.
“past three years, and the land being planted cannot have been treated with synthetic materials for that period either.”
They forget to add that to be certified, one must also
“Schedule an on-site inspection of the operation to determine whether the applicant qualifies for certification if the review of application materials reveals that the production or handling operation may be in compliance with the applicable requirements of subpart C of this part.
(b) The certifying agent shall within a reasonable time:
(1) Review the application materials received and communicate its findings to the applicant;
(2) Provide the applicant with a copy of the on-site inspection report, as approved by the certifying agent, for any on-site inspection performed; and
(3) Provide the applicant with a copy of the test results for any samples taken by an inspector.” So they can’t just say they’ve had a wash-out period and be done, your soil and crops have to test at acceptable levels (for most chemicals, that’s non-detectable or trace levels only) by an accredited inspecting agency. You also have to
“(f) Immediately notify the certifying agent concerning any:
(1) Application, including drift, of a prohibited substance to any field, production unit, site, facility, livestock, or product that is part of an operation; and
(2) Change in a certified operation or any portion of a certified operation that may affect its compliance with the Act and the regulations in this part.”
So if your neighbor dusts on a windy day, and it blows onto your crops, you could lose your certification or be subject to additional testing. It’s not quite as simple as Berkley implies.
“Most organic farmers (and even some conventional farmers, too) employ mechanical and cultural tools to help control pests. These include insect traps, careful crop selection (there are a growing number of disease-resistant varieties), and biological controls (such as predator insects and beneficial microorganisms).”
I question their use of “some conventional farmers” in here; (yes, personal experience) I’ve never met a farmer that used integrated pest management and called themselves conventional, but if just two in the country do, then they have their “some” so it’s kind of a meaningless statement.
“When you test synthetic chemicals for their ability to cause cancer, you find that about half of them are carcinogenic.”
It’s actually over 60%, according to Ames and Gold, 1990 (Chemical carcinogenesis: too many rodent carcinogens. Proc. Natl. Acad. Sci. USA 87:7772-76). That compared with less than 50% of natural chemicals, but see the full paper for how they decided which natural chemicals to test.
“Until recently, nobody bothered to look at natural chemicals”
If you consider twenty years ago “recently” then sure this statement is 100% accurate. For me, 5 years or less is “recently” but I work in a developing field, so five years covers the whole history.
“effectiveness of a rotenone-pyrethrin mixture versus a synthetic pesticide, imidan.”
Rotenone was disallowed in 2005, and pyrehtrin is also not currently allowed, so not sure what point they’re trying to make here, comparing not-allowed chemicals with not-allowed chemicals.
And starting off a page with “When I’m not busy griping about the use of pesticides in organic farming,” pretty well screams “bias” right off the bat to me.
Thank you lkregula. You have taught me a lot. I have a lot of reading to do. Your government link alone illustrates how frustrating it is to accomplish anything in today’s terribly complicated world.
Now please tell me if you personally would call Michele’s farmer, the one “who is interested in preserving heirloom tomato species, using compost instead of industrial fertilizer and cutting back on pesticide use” an organic farmer. Do you think that most people in the general public would consider a farmer who used “pesticides”, an organic farmer?
And thanks to squirrelelite too. Sorry I just noticed your informative comment above linking to Dunning’s podcast. Your comments, except for those linking organic and CAM, are pretty much the same as mine.
Sorry. I meant that Squirrelelite’s comments pretty much reflect my feelings on the topic, but I’ve have to investigate further.
1) Commenters on this thread disagree on what “organic” means.
2) We disagree on whether it could have any benefits, and if so, for who or what.
3) We therefore have no basis for thinking that the general public has a firm, monolithic view. (We can assume that this lack of clarity is deliberate, an effect of a marketing strategy to use the “organic” label to sell at a higher margin to as wide a market as possible.)
So. Do we have any basis for thinking that a significant proportion of…
[americans? human beings?] would respond to “You eat organic food. Does this mean you will never get cancer?” with an unqualified “yes”?
“Hoping that organic food is somehow better,” or “believing that organic food must be better for my health in some way” are a little different from “believing that organic food is a miracle cure for cancer.” So saying that we know that most people believe that they can cure or prevent cancer through diet because “organic” is used as a marketing ploy is skipping a few steps in the chain of causality.
Rosemary, it totally depends what pesticide, how much, and when this theoretical farmer was using. Based on those answers, he may very well be consider in the organic vein of farming practices- but those answers matter and without them, you can’t say a precise yes or no. Is the pesticide a mole trap to keep small rodent populations down? Is it a Japanese beetle bag? Is it a chemical herbicide, or a chemical insecticide? If so, is it on the approved list? Is it applied prophylactically, or only when pests are becoming a problem?
[...] Hall in a following post, Diagnosis, Therapy and Evidence, that takes it’s lead from this comment has condensing it [...]
I think it’s already been mentioned, but organic farmers use organic pesticides. At least, many do. Conventional farmers use synthetic pesticides. Yes, organic proponents tend to confuse the two and make it seem like organic pesticides aren’t as dangerous, just like CAM proponents imply that organic medicine isn’t possibly dangerous or is side effect free. The problem is with pesticides, period, and the problem is that pesticides are designed to kill unwanted weeds or bugs or diseases on the farm. But they don’t distinguish between pests and beneficial wildlife, and many don’t wear off before they leech into the water supply. True “organic” gardeners do have a respect for life, and nature, it’s true, and that respect also includes a respect for certain natural dangers. For example, organic insecticides hellebore (from a plant) and nicotine (duh) are no longer commonly used, are extremely dangerous, but are certainly organic. A commonly used organic pesticide is rotenone, but is certainly as dangerous as many synthetic ones. Carbamates, DDT, organophosphates are toxic synthetic pesticides (and bug resistance is also a problem here).
Sustainable agriculture (and it tends to be more common on the organic side) includes practices such as bagging fruit, handpicking insects, beneficial pairing of crops, crop rotation, traps, soil enrichment, compost, cover crops, and mulching (for example). The bottom line is that both natural and organic pesticides need to be researched further for effects on the farmworker, the consumer, and the environment (see EIQ- environmental impact quotient).
People on the anti-organic side need to be able to see long term and on a global level- while industrial agriculture might be good for us Americans in the early 20th century, what about for Somalians or Mexicans? What about for next century? I know it’s trite, but our food system right now is NOT sustainable. It’s also NOT doing a good job of feeding the world.
Rosemary, it is similar to the CAM v M debate in some ways. I don’t really know how to say this without the purists on this site getting ticked at me… but the one place sCAMers hit their stride is in certain criticisms of modern medicine, particular the high cost, the pervasive influence of drug reps and pharma funding of drug trials and procedures, the reliance of doctors on their own numerous patient anecdotes, the lack of research evidence for some interventions, little focus on preventative medicine. Sometimes I’m afraid the focus on the relatively few acupuncturists in the world is just… missing the point. I’m not sure it’s as black and white as each side would like to think. I am a bit familiar with the organic vs. traditional agricultural debate. I think it’s probably nastier than the debate on here about CAM. And yet, barring this website, as far as I can tell from local hospitals, practitioners, mainstream media, “integrative” medicine is here to stay. Organic farming is too. The key will be in finding a balance. However, it will take a generation of doctors/farmers retiring to make the change complete.
Zoe, Rotenone isn’t allowed under the current organic standards anymore, precisely because research showed that it’s dangerous.
There is no absolute definition of “organic.” There are functional definitions, as in, it’s organic if it’s OCIA certified. If you want to know what the OCIA considers to be organic you can look here: http://www.ocia.org/
You’ll get different definitions if you go to different certifying bodies. There are farmers who consider themselves organic who aren’t certified, but it’s a little like the difference between calling yourself “liberal” and “a member of the Liberal Party of Canada.” The latter is straightforwardly measurable while the former is perhaps more interesting but harder to define and harder to measure.
Arguing about the real meaning of organic is going to get you about as far as arguing about who is a real liberal and who is only pretending.
First, I get the impression from reviewing comments on this blog, not specifically this thread, that a lot of people believe that one should not hit a key on the computer to write a comment unless one is prepared to post a well researched scientific journal article, and I assure you that I wouldn’t have the time or inclination to do that even if I thought it was what comments were about. I think that conversations and exchanges still have a very valuable place in education and society and, unless I am commenting on a subject I am sure I know well and state that, I am trying to learn from others who know more than I do.
I am very grateful to all of those who have taken the time to teach me. I have read Harriet’s review for the blog on one of Michael Pollan’s books along with the comments and ordered 3 of his books although I can tell you that from the excerpts I suspect I will have some serious problems with them. (The last comment to Harriet’s review sounds like it with a few others may sum them up.)
From what I presently know, Alison’s comment (with the numbered points) makes a lot of sense to me and as does Zoe’s explanation of what goes on in organic farming. The way that she explains it is the way that I understand it. Unlike myself, she has knowledge of specifics and clearly explains that some natural chemicals are quite dangerous.
I also agree with Zoe’s comments on the problems with the practice of scientific medicine, except for the one on prevention, and guess that even most or all of the bloggers themselves would too, but obviously I can’t speak for anyone other than myself. Regarding prevention, I think that most of those who practice scientific medicine and most such organizations do very actively promote prevention. The problem is compliance. The other problem is knowing what preventive practices really do less harm than good. I hate to say this here but Dr. Tuteur had a blog on that recently which I considered excellent.
lkregula, I know this is an emotional issue for you and appreciate that you are taking the time to educate me. You answered my first question about Michele’s farmer. Now please answer the second, “Do you think that most people in the general public would consider a farmer who used “pesticides”, an organic farmer?”
Because my answer to that question is no. But not only do I not think that most people in the general public would not consider a farmer who said he used a “pesticide” an organic farmer because they would equate that with his using “chemicals” which they believe organic farmers never use because organic farmers believe that they are bad, but all the sites I’ve found in a quick check of the internet including your oeffa site state that organic farmers do not use pesticides. They don’t mention exceptions. They don’t clarify.
IMO, the site owners either know well, or should know well, that most consumers believe that means that they don’t use synthetic chemicals because they are dangerous which is exactly the belief upon which CAM is built. That in a nutshell is the problem I have been having with the terms “organic farming” and “organic food”. Many CAMers and many organic farmers and their customers along with many in the general public really do believe that natural is good and synthetic dangerous. Large corporations that don’t believe that and couldn’t care less have noticed and used the concept to sell goods and services and in the process those corporations deliberately continue promoting the erroneous belief convincing more and more people that maybe it is true because it makes them money. IMO, that is a very dangerous belief because it makes many reject science to varying degrees.
If the material promoting organic farming and food, or at least the bulk of promotional material, clearly explained the way that organic farming uses chemicals, and I do not distinguish between natural and synthetic, like Ikregula and Zoe have started to do here, I wouldn’t have a problem because I would think that the industry was giving accurate information to consumers rather than trying to get their business by misleading them into believing that natural is good and synthetic is bad and by deceiving them so that they will buy their products because, based on misleading promotional material, they believe that their products are safer and more beneficial than the other guys.
Does that make any sense to anyone? The main thing that is important to me is honesty. I don’t care what choices adults make or what they believe as long as they don’t hurt others, but I think that people who sell goods and services should have to provide customers with accurate information or information based on presently available objective evidence. Of course, I think consumers should also have a bit of common sense and not trust salesmen’s claims until they can independently verify them or check a review by an expert who has done that.
“Zoe, Rotenone isn’t allowed under the current organic standards anymore, precisely because research showed that it’s dangerous.”
Good to know. IME, organic promoters are MUCH quicker to respond to any sort of research showing harms in the allowed natural pesticides. I firmly believe the organic movement has brought more good than bad, even if the recent commercialism and mistaken notions bother me.
Heck, there are still plenty of libertarians defending the use of DDT for malaria control.
The one caveat in natural vs synthetic is that natural pesticides are generally less effective than synthetic. That’s why a previous commenter mentioned the lower crop yields of organics (in the short term though, not necessarily in the long term). This also (many times) translates into less damage to the environment. So we kind of have a catch 22 here… anything that’s really good for killing bugs/disease/fungus/weeds is also really good at killing or harming everything around it (enter roundup ready… never mind).
“Heck, there are still plenty of libertarians defending the use of DDT for malaria control.”
Just for my information, are there effective alternatives to DDT for mosquito control in malaria prone areas? I wasn’t aware of any, but I haven’t looked into it.
Rosemary – “The main thing that is important to me is honesty. I don’t care what choices adults make or what they believe as long as they don’t hurt others, but I think that people who sell goods and services should have to provide customers with accurate information or information based on presently available objective evidence. Of course, I think consumers should also have a bit of common sense and not trust salesmen’s claims until they can independently verify them or check a review by an expert who has done that.”
I agree entirely. And I suspect that your focus on the idea of “organic” as being particularly dishonest comes from only looking at the industrial marketing by big corporations and critiques of that marketing. This is an easy enough conclusion to come to if you’re not actually on the ground and just getting your information second hand. The reality is that most grassroots organic farmers are very honest and invested in acting with integrity, it’s generally why they became organic farmers in the first place (like all family style farming, it’s not highly lucrative). However, as the public became more interested in buying organic produce and, most importantly, showed they were willing to pay a premium for organic products and produce, the large corporations started trying to take over and exploit “organic” as a brand (rather than a way of farming).
As soon as the major corporations got involved it meant a corruption of “organic” to increase profits – this ranges from lobbying to get organic certification weakened, to putting “organic” as part of a trademarked name, to buying up small farms to starting pseudo-organic factory farms, and of course flat out lying and fraud. (This would happen sometimes before, now it’s rampant.) This is one reason that more and more people genuinely concerned with sustainability and buying organic and fair trade are now more likely to belong to CSAs (community sponsored agriculture) or buy at farmers’ markets where they get to know the producers. It’s also why a lot of people who are concerned with sustainability will buy local non-organic produce over imported organic produce (which just goes to show it’s about the larger picture for people interested in sustainability). Not that we don’t all enjoy an imported mango once in a while! It’s not about turning back the clock, it’s about creating a sustainable future for humankind (the planet and some other life forms will do fine even if we die off) and not rushing in like naive idiots with every new technology simply because someone somewhere wants to make lots of money. (I’m all for new inventions, I just think adequate testing and transparency by corporations is necessary. As is a bit of time spent thinking about actual real world consequences.)
Of course there are people who shop at Whole Foods because it’s trendy and eat organic because they think it will make them more beautiful, hip or live longer (or not get cancer)…they’re the same people who get botox shots to try to look younger and drive their SUVs to WF to pick up organic, fair-trade coffee but don’t care that WF is anti-union and the company itself is about all kinds of things antithetical to fair trade. These people don’t suffer from cognitive dissonance because they’re not really thinking about sustainability or even what it means for something to be organic – they’re simply doing what they think makes them look “good”. And, yes, some of these same people the same people who use CAM. (Wealthy, often educated – they lean to both the left and the right politically, or manage somehow to espouse liberal social ideals while practicing conservative economic/business ones…once again, cognitive dissonance isn’t a problem for people who don’t really think beyond “what can I get for me, me, me”.) These people aren’t being conned so much as they’re conning themselves.
Having just made a generalization about a certain kind of upmarket organic consumer – as opposed to someone who is interested in sustainability – I’d also add that it doesn’t really make much sense to make generalizations about what people believe. Even polls about people’s beliefs are often wrong or skewed so making assumptions or assertions based on our own observations about what “most people believe” is bound to be inaccurate (if hard to resist doing). And making assumptions about what most people believe based on marketing is even more problematic (not that marketers aren’t busy trying to make people believe things or to harness common beliefs or desires).
In the end, I think you’d actually find common cause with most people genuinely interested in sustainability and eating organic/fair trade when it comes to accurate labeling. After all, your main source of information to critique organic labeling (and “organic” being turned into a meaningless brand or signifier) was actually from someone that promotes eating organic when possible. Are you aware that the food/seed/chemical industry pressures academia (using funding clout) to try to manipulate what science gets done around GMOs and organic? (A bit like how major pharmaceutical companies threaten to pull academic funding if someone who questions pharmaceutical efficiency is hired.) The problem is really with industry and what industry is allowed to get away with by our governments. If we want to advocate for truth in labeling/marketing and honest science so that we can make informed choices, we need to recognize where the corruption is coming from.
michele – re: mosquitoes and malaria…nets are what are promoted and cleaning up stagnant water where they breed. In Africa the problem is associated, in some cases, with other issues to do with poverty, sanitation, and mining and the environment (you’ve got to have frogs and lizards to eat mosquitoes and they tend to be quite vulnerable to pollution).
Malathion’s pretty good at mosquito, if memory serves, but I can’t vouch for the safety. Fifi’s point about nets and fauna are my preferences for malaria control.
As for crop yields, they’ve mostly leveled out at this point, even with increased pesticide/herbicide application. Dave Pimentel had a nice review back in 1991 about the effects of reducing pesticide use (Pimentel, D. (1991). Environmental and economic effects of reducing pesticide use. Bioscience, 41(6), 402.)- it’s worth a read, and it’s not very long.
It’s this reduced benefit in the face of increased cost that’s driving the push for GM right now. Carol Auer (Auer, C. (2008). Ecological Risk Assessment and Regulation for Genetically-Modified Ornamental Plants. Critical Reviews in Plant Sciences, 27(4), 255-271.) has a good review of the risks associated with GM ornamental plants, although it is a longer piece. Escaped trangenes have already been documented and are occurring (Zapiola, M.L., Campbell, C.K., Butler, M.D. & Mallory-Smith, C.A. (2008) Escape and establishment of transgenic glyphosate-resistant creeping bentgrass Agrostis stolonifera in Oregon, USA: a 4-year study. Journal of Applied Ecology, 45, 486–494.), so it’s not like this is theoretical scare tactics, the key is to decide what level of risk is acceptable and where each case of GM crops lies in relation to that acceptable risk level. Personally, I’m aware of the damage that invasive plants can present, so I’d rather tackle that problem before we invite more similar problems but I’ll admit to being a risk averse person generally.
Thanks FiFi, something I haven’t thought about in awhile.
Also, cause I was curious and wasn’t sure if anyone would respond. a quick WHO search yielded this result. http://www.who.int/mediacentre/news/releases/2009/malaria_ddt_20090506/en/index.html
“Ten projects, all part of the global programme “Demonstrating and Scaling-up of sustainable Alternatives to DDT in Vector Management”, involving some 40 countries in Africa, the Eastern Mediterranean and Central Asia are set to test non-chemical methods ranging from eliminating potential mosquito breeding sites and securing homes with mesh screens to deploying mosquito-repellent trees and fish that eat mosquito larvae.”
The article goes on with more specifics for folks who are interested.
As a bird watcher, it is good to see the effort being put into using other more sustainable (non DDT) malaria prevention measures.
Michelle, thanks for that link. As an aside, the species of fish used in mosquito control can be problematic. Mosquitofish (Gambusia affinis) have often been used in the past, and they turn out to be least interested in mosquito larvae and most interested in other things, like amphibian eggs. I wish they mentioned which fish they were promoting.
@rosemary, I think agree with your comments.
@alison and michelle, I thought the comment about frog piss gelcaps was funny. Unfortunately, some people probably are that clueless. I understand the ancient Romans drank human urine because they thought it was good for them. I would have to be pretty desperate to try that. Gatorade is close enough.
Here are some of my thoughts.
1. General Blog Comment Standards
I don’t think any blog comment needs to be researched and supported to the level of a scientific paper, although from some of the comments that turn up from time to time you might think that. If every commenter tried to do that, the comment threads would dry up! I do think it is reasonable to hope that a commenter tries to have something coherent and informative to say to help us all to a better understanding of the general subject of a specific blog.
No argument is true merely because I can find someone somewhere on the internet who says something that agrees with me. In general, I try to explain my thoughts in a way that can stand or fall on its own merits. However, I often find it useful to look for what seem to me to be good sources of information to inform my own point of view, better illustrate the point I want to make, and suggest as a resource for others.
I try to refrain from name-calling and profanity because I don’t think they help to convince the general reader and because that is a style of language that I have grown up and lived with and that seems “natural” to me. Nevertheless, I must admit they are occasionally amusing.
2. General Organic Food Standards
Organic food products are indirectly certified by the U.S. Department of Agriculture. Here is their link:
http://www.usda.gov/wps/portal/!ut/p/_s.7_0_A/7_0_1OB?navid=ORGANIC_CERTIFICATIO
As they explain it,
“U.S. producers are turning to certified organic farming systems as a potential way to lower input costs, decrease reliance on nonrenewable resources, capture high-value markets and premium prices, and boost farm income. Organic farming systems rely on ecologically based practices such as cultural and biological pest management, exclusion of all synthetic chemicals, antibiotics, and hormones in crop and livestock production.”
Note the profit motive.
Various organizations in each state are accredited by the USDA as Organic Certifying Agents. A quick check showed 14 different organizations in the state of California which range from a couple of local county agricultural agents to various farmers organizations to what seem to be private businesses making a little money certifying organic food producers. Here in New Mexico there is only one organization as an OCA. They may have some state connection because they have a .state.nm email address. Accreditation seems to be fairly loosely policed because the .pdf file of their accreditation expired three years ago! The list of certified organic producers ranges from a local food coop to a historic farm that operates mostly as a living museum and popular field trip location to a department of the University of Arizona!
I noticed a few salient points in the USDA info sheet:
Products labeled “organic” must consist of at least 95
percent organically produced ingredients (excluding
water and salt).
Processed products that contain at least 70 percent
organic ingredients can use the phrase “made
with organic ingredients” and list up to three of the
organic ingredients or food groups on the principal display panel.
Processed products labeled “made with organic
ingredients” cannot be produced using excluded
methods, sewage sludge, or ionizing radiation.
I didn’t dig deeply enough to check out the currently approved pesticides and fertilizers. Perhaps I’ll take a look at it when I finish my LD50 research.
3. The distinction between organic and inorganic chemicals dates back at least several hundred years to a time when it was generally presumed that the chemicals found in living organisms (or materials that had been living organisms) were fundamentally different from those found in rocks, the soil, water, the air, etc. Organic chemicals were thought to have a “vitalistic” life essence that made them different from inorganic chemicals and could not be reproduced by the means of ordinary chemistry. When it was discovered in the mid-nineteenth century that these same chemicals could be produced by ordinary means, the vitalistic concept was abandoned. Since then, organic chemistry has focused on the study of chains of 1 or more carbon atoms with hydrogen or other elements attached.
The distinction is fuzzy at the boundary, since some compounds containing carbon such as carbon dioxide and calcium carbonate are not generally considered organic chemicals (although Wikipedia and the Encyclopedia Britannica don’t say one way or the other). At least, I don’t think of marble, chalk and limestone as organic chemicals. It does make me curious though if adding lime to your soil (to adjust the pH, if I remember right) is allowed under organic gardening?
Finally, I took a moment to read the Berkeley link. It was a short discussion, but the author had evidently done some research with several organic certifying agents and state agricultural departments as well as a Science article which was referenced. It discussed a few pros and cons of organic and conventional farming methods. I especially liked the point that both sides find it in their interest not to be exhaustively blatant about all the substances and methods used in the production of their products.
I particularly liked two quotes:
“We assumed that “natural” chemicals were automatically better and safer than synthetic materials, and we were wrong.”
“Unless you know your grower personally, there is no guarantee that your produce has been grown without pesticides or other chemicals. It’s a point to consider, given the substantially higher cost of organic foods.”
“The distinction is fuzzy at the boundary, since some compounds containing carbon such as carbon dioxide and calcium carbonate are not generally considered organic chemicals (although Wikipedia and the Encyclopedia Britannica don’t say one way or the other). At least, I don’t think of marble, chalk and limestone as organic chemicals.”
Back in college when I enjoyed the pleasures of organic chemistry, we were taught that organic meant it dealt with carbon containing compounds. Limestone and CO2 would definitely be considered organic. They are also produced by living organisms.
Back in high school when I studied introductory chemistry, we were taught that technically, an organic compound was one containing carbon. But that when people refer to “organic compounds” they mean one containing carbon and hydrogen. So anyone who thought they would be clever and list limestone and C02 on their exam as examples of organic compounds were marked wrong.
ikregula – “As an aside, the species of fish used in mosquito control can be problematic. Mosquitofish (Gambusia affinis) have often been used in the past, and they turn out to be least interested in mosquito larvae and most interested in other things, like amphibian eggs. I wish they mentioned which fish they were promoting.”
CANE TOADS!
You make a good point – even seemingly “natural” interventions into ecosystems can have disastrous unintended consequences. (Since it’s a closed ecosystem, Australia is a wonderful – well tragic really – example of how introducing foreign species can go horribly wrong for the native species and ecosystem. Cane toads were introduced for pest control by cane farmers and have been taking over and poisoning native wildlife and pets that eat them ever since.)
The common thread in this isn’t whether an intervention is “natural” or “synthetic”, it’s humans and our lack of forethought and knowledge about ecosystems. We’ve become slightly more sophisticated and knowledgeable but we keep making the same mistakes that previous civilizations have regarding sustainability and destroying our own habitat. Only now we have the means to do so in a much more spectacular manner. Sometimes – as in the case of the cane toads or frog larvae eating fish – it’s ignorance and good intentions gone awry but, sadly, in other cases it’s greed and arrogance (with a good dose of willful ignorance).
“Unless you know your grower personally, there is no guarantee that your produce has been grown without pesticides or other chemicals. It’s a point to consider, given the substantially higher cost of organic foods.”
Which is why most people genuinely interested in sustainability and eating organic belong to CSAs (community sponsored agriculture), have started to grow their own (or at least some of their own, you can even do this on a balcony or rooftop if you’re an urban dweller) or shop at farmers markets where they get to know local farmers. If you have no clue about gardening or aren’t capable but have a yard, there are also yard share programs in some places.
I’ve participated in a CSA for a number of years now and it’s actually cheaper in the long run that buying non-organic imported produce at the supermarket (and substantially cheaper than buying organic at the supermarket). Plus what I get each week is much tastier (really, nothing you can buy at the supermarket compares to a freshly picked heirloom tomato). I’m also usually eating frozen tomato sauce and veggies, and squashes and garlic, well into the winter. (I’d just given up eating tomatoes previously because the supermarket ones were so disgusting – mealy and tasteless. I’ve got one younger friend who grew up with these and hated tomatoes until he tasted one from my CSA…kind of fun to introduce deliciousness to people! It’s a bit like turning them on to a great band or incredible artist
Fifi, are you in the Montreal area? We’re looking for a CSA and we’re open to references.
Alison,
So carbon tetrachloride would not be considered organic? Interesting.
Alison, yes I am. To see who drops off in your area, check out Equiterre (a great resource regarding local sustainability issues) – I think their CSA page is only in French (I’m assuming you’re bilingual
)there’s a list of the various CSAs).
http://www.equiterre.org/agriculture/paniersBios/listeFermes.php
I’m in Mile End and I’ve got friends who have participated in one in St-Henri – I love my farmers and the food they grow
They also do trades with other local organic farmers so we get pears and blueberries as well. If you’re around the Mile End area, my farmers are…
http://www.lesjardinsdambroisie.com/
There’s also a weekly organic market in the plateau that started up last summer that I’m sure will be active again. Despite our winter, or perhaps because of it, we’re pretty lucky in Montreal regarding fresh summer produce. And there’s also the Jean-Talon market (for local and some organic).
Thanks, Fifi!
I’m in La Petite Patrie. I’ve looked at the Equiterre site every year, but it seemed that either the selection was poor (all eggplant and ground cherries) or terrific (from Southern Ontario). I have a friend in St-Henri who did it for a year and was overloaded with fresh herbs that she didn’t know what to do with — which actually I wouldn’t mind, but it reinforces that I’d like to get a personal reference.
Either that or go to the Marché Jean-Talon, which we do anyway, or to Sami Fruits which is very anti-ecological but pro-community and sooo much fun.
(Rather than clogging up SBM, you can go to my blog if you care to respond to this.)
Alison – I commented at your blog and please feel free to contact me via email. Certainly you get a bit of a glut because it’s season but that’s what freezers and dinner parties are for (zucchinni tends to be the worst offender for my farm!)
Fifi- “CANE TOADS!”
The one amphibian I love to hate. Our North American bullfrog has also been the cause of problems, so I shouldn’t say much against the cane toads. They were just taken for a ride.
Yeah, not really the cane toad’s fault for being a cane toad. I brought it up as another example of human intervention that went horribly wrong. They even studied it before releasing even more into the environment but didn’t take native lizards into account! On top of it, it isn’t even good at eating bugs in cane. Ahhh, the 50s when we – well my predecessors – were still busy trying to turn Australia into somewhere that wasn’t Australia!
Alison and Fifi,
Good luck in your gardening efforts. It is definitely the time of year to get started on them. Speaking as someone who grew up helping his parents and grandparents work in their gardens, I know that it takes a significant and regular commitment of time to get a successful garden, but I do like the results!
Invasive species are a world-wide problem. Some of them are an unexpected side effect of other interventions. One of some importance in the northeast is the sea lamprey which invaded the Great Lakes with the opening of the St. Lawrence Seaway 50 years ago and drastically reduced the population of lake trout. This was partly coped with by the introduction of coho salmon, but it remains an ongoing pest.
As I said, the boundary between inorganic and organic chemistry is fuzzy. This somewhat circular definition from thinkquest illustrates the fuzziness:
“Organic chemistry is the study of the properties of the compounds of carbon that are organic. All carbon compounds except for a few inorganic carbon compounds are organic. Inorganic carbon compounds include the oxides of carbon, the bicarbonates and carbonates of metal ions, the metal cyanides, and a few others. ”
Organic chemistry mainly looks at the enormous variety of compounds that can be formed by connecting carbon atoms together. Methane (CH4) is the simplest organic compound and the starting point for this study, but just as the number 1 is the starting point for arithmetic and mathematics, it is only the starting point.
Sounds like useless hair splitting. I prefer what I was taught. The chemistry of compounds containing carbon.
Zoe, “Heck, there are still plenty of libertarians defending the use of DDT for malaria control.”
Zoe, I have a friend who is not a Libertarian, although like myself and lots of others, he has many libertarian views. He is a retired medical chemist who developed and held the patent for a drug to treat malaria which has long since been replaced by better drugs, and he advocates the use of DDT to control malaria. He does so because he believes that the benefits in human lives outweigh the risks of harm. To me that says a lot in a nutshell. No matter how badly we want to completely irradiate bad things like disease it isn’t possible. We always have to decide which is the lesser of two evils. IMO, that is a concept ingrained in science and denied by CAMers and all those who believe that “Natural is safe. Synthetic is dangerous.”
This same friend also maintains that the evidence showing that a lot of “natural chemicals” effectively manage organisms that destroy food crops wouldn’t be anywhere near as convincing if the farms they were used on weren’t surrounded by others which eliminated those organisms with synthetics thereby reducing the burden needed to be controlled with organic methods.
Fifi, “I suspect that your focus on the idea of “organic” as being particularly dishonest comes from only looking at the industrial marketing by big corporations and critiques of that marketing.”
No, Fifi. My concept comes from the “organic” farmers around me. (I only wish I were at liberty to post anecdotes about them publicly.) They are IMO completely wacky and they completely reject science and embrace nonsense and myth both for their own health care and that of animals, crops and land. They are the vanguard for alt. med., not CAM, organic, and all natural everything in my area. Ikrugula’s site recommends that people “know their farmers”. It is precisely because of the organic farmers I know that I will not buy their products. What I can tell you is that I, who don’t read newspapers, read at least one story in a local paper in which a local “organic” farmer bragged about not using any kind of approved drug on his animals and using homeopathic remedies. I can also tell you that I follow animal quackery pretty closely and know that they too have no distinction between alt med and organic food. They consider everything scientific as bad and everything unscientific as good. They are also pretty dishonest about it, but that is another story. And finally CVM, the dept. of FDA that regulates animal drugs has stated that silver cannot be used on animals. They are concerned because they have found silver supplements in dairy barns and milk is one of the main sources of silver in the human diet.
Michele, thanks for the WHO link. I’ve glanced at it and saved it to read later. I did notice that they said the first study was done in 2003 which brings up another common thread I see in CAM and Organic. Preliminary studies are taken as conclusive and brought to market immediately and used to sell products. (I have the evidence to show this with CAM and will see if I find it for Organic, but I suspect it is right there with the way they have used Bruce Ames’s work.)
Squirrelelite quoting the USDA site, “Organic farming systems rely on ecologically based practices such as cultural and biological pest management, exclusion of all synthetic chemicals, antibiotics, and hormones in crop and livestock production.”
That is the point I am trying to make. There is a common denominator, an element that continually appears on sites, in promotional material and in what people who label themselves organic farmers say. While it is stated a little differently by each, it all boils down to what they say here which is that they exclude “all synthetic chemicals, antibiotics, and hormones in crop and livestock production.” That is the message. They exclude scientific products and use “natural” ones. That is the same message shouted by alt. med.
Now I realize the problems of saying that “most people believe that…” since it is virtually impossible to know what “most people believe” when speaking of huge populations. However, that doesn’t mean that it is impossible to get a very accurate idea and I think that a good way to do that is to first look at what organizations that represent people state. Assuming that people join them voluntarily, I think it quite rational to assume that at least the majority of their members agree with their official statements. I also think that looking at what is stated on Internet sites gives one a fairly accurate idea since, I believe, there are statistics showing that huge numbers of people get their information from the Internet and usually from the top 10 search sites that come up on Google. Then if personal experience confirms what one finds there as it does in my case…
Fifi, where I live, in the Northeast Kingdom of Vt and the Eastern Townships of Que., gardeners have raised their own food for generations. Most of those who garden do not call themselves “organic farmers” or follow lists made up by organizations. But most of the large commercial farming here is dairy.
Until I see a substantial number of people who advocate “organic” anything clearly stating that they are trying to protect humans, animals and the environment by finding and using products for which there is solid objective scientific evidence that they offer benefits which outweigh the risks instead of promoting them based on the myth that natural is good and synthetic is bad I will group Organic with Alt. Med, and until I personally am convinced that people selling food that is labeled organic believe in and follow scientific practices, I will not buy their products.
Rosemary,
“While it is stated a little differently by each, it all boils down to what they say here which is that they exclude “all synthetic chemicals, antibiotics, and hormones in crop and livestock production.” That is the message. They exclude scientific products and use “natural” ones. That is the same message shouted by alt. med.”
Fascinatingly, while you avoid organic farmers on the grounds that they prefer ineffective remedies to effective ones, that’s exactly why I prefer them!
For animals to be able to stay healthy without antibiotics, they can’t be crammed together. My working presumption is therefore that animals on an organic farm are raised in more space and less misery than animals in conventional production.
(I hadn’t known that about the silver though. Crap.)
Rosemary – Nobody is asking you to buy organic products or support organic farming or local farmers! Where you spend your money and what you choose to eat and support is your choice. Interesting that we live so close to each other but have entirely different experiences of the organic farmers in Quebec. Maybe it’s a franco/anglo thing. (I have no idea of what organic farmers in Vermont are up to.) I’m not sure what people growing their own food has to do with organic labelling. In the Eastern Townships, one of the big industries is factory pig farming (and ducks) – both have caused environmental problems.
I find it interesting that you seem to want to deny the political, commercial and PR machinations of the major corporate players in the food industry (which does indeed also include some promoters of CAM and organic like Whole Foods) and companies like Monstanto yet used the information gathered and arguments by Marion Nestle whose whole focus is on calling out Big Food on their dishonesty and politcal machinations! It strikes me as being like wanting to call out Big sCAM while giving Big Pharma a pass – they’re both industries and they both act like industries and big corporations. Do you trust corporations to be acting in your best interest?
Just as many of the lies about food – and exaggerated health claims – are about non-organic products as they are about organic. The mainstream is perpetuating these ideas and inserting them in the mainstream market as much as, if not much more, than small, local, organic farmers that are essentially just running family farms. Family farms – organic or not – have been the major losers in the corporate take-over of all food production. It seems like you want to put all responsibilty for the lies of the food industry at the door of small farmers. Maybe this isn’t your intention but that’s how it’s coming off.
Me? I’ll take my locally grown organic tomatoes that ship poorly and haven’t been refrigerated over the crappy supermarket version any day. That, of course, is a matter of taste and choice.
This whole idea that synthetic chemical are “scientific” and organic farming or environmentalism is somehow anti-science is just weird. Industry uses science, it isn’t science itself and often abuses science just as badly whatever it’s promoting. Being pro-chemical industry or pro-chemical pesticide isn’t being pro-science. I also find it weird since there’s plenty of support for organic and sustainable farming amongst scientists, and plenty of questions about industrial practices. At McGill University here in Montreal – which is also a well respected medical school with a very strong research arm – there’s a whole program built around sustainability. Ecologists are scientists, so are biologists. Sorry but this idea that anyone who is interested in the environment or organic farming is anti-science is simply misguided and not a reality-based belief.
I also think that it’s just as weird to think that organically farmed food is automatically good and corporate farmed or genetically modified food is automatically bad.
weing – Agreed, thinking anything is all good or all bad isn’t engaging in reality-based thinking. And automatic thinking isn’t critical thinking. Like the Big Pharma vs Big sCAM dualism, the Big Agro vs Big Organic is a false dichotomy. It’s pretending that slighly different varieties of oranges aren’t oranges but are apples and oranges (to use a fruity metaphor).
Interestingly, I’ve learned most of what I know about the toxicity and dangers of “natural” insecticides from people who grow organically themselves. For instance, neem oil is an apicide – which is obviously not good for farming of any kind or the environment even though it’s marketed as being a “safe” choice.
I don’t think GMO foods are automatically bad. However, the kinds of tactics Monsanto has employed to try to dominate and manipulate seed banks and so on are pretty unethical. (And certainly a lot of the condemnation has come from farmers that aren’t using organic methods but just want to be able to save seed for the next season. Or not be sued for copyright infringement when the wind blows GM seeds into their fields.) The problem with GMOs is that once they’re released into the wild, they’re not longer controllable and there simply hasn’t been enough research done on the consequences. (And there seems to be increasing evidence that the RR variety of GMOs simply create weeds that are more resistant to herbicides.) They’re the cane toads or antibiotics of our time in many ways.
Industries like to pretend that they’re pro-science simply because they use science, this obviously isn’t the case and conflating the two is a PR (and political) strategy that often results in the degradation of real science. Gaming the results of research is promoting pseudoscience no matter who’s doing it. And pretending that everyone who’s interested in sustainability or criticl of industry is anti-science is just silly.
Rosemary – do you believe that the non-organic food products you buy are somehow more “scientific” and honest about labeling and marketing than organic food products? If so, why?
rosemary “Michele, thanks for the WHO link. I’ve glanced at it and saved it to read later. I did notice that they said the first study was done in 2003 which brings up another common thread I see in CAM and Organic. Preliminary studies are taken as conclusive and brought to market immediately and used to sell products. (I have the evidence to show this with CAM and will see if I find it for Organic, but I suspect it is right there with the way they have used Bruce Ames’s work.)”
I guess you mean this section of the report (excepts)
Mexico and Central America
“The first of the demonstration projects, which began in 2003, has been coordinated by the Pan American Health Organization of the WHO in partnership with a wide range of bodies including UNEP, the Commission for Environmental Cooperation, and the eight country governments.
It has involved the Ministries of Health of Belize, Costa Rica, El Salvador, Guatemala, Honduras, Mexico, Nicaragua and Panama where DDT has been extensively sprayed in homes and onto water bodies in the region order to combat malaria since the 1950s.
More than 89 million people in Mesoamerica live in areas suitable for malaria transmission of which over a third or 23.5 million live in highly endemic areas.”
“The work covered close to 160 000 people directly and an estimated 6.8 million indirectly representing nearly 30 per cent of those in the highly effected areas.”
“The project achieved a 63 per cent reduction in malaria cases and a more than 86 per cent cut in ones linked with Plasmodium falciparum, the malarial parasite that causes the most severe kind of infection and the highest death rate globally.”
“Projects are now going global with several new, five year regional demonstrations of sustainable alternatives to DDT launched, or set to be launched over the next 12 months.”
To me characterizing this extremely large scale project as a “study” is inaccurate. This was not a preliminary study of say 2000 people. As to the results being taken as “conclusive”, I have not problem with WHO taking the information they have gained from projects that “160 000 people directly and an estimated 6.8 million indirectly” and achieved a 63% reduction in malaria cases over the previous DDT program being rolled out into other populations over 5 years.
This is what I expect from science, medicine and public health and I think it is highly inaccurate to equate it to CAM or even Organic farming. The medical aspects of the program are conventional medicine and the mosquito control aspects incorporate the use of non-DDT synthetic chemicals.
Rosemary – “Preliminary studies are taken as conclusive and brought to market immediately and used to sell products. (I have the evidence to show this with CAM and will see if I find it for Organic, but I suspect it is right there with the way they have used Bruce Ames’s work.)”
This is actually done across the board by Big Food – it has nothing to do with “Organic”. Big Food makes all kinds of exaggerate health claims for all kinds of products and is actually the main player in mainstreaming these ideas (since they market to the mainstream – the other big player is mainstream beauty products that tend to put the “magic” natural ingredient du jour in their product and promote it on the basis of that additive).
Dairy boards and the marketing bodies of certain segments of the food/farming industry – often ones that are heavily subsidized by goverment – are also very prone to making exaggerated health claims for their products (or even marketing directly to segment of the population that their product is generally not healthy for – such as promoting milk to segments of the population that are statistically prone to being lactose intolerant, for instance). To try to hang this kind of behavior on “Organic” and ignoring the very ample evidence of how Big Food does this across the board is ignoring reality. (And a bit odd considering that you tried to use a critic of Big Food, Marion Nestle, prove your point about the corruption of organic standards by ignoring what her actual critiques of Big Food are!)
From an article by Marion Nestle…
“There is no reason to think that organic foods would have fewer nutrients than industrially produced foods, and there are many reasons to think that organics have greater benefits for the environment, for pesticide reduction, and for taste, all of which affect human health at least as much — or more — than minor differences in nutritional content. I buy organics because I want foods to be produced more naturally, more humanely, and more sustainably. I see plenty of good reasons to buy organics and this study does not even begin to address them.”
http://www.thedailygreen.com/healthy-eating/blogs/healthy-food/organic-food-nutrition-47073102
That said, I think we can probably all agree that we would all like truth in advertising and labelling that provides honest and accurate information across the board for all products (be it a fridge or tv, food of any kind, or drugs and health products). That, however, is about government regulations and enforcement of those regulations and corporate behavior (since most advertising is done by corporations, and this includes lobbying by industry groups…few citizens groups have the money or resources as industry groups, or can offer the same future career prospects to politicians as they can…one only has to look at how so many politicians jumps from jobs in government to corporate ones, or in Canada how corporate VPs are actually being put in positions to manipulate funding of public research).
Continuing the organic food theme, here are a couple of links:
From the BioFortified website, here is a little photo article on a recent organic food conference in Wisconsin:
http://www.biofortified.org/2010/03/frank-at-moses/
Short on facts and discussion, but the photos are fun.
On the fawning advocacy side, my email recently turned up a link to this article from Maria Rodale:
http://www.menshealth.com/men/nutrition/food-for-fitness/organic-food/article/fab147b24b037210vgnvcm10000030281eac/7
There were a few studies mentioned, but no links to check out, and a lot of “may help with this, may reduce that”.
When I tried to check out a rat study on Monsanto’s genetically modified corn, it lead me to that shining beacon of veracity and perspicacity, the Huffington Post !?!?!
Does anyone know anything more about the gm corn study?
I thought I had read about it a little while ago, but didn’t find anything quickly.
I guess I’ll have to do some more digging.
Are you talking about this study? It’s not cutting edge, but still one that gets brought up now and again.
Séralini, G., Cellier, D., & Vendomois, J. S. (2007). New Analysis of a Rat Feeding Study with a Genetically Modified Maize Reveals Signs of Hepatorenal Toxicity. Archives of Environmental Contamination and Toxicology, 52(4), 596 – 602.
“Health risk assessment of genetically modified organisms (GMOs) cultivated for food or feed is under debate throughout the world, and very little data have been published on mid- or long-term toxicological studies with mammals. One of these studies performed under the responsibility of Monsanto Company with a transgenic corn MON863 has been subjected to questions from regulatory reviewers in Europe, where it was finally approved in 2005. This necessitated a new assessment of kidney pathological findings, and the results remained controversial. An Appeal Court action in Germany (Münster) allowed public access in June 2005 to all the crude data from this 90-day rat-feeding study. We independently re-analyzed these data. Appropriate statistics were added, such as a multivariate analysis of the growth curves, and for biochemical parameters comparisons between GMO-treated rats and the controls fed with an equivalent normal diet, and separately with six reference diets with different compositions. We observed that after the consumption of MON863, rats showed slight but dose-related significant variations in growth for both sexes, resulting in 3.3% decrease in weight for males and 3.7% increase for females. Chemistry measurements reveal signs of hepatorenal toxicity, marked also by differential sensitivities in males and females. Triglycerides increased by 24–40% in females (either at week 14, dose 11% or at week 5, dose 33%, respectively); urine phosphorus and sodium excretions diminished in males by 31–35% (week 14, dose 33%) for the most important results significantly linked to the treatment in comparison to seven diets tested. Longer experiments are essential in order to indicate the real nature and extent of the possible pathology; with the present data it cannot be concluded that GM corn MON863 is a safe product.”
Fifi, “Rosemary – do you believe that the non-organic food products you buy are somehow more “scientific” and honest about labeling and marketing than organic food products? ”
Fifi, I had a theory that I attempted to test. My theory was that the reason that you and several others exhibited such a strong dislike for Dr. Tuteur was because you sensed that she did not share your views about organic farming and food and environmentalism and that you attacked Dr. Hall in this thread in the same manner in which you attacked Dr. T because you suspected that she shared Dr. T’s views.
Please note: I have no idea what Dr. H or Dr. T’s views on the topics are.
Now if anyone really cares about what I believe, weing stated it best when he said, “I also think that it’s just as weird to think that organically farmed food is automatically good and corporate farmed or genetically modified food is automatically bad.”
lkregula,
That sounds like it might be the one.
It does involve Monsanto’s GM corn and rats and possible signs of renal/kidney damage.
Rodale’s article said that
“+ Genetically modified organisms have never been tested on humans, and now results from animal studies are showing kidney and liver failure. In a recent study in the International Journal of Biological Science, rats that ate a diet of genetically modified corn (which we ingest in large doses every day) had internal damage to their organs, especially the liver and kidneys. ”
I think I saw a statement about prying the results loose from Monsanto, but that may have been in the HuffPo.
I think I started by stating that I like to have the toxins in my food identified. I have also stated that the people I know who claim to be organic farmers reject science and are deeply into alt. med and treat their animals with alt. remedies, something I find scary. I guess that isn’t simply a VT custom. Check here:
http://online.wsj.com/article/SB10001424052702304370304575151663770115120.html?mod=WSJ_hpp_MIDDLENexttoWhatsNewsFifth
WSJ
MARCH 30, 2010
A Clash Over Unpasteurized Milk Gets Raw
FDA Cites Risks of Drinking Unprocessed Dairy Products Despite Advocates’ Claims of Improved Taste and Nutrition
“At the Grassfields farm in Coopersville, Mich., where 150 families belong to a cow-sharing program called Green Pastures, the farm is inspected by the state regularly, according to Betsy Meerman, whose family owns the farm. The farm also sends raw milk samples monthly for lab tests, and Ms. Meerman says there has never been a positive result for four types of bacteria. Cows are checked weekly for mastitis, an infection of the mammary glands that FDA officials say can also cause the spread of bacteria to milk. The Green Pastures Web site says it treats infections when they occur with ‘herbs, homeopathy, tinctures, prayer and vitamins.’”
If you go to the farm’s site and look at the question page, you can read it for yourself.
I hope that anyone reading this who buys food from small farmers because they believe that the products are better for themselves, the farm animals and the environment at the very least realizes the need to question the people they buy from about what exactly they use and don’t use.
Interestingly enough, most organic milk is ultra-pasturized, I guess because it often is shipped further OR sits on the shelf longer. The ultra-pasteurization process kills more microbes and gives it a longer shelf life. non-refridgerated boxed milk is also ultra-pasturized.
Sadly, the ultra-pasteurization process also makes it very difficult to froth the milk. The reason why this latte drinker buys standard milk for myself.
I have no idea how raw milk froths…since I have had food poisoning enough times to forgo an obvious risk.
I have to say, if I were to compare my concern regarding using antibiotics to promote growth and as a prophylaxis for infection in dairy farming to my concern over the use of homeopathic medicines in dairy farming I would rate the antibiotic concern much higher. Maybe that is only because both my brother and sister and a neighbor have all been hospitalized with MRSA.
As far as I understand, organic farmers have to abide by USDA standards as conventional farmers do. So any concern over what non-traditional remedies are being used would be equal for organic or conventional dairy. Of course if someone is aware of a farmer who is not in compliance with USDA standards, I suppose they could report them.
Squirrelite – I suspect this is what you’re referring to…they have to do with GMOs that incorporate pesticides, such as RR corn…
http://www.biolsci.org/v05p0706.htm
And a good look at the analysis with a more skeptical eye that is neither pro nor anti GMOs (or at least makes a distinction between diferent kinds of GMOs)…
http://thelastpsychiatrist.com/2010/01/is_genetically_modified_food_s.html
Rosemary – Do you question the supermarket servers about what exactly was used on the products you eat? Do you know what insecticides and fertilizers were used? Do you know if they’ve been independently studied for safety? What preservatives are used so it lasts? If the cow you’re eating was a “downer” or healthy? How long the food you’re eating has been in storage? Where it is shipped from? If it’s a GMO or not? How much do you know about the food you eat? Do you and did push for labeling of GMOs so that consumers can choose for themselves and make informed choices? Or do you blindly trust that GMOs are a good thing? Do you think that it’s a good thing that industry has lobbied to avoid consumers being able to know if what they’re buying is a GMO or not?
It really seems as if you assume that anything that mainstream industry produces or markets to you is safe and anything “organic” or sustainable is suspect. You seem quite unwilling to accept and acknowledge the reality that it’s the mainstream food industry that promotes and, yes, mainstreams exaggerated claims about food (organic or otherwise), that pushes super/miracle foods and drives the mainstreaming of food trends (and has whole departments dedicated to doing this). You also seem to question the safety of “organic” practices yet have absolutely no doubts about factory farming and the mainstream food industry.
The reality is that I can actually ask my farmer what he uses on his crops and with his animals, I can even visit the farm to see for myself. On the other hand, anything I buy in a supermarket is a mystery in terms of where it comes from and what has been done to it (be it labelled organic or not).
Fifi- “GMOs that incorporate pesticides, such as RR corn…”
Huh? Round-up Ready corn doesn’t incorporate any pesticide, it makes the plant non-susceptible to glycophosphate herbicides (i.e. Round-up and Rodeo) so you can use herbicide without killing the plant you want to grow.
Ikregula – You’re right, that was my misunderstanding. Thanks for the correction. The environmental/health issue is with gene transfer in the wild and increased pesticide use. The political issue is with Monstanto, Dow, etc trying to interfer with science and consumers’ right to make an informed choice based on accurate science.
Obama Gives Key Agriculture Post to Monsanto Man
http://www.globalresearch.ca/index.php?context=viewArticle&code=RUS20100405&articleId=18499
http://www.sourcewatch.org/index.php?title=Monsanto_and_the_Roundup_Ready_Controversy
“Remarkably “the USDA has announced it will completely eliminate the program [that tracks pesticide and herbicide use in agriculture] in 2008, due to budget cuts, and won’t be collecting any data…. Benbrook finds the USDA’s actions curious at a time when herbicide use on Roundup Ready crops has increased: ‘The 2007 data would have shown an enormous increase in the pounds of herbicides applied on Roundup Ready crops, especially soybeans. The farm media has been full of stories over the past few years of the problems farmers are facing as weeds become resistant to Glyphosate and other herbicides. I find it curious that at the time of peak interest and need for solid information on pesticide use in soybeans that the Department of Agriculture has decided to stop collecting the data. I wouldn’t be surprised if there was some quiet lobbying done by Monsanto to let the program lapse’” [35]. Interestingly “the Agriculture Department is looking into purchasing that information for use in policymaking, but the data would likely not be made public” [36].”
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