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January 16, 2010

A doctor calls for a kinder gentler war

by tarran

I regularly read the Science Based Medicine Blog since it is an interesting combination of intelligent, rational examination of medicine and the naive monstrous morals of a toddler.

This week’s column by Dr Steven Novella does not disappoint. The good doctor reviews the medical impact of modern sodium consumption and states:

As usual, the medical and regulatory communities are tasked with making sense out of chaos – with implementing bottom-line recommendations in the face of inconclusive evidence. While there remains legitimate dissent on the role of salt in vascular health, the current consensus is something like this:

  • Most of the world, including Americans and those in industrialized nations, consume more salt than appears to be necessary.
  • In the US most of that salt comes from processed or restaurant food (while in other countries, like Japan, most salt intake is added while cooking).
  • There is a plausible connection between excess salt intake, hypertension, strokes and heart attacks.
  • There is evidence to suggest that reducing overall salt intake will reduce the incidence of these health problems, but the evidence is not yet conclusive and longer term and sub-population data is needed.

Given all this it seems reasonable (from a scientific point of view – and ignoring the role of political ideology) to take steps to reduce the amount of salt in processed and restaurant food, while continuing to study the impact of such measures. But we also have to consider unintended consequences. Part of the reason salt is added to processed food is because it helps preserve it – give it a longer shelf life. People also develop a taste for salty food, and a sudden decrease in salt content may be unsatisfying, leading people to seek out higher salt foods. But these are technical problems that can be addressed.
It should also be noted that salt requirements and tolerance may vary considerably from individual to individual – based upon genetics, and certainly underlying diseases. Therefore recommendations from one’s doctor should supercede any general recommendations for the population.
In any case it seems that the War on Salt has begun. I only hope this is a war we choose to fight with science.

The last sentence left me gobsmacked. A war fought with science? Does he understand what exactly it means when a government wages war?

The essential feature of government is the enforcement of its decrees by beating, killing, and imprisoning. Those who are asking for more government interference are asking ultimately for more compulsion and less freedom.

Ludwig von Mises, Human Action

Let’s take, for example, the war on (some) drugs. 150 years ago, if I had described the government proscribing the growth of hemp, sowing poison on illicit fields in an attempt to kill marijuana smokers, sending paramilitary forces into homes with orders to shoot first and ask questions later, and setting up checkpoints where people with large amounts of cash would have it confiscated on the grounds it must be involved in this illicit trade, it would have beggared belief. Those who lobbied for its outlawing would have denied wanting to do those things, they merely wanted to protect white women from being seduced by black jazz musicians and to preserve the social order against uppity darkies.

And once the stuff was outlawed, once the law enforcement apparatus started to wage its low level guerrilla campaign, and faced resistance the government naturally escalated, flooding the media with propaganda to buttress its position, until the war became an end to itself, with otherwise sensible people saying things like “I am a fan of freedom but we must protect the citizenry against the scourge of drugs”

I am curious why the good Dr Novella thinks that a war on salt will turn out any better than the War on Gold, the War on Sucrose, the War on Opiates, the War on Miscegenation or any of the other social crusades little petit tyrants enlist the government to engage in?

Moreover, is he blind to the fact that these wars on inanimate substances and ideas are actually wars on people? It’s not the marijuana that’s getting its child’s hand shot off in a police raid, it’s a person. It’s not the marijuana who is having their life savings confiscated, it’s the retired couple who don’t trust banks. It’s not the marijuana who has his dogs shot in his home, its the hardworking mayor of a small town.

If I were to propose a War on the North Korean Government, I would imagine that Dr Novella might be a little reluctant to support it, given the large number of innocent people who would inevitably die having been propagandized into fanatically defending the state that looted and brutalized them so thoroughly.

But here, we get nary a peep of condemnation, only a pious desire to have “science” inform the strategy of the war on a common cooking ingredient, which will really be a war on people who use to much salt (according to the government) in their food preparation.

And, I should note, this war would have savage monsters like Mary Beth Buchanan deciding what was an appropriate amount of salt, just as she decided her judgment on how much pain medicine was appropriate for patients in chronic agony was better than that of the MD’s treating them, and used that rationale as justification on her war on doctors.

Dr Novella’s blindness it encoded in an assumption in the first sentence I quoted:

As usual, the medical and regulatory communities are tasked with making sense out of chaos – with implementing bottom-line recommendations in the face of inconclusive evidence.

Why are they tasked with this? Sure, doctors are asked to give advice on questions where there is no clear answer, much like any other profession. They have the power to say “I don’t know”, however. Moreover, there is nothing wrong with doctor’s giving advice. The act of making a suggestion does not actually harm anybody.

The regulatory apparatus, on the other hand, is dangerous. When it acts, people get hurt, they go to jail, they have their finances ruined. If we assume such an apparatus should exist, then we should use it only when the harm it does is worth the benefit. Otherwise, the regulatory apparatus need do nothing! Especially where there is no overwhelming evidence to justify regulation. It’s not as if salt causes an epidemic like cholera! The notion that people with vascular disease drives up health care costs requiring such regulation is laughable. Dr Novella has never, in all the essays he has authored that I am familiar with, shown much concern with the major reasons why health care costs are so high. If anything he supports the measures that are the primary drives of the high costs.

It is a shame that otherwise rational people fail to learn the lessons of history. Their blindness would not be so bothersome, if it weren’t for the fact that their hands are helping aim the guns pointed at us.

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10 Comments

  1. tarran,

    Where, in his whole piece, does Steven Novella say he supports the government’s war on salt?
    Quote: “In any case it seems that the War on Salt has begun” – does that sound like a ringing endosement of “the war on salt”.
    Quote: “I only hope this is a war we choose to fight with science” – does that not sound that he has misgivings about “the war on salt” and that he hopes at least this time they fight the war based on the scientific facts, not political rhetoric?

    Against this you offer: “the naive monstrous morals of a toddler.”
    May I gently suggest that you look yourself in the mirror.

    regards,
    BillyJoe

    Comment by BillyJoe — January 16, 2010 @ 3:06 pm
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    Pingback by Tweets that mention The Liberty Papers »Blog Archive » A doctor calls for a kinder gentler war -- Topsy.com — January 16, 2010 @ 3:47 pm
  3. Dr Novella routinely condemns things he thinks are a bad idea. Ergo, he doesn’t think the regulation of salt is necessarily a bad idea.

    He even goes further. Note he doesn’t say that he hopes the government will choose to fight the war with science. The subject of his last sentence is “we”, meaning that he is including himself in the group of people choosing to fight the war.

    QED.

    Comment by tarran — January 16, 2010 @ 8:34 pm
  4. tarran,

    “The subject of his last sentence is “we”, meaning that he is including himself in the group of people choosing to fight the war.”

    Your interpretation of that sentence is a little perverse in my opinion. Here it is again with the preceding sentence:

    “In any case it seems that the War on Salt has begun. I only hope this is a war we choose to fight with science.”

    In mean time perhaps I will leave everyone with the following quotes from his article, and they can decide for themselves where he stands:

    “Salt reduction reduces blood pressure, but only a little.”

    “However, most of these studies are short term. Longer term studies are still needed.”

    “Some reviews claims that salt reduction…reduces cardiovascular risk. Meanwhile, other reviews claim the evidence is inconclusive on long term effects.”

    “Given all this it seems reasonable (from a scientific point of view – and ignoring the role of political ideology) to take steps to reduce the amount of salt in processed and restaurant food, while continuing to study the impact of such measures.”

    “Part of the reason salt is added to processed food is because it helps preserve it – give it a longer shelf life.”

    “People also develop a taste for salty food, and a sudden decrease in salt content may be unsatisfying, leading people to seek out higher salt foods.”

    “It should also be noted that salt requirements and tolerance may vary considerably from individual to individual – based upon genetics, and certainly underlying diseases. Therefore recommendations from one’s doctor should supercede any general recommendations for the population.”

    regards,
    BillyJoe

    Comment by BillyJoe — January 17, 2010 @ 12:55 am
  5. Dr. Novella is a firm believer in the heavy hand of government insofar as regulating the medical industry is concerned. I find it very reasonable to assume that the same guy who is in favor of the government dictating people’s health care selection habits is also in favor of the government dictating people’s dietary habits.

    Comment by Justin Bowen — January 17, 2010 @ 9:22 pm
  6. JB,

    In that article, Dr. Novella writes that science – not political ideology – should dictate what medical treatments are effective.

    It is similar to his theme in the article that prompted this blog. Quote: “from a scientific point of view – and ignoring the role of political ideology…”

    You should be applauding him.

    regards,
    BJ

    Comment by BillyJoe — January 18, 2010 @ 2:15 am
  7. BillyJoe, you are way off base, and tarran is right on target. Here’s an extremely telling quote from Novella: “It should also be noted that salt requirements and tolerance may vary considerably from individual to individual – based upon genetics, and certainly underlying diseases. Therefore recommendations from one’s doctor should supercede any general recommendations for the population.”

    This is the rhetoric of a control freak, one who wishes to elevate members of his profession to a God-like status. It’s up to each one of us, NOT some damned doctor, to determine how much salt we take in!

    From everything I can tell, the evidence that salt is harmful is weak at best. But even if the evidence were overwhelming, we don’t need pompous people like Novella trying to tell us what to do!

    Comment by John deLaubenfels — January 18, 2010 @ 6:25 am
  8. Dr. Novella is a firm believer in using the law to enforce his personal dictates as to what constitutes good health care upon the population.

    On numerous occasions I have observed him state these beliefs, usually prefaced with ‘I believe in a free market but…’

    The comment about removing political ideology is not aimed at himself; it’s aimed at those of us whose morals would lead us to withold submission to his dictats.

    Comment by tarran — January 18, 2010 @ 7:49 am
  9. John,

    “From everything I can tell, the evidence that salt is harmful is weak at best.”

    And, yet, if you read those quotes from Dr. Novella that I posted above, it is obvious that he agrees with you. The evidence that salt is harmful IS weak.

    “But even if the evidence were overwhelming, we don’t need pompous people like Novella trying to tell us what to do!”

    I guess we differ on the meaning of his article. He seems to be at pains to make suggestions only, not dictate what you should do and those quotes above bear that out in my opinion.

    “This is the rhetoric of a control freak [recommendations from one’s doctor should supercede any general recommendations for the population], one who wishes to elevate members of his profession to a God-like status.”

    So far I have not read anything he has said which is against what is called “informed choice”. He is, however, concerned that people make an INFORMED choice by using science based information instead of information that seems to be nothing more than someone’s personal opinion.

    “It’s up to each one of us, NOT some damned doctor, to determine how much salt we take in!”

    Medical professionals merely try to determine, as accurately as possible, based on the results of clinical studies, what a safe level of salt intake is. They sometimes get it wrong but the nature of science is that eventually errors are corrected. But it is government who, to some extent, “tell you what to do” by legislating certain measures.

    In the case of salt, the evidence, according to Dr. Novella, is not clear. Yet our government (hence the “we”, in case anyone is still wondering), has decided to act. Dr. Novella hopes that they at least base their actions on science not political ideology.

    regards,
    BillyJoe

    Comment by BillyJoe — January 18, 2010 @ 12:40 pm
  10. tarran,

    “Dr. Novella is a firm believer in using the law to enforce his personal dictates as to what constitutes good health care upon the population.”

    I have not seen that to date, but I have limited experience of what he has written. I only commnet here about the particular article you referenced here.

    BJ

    Comment by BillyJoe — January 18, 2010 @ 12:43 pm

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