The label was mandated in 1994; sodium labeling had been in effect a decade before that.

Over the past ten years, 5% more reported "never" using the label.  For salt/sodium, the increase in "never use" increased by 10 points from 12% to 22%.  A decade earlier, 36% "always/often" used the sodium label; that eroded to 34%.

It would take another study to tell us why consumers are shunning nutrition information, but the pattern is consistent.  Eleven percent fewer are using label health claims (37% "never") and even the ingredient list (32% "never").  Perhaps consumers are mary wary of over-promising (this report, for example, claims the labels help consumers link diet choices with health outcomes and "nutrition-related morbidity."  The medical evidence fails to show positive health outcomes for decreased dietary sodium.  With the multiplicity of advisories and the fact that scientists dispute the health consequences of cholesterol and sodium (and other nutrients), consumers are overwhelmed and doubtful about the advice they're being given. 

That's why the new Dietary Guidelines should adopt an "evidence-based medicine" approach in lieu of the expert panel approach of past reviews.

This survey of what Americans eat and how it relates to their health and mortality has been conducted for about 35 years.  The 9,349 individuals are selected to be a cross-section of American society.

Analyses of earlier NHANES reports (I, II and III) have consistently and convincingly disparaged the notion that those on low-salt diets enjoy any health advantages.  See, for example, the analysis of NHANES III on this point presented recently to the annual meeting of the Canadian Society of Clinical Nutrition.

The 2005-2006 data will eventually be combined with health outcomes data allowing this analysis.  For now, however, we have the nutrient intake data.  The sodium data is on page 4.  Those data unmask another shibboleth employed by crusaders for universal salt reduction, namely that African Americans and Mexican immigrants are particularly prone to consume "excess sodium" putting themselves at a health risk.

The data tell a different tale.  Whatever the ultimate health outcomes of these groups, don't blame salt intake.  The average American in 2005-2006 consumed 3,436 milligrams of sodium a day -- the same as it's been for a century or more and smack dab in the middle of the global range of population intakes, contrary to anti-salt proselytizers' contention that Americans eat an abnormally high amount of salt.

Compare the average 3,436 mg/day to these groups; what do you find?  African Americans ("non-Hispanic blacks" in the government's nomenclature) consumed only 3,257 mg/day.  That is 5% less than average and 8% less than Caucasians.  For Mexican Americans the difference is greater still; Hispanics eat only 3,162 mg/day of sodium, 8% less than average and more than 10% less than whites.

The Salt Institute has argued that we need to focus more on total quality diet; our opponents have explicitly rejected that policy direction, arguing that sodium/salt reduction would be superior.  Let's follow the data.  African Americans are the identified priority beneficiaries of salt reduction, its proponents say.  Experts have argued that dietary potassium is an excellent indicator of a qualty diet:  the higher the potassium, the better the diet.  These new USDA data show African Americans eating 14% less potassium than average.  The data support our call for an emphasis on overall dietary improvement, not salt reduction.

It's been another bad month for the anti-salt crowd.  In early July, other USDA data showed no change in Americans' sodium consumption over the past 40 years, disproving the argument that our increased consumption of processed foods has led to an increase in sodium intake.  Not so, said USDA.  Then,  the study they welcomed as "definitive," actually disproved their contention that salt worsened asthmatic conditions.  Pesky data, those.

The article recounts the pioneering public health efforts to combat iodine deficiency by iodizing salt, quoting Venkatesh Mannar, executive director of the Ottawa-based Micronutrient Intitiative, explaining that salt is the "food that comes closest to being universally consumed."   Salt is preferred because "the risk of overdose is minimal because everyone eats a predictable amount."

Building on the success of salt iodization, salt was fortified with other additives, first fluoride to prevent dental caries and then chloroquine to prevent malaria and most recently DEC (diethylcarbamazine) to combat lymphatic filariasis.  Willyard featured the World Health Organization's ongoing work with DEC-fortified salt in Haiti and Guyana.

The article also broaches the question of the adequacy of iodine nutrition in the U.S. where substitution of processed foods using plain salt for home-cooked meals using iodized salt has led to a gradual decline in iodine intake levels.  Willyard includes the Salt Institute's views, noting "officials may think about adding iodized salt to processed foods, (Salt Institute president Richard L.) Hanneman says.  The important things, he adds, is to keep monitoring."

A related theme is voiced in an op ed piece from earlier this week in the Financial Post, part of the National Post, one of Canda's largest papers.

Author Dr. Beth Whelan, president of NYC-based American Council for Science and Health, decries "the witch hunt against corporate funding of research," pointing out several recent example of how Health Canada has embraced junk science in order to address alleged health threats.  She explains that the

latest unscientific legislation (was) made possible in part by a dangerous prevailing assumption: namely, that anti-corporate claims are by definition "good science" while claims made in defence of industry or new technology -- by anyone with the slightest ties to industry -- are by definition "suspect science."

She continues:

Ironically, consumers end up paying higher prices as a result of such ostensibly consumer-protecting measures (as products need to be replaced or reformulated) or even end up using less-safe replacement products, such as old-fashioned glass bottles.

Because the insidious de-legitimizing has progressed so far, she laments:

CSPI and others, ignoring decades of productive collaboration between industry and science, can now delegitimize any scientist or scientific conclusion with which they disagree by showing that the scientist or research in question is tied to corporate money.

Our beef is the other side of this coin, namely that the converse of uncritically rejecting any privately-funded research as biased is the uncritical acceptance of publicly-funded research as immune from bias since its sponsors are public agencies.  We've seen too many examples of government cooking the books and funding scientists who refuse to divulge their data for independent expert verification.

Economists well understand the perverse incentives that apply when government insists on owning the means of production.  Will the public -- and public health practioners themselves -- recognize the perverse incentives inherent in the uncritical acceptance of junk science based on the supposedly-untainted funding from public agencies?

Except to the news media.

The Centers for Disease Control and Prevention just issued the latest data from the National Center for Health Statistics. Its news release trumpeted "U.S. Mortality Drops Sharply in 2006.  Latest Data Show." 

For public health practitioners, health outcomes should be the consensus metric. The data show convincingly that 8 of the 10 leading causes of death in the U.S. all dropped significantly in 2006. This continues the trend of the past quarter century and trumps the fact that our aging population would be expected to fare worse; in fact, both the raw and age-adjusted rates reflect the improvement. In just the single past year, deaths due to heart disease dropped 5.5%; strokes, 6.4%; hypertension, 5%. The list goes on. But the media loves negativity and too many advocacy groups have a vested interest in (manufacturing and) peddling a mileau of health threats.

Just a month ago, a prestigious research team published another analysis of federal health outcomes statistics in a well-regarded, peer-reviewed journal examining the comparative health outcomes of Americans choosing low-salt diets compared to those choosing diets unchanged in the amount of salt customarily used over the past century. Mortality in the low-salt group was much higher. Low-salt diets didn't deliver promised benefits; they even may add risk. This wasn't news either. The data undermined the crisis advocates' politically-correct intervention.

We need to get beyond the rhetoric and look at the facts, the data. Clearly, the view through the prism of the media and at least some public health advocates is preventing us from focusing on evidence-based policy decisions.  For more information.

The top three:

1.  Combatting micronutrient malnutrition by fortifying foods with vitamin A and zinc.

2.  Completing the Doha round of international trade liberalization.

3.  Iodizing salt and fortifying foods with iron.

Micronutrient malnutrition ("hidden hunger") is the clear winner with two of the top three "solutions."  Fortifying with vitamin A and zinc return $17 for every dollar invested.  The benefits of iodizing salt are $9 for every dollar invested.  Although the U.S. solved its problems of iodine deficiency in the 1920s when it iodized salt, huge populations around the world still remain unprotected.

With the candidates for the Democratic US presidential nomination competing to bash free trade, #2 may gain some political salience.  But investing in micronutrient fortification -- including universal salt iodization -- should be high on the public health agenda.

The largest threat to freedom, democracy, the market economy and prosperity at the beginning of the 21st century is no longer socialism.  It is, instead, the ambitious, arrogant, unscrupulous ideology of environmentalism. Like their [communist] predecessors, they will be certain that they have the right to sacrifice man and his freedom to make their idea reality. In the past, it was in the name of the Marxists or of the proletariat -- this time, in the name of the planet."

Whatever your views on the arrogance or scientific credibilty of the environmental movement, it was Klaus' comments in response to media questions afterwards that caught my eye.  Asked why global warming is presented to the public as the overwhelming, consensus position of scientists, Klaus responded, according to John Fund of the Wall Street Journal, explalining that

the careers and funding sources of many scientists now are dependent on 'climate alarmism' and climate alarmists have become an interest group with the power to intimidate into silence skeptical colleagues and public figures. The climate issue, he added, 'is in the hands of climatologists and other related scientists who are highly motivated to look in one direction only.'

Klaus could have been talking about the salt and health issue where anti-salt proponents have tried to convince the public that critics of their views, despite their professional prominence and unassailable credentials, should be ignored and that they, the anti-salt crowd, Not only are major voices in this group funded heavily by the government agency, but careers are enhanced by toeing the government's anti-salt line.

Perhaps Klaus should review The (Political) Science of Salt by Gary Taubes.  It would be wonderful to have this courageous national leader tell truth to those in authority on salt and health. 

It's not fair and must be some big conspiracy network (with "co-conspirators"), he says (in essence), because she's just a girrrrl. A "mother and housewife" can't possible be smart enough to able to research the internet and medical journals, and write such well-researched pieces. She couldn't just be a concerned mother of an autistic child, somebody had to be helping her, he says, and she must be "either an agent of the defendant or of industry." Therefore, he wanted to find out who she was working for or with. Yes, she must be an industry shill.

The Salt Institute is familiar with this line of attack.  On us it goes:  Salt Institute spokespersons aren't medical doctors, so they are not capable of either quoting recognized experts or summarizing the results of the scientific studies we call to public attention.  After all, they say, what's important is who they represent.  Of course, they are reduced to this misdirection because (apparently like the "girrrrl" blogger somehow the messenger makes a better target than the irrefutable message.

Szwarc tells the story with more pizazz.  And the blogger's post is even better.

The Secretaries should consider carefully the critical importance of the selection criteria for Committee members.  With obesity at historic levels and childhood obesity a near epidemic with grave long-term consequences for our nation, the need for policy guided by expert scientists is clear.  No one could deny that the first six DGACs were composed of prominent medical and nutrition experts.  There can be no quarrel with the professional, subject matter qualifications of past DGAC members.  It's the paradigm that needs changing.

Committees of subject matter experts produce reports with expert opinion.  That sounds better than it really is.  In the hierarchy of "evidence-based" medicine, expert opinion is the lowest level of evidence.  Rigorous data analysis trumps even well-informed opinion.  To sort out public confusion and establish consensus authority, we need to move higher on the evidence-based hierarchy.  We must do better for the nation.  Evidence-based decision-making focuses less on the experts and more on the evidence.  While as good they could be, because past DGACs have not followed the best discipline, their reports cannot claim the mantle of evidence-based reviews.  We need to change the DGAC process, not just the people on the Committee.

Using a process like the one developed in the 1980s by the Cochrane Collaboration, inventors of "evidence-based medicine," will allow this new DGAC to take the next step in the process and set the standard and grade the evidence before considering the policy analysis.  We need this different expertise on the DGAC in order to make the Guidelines reflect the science and become most relevant to Americans' health.

The federal government endorses an evidence-based approach to health policy and the U.S. Preventive Services Task Force (USPSTF) is the model for how the DGAC could adopt the discipline of evidence-based decision-making.  Supported by the HHS Center for Outcomes and Evidence and a contracted Evidence-based Practice Center in Oregon which conducts systematic reviews of the evidence, the USPSF makes its recommendations on the basis of explicit criteria.    The USPSTF reviews the evidence, estimates the magnitude of benefits and harms for each intervention, reaches consensus about the net benefit for each intervention, and issues a recommendation - from "A" (strongly recommends) to "I" (insufficient evidence to recommend for or against).

The USPSTF process would be the most appropriate and effective model for the DGAC.  An evidence-based review will require an evidence-based process; this requires  changing the concept of the DGAC which up until now has been compiling expert opinion instead of conducting an evidence-based review. 

In a courtroom, judges rely on subject matter experts:  witnesses attest to their observations and "expert witnesses" offer their professional opinion.  Judges are not subject matter experts; they are process experts.  They know what observations and opinions to admit into evidence.  They discipline the process.  The DGAC has been acting as an "expert witness" instead of a judge.  We need a DGAC composed of "judges" - experts in the process of evidence-based decision-making.  We need "judges" who have a proven dedication to dispassionate review of the evidence.  And we need their report to reflect their conclusions about the quality of the evidence before the policy conclusions and recommendations.

Overall, for January - March 2008, the salt industry reduced lost-time injuries by 20% (with the additional work-hours, the incidence rate declined 27.15%.  The severity index, measuring days lost, improved even more, recording a 72% improvement.

The Salt Institute safety program supports member company safety efforts in 51 salt plants in the U.S., Canada and the UK.  Of those 51, 48 completed the three month period  -- nearly 3 million work-hours -- without a single lost-time accident.  "We are working towards zero injuries and having only 21 reportable injuries and only four of those serious enough to result in lost time, is a fantastic step forward.  That progress is the result of safety-prioritizing management and a safety-aware workforce working closely together.

The data seem to be giving the public health nutrition establishment a slap in the face trying to wake it up. The lowest quartile was a good surrogate for the politically-correct social elite. They were, by far, the best-educated, smoked less, consumed the least salt, added the least salt at the table and had the lowest body mass, but still had non- significantly higher systolic blood pressure and, of course, they suffered vastly higher mortality outcomes."

The authors conclude that "These data are consistent with the hypothesis that lower sodium intake is associated with increased CVD and all-cause mortality." Although many associations lacked statistical significance, they "were remarkably consistent." They added: "In contrast, no analysis of the two mortality outcomes generated (Note: CVD and all-cause)any trend supporting the competing hypothesis that the highest sodium relative to the lowest sodium is associated with increased mortality."

Bottom line: "There are no randomized trial data linking sodium intake to CVD events or mortality." In fact, the findings, they declare, affirm "that for the broad general US population, higher sodium is unlikely to be independently associated with higher all-cause or CVD mortality."

The April 21 edition of National Review (subscription required) examines the historic tax take of the national governments of the US and its OECD partners.  An excerpt illustrates, but please keep reading because I'd like to draw a parallel to an issue regarding salt.  NR's Kevin Hassett wrote:

As reporters sort through these debates, they must write at a far lower level of sophistication than that of the studies in question. Since New York Times readers don't know econometrics, they are instead offered pseudo-analysis. The economists who agree with supply-side economics are generally described in terms to suggest that they are nut jobs. Those who disagree with supply-siders are "distinguished professors" or "senior fellows" at "nonpartisan" institutes. We are invited to judge, not the arguments, but the reasonableness of those who make them -- and it is clear what our judgment is supposed to be.

But interestingly enough, it's possible to determine with some precision whether a policy has been formulated by nut jobs. To see how, consider the following statement: "U.S. fiscal policy in recent years has deviated wildly from fiscal policy in other developed nations." If that's true, one can presumably make the case that U.S. policymakers have ignored policy norms. (This is of course just what one would expect nut jobs to do.) If the claim is false, however, then it's rather harder to claim that American fiscal policy is in the hands of kooks.

Let's apply that method to the question of income-tax cuts. The nearby chart depicts recent trends in the share of GDP that governments collect through income taxes. The purple line represents the U.S.; the blue line represents the average for large developed nations in the OECD, excluding the U.S. And the story is clear: For most of recent history, the U.S. share was about equal to that of the OECD generally. It did deviate wildly at one point -- in the second term of President Clinton, when the U.S. was collecting a markedly higher percentage of its GDP in income-tax revenue than were its fellow OECD members. But the Bush tax cuts returned us to normalcy.

The "salt" issue?  The policy debates over whether the entire population should be encouraged to reduce dietary salt often comes across as a debate with an empty chair.  Proponents of this intervention are content to point to their accepted "expert" status and insist that their informed opinion should determine the policy question.  These are the "distinguished professors" etc of Mr. Hassett's narrative.  By no means all, but some of these activists have tried to marginalize the equally-distinguished experts who argue that no evidence shows low salt diets will improve public health. They duck the issue and try to dismiss opposing scientists as somehow less informed or, surely, more biased -- in short, akin to the "nut jobs" Mr. Hassett describes (though none of them have stooped that far to date).

The parallel?  Mr. Hassett graphs the data.  That's what we should be doing too:  looking at the data.  Those data can tell us a lot more than the "expert" opinion of those who cannot or won't deal with the real evidence.  Let's stop talking with the empty chair.  The public deserves better.

Examples abound.  He notes the U.S. military's missteps in Iraq, the D.C. treasurer's problem with escalating bond interest rates, UCLA's point guard's observations about the shooting accuracy of the Mephis Tigers' basketball team in the Final Four semis, Barack Obama's 20 year association with his fiery minister and Hillary Clinton's faulty sniper fire memory.  Best, it seems:

While he was press secretary for President Bush, Tony Snow was constantly fending off media questions that implied that officials should have anticipated the unforeseen, he says. "Everyone plays that game," Snow says. "It's always taken as a sign of your incompetence, cupidity or callousness if you didn't anticipate a million different reactions."

Snow says he tried to avoid we-didn't-anticipate responses to questions about the administration's policies because "it probably sounds defensive." Instead, he says, he tried to explain the context in which decisions were made -- what the facts, goals and priorities were at the time -- and let others engage in "retroactive perfectionism."

As toxic as is "retroactive perfectionism," so is our inability to recognize that our understanding DID err and our perspective should become more "perfected."  So we don't exactly agree with Farhi  who rejects the Tony Frost worldview.  He quotes Grant Barrett, the editor of the <em>Oxford Dictionary of American Political Slang</em>.

It's a buck-passing maneuver and a tacit admission of failure"...

"It really means that you didn't have foresight, that you didn't plan well, that you were ignorant before and that you're confessing that you're not ignorant now," Barrett says. "You're basically providing your opponents with the wedge in which they'll place their hammer and chisel to chip away at your credibility. You might as well draw up your letter of resignation."

Often, Barrett says, we-didn't-anticipate can give the perception that you just ignored someone else's anticipation.

We're big into transparency and accountability, but we cannot agree with Farhi.  Sure, in many decisions we make, the easy-out of "unanticipated consequences" must be rejected.  After all, how "unanticipated" is it that our social values have demographic consequences?  That economic mobility in America re-shuffles the poverty "quintiles" every decade?  That earmarks "buy" Congressional votes?  That disparaging certain foods results in diminished intakes of not only the complained-of nutrients, but all those in that food?  The list is endless and reinforces George Santayana's observation that "Those who cannot learn from history are doomed to repeat it."

Unanticipated consequences, however, are also how we learn.  Particularly in science, the discovery that the hypotheses is NOT confirmed shouldn't be an occasion for mourning; celebrate the advance -- one less dead end to pursue.  Truth is like an onion being stripped away layer by layer, so disposing of the discarded layer of only partially-understood truth is an advance.

So is it, for example, with our understanding of the role of dietary salt and health.  We know all healthy bodies require salt.  We know that salt is related to blood pressure.  We know that populations with lower blood pressures have less risk of cardiovascular events and mortality.  Our investment in studies to examine the question of whether lowering intakes of salt will lower the rates of heart attacks and strokes have been worthwhile -- even if they've produced the contrary, "unanticipated consequence" that the evidence does not support a link of lower sodium diets to improved health.  Rather, the resesearch has unmasked other "unanticipated consequences" that we now know well occur when dietary salt is reduced:  insulin resistance rises, the kidney produces the hormones renin and aldosterone.  "Unanticipated" at one point, they have been predictable for a couple decades now.  So, let's face facts and get on with our pursuit of truth.  It doesn't look like reducing dietary salt is going to reduce cardiovascular risk.  Don't believe it?  Fine.  Let's test the proposition -- a solution we suggested to HHS nearly two years ago, "up close and personal" after having voiced the recommendation publicly even earlier.

Even worse that the mea culpa that US preventive medicine couldn't have foreseen the "unintended consequences" of low salt diets that has neutered the expected benefits (and perhaps even reversed them such that a number of studies have found greater risk for those who cut back salt, is the unexcusable insistence on pursuing this discredited strategy and pretending that the "unanticipated consequences" aren't actually happening.

That's what prevented the Bush Administration from recognizing the need for its new strategy in Iraq and what sent UCLA's basketball team home last Saturday.  Things may not turn out the way we believe going in.  Get over it.  Move on.