“TRUMPING” SCIENCE WITH IDEOLOGY

Shortly after taking office, Donald Trump misguidedly reinstated an executive order banning U.S. aid to any international organization that supports abortion related activities, including counseling or referrals. This policy is often referred to as the “global gag rule” on women’s reproductive health, supposedly aimed at reducing the number of abortions performed worldwide. First applied by Reagan as an executive action in 1984, the global gag rule as been restored and rescinded repeatedly by administrations for 17 of the past 32 years.

Seemingly well meaning and driven by the religious principles held by some members of our society, what have the results shown? Since the policy defunds—and thus incapacitates—organizations that provide education and contraceptive services, and their functions actually reduce the need for abortions. Thus the resulting evidence indicates that the defunding policy actually increases abortion rates, which in turn increases pregnancy related complications, maternal mortality, increased reliance on unsafe abortions, and higher rates of unsafe sex that include more HIV infections.

An important study published in 2011 compared the changes in the number of abortions in 20 countries in sub-Saharan Africa over a fifteen year period after the restrictive policy was implemented. Unsurprisingly, women living in the countries most affected by this U.S. Gag policy had 2.6 times the odds of having an abortion in comparison with those residing in countries least affected. Similar results had been previously disclosed in a smaller study performed in Ghana in 2006; moreover, this latter study found that the gag policy also resulted in poorer nutritional status in the affected children.

Another similar example is provided by the U.S. President’s Emergency Plan for AIDS Relief (PEPEAR). Since 2004, in an effort to control the global epidemic of AIDS, PEPFAR has provided aid for prevention, treatment, and care of HIV infections in many low-income countries. It increased the access to antiretroviral therapy, which is an evidence-based effective strategy for reducing transmission of HIV and related mortality. That investment has reduced global mortality by an estimated 700,000 adults within the program’s first four years alone, with related economic and employment gains.

By contrast, PEPEAR included a prevention program based upon urging sexual “abstinence and be faithful,” a strategy that has never been demonstrated to be effective in any context. This strategy originally received one-third of the PEPFAR budget. After a decade and a cumulative cost of more than $1.4 billion, a published study showed no measurable impact on disease rates and consequences.

The lesson from these experiences? Scientific data always “trumps” ideology, no matter how seemingly well-intended! Such ineffective and misguided foreign policies, already begun by Trump, ignore scientific analysis and undermine our ability to support global development as well as wasting valuable resources. This will ultimately—directly or indirectly—hurt the American people.

    It seems that Trump’s anti-scientific policies may be disastrous in many other ways as well!

 

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MYPILLOW MAY NOT BE ALL IT’S HYPED TO BE

Are you enticed by those TV ads promoting the “fantastic” pillow, called “Mypillow” that guarantees the greatest sleep you ever experienced and is good for whatever ails you? Well, if so, think again!

In October 2016, Minnesota-based MyPillow settled a complaint by district attorneys in California by agreeing to refrain from making unsubstantiated claims that its pillows can prevent, treat, or cure diseases or symptoms. The agreement also required MyPillow to (a) pay $995,000 in civil penalties, (b) give $100,000 to homeless and domestic violence shelters in California, and (c) stop promoting its pillow as the “official pillow” of the National Sleep Foundation (with which it had had an undisclosed financial connection). The California agreement stems from a suit filed by the Alameda County District Attorney and nine other counties that focused on unsubstantiated claims to treat conditions such as insomnia, sleep apnea and fibromyalgia and the company’s relationship with the National Sleep Foundation. Many of the questionable claims were presented through testimonials. The lawsuit alleged that MyPillow “knew or reasonably should have known” that the marketing claims were likely to mislead consumers. In August 2016,  MyPillow agreed to pay $1.1 million to settle a whistleblower case handled by the New York attorney general’s office that alleged it knowingly failed to collect sales tax on Internet and phone sales of pillows marketed in New York. The company is also facing class-action suits. Truth in Advertising, Inc., which provided its findings to the California officials, has monitored the situation closely and archived many of the relevant documents.

So, I guess even pillows may not be beyond reproach!

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EATING PATTERNS AND HEALTH

It’s generally believed that wide swings in weight—up and down—are less healthy than simply being constantly overweight, although both situations are worse than maintaining a constantly normal weight.

Now medical science has clarified this issue: Weight fluctuations – i.e. the pattern of of major weight loss followed by partial or total regain (also termed weight cycling)—is strongly associated with higher mortality, more cardiovascular events, and new-onset diabetes, according to an analysis of a trial published in April, 2017, in the New England Journal of Medicine.

To examine this association, the investigators conducted an analysis of data from a randomized trial of therapy in patients with established coronary artery disease. In this analysis, they focused on 9,509 patients who had a median of 12 weight measurements during 5 years of follow-up.

The primary outcome measure—the composite rate of death from coronary heart disease of all types—was significantly associated with weight fluctuations, showing that the greater degrees of variability in body weight were linked to higher problem rates. When compared with the lowest fluctuations, patients with the highest variations had an increase in the risk of coronary events of 64%, an increase in the risk of stroke of 136%, and an increase in the risk of new-onset diabetes of 78%, and, overall, an increase in the risk of death of 124%. All these risks were independent of traditional risk factors such as blood pressure, diabetes, etc.

This association remained strong regardless of the patients’ weight at baseline, consistent among those of normal body weight and those who were overweight or obese.

Although this study was limited to patients with already established cardiovascular disease, the results accord well with the general belief that major weight fluctuations over long periods should be avoided.

But now we are learning that even short-term eating patterns may also help to protect against cardiovascular disease: According to a new scientific statement from the American Heart Association (AHA), which reviewed the health effects of specific eating patterns such as skipping breakfast, intermittent fasting, meal frequency, and timing of eating occasions. Their conclusions follow:

  • Irregular eating patterns appear less favorable for achieving a healthy cardiovascular profile.
  • Intentional eating with mindful attention to the timing and frequency of eating occasions could lead to healthier lifestyle and cardiovascular risk factor management.
  • There is evidence that both alternate-day fasting and periodic fasting may be effective for weight loss in the short run, although there are no data that indicate whether the weight loss can be sustained long term, and, as noted above, wide fluctuations would be counterproductive.
  • Daily breakfast consumption is helpful in promoting healthy dietary habits throughout the day, and I have covered this subject in detail in a previous post: http://www.mortontavel.com/2013/08/04/

                                  CONCLUSION

Keep your weight low and steady, and, above all, don’t forget breakfast!

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FISH OIL SUPPLEMENTATION: CURRENT STATUS


The American Heart Association has issued a science advisory1 on the effects of omega-3 polyunsaturated fatty acid (fish oil) supplementation and its possible role in prevention of cardiovascular disease. They reviewed many randomized controlled trials and focused on the common indications for these supplements related to whether or not fish oil can prevent any diseases. Prior recommendations for patients with existent coronary heart disease were updated and new recommendations made for patients with other problems that included patients with diabetes and prediabetes and those with high risk for heart disease, stroke, heart failure, and atrial fibrillation (heart rhythm disorder). Their recommendations are presented below:

  • Treatment with fish oil supplementation is reasonable for retarding advancement of disease in patients who have already suffered from problems such as a prior heart attack (myocardial infarction) or from established reduced heart function.
  • Treatment with these supplements is, however, not recommended to prevent strokes in those suffering from atrial fibrillation, or in patients with diabetes, unless their risk of developing heart disease is excessively high.
  • Finally, the available evidence does not support the use of fish oil supplements in the general population who are not at high cardiovascular disease risk, including those with diabetes.

COMMENT

As I have stated previously, prior data have demonstrated a prevention of cardiovascular problems in individuals who consume fish (which contain omega–3 fatty acids), at least twice a week. This has led to randomized trials that evaluate the effect of fish oil supplements alone on cardiovascular outcomes. A potential mechanism by which they may decrease serious outcomes is through their ability to decrease the likelihood of serious or fatal heart rhythm disorders (ventricular fibrillation), in those who are already afflicted with such disorders. I also emphasize that this AHA statement refers to evidence-based recommendations about supplementing diet with fish oil, and this does not apply to eating fish or replacing meat with fish as a part of a healthy lifestyle.

The bottom line in the AHA statement is that fish oil may be beneficial for those already afflicted with heart disease. However, there is no evidence to support its use for prevention of cardiovascular disease in either low or medium-risk individuals from the general population. Furthermore, most of the evidence suggested no effect even in high-risk individuals such as those with a strong family tendency to develop these maladies, though there was a lack of consensus for these particular individuals. Therefore, use of these products is not helpful in most people who have shown no tendency to develop such problems. But, for all of us, the lifestyle dietary patterns that should be followed are still clearly in force!

1 Siscovick DS, Barringer TA, Fretts AM, et al. Omega-3 polyunsaturated fatty acid (fish oil) supplementation and the prevention of clinical cardiovascular disease: A science advisory from the American Heart Association. [Published online ahead of print March 13, 2017]. Circulation. doi:10.1161

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