Health and Illness

Post image for Regulating E-Cigarettes Creates the Wrong Incentives

The U.S. Food and Drug Administration (FDA) is gearing up to regulate electronic cigarettes (e-cigarettes) by early October. These regulations, rather than protecting the public health, will unintentionally push people towards using more dangerous tobacco alternatives.

Smokers all over the world have transitioned to e-cigarettes because they believe them to be a safer and more convenient alternative to tobacco. Users inhale a vapor that contains a mix of nicotine, propylene glycol, glycerin, flavoring ingredients—and no tobacco.

To date, users have been able to enjoy these products without the inconvenience of having to go to designated smoking areas and inhaling the harmful tar from actual smokers’ cigarettes. A recent study conducted by the American Medical Association (AMA) concluded that “although it cannot be said that currently marketed e-cigarettes are safe, e-cigarette vapor is likely to be much less toxic than cigarette smoke.”

However, that doesn’t seem to be good enough for some public health advocacy groups. The American Lung Association , the American Cancer Society, and others have expressed concerned that people are unaware that e-cigarettes contain a potentially dangerous mix of chemicals. The FDA’s tobacco czar has compared the current state of the e-cigarette industry to a “wild west” situation in dire need of regulation.

The proposed regulations will likely have severe ununitended consequences by decreasing the incentives to stay away from more dangerous tobacco alternatives. These regulations will raise the price of e-cigarettes, decrease innovation in the market, and force users to consume them outside around smokers, thereby exposing them to secondhand smoke and the temptation to turn back to traditional tobacco products.

Regulators’ main concern seems to be that e-cigarettes will encourage more people to start using nicotine (and eventually tobacco products) and prevent current smokers from quitting. With a flavored product that doesn’t require users to go outside, has lower health risks, and is less expensive, nicotine use loses many of the costs associated with smoking. Therefore, people will have less incentive to quit or stay away from nicotine products to begin with.

All medical professionals will readily agree that regularly inhaling anything other than the mixture of oxygen and carbon dioxide around you is detrimental to your health. Of course, it would be better from a health perspective if people didn’t use nicotine at all. However, as an alternative to smoking, e-cigarettes could save millions of lives.

More troubling is the fact that the FDA has announced plans to regulate the e-cigarette market without conducting any substantial research. And while secondhand vapor may seem like a legitimate concern, the majority of studies conducted show that this is not the case.

Unless new evidence shows that e-cigarettes are comparable to tobacco products in their effects on public health, regulators should be careful of unintentionally pushing users away from a safer mode of nicotine consumption.

Post image for Bad Science: CDC Forced to Reverse its Recommendations on Salt

Mother may know best, but Uncle Sam certainly doesn’t.

In 1977, the federal government put a warning label on saccharine, claiming it caused cancer. It took only 20 years to to admit this was wrong. Then there’s the so-called Healthy Food Pyramid created by the USDA to advise Americans on the composition of a supposedly healthy diet. Although many still follow the recommendations of the food pyramid, it has since been questioned by researchers and nutritionist and even cited as a potential factor in America’s skyrocketing rate of obesity. Now we have another example of bad advice — government recommendations on sodium intake.

For years, public health advocates, politicians, and government agencies such as the FDA, and Centers for Disease Control and Prevention have been cajoling Americans to cut their salt intake and pressuring food makers to comply with salt-reduction programs.  Agencies recommended we cut sodium consumption to less than 2,300 mg a day. In May, the CDC was forced to admit this advice was wrong as well. A report commissioned by the CDC and conducted by the Institute of Medicine of the National Academies found no evidence to support this previous advice.

Over the last decade, studies on salt, many with conflicting conclusions, have called into question the commonly accepted wisdom that less salt is better. Some research has even concluded reducing sodium consumption too much might result in increases in mortality for certain groups of people. According to the report brief, the committee of researchers with the Institute of Medicine was tasked with assessing this new body of research on sodium and to come to conclusions about dietary recommendations for the general population.

The study, titled, “Sodium Intake in Populations: Assessment of Evidence,” found higher levels of sodium consumption were associated with increased risk of heart disease. But there was no evidence to suggest that consuming less than 2,300 mg of sodium was correlated with any increase or decrease in risk for heart disease, stroke or death. Furthermore the study found that reducing sodium intake to less than 1,840 mg a day could increase the risk of negative health outcomes for certain people.

“Recognizing the limitations of the available evidence, the committee found no consistent evidence to support an association between sodium intake and either a beneficial or adverse effect on health outcomes other than cardio-vascular disease outcomes (including stroke and CVD mortality) and all-cause mortality.” But the committee also concluded that “evidence from studies on direct health outcomes is inconsistent and insufficient to conclude that lowering sodium intakes below 2,300 mg per day either increases or decreases risk of CVD outcomes (including stroke and CVD mortality) or all-cause mortality in the general U.S. population.” The committee’s ultimate conclusion is that for most people, sodium consumption is not all that important a factor in managing their health risks. “We found no consistent evidence to support an association between sodium intake and either a beneficial or adverse effect on most direct health outcomes,” said Dr. Brian L. Strom, George S. Pepper Professor of Public Health and Preventive Medicine at the University of Pennsylvania, who chaired the committee that released the report.

So what does this mean? Many people will, undoubtedly, become frustrated with the repeated reversals on dietary recommendations. But this is simply the nature of scientific research. It takes years of good research and rigorous academic debate to come to conclusions about how the human body operates. And even then, those conclusions are –or at least they should be—readily re-evaluated and amended when new evidence is found. This lack of perfect knowledge isn’t a problem when individuals are allowed to examine the current body of evidence and choose whether the recommendations are appropriate for their unique situation. Problems arise when politicians or health advocates assume that one research paper constitutes gospel truth for every person and then attempts to coerce the entire population into complying with those recommendations. One person’s magic potion could be another person’s poison, and  both should be free to make that determination for themselves.

Post image for French Cheese Ban: An Attack on “Scientific Principles” in Violation of Treaties Protecting International Trade?

Earlier, we wrote about the U.S. government’s de facto ban on the commonplace, perfectly healthy, normal-smelling French cheese mimolette (which I once confused with cheddar while eating it in France). It is banning the cheese from the U.S. due to the presence of harmless cheese mites in its rind. As The Washington Post notes:

For centuries, microscopic mites have been part of the process for making Mimolette, a mild-tasting cheese shaped like a cannonball and electric orange in color. For decades, the cheese has been imported from France and distributed to shops and grocery stores across the United States.

That is, until this spring, when the Food and Drug Administration began blocking shipments of the Gouda-like product at U.S. ports, leaving thousands of pounds of it stranded in warehouses from New Jersey to California.

The FDA says inspectors found too many cheese mites per square inch crawling on the cantaloupe-like rinds of Mimolette, raising health concerns. But it hasn’t explained exactly why it began holding up the cheese shipments after decades of relatively few problems. “The only thing we can do is cite our regulations, which show very clearly that our job is to protect the food supply,” FDA spokeswoman Patricia El-Hinnawy said.

Cato Institute scholar Simon Lester says the ban may violate treaties designed to protect international trade from attacks rooted in ignorance of science. He discusses the WTO agreement that “deals with ‘Sanitary and Phytosanitary Measures,’” noting that it is likely

that the FDA actions would be covered by these terms, and thus the agreement applies here. . . . Among other things, it requires that governments “shall ensure that any sanitary or phytosanitary measure is applied only to the extent necessary to protect human, animal or plant life or health, is based on scientific principles and is not maintained without sufficient scientific evidence … .” It also says that governments “shall ensure that their sanitary or phytosanitary measures are based on an assessment, as appropriate to the circumstances, of the risks to human, animal or plant life or health, taking into account risk assessment techniques developed by the relevant international organizations.” What these and related provisions mean, in a nutshell, is that these kinds of government actions have to be backed up by science . . . if there is a complaint under the agreement, a WTO panel hearing a claim under these provisions will consult with scientific experts to figure out what the science is, and then reach a conclusion on whether the measure violates the agreement (that is, if it is based on sound science). What does the science say here? . . .there is the following from the Post article:

Rachel Dutton, a microbiologist who runs a cheese research lab at Harvard University, said people who handle cheese and come into contact with large amounts of mites have been known to have occasional allergic reactions. But she said she’s unaware of anyone getting sick from eating mites in cheese, which itself is full of various microbes that provide distinct textures, flavors and aromas. ‘I understand their desire to protect the consumer,’ Dutton said of the FDA’s caution. But ‘it’s true that these cheeses have been consumed for hundreds, if not thousands, of years with no apparent link to disease from the mites.’”

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Post image for TTB to Allow, Not Require, Nutritional Labeling on Alcoholic Products

It’s a rare occasion that we get to praise government agencies. While the federal agency governing alcoholic beverages certainly took it’s time to make a ruling on nutrition labeling on alcoholic products — a topic it has been considering since 2003 — it appears the Alcohol and Tobacco Tax, and Trade Bureau (TTB) ultimately made the right decision to allow, not require, companies to add a “serving facts” nutrition panel to their labels. According to a press release dated May 28, 2013, the TTB reviewed the issue of having a “serving facts” statement on beer, wine, and spirits — something that the spirits suppliers have been asking for — and it concluded that it will allow, but not require the use of nutrient analysis in labeling as well as advertisements.

Happily, companies will not have to apply for approval for a new label, so long as the added nutritional facts panel follows the example provided by TTB and they may include information regarding the serving size, number of servings in a container, calories, carbs, protein, and fat per serving.

This is good news because there had been some talk in the past about requiring all suppliers of alcohol to add this nutritional information to all of their products, a change that could have been disastrous for some smaller producers of alcohol and consumers who like variety. As I wrote back in 2011:

“Craft brewers on the other hand, produce a wider variety of beers, and far fewer barrels of each one, so they will struggle with the cost of testing and labeling the nutritional contents of their many beers. In its 2008 comments on the TTB labeling requirement proposal, the Brewers Association, which represents more than 1,400 U.S. small brewers, estimated that the annual cost of compliance with the proposed labeling requirement could be as high as $18,000 for brewers producing less than 1,000 barrels a year and more than $350,000 for brewers making more than 100,000 barrels a year.”

Requiring all suppliers of alcohol to label their entire line of products would almost certainly mean that smaller wine makers and brewers would have to reduce the range of products they sell and/or raise their prices. While this guidance issued by the TTB is a stop-gap until it issues regulations regarding nutritional labeling, let’s up that the voluntary aspect remains part of the plan.

Does austerity kill? In a recent New York Times op-ed, David Stuckler and Sanjay Basu claim that fiscal austerity leads to a worsening of health outcomes, using higher suicide and disease rates across Southern Europe as their case-in-point. But there are problems with this formulation.

First, the authors make the mistake of linking fiscal austerity with less health spending.  Greece, Spain, and Italy chose to cut health spending even though there were better choices for cuts. And health spending didn’t put them into deep debt to begin with. Borrowing at cheap interest rates and spending it on pet projects and political patronage — which includes the welfare state, but not so much in health — put them in deep debt. Estonia swiftly and severely began to reduce the size of government in 2009, but it increased health spending during that period and suffered no health declines.

Second, Stuckler and Basu point to high unemployment and trimmed social services as the sources of increased depression and suicide in Southern Europe. But this is not an argument against austerity; it is an argument to make people less dependent on the social welfare system. In Southern Europe, labor markets are broken. That’s why the IMF gave each country a failing grade in labor market efficiency in 2010. In Italy, it’s illegal to fire employees for poor performance and difficult to dismiss them for outright negligence. Layoffs also are a long and expensive process. So,when recession comes, employers can’t hire at lower wages and don’t want to hire because of these factors — which makes matters even worse. Droves of Italians and Spaniards wouldn’t be dependent upon state welfare today if labor markets were more flexible. That’s why austerity should regard not just cutting spending and revenues, but also shrinking the regulatory state. Job protections,  a hidden cost of the welfare state, are the real killer.

The narrative with which the authors open their op-ed—in which an older Italian family commits suicide because Italy’s increasing the pension eligibility age forced the main breadwinner back into a workforce with meager opportunities—tells us to abandon not austerity but the level of commitment to current welfare-state policies. If businesses had more flexibility to hire and fire workers, if the implicit tax rate on labor wasn’t the highest in all of Europe, and if Italy’s court system was more efficient in resolving labor disputes, this family wouldn’t have been so reliant on receiving a state pension in the first place. Finding work would not have been such a hopeless proposition that it  ended in such tragedy.

Third, the authors bring up Estonia’s experience with poor health outcomes during its transition from communism but conveniently fail to mention its success with real austerity from 2009 to the present. After making deep cuts to both spending and revenues beginning in January 2009 (unlike any other country in the Euro Area), Estonia experienced positive economic growth by the third quarter of that year — more than 2 percent growth in 2010, and 7.6 percent growth in 2011. Unemployment began to decrease by the sixth quarter after austerity and is now below the Euro Area average. And most importantly to Stuckler and Basu, neither the change in the rate of suicides nor the change in the total death rate were statistically significant relative to Estonia’s previous 10 years. See my in-depth statistical report for more information:

Painting austerity as the grim reaper is more than a stretch. “Austerity” need not mean a reduction in health spending. And focusing on the short-term effects of trimming the welfare state ignores the long-term causes behind why some citizens’ lives depended so heavily upon it. Does austerity “kill”? It doesn’t have to.

Post image for U.S. Government Bans French Cheese Based On Food Prejudices

The U.S. government is banning a standard, normal-smelling French cheese based on its own squeamishness. The cheese in question is Mimolette, a commonplace, orange French cheese so mild in flavor that I once confused it with cheddar when I visited my French relatives and ate it for the first time. The ban has triggered protests in New York City, reports the Global Post:

Around 40 protesters took to the streets of New York on Saturday to demonstrate against a US ban on mimolette that has angered lovers of the distinctive French cheese.

Since March, several hundred pounds of the bright orange cheese have been held up by US customs because of a warning by the Food and Drug Administration that it contained microscopic cheese mites.

The mites are a critical part of the process to produce mimolette, giving it its distinctive grayish crust.

The US decision has angered importers and consumers, who have even set up a Facebook page titled “Save the Mimolette.”

Benoit de Vitton, an importer of the cheese. . . said he was baffled by the recent blockade, noting he has imported mimolette for two decades without a problem.”They are afraid of allergies,” he said. “But we’ve been doing this for 20 years without any problem.”

Who cares if it has tiny, invisible mites in it? Cheese is the product of bacteria. Good yogurt has live cultures of bacteria in it, and that is beneficial for your health. Food that is alive can be good for you. The human body is full of living, friendly microbes that keep us alive. The cheese mites in Mimolette are there to enhance its flavor: as Wikipedia notes, the “crust of aged Mimolette is the result of cheese mites intentionally introduced to add flavor by their action on the surface of the cheese.”

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Post image for Bill Would Prevent CDC’s Taxpayer-Funded Anti-Food Propaganda

Even in a divided Washington, everyone agrees on the importance of creating jobs in America. So why are some government agencies using taxpayer money to lobby against some food manufacturers?

At least one lawmaker, Rep. Aaron Schock (R-Ill.) thinks it’s time government officials stopped using taxpayer money to run smear campaigns against the makers of lawfully produced goods that consumers want. On April 15, Rep. Schock introduced the Stopping Taxpayer Outlays for Propaganda Act (STOP) Act (H.R. 1572), which would prohibit the use of federal funds for advertising and media campaigns to discourage consumption of any food or beverage that is lawfully marketed under the Federal Food, Drug, and Cosmetic Act. In a Politico op-ed this week, Schock explains that in this time of economic stress, using taxpayer money to harm American industry doesn’t make a lot of sense.

Not only do these government-funded campaigns harm American businesses, they are doing nothing to improve Americans’ health — and may even cause harm in some cases. Government is simply not very good at determining what is best or healthy for each individual. Studies funded by government grants are often cited by legislators to promote one-size-fits-all policies that fail to take into account a person’s health risks or specific dietary needs. Yet many such studies are based on limited data that often result in incorrect conclusions.

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“Proposed FDA safety rules frustrate tree fruit farmers,” reported The Washington Post. As the FDA puts “in place a massive overhaul of the nation’s food safety system,” due to the Food Safety Modernization Act, “Few groups have expressed more frustration than tree fruit farmers, who grow apples, pears and a variety of other produce. They complain that the FDA’s approach, in some ways, defies common sense.” The 2010 law is proving far more costly than its supporters promised it would be in order to get enacted. The “Food Safety Modernization Act would impose only modest costs on farmers, or so we kept being assured when it passed in 2010.” But many orchard growers now face tens of thousands of dollars in costs, notes the Cato Institute’s Walter Olson. As he notes, the law’s unexpected costs have caused a furor in some farming communities, and the Town of Brooksville recently became the “ninth in Maine to pass symbolic ‘food sovereignty’ resolution [See Jordan Bloom, The American Conservative; Food Renegade (Dan Brown of Blue Hill)].”

“The FDA has issued two proposed rules to implement the Food Safety Modernization Act enacted in 2011.” [Brian Wolfman, Public Citizen, including details and links; The Packer] “The costs to fruit and vegetable growers for complying with the newly proposed produce safety regulation have been estimated at more than $30,000 annually for large farms and about $13,000 per year for smaller farms.” [The Grower] As Olson observes, this could be an enormous burden for some farmers: “How much do typical US farm households make in a year, you may wonder? According to U.S. government figures (here and here, for example) a large proportion of smaller family farms make little or no profit, and are instead supported by the off-farm earnings of family members.”

Liberal newspapers trumpeted the passage of the Food Safety Modernization Act, while ignoring its potential harms to innovation, small business, and the availability of unconventional foods. CEI’s  Greg Conko, who studies biotech and food safety regulation, earlier explained how the bill’s expensive and cumbersome red tape might thwart “firms from developing innovative new processes and practices that could deliver real food safety improvements.” Earlier versions of the bill backed by left-leaning interest groups were even worse, and would have driven “out of business” many more “local farmers and artisanal, small-scale producers of berries, herbs, cheese, and countless other wares, even when there is in fact nothing unsafe in their methods of production.” The version of the bill ultimately enacted was less extreme, but even it could “leave tens of thousands of small and mid-sized farms and food stands to be crushed under the weight of rules designed for some of the world’s largest food processors,” Conko observed.

Post image for When The Nanny State Kills

The government told people to switch from saturated animal fats to unsaturated vegetable fats. But that advice may have killed a lot of people. As David Oliver notes, a recent study “in the British Medical Journal” shows that ”those who heeded the advice” from public-health officials “to switch from saturated fats to polyunsaturated vegetable oils dramatically reduced their odds of living to see 2013,” incurring up to a ”60% increase in risk of death by switching from animal fats to vegetable oils.” This possibly deadly medical advice has a long history:

Fifty years ago the medical community did an about-face . . . and instead went all in on polyunsaturated fats. It reasoned that since (a) cholesterol is associated with cardiovascular disease and (b) polyunsaturated fats reduce serum cholesterol levels, it inescapably followed that (c) changing people’s diet from saturated fats to polyunsaturated fats would save a lot of lives. In 1984 Uncle Sam got involved – Time magazine reported on it in “Hold the Eggs and Butter” – and he made a big push for citizens to swap out animal fat in their diet for the vegetable variety and a great experiment on the American people was begun.

As Oliver, an expert on mass torts, points out, it is hard to ”think of any mass tort, or combination of mass torts, that has produced as much harm as the advice to change to a plant oil-based diet” may have done.

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With time running out for the Senate to act on a continuing budget resolution, members are trying to find some magic pot of money that would mask the fact that our government spends far more than it raises in revenue. Tonight, it looks like Sen. David Vitter has resurrected an old proposal to ban what are known as reverse payment patent settlements — agreements in which brand name drug manufacturers pay generic firms not to challenge patents on the innovators’ drugs.

Critics, including the Obama administration and the Federal Trade Commission, call these settlements “pay-for-delay,” and argue that successful patent challenges would get generics to market sooner. In turn, they claim, that could save federal health programs billions of dollars every year, which is why the proposal is so popular with both Democratic and Republican members of Congress. A CBO analysis scored a ban proposed in 2011 as saving federal health programs $2.68 billion over 10 years.

The problem is, any alleged savings from a ban on these patent settlements is illusory because reverse payment settlements actually have the effect of getting generic drugs on the market sooner, thereby lowering drug costs, not raising them.

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