Dispatch: PLoS and NYT vs. Money; FDA vs. Flavor; Hype(r)tension

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Medical Journal Gives Up on Evaluating Science
Today the editorial staff of PLoS Medicine, a peer reviewed, open access journal published by the Public Library of Science, declared, “While we continue to be interested in analyses of ways of reducing tobacco use, we will no longer be considering papers where support, in whole or in part, for the study or the researchers comes from a tobacco company.”

“By deciding to no longer allow for research funded in any part by tobacco industry, they're acknowledging that they're no longer able to evaluate science,” says ACSH's Jeff Stier. “It is the very role of journals to discern between good and bad science, and they're throwing their hands up in the air and saying, 'We can't do it.' It's a regression of scientific standards that journals can no longer trust themselves to evaluate science.”

The editorial offers the justification for this decision: “As a medical journal we do this for two reasons. First, tobacco is indisputably bad for health...Second, we remain concerned about the industry's longstanding attempts to distort the science of and deflect attention away from the harmful effects of smoking.”

“It's true that tobacco companies knowingly deceived their customers for many years,” says ACSH's Dr. Gilbert Ross. “We can name a few activist groups funded by other interests that have also distorted science to suit their agenda. Still, it's the twenty-first century now, and there are many tobacco products - be they smokeless tobacco or lozenges - that may be used to help people quit smoking. Who but the tobacco industry that produces these alternatives is going to fund research concerning their safety and efficacy? And while smoking is decidedly bad for anyone's health, are the PLoS editors going to ban research supported by other disfavored industries - beverages, pharmaceuticals, who knows what others? - in the near future?”

Funded Education Is Flawed Education
New York Times reporter Duff Wilson was recently apprised of the well-known fact that “[m]ore than half of the nation's medical residency programs to train doctors in internal medicine accepted financial support from the drug industry,” which is a flashing red light on his conflict-of-interest radar.

“I guess the point he's making is that pharmaceutical industry funding indicates that the teaching all these decades has been biased,” says Dr. Ross. “Shouldn't it be the teachers' responsibility to make sure their curriculum is honest?”

“Apparently the teachers, like some medical journals, are no longer able to delineate between good science and bad,” says Stier. “So if they accept industry funding, must they therefore be corrupt?”

Tobacco Lozenges
The tobacco company Star Scientific Inc. filed an application with the FDA to allow its dissolvable tobacco “lozenge” to be certified as less harmful than traditional forms of tobacco.

“The new FDA tobacco regulations supposedly provide a framework for products to be approved under harm reduction claims,” says Stier. “Many of us have been skeptical as to whether any product would be approved, so this could be a test to see if the system works. This product is a much cleaner form of nicotine than cigarettes, but the key here is that the company has to show with scientific support that not only will their product reduce tobacco-related harm for users, but that it will improve the overall health of the U.S. population. The requirement to prove that it's good for the overall health of the country is a poison pill for the approval process, since doing so would have to be based on assumptions that are impossible to make. We hope the FDA approves it, but it is perhaps ironic that one of the brands seeking approval is called 'Stonewall,' because that may be what the FDA does to them and, sadly, to cigarette smokers looking for a less harmful alternative.”

“It's also significant that the lozenge is wintergreen flavor,” says Dr. Ross. “Opponents will say that they will attract young people, despite the overwhelming evidence to indicate that these products are not a gateway to cigarettes. The default legislative mechanism is always against anything related to tobacco.”

According to Reuters, a report on hypertension by an expert panel with the Institute of Medicine “urges the CDC to promote policies that make it easier for people to be more physically active, cut calories, and reduce their salt intake. High blood pressure or hypertension is easily preventable through diet, exercise, and drugs, yet it is the second-leading cause of death in the United States, said committee chair David Fleming.”

“While we applaud this outreach program to raise awareness of hypertension in this country, I'm afraid that is simply not true,” says Dr. Ross. “Cardiovascular disease (CVD) is the leading cause of death, and cancer is second. Hypertension contributes to CVD, but it's not the only factor.”

“We're not saying that just because the toll of hypertension is overstated here that it's not a risk for mortality,” adds Stier, “but we encourage our readers to put risk into perspective [perhaps by looking at our Riskometer ]. We agree that pharmaceutical approaches can be helpful, but we are cautious about the priority they give to reducing salt in the diet. As John Tierney points out in today's New York Times when he quotes hypertension expert Michael H. Alderman, 'When you reduce salt, you reduce blood pressure, but there can also be other adverse and unintended consequences. As more data have accumulated, it's less and less supportive of the case for salt reduction, but the advocates seem more determined than ever to change policy.'”

Hot Dogs of Death
HealthDay reports, “The leading group of pediatricians in the United States is pushing for a redesign of common foods such as hot dogs and candies, along with new warning labels placed on food packaging, to help curb sometimes fatal incidents of child choking.”

“What is the responsibility of food companies when it comes to foods that have been in use for generations?” asks ACSH's Dr. Elizabeth Whelan. “And what about parental responsibility? I'm eager to hear whether they can get off easy and just put a label on hot dogs saying that they are a choking hazard. In the meantime, we're warning parents to be careful, not only about hot dogs but anything that could make kids choke.”

Stier, seeing the issue as a bit too obvious for panic, adds: “As Free-RangeKids blogger Lenore Skenazy writes, “Surely You Must Be Choking.”

Curtis Porter is a research intern at the American Council on Science and Health (ACSH.org).