hectorse said:
Here I go again, with feeling. I had articulated a great answer but closed the window! Let's see if I can remember
One professor made a great comment that summarizes my view on this debate:
The mechanism and chemical reactions that allow a human to feel pain when one is hit by a hammer from a fiendish jokester, all from skin to a synapse ion pump, are incredibly complex and require a great amount of effort and study to only begin to understand. But the underlying reason is still very simple and that is that you need to change friends
I agree that the root cause should always be searched for, but I would also argue that this should not limit treatment which affect intermediary pathways. Would you argue that because sodium is not the root cause of hypertension (I personally am unsure of it), that clinicians should stop prescribing diuretics to hypertensive patients and those with heart failure? Why should a heart failure patient continue to consume excess sodium when the medication he is on is acting on removing that sodium? Decreasing sodium intake would help make the medication more efficacious IMO. Am I treating the root cause of his heart failure or hypertension? No. But I am keeping his pressure down and preventing ongoing renal failure and cerebral stroke.
hectorse said:
Medicine, specially something incredibly complex like nutritional science, sometimes suffers from kind of the same myopic approach that only gets a pass on medical research and would get promptly shot down in any other science.
The reason that clinical science as a whole (not just nutritional science) gets a "pass" is because it has to be based on large population studies to be meaningful. Replication of results is difficult. My opinion why nutritional science is so controversial is because everyone can chime in because the phenotypical effects are so readily apparent (obesity, heart attacks, etc).
hectorse said:
It is great that we now can understand what the mechanisms of the de novo cholesterol synthesis are in the sense that we can now degradate the cholesterol synthesis enzyme to regulate serum cholesterol levels, but that does not a policy make.
It actually did, from my perspective. Thanks to the Nordic countries' health databases we now prescribe statins routinely to treat hyperlipidemia. I would argue that understanding the mechanisms, finding the drug, and applying it to translational research by large, randomized studies allowed multiple professional medical societies to recommend statin treatment. Did we add statins to the water? No, but we're treating millions of people with purported benefit. People will argue that statins are not helping, and that's what post-market surveys are for. That's a separate discussion.
hectorse said:
The liver segregation of smaller longer lived lipoproteins is still happening. Then there are studies that are too big in scope to provide any kind of conclusive smaller scope conclusions yet include them in the abstract for funding reasons. We measured an increase in Cytosol activity when we increased carbohydrate composition. Does this mean that carbohydrates promote weight loss? Yes, no, maybe, I don't know, in the meantime it goes in the abstract.
When it gets put into translational research and starts making results that gets the attention of multiple people, then it piques the interest of people from my realm. You know as much as anyone else that bench to bedside is a harsh, cruel, unforgiving increasingly-narrow path. Is your next collaboration going to include an MD with a clinic who can test your hypothesis of carbohydrate-->weight loss? And yet there have been already many population studies that have looked into this "lipid hypothesis." Why should the results from a minority of studies outweigh those from the majority?
hectorse said:
And then forum warriors, politicians and the media skim these papers without really understanding the science and make policy that funds a more conclusive result. That is still NOT science though. And that's why I have a problem with this legislation.
It is the bridge from basic research to policy what I have a huge problem with.
I do not think you are giving enough credit to all the RCTs over the years that have established the link between treating sodium intake with decrease in heart disease. There has been enough research in my mind that establishes this link. I'm not saying it's the root cause, but it's a treatable cause with real results. And I have grave reservations to anyone who would claim that this would hinder any meaningful further research into hypertension. In fact, I would argue that this would INCREASE funding into hypertensive research. Medical centers will be able to actually track blood pressure patterns and determine whether this intervention was actually useful. This isn't "one and done." Research will continue and if the expected changes did not come about,
then we stop and pause. What happened? Did we hype sodium too much? That will bring about more studies and that could very well vindicate all the armchair clinical scientists in this thread. I do not think a regulation would hinder research progress. It didn't stop Drs. Marshall and Warren from discovering H.pylori in the cause of peptic ulcers. This wouldn't stop the next Dr. Marshall or Warren.
hectorse said:
This is not voodoo and is not something that is impossible to understand if you didn't go to school for 8 years. That's why I think the work of Taubes and other science journalists is extremely important. It creates an incredible bridge between the general public and the more specialized research body that is necessary for policy making and regulation.
I don't disagree with that. There will always be opponents and in a field like nutritional science where media exposure is great, everything is magnified. But Taubes and others have a great hurdle to clear, as they in my eyes would like to reverse the career works of many without going through the same hard work (more likely because that's difficult, not because they don't want to).