Diabetes and the CDC, FDA, NIDDK, NIH, and USDA

David Mendosa Health Guide November 23, 2008
  • We can't completely trust anything, anyone, or any organization. Nowhere is this more true than for our health.

    Yet we have to decide. Doing nothing is impossible.

    A correspondent that I know only as "drscll" prompted these reflections. He or she asked if we could trust even the U.S. Centers for Disease Control and Prevention (CDC).

    The question startled me at first, because if any part of our government is trustworthy, I've always thought that it was the CDC. Staffed by a dedicated group of people, many of whom put their lives on the line to control epidemics, the CDC deals in facts, not opinions or recommendations.


    Even though I spent about 15 years of my live working for the U.S. Government, I certainly don't trust it in general, even though I distrust it less than any other national government. My serious distrust dates back to the Vietnam War, which we can blame on both Republican and Democratic administrations (read Nixon and LBJ).

    But specifically in terms of our health, four parts of the executive branch have the most to say to us. Besides the CDC, they are the National Institutes of Health, particularly its National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the Food and Drug Administration (FDA), and the Department of Agriculture (USDA).

    Unlike the CDC, which has its headquarters in Atlanta, the other three agencies call the Washington, D.C., area home. Perhaps because of that, politics plays a bigger role with them.

    The NIDDK seems to be the least politicized of these Washington agencies. But conflict of interest scandals regularly rock the FDA. Too many of its executives move back and forth between industry and the government agency in charge of regulating that industry.

    Maybe because it's bigger, the USDA is more of a mixed bag than the other government agencies. The food companies have so much input into its dietary recommendations like the so-called "Food Pyramid" that they would be a joke if they weren't so dangerous to our health.

    Yet we have no more reliable guide to the nutrients in our food than the USDA National Nutrient Database. That's because nutrients are facts, not recommendations.

    Still, I know that the nutrient database contains some errors as do the government-mandated "nutrition facts" panels on the food products we buy. That's probably simply because to err is human, which is forgivable. But undeclared conflicts of interest are not.

    I declare a "full disclosure" any time that I write about one of the three companies that I own stock in. I don't kid myself into thinking that I have enough influence to make any amount of money by promoting any of those companies. But that's what all responsible journalists have to do so readers can judge whether writers have a conflict of interest in something that we write.

    Even worse are the conflicts of interest among authors of journal articles. Even the most respected peer-reviewed journals like The New England Journal of Medicine
    are guilty. I was angry enough to write "Statin Rage" about the JUPITER study trumpeting the use by people with high levels of C-reactive protein (CRP) of a statin drug called Crestor, which a company called AstraZeneca sells. After my article appeared, an editorial in The New York Times wrote:


  • The results must also be evaluated in the light of two potential conflicts of interest. The lead investigator stands to benefit from a patent involving the use of CRP to evaluate the risk of cardiovascular disease, and AstraZeneca financed the study...

    Under pressure to be more transparent, more and more journals are now asked their authors to declare conflicts of interest. The most obvious ones are where the author is also an executive of the company in question. That's why, for example, in my review here of the RESPeRATE device for treating high blood pressure without drugs I made sure to exclude journal articles by company officials.

    An easier conflict of interest to spot is advertising. Even some M.D.'s run websites where they profit by the products they push.

    And its not just our government, our professional journals, and other websites that can mislead us. Many of us, myself included, think that the largest diabetes charity keeps pushing diet recommendations that are counterproductive for our health.

    The American Diabetes Association, like much of the American medical establishment, is so scared that dietary fat is bad for the heart that it keeps pushing for a diet high in carbohydrates.

    I don't question their honesty. But those of us with diabetes need to remember that science -- including the nascent science of nutrition -- is built on better and better hypotheses. But hypotheses are just theories.

    Since we can't put our lives at risk by trusting these respected organizations, who can we trust?

    The answer has to lie within. We have to decide for ourselves and keep an open mind as we learn more.

    I fall back to something that my spiritual leader, Oscar Ichazo, told followers of his Arica School years ago. Don't believe me, I am not a guru, he told us again and again. Don't believe anything. Act upon knowledge.

    We have to do what works for ourselves. Of course, that leads to the placebo problem of belief. But we can take advantage of it. If we believe something works, it probably will work, at least a little for a while.

    You are probably left with some cognitive dissonance, as I am. I know no way around it. The best conclusion that I can offer are the wise words of President Reagan, "Trust but verify."