The American Institute for Cancer Research (AICR) has sent a strongly worded letter to Tommy G. Thompson, Secretary of the Department of Health and Human Services (DHHS). The institute charges that the criteria used by U.S. health policymakers to craft advice for disease prevention is not keeping pace with the changing scientific landscape.
AICR Executive Vice President Kelly Browning called to acknowledge the many differences that exist between disease treatment and disease prevention. Until health policymakers rethink their assumption that a single method can be used to investigate these different scientific fields, the letter said, federal prevention policy will remain "fundamentally flawed."
"The way to assess the potential of a drug to cure an illness is not the way to assess the potential of overall diets to prevent the illness in the first place," said Browning. "Yet it is still official U.S. health policy to attempt to answer these very different questions with a single set of scientific criteria. This practice is unfortunate and ultimately misleading. When it comes to the multifaceted issue of prevention, one size does not fit all."
According to the letter, many in the international scientific community who study prevention shun the federal government's "reductionist" focus on randomized, controlled trials and have instead embraced the more comprehensive "portfolio approach" to study the issue.
The portfolio approach is used to assess the many different forms of scientific evidence together, without giving any single form greater weight. According to AICR experts, this more comprehensive method can answer complex, interrelated questions about the prevention of chronic disease that randomized trials--which measure the effects of a specific treatment in patients with an already existing disease--are simply not designed to ask.
The sharp distinction between these two approaches came to a head in early 2004, when the government sent its own letter to the World Health Organization (WHO) and the Food and Agriculture Organization (FAO). In the letter, William R. Steiger, Special Assistant to the Secretary for International Affairs at the DHHS and the Department of Agriculture, criticized the methodology behind a draft of the WHO/FAO Report, "Diet, Nutrition and the Prevention of Chronic Diseases."
The DHHS criticism centered on the fact that the WHO/FAO draft did not use the same set of evidence-based guidelines that are used by all federal health agencies. …