Dr. David Katz, Preventive Medicine: Diet and Truth

New Haven Register (New Haven, CT), March 12, 2017 | Go to article overview

Dr. David Katz, Preventive Medicine: Diet and Truth


In late February, Dr. Salim Yusuf, a prominent cardiologist, gave a talk at the Zurich Heart House, circulated on YouTube before it was pulled. Citing observational data of his own, Yusuf asserted, after noting that he has no expertise in nutrition, that in effect, everything we know about diet and cardiovascular disease is wrong.

He told the world that eating fish is neutral, eating vegetables useless, and that heart disease rates go down as meat-eating goes up. If only he had recommended smoking cigarettes, the bizarre, surreality of it would have been complete enough to rival that famous scene in Sleeper.

Of course, this is wrong -- and strangely, for a researcher who has written many times on matters of epidemiologic methodology, wrong at the level of Epi 101.

Yusuf was citing observational data across many countries. The sine qua non of interpreting such data reasonably is the avoidance of the ecological fallacy, in which A and B both happen but are "true, true, and unrelated."

For instance, there is much less Ebola where there is more 4G LTE cell phone service, and more Ebola where cell phone service is poor, patchy, or absent. This, of course, is not because 4G LTE cell towers protect against the Ebola virus, but because Ebola is endemic in poor, rural areas of sub-Saharan Africa that lack such towers. There are innumerable examples of similarly nonsensical associations.

Sticking with only the most obvious of rebuttals: meat is a very small part of the diets in poor countries. As countries become more affluent, they can afford, and -- sadly for the health of people and planet alike -- generally choose to eat more meat. But affluence doesn't just procure meat. It also procures medicine, and technology. Countries that eat more meat have more cardiologists to prescribe drugs, and perform angioplasties; they have more cardiothoracic surgeons doing coronary bypass procedures.

One obvious way to confirm or refute the merit of cross-sectional data is to look for change over time in those very behaviors in a given population, and then ask if the results were as predicted.

Cultural transitions in both India and China have shifted traditional, plant-based diets to more meat-centric, Western type diets, and rates of chronic disease in general, diabetes and heart disease in particular, have skyrocketed. These massive examples, alarmingly on display for all the world to see, belie Dr. Yusuf's conclusions.

So does a study, just published in JAMA, which looked at dietary components associated with mortality in the U. …

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