Healthcare Should Not “Be About Prevention”

The last several years has seen dramatic changes implemented to the American healthcare system. In addition to the passage of the Patient Protection and Affordable Care Act, the President’s flagship piece of legislation (known colloquially as “Obamacare),” into law in 2010, we have seen a paradigm shift in how healthcare is delivered to patients in this country. Physicians and hospitals are more committed than ever before in attempting to provide the most efficient care possible; that is, minimizing a patient’s length of stay in a hospital, reducing the amount of patient readmissions, and providing only those treatments or procedures that have been deemed “medically necessary” to the patient’s care.

Quality improvement is another newer concept in American healthcare: it describes the processes by which healthcare providers measure the effectiveness of the procedures and treatments that they administer to patients. Other outcomes measured include the sufficiency of hospital safety procedures and patient satisfaction scores, which are measured using surveys. At their core, quality improvement programs seek to emphasize treatments that have been demonstrated to be efficacious. Safe, efficient, evidence-based care that meets the patient’s needs is the name of the game now and providers must work in unison to ensure these processes and outcomes are maintained if they wish to be reimbursed and to avoid financial penalties levied by government insurers and accrediting organizations.

Medicare, our federal government’s health insurance provider for citizens over age sixty-four, and private insurers have led this charge in this new era of managed care. Medicare, working through private contractors (known as MAC’s), is more stringent and discerning than ever before in determining what it will and will not reimburse based on a host of criteria such as medical necessity, the comprehensiveness of the patient’s medical documentation, the competency of the staff involved in the patient’s care, and the safety procedures utilized. Healthcare providers must meet these benchmarks to receive payment for their services. To make matters more difficult, these goals are in constant flux and practitioners must keep up with the frequent revisions.

In this swirl of efficiency modeling, data analysis, outcomes assessment, government oversight, and seemingly endless documentation, many providers worry that healthcare is forgetting the most important piece of the puzzle: the patient.

Often, patients themselves can attest to feeling overwhelmed, under-informed, and hurried through their treatment. Some will feel confused, others angered or frustrated, and still other patients will maintain that they were violated or harmed in some way by the medical juggernaut.

Many view this emphasis on streamlined managed care and evidence-based treatments as having detrimental effects on the patient and perhaps even crumbling the most sacrosanct component in all of healthcare, the doctor-patient relationship. Physicians themselves have expressed these concerns. Some pundits, many of whom are healthcare practitioners, argue for blowing the whole thing up and starting anew. Medicine as it’s currently practiced, they allege, is failing our patients. A cursory glance at our overcrowded emergency departments, our hopelessly sick patients requiring repeated lengthy hospitalizations, and our expensive treatments that can lead to debilitating complications, serves to reinforce these concerns, so says these commentators. One study even demonstrated that the majority of treatments rendered to patients are wholly ineffective.

One idea that has gathered steam in recent years is the belief that healthcare practitioners (and presumably insurance providers) should focus their efforts primarily on preventing illness rather than simply treating it when it occurs. This romantic notion has been trotted out as a solution by many to the perceived problems that arise resulting from our traditional concept of medicine. In essence, this idea stems from the logic that, by addressing and reversing disease risk factors, such as lifestyle habits, and potential medical conditions early before they can become full-fledged chronic disease, we can reduce the incidence and severity of disease itself, better treat the patients who are sick, and save untold billions of dollars in the process. We could improve our citizens’ health and provide superior care in the hopefully rare event that some of them do fall ill.

Certainly a noble suggestion. One problem, though:

It doesn’t make any sense.

Let’s first examine the disease component of this idea.

The Centers for Disease Control (CDC) track mortality rates of adult U.S citizens and compile this data into a report known as the “Leading Causes of Death.” The most recent report available online is from 2013. Here we can examine the pertinent statistics regarding the primary causes of death in our population. The following chronic conditions, taken from the aforementioned report, kill tens of thousands of Americans every year:

  • Cardiovascular disease
  • Cancer
  • Chronic respiratory diseases
  • Stroke
  • Alzheimer’s
  • Diabetes
  • Kidney failure

All of the above conditions have multifactorial etiology; usually some combination of genetic predisposition, a multitude of lifestyle elements such as smoking history and nutrition, perhaps even DNA mutations and/or congenital defects, and plain bad luck all contribute to their development. How are we supposed to prevent, say, cancer when cancer is considered to be not necessarily a single disease but instead a term to describe literally dozens of cellular malformations that can affect every tissue and organ system in the human body? Oncologists struggle to treat cancer patients as it is, but to task them with preventing it’s occurrence throughout our population? Unfathomable hubris or naivete, one. As one of the leading killers of American adults, cancer is an undeniably complex, insidious, and resilient affliction that has proven extraordinarily difficult to treat and so far impossible to cure despite centuries of dedicated research. We cannot fall into such unrealistically idyllic thinking to posit that cancer incidence could be drastically reduced by “prevention” strategies.

What about lung disease? Surely by greatly reinforcing the benefits of tobacco cessation we can successfully prevent the large majority of these conditions, such as lung cancer and chronic obstructive pulmonary disease (COPD). But other common lung conditions, such as interstitial disease, fibrosis, pulmonary hypertension, sarcoidosis, and bronchiectasis aren’t all directly caused by cigarette smoking per say. Many patients with severe pulmonary disease have never smoked.

How would “prevention” help these patients, some of whom are ill through no fault of their own? Many of these diseases can be associated and potentially may be caused by environmental factors such as pollution and toxins. This would presume that people living in congested urban areas or people who frequently work around toxic substances would be at a higher risk for lung disease than people who do not. This disparity would negatively impact any prevention efforts, as we can’t tell people in Los Angeles, for example, to all move to somewhere less crowded in the hopes of preventing respiratory ailments caused by polluted air.

Some of these conditions are idiopathic, meaning that the patient’s physicians (and maybe even medical literature) don’t know what caused it. We can’t prevent these maladies when we have no idea what brought them on in a particular patient, let alone millions of potential patients.

What about osteoarthritis? A degenerative condition in which the joints of the skeletal system deteriorate with age and overuse, this condition affects tens of millions of Americans, crippling a great many of them. It is the leading cause of chronic disability in this country. Osteoarthritis is the reason orthopedic surgeons perform hip and knee replacements, home health companies distribute countless canes and walkers, and the pharmaceutical industry is booming with painkillers.

Prevention of a degenerative joint disease that could be caused by mechanical stress, ie. overuse, would prove tricky. Current physical activity guidelines, proffered by the Department of Health & Human Services (HHS), recommend up to five hours per week of aerobic exercise for improving health and maintaining an ideal body weight. We could hypothesize that this chronically high volume of repetitive motion could have a deleterious effect on the joints. Research in this area is inconclusive but we can’t completely disregard the idea that exercise, while the source of many health benefits, might be injurious to our joints if done as frequently and for as long as the federal government is recommending.

But how would we prevent osteoarthritis? Caution Americans to exercise, but not too much? Inform them that while climbing stairs gets the heart rate up, it could also cause wear-and-tear in the knee joints and should be done sparingly? How do we tread this line?

Coronary artery disease (CAD) is another chronic condition that presents it’s own set of questions. If the healthcare system sought to eradicate CAD by funding extensive nationwide prevention strategies, we would certainly see some benefit as a society. But not everyone would enjoy the same downtrend of heart disease risk factors. While the typical cardiac patient can probably be described as older, overweight, and having a history of smoking and poor diet, there are a great many patients who are otherwise remarkably healthy, or at least engage in all of the behaviors theoretically associated with good health. There are many instances in which marathon runners arrest out in the field, lifelong vegetarians need bypasses, and health nuts drop dead in their thirties and forties after throwing a clot. While rare, these cases present serious challenges to the preventative healthcare model.

How can we advocate prevention when a small but important fraction of people would still fall ill despite religiously following preventative health advice?

Besides, how do we even know what advice to give? Are we settled on the ideal healthy diet? Is the research conclusive? What do we still question?

There have been and still remain critical questions as to what we should eat if we want to remain healthy. While the message of the Department of Agriculture (USDA), arguably the federal government’s mouthpiece on nutrition, has long been to consume a low-fat diet rich in fruits, vegetables, and grains, randomized trials and meta-analyses have raised doubt as to whether this diet, or perhaps one higher in animal products and lower in carbohydrate, would the best option. Zealots from both sides continue to keep this debate stirred up as the research is still inconclusive. The fact remains that our best data demonstrates that a reduced-carbohydrate diet is at least as effective in the short-term (two to eight years) as a low-fat diet for improving body weight, blood lipids, glycemic control, and markers of inflammation and metabolic dysfunction, all considered vital constituents of an individual’s overall health. While we can’t yet say that the traditional diet advice is wrong, we can’t state with confidence that it’s right, either.

Maybe prescribing medications to prevent diseases such as CAD would be prudent and effective. Elevated blood lipids, also known as high cholesterol, is usually considered to be a risk factor for future heart disease. The word “usually” is apt: while the majority of cardiologists support the notion that assaying lipids and prescribing statin (cholesterol-lowering) drugs to improve them will reduce the likelihood that the patient develops CAD, a great many physicians have long been skeptical of the cholesterol-heart disease connection.

Nevertheless, we can take solace in the fact that prescribing a statin to most of the adult U.S population would presumably curb the occurrence of CAD. Many doctors would comfortably agree with that statement based on the seemingly overwhelming support of the available data. But the research might not be conclusive. It is here I will very highly recommend the book Worried Sick: A Prescription for Health in an Overtreated America by Nortin Hadler, M.D. The book’s third chapter brilliantly describes the methods by which data is twisted and tortured in these statin trials to exaggerate the cholesterol-lowering and life-saving benefit of these drugs in a way that I cannot. Hadler’s work informed much of this article.

What Hadler contends based on the cholesterol data is that if physicians were to treat one hundred well people (ie. people without diagnosed heart disease) with statins to prevent CAD, very few of these people, perhaps only one or two would be spared a heart attack. He describes the results of the seminal West of Scotland study thusly: although purporting to demonstrate the efficacy of statins for preventing CAD, the data shows that prescribing statins to adult males with elevated blood lipids for up to ten years would result in not one person being spared from early death from heart disease. Potentially hundreds of people would need to take statins in order for a handful of people at most to realize any benefit whatsoever.

The Cochrane Collaboration, a not-for-profit organization of volunteer medical researchers, publish extensive meta-analyses of data collected from randomized trials that examine the efficacy of drugs, treatments, and procedures in treating diseases. Their systematic reviews are considered to be the most accurate and reliable medical knowledge that we have available and physicians routinely utilize their database in determining best practices for patient care. Their process is very scientifically stringent and their work is unadulterated by outside financial interests.

In 2011, the Cochrane Collaboration published a review examining the data on statins prescribed as primary prevention for CAD. The results were far less than encouraging. In fact, the authors espouse that some of this data may have been manipulated in order to suggest a benefit greater than in reality.

We’re forgetting the potential harms associated with statin use, such as liver damage and deterioration of the skeletal muscle. Memory problems correlated with statin use is still a matter of debate. Are we improving our health if, by taking a drug to lower our cholesterol by a little bit (at no benefit to our longevity), we’re experiencing potentially stifling pain throughout our body and maybe even some deficits in our cognition? Doubtful.

So “prevention” might not be the best idea from a medical standpoint seeing as how the diets may be ineffective, the drugs may be ineffective and dangerous, and the diseases themselves are still not thoroughly understand enough to offer reliable advice on how to impede their development.

This bring us to the other component of the healthcare prevention model: how would this be implemented?

Remember that in order for this to work, we would have to reach the maximum amount of people, ideally the entire U.S. population, and get them to follow lifestyle recommendations to the best of their ability.

But this would be inconceivably difficult to accomplish.

Think of all of the advertising, the public service announcements, the social media campaigns, the television and radio commercials, the internet memes, and the “expert” interviews which would need to be disseminated regularly to the American people. The messages to eat healthy, exercise (correctly), and stop smoking would have to incessant yet nuanced. Whomever took on this task would constantly have to find new and interesting methods to say basically the same thing over and over. Public interest would have to be maintained. Strategies would have to be multifaceted in order to reach such a wide range of demographic groups; senior citizens would have to be reached through newspaper columns and mainstream news media broadcasts. The younger generations would respond most favorably to grassroots campaigns and viral marketing on the Internet, perhaps using celebrities and athletes as pitchmen for the cause. Children could be taught the value of preventative healthcare as part of grade school curriculum. That is, if they have time for any more subject matter.

And on top of that, people would have to believe what we’re saying is right. Consider that faith in the competence of our government and support for our political leaders are at all-time lows, we probably can’t put this job in the hands of federal health agencies such as HHS or the USDA. So many citizens believe the government is fallible on issues foreign and domestic; they’re certainly not going to view government health recommendations as inerrant.

Finally, the public needs to act on this advice. Getting Americans en masse to put down the junk food and permanently alter their lifestyle habits is a pipe dream. It’s just not going to happen.

But maybe we have an ally in this fight, a willing battalion ready to help in the war against disease:


We can surmise that anything will suppress or even prevent chronic disease would have the support of our doctors. But here again we run into the challenge of trying to reach everyone. If we want to make a quantifiable dent in the prevalence of chronically diseased patients, then we would have to intervene in people well before they reach retirement age in order to increase our chances of addressing risk factors and improving lifestyle habits long enough to show significant benefit. This means getting those 20- and 30-year-olds to visit the doctor, something that this demographic just doesn’t regularly do.

Former Democratic Presidential candidate John Edwards mentioned in 2007 while promoting his universal healthcare plan that all Americans should be mandated to visit a doctor once every year. His idea, which he portrayed as a “continuum of care,” would force people, many presumably against their free will, into an examination room with a physician for a physical and a health history taking. What Edwards did not say, but can be logically implied, is that any condition or disease uncovered during these forced check-ups would have to be treated with or without the patient’s consent. What good is a doctor visit that results in a diabetes diagnosis or the discovery of a breast lump if the patient walks out the door without any treatment or guidance? Edwards assuredly would want these people treated regardless of their consent. All in the name of preserving their health. Does this sound like a reality you want to experience?

One Cochrane Collaboration review published in 2012 demonstrated that regular doctor visits did nothing to reduce morbidity or mortality in patients. The only thing these visits did do was increase the number of diagnoses a patient had. This only holds true if we can remember and effectively process the information the doctor is telling us, something with which many patients struggle.

So, according to our best research, going to the doctor does not improve health (or delay death or disease) but does saddle a person with the stigma of disease. Does this sound like preventative medicine to you?

Step back a second and look at the big picture.

Do we want to be assaulted daily from every angle with preventative health messages and advice? Is it beneficial to always be keenly aware that we may be festering with disease, riddled with plaques, and likely to keel over at any minute?

Should we trade our current system (go to the doctor when you’re sick, live your life when you’re well) for the opposite (go to the doctor when you’re well, live the rest of the time like you’re sick)?

Healthcare should not be about prevention because there’s too much to prevent. It shouldn’t be about prevention because we don’t know how to reliably prevent many of the conditions that afflict us. Healthcare shouldn’t be about prevention because we might turn healthy people into anxious hypochondriacs always shuffling to their next specialist visit or blood lab appointment.

Healthcare should be about treating patients safely, effectively, and as kindly as possible. Let them present to the doctors and hospitals when they fall ill; don’t waste the effort trying to reach them when they don’t need healthcare. You risk jading some to the benefit of medicine while inciting others into a worried frenzy about their next possible diagnosis.

The onus is on us as adults to take care of ourselves. We need to assume the responsibility for making healthy choices in our lives. In order for this to work, in order for us to avoid believing the questionable advice dispensed by government health agencies, celebrity doctors, news media, and our social circle, we must be very selective in whom we trust. A skeptical eye towards any health recommendation is prudent; there’s just too many talking heads with too many conflicts of interest. It’s easy to get overwhelmed by it all.

But we must try. At our fingertips is a wealth of information provided by National Institute of Health’s Library of Medicine. It’s a searchable database known as Pubmed. This invaluable resource allows users to search the medical literature for specific studies, papers, and data analyses of nearly every known human disease. While many of the journal articles require a paid subscription in order to access the full text, there are plenty of free papers wherein one can get a grasp on the research about a particular condition, medication, or syndrome. Pubmed, along with the aforementioned Cochrane Collaboration database, are the two preeminent sources of reliable healthcare information.

Use them when you have questions about the effectiveness of a particular drug or diet or exercise regimen. Education is the most powerful tool we have in our quest for health and we can’t expect a bloated healthcare system or an incompetent (and perhaps misleading) government health agency to do these things for us.

If we want to prevent disease, then that is our responsibility as individuals, not the job of a third party.


The Nanny State Lifestyle: How Useful are Government Health Recommendations? (Part One – Nutrition Guidelines)

Let’s say the time has come for you to improve your health. You’ve noticed that your clothes are getting tighter and that your annual winter cold has lingered longer than usual. It seems more difficult to do yard work without feeling short of breath. You lack energy and your back always hurts. Say that you want to stop smoking, too.

How do you fix these problems? What’s the best way to get in shape? To lose weight? To lower your risk of disease? How can you reduce joint pain? An search of key phrases like “weight loss” or “diet” leads to an overwhelmingly dense and diverse selection of books. How do you know which has the right information, the advice you need to begin following a healthier lifestyle?

You could turn to a lot of resources for answers. The Cochrane Collaboration is a not-for-profit organization of volunteer researchers who provide thorough analyses of data comprised from the results of dozens of randomized controlled trials, the gold standard of research design, in order to determine the most effective treatments for a host of medical conditions. Using a discerning and highly-selective standardized methodology and unadulterated by the financial influence of outside sources, the group provides physicians and healthcare practitioners with “best practices” backed by data that can be trusted to be accurate. See the Cochrane Library for the results of these meta-analyses concerning a number of health conditions.

But medical literature can be intimidating to and difficult to understand for a layman. You risk encountering any and all degrees of quackery sifting through blogs, social media, TV shows, magazine articles, news columns, and internet videos for health advice. Family members and coworkers might not be of much help. Personal trainers, supplement store employees, and nutritionists can provide conflicting and incorrect information. Your doctor may just pull out the prescription pad and hurry you out the door when all you wanted was some guidance. It’s easy to feel misled and overwhelmed.

So let’s turn to our government health agencies for help.

And since we want to improve our overall health, let’s try to follow all of the health recommendations made by these federal agencies.

Is it even possible to live the nanny state lifestyle? How useful is the information that these agencies provide the public?

The U.S. Department of Health and Human Services (HHS) is one of fifteen executive departments of the federal government and an umbrella agency for a number of federal agencies and centers aimed at “protecting” the well-being of all Americans. Below is a partial list of the divisions that operate under the administration of HHS and that provide health recommendations and/or guidelines for the general public:

  • Centers for Disease Control and Prevention (CDC)
  • Food and Drug Administration (FDA)
  • National Institutes of Health (NIH)

In addition to these agencies and their own multitude of offices, there are other executive departments which publish health recommendations. The Department of Agriculture (USDA) and Department of Labor (DOL) both offer detailed directives against developing chronic disease and sustaining injury, respectively.

For the purposes of our discussion, we will analyze the main public health recommendations proffered by the aforementioned agencies. Certainly with some more research of the other federal departments we could uncover additional suggestions for maintaining or improving our health. This post is not meant to be an exhaustive review of every piece of health information dispensed by our government’s myriad voices of authority.

What we’ll instead attempt to do is answer these questions: Can an Average Joe expect any benefit by following these guidelines? Can he do so without having to do time-consuming research? Can we the public, a nation of Average Joes, follow government advice without doing a disservice to our health, our sense of well-being, our family, our free time, our privacy, and our liberty?

The Average Joe might indeed have a bad back, a smoking habit, some extra weight, and maybe even a little depression. Let’s say Joe can use an internet search engine to find popular medical websites that espouse basic health information. Joe cannot, however, interpret papers from medical journals. Distilling scientific research into usable information is just not in Average Joe’s wheelhouse.

So Joe will turn to government health agency websites for help.

Let’s start with those extra lbs. What’s Joe supposed to eat if he wants to maintain a healthy weight and minimize his risk of disease? The USDA’s Dietary Guidelines Advisory Committee, who work in the Center for Nutrition Policy and Promotion (CNPP), an agency of the USDA’s Food, Nutrition, and Consumer Services mission area, release every five years the Dietary Guidelines for Americans in collaboration with HHS.  This hundred-plus page document is meant to summarize the best available scientific literature concerning nutrition, overweight and obesity, and chronic disease and provide to all Americans over age two sound research-based guidelines for making healthy food choices. The next version of this document is expected to be released in Fall 2015.

For our purposes of deciding what to eat to facilitate weight loss, we’ll first use the four-page executive summary, as no busy American can be expected to read the entire voluminous Dietary Guidelines report.

If Joe wants to lose weight, he’s going to have practice “calorie balance” according to this report. Also known as energy balance, this entails counting the calories in everything you ingest and also estimating how many calories you burn through resting metabolism and physical activity. Although poorly understand and nearly impossible to do accurately long-term, practicing energy balance is the go-to method for losing weight as prescribed by the U.S government. This is in spite of a growing body of evidence from research that seems to demonstrate that it is, at best, a theory in need of further study.

So Joe is going to have to calculate the calories of everything he eats and the energy requirements of everything he does. Is that any way to live? Can Joe enjoy food and enjoy life constantly worried about portion sizes and calorie expenditure? Luckily for Joe and the rest of us, the CNPP has an online tool for tabulating this data, the SuperTracker, which provides calculators for physical activity, food choices, and a personalized weight management system.

For practicing energy balance to be efficacious, Joe will (theoretically) have to count calories all day, everyday, presumably lifelong. It wouldn’t be too far fetched to assume that this process could lead to one of two outcomes: Joe gives up on the whole idea, or he becomes obsessively focused on it at the detriment of a healthy relationship with food and his own self-image.

What foods should comprise Joe’s new healthy diet? The 2010 Dietary Guidelines executive summary counsels all Americans to choose low-fat protein sources, get plenty of fruits and vegetables, emphasize whole grains, and avoid sodium and dietary cholesterol (they’ve changed their tune on this one, however). The full document is worth a cursory glance but perhaps other government resources could be more illuminating. For example, the Dietary Guidelines Advisory Committee releases to the public “Nutrition Insights” which are brief literature reviews aimed at providing Americans with tangible research-backed dietary information.

If Joe wants to know what to eat for breakfast to help him lose weight, he’s in luck: this very topic was covered by the Committee in 2011. For reasons unspecified, however, they failed to “review the literature on the use of breakfast consumption as a tool for adults actively losing weight.” Curious decision seeing as how adults, not children, seek the help of these guidelines as they try to lose weight. Previous incarnations of the Guidelines have netted similar complaints. Good thing the USDA has instead focused their research efforts (and funding) on more pertinent topics such as whether Americans like to eat sandwiches and how to measure a piece of cake. Or maybe they’re too busy playing with their food.

Looks like Joe has exhausted the help of the USDA. Sure, they have issued other recommendations for healthy eating, but Joe is a little confused by the ambiguity of the Dietary Guidelines. He’s certainly not the only one.

But the USDA does have the Nutrition Evidence Library (NEL), a sort-of government-sponsored version of the Cochrane Collaboration, except dealing in only dietary matters. With eight topics ranging from energy balance to food safety, the NEL’s reviews cover plenty of issues applicative to Joe’s quest for health. There’s only one problem: the NEL, despite its collaboration with “leading scientists” to create “systematic reviews,” makes a blunder most high school statistics students wouldn’t make. They confuse correlation with causation. In matters of public health, a slip-up of this magnitude, apparent throughout the NEL’s reviews, could have disastrous consequences.

Vague advice is one thing but recommendations riddled with potential mistakes are another. This is Joe’s health we’re talking about. We have to get this right.

Joe can try the USDA’s MyPlate website. Released from the CNPP in 2011, MyPlate served to update the agency’s “food icon” from the Food Guide Pyramid, which endured plenty of criticism throughout it’s reign as the previous icon for the USDA’s healthy eating crusade. The website is full of helpful tips, including these simple guidelines for constructing a healthy meal, and these instructions for making smart food choices in a cafeteria.

After perusing the content of the MyPlate website, several things become apparent to Joe. The most perplexing is the concept of tricking yourself into eating less. Take a look at this guide on portion control. The USDA is assuming that smaller plates are a key strategy in conquering the obesity epidemic. The problem with this logic is that it just might not work.

Eating less than necessary to satisfy hunger is the key tenet behind what used to be called the semi-starvation diet. As expected, the effects of these diets on the dieters were not conducive to long-term adherence. Research in rodent models on semi-starvation diets serves to further dampen the enthusiasm behind the government’s portion control advice. Perhaps the authors of these MyPlate tips are putting too much faith in microorganism research. Besides, maybe Joe doesn’t even need to restrict calories everyday to obtain the benefit.

As evidenced by the MyPlate icon, the USDA heavily emphasizes grains, vegetables, fruits, and starches as majority components of a healthy diet. Never mind that carbohydrates as a macronutrient are inessential to human life, numerous studies have demonstrated the benefit of diets that are devoid of these foods can result in improved health markers.

Can we fault the USDA for being a little behind the research? We could especially considering how busy they are saving us from bad shrimp and imported pork rinds and crafting over a hundred documents on nectarines and peaches grown in California. At least they can define for the discerning public what a catfish is.

But it looks they can’t help Average Joe lose weight.

Research is surprisingly inconclusive on what exactly constitutes a healthy diet. Although they attempt to designate which foods can and cannot be labeled as healthy, the reality is that the literature is ambiguous. The USDA’s nutrition recommendations are at best an educated guess and might very well be a good starting point for Average Joe looking to drop some weight and improve eating habits. But doubts over their accuracy and usefulness have persisted throughout the federal government’s tenure as health educators. An internet search of critiques of the USDA’s Food Pyramid is illuminating.

Would it hurt Average Joe to just eat more fruit, pass on the salt, and maybe cut down on the red meat? Probably not. (The salt thing is debatable; actually, it’s all debatable, but we’re running out of room). These guidelines can give us some semblance of informed counsel on dietary matters but their research certainly is not airtight. To us as citizens, as naive consumers, as a people rapidly getting sicker, the USDA, despite their best efforts, are lacking as a resource.

Other federal agencies which cover nutrition, such as the FDA, might be better in this regard. But they’re more caught up in food labeling which does have undeniable value. One could make the case, however, that they get a little carried away with this responsibility. Consider this forty-four thousand word document on how to quantify the serving size of fruit cake and breath mints.

Could the CDC be our source of usable, accurate, and detailed information? Their Division of Nutrition, Physical Activity, and Obesity offers some guidelines on healthy foods, and although these are aimed at food service, we can still potentially glean some individual advice. But something strange appears on their page detailing “healthier choices:” 100% fruit juice. With the help of the FDA, we as consumers can read the labels on many fruit juices and find alarming amounts of sugar and high fructose corn syrup. See this video for an initiation into the research of these substances on human health. The literature on this deleterious effects of sugar is growing exponentially. To pick a couple papers would do a disservice to the research as a whole. This considered, it’s certainly odd that the CDC, in its quest to prevent disease, is hocking a nutritionally-worthless and insidiously disease-causing food.

Average Joe still has a gut, however, and would like to lose it. It’s no surprising that upping consumption of fruits and vegetables is a tenet of the CDC’s weight loss dogma. Consider their Weight Management Research to Practice series which discusses for health professionals, in the hopes they will provide clients and patients with this information, the “science on… weight management.”

One look at the recommendations for fruit and vegetable consumption, housed in a “research review” for practitioners, reveals an almost laughable admission: “no studies have directly linked consumption of fruits and vegetables to weight loss.” That doesn’t mean they don’t know that eating these foods causes weight loss. They don’t even know whether or not there is a relationship between eating these foods and body weight. How can they have built an empire of recommendations on healthy eating when one of their key pillars is not supported in any way by any research? And how can you review the literature when you admit that no literature exists for your particular topic?

The average person simply doesn’t have the time or the education required to peruse medical journals and read human physiology textbooks and glean from them practical information on how to live healthily. It could be argued that the federal government’s public health agencies are doing us a favor by condensing down this huge morass of data and complicated biology and extrapolating from it simplified guidelines on what to buy at the grocery store and how to prepare it at home. The sheer amount of funding required for this undertaking, provided by our tax dollars, suggests this argument is invalid. A more productive argument would be whether or not our government should be spending our money to provide nutrition guidelines in the first place.

In Part Two, we will examine the government health agencies’ advice on physical activity, smoking cessation, and mental health.