Swallowing the Hype
By Sam McManis, The Sacramento Bee, Calif.
Jun. 11–Dark chocolate mania, first touted several years ago as a boon to dietary wellness, shows no signs of abating in the media.
A cursory database search over the past six months produces plentiful stories chock-full of health claims for the tasty treat.
Dark chocolate can, if reports are to be believed: lower blood pressure, reduce the risk of strokes, improve skin clarity, protect against preeclampsia in pregnant women, stop coughs, guard skin from the sun, produce “aphrodisiacal” effects, cut the risk of blood clots and make depressed people happier.
Whoa, is this some type of superfood, or what?
We swallow, quite happily, each new finding about this antioxidant-packed hunk of goodness because, well, that’s the way it’s presented to us. And we so want to believe that chocolate is good for us.
The truth about dark chocolate and myriad health claims is more nuanced and complex, says veteran health journalist Robert J. Davis in his new book, “The Healthy Skeptic: Cutting Through the Hype About Your Health” (University of California Press, $21.95, 254 pages).
“We as human beings are attracted to the idea of a specific food, in isolation, having the power to head off disease because it’s so compelling,” Davis says.
Less compelling, according to Davis, but more accurate is this: “In the long run, what matters, according to research, is our overall diet — not whether we include one specific food or another.”
A balanced diet? What a buzz kill.
The media (and credulous consumers) love stories about curative superfoods — be it the guilty pleasures of red wine and dark chocolate or virtuous almonds and blueberries — because they are attention-grabbing and an antidote to the steady stream of bad news. And researchers and marketers often are happy to emphasize, even overstate, conclusions from preliminary studies often with dubious methodology to hype health claims.
Oh, and by the way, the funding source of several of the aforementioned chocolate-as-disease-preventer studies?
Mars Inc., the candymaker.
But unless you dug deep, you probably didn’t hear that part of it. Or learn that many of the studies cited involved small samplings over a short time period. Or that, in some cases, you’d have to eat enough dark chocolate to go into a diabetic coma to have a hope of gaining the full benefits.
“The correct thing to say would be: ‘There is some evidence to suggest that dark chocolate in moderate amounts can be beneficial in the short term, but we aren’t sure of the long-term benefits,’ ” says Davis, who has written for the Wall Street Journal and teaches in the health department at Emory University in Atlanta.
“I mean, it’s OK to eat dark chocolate, but don’t think of it as medicine. But the message often gets translated into a one- sentence line that overstates the truth.”
As the book’s title implies, “The Healthy Skeptic” seeks to educate consumers on all health matters: nutrition and natural-supplement claims; how much weight to put into recommendations about everything from sunscreen to hormone replacement therapy, to when to get tested for colon cancer; what the FDA lets manufacturers put and not put on labels.
Davis is quick to add that, while he believes people should be skeptical of information coming from research and filtered through the media, they should not succumb to cynicism. He does not think all health claims are manipulated to fit an agenda.
Rather, the messages just get oversimplified.
“There’s a perception among those disseminating the information that people get too many messages and that you need to cut through the clutter to be heard through the din,” Davis says. “(The consumer) wants simple answers — ‘Is this dangerous? Yes or no?’ ‘Should I take this? Yes or no.’ That expectation leads health promoters to simplify the message.
“It’s worth it to do a little homework and not take things at face value. Go to resources and verify.”
The problem, say health care advocates, is that consumers don’t know where to turn for truly independent analysis of health claims.
A startling statistic And they are in serious need of quality information. A recent study by the Agency for Healthcare Research reported that only 12 percent of America’s 228 million adults have the skills to manage their own health.
“I can understand the frustration,” says Maryann Napoli, associate director of the nonprofit Center for Medical Consumers. “Take statins (the cholesterol drug) for instance. There’s no independent Web site where someone can go and get understandable, honest information.
“Most people, for instance, don’t know that three of the six primary prevention trials (for statins) on healthy people have not released their serious adverse events data. So we don’t really know whether they truly are effective or not.”
Several Web sites make it possible to pore over both abstracts and full studies.
The most encompassing database is PubMed.org, sponsored by the U.S. National Library of Medicine and the National Institutes of Health. Consumers can look up the particulars of studies, such as sample size, the methodology used and conclusions that may have been omitted from a media report or press release.
PubMed, however, can be daunting to someone not well-versed in academia or medicine.
“The average person is not going to go on PubMed, and I don’t expect them to,” Davis says. “But if they want to get their questions answered …”
Another resource is the Health News Review, an online rating system of health and medical journalism. It takes articles that appear in mainstream newspapers and television news and uses objective criteria — the number of independent sources quoted, evaluation of evidence, quantifying the potential benefits and harm — to award each a star rating.
Gary Schwitzer, director of the University of Minnesota’s master’s program in health journalism, runs the site and uses a panel of physicians to review articles. He says mainstream media spend too much time writing about “the latest study” and not enough time tackling serious health policy and access-to-care issues.
Of the 550 stories the Web site has analyzed in the past two years, Schwitzer says 65 percent to 70 percent “failed to adequately discuss costs of the ideas and failed to tell you how small might be the potential benefit or how large might be the potential harm.”
The bottom line?
“(The media) are giving us an imbalanced, kid-in-the candy-store picture of the American health care system whereby everything looks terrific and risk-free, and nothing has a price tag associated with it,” Schwitzer says.
Until recently, health advocates say, one of the most underreported aspects of studies has been the financial ties of researchers and their corporate funders. Data show that 70 percent of all medical and nutritional clinical research is industry funded and 30 percent federally sponsored. In 1980, it was the reverse, says Merrill Goozner at the nonprofit Center for Science in the Public Interest in Washington, D.C.
“When you have a financial relationship with someone who has a stake in that research, it’s absolutely a conflict of interest,” Goozner says.
“That doesn’t make the (research) results irrelevant or necessarily suspect. But I’ve seen independent, peer-reviewed studies in (the Journal of the American Medical Association) that show that when someone with a stake in the outcome funds the research, the outcomes are far more likely to favor the sponsor than similar research funded by people without a stake in it.”
Goozner’s group has developed the Integrity in Science Project, which provides a database that lists — by scientist, university or industry — which corporation funds which studies.
Type in “Mars Inc.,” and the database reports that UC Davis has received more than $10 million in funding by Mars for chocolate research. Professor Carl L. Keen received $830,875 in 1997 and 1998 alone from Mars for research on “the cardiovascular benefits and antineoplastic properties of select cocoa polypherols.”
Keen, who has published dozens of papers on the positive antioxidant qualities of dark chocolate, says the funding by Mars in no way sways his research.
“Our papers in this area are routinely submitted to high- quality journals where they undergo rigorous peer review,” Keen writes in an e-mail response for comment. “We are careful in these papers to cite the source of funding for the work, thus there is transparency.
“There is a long history of industry-funded research in the field of nutrition. What is critical is that the work is reviewed by experts in the field, and this is what occurs with the journal peer-review process.”
Goozner scoffs at the notion that industry-based research is as purely scientific-driven as federally funded studies.
“We need to have faith that research is done with the highest standards of objectivity and not driven by the financial stake of the various providers, whether they be drug companies, device companies, hospitals, insurance companies, or for that matter, physicians who are on the payroll of some of those players,” he says.
The answer, he says, is a government-run “comparative effectiveness agency” similar to the National Institute of Clinical Effectiveness in Great Britain. Goozner says it would be an independent committee of scientists, specializing in biostatistics, that would vet studies for accuracy and publish conclusions. It would be “constantly updated and … available to the general public.”
But, as Davis says in his book, the public needs to be less credulous.
“If you ask people what’s most important to them, they’ll put health near the top of the list,” Davis says. “If people really believe that, they need to do their homework.”
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