In the spirit of this blog’s previous incarnation as Medical False Knowledge I want to talk about two dismaying stories on the Canadian Broadcasting Corporation. The CBC got caught up in ‘pop medicine’ like a pant leg caught in a bicycle chain. The first was an episode of The Nature of Things on heart attacks. It did well on how the cholesterol hypothesis has died. (It has. The question is what comes next. I’ll probably have something about that in the future.) But the rest of the episode which had some jokey cartoon graphics (the heart attack cause “suspects” pictured as criminals in a lineup) proceeded to seek out a ‘single simple chemical’ cause of heart attacks. This startled me because I have an internal medicine textbook, Harrison’s, from 2004 that describes heart attacks is being caused by plaques. Plaques are hardened areas inside of arteries with hunks of stuff sticking to them. Plaques have anatomy. According to Harrison’s the stuff on the plaque breaks off and flows downstream blocking the artery. Or by the accumulated stuff of the plaque causing blood clots to form. Which break off and float downstream, etc. Anywhere your blood flow slows down too much clots start to form. But here’s the really creepy part, Harrison’s said that plaques are formed by cells from one layer of muscle tissue, your blood vessels are made of muscle tissue, migrating into the lining layer. The lining layer is really thin like, I don’t know, wet Kleenex. Whereas the muscle layer is made of you, know, muscle. So when these muscle cells go into the lining layer they make it all stiff. That’s the beginning of the plaque. They also I believe bugger up the surface and cause blood clots to start to form. There’s another process I know of involving cholesterol. Cholesterol is a chemical that does lots of vital things in the body. Including making steroid hormones. It gets inserted into the inside of these wet Kleenex type lining cells. And then a chemical comes along and takes it out again. We have no idea why. If the chemical doesn’t come along and take it out again the cell gets fatter, and starts to fill in the hollow part of the artery. That’s narrowing of an artery like people have bypass surgery for. None of this was in The Nature of Things show about how heart attacks happen. Though the show was being presented as the big new insights into heart attacks. But was pop medicine. Which is, among other things, all those stories on the news with the Headless Giant Tummy People or telling you What Not To Eat. The “medicine” in pop medicine stories is never about what real diseases are like. It’s about how to avoid some disease (usually heart disease) and by fiddling with what you eat. Sometimes “exercise” of some indeterminant sort is thrown in. Now we even have meta pop medicine stories about how the fiddling with what you eat stories disagree with each other! The point is this stuff is crap. No news outlet should do it. Including the CBC and certainly not on The Nature of Things.
The CBC show Marketplace, which is an often excellent consumer affairs show, had a pop medicine story too. They went after sodium again. THE new pop medicine bogeyman and one Marketplace already sullied itself with in May 2013. Both stories claimed that certain diseases and medical conditions are caused by excessive sodium intake. Now to be fair Health Canada actually puts out guidelines on how much sodium intake/eating per day is “too much”. I have no idea how they would get a number like that. Our bodies turf out all the sodium we don’t need. It’s one of the main activities of the kidneys. It totally works. Unless you have a particular kidney disease. If not, we can eat huge amounts of sodium and it will not hurt us. Interesting fact, some of the diseases they claim are caused by sodium aren’t even diseases. High blood pressure. Kidney stones. Obesity. It’s not biologically possible for high sodium intake to cause kidney stones or obesity. (Obesity?) No matter how goddamn high it is. On the show the person presenting this Diseases It Causes information was, wait for it, a nutritionist. Interesting thing: a nutritionist isn’t a doctor. In the 2013 story they had a doctor. But he specialized in quitting smoking. As you’ll recall an intrinsic element of pop medicine is fiddling with what you eat to prevent some disease. 1) that’s not how medicine works. Medicine starts with diseases and tries to find out everything about them that is relevant. Not just everything about them that is food related. 2) having a doctor on your consumer affairs show say a bunch of crazy ass stuff (food, disease, prevent) does not make it medical and scientific and okay. It just means you found a screwball doctor. Or in the case of this story, nutritionist. The message for journalists is: don’t do pop medicine stories. Real medical stories are about diseases or about medical fuck ups or things our medical system needs to do or about new treatments. On the latter the journalists are always being manipulated though.
The context in which they were going after sodium was breakfast sandwiches, like Egg McMuffins. They also felt it was important to pitch a fit about the number of calories in each of the different fast food chains brekkie sandwich. The high one which the presenter affected to be appalled by it was 500 cal. For breakfast. If normal caloric intake is said to be 2000 cal per day, or more, then unless you’re eating four meals a day it seems to me 500 cal for breakfast is actually a little low. Although the show was happy to quote Health Canada’s nutty maximum sodium number they didn’t manage to present any number for daily caloric intake. Apparently we’re just supposed to think every bit of food we eat should be the lowest number of calories it could possibly be. I call that the anorexic mindset. And it’s really not appropriate that a consumer affairs show try to teach us that.
In short pop medicine stories are terrible and bad and medicine is not a toy for journalists. If the news, especially on TV, is going to have anything about medicine they need to vet it way, way better than anything else they tell us about, short of an evacuation order. Pop medicine stories usually feature food. But that doesn’t make ’em food stories. If you talk about diseases it’s medicine. Do it right.