Sunday, March 15, 2009

Congress ratchets up the obesity war

One little bit of language in the omnibus appropriations bill signed today could shift the government's focus on food marketing and childhood obesity from kids under 12 to everyone under 18, potentially affecting hundreds of millions of dollars of food, beverage and fast-food advertising on TV. Besides funding government agencies and a number of pork-barrel projects, the bill signed by President Barack Obama today calls for several government studies, including one examining whether the government should set standards for determining which foods are healthy and appropriate to market to youths as old as 17.

Late Tuesday, Sen. Sam Brownback, R-Kan., one of the study's sponsors, inserted a statement in the Congressional Record indicating that the under-17 language should be considered a mistake. "I think it would be more appropriate to limit the scope ... to children under 12," he said. The legislation, though, still has original language.

Tom Harkin, D-Iowa, was the other sponsor for the study. His communications director, Kate Cyrul, took a different tack. "Childhood obesity is on the rise and nearly at an epidemic proportion. And we know the obesity rate does not end with children [who are] 13. It affects all school-age children," she said. "Considering the health risks that are involved and the potential impact on our nation as a whole, it would be irresponsible to only focus on a portion of school-age youth."

The bill calls for the Federal Trade Commission, the commissioner of the Food and Drug Administration, the director of the Centers for Disease Control and Prevention, and the Secretary of Agriculture to establish an "Interagency Working Group on Food Marketed to Children," according to a report attached to the legislation. "The Working Group is directed to conduct a study and develop recommendations for standards for the marketing of food when such marketing targets children who are 17 years old or younger or when such food represents a significant component of the diets of children," it says. Further, the "Working Group will determine the scope of the media to which such standards should apply," asking that the group report back to Congress by July 15, 2010.

"This proposal is completely unnecessary," said Scott W. Openshaw, director-communications for the Grocer Manufacturers Association. He said the FTC is monitoring the effectiveness of the industry initiative. "Taxpayer dollars and agency time could be made much better use of. Besides, the proposal -- the way it is written -- not only reinvents the wheel, it does so poorly with broad, misdirected language that goes far beyond marketing to children. Too far."

Many marketers have already reined in their food and fast-food advertising. Under Capitol Hill pressure, major food and fast-food companies launched the Children's Food & Beverage Initiative in 2006 and altered their ad mix and their products to sell healthier products to children under 12. Candy-makers pulled their ads from such media.

There has been some criticism, including from the Federal Trade Commission, that even as the voluntary industry action led to healthier products being advertised to children, each company was creating its own standard for what healthy meant. In other words, the government should step in and set standards.

The [far-Left] Center for Science in the Public Interest, for one, is happy about the language in the bill. "I think it's terrific," said Margo Wootan, director of nutrition policy for CSPI. She noted that the FTC has urged development of more uniform standards for what foods are and aren't appropriate to advertise. "This would set up a mechanism to do that." She also said the teen audience could be more at risk. "In a lot of way, teens are more vulnerable than younger kids because they have more options to make choices out of their parents' supervision," she said. [Horrors! Fancy teenagers having choices!]

Food manufacturers and advertising groups, however, were concerned. They traditionally have said that there are no good or bad foods, and that any food can be fine with the right diet and exercise regimen. Dan Jaffe, exec VP of the Association of National Advertisers, said setting standards for what should be advertised and then extending the focus to teens is troublesome. "When you start to look at rules that would affect kids almost old enough to vote, it could raise major issues," he said. "There is a good food-bad food approach and if they are going to say some specific food is not OK to advertise, it would be unconstitutional."


Wonder drug that stole my memory

Statins have been hailed as a miracle cure for cholesterol, but most people know little about their side effects

I had just walked in to the party, and spotted a familiar face. "Oh, hi," I said brightly, "you're just the person I wanted to see: I had something to ask you." There was a pause. "Yes?" said my friend gently. I stood there in confusion. I couldn't remember her name. And the thing I wanted to ask her had slipped completely out of my mind.

That was a year ago, and it had been happening to me more and more frequently. At first I could shrug it off as examples of those senior moments we all have in late middle age. It started with the names of people and places. "Oh, you know, that man who wrote a book about depression. He used to live in that road just off Primrose Hill. Begins with G."

I have always been a trifle absent-minded. Walking home from prep school, I was usually the one who left his lunchbox behind, or managed to lose his cap while taking a short cut through the copse. Even now, I am not the most reliable person in the world with whom to leave the back door keys. But this was different. I was beginning to be plagued not just with forgetfulness but with confusion. I got into small panics, when for a moment I couldn't make sense of what was going on around me or what I was supposed to be doing. Playing doubles tennis, for example, as I do most weekends, I would get the score wrong and I had to watch the other three like a hawk when we started each new game, so that I knew to stand in the right place.

Worse still was when not only proper nouns but also everyday words escaped me. As a novelist and journalist, my whole life is about words: getting them right and putting them down on the page speedily. Now I found myself looking perplexedly at the keyboard, not only for the right word, with the help of a thesaurus, but where to find the letters I wanted on the laptop.

My wife was by now accustomed to providing names and finishing my sentences for me. It was an unhappy time for both of us. She thought that this was how life was going to be for the next 30 years; I became unusually reclusive for fear of making a fool of myself in public. Both of us read about Alzheimer's with a gripping sensation around the heart, although my symptoms did not seem to fit the classic patterns of the condition.

What, if anything, did seem to fit the pattern, besides incipient dementia? I was pretty healthy, except for moderately high cholesterol, for which I took the statin drug Simvastatin. Other than that I went through periods of taking vitamin supplements - that was all. "Did you say Simvastatin?" asked a friend. "Did you know that statins have been linked to memory loss?"

This was news to me. Statins are, I think, among the greatest successes of modern pharmacology. They work by blocking the action of a chemical in the liver which is needed to make cholesterol. By lowering blood-cholesterol levels, they help defend against arterial diseases such as high blood pressure, diabetes and strokes. My doctor, when prescribing me tablets of Simvastatin to be taken once a day, described it to me, rightly I'm sure, as a "wonder drug" which deserves to be taken by most of the Western world.

Because the drug worked so well in reducing my cholesterol, it never occurred to me to think of statins as a feature in my memory loss. But looking back to when I began taking that 40-milligram dose, I realised that it more or less coincided with the intensification of my memory problems. I decided to take the bull by the horns. I went to our very good local doctor, told her what was happening, and asked for her advice. She nodded, and said: "We'll take you off statins for three months. Let's see what happens".

For six weeks or so, I noticed. I continued to go around in a daze. Then my life began changing back. At dinner parties I could tell stories without losing track halfway through. In tennis, I didn't have to think about the scores or where I stood at changeovers. Words came back like old friends jostling to greet me. My shattered confidence began returning as decisions became easier to make. The other day, my wife said, "I feel I've got my husband back".

The strangest thing was that for most of last year I noticed something I had never suffered from before: poor circulation in my fingers and toes. I thought my numb white index fingers might be connected to my furious two-finger typing. Nearly every day I had to stop and massage my fingers to get the blood circulating. Then, at about the time my memory began returning, my circulation came back to normal too. Through this coldest winter for 20 years, my fingers have not once lost their nice healthy pink.

I would be a fool to pretend that I know anything about the circulation of the blood to the brain, but an even greater fool to suppose that the medication I took might not somehow be connected to it. Unscientific and simplistic though it is, I truly believe what the history of my symptoms suggests that the Simvastatin I took, so effective in lowering my cholesterol, simultaneously affected my brain.

I am not alone in coming to this conclusion. Google "statins" and "memory loss" and you will come upon a selection of websites connecting the two. In a recent Dutch survey of 4,738 statin users, a quarter reported physical or mental side effects, of whom 13 per cent reported memory loss. Nobody knows why this should be [Rubbish! It is well-known that the brain needs cholesterol to function properly. The brain even makes cholesterol], although many researchers point out that statins can block the production of Co-Q10, a vital heart nutrient. The Canadians now print a mandatory warning on all packets of statins that Co-Q10 reduction "could lead to impaired cardiac function".

The Medicines and Healthcare products Regulatory Agency and the Commission on Human Medicines include memory loss as one of the potential adverse effects of taking statins. A recent discussion paper on statins and memory loss, published by the Pharmacotherapy Press, reports that "the effects of these agents on the human brain are not [as] well established. The more lipid-soluble the statin, the greater propensity it has to cross the blood-brain barrier and affect the central nervous system. According to some reports, Simvastatin is the most lipophilic drug in its class."

Sounds worrying to me. Last month Britain's "heart tsar", Professor Roger Boyle, argued that millions of healthy people over 40 should be considered for statin therapy after a study published in the Archives of Internal Medicine suggested the drugs were even more effective than previously thought. The study, of 230,000 people, found that the drugs halved the risk of heart attacks. At present, the prescription of statins for primary prevention of heart disease is confined to those considered to be at high risk of developing heart disease.

Maybe they are right and the benefits of these drugs outweigh the side-effects. However, now that I've got some of my memory back, I'll remember to look for other ways of keeping down my cholesterol.


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