What’s Wrong with Health Studies?

Like many vegetarians, I enjoy reading news reports about new health studies that come out. Most of these studies, of course, directly or indirectly support the vegetarian cause by showing that some aspect of eating plants is good for us, and/or some aspect of eating animal products isn't so good for us. I've come to count on these scientific findings as continuing confirmation of my good judgment to be a vegetarian.

But what about those other studies—the ones that you occasionally see that find eating meat or dairy products may be healthy? What do we do about those?

I used to think that any studies that found meat-eating to be healthy were aberrations that should be relegated to mere footnote status in the great tide of favorable literature. They must be written by people with loose scientific morals and a vested interest somewhere, I thought. Lately though, I've read some pretty troubling findings from some pretty credible sources. I've had to delve a little deeper and rethink my position.

What I've learned is that the whole system of scientific inquiry into the relationship between diet and health is hugely unfavorable to vegetarianism. More importantly, though, I've learned not to take any study results as gospel. Here's why:

• People really do have loose scientific morals and vested interests. The meat, dairy, and egg industries have the money and organization to fund a lot of research. Cantaloupe and lettuce growers don't. No matter how honest scientists try to be, their results are going to favor the people paying the bill. If you need an example, just look at our court system. "Experts" can be hired to support any position.
  
• Cause and effect relationships are difficult to establish. Whether you're doing research in the lab or conducting an epidemiological study, it's incredibly difficult to isolate the effect of just one dietary factor and study its health consequences. There are simply too many environmental and genetic variables, and too many interactions between variables to get in the way. Results from even the best-designed studies can vary widely.
  
• Animals may be lousy models for people. When you take animals in the lab and pretend they are people, you've introduced a potential for serious error right off the bat. Just last week I happened to be reading the literature on a new drug. Testing found it caused cancer in mice, but not in hamsters. Okay… so what can we do with that useful information? It should be obvious that any results based on animal testing are suspect, and should be subject to additional scrutiny.
  
• Test subjects lie. Maybe they don't intent don't intend to, but it's human nature. In any study that requires people to report on their own diets there's going to be an impetus to report things just a little healthier than they really were. (I mean, who's really going to own up to eating a whole box of Ding Dongs for dinner?) The errors are magnified when, as in many studies, people have to report on their dietary patterns in the past. Of course, this exaggeration is always going to make the results of "healthy" food choices seem a little less healthy.
  
• There aren't enough "vegetarians." It's especially difficult to do studies of vegetarians, because there often aren't enough of us to be a good sample. More importantly, we all know that people lie about their vegetarianism. (A recent Time Magazine poll found that 37% of the people calling themselves "vegetarian" had eaten red meat in the last 24 hours!) Finally, there are huge variations in vegetarian diets, and studies may not compensate for that. They may lump the raw foods folks in with the people who live on Ding Dongs. Again, the result of this is going to make "vegetarians" seem a lot more like everyone else, and a "vegetarian" diet seem a lot less healthy.
  
• There aren't any vegans. Vegans are so few in number and so misunderstood, that it is going to be a rare study indeed that will properly analyze and/or give meaningful results that apply to this group. Because of the problems cited above, results for "vegetarians" may be totally inapplicable.
  
• Since practically everyone eats meat, dietary studies often suffer from the "lesser of the evils" syndrome. For example, we've all seen lots of studies that cite the benefits of eating fishes. But if the "control" group is made up of folks who eat other kinds of flesh foods, it's hard to draw absolute conclusions. Sure, fish-eaters may be healthier than hamburger-eaters, but if fish-eaters were compared to vegetarians, the results might look entirely different.
  

  Another recent example was a study that found that, among overweight and obese adults, those who ate massive amounts of dairy products were less likely to develop insulin resistance syndrome. The conclusion, widely reported in the media, was that 5 servings a day of dairy products protects us. But how did the people who ate less dairy make up those calories? Almost certainly by eating more meat. (I doubt that any vegetarians were in their sample group.) Could the conclusion of the study just as easily have been "avoid meat at all costs—even if you have to eat lots of dairy?"
  

• Since practically everyone eats meat, results of dietary studies may not apply to vegetarians. Results from dietary studies may only apply to people with diets similar to the test group, and that rarely includes vegetarians. For example, I recently read a report raving about the benefits of fish oil (omega-3 fatty acids). The primary benefit noted was fish oil's ability to thin blood and thus prevent heart attacks and strokes. But thinner blood is only of benefit to people already sick with cardiovascular disease (i.e., most people on the Standard American Diet). For many vegetarians and vegans, and others with healthy cardiovascular systems, this blood thinning could be a health detriment rather than a benefit.
  
• There is scientific evidence out there to support everything. A librarian friend of mine once told me "doctors like to write." It's true. You can find a study out there to support almost anything you can imagine. If it isn't there yet, it's on the way. No individual study, nor the credence that someone gives to it, should be taken as definitive.
  
• People give more authority to later studies than earlier ones. While the conclusions expressed in the scientific literature may vary wildly, people tend to believe the latest news they hear. They mistakenly believe that new scientific studies override the results of those that came before. This is unfortunate indeed when poorly designed or aberrant studies conflict with what has been established in numerous previous studies.
  
• People like good news. How much press has "red wine is good for you" received? How many millions of books has Dr. Atkins sold by telling people it's healthy to eat lobsters and butter? People want to believe, and they tend to cite, studies that favor their own positions. We vegetarians are guilty of this all the time. On the other hand, since the vast majority of people in our society are addicted to animal products, any study at all hinting that meat and dairy products might somehow be good for us will receive considerably more notoriety than a study finding the opposite.
  
• The press exaggerates. (And that's an understatement!) Combine this with the fact that people like good news, and the potential for the public to be misled in favor of meat and dairy products is enormous. For example, a report on the fish oil study mentioned above, written by a registered dietician, starts off proclaiming the "good news," and ends with the pronouncement that "Including rich fish as a regular eating habit is one of the most positive steps anyone can take to protect against the development of heart disease. Best of all, it is good nutrition at its tastiest." Objective medical reporting? Hardly.
  
• Doctors still believe in what they grew up hearing and doing. Old ways die hard for most of us, and that's true for doctors and medical researchers as well. Anything that goes against what their mothers told them as children is going to be looked upon with additional skepticism. That doesn't bode well for vegetarianism. Just consider how Dr. Spock was almost drummed out of the medical community when he had the audacity to suggest that cow's milk isn't good for growing children. Consider how many doctors are happy to heed medical evidence and recommend eating more vegetables and less meat (Mom would have liked this). Consider how few are willing to heed that same medical evidence and recommend vegetarianism (Mom definitely wouldn't approve).
  

  
   

  Given all of the problems inherent in medical studies of diet and disease, it's amazing that we can learn anything at all. Yet, the fact that some results (saturated fat is bad; fiber is good, etc.) keep coming up over and over again, means that we can probably trust them and rely upon them. The best advice may be to use our common sense (if it sounds too simple or too good, ignore it) and take a big picture/long term approach. (I'm starting to sound like my stockbroker!)
  

  Considering how the odds are stacked against vegetarianism, it's equally amazing that we get any good news at all from the medical community. And yet, there they are, week after week—new scientific studies lending support to the vegetarian way of eating. No, they may not be the only things we read, but that's good enough for me. They are more than enough to make me feel confident that my decision to be a vegetarian was a good one.
  

An Insider’s Look at the US Medical System

I recently had the chance to get a 4-day, inside look at a real, functioning emergency room and hospital. I came upon this unique opportunity (actually, it came upon me) when I happened to be the driver of the losing vehicle in an automobile/bicycle winner-take-all grudge match staged at a local intersection. (Please do not try this at home!) In any event, I am fine, thanks, and the experience was most enlightening—even better than watching old reruns of ER!

Now, I know it's always been fashionable among vegetarians to bash Western medicine. I've done my share of that bashing in the past, and nothing in this experience changed my mind about the things that I've written and said. On the other hand, our medical institutions are incredibly good at some of the things that they do, particularly in the practice of "horizontal" medicine. (That's Dr. Michael Klaper's term for what doctors do when the patient arrives in a "horizontal" position.) Here's a sample of the good and the bad that I experienced during my recent sojourn.

• Security guards are there to keep us safe. I arrived at the emergency room in a bit of distress. (If I had been a car, a mechanic might have said that I had an alignment problem.) Did anyone offer to let me lie down? No. Pain medication? Not for 7-1/2 hours. A bandage for my bleeding elbow or leg? Never. After I'd been there for a few minutes, though, the uniformed security guard on duty came over to me and asked, "Can I get you some ice for that arm?" I was very happy to take this kind soul up on his offer. Obviously, in the US medical system, security guards are a critical link in the provision of emergency services. God bless 'em!
  
• Your medical dollars at work. There are two reasons why Americans spend over a trillion dollars a year on medicine, and why those costs increase every year by double-digit percentages: prescription drugs and paperwork. Speaking of the latter, my first night in the hospital I had to give my medical history three separate times—the first two to doctors and the third to a nurse. Any clerk with minimal training could have done this, filling out a database questionnaire on the computer. Such a simple change in procedure would have saved the hospital at least $100 on me that night, and would have substantially lessened the risk of a mistake being made because of incomplete or conflicting data. (Of course, an even better and cheaper solution would be to keep everyone's medical information in a database accessible by doctors over the Internet—but that would be too simple, I guess.)
  
• Hospital beds are hard to come by. It was 10 o'clock at night and I'd been in the emergency room for four hours when they told me I was being admitted to the hospital. But then they said I would have to wait for a bed to become available. I thought about that and panicked. "What?!" I screamed. "Who checks out of a hospital at 10:00 at night? A dead person, that's who! You're going to put me in a dead person's bed, aren't you?!" It took me several minutes to calm down, after which I realized that somebody had probably died in every bed in the hospital. By 1:30 in the morning, more than 8 hours after my accident, I was finally tucked away in one of those beds, feeling like the dead person myself. I had Benedryl to put me to sleep, two syringes of morphine in my veins for the pain, and I was still wearing my dirty bicycling clothes.
  
• The forms aren't made for vegetarians. I became a vegetarian for ethical reasons alone. But I do have to say that it was awfully nice to say "no… no… no" when they asked over and over again if I had any of the long string of diet-induced maladies on the hospital's charts. (It was also nice to say "none!" when asked what drugs I take regularly.) "You seem pretty healthy …for such an old guy," I was told several times. "I'm a vegan," I would reply, trying to get in a good word for the cause. "You can write that on my chart!"
  
• The food isn't made for vegetarians. My first day in the hospital the only thing I was offered to eat was a quart of barium drink (Mmmm!) that would make my organs glow under the cat scan. (By the way, they don't use real cats in this procedure.) The food didn't improve much after that. Indeed, the only thing remotely healthy about hospital food is the small portions. In general, hospital diets are tailored to make patients come back soon and come back often. If you're a vegetarian, expect to eat a lot of eggs and cheese. If you're a vegan and ask nicely, they'll bring you a plain salad and a baked potato. …Kind of like being in Texas.
  
• Hospital people aren't necessarily healthy people… I can't tell you how many really unhealthy people I saw in the hospital—and they were working there! It struck me as very odd—kind of like walking into a health club and seeing the whole staff smoking cigarettes. One morning a very overweight and out-of-shape young woman was pushing my wheelchair to x-ray. As she huffed and puffed it was all I could do to keep from saying, "Gee lady, maybe we'd better trade places."
  
• …but they do work hard. I saw doctors on rounds at 5 in the morning, and people putting in 16-hour days on Labor Day weekend. And then, of course, there are the people who toil all night long, waking patients up every 2 hours to take their pulse and make sure they're still with us. (I guess these are the folks who phone the emergency room to tell them when beds open up.)
  
• Misdiagnoses happen. You always know you're in trouble when they repeat a medical test on you. That's what happened to me. Then, a few hours later, a stern-faced doctor trailing half-a-dozen medical students showed up beside my bed. "There's one thing we didn't tell you about your test results…" he began. "You may have Gilbert's Disease, a really horrible disease of the liver." Immediately I recalled all the stories I'd heard of relatively healthy people going into the hospital and never coming out alive. Then the doctor smiled. "Actually, I have Gilbert's Disease!" Well, it turns out that Gilbert's Disease is a disease without any bad symptoms at all, and in any event I didn't even have it. The official diagnosis, given to me after still more tests the next day, was that I just "beat the crap" out of my liver. (Doctors do love those fancy medical terms!)
  
• Sometimes, they get it all right. When you see all the chaos in a modern hospital, see one thing bungled after the other ("What did you say you were allergic to?"), and wait around endlessly for every simple procedure, it's tempting to just write off the entire medical community. But that's often when something extraordinary happens. It happened to me. In my case they found a potentially serious problem (a partially collapsed lung) and fixed it. (They put a tube in my chest and re-inflated the lung—thereafter giving me the perfect excuse for looking like a blimp!) I don't want to sound corny, but it's almost magical to watch up-close (okay, too close) as very smart, very well-trained doctors and nurses use some of the most sophisticated machines science has ever developed to do miraculous repairs on the human body. If I ever grouse about modern medicine again (and I'm sure I will), just remind me of that, and I'll put everything in perspective. I may have learned it the hard way, but I have to admit hospitals are pretty amazing. …Now, as the bills roll in, I just wish I could say the same thing about insurance companies.