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I Inside: ' ' "Science" • tn the . headlines PAGE 3 Why'do women live . longer than,men? PAGE 3 The truth about growth hormone - • releasers PAGE 12 Antibiotics in animal feed: a health threat? PAGE 13' VOLUME 6, NUMBER 2 MARIAPR 1985 , PRICE: $2.00 N EWS & VI EWS PUBLICATION OF TH E AMERICAN COUNCIL ON SCIE NCE AND HEALTH • 1995 BROADWAY • NEW YORK, NY 10023 (212) 362-7044 How to Reduce Your Risks on the Road I ACSH offers measures for combating a public health problem of major proportions-traffic accidents. By Kathleen A. Meister ON:SEPTEMBER 13,.1899,HENRY H. BLISS SIF.PPED OFF A NEw'YORK CITY TROLLEY CAR AND IN"tO A DUBIOUS PLACE IN THE HISTORY BOOrs. As he alighted, he was struck and killed by an oncoming automobile. Mr. Bliss is believed!to be the first person killed in an automobile accident in the United States. In 1 983, the most'recent year for which figures are available, 42,500 people were killed in traffic accidents in this country and as many as five million may have been injured. The traffic death toll7or that single yeanw'as about equal to the total number of U.S: ground troops killed during the entire war in Vietnam. Accidents are the fourth- leading cause of death in this country, and the leading cause of death for people age one to 38. Motor vehicle accidents comprise about half of the total number of fatal acci- dents. ltaffic accidents are also America's number one occupational hazard;,they are the leading cause of death on the job. It' is clear that what we are dealing with here is a public health prob6em of major pro- portions. Fortunately, like many public health.problems, it can be reduced by well- chosen preventive measures. We may call traff ic mishaps "accidents," but theyare far from accidental. What are the most effective things that you; as a driver„ean do to reduce the risk that you or your passengers will be killed or injured in a traffic accident? If you ask twenty people this question, you'll get twenty differennanswers and a Imt of vague and sometimes contradictory advice. The Chelation Therapy: Quackery or Cure? Despite the lack of evidence that chelation therapy is of any benefit in the treatment of atherosclerosis (hardening of the arteries); chela- tion clinics continue to proliferate, and an increasing number of law- suits against practitioners is the result. By Densie Hatfield '' emy of Family Physicians, the American Society fon Pharmacology and Therapeu- ociation thie A it h A O ' i , ss mer an steopa e t a, t What do the American Heart Associa- the American Medical Association, the t"ion, the National Institutes of Health, the Food and Drug Administration, and the American College of Cardiology, the Ameri- California Medical Association all have in can College of Physicians, the New Zealand common? Answer: They all agree than the Medical' Association, the American Acad- ,_ t:oNrtNUto oN ntGE 2 The evidence In r..or of oeat belts is overw'hetming; their ase could save 12,000 lives a year. (Photo, by JoyceJuoc) scientific evidence, fortunately, is far ltss confusing. ACSH reviewed the statistics on traffic accidents, scientific studies of acci- dent and injury prevention, and the views of safety experts, and we identified eight keyy things that you can do to reduce your risks on the road. Alliofthese recommendations are backed by'solid'evidence. Five of them are things we think everyone should do; the other three, however, have substantial dis- advantages in areas other than safety„and many people may reasonably choose the increased risks. We also identified two sup- posed risk-reduction measures that are widely used but have been proven ineffec- tive. (For those of you who ean't wait for the answers, they're listed in the box on page 8.) " Alcohol: The Number One Highway Hazard Our first piece of advice• "Don'.tiDrive Undenthe Influence of Alcohol," will surprise few people; public awareness of the hazards of alcohol-impair- ed driving has CONTINUED ON PAGE a

agents was carried out in Britain and Ger- many in the 1940s and subsequently in Switzerland' in the 1960s. The British gor ernment had feared that the Germans would use chemical warfare in the form of lewisite, an arsenic-containing gas, and asked a Brit- ish researcher to prepare an antidote. This antidote was called HAL (British anti-lewi- site). This work led the way for the develop- Patienls reeeive ehelatioe therapy at one of the maay chelatton~ dinicsthroughout the eouutry. .. David Hutson, New York'Tfma. , which is not recognized by the American ones or w1evtatmg the symptoms of heart Medical Association. ~:. ii Morton Walker, the author of duease, to being a cure for other serious dis- ' American Academy of Medical Preventics, thaCpurpose. „ pnstng. owever„t e c ros for e elatton a 480-member group based in California therapy range from the more commonplace _ f - ment of ethylenediaminetetraacetic acid, or in a more easily uttered acronym, EDTA. The rationale for the use of chelation ther- apy'for the.treatmenf of atherosclerosis sprang from work done in the 1950s, in which a decrease in calcium deposits was observed in several parts of the body after administration of EDTA. When this was seen, it was suggested that EDTA might also promote the removal'of calcium from hard- ened arteries and possibly stop the develop- ment of atherosclerosis or even reverse the damage alfeady done. Some of the most carefully done studies on chelation therapy for the treatment of cardiovascular disease were carried out in the 1960s. However, the researcher labeled the results as °disappointing"'and did not recommend chelation therapy as a treatment th t i Abb f l b rie or a erose eros ott s: a orato s, Chelation Tht?ra ies. Since EDTA binds with metals in the PY blood and allows them to be excreted, it i,r an the makers of one brand of EDTA, also C9N77HUED FROM PACE I effective treatment in lead poisoning. The sponsored some studies in the 1950s. These use of chelation (kee-LAY-shun) therapy for Food and Drug Administration (FDA) were not pursued either because of disap• the treatment of atherosclerosis (hardening approved EDTA for that use in 1953. How- pointing results. of the arteries) is of no proven benefit and ever, even though the FDA is authorized'by Growth of Chelation Therapy Clinics that the adverse effects of the treatment can Congress to regulate how manufacturers be fatal. -- promote a product, it cannot dictate how a Even if the claim that chelation therapy Despite this overwhelming consensus of physician prescribes it The result is that can eliminate the need for 75 percent of all opinion, chelation clinics are flourishing while the manufacturers of EDTA cannot coronary bypass surgery in the United' with an estimated d',t100 practitioners or clin- promote their product for the treatment of States were its only one, the phenomenal ics in the United States. One group that does heart disease, there is nothing to prevent growth in popularity that chelation therapy support'the use of chelation therapy is the doctors from prescribing and using it for ~ni¢s Have experienced would nof be sw- H h 11 h While the treatment is typically promoted for angina or other symptoms of athero- sclerosis and held out as an inexpensive alternative to coronary bypass surgery, pro- moters also claim that it can improve your memory, reverse blindness, dissolve kidney stones and cataracts, reduce arthritis symp- toms, and reverse the side effects of aging, just to name a few. It would be worth its weight in gold ... if it worked. What Is Chelation Therapy? Chelation therapy is a method of treat- ment which is based on the administration of a substance (EDTA) that binds with metals in the blood and is then excreted byy the kidneys. The word chelation comes from the Greek work "chele," meaning claw. In essence, thc EDTA grabs metals and miner- als in the blood and they are excreted together. The process involves injection of EDTA and in some instances various vitamins, minerals, enzymes and amino acids into the bloodstream where they allegedly d ean ouD unwanted mineral' deposits from various locations in the body, particularly the arter- s disease and mus- the most pop ular book on chela- eases such as Parktnson tion, The Chelation Answer, is cular dystrophy. being sued along with the doc- An estimated 350,000 people in the tors whose jlallents underwent United States have undergone chelation It therapy. Many do not even suffer from any chelation t erapy and conse- of the illnesses that chelation therapy is pur- quently suf ered serious side po rted to cure, but take it as a preventive effectsan eomplications. ~~ •'fneasure. However, this is not a unani- The rationale for the use of this treatment': in atherosclerosis is that EDTA binds cal- cium and removes it from the bloodstream.. Because calcium is found in the plaques that block arteries, proponents of chelation claim that lowering blood levels of calcium will cause calcium to dissolve out of the plaques in the artery, and allow blood to flow more freely. But in fact, 1) the bulk of material in a plaque is not calcium; 2) EDTA has nofbeen proven to remove the calcium from plaques; and 3) to date, no persuasive evidence from properly controlled studies has established that chelation therapy relieves symptoms of atherosclerosis. History of Chelation Some of the earliest research on chelation mously recommended procedure even among chelation promoters as evidenced in a booklet by Dr, Kurt Donsbach (see ACSH NEWS & VIEWS Jan/Feb 1981 for more information on Donsbach) which states in bold letters "It'Ichelation therapy] is not, and! should not be considered a preventive technique . . . but as an emer- gency measure. . ." - Along with the proliferation of these clin- ics has come an increase in lawsuits againsr their operation and even against the author of the most popular book on chelation, The Chelation Answer. The author,, Morton Walker; is being sued along with the doctors whose patients underwent chelation therapy and consequently suffered serious side effects and complications. This doesn't . , CONTfNVEDONPAGE4

- _ =-----~ti 1 1 Commentary The Media's Premature Delivery of Scientific Information _ Sometimes a headline-grabbing news story is based only upon `preliminary research' which could mean that the facts' came from little more than a press release submitted by the group which conducted the study. You see them in the newspapers and on television almost every day - the headlines proclaiming that a new study has deter- mined that something is toxic, carcinogenic, • or detrimental to the environment. Often, the studies cited represent research which has been published in reputable scientific or medical journals and thus, by definition, reviewed and accepted by other scientists. •• This gives reasonable assurance that the research - and the investigators' interpreta- tion of its results - are, at the leasti scientif- ieally sound. This does not guarantee that the research has no flaws or that the findings will not be refuted by other researchers„but it does indicate that the research is probably a valid piece of evidence to be considered in evaluating a substance S effects. Sometimes, however, the newspaper or television story is based upon "preliminary" research. In such instances, "preliminary° usually means that the story is based upon little more than a press release from the group which conducted the study. The find- ings have not been peer reviewed or accepted for publication in a scientific journal. There is, thus, no way for reporters or readers to judge the validity of the findings. The study may, be legitimate, or then again it may not, but there is no way for the average layperson to know until it has undergone rigorous review by other scientists knowledgeable in the field. Cancer in Massachusetts 'Iwo prime examples of the release of such "preliminary" research findings preseated' in the media as fact come to mind. The first was the so-called Woburn study, which reported an increased incidence of cancer among residents of' a Massachusetts com- munity early last year. The researchers attributed this to chemical contamination of the drinking water. Although the findings incited widespread coverage on television and in the papers, including a recent feature story in the New York Times Magazine, this study had not' been peer reviewed nor published in any scientific journal when its results were released. As of this writing, the study still has not been published and numerous flaws have been detected inthe study design and analy- sis. One flaw was the fact that epidemiologi- cal information was collected by volunteer residents of the area who were concerned about their cancer "epidemic" and already harbored hypotheses as to the culprit. It is a cardinal rule in any epidemiological'studyl that interviewers should be unbiased'so as to avoid influencing (either intentionally or unintentionally) the responses of study par- ticipants. This is not to say that there is no link between drinking water and cancer in Mas- sachusetts. There may be, but the point is that the results of' one unpublished study cannot provide substantial evidence of a relationship Yet many people have been left with the false impression that the cancer - drinking water link in Woburn, Massachu- setts is a proven fact. Chemical Plants and Cancer Another example of the uncritical release of "preliminary" information was heralded by the New York Times headline "Chemical and Oil Plants Linked to Increased Cancer Death Rates." While the ensuing article went on to describe how cancer death rates had increased precipitously in rural areas with growing petroleum and chemical indus tries„it did not mention that the only place this study had been published was in a news- letter of the group which sponsored the research, the Council on Economic Priori- ties (CEP): The newsletter article gave little or no information about howttie study was conducted, where the researchers had obtained' their information or how the results had' been analyzed - things which must be described'in,excru- eiating detail ho merit publi- cation in a reputable scien- ~- tlfic journal. When we attempted to gather more information about the study, we were told that the "actual study" would not be completed or published for some time. Since we were able to make neither heads nor tails of the CEP's allegations in their newsletter article, we asked: an epidemiologist at the National Cancer Institute if he, with his expertise, could make any kind of evaluation of the "study."' He replied that he had no idea from the information available what the researchers had done or how they had arrived at their conclusions and that no evaluation could be made until a much more detailed description of methodology and findingswas published.. Yet„once again, the pub- lic has been led to believe that the link between ehemi- eal industries and rural can- cer rates is an established fact. These are only two examples of what appears to be a rather widespread practice of presenting provocative but dubious scien- tific findings to the public as facti We wish the media would be a bit more restrained in publicizing the results of unpublished stud- ies. The premature delivery of alarming sci- +entif"ic information may sell newspapers, but we would all be better offif this practice were aborted. Cathy Becker Popescu, M.S. Research Associate, ACSH ~;.r 3:~tA=s.~~, ~HEALTH QUIZ y ~ Females in the United States have _ a longer life expectancy than do males. Is this due to innate btolog - ical differences? ~t r.~•[ - f ! u }.~b . Answer to Health Quiz on page 4.-;. 3

on the grounds that it is an unproven treat- ment. These costs can beiormidable. While the government argues over techni- calities and the lawsuits are pending in the courts, the chelationists are getting rich, A course of chelation therapy may begin with a battery of tests in order to "profile" the patient's condition. The costs of these tests may exceed 51,000. The treatment itself typ- ically consists of 30 to 40 sessions in which EDTA is given intravenously (IV) over three to four hours on a strictly out-patient basis. The sessions are generally spread out over several weeks or even several months. Each one of these sessions may'run $75. The patient may then be left with somewhere in the neighborhood of $4,000 in out-of- pocket expenses for somewhat dubious benefits. Chelation therapy is obviously not a cheap alternative to orthodox medicine, as , many of its supporters claim. Dr. John H. Renner, • one of the sources for this article, is a family physician in Kansas City, Missouri. I He has become quite active in.trying to educate the public as to the bogus promises behind chelation therapy and its inherent dangers. As head of the Kansas City Committee Against Nutrition Fraud and Abuse, he is attempting to collect information on negative reactions or side effects from individuals who have received chelation therapy. If enough infor- mation is gathered and documented, perhaps tighter control will be obtained over the procurement and use of EDTA forpurposes other than those that are approvedby the FDA. Dr. Renner welcomes any reports that our readers may have. The toll- free number to call is 1-800-821- 6671. Hazards-of Chelation Therapy Unfortunately, EDTA does not fall into the" "if-it+can't-help-you-at-least-it-won't- hurt'-you" category. In the 1970s, 13 deaths resulted over a two year period from chela- tion therapy being administered at a clinic in Louisiana. The causes of death included severehypoglycemia,e congestive hearv failure, and renal failure- All were judged to be attributable to EDTA administration. Renal failure, stroke and diabetic eomplica- LL Chelation therapy would be worth its weight in gold... if it worked. » tions are among the side effects suffered'by people whose lawsuits are currently pend- ing. There is normally a certain amount of ca1~ cium circulating in the blood, which is abso- lutely essential ifor heart, nerve, and muscle funMion, The administration of EDTA can upset this delicate balance by combining rapidly with the calcium and then being excreted via the kidneys. In addition, the removal of calcium from plaques in the arteries can literally be life-threatening in itself if the loosened material that is being carried by the bloodstream lodges else- where. The result can be stroke or heart attack; exaetly what chelation therapy is supposed to prevent- ' - A much more insidious but no Itss real hazard of chetation therapy is that some patients' complete belief in its healing powers prevents them from seeking conven- tional' life-saving therapies such as hemo- dialysis, with permanent disability or even death as the result. Quackery or Cure? Without a doubt, chelation therapy is not the panacea that promotional' materials - make it out to be i.e., that it has the power to improve liver function, improve blood cho- lesterol ratios, lower blood' fats, reduce blood pressure,,reduce leg cramps, improve vision, relieve angina pains, relieve symp- toms of senility, heal ulcers caused by poor circulation, forestall heart attacks and' strokes, relieve symptoms of Parkinson's disease and multiple sclerosis, improve memory, and reduce the incidence of cancer. There are some physicians, albeit a minor, ity, who feel that chelation therapy does hold some promise for a certain type of patient and only for a limited'number of dis- eases and feel: that it is worthy of a con- trolled trial study under properly controlled conditions. But no one seems to feel that it is worth the time, money and energy that is necessary to carry out thistype of study, non even the chelation therapists and their sup- porting group, the American Academy of Medical Preventics. Should scientific studies demonstrate some efficacy of chelation therapy for cer- tain conditions, the medical and scientific community will be willing to take a second look atthe procedure. Until that time, how- ever, anyone who accepts chelation therapy for any purpose other than those approved rby the FDA is automatically a guinea pig with no guarantee of the outcome. : I,: DensieHatTeld, Ph.D., R.D., rsaResearch Associate withACSFL ~ . : AnswertoHealthQuiz Page3 ~ j-`~e m ajor svl.~s~+.." causesofexcesimalemoriality .'disease,istitoughttooceurmorefroqitently' seem to have deterred Walker from pro- mulgating his cause, howevir, as he is in the process of writing his fourth book on the "topic. There are suits pending in Washing- ton, D.C., Kansas, Michigan and Pennsyl- vania vania against both chelationist practitioners and Walker. Tlte growing popularity and the -subsequent lawsuits have been the topic of stories in TheNew York Times and The Chi- ovgo Tribune, and havetieen covered on the national'network news within the past year. The controversy is clearlj not going to go . away. - ' . Chelation Costs The FDA has never received an IND (Investigational'New Drug) form identify- ing interested investigators to carry ourwell- controlled studies, and no party has ever provided the FDA with an organized sub- mission attempting to show that EDTA is effective therapy for atherosclerosis. Chela- tion enthusiasts claim thaoit is only.a matter ' of time before they get the basic research to know exactly how well and in what manner the treatment works. In the meantime, insurance eompanies and Medicare refuse to reimburse the costs of chelation treatment r.•..,:. in rennt~vears~- which~aeenunt-for un tn ~{Tsmmnomen nr att, ages, rncmatng ine perwa oerore .-three-quarters of the sex differential pung ~- Heavyor irresponsible drinking ii'respon -' stors play a large role in explaining the dif- 'rapomible for some 30 percent of a11 heart ~many women attempt suicide unsuccess-~ -tercttces in survival betwcea males and disease deaths. A" behavior, which fully. Part of this paradox can be explained a ~~ '~~~ ~`u~+.i[~`s.,. "'"' has been linked with dncreased risk of heartthe_fact:that men more_often use violent„ ~sa_~ ~ ble- t ,-., ;~~ar~ ~gely responsible for the deaths . increasedlikelihoodofaccidents ~; tCir~ There ts also substantial evidenix, how „due to lung cancer and other lung diseases, Although three times more men thani .'ever, that cultural and envtronmentat fac- '..s well as other cancers Smoking is also women actually commit suiade twice as -• -•° •_•° -"^°-° - cancet; otner mng otseases, motor vemcte - atbte tor many motor vemcte ann otner acct-t females. Increased female aurvival is °_ ;~dents, suieide, other accidents, cirrhosis 'dents, as well as cirrhosis of the live , and observed in all advanced human societies of the liver and heart disease), all have targe , j men are much more likdy than women to be' 'and in many, although byao means all ant- :,~avioral componenu ,'.? {+a.ye:b~;+t ;'problem d>•-inkers. Employment in morei ;mal species, suggesting that innate biologt ',y,Cigarette smoking, which was much more dangerous jobs, as well as greater risk-tak-i F cal factors may be atleast partially responsr e0on among men for many years, is, of Ing behaviors, may al3o contribute to menli e'` x t'' e ~ 4

I William G. Cahan, M.D. Attending Surgeon, Thoracic Service, Memorial Sloan-Kettering Cancer Center, New York, NY LL The patients I see who havepreventable tobacco-related cancer fan the anger I feel towards those people who, purely for their own gain, deliberately choose to ignore the human destruction they propagate. 99 Education: M.D., Columbia University; B.S., Harvard College. Honors and Awards: Distinguished Service Award; American Cancer Society; 1982; Honorary Academician, Faculty of Physical, Mathematical'and Natural Sci- ences of the Noble Academy of Empress St. Theodora in Rome, 1968. Professional Interests: "Generally: the search for the cause, prevention and cure of cancer by all and every means, and transmitting all I know to younger physi- cians. "Specifically: a) radiation-induced osteogenic sarcoma; b) radical neck dis- section; c) radical lobectomy and pneu- monectomy; d) multiple primary can- cers, one of which is lung; e) cryosurgery; f) experiments on the effects of smoking in dogs; g) anti-smok- ing campaigns in association with the American Cancer Society; h) I served as an American Cancer Society representa- tive at Congressional' hearings on the revision of warning labels on cigarette packages." Turning Point: "There were two important turning points in my Gfe that influenced my professional career. First, when I was 15 years old, my grandmother died sud- denly in my presence. I felt heltaless and vowed never to feel that way again. The second'4urning point was when I started my residency at Memorial Sloan-Ket- tering Cancer Center, then called'Memo- rial' Hospital for Cancer & Allied' Dis- eases, in 1942. With this came the chalknge of continuous exposure to a huge population of cancer patients in an environment conducive to investiga- tion." What are the most important public health problems that Americans face today? "The hazards of smoking and the cost'of patient care." What is the most important public health accomplishment that you expect to see in the coming years? "Wider dissemina- tion of information on the hazards of tobacco, thereby helping to create an environment in which the temptation of the young to start is reduced and the resolve of adults to quit is strengthened." wittitm c. Caban Personal Health Code: "Moderation and pacing: not stretching to extraordinaryy limits the remarkable resiliency and recu- perative wisdom of the body; ergo, not too much food'or drink; not too little exercise and diversions. Loving myy work, my family, and. 'all things both geanand small: ]nth'ese are reservoirs of strength and'patience which enable me to deal with the problems of cancer patients. "The patients I see who have preventa- bk tobacco-related cancer fan the anger I feel towards those people who, purely for their own gain, deliberately choose to ignore the human destruction they prop- agate. They are living examples of the so- called HIS (head-in-sand) syndrome." Why, did you join ACSH? "The Council impressed me with its zeal and militant' concern with the prevention of disease and the prevention of cancer in particu- lar. To my mind, this dedicated group has a program that balances conservative, show-me-for-a-fact attitudes with a feisty;putspoken, frank and daring han- dling of controversial health issues. We ~ ,,are all going to be better off with just such an approach." f r,Trst-x*~vm:y-"°~;~r-wryvc=.^~--°.T-nc~v;:;~r'~r*....a_r e.-, -.b ' ureversible methods whereas women are „ Part of the increase in the sex differenttaf " who smoked was lower than the peak pro- more likely to use poisons, the effects of in mortality may be accounted for by a~ porGon of men who smoked.) ~'~ jwhich may be reversible with prompt treat- ~f decline in deaths associated with chtldbear- ' ~;i :Although smoking obviously aaounts, tment. * i<;? rnganduterinecanceramongwomen. Ris- -`'forasubstanGalpercentageofthesexdiffer-' ~- ln the Umted States, the dtfferential ing male mortality for cardiovascular-renal ential in Gfe expectancy, there is still disa- a'1 tbetween male and female life expectancy has . diseases until the early 1960s and a dramatic . greement over how much. One group of 'g. .been increasing over the years. In 1920, life increase in lung cancer deaths have also been researchers who studied a large group of ~ iexpectaDcy at' birth for females exceeded cited as significant factors. Both of these . nonsmokers in Pennsylvania concluded that that of'males by only two years, whereas the trends can be linked to the sizeable increases .. nearly all of the sex differential could be :~ ydifference in 1940 was 4.5 years. By 1980, in cigarette smoking by men during the first - accounted for by cigarette smoking when, j; tfemates oould expect to live 7:9 years longtt third of the 20th century. (Women did not violent deaths were excluded. Others con-' s ;than males. Thus, while life expeaanry of begin to take up smoking in large numbers tend that no more than half is related to ~ both sexu has increased during the 2oah cen- until some thirty years after men did and, _ smoking, i ~ p ~r + z tur women a -t~` 'F~" ~ ` `~ y pear to have benefited more v n then the eak t f , p , p propor women e e ton o 5

"An establishment scientuthas attended and graduated from an accredited'univer- sity, belongs to one or more well-respected prqfessional organizations, conducts care- fully controlled and (locumented research and reports these findings in professional journals that maintain high standards for accepting research papers." In the 1960s the word "establishment" generally meanu anyone ovei the age of 30 who had accepted'responsibility and joined the mainstream of day-to-day living. To those under 30, becoming part of the establishment was viewed as a fate worse than death. Well, 20-plus years have passed; those who were under 30 in the 1960s are now staring 50 in the face; and times have definitely changed. The term "establishment", however, still bas a negative connotation, but with a new twist. Now it is the scientifrc establishment that is perceived as the bad guy, and age is no consideration. From the public's viewpoint, the procurement of scientific information, particularly pertaining to health and the environment, has unfortunately become a situation of "us" against "theml" "Us" includes everyone that the public per- ceives as being truly concerned about preventing and curing disease, cleaning up the environment, and making this a bet- ter world in which to live; while "them" is a group of seien- tistS imagined to be involved in an industry and government backed conspiracy to prevent new discoveries in health and medicine, perpetuate our illnesses, and keep only their bank accounts healthy. When the scientific establishment lacks credibility with the consumer, quacks and charlatans step in to fill the gap. While their theories won't hold water, their unconditional guarantees for good health hold the public's attention. We flock to these people with open minds and open wallets, sure that this is "the way." Those who fall prey to such opportunistic hogwash are not limited to the uneducated! Most are, however, uneducated as to the ways of science. The situation is critical, as scientific illiteracy is the rule rather than the exception here in the United States (See ACSH NEWS& VIEWS Nov/Dec 1984). When the average person has no concept of what science is or how scientific theories are tested, how can he or she possiblybe expected to differentiate between health science and health fraud? The public should be relying on those scientists with proven expertise in specific areas of science. Unfortunately, many times in our ignorance we reject information from the scientific establishment, simply because it is the establish- ment, and wholeheartedly embrace hocus-pocus pro- nouncements because they are handed out in a more palat- able manner. Who belongs to the scientific establishment varies depending upon whom you ask. There is no official mem- bership list. Generally speaking though, an establishment scientist has attended and graduated from an accredited university, belongs to one or more well-respected profes- sional organizations, conducts carefully controlled and documented research (While personal testimonies, hearsay, and casual observations can serve as the motivation for research, they are not in themselves legitimate evidence for any scientific conclusions), and reports these findings in professional journals that maintain high standards for accepting research papers. By contrast, those claiming to be an alternative to estab- lishment science have no common set of standards or prac- tices from which measurements and comparisons can be made or quality of performance judged. Personal testimo- nies and casual observations quite often serve as the basis of their research rather than act as the impetus to begin research. They proudly disassociate themselves from the mainstream, uttering the words "scientific establishment" with a snarl. The more vocal groups portray themselves as the underdog merely trying to defend truth, justice, and the American way. The scientific establishment is clearly put in a no-win situation. Science on the Defensive At the Institute of Food Technologists' 44th Annual Meeting, Dr. Louis E. Grivetti, Associate Professor of Nutrition at the University of California, defended his sta- tus as part of the scientific establishment when he stated, "It is certainly true that we are the establishment. We represent and reflect establishmenrscience„and we submit our find- ings to establishment publications. As establishment scien- tists, howeverq we have accepted and met the challenge of sustained quality and professional excellence:' His last comment is the key. While establishment science is restrieted' to the laws of logic and the dictates of scientific procedure, opponents of the establishment are not. Whyis it that the establishment is being put on the defen- sive at all? It would seem~that those who are attacking the establishment should be the ones to defend themselves. But,

-- : =-~=--~ are handed out in a more palatable manner. .: ' wholeheartedly embrace hocus-pocus pronouncements because they Unfortunately, many times in our ignorance we reject information from the scientific establishment, simply because it is the establishment, and "Those claiming to be an alternative to establishment science have no common set of standards or practices from which measurements and comparisons can be made or quality of performance judged. Personal testimonies and casual observations quite often serve as the basis of research rather than act as the impetus to begin research:" , , as it is now, most people consistently doubt, question and attack well=trained professionals, while showering thanks and praise upon self-professed specialists with Httle or no training. The reason behind the establishment's defensive position is actually two-fold. While the scientific establishment pro- vides only conditional answers until definitive information is available, the self-proclaimed specialists throw caution to the wind„making bold statements and providing the public with concrete answers to questions with no ifs, ands, or buts. People want definitive answers to their questions and they want to hear good news. It's human nature. When the scientist says, "This is what we know, this is what we don't: know, and we cannot and will not make guesses as to how this may affect you in your everyday life," the average per- son hears doubletalk and becomes disillusioned and frus- trated. The scientist is then put'on the defensive about his approach to science. He or she is merely doing what all sci- entists have been trained to dol,tell it like it is, not how we wish it to be. To add insult to injury, the scientist is not only questioned as to his statements, he is questioned as to his very credibil- ity, and his role in the perceived conspiracy. He becomes indignant and defensive, further breaking down communi- cation between the scientific establishment and the public. After years of preparation and training to be precise, accurate and logical, the scientist is suspect. His indignation and'defensiveness merely confirm in people's minds every- thing that is wrong with the establishment. Scientific Catch-22 This is not to say that the scientific establishment is either infallible or beyond reproach. Even with endless repetitions of rigoroustesting4o ensure the validity of research, there have been and will no doubtcontinue to be instances where ineffective and even harmful drugs and procedures have been put to use. In the rare instances where this has occurred, the results have sometimes been tragic, and the public outcry against the evil scientific establishment has been heard. Why is it then that people are willing to so easily accept and actively promote many unproven and even dis- proven theories and procedures from those outside the sci- entific establishment? If these same theories and procedures were being promoted by the establishment, the public would demand proof of efficacy and safety from both the researchers and the government: A laissez farre approach would not be tolerated. However,, just such a hands-off approach is demanded by those on the fringe of the scien- tific establishment, and this sentiment is echoed by their fol- lowers. So,, it seems as though the establishment is in a Catch-22 situation. If research is long and thorough, they are accused of conspiring to keep valuable information from the public, but if something goes awry after a product or procedure is put into use, then testing was not rigorous enough. - How to Reinstate the Establishment Everyone carries a portion of the blame for the present situation; the public, the establishment„and the anti-estab- lishment sector. What can be done? Well, nothing can be done to change human nature. As long as there are individ- uals to provide easy answers (factual or not) to difficult questions, it will continue to be human nature to want to believe those answers. However, something can and should be done to increase the scientific literacy of oun population: Science must be given at leastequal!status to subjects like math and English in American ~ secondary school education. Such scientific knowledge would ~enable people to make sound judgments about health information that is presented to them, and to distinguish sense from nonsense. Until this occurs, counter- ing nonsense with reason will continue to be an uphill strug- gle. However, those who consider themselves to be part of the scientific establishment should be careful1 not to make the same mistake as those on the outside, i.e., issuing a verdict of guiltywithout a trial. Rather, they should approach new and innovative ideas and theories with open minds. They should be willing to freely offer explanations, even to ques- tions whose answers may appear self-evident to someone so well-versed on the topic. Only then may the scientific estab- lishment acquire equal access to the public and gain their respect and trust. Densie Hatfield, Ph.D., R.D. Research Associate„ACSH 7

REDUCING RISKS: WHAT WORKS AND WHAT DOESN'T THINGS THAT WORK 1. Don't drive under the influence of alcohol. 2. Drive at a speed appropriate for the prevailing conditions. 3. Wear seat belts. ' 4. Use child restraint devices for all children under the age of five. 5. If you ride a motorcycle, wear a helmet. THINGS THAT WORK (BUT YOU PAY A PRICE) 6. Don't ride motorcycles. 7. Drive a large car. 8. Avoid driving at night on the weekends. THINGS THAT DON'T WORK 9. State motor vehicle inspection programs. 10. Driver education. increased greatly in the past few years. How, ever, many people still underestimate the magnitude of the alcohol-impaired driving proklem. Sixty-five percent of the traffic deaths in 1983 occurred in accidents where alcohol played a role. That's more than 27,000 peo- ple killed. Drinking is universally recognized by traffic safety experts as the number one cause of accidents. It has been known since 1963, when a classic study of alcohol and driving was conducted in Grand Rapids, Michigan, that drivers with blood' alcohol levels in the range eommonly considered ille- gal' are 15 to 25 times more likely to be involved in crashes than are nondrinkers on the road at the same time and place. The National Commission Against Drunk Driv- ing regards drunk driving as a bigger social problem than murder. While this may sound a bit overdramatic, the commission has a point; more people die as a result of altohol- related crashes than as a result of homicide. What can you do about this? First, and' obviously, never drive while under th¢influencet of alcohol. Seeond, never ride as a passenger in a car driven by someone who has been drinking and insist that other members of your family take the same precaution. This is particu- larly important for young people, who may ride with a drunk driver because they think they have no other way of getting home. Parents can protect their teenage children's safety byy always providing another way, either byy giving the youngsters taxi fare or by being willing to pick them up anytime, anyplace, no questions asked. Your third defense against drunk driving is to be alert to the presence of drivers (and pedestrians!) who may be intoxicated, par- ticul'arly at night and on the weekends. On 8 Friday and Saturday nights around mid- night, for instance, one out of three drivers has consumed some alcohol during the eve- ning, and one in ten is legally drunk, so there's plenty to watch out for. Table 1(on page 9) lists some key signs of impaired driv- ing. It can help you to spot problem drivers. If you have a CR radio, you can warn the authorities about them; if not;,thebest thing to do is to stay well out of theirway. Finally, your, fourth defense is to be toler- ant and supportive of law enforcementlacti- vities that may seem intrusive and inconven- ienti such as sobriety checkpoints (roadblocks), Studies have shown that the most effective thing the authorities can do to get drunk drivers off the road is to increase the public's perception that the risk of being caught and convicted is high. Increasing the severity of the punishment for drunk driving doesn't seem to help„and'even increasing the actual number of arrests and convictions dcesnR help unless the public knows about it. Vlsrble enforcement is the key, and road- blpcks are extremely visible. The Insurance ldstitute for Highway Safety has found that even when the number of arrests was actu- ally equal or higher in an area without a roadblock program„people tended to iden- tify an adjacent area that did have active roadblocks as the place where drunk drivers are more likely to be caught. Watch Your Speed - Most traffic safety experts and studies agree that drinking and speeding, sometimes in combination, are the two most important causes of crashes. Speed per se does not nec- essarily increase your chance of crashing, if it is not excessive for the prevailing road conditions. For instance, statistics show that highways in the Interstate system, which generally have 55 mph speed limits, have half the death rates of local roads with lower speed limits. This is probably attributable to the better design of the Interstate highways and the fact that these roads are more lightly traveled. However, when a crash does occur, the higher the rate of speed, the greater the likelihood of serious or fatal injuries. Ironically, the single most effective action ever taken to reduce the highway death toll in the United States was done for reasons that had nottiing to do with safety. This was the imposition of'the 55 mph national speed limit in 1973. The speed limit was designed to reduce energy consumptiona but it had an unexpected fringe benefitl After it went into effect, traffic fatalities dropped suddenly and substantially. One reason for this is that the chance of dying in a 60 mph crash is twice that of a 45 mph crash, At 70 mph, it's four times greater than at 45 mph. Recent stitistics show that where enforcement of the 55 mph limit has become lax (as is the case in many western states) traffic fatalities have increased again. .. Inappropriate speed can cause a crash even when you are observing the speed limit, if you are driving too fast for conditions. In fact, driving too fast for conditions (but within the speed limit) causes more accidents than exceeding the speed limit does. The California Highway Patrol compiled data on the fatal accidents that they investi- gated in 1976, and identified the single most important factor causing each fatal crash. The ten top causes of accidents, as shown by this study; are listed in Table 2. As the table shows, the second most important factor causing fatal crashes was driving too fasr for conditions. Driving in excess of the speed limit didn't even make the top ten. Thardoesn't mean that you can E'~-

. - Table 1: Spotting Drunk Drivers If a nighttime driver does the following, the chances are at least 50:50 that he or she is drunk, according to the National'Highway'Itaffic Safety Administration Clue 'Iurning with wide radius Straddling center or lane marker Appearing to be drunk Almost striking object or vehicle Weaving Chances in 100 that the driver is drunk Driving on other than the designated roadway Swerving - • Slow speed Stopping in the traffic lane Following too closely ' Drifting ignore speed limits - they're generally designed in such a way thaT if you exceed them, you're automatically driving too fast for conditions. The important point here is that you mayalso be driving too fast when you're not violating the law. For this reason, our second recommendation to you isn't "Don't Speed," it's "Drive at a Speed Appropriate for the Prevailing Conditions." Protgcting Yourself in a Crash Our third, fourth, and fifth recommenda- tions aren't aimed at preventing accidents; they're aimed at helping you and others to survive with the least possible injuries when an accident occurs. It isn't the collision between your car and another object that kills you; its the so- called second collision - the one between your body and some other object - thar does most of the damage. The mosrimpor- tant thing that you can do to increase your chances of surviving that second collision is to wear your lap and shoulder safety belts. That's our recommendation number three. The evidence in favor of seat belts is over- whelming. The National Highway Traffic Safety Administration says that safety belts can eut your chances of dying in a motor vehicle crash by 50 percent. IYs also fre- quently stated that seat belts could save 12,000lives a year. •' In a study of 1,126 accidents in which at least one victim was injured seriously enough to require hospitalization, those wearing safety belts had 86 percent fewer life-threatening injuries. Only 28 percent of ' If you've been keeping track of the statis- tics in this article, you may think that there: s an error here, because 12,000 isn't 50 per- cent of 42,500„the figure given earlier for total highway deaths. But the numbers really aren't!inconsistent. The 42,500 fatali- ties include pedestrians, bus riders, motor- cyclists, bicyclists, and others who could not be helped'by safety belts. What belts do is to reduce an automobile occupanr } chances of death by half. unbelted'occupants were completely unin- jured, compared with 42 percenn of belted ones. Severe head and spine injuries were twice as common in unbelted riders. Seat belts help to protect you even in those situations where most people think they add to the hazard. Studies have shown that preg- nant women and their unborn children are more iikely to survive a crash if the mother is belted than if she is unbelted. In accidents where a car catches on fire or goes underwa- ter, seat belts improve your chances of sur- vival, because they increase your chances of remaining conscious after the initial impact and being capable of escaping: The only per- son who's at a disadvantage wearing a safety belt is a small child who would be better pro- tected in a child safetgseat. But even that child is better off with the belCthan with no restrainfat all. In a Swedish study of more than 28,000 people involved in crashes, people who weren't wearing seat belts died in accidents at speeds as low, as 12 mph, but nobody who was wearing both shoulder and lap belts was killed in a crash at a speed of less than 60 mph. Unfortunately, less than 15 percent of American adults wear seat belts regularly, despite all the evidence favoring them, and scientifically valid studies have shown that . campaigns to encourage voluntary seat bell use (such as this article) don't work. Insur- ance incentives, such as larger compensation payments for clients injured or killed in a motor vehicle crash while using a seat belt, also don't work. There seems to be a powerful resistance to seat belt use among American drivers and passengers. Some psychologists say that people don't wear belts because they think they are invulnerable to accidents. Others say that people won't buckle up because the very act of fastening a sear belt reminds them of the possibility of an accident, and people want to avoid the thoughrofdanger. Mandatory seat belt use laws, such as the one that recently went' into effect in New York, may change this. We may consider ourselves invulnerablt to accidents, but mosfofus don'ftxlieve that we're immune to being arrested. And while we may not be able to face the thought of a crash, most of us can tolerate the thought of'.getting a ticket. Some of us mighralso be more willing to wear searbelts if we knew that our failure to buckle up could hurt other people. One rarelymentioned argument for seat bell use is that it protects other people in the car. A Michigan study of more than 4000 accidents showed that occupant-to-occupant colli- sions caused or worsened injuries in 22 per- cent of the accidents. Thirteen percent of the collisions between people contributed to severe injuries or deaths. People wearing safety belts don't crash into each other in an accident. Child Restraints Proper safety restraints are even more important for small children than they are for adults, because the anatomy of a child's body makes him or her much more vulnera- ble to serious injury. Tennessee was the first state to pass a law requiring tharall infants and small children ~ " CONTINUEDONPAGEIO. Table 2: The Ten Top Causes of Fatal Accidents Percentage of accidents in which this was the primary Rank Causative Factor factor causing the accident I Driving while intoxicated 28 2 Driving within speed limits but too fast'for conditions 15 3 Pedestrian stepped into road 9 4 Driving on the wrong side 6 5 Failure to yield abintersection 6 < 6 Disobeyed stop signal' 5 7 Improper driving maneuver 4 ~ 8 Driver distracted by passenger 4 ~ > 9 `Improper turns 3 d 10: Pedestrian failed'to yield' 3 z Source: California HighwayPatrol 1976. s , t3 < 9

ride in federally approved child restraint devices. Even though the law is not univer- sally obeyedi it hasild to a 50 percent reduc- tion in childhood motor vehicle fatalities in that state. A study of Tennessee death records has shown that children who were not in restrainfdevices were I1'times more likely to die in crashes than those who were. • Practicallytvery state in the union now requires infants and small children to ride in safety restraints, and physicians and physi- dans' organirations, especially the Ameri- can Academy of Pediatrics, are making active efforts to increase the use of child' restraints. As a result of these activities, the percentage of children riding safely is increasing. This has benefits beyond the protection of the restrained child. Children who ride restrained can't' interfere with or distract the driver. Distraction is an impor- tant'cause of accidents; it S number eight on the list in Table 2. Also, when children are restrained, the driver need not hesitate about making sudden stops or sharp turns. Children in child restrainrdevices also have ~ fewer opportunities to misbehave. LL Studies have shown that the majority of child safety seats are used improperly. » However, two important problems remain. First, the percentage of'children rid- ing safely decreases with age. Many parents who put their infants in proper restraints don't use adequate restraints for their tod- dlers, and even more fail to enforce seat belt use among youngsters age five and older who have outgrown the special' children's seats. Second, studies have shown that the majority of child safety seats are used Jrnproperly. In a survey conducted by Physi- cians for Automotive Safety, fully 75 per- cent of the child restraint devices were incor- ractly anchored. Crash testing at the University of Michigan 7tansportation Research Institute has shown that with some child restraints misuse can critically jeop- ardize the child'ssafety in a crash, and the National 'Itansportation Safety Board is accumulating a tragiciist of cases in which children were killed in crashes while riding in safety seats which didn't work because they were improperly anchored to the vehicle or otherwise misused. Motorcycles and Motorcycle Helmets People who ride motorcycles without wearing helmets should have their heads examined. Some safety experts would also contend' that anyone who rides a motorcycle arall - even with a helmet - is taking an unreason- able risk. There S no question that motorcycle hel- 10 " time, they were involved in 55 percent of fatal crashes. ` It has been argued that some of the appar- :. ent difference in risk between small cars and ;'. large ones may bedue to characteristia of the drivers rather than the automobiles. For instance, many young drivers choosee small cars, and young drivers have high accident rates. Also, people who do a lot of driving : may choose small cars to save on fuel costs. Their automobiles may be involved in more crashes simply because they are driven more miles. - However, while these differences in driver ,- ,., characteristics may skew the statistics some- what, the higher risks of small icars are real' ' and as unavoidable as the laws of physies: In a crash between a small car and'a large one, the smaller vehicle is at a disadvantage because it has less momentum. Even in colli- sions between similar-sized vehicles, the ..chanxs of avoiding death or injury are greater in a large car b'ecauseof the vehicle's size. Large cars have more "crush space" - the distance between the occupants and'the Akohol t.s universally recogoized by traff[c safeqy ecperts.s the No. I cause of accideots. - mets save lives and'prevent serious, disabl- ing injuries. Motorcyclist deaths have increased substantially since 1975, when some states dropped their mandatory hel- met use laws. Motorcycle accident victims who are not wearing helmets are three times more likely to suffer permanent brain dam- age than those who are. Even with a helmet, however, a motorcy- clist is at far greater risk than the occupant of any other vehicle. Motorcyclists have a seven times higher fatality rate, per mile of travel, than occupants of automobiles. We think that it i imperative that everyone who rides a motorcycle should wear a hel- met. That's our recommendation number five. We also think that if you're seriously concerned about safety, you should give some consideration to choosing a vehicle other than a motorcycle. But we recognize that for some people, the pleasures of motorcycling are more important than the risks. That S fine, as long as you are aware that there are increased risks in choosing this form of transport. - L L Motorcyclists have a seven times higher fatality rate, per mile of travel, than occupants of automobiles. » Bigger Is Better . Many people who would never consider riding a motorcycle have also chosen a type of vehicle that carries an increased safety risk, namely, a small' car. A study by the Insurance Institute for Highway Safety showed that during the years 1978-1980, occupants of the smallest cars were more than twice as likely to diein a crash as occu- pants of full-size cars were. Although com- pact and subcompact cars accounted for only 38 percent of all automobiles at that car's front bumper, In a ftontal collision, the structure of a large car will absorb more of the impact than a small one will. We certainly aren't advising everyone to avoid small cars. The higher gas mileage and lower price of most small cars are important advantages that outweigh the increased risk LL A great deal of money is sp ent on two types of programs that are sup osed to reduce risks on the road but don't - state motor vehicle inspection pro- grams and driver education. 9 y for many people. Moreover„the difference in risk between small cars and large ones is nowhere near as great as the difference between motorcycles and automobiles. But iris real, and while future improvements in the design of small cars may make them safer, they are never going to be as safe as an equally well-designed large car. Night and Weekend Driving In terms of risk, when you drive may be as important as what you drive. Statistics con- sistently show that there are more fatal crashes on weekendss than on weekdays. Crash rates are also higher in the evenings than during the day. On weekdays, the ntun- ber of traffic fatalities is greatest during the evening rush hours. On weekends, the worst time period is later, with a peak in fatal'acci- dents at around midnight. The Nationall Highway 'IYaffic Safety Administration attributes the increased number of fatal crashes on weekend nights to increased recreational driving and increased use of alcohol during these periods, rather than to night driving per se. Of course„few people will want to give up