On arsenic and apple juice: Is the EPA’s drinking water limit even safe?

By Melinda Wenner Moyer
Posted: December 13, 2011

There’s been a lot of chatter about the arsenic-in-apple-juice debacle involving TV’s Dr. Mehmet Oz, the FDA and Consumer Reports. If you don’t know the backstory, fellow PLoS blogger Deborah Blum has written two great posts about it, which you can find here and here.

I only have one thing to add. I’ve heard some people react to the Consumer Reports findings with comments like, “well, most of the arsenic levels were at or below the EPA’s limit for drinking water, so it can’t be that bad.” But for this to be true, the EPA’s arsenic limit has to be adequately protecting the public. I don’t think it is.
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Nutritional oxymoron: Fat-free milk with omega-3′s

By Melinda Wenner Moyer
Posted: December 12, 2011

When I saw an ad for this milk the other day, I couldn’t help but laugh.

A milk that contains DHA cannot, in a strict sense of the word, be fat-free.
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The epigenetics of cancer

By Melinda Wenner Moyer
Posted: November 18, 2011

I’ve taken an embarrassingly long break from blogging, thanks in part to several big changes in my life. Since I last posted here (in January—egads!) I’ve bought my first home, given birth to a son (his name is Dean) and begun teaching a health journalism class at CUNY. But now I’m back writing again, at least part-time, so I thought I’d revisit my favorite old PLoS haunt. I also have to give due thanks to fellow PLoS blogger John Rennie—he gave an inspiring talk to my class yesterday and reminded me that, yes, I do like this thing called blogging and I would like to do it again sometime. So: hi, everyone!

A long while back, here on this very site, I wrote about how frustrated I get when people claim that the only way a substance can cause cancer is if it directly breaks DNA or other molecular bonds. In that post I was singling out a column Michael Shermer had written for Scientific American arguing why cell phones can’t possibly cause cancer; while I don’t necessarily think that cell phones do cause cancer, I nevertheless get red-faced when people invoke non-scientific arguments to make their case.
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How many omega-3s does your dinner have?

By Melinda Wenner Moyer
Posted: January 21, 2011

As I approach my third trimester, I’m becoming a bit of an omega-3 fiend. The unsaturated fatty acids have not only been tied to lower heart disease risk in adults, but they have also been shown to boost fetal brain development, especially when consumed in the final few months of pregnancy. Given that I’m not much of a cold water fish fan—the thought of chewing a mouthful of sardines makes me want to gag—I’ve been looking into how else to get them, and what I’ve uncovered has surprised me.
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Why pregnant women deserve drug trials

By Melinda Wenner Moyer
Posted: January 6, 2011

It’s easy to gloss over health care disparities until they start really affecting you or your loved ones. When I became pregnant this summer, I discovered the dearth of information available about drug safety during pregnancy. (I wrote a little about it in this Slate article published in July.) Women who rely on medication get pregnant—for instance, one in eight pregnant women takes antidepressants, which could pose serious risks, as I’ve discussed elsewhere—and pregnant women develop complications that require medicine. Yet the only drugs that have been approved by the FDA for use during pregnancy are for gestation- or birth-related problems, not for conditions like depression, hypertension or infection. And if you ask two obstetricians for their opinions about a drug’s safety, they’ll sometimes give you two different answers, as I discovered when I looked into taking Sudafed for a nasty cold I had this fall.

Certainly, it seems unethical to expose a fetus to a potentially dangerous drug in a clinical trial—after all, it cannot consent. But isn’t it worse to expose a fetus to a drug without any safety data at all, and outside the structured trial setting, where there is no patient monitoring? Yes, clinical trials in pregnant women could be dangerous. But not having them is even more so, given that pregnant women have to take drugs anyway—and without any knowledge of how they might affect them or their unborn children. Remember the sedative thalidomide, which caused pregnant women to give birth to babies with missing limbs in the 1950s, and DES, a drug prescribed to prevent miscarriages that increased the risk that female babies would develop rare vaginal cancers? Might we have avoided these disasters, or at least lessened their magnitude, if thalidomide and DES had been tested in controlled clinical trials in pregnant women first?

Thankfully, we haven’t had any major disasters like these in decades, but the government still makes drug recommendations based on little data. Take flu shots: The CDC has been telling pregnant women to get seasonal flu shots since the 1960s, but the first randomized, prospective trial testing the vaccine on pregnant women and their babies was not completed until 2008—and it was comprised of just 340 subjects in Bangladesh. (Luckily, the trial suggests that flu shots are safe, although it only tracked the health of the babies for 24 weeks after birth.) For decades, then, the FDA’s recommendations and assurances about flu shots were not based on clinical trial evidence, but retrospective data, which is often flawed. “The agency said, ‘there’s so much risk, we won’t put you in a trial—but as soon as it’s approved in a different population, we’ll give it to you,’” explains Francoise Baylis, a bioethicist at the Dalhousie University in Canada. (Not that the FDA is entirely to blame—drug companies certainly have little interest in testing their compounds in pregnant women, a small population that could pose them serious liability risks.)

I struggled over the decision to get a flu shot myself. For one thing, last year in an article in the Atlantic, veteran science journalists Shannon Brownlee and Jeanne Lenzer raised questions over whether the vaccine actually works. And although pregnant women who catch the flu in the first half of their pregnancy are at an increased risk of giving birth to children who develop schizophrenia, given the timing of my pregnancy, I was at low risk for getting the flu then anyway—and I know from conversations with Caltech biologist Paul Patterson that there is a possibility that the vaccine itself confers this same increased risk. (For more about the link between prenatal infections, vaccines and mental illness, check out this feature I wrote in Scientific American MIND in 2008.) On the other hand, I also know that it could be dangerous to get sick in my third trimester, when I will be at an increased risk for serious respiratory problems. In the end, I decided to get the flu shot once I reached the halfway point in my pregnancy, when I felt the potential schizophrenia risk was minimal, and the shot could still (possibly) protect me towards the end of my pregnancy. Still, my decision was a gamble based on a lot of incomplete information.

It’s not just flu shots, though: pregnant women are taking more medicines than ever now, as they’re having babies later in life—when they tend to be on more drugs—and medical breakthroughs have made some pregnancies possible for the very first time. “We have people with cystic fibrosis who never in decades past would survive long enough to consider pregnancy, who are now living well into middle age and beyond,” says Ruth Faden, executive director of the Johns Hopkins Berman Institute of Bioethics. These women typically need to take medications throughout their pregnancy, yet no one knows their effects.

So what’s the solution? There isn’t a perfect one, but Baylis and Faden argue that there should be trials designed to test drugs in pregnant women who are going to be taking them no matter what. That way, structures are at least in place to collect data and look for adverse events. As for new experimental drugs, Baylis recommends incorporating pregnant women into later-stage trials, once the drugs have been shown to be safe and effective for other adults. “Instead of thinking of research as a risky activity,” she says, “we need to think of the continued off-label use of drugs [during pregnancy] as the risky activity.”

Citations:

Zaman, K., Roy, E., Arifeen, S., Rahman, M., Raqib, R., Wilson, E., Omer, S., Shahid, N., Breiman, R., & Steinhoff, M. (2008). Effectiveness of Maternal Influenza Immunization in Mothers and Infants New England Journal of Medicine, 359 (15), 1555-1564 DOI: 10.1056/NEJMoa0708630

Brown, A. (2005). Prenatal Infection as a Risk Factor for Schizophrenia Schizophrenia Bulletin, 32 (2), 200-202 DOI: 10.1093/schbul/sbj052

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How to avoid harmful chemicals: just pick up your iPhone

By Melinda Wenner Moyer
Posted: January 4, 2011

Happy New Year! My first post of 2011 will be a cheerful one: I’ve made a new and potentially very useful discovery. I frequently harp on the fact that household and personal care products are rife with nasty chemicals (even the ones that say they’re not!), but I’ve never found an easy way to avoid them. How can you tell which products are the safest when you’re browsing the drug store aisle without your computer?

Well, turns out there’s an iPhone app for that. The GoodGuide, a database that ranks household products according to their health and environmental impacts, has a new feature on its free iPhone application that uses the phone’s camera as a barcode scanner. Simply pick up a product, use the camera to scan the barcode, and within seconds you can see its GoodGuide score (the higher the number, the better the product). I discovered this new feature yesterday and ran around my apartment scanning barcodes like a mad woman. I’m proud to note that most of what I scanned scored quite well—but that’s probably because I do my homework before I go shopping. Now, though, I won’t have to. Yet another excuse to be lazy.

Download the Goodguide’s free iPhone app here.

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The dirty truth about “green” products

By Melinda Wenner Moyer
Posted: December 8, 2010

This month I have a short feature in Redbook about managing and preventing indoor air pollution. It might not be the most eloquent article I’ve ever written, but in all honesty, I am more excited about this piece than I am about most of my others, because it is an article that I know could really and truly help people. If some of the suggestions end up reducing a family’s exposures to toxic chemicals, then I am one happy lady.

While reporting the piece, I learned something that really shocked me: so-called “green” or “natural” household cleaners aren’t any less toxic than regular ones—and in fact, are sometimes more so. 
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On vacation

By Melinda Wenner Moyer
Posted: November 11, 2010

Hi all—just wanted to write a quick post to let you know that I’ll be away from now until after Thanksgiving. My husband and I are off to Italy for two weeks. We can’t wait! Take care and enjoy the holiday(s).

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Eggs, KFC Double Downs, and Heart Disease

By Melinda Wenner Moyer
Posted: November 10, 2010

Last week, my husband sent me a link to a press release. (He loves sending me press releases that he thinks will incense me.) This one was a doozy: “One Egg Yolk Worse than a KFC Double Down When it Comes to Cholesterol,” the headline read. Um. Wow.

Intrigued (and, I’ll admit, a little incensed), I looked up the study—which actually turned out to be a review article—published in the Canadian Journal of Cardiology. I also looked up what I could find in the scientific literature about the risks associated with eating too many eggs. The general idea is that egg yolks contain upwards of 200mg of cholesterol, and dietary cholesterol is thought to increase blood cholesterol levels and therefore heart disease risk. But dietary cholesterol only contributes a tiny amount to your blood cholesterol—about 70 percent of your cholesterol is actually made by your liver. And I won’t go into this right now, but earlier this year in Slate, I discussed some of the reasons we should question the link between blood cholesterol levels and heart disease risk.

Here’s what I found: according to a handful of epidemiological studies, eggs aren’t so bad (and may even be good) for the heart.  A study based on the famous Framingham Heart Study, which investigated the effects of host and environmental factors on the development of coronary heart disease, concluded that there is “no relationship between egg intake and coronary heart disease incidence.” A 1999 study published in the Journal of the American Medical Association drew on data from the Nurses’ Health Study and the Health Professionals Follow-Up Study and reported “no evidence of an overall significant association between egg consumption and risk of CHD or stroke in either men or women,” though the study did find that diabetic subjects had an increased risk of developing heart disease if they ate more than one egg per day. A 2008 study published in the American Journal of Clinical Nutrition analyzed data from 21,327 subjects who participated in the Physicians’ Health Study and concluded that egg consumption was not associated with heart attack or stroke. And finally, an analysis from the National Health and Nutritional Examination Survey (NHANES) III found that people who reported eating more than 4 eggs per week had significantly lower mean serum cholesterol levels that than those who reported eating less than 1 egg per week.

The epidemiological data seem pretty convincing to me, so I wondered how the authors of the review paper were going to address the findings. Interestingly, I found, they chose not to delve immediately into the science—instead, they began by attacking two studies published earlier this year that reported that eating eggs had health benefits, pointing out that the studies were funded by egg marketing agencies. There’s nothing wrong with questioning conflicts of interest in research, of course, but something about the vigor with which they made the point felt funny to me. I glanced to the end of the paper to see whether the authors had any conflicts of interests themselves. Here’s what I found:

None of the authors receives funding from purveyors of margarine or eggs. Dr Spence and Dr Davignon have received honoraria and speaker’s fees from several pharmaceutical companies manufacturing lipid-lowering drugs, and Dr. Davignon has received support from Pfizer Canada for an annual atherosclerosis symposium; his research has been funded in part by Pfizer Canada, AstraZeneca Canada and Merck Frosst Canada Ltd.

Okay, so it seems that Dr. Spence and Dr. Davignon have their own potential biases to contend with. Maybe they’re motivated by more than just concern for the health of their fellow Canadians? But back to the science: what do the authors say? “Concern about dietary cholesterol has been developing over the past 40 years,” they write. “This concern is based on the careful and independent conclusions of Ancel Keys and Mike Hegsted, who formulated our two most commonly used equations relating dietary saturated and polyunsaturated fat and cholesterol to serum cholesterol.” Now, I can’t say that I myself have closely looked at Keys’ and Hegsted’s work, but I know that science writer Gary Taubes has. His famous 2001 piece in Science, for instance, suggests that these “careful conclusions” aren’t actually based on sound data. I’m not going to go into all that here, but suffice it to say, I don’t think an equation that two scientists came up with 40 years ago trumps recent epidemiological data.

Thankfully, towards the end of the article, the authors do address the epidemiological findings. They mention the findings from the Physician’s Health Study suggesting that diabetics may for some reason be adversely affected by high egg consumption. Fine. But what about the risks posed to people without diabetes? “Failure to show harm from eggs in healthy people is likely an issue of statistical power,” they write. “In healthy people, a larger study with longer follow-up would be required.”

In other words, maybe all those studies just aren’t big enough to find evidence that eggs are harmful. Really, guys? The Health Professionals Follow-up Study included 37,851 people. The Nurses’ Health Study had 80,082. NHANES had 27,378. Surely if eggs were deadly, these studies would have found a signal amongst the noise. And as for your implication that people might be better off starting the morning with a KFC Double Down than a single egg yolk, well, that I can’t even dignify with a response.

Citations:

JD Spence, DJ Jenkins, J Davignon (2010). Dietary cholesterol and egg yolks: Not for patients at risk of vascular disease The Canadian Journal of Cardiology, 26 (9)

Dawber TR, Nickerson RJ, Brand FN, & Pool J (1982). Eggs, serum cholesterol, and coronary heart disease. The American journal of clinical nutrition, 36 (4), 617-25 PMID: 7124663

Hu, F. (1999). A Prospective Study of Egg Consumption and Risk of Cardiovascular Disease in Men and Women JAMA: The Journal of the American Medical Association, 281 (15), 1387-1394 DOI: 10.1001/jama.281.15.1387

Djoussé L, & Gaziano JM (2008). Egg consumption in relation to cardiovascular disease and mortality: the Physicians’ Health Study. The American journal of clinical nutrition, 87 (4), 964-9 PMID: 18400720

Song WO, & Kerver JM (2000). Nutritional contribution of eggs to American diets. Journal of the American College of Nutrition, 19 (5 Suppl) PMID: 11023007

Taubes, G. (2001). NUTRITION: The Soft Science of Dietary Fat Science, 291 (5513), 2536-2545 DOI: 10.1126/science.291.5513.2536

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If BPA exposure is so low, why should we be worried?

By Melinda Wenner Moyer
Posted: October 19, 2010

In response to my earlier post about bisphenol A in soda and beer, reader Skeptic had an insightful comment:

As someone involved in environmental health myself, I have been following the BPA controversy from north of the 49th parallel with some interest. I have often wondered whether the actual data supports regulation of BPA. The first study you cite, for example, hides this line in its discussion: “Thus, median and 95th percentile intake estimates were approximately two to three orders of magnitude below the current health-based guidance value. This result is similar to that given by Ye et al. (2009) for a cohort of Norwegian women, with the estimated average daily intakes of BPA reported to be about three orders of magnitude lower than the RfD and TDI.”

What is your take?
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