Metabolic Danger of High-Fructose Corn Syrup

Metabolic Danger of High-Fructose Corn Syrup

By Dana Flavin, MS, MD, PHD





Americans are being poisoned by a common additive present in a wide array of processed foods like soft drinks and salad dressings, commercially made cakes and cookies, and breakfast cereals and brand-name breads.

This commonplace additive silently increases our risk of obesity, diabetes, hypertension, and atherosclerosis.

The name of this toxic additive is high-fructose corn syrup. It is so ubiquitous in processed foods and so over-consumed by the average American that many experts believe our nation faces the prospect of an epidemic of metabolic disease in the future, related in significant degree to excess consumption of high-fructose corn syrup.

The food industry has long known that “a spoonful of sugar helps the medicine go down in the most delightful way.” And cane sugar had been America’s most delightful sweetener of choice, that is, until the 1970s, when the much less expensive corn-derived sweeteners like maltodextrin and high-fructose corn syrup were developed. While regular table sugar (sucrose) is 50% fructose and 50% glucose, high-fructose corn syrup can contain up to 80% fructose and 20% glucose, almost twice the fructose of common table sugar. Both table sugar and high-fructose sweetener contain four calories per gram, so calories alone are not the key problem with high-fructose corn syrup. Rather, metabolism of excess amounts of fructose is the major concern.

The alarming rise in diseases1,2 related to poor lifestyle habits has been mirrored by an equally dramatic increase in fructose consumption, particularly in the form of the corn-derived sweetener, high-fructose corn syrup.3-12 In this article, we’ll examine the evidence for these associations, and we’ll attempt to determine if high-fructose corn syrup is a benign food additive, as the sweetener industry has lobbied us (and the FDA) to believe, or a dangerously overlooked threat to public health.

Rising Concern

While cardiovascular disease remains the number one killer in America,1 scientists have noted that “we are experiencing an epidemic of [heart and kidney] disease characterized by increasing rates of obesity, hypertension, the metabolic syndrome, type 2 diabetes, and kidney disease.”2 Add to this list a disturbing rise in new cases of non-alcoholic fatty liver disease, and you have a public health crisis of enormous proportions.

With a growing sense of urgency, scientists are examining the relationship between consumption of high-fructose corn syrup (HFCS) and numerous adverse medical conditions. And they’re coming away with a sour taste in the mouth. Emerging research shows that excessive dietary fructose, largely from consumption of HFCS, represents “an important, but not well-appreciated dietary change,” which has “…rapidly become an important causative factor in the development of the metabolic syndrome,”9 a conglomeration of risk factors that greatly elevates the risk of cardiovascular disease and diabetes. Other research suggests that high dietary fructose consumption contributes to obesity and insulin resistance,5,7 encourages kidney stone formation,13 promotes gout,14-17 and is contributing to an upsurge in cases of non-alcoholic fatty liver disease.4,18,19 Furthermore, high dietary fructose consumption is associated with increased production of advanced glycation end products (AGEs), which are linked with the complications of diabetes and with the aging process itself.2,5,7

Stealthy Insertion Into the Food Chain

With little fanfare, and even less scrutiny, HFCS was introduced into the food supply decades ago. It is now commonly found in an astounding array of popular food and beverage products. Sweetened, carbonated soft drinks are considered by many to be the worst offenders.4,7 Food manufacturers embraced HFCS wholeheartedly because it is substantially cheaper than sucrose (table sugar) and mixes well with a variety of products, including beverages, baked goods, jams and jellies, candies, and dairy products. In fact, between 1970 and 1990, the annual intake of HFCS increased by more than 1,000%, greatly exceeding the change in intake of any other food or food group. High-fructose corn syrup is now the primary caloric sweetener added to soft drinks in the United States, and comprises more than 40% of caloric sweeteners added to foods and beverages.20,21

Stealthy Insertion Into the Food Chain

While it is derived from a natural source, HFCS is essentially an unnatural product, in the sense that for most of human history we consumed no more than about 15 grams of fructose per day (approximately one-half ounce), mostly from fruits and vegetables.

In contrast, daily consumption in 1997 was estimated to have increased to 81 grams (nearly three ounces) per day.7 For the first time in history, humans are consuming fructose at extraordinarily high levels.

The Dangers of Fructose

High dietary intake of fructose is problematic because fructose is metabolized differently from glucose. Like fructose, glucose is a simple sugar. Derived from the breakdown of carbohydrates, glucose is a primary source of ready energy. Sucrose (table sugar) comprises one molecule of glucose and one molecule of fructose. Thus, excessive sucrose intake also contributes to the rise in overall daily fructose consumption. Glucose can be metabolized and converted to ATP, which is readily “burned” for energy by the cells’ mitochondria. Alternatively, glucose can be stored in the liver as a carbohydrate for later conversion to energy. Fructose, on the other hand, is more rapidly metabolized in the liver, flooding metabolic pathways and leading to increased triglyceride synthesis and fat storage in the liver. This can cause a rise in serum triglycerides, promoting an atherogenic lipid profile and elevating cardiovascular risk. Increased fat storage in the liver may lead to an increased incidence in non-alcoholic fatty liver disease, and this is one of several links between HFCS consumption and obesity as well as the metabolic syndrome.7

Fructose may have less impact on appetite than glucose, so processed foods rich in fructose can contribute to weight gain, obesity, and its related consequences by failing to manage appetite.20 Additionally, loading of the liver with large amounts of fructose leads to increased uric acid formation, which may contribute to gout in susceptible individuals.7

What You Need to Know: Health-Damaging Effects of Excess Dietary Fructose

    Dietary intake of fructose, particularly in the form of high-fructose corn syrup (HFCS), has dramatically increased in the US in recent decades. Increased HFCS consumption has paralleled increasing rates of obesity, metabolic syndrome, and other conditions associated with poor lifestyle habits.

    High-fructose corn syrup is found in sweetened carbonated soft drinks as well as in many packaged foods such as cakes, cookies, jams, jellies, and crackers.

    Excess fructose intake has been associated with adverse health effects such as metabolic syndrome, elevated triglyceride levels, hypertension, non-alcoholic fatty liver disease, excess uric acid levels (associated with gout), and elevated levels of advanced glycation end products (AGEs; linked with aging and complications of diabetes).

    Minimizing intake of dietary fructose is essential to mitigating its potentially dangerous effects. Sources of dietary fructose include HFCS, fruit juices, honey, and table sugar (sucrose; comprising fructose and glucose).

    Targeted nutritional strategies can help avert some of the damaging effects of excess fructose intake. Beneficial nutrients include benfotiamine, alpha-lipoic acid, carnosine, pyridoxamine, acetyl-L-carnitine, vitamin C, and fish oil.

Fructose Linked With Insulin Resistance and Diabetes

The high flux of fructose to the liver, the main organ capable of metabolizing this simple carbohydrate, disturbs glucose metabolism and uptake pathways and leads to metabolic disturbances that underlie the induction of insulin resistance,9 a hallmark of type 2 diabetes.

Fructose Linked With Insulin Resistance and Diabetes

In fact, the effect of HFCS on insulin resistance has been shown to have an impact on the prevalence of diabetes. In 2004, investigators conducted an ecological correlation study, in which they compared the relationship between food consumption of refined carbohydrates and the prevalence of type 2 diabetes in the US from 1909 to 1997. They found that during this period, the use of corn syrup sweeteners, which were almost non-existent at the turn of the century, increased by more than 2,100%. During the same period, the prevalence of diabetes skyrocketed. After controlling for total energy intake from other foods such as fats and proteins, only the increase in corn syrup and a decrease in fiber intake correlated positively with the prevalence of type 2 diabetes.22

Scientists have therefore come to realize that all sugars are not created equal, which has been borne out in a number of studies. In one study, investigators looked at whether reduction in insulin sensitivity was caused by glucose or fructose components of the diet. They took two groups of young healthy men and fed one group a high-glucose diet, while the other received a diet high in fructose. At the end of one week, high-fructose feeding was accompanied by a significant reduction in insulin sensitivity and insulin binding, whereas no significant changes were seen in the high-glucose group.23

Another study found that diets containing a moderate amount of fructose produced undesirable changes in glucose metabolism in both normal and hyper-insulinemic men.24

Strategies to Prevent or Minimize Dangers of Excess Dietary Fructose

Today, high-fructose corn syrup (HFCS) hasbecome nearly ubiquitous in the food supply. The sticky stuff features prominently in everything from packaged cereals and convenience drinks to ketchup and baked goods. Sugary soft drinks are thought to be the single largest source of this fructose-rich sweetener.

The best way to avoid the dangers of excess dietary fructose is to avoid foods with added sugars as well as processed or pre-packaged foods and undiluted fruit juices. Instead, focus on a heart-healthy diet—such as the Mediterranean diet, which emphasizes whole grains, fresh vegetables, low-fat dairy, fresh fish, and limited meat.

Other tips to protect yourself against the danger of excess fructose include:

    Avoid all sweetened soft drinks. Consider switching to an alternative, such as sparkling water, herbal tea, or green tea (stick to home-brewed teas, since most commercially available bottled tea is brimming with HFCS).

    Read product labels carefully. Avoid any products containing “high-fructose corn syrup” or fructose. Fruit juices—even unsweetened juices—contain fructose and should not be consumed in excess. Fruit juice diluted with sparkling water is delicious and contains less fructose than undiluted juice.

    Find ways to cut your overall intake of table sugar. Sucrose consists of one molecule of glucose and one of fructose. Thus, sucrose consumption can contribute to unnaturally high fructose levels.7 Furthermore, research suggests that sucrose may have similar adverse metabolic effects as fructose, thus contributing to obesity and metabolic syndrome.49

    Try using the natural non-caloric sweetener stevia extract in your coffee, tea, or homemade desserts.

    Consider writing a letter to the manufacturers of your favorite products; ask them to market alternatives to HFCS-sweetened products. If enough people vote with their pocketbooks, manufacturers may eventually respond with more healthful products.

    Consider taking supplements that may prevent or ameliorate the damage associated with elevated blood sugar.

Fructose-Induced Hypertension

Very few people realize that excess fructose intake may contribute to hypertension.25 High blood pressure is a well-known comorbidity associated with obesity, hyperinsulinemia, and hyperlipidemia.12 Hypertension is part of a cluster of dangerous disorders called the metabolic syndrome, which is characterized by insulin resistance and is a key factor in the development of many vascular diseases.

Excess fructose contributes to hypertension by inhibiting a key enzyme called endothelial nitric oxide synthase,26 which is located in blood vessels walls and is essential for the production of the vasodilator, nitric oxide. By allowing healthy blood vessels to relax and ensuring smooth blood flow in vessels, nitric oxide is absolutely necessary for preventing hypertension, coronary artery disease, and erectile dysfunction.

Atherogenic Lipid Profiles and Coronary Artery Disease

Unlike glucose, fructose is readily converted to fat by the liver, leading to an excessive concentration of fats and lipoproteins in the body.9 High and prolonged fructose ingestion increases unfavorable lipid profiles in the body. By increasing triglyceride levels12,27—an independent risk factor for coronary heart disease—fructose promotes potentially dangerous lipoprotein changes that increase atherogenic risk. For example, fructose increases apoB100—the primary lipoprotein responsible for carrying cholesterol to the tissues—which leads to the formation of fatty deposits. Conversely, high-density lipoprotein (HDL), which is responsible for carrying cholesterol particles back to the liver to be eliminated, is decreased by fructose.28 Fructose ingestion therefore contributes to fat deposits in the liver (fatty liver)7 and increases the amount of dangerous lipoproteins that enhance cholesterol deposits in blood vessels walls.29 This can lead to plaque buildup and narrowing of the blood vessels—a ticking time bomb for the development of both stroke and heart attack.

Potential Consequences of Excess Dietary Fructose Consumption

    Accelerated aging

    Insulin resistance

    Type 2 diabetes

    Diabetic complications

    – Retinopathy (may lead to blindness)

    – Nephropathy (may lead to severe kidney disease, requiring chronic dialysis)

    – Neuropathy (may involve numbness, pain, impotence, speech impairment, loss of bladder control, etc.)

    Non-alcoholic fatty liver disease

    Abnormally high blood uric acid levels (hyperuricemia; may result in the development of gout; implicated in the development of diabetes and the metabolic syndrome)

    Abnormally high triglyceride levels (hypertriglyceridemia; implicated in the development of atherosclerosis and cardiovascular disease).5,7,15

Non-Alcoholic Fatty Liver Disease

Once a relatively rare clinical oddity, non-alcoholic fatty liver disease is now estimated to affect 20-30% of adult populations in developed countries.19 Like obesity and diabetes, the rise in non-alcoholic fatty liver disease cases has paralleled the rise in consumption of dietary fructose.4 For example, a recent study by scientists at the University of Florida, Gainesville, determined that fructose consumption in patients with established non-alcoholic fatty liver disease was about two to three-fold higher than among normal control subjects.4

As its name suggests, non-alcoholic fatty liver disease is a constellation of conditions affecting the liver, characterized by excessive accumulation of fat in the organ, and unrelated to alcoholism. It is associated with higher rates of death from liver diseases, such as cirrhosis and liver cancer, and with cardiovascular disease.30-32 It is intimately linked to insulin resistance and the metabolic syndrome, and often progresses to an inflammatory condition known as non-alcoholic steatohepatitis.33

The AGE Connection

The adverse effects of excess dietary fructose are not limited to detrimental effects on blood sugar meta-bolism, lipid profiles, or liver health. Excess fructose also encourages the formation of toxic advanced glycation end products (AGEs). These are aberrant hybrid proteins, formed when sugars and lipids react with these molecules, altering their structures and damaging their functionality. As AGEs accumulate they encourage inflammation and oxidative stress. They have also been linked to accelerated aging. Advanced glycation end products are believed to play a key role in the development of hypertension as well as complications associated with type 2 diabetes like neuropathy and retinopathy.5,7,34-37 Neuropathy afflicts the nerves and can cause tingling, prickling sensations, numbness, and pain, while retinopathy damages the eye’s retina and may lead to blindness.

In terms of the reactions that lead to the development of AGEs, fructose is far more reactive than glucose, so even a small amount of fructose circulating in the bloodstream is potentially damaging. In the laboratory, it has been shown that the rate of fructose/protein cross-linking is 10 times greater than the linkage rate associated with glucose.38 This suggests that excess dietary fructose is intimately linked to accelerated aging, as this type of protein cross-linking is a common manifestation of aging.7,39-41

These aging-accelerating effects of dietary sugars were investigated in lab rats fed diets featuring sucrose, glucose, or fructose. Three measures of aging, including the cross-linking of collagen (a protein that provides structure and support for the skin and other tissues), were each significantly greater in rats that were fed fructose than rats that consumed glucose or sucrose. “The data suggest that long-term fructose consumption induces adverse effects on aging,” concluded researchers.42

Advanced glycation end products are also known to induce acute endothelial dysfunction.43 Endothelial dysfunction is implicated in the development of atherosclerosis, and thus cardiovascular disease.44 Scientists also believe that AGEs may contribute to the development and progression of chronic heart failure by inducing vascular and myocardial stiffening.45
Supplements that May Protect Against Fructose-Induced Damage

Excessive intake of dietary fructose from sources such as high-fructose corn syrup (HFCS) may contribute to myriad adverse health effects ranging from metabolic syndrome to kidney stones to the complications of diabetes. In addition to limiting exposure to dietary fructose, nutritional supplements may offer important protection against these harmful effects.

Protect against Advanced Glycation End Products.

Fructose promotes the formation of advanced glycation end products (AGEs), which are clearly linked to some of the worst side effects of diabetes.5,50 Advanced glycation end products are also linked to accelerated aging, even among the healthy.7,39,40

    Benfotiamine: This highly bioavailable vitamin B1 analog has been shown to prevent some of the damage associated with diabetes-related high blood sugar levels. Benfotiamine blocks three of the “major molecular pathways” by which hyperglycemia damages cells.51 A recent study of patients with type 1 diabetes confirmed that benfotiamine, in combination with supplemental alpha-lipoic acid, “…completely normalized increased AGE formation…” associated with diabetic complications. Benfotiamine also corrected endothelial cell deficits associated with high blood glucose levels.52 Benfotiamine similarly shows promise against the adverse effects of type 2 diabetes.5

    Benfotiamine also acts as an antioxidant.

    According to new research published by German scientists, “benfotiamine shows a direct antioxidant action. This effect of benfotiamine may be involved in the improvement of diabetic late complications, including peripheral neuropathy.”54

    Alpha-lipoic acid: Recommended to preventglycation and reduce the accumulation of AGEs as well as enhance glucose utilization.55 Alpha-lipoic acid may decrease the development or improve the symptoms of neuropathy in diabetic patients.56 Alpha-lipoic acid offers powerful antioxidant effects in both aqueous and lipid environments. Only lipid-soluble antioxidants readily enter cells’ organellesto prevent damage from free radicals. Alpha-lipoic acid is a mitochondrial metabolite; it is particularly effective at protecting these vulnerable cellular “powerhouses” from oxidative damage.57-61

    Carnosine: This dipeptide acts as an anti-glycating agent that inhibits AGE formation as well as protein glycation, oxidation, and cross-linking associated with aging and its associated pathologies. Animal studies suggest that carnosine suppresses the complications of diabetes.62-65 Late research suggests that carnosine may prevent diabetes-associated atherosclerosis.66

    Pyridoxamine: Harvard-based researchers recently showed that pyridoxamine, an advanced formulation of vitamin B6, acts as a “broad inhibitor” of advanced glycation to benefit patients with diabetic nephropathy (kidney disease).67,68

Fight the Metabolic Syndrome. Excessive fructose intake is intimately linked with metabolic syndrome and its components such as elevated triglycerides, high blood pressure, and increased cardiovascular risk.

    Supplement regularly with omega-3 fatty acids (fish oil). Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are omega-3 fatty acids, found primarily in fish oil, which have been shown to decrease inflammation, improve the lipid profile, reduce insulin resistance, and improve cardiovascular health.69-73

    Alpha-lipoic acid: Ameliorates several components of the metabolic syndrome in animal studies, including insulin resistance, atherogenic lipid profiles, and high blood pressure.74

    Acetyl-L-carnitine: In combination with alpha-lipoic acid (also a mitochondrial antioxidant), acetyl-L-carnitine has been shown to improve blood pressure in patients with coronary artery disease.75

Reduce the Risk of Elevated Uric Acid Blood Level. High dietary intake of fructose—particularly in the form of HFCS—is associated with elevated blood levels of uric acid, which are linked with gout.

    Supplemental vitamin C: A recent study of more than 1,300 men showed that a greater intake of vitamin C decreases the risk of abnormally high blood levels of uric acid (hyperuricemia).76 Hyperuricemia is strongly linked to the risk of developing gout. Intakes of 500 mg vitamin C per day or more were associated with correspondingly low levels of uric acid in the bloodstream.76

Uric Acid Elevation, Gout, and Kidney Stones

A recent study by Canadian researchers clearly shows that drinking high-fructose sugar-sweetened beverages is associated with elevated blood levels of uric acid. Known as hyperuricemia, this condition is incontrovertibly linked to elevated risk of suffering from the painful joint disease, gout. Researchers drew their conclusions based on data gathered from nearly 15,000 adult Americans who participated in the Third National Health and Nutrition Examination Survey (1988-1994). “Serum uric acid levels increased with increasing sugar-sweetened soft drink intake,” wrote the scientists. Tellingly, drinking diet soft drinks, which do not contain HFCS, was not associated with elevated uric acid levels.15

Uric Acid Elevation, Gout, and Kidney Stones

“Fructose-induced hyperuricemia might have a causal role in metabolic syndrome, hypertension, and other chronic disease,” noted Harvard-based scientists in 2007.46 In 2008, Canadian researchers narrowed the focus of their previous inquiries, examining the relationship between soft drinks, fructose consumption, and the risk of gout in men. In this study, more than 46,000 men with no history of gout were followed for a dozen years. Writing in the influential British Medical Journal, they concluded: “Prospective data suggest that consumption of sugar-sweetened soft drinks and fructose is strongly associated with an increased risk of gout in men.”17

In a recent study, researchers at Harvard Medical School analyzed data gathered from literally hundreds of thousands of subjects, comparing fructose intake with risk of developing kidney stones. While “non-fructose carbohydrates” were not associated with increased risk, the relative risks of kidney stones “significantly increased” for subjects with the highest intake of dietary fructose, compared with subjects who had the lowest intake. It should be noted that sucrose (table sugar) acts as a source of dietary fructose, as it comprises fructose and glucose. “Our study suggests that fructose intake is independently associated with an increased risk of incident kidney stones,” researchers concluded.13 This information is so new few scientists have had time to even attempt to replicate it. But the enormous sample size of the study, and the prestige of its authors, lends credence to the results.

Abnormally elevated levels of blood uric acid have been cited as one potential mechanism by which HFCS precipitates the undesirable metabolic changes leading to conditions such as the metabolic syndrome.47,48 It is likely that this fructose-driven increase in serum uric acid also plays a role in the increased risk of kidney stones. The ability of fructose to induce an increase in uric acid may be a major mechanism by which fructose can cause cardiorenal (heart and kidney) disease.

Conclusion

High-fructose corn syrup (HFCS) quietly and grimly entered the food supply decades ago. Today HFCS is ubiquitous in a wide variety of foods, including pasta sauces and salad dressings.

High-fructose corn syrup has been linked to an increased risk of a broad range of metabolic diseases and conditions. Fructose is preferentially stored in the liver as fat, and is associated with abnormal spikes in blood levels of uric acid.
Non-Alcoholic Fatty Liver Disease

High levels of fructose consumption are also associated with the development of AGEs, which, in turn, are linked to accelerated aging and some of the worst side effects associated with type 2 diabetes. Despite assurances of safety by the corn sweetener industry, prudent health-conscious consumers would do well to decrease their intake of sweeteners containing HFCS. The nutritional content of HFCS offers “empty calories” - calorie-dense, with no micronutrient (e.g. vitamins, minerals, phytonutrients) value. Because sucrose (table sugar) is half fructose, intake of this sweetener should also be limited whenever possible. The best way to reduce your intake of high-fructose corn syrup (HFCS) is to read the label of food products before you purchase them. One can slash their dietary intake of HFCS by avoiding foods that contain it and other added sugars such as sucrose.

Dana Flavin, MS, MD, PhD is former science assistant to the associate bureau director for toxicology at the FDA.

If you have any questions on the scientific content of this article, please call a Life Extension Health Advisor at 1-800-226-2370

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50. Ahmed N, Thornalley PJ. Advanced glycation endproducts: what is their relevance to diabetic complications? Diabetes Obes Metab. 2007 May;9(3):233-45.

51. Anon. Benfotiamine. Monograph. Altern Med Rev. 2006 Sep;11(3):238-42.

52. Du X, Edelstein D, Brownlee M. Oral benfotiamine plus alpha-lipoic acid normalises complication-causing pathways in type 1 diabetes. Diabetologia. 2008 Oct;51(10):1930-2.

53. Stirban A, Negrean M, Stratmann B, et al. Benfotiamine prevents macro- and microvascular endothelial dysfunction and oxidative stress following a meal rich in advanced glycation end products in individuals with type 2 diabetes. Diabetes Care. 2006 Sep;29(9):2064-71.

54. Schmid U, Stopper H, Heidland A, Schupp N. Benfotiamine exhibits direct antioxidative capacity and prevents induction of DNA damage in vitro. Diabetes Metab Res Rev. 2008 Jul;24(5):371-7.

55. Thirunavukkarasu V, Anitha Nandhini AT, Anuradha CV. Lipoic acid improves glucose utilisation and prevents protein glycation and AGE formation. Pharmazie. 2005 Oct;60(10):772-5.

56. Vincent AM, Perrone L, Sullivan KA, et al. Receptor for advanced glycation end products activation injures primary sensory neurons via oxidative stress. Endocrinology. 2007 Feb;148(2):548-58.

57. Hao J, Shen W, Tian C, et al. Mitochondrial nutrients improve immune dysfunction in the type 2 diabetic Goto-Kakizaki rats. J Cell Mol Med. 2008 Apr 9.

58. Sena CM, Nunes E, Louro T, et al. Effects of alpha-lipoic acid on endothelial function in aged diabetic and high-fat fed rats. Br J Pharmacol. 2008 Mar;153(5):894-906.

59. Foster TS. Efficacy and safety of alpha-lipoic acid supplementation in the treatment of symptomatic diabetic neuropathy. Diabetes Educ. 2007 Jan;33(1):111-7.

60. Aliev G, Liu J, Shenk JC, et al. Neuronal mitochondrial amelioration by feeding acetyl-L-carnitine and lipoic acid to aged rats. J Cell Mol Med. 2008 Mar 28.

61. Palaniappan AR, Dai A. Mitochondrial ageing and the beneficial role of alpha-lipoic acid. Neurochem Res. 2007 Sep;32(9):1552-8.

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63. Hipkiss AR, Preston JE, Himsworth DT, et al. Pluripotent protective effects of carnosine, a naturally occurring dipeptide. Ann NY Acad Sci. 1998 Nov 20;854:37-53.

64. Hipkiss AR. Would carnosine or a carnivorous diet help suppress aging and associated pathologies? Ann NY Acad Sci. 2006 May;1067:369-74.

65. Reddy VP, Garrett MR, Perry G, Smith MA. Carnosine: a versatile antioxidant and antiglycating agent. Sci Aging Knowledge Environ. 2005 May 4;2005(18):pe12.

66. Rashid I, van Reyk DM, Davies MJ. Carnosine and its constituents inhibit glycation of low-density lipoproteins that promotes foam cell formation in vitro. FEBS Lett. 2007 Mar 6;581(5):1067-70.

67. Williams ME, Bolton WK, Khalifah RG, et al. Effects of pyridoxamine in combined phase 2 studies of patients with type 1 and type 2 diabetes and overt nephropathy. Am J Nephrol. 2007;27(6):605-14.

68. Williams ME. New potential agents in treating diabetic kidney disease: the fourth act. Drugs. 2006;66(18):2287-98.

69. Davidson MH, Yannicelli HD. New concepts in dyslipidemia in the metabolic syndrome and diabetes. Metab Syndr Relat Disord. 2006;4(4):299-314.

70. Robinson LE, Buchholz AC, Mazurak VC. Inflammation, obesity, and fatty acid metabolism: influence of n-3 polyunsaturated fatty acids on factors contributing to metabolic syndrome. Appl Physiol Nutr Metab. 2007 Dec;32(6):1008-24.

71. Carpentier YA, Portois L, Malaisse WJ. n-3 fatty acids and the metabolic syndrome. Am J Clin Nutr. 2006 Jun;83(6 Suppl):1499S-504S.

72. Lombardo YB, Hein G, Chicco A. Metabolic syndrome: effects of n-3 PUFAs on a model of dyslipidemia, insulin resistance and adiposity. Lipids. 2007 May;42(5):427-37.

73. Nettleton JA, Katz R. n-3 long-chain polyunsaturated fatty acids in type 2 diabetes: a review. J Am Diet Assoc. 2005 Mar;105(3):428-40.

74. Pershadsingh HA. Alpha-lipoic acid: physiologic mechanisms and indications for the treatment of metabolic syndrome. Expert Opin Investig Drugs. 2007 Mar;16(3):291-302.

75. McMackin CJ, Widlansky ME, Hamburg NM, et al. Effect of combined treatment with alpha-Lipoic acid and acetyl-L-carnitine on vascular function and blood pressure in patients with coronary artery disease. J Clin Hypertens (Greenwich). 2007 Apr;9(4):249-55.

76. Gao X, Curhan G, Forman JP, Ascherio A, Choi HK. Vitamin C Intake and Serum Uric Acid Concentration in Men. J Rheumatol. 2008 Sep;35(9):1853-8.

90 Percent of People Want Labeling on Engineered Food, But We Still Don't Have it: Why Is that?

AlterNet.org

FOOD  

AlterNet / By Dave Murphy

90 Percent of People Want Labeling on Engineered Food, But We Still Don't Have it: Why Is that?

More than a million people have asked the FDA for mandatory labeling of genetically engineered food, yet we still don't have it. Why? Here's a little history lesson.

May 29, 2012  |  

 

Photo Credit: Africa Studio/ Shutterstock.com

 

Popular resistance is boiling over on the GMO labeling issue, as the New York Times reported recently in a front page story.

More than a million people have asked the U.S. Food and Drug Administration (FDA) for mandatory labeling of genetically engineered food on a legal petition in March and on May 2nd, nearly a million voter signatures were submitted in California to place a GMO labeling initiative on ballot in November. Clearly, Americans believe strongly in their right to know what's in their food. Ninety percent of US voters want this type of labeling. Yet we still don't have it. Why?

Twenty years ago this week, then-Vice President Dan Quayle announced the FDA's policy on genetically engineered food as part of his "regulatory relief initiative." The policy, Quayle explained, was based on the idea that genetic engineering is no different than traditional plant breeding, and therefore required no new regulations.

Five years earlier, then-Vice President George H.W. Bush visited a Monsanto lab for a photo op with the developers of Roundup Ready crops. According to a video report of the meeting, when Monsanto executives worried about the approval process for their new crops, Bush laughed and told them, "Call me. We're in the dereg businesses. Maybe we can help."

And help he did - more than anyone could have ever imagined. Today, the politically motivated policy lives on, even though it contradicts modern scientific consensus.

How is it possible that the U.S. is making critical decisions about our food system with a decades-old policy that is at odds with global opinion? In a word: politics. As Quayle explained in the 1992 press conference, the American biotechnology industry would reap huge profits "as long as we resist the spread of unnecessary regulations."

Politics Not Science Set the Agenda

Dan Quayle's 1992 policy announcement is premised on the notion that genetically engineered crops are "substantially equivalent" to regular crops and thus do not need to be labeled or safety tested. The policy was crafted by Michael Taylor, a former Monsanto lawyer who was hired by the Bush FDA to fill the newly created position of deputy commissioner of policy.

In an ironic twist, the Obama administration appointed Michael Taylor as the deputy commissioner of foods in 2009, where he now oversees food safety policy for the federal government. Taylor's appointment was highly controversial, not only for crafting this pseudo-scientific policy, which laid the groundwork for helping GMOs avoid rigorous scientific testing and common-sense labeling, but also for his role in guiding the approval of Monsanto's genetically engineered synthetic hormone rBGH.

From the start, the policy of "substantial equivalence" had many critics. The concerns by the FDA's own scientists were summed up in a memo by FDA compliance officer Dr. Linda Kahl, who protested that the agency was "... trying to fit a square peg into a round hole . . . [by] trying to force an ultimate conclusion that there is no difference between foods modified by genetic engineering and foods modified by traditional breeding practices."

As Kahl wrote, "The processes of genetic engineering and traditional breeding are different, and according to the technical experts in the agency, they lead to different risks."

The FDA itself admitted as much in 2001, with a proposed policy that companies should notify the government at least 120 days before commercializing a transgenic plant variety and provide data on each separate genetic transformation event -- information they said they did not need for foods derived through traditional cross breeding.

In other words, the FDA said there is a difference between genetic engineering and traditional plant breeding. In spite of this, the FDA is still following the Dan Quayle/Michael Taylor inspired policy instead of its 2001 policy to set the agenda.

Out of Step with World Opinion

Across the world, there is now agreement that genetically engineered foods are different from conventionally bred foods and that all genetically engineered foods should be required to go through safety assessments prior to approval.

These positions are spelled out by Codex Alimentarius, the food safety standards organization of the United Nations, which the World Trade Organization considers to be the global, science-based standards, and thus immune to trade challenges.

But, at present, none of the genetically engineered plants on sale in the United States can meet this global standard, because - unlike all other developed countries - the U.S. does not require safety testing of genetically engineered crops.

The U.S. stands nearly alone on the issue of labeling, too. More than 40 other countries require labeling of genetically engineered foods, including European Union member nations, Japan, Australia, Russia and even China, allowing consumers in those countries to make informed choices about whether or not to buy these foods. Yet we haven't been able to get labeling here in the U.S., thanks to Dan Quayle and Michael Taylor's deceptive policy.

Growing Pressure for Change

The FDA position on GMOs is also out of step with the wishes of the overwhelming majority of Americans, 90% of whom want labeling. The issue is so reasonable and makes such common sense that in November 2007, then Senator Barack Obama felt compelled to make a promise to Iowa farmers that if elected he'd label GMOs, saying he'd "let folks know whether their food has been genetically modified because Americans should know what they're buying."

But lacking the courage or political will to get this done at the federal level, and stymied in the state legislative area - nearly 20 states have tried to pass labeling mandates and failed due to intense lobby pressure by special interests - all eyes are now on the California ballot initiative that will take the issue directly to voters.

As the Times reported, "The most closely watched labeling effort is a proposed ballot initiative in California that cleared a crucial hurdle this month, setting the stage for a November vote that could influence not just food packaging but the future of American agriculture.

The 20th anniversary of Dan Quayle's announcement fell on Memorial Day weekend, a fitting symbol for the question before us: Will democracy win out and will Americans have the right to know what's in our food? Or we will continue to let our food policy be ruled by political decisions engineered last century in a Monsanto boardroom by corporate lobbyists?

Dave Murphy is the founder of Food Democracy Now!, a sixth generation Iowan, and an advocate for sustainable agriculture.

Better Than Sugar? The Truth About 6 Alternative Natural Sweeteners

AlterNet.org

  FOOD  

AlterNet / By Anneli Rufus

Better Than Sugar? The Truth About 6 Alternative Natural Sweeteners

The global market for non-sugar sweeteners is expected to reach nearly $10 billion by 2016. But what's in this stuff, and is it worth the switch?

June 6, 2012  |  

 

 

 

It's been a wild week in the sugar wars. Disney just announced that it will ban ads for candy, sweet cereals and other sugary foods on all child-focused broadcasting. New York City Mayor Michael Bloomberg proposed a ban on the sale of large sugary drinks. On the heels of a brand-new UCLA study linking high-fructose corn-syrup consumption with memory loss, the USDA rejected a petition last Thursday from the Corn Refiners Association to change the name of high-fructose corn syrup to "corn sugar."

Every anti-sugar, anti-HFCS fusillade boosts a booming business sector: The global market for non-sugar sweeteners, now topping $9 billion, is expected to reach nearly $10 billion by 2016. We're spending big money on stevia and agave, and just starting to discover dark horses such as erythritol and monk fruit.

What's in this stuff, and is it worth the switch? Here are six to consider.

1. Stevia 

Stevia gets most of the buzz and leads the industry, with stevia-sweetened products expected to comprise a $1 billion sector all its own by 2014. Up to 300 times as sweet as table sugar, powdered stevia extract is derived from the leaves of subtropical shrubs that have been consumed by indigenous South Americans for centuries. Yet it has virtually no calories and doesn't raise blood-sugar levels or promote tooth decay. The FDA approved stevia for food use in 2008; now Coke, Pepsi and Starbucks put it in drinks. What could possibly go wrong? Well -- a yucky bitter aftertaste. But two weeks ago, German researchers announced their discovery of two taste receptors on the human tongue that specifically detect stevia's aftertaste. This new data could revolutionize the way stevia is cultivated and refined.

2. Agave Nectar

Made from the sap of succulents native to Mexico, agave nectar is about 150 percent as sweet as sugar but lower on the glycemic index. Loaded with cachet -- evoking sunshine and tequila -- it's turning up everywhere: in Coca-Cola's Full Throttle Blue Agave energy drink, for instance. But agave is highly processed and about 90 percent fructose, "so it dumps right into your liver," warns wellness expert Maria Emmerich, author of The Art of Eating Healthy: Sweets (CreateSpace, 2011). "Things that are lower on the glycemic index are not necessarily better for your health. I received a huge box of agave nectar from a company to review for my blog recently, and I couldn't even bring myself to give it away for free."

3. Erythritol

Far less familiar is erythritol, a non-glycemic, virtually non-caloric, aftertaste-free polyol or "sugar alcohol" that occurs naturally in fruits such as melons, pears and grapes. About 70 percent as sweet as table sugar, whose taste it resembles, erythritol comes in white crystalline powder form and is a common ingredient in foods -- especially baked goods -- labeled as "light" and "low-calorie." Studies show that up to 90 percent of erythritol is excreted unchanged in human urine within 24 hours of consumption -- thus it's not absorbed into the body -- and that, like stevia, it does not harm teeth.

4. Monk Fruit (Lohan Guo)

Industry insiders predict that monk fruit, aka lohan guo, is on the verge of becoming stevia's fiercest new rival. Calorie-free, aftertaste-free and non-glycemic but about 300 times sweeter than sugar, liquid and powdered lohan guo concentrate is derived from the antioxidant-rich, lemon-sized fruits of trees that thrive in the hot, misty mountains of southern China and northern Thailand and were allegedly first cultivated by Buddhist monks 800 years ago. Its presence in Kellogg's Kashi Squares Berry Blossoms cereal and Kashi Cocoa Beach granola is just the beginning.

5. Tagatose

You've probably never heard of tagatose, but it's a low-calorie, low-glycemic, aftertaste-free, probiotic ... sugar. FDA-approved for US food use since 2003 but still seldom seen, tagatose is over 90 percent as sweet as table sugar, yet contains far fewer than half as many calories. Molecularly speaking, tagatose is a form of sugar that occurs naturally in dairy products. But the body metabolizes tagatose differently than it metabolizes sucrose, aka table sugar, so as to produce different effects: Amazingly, some studies suggest that tagatose actually lowers blood sugar. Thus it is being studied for use in anti-diabetes drugs.

6. Barley-Malt Syrup

Barley-malt syrup is made by soaking and sprouting barley grains, then drying and cooking them until the mash becomes viscous, dark and earthily sweet -- but not quite as sweet as table sugar. Relatively low on the glycemic index, barley-malt syrup digests slowly, thus guarding against blood-sugar spikes and crashes. It's a leading sweetener in the macrobiotic diet, which credits whole grains with fighting disease. "Flavorwise, barley-malt syrup is reminiscent of molasses and brown sugar," explains Barbara Johnston-Brown, who bakes with it at her vegan-macrobiotic Green Earth Café in Berkeley, CA. "It can be a little bitter if you overuse it, but used judiciously it heightens the richness of whatever you're making."

Wellness expert Emmerich, who favors erythritol, doesn't try to persuade her clients -- even the most obese ones -- to stop eating sweets. Rather, she educates them about non-sugar alternatives and suggests that they bake their own treats to keep in the freezer.

"If a donut or Pop Tart is screaming in your face and you can't resist the idea of a donut or Pop Tart, then I would prefer that you have a healthier version on hand. If you just tell people no, no, no, and give them no other options, they tend to give up and not even try."

She denounces the marketing tactics used by the alternative-sweetener industry -- which is an industry, after all.

"They promote honey instead of sugar. Well, honey is the highest-caloric sweetener out there. Why do you think the only animal found in nature that has tooth decay is the honey bear? And agave is widely promoted as being '100-percent natural.' Just because things are natural doesn't mean they're good for us. Heroin's natural, too."

Anneli Rufus is the author of several books, most recently The Scavenger's Manifesto (Tarcher Press, 2009). Read more of Anneli's writings on scavenging at scavenging.wordpress.com.

7 Medical Tests and Treatments You May Not Really Need

AARP

7 Medical Tests and Treatments You May Not Really Need

Think twice before getting these procedures or meds

by: Elizabeth Agnvall | from: AARP Bulletin | April 4, 2012

En español | The exercise stress test that's part of your yearly physical. The MRI you got when you threw out your back moving the couch. The antibiotics you took for your sinus infection.
You probably didn't need any of them.

Sign up for the AARP Health Newsletter.

Many common medical exams may not be needed for people over age 50. — Photo by Caspar Benson/fstop/Corbis

The American Board of Internal Medicine Foundation (ABIM) asked nine medical societies — from family doctors to allergists and cardiologists — to each identify five commonly used medical tests and treatments that are often unnecessary. A list of 45 overused procedures was presented Wednesday, April 4, 2012, at a news conference at the National Press Club in Washington, D.C.

"We're changing the culture in medicine," says Christine K. Cassel, M.D., president of the ABIM, about this new Choosing Wisely campaign, which represents some 375,000 doctors. Consumer Reports also has joined the doctors' campaign.

Related

• What tests and screenings do you need if you are over 50? Read
• Understanding lab test results. Read
• Clean out your medicine cabinet. Read
  

"Too much testing is being done that isn't needed, that doesn't work," says John Santa, M.D., who directs health ratings for Consumer Reports.
Here are seven of the most popular, most overused tests and treatments for people over age 50 that the AARP Bulletin has selected from the Choosing Wisely campaign. For the complete list go to choosingwisely.org.


1.  EKG and other heart screening tests for low-risk people without symptoms.
American Academy of Family Physicians
These can be lifesaving for those experiencing chest pain or other symptoms of heart disease. But a 2010 Consumer Reports survey found that 44 percent of people with no signs or symptoms of heart disease had an EKG, an exercise stress test or an ultrasound. For several years, cardiology guidelines have discouraged heart screening tests for people who have no symptoms and are not at high risk, and yet their use "is more common than it needs to be," says James Fasules, M.D., an official with the American College of Cardiology. For those at low risk for heart disease, an EKG or cardiac stress test is far more likely to show a false positive result than find a real problem.
Dangers: False positive tests often lead to more tests and even invasive heart procedures.
Exceptions: If you have diabetes or other conditions that raise your risk, talk to your doctor. Use this calculator to find out your 10-year risk of having a heart attack.
2.  Bone scans for osteoporosis for women under 65 and men under 70 with no risk factors.
American Academy of Family Physicians
Bone density decreases and the risk of fractures increases with age, but medical experts say that most women don't need a bone density test until age 65. Still, many doctors recommend the scan starting at age 50.
Dangers: Bone density (DXA) scans can lead to unneeded medications that can have serious side effects.

Exceptions: Talk to your doctor about a scan before age 65 (70 if you're a man) if you were or are a smoker; you've used steroid medications regularly; have low body weight; or have already had a fracture. This FRAX tool can help you calculate your risk.3.  Antibiotics for mild-to-moderate sinus infections.
American Academy of Family Physicians, American Academy of Allergy, Asthma & Immunology
Despite physician awareness campaigns about the overuse of antibiotics for sinus infections, the drugs are prescribed in more than 80 percent of cases, according to the American Academy of Family Physicians. More than 90 percent of sinus infections are caused by viruses — and the drugs only work against bacterial infections.
Dangers: The widespread overuse of antibiotics is behind the spread of increasingly virulent strains of drug-resistant bacteria.
Exceptions: If symptoms last more than seven days or worsen after initially improving. Some people develop a secondary bacterial infection and then antibiotics may be needed.
4.  NSAID painkillers for people with high blood pressure, heart failure and any chronic kidney disease.
American Society of Nephrology
Many people use Advil, Motrin (ibuprofen) or prescriptions such as Celebrex and Voltaren for everything from arthritis to headaches. But these common painkillers can be dangerous, especially for people with high blood pressure or kidney disease. (These medications can raise blood pressure, cause fluid retention and interfere with kidney function.) Tylenol (acetaminophen), tramadol, or short-term use of narcotic painkillers may be safer than NSAIDs, according to the nephrologists.
Dangers: These drugs are linked to stomach bleeding and increased risk of heart and kidney problems.
5.  X-ray, CT scan or MRI for low back pain.
American College of Physicians, American Academy of Family Physicians
About 80 percent of Americans will suffer from back pain. Low back pain is the fifth most common cause for all doctor's visits. "The vast majority of people with nonspecific low back pain simply get better … within four to six weeks, with or without a physician's intervention," says Patrick Alguire, M.D., an official with the American College of Physicians. If older people get an image, experts say the results will almost always show an innocent abnormality that has nothing to do with the back pain.
Dangers: Some tests expose people to unnecessary radiation and can lead to expensive back surgery.
Exceptions: When the doctor suspects serious underlying conditions or if the pain isn't better in six weeks.

6.  Diagnostic tests for suspected allergies.
American Academy of Allergy, Asthma & Immunology
Some 35 million Americans suffer from seasonal allergies. And millions of Americans increasingly blame a food allergy or sensitivity — from gluten to milk — for their health woes. Some doctors or health providers now perform a blood test, called an immunoglobulin (IgG), for food allergies. But Linda Cox, M.D., president elect of the allergy group, says the test simply doesn't work. For seasonal allergies, many doctors run a battery of blood and skin tests dubbed IgE, when just a few specific tests would do. By asking patients when and where they have symptoms, doctors can pinpoint what tests they should run.
Dangers: The superfluous use of allergy medications; an overly restricted diet.
7.  CT scans and other imaging procedures for uncomplicated headaches.
American College of Radiology
Severe headaches can be excruciating and frightening, but unless they are accompanied by other key symptoms it rarely makes sense to get a CT scan or MRI of the brain. Yet "it happens all the time," says David Seidenwurm, M.D., a neuroradiologist in Sacramento, Calif. Patients get frightened, doctors worry about lawsuits and people "want all the information right away," he says. "It's easier to do the scan than to have the conversation."
Dangers: Radiation exposure raises cancer risks in the population and false-positives lead to more testing and patient anxiety.
Exceptions: Worrisome symptoms — trouble speaking, blurred vision, weakness on one side — or other signs that the headache is caused from something more dangerous, such as a brain tumor.

Choosing Wisely

The nine organizations releasing lists as part of Choosing Wisely:

• American Academy of Allergy, Asthma & Immunology

• American Academy of Family Physicians

• American College of Cardiology

• American College of Physicians

• American College of Radiology

• American Gastroenterological Association

• American Society of Clinical Oncology

• American Society of Nephrology

• American Society of Nuclear Cardiology

Ask Your Doctor if This Big Pharma Scam Is Right for You: The Dangers of a Drugged Up America

AlterNet.org

PERSONAL HEALTH  

Hightower Lowdown / By Jim Hightower

Ask Your Doctor if This Big Pharma Scam Is Right for You: The Dangers of a Drugged Up America

In medicated America, the fix for every problem is just a prescription away. Except that it's not.

May 8, 2012  |  

 

 

 

Butterflies waft across a beautiful field of spring flowers. A delightful young family bicycles joyously down a country lane. A couple on a park bench leans sensually into each other. A 40-something woman's face radiates with both perfect beauty and internal happiness. "All's right with the world," is the message... as long as you've taken your dosages of Lunesta, Celebrex, Cialis, and Botox.

Welcome to medicated America, where the fix for every problem--from incontinence to erectile dysfunction, stiff joints to mood swings, weight gain to wrinkles-- is just a prescription away. Thus the beautiful images, stirring music, attractive actors, and soothing words in the omnipresent, multibillion-dollar kaleidoscope of drug advertising by Pfizer, Merck, Eli Lilly, Johnson & Johnson, and other giants of Big Pharma--all pitching their particular brand-name nostrum directly at us hoi polloi (the industry spends a fourth of its income on ads and other promotions, nearly double its expenditures on research and development). The corporate come-ons typically conclude with a phrase that has achieved cliche status in America's vernacular: "Ask your doctor if 'Suprema Wundercure' is right for you."

The better question, though, is one that cartoonist Dan Piraro expressed in one of his "Bizarro" panels: "Ask your doctor if playing into the hands of the pharmaceutical industry is right for you."

One would assume that in a rich, medically advanced, health-conscious nation like ours, dicey decisions about whether to allow a particular pharmaceutical product into our bodies would be among the most rational we make--as determined by (1) the best science available, (2) the strict moral duty of medical purveyors to "First, do no harm," (3) good government regulation, and (4) the profession's fear of public reproach and legal punishment. One would, however, be wrong on all counts:

• Science has been supplanted by rank hucksterism
• The strictest "moral duty" of corporate executives has been reduced to maximizing profits
• A "good" regulation is one that's good for profit seekers
• Public reproach is just a momentary embarrassment to be covered over by corporate image makers
• Legal "punishment" never includes jail time, but only a fine that's easily absorbed as a necessary cost of doing business by these immensely profitable entities.

In the past three decades, America's healthcare system has radically metamorphosed from a public service network (largely run by independent physicians and nonprofit hospitals) into a corporate profit machine--one that Dr. Arnold Relman, the renowned former editor of the New England Journal of Medicine, calls the Medical-Industrial Complex. Drugmakers have been among the most ambitious, in-your-face pushers of this transmutation of medicine into just another commodity to be sold by hook or crook. In this system, the concept of "care" has been reduced to "caveat emptor," with the shareholders' interest in monetary gain overriding all other interests.

The DTC contagion

A fast-moving, systemic epidemic called DTC has swept across America, endangering public health, jacking up our costs, and weakening the curative connection between health professionals and patients. DTC stands for "Direct-to-Consumer" drug advertising. It's a plague of marketing, empowering profiteering corporations to short-circuit the judgment of doctors by using all of the tricks of Madison Avenue (including lies) to convince viewers and readers that (first) they're suffering from a particular malady, (second) the advertiser's brand-name medicine is the very best cure, and (finally) they must go to their doctors pronto to insist on getting a prescription for that specific drug. The essence of this marketing scheme is to turn consumers into sales representatives for drug peddlers. Brilliant.

Prescribing medicine through the television, radio, print, and internet ads of corporations (whose sole motive is to sell more pills) is so crass, so awash in conflicts of interest, and so inherently dangerous that only two countrieshave ever legalized it: New Zealand in 1981 and the USA in 1997.

In our country, the corporate-friendly government of Ronald Reagan first okayed DTC drug ads in 1985, but his Food and Drug Administration ruled that pages-long consumer warnings about health risks had to be included, so there were few takers. Then came Bill Clinton's corporate-friendly government, which issued a revised FDA rule in 1997 allowing drugmakers to dodge the full disclosure provision--as long as their ads met an "adequate" standard for informing consumers about risks.

Such squishy words (slipped into regulations by industry lobbyists) are a corporate wet dream. Thanks to the adequacy loophole, fluffy-puffy, no-worries prescription drug ads quickly mushroomed. In 1997, spending on DTC ads was only $220 million; by 2002, it was $2.8 billion; and it has kept a steady pace of roughly $3 billion a year ever since.

Corporations don't spend that kind of money to dramatize the severity of their products' nasty side effects. As two ad execs giddily put it in a 1998 report to the industry, "The ultimate goal of DTC advertising is to stimulate consumers to ask their doctors about the advertised drug and then, hopefully, get the prescription." Obviously, to "get the prescription," corporate ads don't stress such unpleasant outcomes as these (taken from the small print of full-page ads for just a half dozen heavily advertised drugs): very high fevers, confusion, uncontrollable bowel movements, trouble swallowing, lower sperm count, prostate cancer, loss of vision, suicidal thoughts... and, of course, death.
Side effects do have to be addressed, but not conspicuously--for example, it's "adequate" for an off-camera announcer to buzz through them with a muted, fast-paced delivery (usually while cartoon butterflies flutter playfully on-screen to distract viewer attention). It's a disgusting, dishonorable way to generate sales--but it works. In 2008, the House Commerce Committee found that every $1,000 spent on drug ads produces 24 new patients, and a2003 research report found that prescription rates for drugs promoted with DTC ads were nearly seven times greater than those without such promos. Ethics aside, these consumer hustles have proven to be profit bonanzas:

• From 2000 through 2004, Merck & Co. poured more than $500 million into adverts promoting Vioxx, turning the pain pill into one of the "Top 100 Megabrands" listed by Advertising Age. The drug was meant for the relatively few people who can't stomach aspirin, but the PR push touted it to all arthritis patients, a much larger marketing pool. The campaign promised "everyday victories" over pain and immobility, featuring former Olympic skating champ Dorothy Hamill spinning effortlessly (and pain-free) on the ice. Merck's ads sold some 20 million Vioxx prescriptions, including to people who paid the ultimate price for buying the hype--a 2005 research report in The Lancet, the prestigious British medical journal, attributed as many as 140,000 sudden cardiac "events" in America to the use of Vioxx. In September of 2004, Merck took the pill off the market over "safety concerns." As an expert pharmacy consultant toldForbes magazine in 2006, "Vioxx wasn't a bad drug for everyone, it was a bad drug for certain patients. Unfortunately, people saw the ads and started demanding the drug from their doctors." That's the deadly power of mass advertising for drugs.
• Some ads are simply frauds, including one that Pfizer ran on TV until 2006, hailing the prowess of the company's cholesterol-lowering drug, Lipitor. The star of the spot was Robert Jarvik, who was described as the well-known "physician" who was the "inventor" of the artificial heart. In a picturesque outdoorsy setting, he was shown vigorously rowing a boat across a lake--visual "proof" that his own heart was in robust condition thanks to his use of Lipitor. His tagline was: "You don't have to be a doctor to appreciate that." Good, because he doesn't practice medicine, and while he worked on the artificial heart, he did not invent it. Oh, he also wasn't rowing the boat--a double played that role. Embarrassed, Pfizer had to yank the ad--but it continues to merchandize Lipitor with some $250 million a year in commercials, generating about $11 billion a year in sales, more than any other pharmaceutical in history.   
• Bear in mind that these pitches are being made to consumers who cannot just go purchase the product--only licensed medical professionals can diagnose and prescribe. But, again, the promotions work, as an industry spokesman happily affirmed: "There's a strong correlation between the amount of money pharmaceutical companies spend on DTC advertising and what drug patients are most often requesting from physicians." He also noted that the trumpeting of brand-name pills "is definitely driving patients to the doctor's office." No surprise, then, that prescription drug use has soared in the past decade, during which spending (by consumers, private health plans, and governments) more than doubled. A 2010 survey by the National Center for Health Statistics not only found that about 35 percent of Americans over 60 take five or more prescription medicines a day (more than twice the intake in 1999), but even 22 percent of children under age 12 are on at least one Rx regimen. "People may be taking too many drugs," deadpanned the NCHS leader. And in recent years, a whole new market has opened up for DTC hucksters: Medical devices. In 2007, Johnson & Johnson launched the first mass-audience TV commercials for highly specialized, complex therapeutic devices. This is beyond odd; it is dangerous. Only expert practitioners have the knowledge and experience to judge whether one brand-name medical gizmo is superior to another. Yet, here was J&J doing a pitch to us clueless consumers for "Cypher," a drug-coated coronary stent for opening closed arteries. I'm all for consumers getting more say in health care, but--come on!--how would I know enough about the efficacy of various stents to instruct my doctor to "Make mine Cyphers"?

The DTD contagion


In addition to getting you and me to push particular products on our doctors, the drug and device industry runs a massive, sophisticated, and relentless "Direct-to-Doctor" sales program that skates on the thinnest ethical ice and frequently plunges all the way into illegality. While these efforts, costing more than $6 billion a year, occasionally pretend to be "educational," they are in fact an elaborate exercise in medical flimflammery--nothing but a door-to-door ploy by each of the major makers to hoodwink your doctor into prescribing their brand-name pill, rather than a competitor's brand or a generic.

To do this, the biggest of Big Pharma deploy an astonishingly large force of "sales reps" all across the country--90,000 of them! That's roughly one for every nine physicians, and they swarm non-stop into doctors' offices--one Virginia physician says his office had to set a quota of three visits in the morning and three visits in the afternoon in order to get any doctoring done. They are highly trained in persuasive arts, motivated to make the sale at all costs, and alarmingly successful (a 2003 Blue Cross survey found that more than half of "high-prescribing" doctors relied on the reps as their main source of information about new drugs).

INTRIGUING QUESTION:

What occupational sub-group of Americans are, by far, the most heavily recruited to take jobs as drug reps? You might think pharmacists, marketing consultants, or even used car salesmen. All wrong.  

THE SURPRISING ANSWER:

College cheerleaders.

Hey, the point is to "make the sale," to entice this mostly male profession to switch from A to B. Solid scientific evidence is one thing, but winks apparently work, too--and who's twinklier, prettier, more buffed, peppier, or more gregarious than cheerleaders? The University of Kentucky, which boasts champion-level cheerleading squads, has been one of the premier movers of talent from pompoms to Pharma. A UK "cheering advisor" notes that his perky collegians are naturals for sales rep positions: "Exaggerated motions, exaggerated smiles, exaggerated enthusiasm--they learn those things, and they can get people to do what they want." He says he routinely receives calls from drugmakers seeking to hire his graduates. "They don't ask what the major is," he says.

The demand is so high that an executive of a business that runs cheerleading camps set up a specialized employment firm in 2004 called"Spirited Sales Leaders." Based in Memphis, it funnels hundreds of former cheerleaders into drug sales.

"There's a lot of sizzle" in being a sales rep, he explains, and these experienced sizzle-generators can earn six figures a year, counting bonuses, for pep-talking doctors into writing more prescriptions for their companies' medicines.
Not that these upstanding corporate citizens would stoop to hiring salespeople based on their sex appeal. No, no, explained a top executive of Bristol-Myers Squibb: "[It] has nothing to do with looks, it's the personality."

Sex appeal or not, the essence of the job is manipulation, and reps are highly trained and well armed to ingratiate themselves with each individual on their list of doctor-clients. Adriane Fugh-Berman, a doctor and professor at the Georgetown University Medical Center, is a drug company watchdog who has studied the doctor-sales rep relationship. In a 2007 article, she reported that the salespeople play to a doctor's feeling of being overworked and underappreciated: "Cheerful and charming, bearing food and gifts, drug reps provide respite and sympathy; they appreciate how hard doctors' lives are and seem only to want to ease their burdens. But every word, every courtesy, every gift, and every piece of information provided is carefully crafted, not to assist doctors or patients, but to increase market share for targeted drugs." Here are key elements of the DTD operation:

The file.

Each doctor is a mark, and drug reps are trained intelligence gatherers who build and constantly update a computerized corporate file on the doc's personality, preferences, interests, and any personal tidbits that might help them change his or her prescribing habits. The strategic goal of good reps is to become each doctor's trusted "friend"--not unlike the relationship that lobbyists try to cultivate with lawmakers.

The data.

How can pill peddlers know which ones your doctor is prescribing--isn't that a private matter? Not in today's bluntly intrusive world of commercial data mining. A majority of pharmacies sell their records of every single prescription written by doctors doing business with them. This vast trove of computerized info is bought by such data hawkers as IMS Health, which procures prescriptions from about 70 percent of US pharmacies. While the names of patients are deleted, the name of the doctor who wrote each prescription is easily discernible, so pharmaceutical giants pay millions a year to buy, slice, and dice the electronic data on exactly which medicines each doctor has ordered and in what quantities. This is regularly fed to the laptops, iPads, and even smartphones of the sales reps on the ground--allowing them to target their daily pitches, and to precisely and carefully track the slightest of changes in a doctor's prescribing habits.

The gift.

Reps don't go to a physician's office empty-handed. Gourmet donuts and lunch treats for the entire staff are daily routines, and doctors and key staffers are treated to dinners at fine restaurants, holiday gift baskets, tickets to a game or show, and such nice personal presents as a silk tie or a monogrammed golf bag. A New York Times report in January of this year says that two-thirds of doctors accept such goodies. For the heavy prescribers of a drugmaker's concoctions, the gifts grow ever-larger--a ski trip to Aspen, an invitation to make weekly paid "lunch and learn" presentations in other doctors' offices, an honorarium to make brief comments at a conference in some five-star resort (complete with an "educational grant" to cover the bar tabs and other incidentals), big-buck "consulting" contracts that require practically no work, and outright cash payments for prescribing particular drugs. The Times' January report found "that about a quarter of doctors take cash payments" and "that they are more willing to prescribe drugs in risky and unapproved ways."

The hoax.

Few doctors are experts in the chemistry and biological impacts of particular medicines, so they rely on honest studies and tests (as reported in credible medical journals) to give them an un-hyped, non-sales-rep picture of the pluses and minuses of the drugs they choose to prescribe to you and me. Unfortunately, this process, too, has been corrupted--drugmakers have regularly paid doctors and researchers to conduct studies and publish results without revealing their financial ties. Pfizer, however, sank this sales-over-science approach to new lows when it launched its antidepressant, Zoloft, in the 1990s. It hired an advertising firm to fabricate "studies," write them up as salutary reports about the drug, pay some big-name psychiatrists a couple of thousand bucks each to put their names on the reports, and convince major journals (read by thousands of doctors) to publish the ghostwritten "findings." About half of the medical articles about Zoloft at that time were ad agency fakes. Journal editors, embarrassed by being scammed, have since imposed safeguards, but many doctors and observers say that up to 20 percent of major journal articles are still being ghosted.

We can do better

DTC and DTD are just two surging branches of the central stream running through America's healthcare industry--an out-of-control stream that should be labeled DTP--"Direct-to-Profit." The very fact that healthcare, an essential human need, has been twisted into an "industry"--a commercial activity for the purpose of maximizing profits--is a damning measure of its moral bankruptcy.
As avaricious and monopolistic drug corporations have demonstrated again and again, "care" is treated, at best, as an externality to their real work of making money--and at worst as an impediment to that corporate imperative. Thus, top executives and boards of directors constantly seek ever more sophisticated forms of deception and manipulation to, at all costs, make the sale. In this ethos, such loathsome products as blatant price gouging, artificial shortages of vital medicines, deliberate promotion of pills that kill, falsification of medical research, and routine corruption of doctors are not merely tolerated, but expected and accepted as normal.

Is this the best that this great, super-rich country can do? Of course not--we Americans can, must, and will create a system that puts public need over private greed. This month's "Do Something" features some groups leading the way. I'll give the final word to Dr. Relman, the thoughtful, insistent, and unflagging voice for an ethical and sensible system of care built around the concept of "Medicare for all." A decade ago, he wrote that "our health policies have failed to meet national needs because they have been heavily influenced by the delusion that medical care is essentially a business... A different kind of approach could solve our problems, but it would mean major reform of the entire system... Since such a reform would threaten the financial interests of investors... the short-term political prospects for such reform are not very good. But I am convinced that a complete overhaul is inevitable, because in the long run nothing else is likely to work."

Jim Hightower is a national radio commentator, writer, public speaker, and author of the new book, "Swim Against the Current: Even a Dead Fish Can Go With the Flow." (Wiley, March 2008) He publishes the monthly "Hightower Lowdown," co-edited by Phillip Frazer.