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Unscientific recommendations

Re: “Eat to Beat Inflammation” (November/December 2007). I am writing to express my concern about this article, which begins with the story of a woman with arthritis who was allegedly promptly cured by the “applied science” offered by a Toronto chiropractor. The article goes on to piece together selected preliminary research findings and implies that a large body of research supports the clinical use of food to reduce the burden of inflammatory disease.

There is no question that research into the role of food in disease promotion/prevention is legitimate, but to assume that correlations noted in observational trials will translate into medical benefit is at best a substantial overstatement of the results. Much more useful would be an article that discusses how suppositions of clinical benefit based on survey data and test-tube results have virtually never been borne out in clinical trials (witness vitamins C and E, antioxidants and multivitamins).

Canadian physicians struggle every day with health misinformation promoted on the Internet and by alternative health-care providers. It is all too easy to give an article the gloss of science by selective citation. I hope you will agree that the last thing we need is to promote the message that the miracle-diet cures of chiropractors are based on good science.

Lloyd Oppel, MD
Vancouver

Clarifications on choking

Re: “Choking Hazards (September/October 2007). I wish to correct several inaccuracies in this article.

1. Cheese is a relatively low-risk food in terms of choking. 2. A large chunk of meat or multiple small pieces of meat (especially of tough texture) can cause choking. But once children can eat thick puréed food without choking, they can be given small, finely cut pieces of cheese and meat. 3. Hot dogs, grapes, gel candies (a.k.a. Mini Fruity Gels and Fruit Poppers) and deflated balloons are the foods and objects most likely to completely obstruct the voice box and rapidly kill a child. Hot dogs and grapes should be cut lengthwise into quarter sections until a child is at least five years old and able to easily chew and swallow steak. 4. Children should not be given pieces of nuts, raw carrots, raw apples or raw pears until they are able to easily chew and swallow crusty bread. Unpopped popcorn kernels are also a major choking risk. 5. Coins are the most common foreign body of the upper aerodigestive tract. They lodge in the esophagus and are the most common reason children have to go to the operating room for choking. Unlike disc batteries (which look like coins on an X-ray), coins almost never cause serious injury or death. 6. Cut-off corners from plastic milk bags — just like metallic stickers, pencil shavings and the corners of ketchup wrappers — can become stuck between the vocal cords and cause a croupy cough and a hoarse voice. These foreign bodies are unlikely to kill a child.

Jeffrey P. Ludemann, MDCM, FRCSC
Vancouver

An unnecessary slur

Re: “Don’t Mind Waiting” (May/June 2007, p. 22). We are reassured by Giancarlo La Giorgia that the exercises he proposes for the bank queue are so subtle that in doing them you won’t look as though you are “off your meds.” Surely in a publication sponsored by the Canadian Medical Association we can expect better than to see this kind of thoughtless slur against patients taking psychopharmacological medications.

Robert G. Cooke, MD
Toronto

Proof please

Re: “Editor’s Letter” (March/April 2007). I have no problem with your becoming a lab rat, but I am not sure whether the CMA should be lending its weight to your effort. The thrust of the study in question is to determine whether a particular diet will improve your lipid profile. If this were the actual end, it would be harmless — though the means to this end might be unpleasant — but probably basically harmless (although even this is, in truth, unknown). But the unstated implication is that altering your lipid profile is somehow going to be beneficial to you, and this is far from proven.

As for “Put Your Home in Detox” (March/April 2007, p. 29), along the same lines, this article strays outside  the bounds of science. Some people’s homes may have elevated levels of some of the chemicals listed, but it is unfounded to suggest that this is universal, or even common. We live in a sea of chemicals, both synthetic and — more to the point — naturally produced by the living organisms that surround us. Acetone is used as a solvent in many commercial preparations but is also produced (and detoxified) in our own bodies. It is no more toxic to us for being manufactured synthetically than it is when we make it ourselves. Our food is filled with toxic chemicals — produced by the plants themselves (cyanide in vegetables, oxalic acid in rhubarb). These are no less toxic when made in food than in a test tube. Unless it can be shown clearly that adverse consequences flow from exposure, it is unjustified to advocate the heroic removal of these substances.

David Maxwell, MD
Halifax