Bottom Line's Daily Health News
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September 2, 2004
In This Issue...
* From Foreign Soil -- Is imported produce safe?
* Ulcers Gone for Good
* Being in the Know -- Getting the inside info on unpublished medical
research
* Make Yourself 10 Times Less Likely to Die of a Heart Attack...
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FROM FOREIGN SOIL
When I was young, there really was a season for summer fruits and
vegetables. Now, due to miracles of modern trade and agricultural
science, fruits and vegetables are available virtually all year long.
Locally grown produce always is best, but as the summer ends and the
winter comes, our markets replace most local and domestic produce
with foreign-grown foods. Problem: The US Food and Drug
Administration (FDA) has limited resources to inspect foreign-grown
foods, and there have been disturbing headlines in years past about
the safety of food from less-developed countries. So... what to do?
Go without? Or eat the imports?
Ronald H. Schmidt, PhD, food science professor at University of
Florida, Gainesville, and coauthor of Food Safety Handbook (Wiley),
is on the frontline of professionals who watch over our food supply.
His answers to my questions were surprisingly reassuring.
Dr. Schmidt reports that because of headline events in the past, the
countries that supply us with produce year-round have become
extremely sensitive to safety issues. They simply cannot afford to
alienate the American market by careless handling of produce.
Additionally, the companies that import foreign produce have
tightened quality controls to help ensure safety. Perhaps the most
stringent followers of good practice standards are the produce buyers
for large US stores and supermarket chains. Dr. Schmidt says that the
buyers who work for the supermarkets show up regularly in foreign
fields to be sure that workers are following best practice rules.
THE SAFETY GUIDELINES
The US Department of Agriculture has established standardized rules
for safety through a formal system called Good Agricultural Practices
(GAPs), based at Cornell University. This addresses the three
red-flag areas: The workers' hygienic practices... how water is used
for irrigation and cleaning... and proper use of fertilizers to avoid
fecal contamination. Although GAPs is voluntary and intended for
domestic farms, Dr. Schmidt says that buyers are insisting that
foreign producers also follow it. Indeed, consumers can ask at their
own markets if the produce there meets GAPs' standards, he says.
Other protective systems often used are the Hazard Analysis and
Critical Control Point (HACCP) and the outreach efforts of a joint
FDA-University of Maryland program called the Joint Institute for
Food Safety and Applied Nutrition (JIFSAN).
SAFETY ENDS AT HOME
Knowing that these systems are in place eases anxiety to a great
degree, but there remains the possibility of oversight and accidents.
I wanted to know what consumers should be aware of as they shop for
and prepare produce.
Dr. Schmidt reminds people to think about how food grows and respond
accordingly.
Example: Melons grow on the ground, which means the rinds are apt to
have -- at the very least -- some dirt on them. There is the remote
possibility that the dirt could carry traces of fecal matter (from
organic fertilizer) or pesticides. Always rinse a melon very well
under running water (soap is not necessary, he says). Use a clean,
freshly washed knife to cut into it to avoid cross contamination, and
serve it on a plate that has not been in contact with the unwashed
rind. The other issue with produce from the ground has to do with
"downed" crops. Those that grow above ground but are harvested after
falling to it have dirt on them and are not fully cleaned. Downed
apples, contaminated with a virulent strain of E. coli, processed
into an unpasteurized product, caused the contamination problem in
apple juice a number of years ago. Today, as a result, producers no
longer use downed apples for juice, nor do they produce unpasteurized
juice.
Interestingly, Dr. Schmidt says that although grapes are sprayed and
always require thorough rinsing before eating, they almost never
carry any bacterial contamination. (The news of contaminated grapes
from Chile in 1989 turned into a catastrophe for the grape producers
and workers. Eventually it was discovered that the furor was over
grapes in Philadelphia that were likely tampered with here in the
US.) Blueberries also are generally free of contaminants, which, he
says, is odd because they are hard to wash. Peeled fruit is safe as
long as you handle it correctly, including washing your own hands
after rinsing the fruit when necessary. He says that he has not heard
of any contamination problems with banana peels.
Sprouts of any sort are the food that causes Dr. Schmidt particular
concern. He explains that to germinate the sprout requires a wet
environment that salmonella can actually grow in. The presence of
salmonella requires chlorine to remove it, and even then it is almost
impossible to do so successfully. People who are immunosuppressed
should definitely avoid sprouts of any kind and even healthy people
might be wise to forego commercially grown products, he says.
The other problem for immunosuppressed people could be raspberries.
Because of their rough surface, if the bacteria cyclospora gets in
them, it is nearly impossible to get out. Nevertheless, he does not
advise healthy people to avoid the pleasure of this delectable and
healthy berry.
No matter where the produce is from, Dr. Schmidt says the most
important step is for people to adopt their own best safety
practices. Rinse everything, including pre-washed, pre-cut salad
greens and garnishes, under running water. Regularly wash your hands,
utensils and cutting boards in warm, soapy water to avoid cross
contamination. With improved safety standards in the US and abroad
and good practices in your own home, nature's bounty can indeed be
enjoyed long after the lazy days of summer are over.
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BEING IN THE KNOW
Recently we discussed how the results of many clinical trials go
unseen. Result: Favorable research results on a given drug might be
played up while the more mixed results are swept under the carpet.
In one of the more egregious examples of this practice, drug
manufacturer GlaxoSmithKline failed to publish negative results
suggesting that use of the antidepressant Paxil in children and teens
might provoke suicidal thoughts. What can you do now while those in
Washington are working to close this dangerous communication loophole?
To learn more about the ins and outs of clinical trials, I spoke with
Timothy B. McCall, MD, a Boston internist and author of Examining
Your Doctor: A Patient's Guide to Avoiding Harmful Medical Care. He
told me that unless a law is enacted to compel them to do so,
pharmaceutical companies are unlikely to change their policy and
begin making negative results available to the public.
WHAT YOU CAN DO NOW
In the meantime, current trial registries are maintained by a variety
of institutions, such as the National Institutes of Health and the
National Cancer Institute. Listings vary. They include open trials,
active ongoing studies and links to and summaries of completed
trials. Although the current focus has centered on published
research, the overall goal is to achieve more open disclosure all
around, for consumers as well as medical professionals.
Other helpful Web sites include...
* National Institutes of Health, http://www.clinicaltrials.gov
* National Cancer Institute, http://www.cancer.gov
* National Library of Medicine, http://www.medlineplus.gov
HOW TO JUDGE A CLINICAL STUDY
The next step is to determine what the results mean. Dr. McCall
observes that it is very difficult for a consumer to make judgments
about a clinical trial from, say, an abstract on Medline. When you
visit Web sites and look at studies, he recommends that you ask the
following critical questions...
* Was it a controlled study? How many participants were involved? A
large, double-blind, randomized, controlled study has the most
validity. In this type of trial, neither the participant nor the
investigator know who is receiving the placebo and who is receiving
the active drug.
* Were patients in the trial like you? If the study looked at
65-year-old men and you are a 40-year-old woman, it doesn't have much
relevance, says Dr. McCall.
* Who paid for the study? If it was the manufacturer of the drug
being looked at, it may be perfectly accurate, but take it with a
grain of salt.
* Who conducted the study? Are the scientists who carried out the
research paid consultants to the pharmaceutical companies involved?
* Where was it published? Rigorous, peer-reviewed journals are best.
The prestigious "biggies" -- such as Journal of the American Medical
Association (JAMA), New England Journal of Medicine (NEJM) and Lancet
-- all are peer-reviewed. The easiest way to find out is to look
on-line. These journals solicit and publish commentary on research
from formally trained, acknowledged experts in the area of the study
in subsequent issues.
STAY INFORMED
Dr. McCall says to keep in mind that no studies are 100% definitive.
Having as much information as possible about your condition and
having a critical eye in reviewing that info will help you ask better
questions and better evaluate your doctor's answers and actions. You
also can protect yourself by sticking with tried-and-true drugs,
rather than what is new on the market.
A final reminder from Dr. McCall -- in an ideal world, there would be
an equal number of dollars distributed to clinical trials on all
treatments. Unfortunately, reality doesn't work that way. Since so
much research is funded by pharmaceutical companies, alternative
approaches such as yoga, herbal remedies or acupuncture often are
shortchanged. But don't rule them out -- you may be missing the
opportunity to try other valuable healing modalities.
Be well,
Carole Jackson
Bottom Line's Daily Health News
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Sources...
>From Foreign Soil
* Ronald H. Schmidt, PhD, food science professor, University of
Florida, Gainesville, and coauthor of Food Safety Handbook (John
Wiley & Sons).
http://www.amazon.com/exec/obidos/asin/0471210641/blpnet
Being In The Know
* Timothy B. McCall, MD, Boston internist and author of Examining
Your Doctor: A Patient's Guide to Avoiding Harmful Medical Care
(Citadel Press). Visit his Web site at http://www.drmccall.com.
http://www.amazon.com/exec/obidos/asin/1559722827/blpnet
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