“There are lies, damn lies and statistics”, Mark Twain. The USA Have you ever wondered why you constantly hear “one in three people die from heart disease” and yet you don’t lose one third of your friends and family every year? The USA death rate from all causes for 2006 was 0.78%. That means 777 people, per 100,000 residents of the population, died in 2006. Death certificates recorded 200 of these deaths as heart disease. So 0.2% of the USA population died from heart disease in 2006. If you have 500 friends, you are likely to lose one of them to heart disease during a year. If most of your friends are female, heart disease is so weighted towards males that you could have 620 female friends, or 405 male friends, with the same risk of losing one friend during a year. That’s still one lost friend too many, but there is also an age dimension to consider. You would need to know 166,667 children aged 5-14 to have a likelihood of one dying from heart disease (which would in turn most likely be a rare hereditary condition) and yet, if you know 100 people aged 85 and over, 22 of them are likely to have heart disease on their death certificate over the next year. In 1950, staying with the same American data, the death rate from all causes was 1.45%. Hence, this has been virtually halved with advances in medical treatment. (I would argue that, had we maintained our natural eating heritage and advanced our treatment options in the way that we have, death rates could have been reduced further still). Of these 1,446 deaths per 100,000 people, 589 (41%) were recorded as heart disease. This is interesting per se as the World Health Organisation was only formed in 1948 and heart disease was a little recognised condition before then. By 1960, the death rate had fallen to 1.34% with 42% of those deaths recorded as heart related. In 1970, the year that the Seven Countries Study was published, the overall death rate had fallen further to 1.22% and heart deaths had fallen to 40% of these. This could be interpreted as fewer than six people in 1,000 were dying from heart disease, or four in ten – depending on lies and statistics. The four in ten positioning provides the context for the impetus for change that preceded the 1977 Dietary Goals for the United States announced by Senator George S. McGovern, chair of the Senate Nutrition Committee. It is worth noting that the conclusions from the 1970 Keys’ study were all that were available at the time when America changed its dietary advice in 1977. The data from the 25-year follow up (which no longer mentioned fat) was not available until 1993. Other studies, not least by Keys and his disciples, were continuing to assert the relationship between saturated fat and heart disease and cholesterol and heart disease and saturated fat and cholesterol (without actually explaining how any of this could happen biochemically). However, it is not unreasonable to assert that America changed its entire public health dietary advice on the basis that some people had been observed bathing and singing and some people had been observed not bathing and not singing. And there wasn’t much more evidence than that. Another point worth noting is that, on the flimsy proposal that CHD, cholesterol and dietary fat “tend to be related” in some of a few hand-picked observations, even if this may have had any relevance for a handful of people in a thousand, the dietary advice was changed for everyone. There were 203 million Americans in 1970; 226 million by 1980 and the Dietary Goals for the United States were mandated for the whole population. The report summary states: “The major objective of the report is to identify ‘risk factors’ in the American diet and ways to reduce them in order to minimize their harmful effects on health.” The dietary goals recommended were:
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