Freedman’s piece used a lot of words to say, in essence, “Don’t believe anything you read when it comes to your health. But read as much as you can. That’s the best hope you have.” It’s awkward common sense, but in offering it, Freedman is tarring with too broad a stroke. His passing mention of Gary Taubes, whose books I publish, alludes to his New York Times Magazine piece, which argued that perhaps fats aren’t as bad for us as commonly assumed. But in two of Gary’s books, Good Calories, Bad Calories (which contains more than 100 pages of source notes and bibliography combined) and Why We Get Fat, he simply follows the science, explaining why some studies seem more solid than others. Importantly, he also makes an explicit plea that the theory he favors be tested—properly and rigorously. As Freedman sees it, that might not bring us any more wisdom than all the other studies, be they double-blind or any other form. But to me, it sets Gary apart from many of those he is lumped in with in the article. Follow the science. That’s the best we can do, and should be encouraged to do so.
Jonathan B. SegalVice president and senior editorAlfred A. KnopfNew York, NY
What Freedman’s article, most health/medical writing, and most research tends to ignore is the issue of heterogeneity. Practically all studies are based on averages, most often of a select group of patients. The findings may well apply to similar patients. But a significant portion of people are outliers, and the data simply does not apply well to them.
The CATIE trial of psychoactive drugs showed that while one class of drugs works best in one group of patients, that drug often did not work well in another group of patients, who responded better to another class of drugs.
Researchers, physicians, and people who write about medicine need to begin to grapple with these issues of heterogeneity. It is the only way we are going to attain the promise of individualized medicine.
Bob RoehrWashington, DC
Helena Bottemiller’s article (“Safe at the Plate,” CJR, January/February) really resonated with my experience getting food-safety records. I have been struggling mightily with the fda’s Center for Veterinary Medicine (CVM) FOIA office this last year, during which time, countless simple inquiries like “Is my FOIA request still open?” went unanswered. At least a dozen such emails and phone calls to CVM went unanswered in the last year, as I attempted to follow up every month or so.
While this lapse may have been due to the retirement of a sick employee, it doesn’t excuse the CVM from fulfilling the requirements of the foia law. The CVM eventually did replace its FOIA officer, but the disturbing pattern of non-disclosure continues. My seven-month-old FOIA requests grow older by the day, and even simple inquiries into their status go unanswered. Thanks for raising awareness on this issue.
Tim SchwabWashington, DC
I was surprised, in the coverage of the passage of Obamacare, that so little was written about how things are done in other countries and how much leverage government-run healthcare has in reducing its costs. You dismiss this leverage in your editorial (“Obamacare: round two,” CJR, January/February), saying it’s not part of Obamacare, but it is part of Medicare. That basic journalistic question—How much does it really cost?—was never adequately answered for US citizens. Let me give you an example. I remember a news story that ran about 20 years ago in the Globe and Mail, about a Canadian woman who gave birth to a baby in a US hospital and received an itemized bill. Canadians like me were aghast at the outrageous overcharging the hospital did. A single maxi pad cost something like $40. We all knew that was insane, and we wondered why US citizens paid those crazy prices. But when I moved to the US and started getting medical bills, I saw that they were never itemized. American consumers have no idea what they’re being charged, in detail, and I think that’s why they accept the price-gouging that is probably the norm. The only reason we saw itemized bills in Canada was that our government-run insurance required them before it would pay. Shouldn’t US journalists insist on that also? Comparing US costs for standard medical procedures to those in Canada, Britain, France, etc—or what the government agrees to pay for the same services in those countries—would be a great idea.
Carrie BuchananUniversity Heights, OH
Depth of field