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Part Nine (sidebar): The Epidemic That Wasn't?

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http://nasw.org/mem-maint/awards/01Taubesarticle9.html

 

by Gary Taubes

 

For half a century, nutritionists have pointed to soaring death rates as

the genesis of their research into dietary fat and heart disease and as

reason to advise Americans to eat less fat (see main text). " We had an

epidemic of heart disease after World War II, " obesity expert Jules

Hirsch of Rockefeller University in New York City said just 3 months ago

in The New York Times. " The rates were growing higher and higher, and

people became suddenly aware of that, and that diet was a factor. "

 

To proponents of the antifat message, this heart disease epidemic has

always been an indisputable reality. Yet, to the statisticians at the

mortality branch of the National Center for Health Statistics (NCHS),

the source of all the relevant statistics, the epidemic was illusory. In

their view, heart disease deaths have been steadily declining since the

late 1940s.

 

According to Harry Rosenberg, director of the NCHS mortality branch

since 1977, the key factor in the apparent epidemic, paradoxically, was

a healthier American population. By the 1950s, premature deaths from

infectious diseases and nutritional deficiencies had been all but

eliminated, which left more Americans living long enough to die of

chronic diseases such as heart disease. In other words, the actual risk

of dying from a heart attack at any particular age remained unchanged:

Rather, the rising number of 50-year-olds dropping dead of heart attacks

was primarily due to the rising number of 50-year-olds.

 

The secondary factor was an increase from 1948 to 1968 in the

probability that a death would be classified on a death certificate as

arteriosclerotic disease or coronary heart disease. This increase,

however, was a figment of new diagnostic technologies--the wider use of

electrocardiograms, for instance—and the changing terminology of death

certificates. In 1949, the International Classification of Diseases

(ICD) added a new category, " arteriosclerotic heart disease, " under the

more general rubric " diseases of the heart. " The result, as a 1958

report to the American Heart Association noted, was dramatic: " In one

year, 1948 to 1949, the effect of this revision was to raise coronary

disease death rates by about 20% for white males and about 35% for white

females. " In 1965, the ICD added a category for coronary heart disease,

which added yet more deaths and capped off the apparent epidemic.

 

To Rosenberg and others at NCHS, the most likely explanation for the

postwar upsurge in coronary heart disease deaths is that physicians

slowly caught on to the new terminology and changed the wording on death

certificates. " There is absolutely no evidence that there was an

epidemic, " says Rosenberg.

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