Trans fats and population health management

Dec. 13, 2013
There may be fewer cardiac troponin tests, among others, in your lab’s future. Last month, the FDA published recommendations that would severely restrict the use of artificial trans fats, linked to heart attacks and strokes, in the manufacture of foods for consumption in the United States. The agency’s proposal says that foods that contain partially hydrogenated oils (PHOs) will no longer be designated “generally recognized as safe.” That means producers of foods that include trans fats would have to prove they are safe—in the face of much scientific evidence to the contrary.

“While consumption of potentially harmful artificial trans fat has declined over the last two decades in the United States, current intake remains a significant public health concern,” says FDA Commissioner Margaret A. Hamburg, MD. “The FDA’s action today is an important step toward protecting more Americans from the potential dangers of trans fat. Further reduction in the amount of trans fat in the American diet could prevent an additional 20,000 heart attacks and 7,000 deaths from heart disease each year.”

“One of the FDA’s core regulatory functions is ensuring that food, including all substances added to food, is safe,” says Michael Taylor, the FDA’s deputy commissioner for foods and veterinary medicine. “Food manufacturers have voluntarily decreased trans fat levels in many foods in recent years, but a substantial number of products still contain partially hydrogenated oils.”

A 60-day comment period on the proposal will continue through early January. If, after reviewing submitted comments, the FDA makes this preliminary determination final, PHOs would be considered to be food additives, and they could not be used in foods without FDA approval. Food manufacturers would be given sufficient time, in the FDA’s words, “to reformulate products in order to minimize market disruption.”

Many scientific and nutritional organizations are hailing the recommendations. “Artificial trans fat is a uniquely powerful promoter of heart disease, and today’s announcement will hasten its eventual disappearance from the food supply,” says Center for Science in the Public Interest executive director Michael F. Jacobson, PhD. (Disclosure: Jacobson happens to be my brother-in-law—due to a decision made by my sister a quarter-century ago. She did not permit a comment period for other members of the family.)

In contrast, organizations that tend to be concerned about what they see as overreach by the federal government are criticizing the FDA. Following the publication of the recommendations, Fox News, for instance, ran a feature criticizing “food police” who seek to impose their will in areas best left to “personal responsibility.”

It’s a reasonable political debate—though, in my opinion, the argument boils down to whether there should be an FDA, as currently constituted, at all. If there should be an FDA, it certainly is acting in accordance with its responsibility to ensure that food is safe. The science is clear. That’s my two cents.

I think that two articles in this month’s issue of MLO offer another context in which to consider the FDA’s proposed ban on PHOs: the idea that healthcare going forward will stress both personalized medicine and population health management.

In the Continuing Education story, “LIS of the future: supporting value-based measures for healthcare” (pp. 8-12), Kim Futrell, MT(ASCP), refers to “healthcare’s collective focus turn[ing] to proactively managing the health of populations.” In the Future Buzz story “Personalizing public health in the medical laboratory” (pp. 36-37), Gualberto Ruaño, MD, PhD, suggests that personalized medicine, which treats the individual sick person, can be allied with the public health approach of reducing the number of people who become sick in the first place.

If, in fact, the emerging healthcare system includes an increasing emphasis on population health management, won’t federally mandated regulations like that being proposed by the FDA need to be part of that? I’d like to know what you think.

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