Monday, 4 June 2018

The Ideal Subjects for a Salt Study? Maybe Prisoners.

salt study

Suppose you wanted to try to do a study of diet and nutrition, with thousands of participants randomly assigned to follow one hotel plan or another for years as their health was monitored?

In the world, studies like these are nearly impossible. That’s why there remain numerous unanswered questions on what’s best for people to eat.

And one of the most important of these mysteries concerns salt and its relationship to health.

But now a gaggle of eminent researchers, including the previous head of the Food and Drug Administration has suggested how to resolve science’s so-called salt wars.

They want to conduct an immense trial of salt intake with incarcerated inmates, whose diets might be tightly controlled.

The researchers, who recently proposed the thought within the journal Hypertension, say they're not only completely serious — they're optimistic it'll happen.

Using inmates as study subjects are controversial, to mention the smallest amount. History is laden with horror stories. within the 1940s, prisoners were deliberately infected with malaria.

In the 1950s, inmates were infected with hepatitis. A decade later, scientists irradiated prisoners’ testicles.

“Prisons are an inherently coercive environment,” said Ruth Macklin, an ethicist, and professor of epidemiology and population health at Einstein College of drugs.

But “that doesn’t mean consent is impossible.”

The point of the proposed study is to place an end to decades of scientific disagreement over salt and its benefits and hazards.

On one side are researchers who say Americans eat an excessive amount of sodium which it's harming their health.

For healthy people, the American Heart Association recommends 2,300 milligrams each day.

But for those with a high vital sign, the perfect amount is 1,500 milligrams or but half a teaspoon.

The higher one’s vital sign, the greater the danger of heart attacks and strokes. Low-salt diets lower vital sign, so a really low-sodium diet needs to end in less disorder and fewer deaths.

On the opposite side are scientific dissenters who say, “Prove it.”

They worry that very low sodium levels can actually make health worse, citing studies that found higher death rates and rates of heart attacks and strokes in people following low-sodium diets.

And the stubborn resistance of individuals told to consume less salt indicates to some experts that humans crave salt for a reason — they have it for his or her health.

Average sodium consumption within us and in many other countries has not budged for many years. it's about 3,200 milligrams each day.

For years, doctors, including a gaggle that produced a report for the Institute of drugs on dietary sodium, have involved a randomized clinical test of sodium within the diet that checked out outcomes like deaths and strokes, not in danger factors like blood pressure.

But there has never been such an attempt, which has made this subject a minefield for scientists and consumers alike.

Dr. Daniel W. Jones, a professor of drugs and physiology at the University of Mississippi School of drugs and former president of the American Heart Association, was alarmed by the bitter arguments and increasingly personal disputes between researchers who disagree about salt.

So he invited senior medical scientists on each side of the talk to satisfy in Jackson, Miss., to work out the way to settle their differences.

“I wanted a balance between different points of view,” said Dr. Jones, who believes low-salt diets are healthier.

“And I wanted people that had avoided the temptation of disparaging the motives of these who disagreed with them.”

Tellingly, those criteria “got me right down to a little list of individuals to ask,” Dr. Jones said.

Those he invited, six altogether, agreed to take a seat right down to discuss their differences at the university in Jackson, Miss.

(He later invited two other researchers — Dr. Eric Peterson, a clinical trials expert at Duke University, and Dr. Robert Califf, also at Duke and a former head of the Food and Drug Administration — to weigh in on the ultimate paper.)

Dr. Jones and Dr. David McCarron, a nutrition researcher at the University of California, Davis, who worries that low-sodium diets are dangerous to health, led the discussion.

They began by putting the Institute of drugs report before the group and highlighting the advice that there be a randomized clinical test during a population whose diet is often controlled.

Then they asked, “What are we getting to do about it?” “Is it not time for somebody to undertake to try to do this? And if the solution is yes, what's the perfect population?” Dr. Jones said, recalling the conversation.

For two days, the group debated and pondered various options. Conduct the study among military personnel? Too young.

Nursing homes? Too many residents are already prescribed low-sodium diets.

The best option, by far, appeared to be people that were incarcerated.

So suppose you are doing the study in prisons, said Dr. Jones. is that the research alleged to benefit the prisoners or simply the population in general? If the prisoners wouldn't benefit, the study would be unethical.

People who aren't incarcerated can choose what proportion sodium they consume, but prisoners cannot — they eat regardless of the facility provides.

If there's uncertainty about the perfect amount of sodium, the experts concluded prisoners would enjoy a study that settled the matter.

The group consulted with Marc Morjé Howard, a professor of state and law at Georgetown University. He also teaches at a close-by maximum-security prison.

“It’s a touch little bit of an ethical minefield,” Dr. Howard said during an interview.

“My concern would be that it not in any way be detrimental to prisoners’ health and it might be voluntary.”

But, Dr. Howard said, “I do think it's possible if it's done very, very carefully with the complete cooperation of prison authorities.”

He added that a lot of incarcerated people have outgrown their criminal pasts and have a desire to assist society.

“They want to repent,” he said.

“I wouldn’t be surprised in the least if many of us would say, ‘I would like to be a part of this study,’” he added.

Dr. Macklin, during an interview, also said many prisoners would be happy to leap in.

She has taught during a maximum security facility and has studied the ethics of doing research in prisons.

“They would say they need to offer back to society,” Dr. Macklin said.

“Even if there are more self-centered reasons, any deviation from the routine of being a prisoner is welcome.”

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