From: young@sasquatch.serum.kodak.com (Rich Young (x37176))
Subject: Re: Vegetarians and Missionaries
Organization: Clinical Products Division, Eastman Kodak Company
Date: Mon, 13 Apr 1992 15:08:10 GMT

altar@beaufort.sfu.ca (Ted Wayn Altar) writes:

>young@sasquatch.serum.kodak.com (Rich Young (x37176)) writes:
>
>>>>Rich Young writes:
>>>>
>>  Please note that the above question about a diabetics' sweet tooth is
>>  quoted completely out of context.  Having said that, the following is
>>  quoted from __The Merck Manual__, Fifteenth Edition, 1987, without
>>  permission:
>[lengthy passage from the Merck Manual here ommitted]
>
>    Well, we know how very conservative this Merck manual
>can be.  After all, it is published by Merck Sharp & Dohme
>Research Laboratories and the chief and assistant editors
>are employees of the same company.  I wouldn't expect a
>major drug company to be overly enthusiastic about dietary
>reforms.

  I see.  And this source is less reliable than Robbins, McDougall, Lappe,
  and Singer?  Let us recall the lines which prompted the quoting of the
  Merck Manual in the first place:

    "I think this is particularly ironic because diabetes is more aggravated
    (and caused) by fat intake (particularly animal fat intake), than sugar
    intake.  A vegetarian (vegan) diet is probably the best thing for a
    diabetic or person interested in not getting diabetes in the future."

  With this in mind, shall we now evaluate the relative veracity of the
  information presented?

  I do not feel it particularly necessary to justify the information presented
  in the Merck Manual, but I will, for the group at large, quote from the
  Foreward, wherein the review process for the Manual is described:

	"Sections of [the previous edition] were...sent to outside experts,
	who had nothing to do with its preparation, to solicit their most
	candid criticism.  Published reviews and letters received from readers
	were analyzed.  Next, the Editorial Board met to compare reviews and
	critiques and to plan this 15th Edition.  Distinguished special
	consultants were enlisted to provide additional expertise.  Then, 269
	authors with outstanding qualifications, knowledge, and experience
	were engaged.  Their manuscripts were edited repeatedly in-house
	to retain every valuable morsel of knowledge while eliminating
	sometimes elegant, but unneeded, words.  [...]  Every mention of a
	drug and its dosage was reviewed by a separate outside consultant.
	[...]  Almost all the manuscripts were revised at least 6 times; 15 to
	20 revisions were not uncommon.  We believe that no other medical
	text undergoes as many reviews and revisions as THE MERCK MANUAL."

  Now, as to the credits of the Editorial Board, it consisted [for the 15th
  Edition] of eleven people, NONE of which are directly affiliated with
  Merck, Sharpe, and Dohme [note that some credits are left out because I
  didn't want to do that much typing]:

	Philip K. Bondy, M.D.
		Professor of Medicine, Yale University

	L. Jack Faling, M.D.
		Associate Professor of Medicine, Tufts University

	Alvan R. Feinstein, M.D.
		Professor of Medicine and Epidemiology, Yale University

	Eugene P. Frenkel, M.D.
		Professor of Internal Medicine and Radiology, University of
		Texas Health Science Center

	Robert A. Hoekelman, M.D.
		Professor and Chairman, Department of Pediatrics, University
		of Rochester

	Robert G. Petersdorf, M.D.
		President, Association of American Medical Colleges; formerly
		Dean, School of Medicine, University of California, 
		San Diego

	Fred Plum, M.D.
		Professor of Neurology, Cornell University

	John Romano, M.D.
		Distinguished University Professor of Psychiatry (Emeritus),
		University of Rochester

	G. Victor Rossi, Ph.D.
		Professor of Pharmacology, Philadelphia College of Pharma-
		cology and Science

	John H. Talbott, M.D.
		Clinical Professor of Medicine, University of Miami

	Paul H. Tanser, M.D.
		Professor of Medicine, McMaster University; Chief of Medicine
		and Head of Cardiology, St. Joseph's Hospital, Hamilton,
		Ontario, Canada

  There are 9 consultants and 269 contributors as well; shall we question the
  credentials and motives of all of these as well?

  There is no doubt that the Merck Manual reflects the mainstream of medical
  thought, but to dismiss it as a valid source of information is unwarranted.
  Perhaps the following, quoted from page 1084, will help to illustrate the
  "bias" you seem to reject (in reference to dietary treatment of diabetes):

	"Complicated dietary problems, especially attempts at weight loss,
	can benefit from guidance provided by a registered dietician or
	other qualified diet counselor who will work closely with the
	individual patient.  Many physicians lack adequate background
	and time to instruct a patient properly about diet."

  Yes, indeed-deed-deedy, this book is certainly a tool of the AMA and biased
  in favor of the drug industry all right.

>     Of course, if such treatments were a matter of course
>for physicians, then presumably such treatments for diabetes
>would be listed.  Let us remember, however, that the Merck
>manual is published for the general practitioner to provide
>a quick reference of the established, conventional practice,
>certainly, not the cutting edge stuff, nor, is it meant as
>an exhaustive compendium of all possible treatments.

  From the Foreward:

	"New and sophisticated laboratory and technologic procedures are
	also described, with comments on their uses, interpretations, and
	limitations."

	"Current therapy is presented for each disorder and supplemented
	with a separate section on clinical pharmacology that describes
	general principles, new advances [...], details of pharmacologic
	groups and specific agents, and even a discussion on the use of
	placebos."

  Having quoted that, it should be recognized that recommended therapies
  may have changed in the new 16th Edition, [to be?] published this year.
  Whatever changes in therapy might have been made, however, it is clear that
  diabetes is not "caused by" fat intake, as claimed by the original poster.

[...]

>     Anyway, the Merck Manual is certainly a cut above
>Science News in at least being a good secondary source (as
>opposed to being a tertiary source),

  I was under the (obviously mistaken) impression that you had called Science
  News a SECONDARY source...have you now changed you mind?  Again, I feel no
  particular compunction to defend the veracity of yet another publication
  that says things you don't like, nor can I vouch for the readership of
  Science News, but if published Letters to the Editor can be taken as
  representative of readership, it would seem that you are one of a very few
  who strive to give it no credence at all:

	Jonathan Shear
		Associate Professor of Philosophy, Virginia Commonwealth
		University

	Edmund Storms
		Nuclear Materials Division, Los Alamos National Laboratory

	Alan B. Shaw
		Geologist

	Robert E. Henshaw
		New York State Department of Environmental Conservation

	John Cairns
		Professor of Microbiology, Harvard School of Public Health

	Jeffrey Roseman
		Director, Center for Health Risk Assessment and Disease
		Prevention; Associate professor of Epidemiology, University
		of Alabama

	Robert E. Crippen
		Jet Propulsion Laboratory, Pasadena, California

	John R. Saylor
		Research Fellow, Dept. of Mechanical Engineering, Yale
		University

	George von Hilsheimer
		Neuropsychologist, Associated Health Professionals, Florida

	Steven R. Newcomb
		Vice Chairman, Center for Music Research, Florida State
		University

	Sidney Karin
		Director, San Diego Supercomputer Center, San Diego, Calif.

  Now, there is no intent to claim that these people are experts in their
  fields, but it is clear that a wide variety of educated professionals
  believe Science News to be a credible source of information.  Note that
  the above list was extracted from _8_ issues (it is published weekly, for
  those not familiar).

[...]

>     Now, it so happens that I too have a personal copy of
>the 15th edition of the Merck manual, but I certainly don't
>go citing passages religiously from this "pocket reference"
>as if such citations are going to so simply resolve a
>complex issue or nutritional debate.

  OK, just for purposes of this discussion, what would YOU have used to
  refute the following inaccuracy...or don't you consider it to be inaccurate?
  As above, I'll leave to gentleman's name off to prevent his further
  embarrassment.

     "I think this is particularly ironic because diabetes is more aggravated
     (and caused) by fat intake (particularly animal fat intake), than sugar
     intake.  A vegetarian (vegan) diet is probably the best thing for a
     diabetic or person interested in not getting diabetes in the future."

  I would think that, in the spirit of presentation of truth and correction
  of error, that you would have spent more time correcting the above statement
  and less time criticizing my sources.  This certainly smacks of a certain
  paranoia regarding data which does not fit a particular mold, but we'll
  be "magnanimous" and assume that omission of better data, from better
  sources, in your diatribe was an oversight.

  Since you reject MY information, we'll be waiting with 'bated breath for
  YOUR reply to this misinformation, or your proof of its veracity.

-Rich (young@serum.kodak.com)

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