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OIA 07-2011 Rimm and Moats MoH

OIA 07-2011 Rimm and Moats MoH

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Published by EricCrampton
New Zealand Ministry of Health response to OIA request on its changes to the 2010 Food and Nutrition Guidelines for Healthy Older People.
New Zealand Ministry of Health response to OIA request on its changes to the 2010 Food and Nutrition Guidelines for Healthy Older People.

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MANATO

HAUORA

133 Molesworth St P.O. Box 5013 Wellington 6145 New Zealand

29 July 2011

Phone (04) 496 2000 Fax (04) 496 2340

Dr Eric Crampton Department of Economics University of Canterbury Private Bag 4900 CHRISTCHURCH 8140 Ref: H2011 021 05

Ref. No

_

Dear Dr Crampton Official Information Request Thank you for your email of 7 July 2011 requesting official information. You asked for all internal and external memorandums, emails, file notes and written notes regarding the deletion of the Rimm and Moats (2007) reference from section 4.15 of the Food and Nutrition Guidelines for Healthy Older People: A background paper (2010). Please find enclosed the information you asked for. As per clause 9 (2)a of the Official Information Act 1982 some information has been redacted to protect the privacy of natural persons. I understand the reference by Rimm and Moats (2007) was removed from these guidelines in November 2010. Following your letter to Minister Ryall dated 20 August 2010, Ministry of Health staff reviewed the section on alcohol in Food and Nutrition Guidelines for Healthy Older People: A background paper (201 0). This process involved internal consultation and no external advice was sought in this instance. As a result, Ministry staff decided the reference to Rimm and Moats (2007) was used incorrectly so it was removed and a more appropriate reference added in its place. You have the right to ask the Ombudsman to review my decision on this request.

Yours sincerely

Dp:Mark Jacobs Chief Medical Officer (Acting) Clinical Leadership, Protection and Regulation

_MOH

Sentby:

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20109/2010 11:30 a.m.
Fw: 10001806 ministerial info'comment request Alcohol policy due

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you please have a look at this Ministerial and draft response as it relates to our HOP

G/lines. I'm happy to discuss as reqd.

Nutrition & Physical Activity Policy Health and Disability Services Policy Population Health Directorate Ministry of Health 001:04 _ http://www.moh.govt.nz mailto: . @moh.govt.nz

----- Forwarded by •••••

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ubject - Alcohol policy

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would be much appreciated (by Friday 1 Oct)

Please let me know if this information should be forwarded to someone else many thanks

alyst Government Relations Corporate Services Directorate Ministry of Health

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Office of Hon Tony Ryall
Minister of Health Minister of State Services

1 t SEP 20m

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14 September 2010

Dr Eric Crampton College Of Business and Economics University of Canterbury Private Bag 4800 CHRISTCHURCH 8140

Private Bag 18041, Parliament Buildings, Wellington 6160, New Zealand. Telephone 6448176804

Facsimile 6448176504

RECE\VED
College of Business and Economics
Department of Economics and Finance
Tel: +64 3 366 7001, Fax: +6433642635
www.econ@Jcdnterbury.dc.nz

2 4 AUG 'LUIO MINISTERS OFFICE

UNIVERSITY OF

CANTERBURY
Te Whare Wiil1al!ga
0

HTaitaha
ZEALAND

20 August 2010

Han, Tony Ryall Minister of Health Parliament Buildings Wellington 6160 New Zealand Re: Health guidelines regarding alcohol.

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CHRISTCHURCH

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Dear Minister Ryall,

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ever drinkers" and "former drinkers"

I substantially affect r The New zea~a ~dA elnuovo a Nu~ti~elines
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was very poor as consequence of drinking, then e concerns were tested and found not to

atl's 2006 meta-study is pretty convincing on this issue. for Older People is shocklnglv bad on this point,

saying: "Met
curve's ~ eVidence~ one of your st isn't good. an essa ~) to the pr ~

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ontrolled confounding have called previous evidence [on the J.
kson et a12005; Rimm and Moats 2007)./1 It's true that previous

Ion. But the Rimm and Moats piece quoted actually proves the exact r confounding affected results and showed conclusively that it didn't. So

opposite: they t~~~ e

. quoting Rimm and Moats as saying X when in fact they instead proved Not-X. This ckson piece is a letter to the editor in The Lancet. Honestly, if a student turned in imm and Moats provide evidence against the J-curve, I'd be tempted to bring him up on academic dishonesty charges if I didn't think it were just sloppy work.

There seems to be a hard core of staffers at MoH who seem more interested in advancing arguments against alcohol and tobacco than in honestly evaluating the science. I hope this can change.

~~'--'-r:: .-c::==
Dr. Eric Crampton

Sincerely,

:::--;;

University of Canterbury Private Bog 4800, Christchurch 8140, New Zealand. www.canrerbUly.ac.nz

Alcohol and Coronary Heart Disease: Drinking Patterns and Mediators of Effect
ERIC B. RIMM, SeD, AND CAROLINE MOATS, MS

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The study of the effects of alcohol on health in ulatlons has spanned a wide spectrum, ran . trolled feeding studies to cross,cultura~,. s t~ large scale prospective studies (1). Many 1 r lew pa pers have covered these areas of res ral~ae a included in this issue of the Anna of ~ . ogy. I~" per we focus on the inverse ass . . n tween mo . cohol consumption and CHO :1: ).' ight recent evi ce that contributes to the thes at alcol~ca~lIy related to lower risk~ n biOI~<': ~isms. The first S~Ud e inv~e a il't)'?' n between alcohol cons ~ n HD' . 's 1 d more than 30 years ago (2). ~ 1 n, additi a . onfirming this association have colle e ethan 25 countries from at least 100 differe vldence (rom these stud, ies suggests thatie cha gcs in HDL cholesterol levels, clotting fa s' . sensitivity, and markers of in' flamm8tion~ p' . logical plausibility to the observed association. ~ , piderniological studies have more carefully adc c importance of drinking patterns,
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and beverage choice while also acdifferences in physical activity, diet, and in alcohol consumption over the adult lifespan. preponderance of evidence suggests that "moderate" drinkers Of. alcohol have the greatest cardiovascular benefit. The definition of moderate drinking has a very broad range (from 5 to 60 g of alcohol per day) depending on the study population and the tool used for assessment. For purposes of this summary, we will use the definition defined by the

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From the Departments of Epidemiology (E,B,R,) and Nutrition (E,B.R., CM,), Harvard Sehoul of Publlc Health, Boston, MA; and Channing Laboratory, Department of Medicine, Bri~ham and \,h1men's Hospital,

Harvard Medical School, Boston, MA (E,B.R,).

Address correspondence to: Eric B. Rimrn, SeD, Deparnnenr of EpidernluIog)" Harvard School of Public Health, 677 Huntington A ve. Boston, MA 02215; Tel.: (617) 432-1813. Evrnall: erimm@h.ph.harvard.edu. © 2007 Elsevier Inc. All rights reserved. 360 Purk Avenue South, New York. NY 10010

2005 USDA Dietary Guidelines (3). Moderate drinking is considered to be no more than one drink per day for women and no more than two drinks per day for men. A drink is more specifically defined as 12 ounces of regular beer,S ounces of wine, and 1.5 ounces of aO-proof distilled spirits. Thus, at the extreme, two drinks a day would be up to approxirnately 30 g of alcohol. Substantial epidemiological evidence from geographical comparisons, large cohort studies, and several meta-analyses links moderate alcohol consumption with a lower risk of cardiovascular disease. There are roo many epidemiological studies that have independently analyzed the association be, tween alcohol and CHD risk to summarize in this paper, though they have been summarized elsewhere (4-7). The population, size, and length of follow-up all vary greatly from study to study, which provides further support to the robustness and generalizability of the findings. For example, in the first study in 1974, Klatsky et al (2) analyzed recent health and lifestyle histories of 464 patients in the San
1047-2797/07/$-5ee front matter doi: I 0.1 016fj.annepidem.2007.01.002

Potassium
Potassium can blunt the effect of sodium chloride on blood pressure and so help regulate blood pressure (Ministry of Health and University of Auckland 2003; NHMRC2006). The Intersalt study found a negative relationship between potassium intake and systolic blood pressure (Intersalt Co-operative Research Group 1988). Vegetables and fruit are a good source of potassium, which may contribute to the relationship between diets high in vegetables and fruit and lowered risk of cardiovascular disease (Ministry of Health and University of Auckland 2003) ..

Limit alcohol intakes
The relationship between alcohol consumption and all-cause morta.lity is usually de~d as a l-shaped or U-shaped curve, where light to moderate drinkers have a lower~morren an those who abstain or drink heavily (Wells et aI2004). This benefit to light and 0 Inkers is attributed mostly to a reduction in coronary disease (Wells et aI2004~. leO jU~ that there was convincing evidence that low to moderate alcohol consu I ed €os ris the cardiovascular disease, but could not make a general reCOinmend~ti or its u 'd~e her cardiovascular and health risks associated with alcohol (WHO an ~ 3). It is n t that the benefits of alcohol consumption have been f'IIfArc:t";;tA There are biological mechanisms that allow a plausible both reduce the risk of cardiovascular disease (throu cholesterol and improved thrombolytic factors) a (through increased blood pressure with heavy Bennett 2006; Foster and Marriott 2006). alcohol consumption and blood p ...>"'..", a l-shaped relationship whereas oth methodological differences linear risk of haemorrhagic moderate alcohol consumoncn-mae considering the relation not consistent. Again (Emberson and
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and patterns of drinking, and in choosing an appropriate drinking against (Emberson and Bennett 2006) Ui.>f<::/I<::uucing stopping their alcohol intake (often associated with or e 'abstainer' category for data analysis, which may have overestimated of alcohol, as it is not the absence of alcohol that increases the risk of isease but ill health (Fillmore et al 2007)

There is convincing evidence that alcohol of all types is a cause of numerous cancers (World Cancer Research Fund and American Institute for Cancer Research 2007). Notably, alcohol is associated with cancers of the upper digestive tract, including the mouth, pharynx and larynx, and oesophagus. The evidence does not show a level of consumption below which there is no increase in the risk of cancer. This means that even small amounts of alcohol will increase the risk of cancer, and therefore should be avoided (World Cancer Research Fund and the American Institute

104

Food and Nutrition Guidelines for Healthy Older People: A background paper

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Prior to the mid 1990s there was a level of agreement among the epidemiology community that alcohol consumption of around 1-2 drinks per day could reduce mortality from coronary heart disease 1. Since that time the consensus of scientific opinion has shifted away from this position, partly due to concerns regarding methodological problems with studies that have found a protective effect from alcohol. Three major problems with the research on alcohol's positive effects on heart disease have been ldentifierf 3 4.

3.

~~~~dVto specific disease QG:;a:;~lPl~1>consumption is associated with dition, people change their tu ies in this area have calculated only have very limited measures of

1 ~. illmore, K., Kerr, W. C., Stockwell, T., Chikritzhs, T. & Bostrom, A. (2006). Moderate al ihQ!A e and reduced mortality risk: Systematic error in prospective studies. Addiction Research and ory, 14,101-132. 2 Middleton Fillmore, K., Stockwell, T., Chikritzhs, T., Bostrom, A. & Kerr, W. (2007). Moderate alcohol use and reduced mortality risk: Systematic error in prospective studies and new hypotheses. Annals of Epidemiology, 17, S 16-S23. 3 Mukamal, K. J. & Rimm, E. B. (2001). Alcohol's effects on the risk for coronary hemi disease. Alcohol Research and Health, 25, 255-26l. 4 Chrikritzhs T, Fillmore, K, Stockwell T, A healthy dose of scepticism: Four good reasons to think again about protective effects of alcohol on coronary heart disease, Drug and Alcohol Review (July 2009),28,441-444 5 McElduff, P. & Dobson, A. J. (1997). How much alcohol and how often? Population based casecontrol study of alcohol consumption and risk of a major coronary event. EM), 314, 1159-1164.

not associated with a significant reduction in heart disease or all-cause mortality", In addition, Health researchers have discovered that alcohol is associated with more risks than previously thought, and have become better at identifying the burden of disease from alcohol. For example, the World Health Organization's International Agency for Research on Cancer has since reviewed the evidence and concluded that alcohol increases the risk of cancers of the oral cavity, pharynx, larynx, oesophagus, liver, colorectum and breast'. On the basis of this evidence it categorised alcohol as a Group 1 carcinogen, reflecting the highest level of certainty that it is carcinogenic to humans", This new evidence has led the World Cancer Rese~r Fund International to alter its previous advice and to state Plainly~t ' the©j~ point of view of cancer prevention, the best level of alcoho c tion

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zero."

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As a result New Zealand epidemiologists and me!E. ~x~s ha a~in leading medical journal articles that the hypothe Icoho ts against heart disease should be seriously ch beca ~ methodological problems with the studies,~ n~. ere likely to be found only at doses that would be ~~at with er' nificant harms to health 10". ~ ~ For this reason the position outli~ ~~e Mi~'~~~d and Nutrition Guidelines for Older People i ~I~dl.~ tted that one of the references quoted was in ~ and th corrected next time the guidelines are updated. .

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tvLUI""-L"Un.Uore, Stockwell, T., Chikritzhs, T., Bostrom, A. & Ken, W. (2007). Moderate K., an reduced mortality risk: Systematic error in prospective studies and new hypotheses. 'demiology, 17, S16-S23. , Straif, K., Grosse, Y., Secretan, B., EI Ghissassi, F., Bouvard, V., Altieri, A. & Cogliano, V. on 6 If of the WHO International Agency for Research on Cancer Monograph Working Group. (2007). Carcinogenicity of alcoholic beverages. Policy Watch, The Lancet Oncology, 8,292-293. 8 Ibid. 9 World Cancer Research Fund I American Institute for Cancer Research. (2007). Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective, p. iv.. Washington DC: AICR, http://www.dietandcancelTepOli.org/downloads/Second Expeli RepOlt.pdf? JServSessionldrO 11=y73h 205hu l.app46a 10 Jackson, R., Broad, J., Connor, 1. & Wells, S. (2005). Alcohol and ischaemic heart disease: Probably no free lunch. Lancet, 366, 1911-1912. 11 Sellman, Connor J, Robinson G, Jackson R Alcohol cardia-protection has been talked up The New Zealand Medical Journal, 122(1303),97-101

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ORIGINAL SUBMITTED

FOR YOUR SIGNATURE

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Ref. no. 10001806 H201003707 Government Relations

Dr Eric Crampton College of Business and Economics University of Canterbury Private Bag 4800 Christchurch 8140

Dear Dr Crampton

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After removing studies that suffer form a number of methodological problems, a meta-analysis of the doseresponse relationship between alcohol consumption and heart disease found that moderate alcohol consumption was not associated with a significant reduction in heart disease or all-cause mortality. The Deleted: Deleted: since the hypothesis that

Zealand epidemiologists and medical experts have argued In ,',' against heart disease should be a ' urnal articles that 1he protective effect of alcohol has beE?n/ / / Deleted: seriously challenged. nl'1'''''''''1'Cl~ _119_ _y_ p~_n~fi!~ 9_r§,JLk~1Y_!o. fo_u_n_d_ 9i 99.s~.s _til?! Y"{o.l!lg p_e_ 911!>t. _/;/ / ~A========< ed with other significant harms to health. - - - Deleted: were )

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ORIGINAL SUBMITTED

FOR YOUR SIGNATURE

for Director-General of Health Date: Reference: H Number: Name of Section: Contact person: Phone: Peer reviewer: Ref. no. 10001806 H201003707 Government Relations

Dr Eric Crampton College of Business and Economics University of Canterbury Private Bag 4800 Christchurch 8140

Dear Dr Crampton

Zealand epidemiologists and medical experts have argued in a 'ournal articles that the protective effect of alcohol has been nd any benefits are likely to be found only at doses that would ed with other significant harms to health.

Status: Waiting Minister's Sign-off Database Number H201003707 Subject Writer Due Date Minister's Office Reference Number Section 5 - Alcohol policy Dr Eric Crampton

Ministerial

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Min Office Ref: 10001806

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14-0ct-2010 10001806

Population Health Directorate, Mental Health Alcohol and Drug

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of Health

Ref. no. 10001806 H201003707 Government Relations

II

Dr Eric Crampton College of Business and Economics University of Canterbury Private Bag 4800 CHRISTCHURCH 8140

Dear Dr Crampton

e references s r Healthy Older rrected in the near ._... .... ,,'-fv,ines is confirmed as position that moderate oronary heart disease. In

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researchers hav studies that h ve-roun analysis an ave.anso the resul een rm

thought. For example, the World Health ational Agency for Research on Cancer has reviewed i nce and concluded that alcohol increases tHe risk of oral cavity, pharynx, larynx, oesophagus, liver, colorectal and t. On the basis of this evidence it categorised alcohol as a G carcinogen, reflecting the highest level of certainty that it is genic to humans. This new evidence has led the World Cancer e arch Fund International to alter its previous advice and to state plainly t "From the point of view of cancer prevention, the best level of alcohol consumption is zero". ati~' esem er As a result, New Zealand epidemiologists and medical experts have argued in leading medical journal articles that the protective effect of alcohol has been exaggerated and any benefits are likely to be found only at doses that would be associated with other significant harms to health.

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Yours sincerely

H?~ Tony Ryall Minister of Hea Ith

05/11/2010 11:40
cc Subject

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http://www.moh.govt.nz mailto:

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12/11/201010:40

a.rn. Subject: Re: Amendrnents to Food and Nutrition Guidelines for Healthy Older People

Hi Thank you so much!

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Re: Amendments to Food and Nutrition Guidelines for Healthy Older People]

Hi e changes to me, and I'll get it changed on the web._ will make the changes to the Indesign file, create a new PDF, then the webteam will replace the existing PDF with the new one. So, it may take a few days. Hope that's ok. Cheers, .;

To 07/07/2011 04:28 p.rn. ee bec Subject

OIA Requests/MOH@MOH

Fw: Offieiallnformation Act request

Good Afternoon, I am currently clearing ElnailMOH, the Ministry's generic email box and we received the following email. Could you help with this enquiry or forward to/suggest a suitable person to respond, please

Thank you

Library Corporate Knowledge Services Ministry Planning and Performance Reporting Corporate Services Ministry of Health

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