Passive smoking and cholesterol control - 17 May 1991

I suppose more than anywhere else in America in California the movement goes on unceasingly to make us live longer, cleaner, healthier, more ecologically satisfactory lives. Or as the wicked Jane Walmsley puts it, to convince us that in America death is optional. From the Mexican border north for six, seven hundred miles, more and more California cities are adopting local ordinances that forbid smoking in airports, bus stations, offices, now most restaurants. Here in San Francisco they've gone so far that as a lawyer friend of mine said the other evening, "three, five years at the most from now it will be illegal to smoke at any time in any public place." It's already true here in office buildings, department stores, shops, taxis so on.

The pressure to ban smoking in public altogether is not due to excessive evangelism in the non-smoking public, or the Puritans' dislike of seeing somebody have a good time. It's due to the new fear of what's called passive smoking, a funny and contradictory phrase but, it has sprung up from a disturbing discovery. That people can get cancer from being long in a room, or close to a regular smoker. I know doctors who quietly ridicule this contention saying, possibly truthfully, that a five-minute walk along Piccadilly or Lexington Avenue or any other traffic thoroughfare will expose the lungs to more polluting smoke and vapours than a month of taking deep breaths in the presence of a smoker. However, the medical establishment is convinced that passive smoking, being constantly in the presence of tobacco smoke is a serious health hazard. There have been law suits in several states and some of them have been won with massive damages. That was enough for the airlines on which passengers can rightly contend that short of being dropped off they have no way of avoiding the wafting cigarette smoke. So since the first of the year, smoking has been forbidden on all American flights of under six hours, which means that if you must smoke aboard you'd better buy a ticket from New York to Alaska. Better really to stay at home.

And now the FDA, the Food and Drug Administration, which some years ago was a strict and watchful a protector of the public health as any nation could wish in licensing new medicines it's still more cautious than most European governments. The FDA has been assailed for the past year or two by a hailstorm of criticism from medical journalists, and consumer groups in the matter of its sanctioning of extravagant health claims for retail foods.

Finally, under new management so to speak, the Food and Drug Administration has wakened up, it's becoming as it ought to be, a pain in the neck and a computer to the cunning people who write advertising copy for packaged foods. They must not now claim that this cereal in its packaged form, often it's refined or otherwise manufactured form, preserves the nutritious quality of the original cereal, fruit or whatever. Orange juice in cartons or bottles may no longer be described as fresh, when plainly may be even fresh orange juice must go through a chemical process of some sort to preserve it. More disciplines hurtful to the advertising boys and girls are promised, only this week the FDA launched an onslaught on dozens of particular bottled and canned oils that prominently display the boast, no cholesterol. We'll go into the demon cholesterol in a moment.

The FDA is ordering new statements on the labels, remarking that while no cholesterol may be literally true, these oils corn oil, margarine and so on, contain enough saturated fats to stimulate the body to manufacture cholesterol. Meanwhile, there's no let-up in the legal requirement which is I believe almost as old as the FDA itself that all foods and across-the-counter medicines must print on their packages a list of ingredients. I don't know how common or compulsory this is in European countries but it used not to be so on Britain.

At least I remember shortly after the war, goodness I must remember to keep saying the Second World War, there arrived in the United States in the chemists' shops a veteran British medicine advertised in the old days as a marvellous pick-me-up, pick-you-up and a sovereign remedy against acidity, gas and other gastric afflictions. It boasted that it was made from a secret magic formula. Sensible people swore by it, my father never went without it, immediately after breakfast, every day of his middle, old and very old life. Suddenly I noticed it was marketed in America, not for long, they didn't know about the compulsory ingredient publication clause. So the second or the next batch arrived and in very fine print on the bottom edge of the label it said, ingredients: bicarbonate of soda, fruit flavouring.

Nothing it seems will persuade the anti-cholesterol campaign to abate or pause. I first spoke a sentence, something like that to a group of doctors over 25 years ago and it had been going on then since the early 1950s. So I figured that in this country there are two generations which don't know that the war on cholesterol is a new crusade, it must be wonderful to live in a country where most ordinary people have never heard the word. I'd better give the correct but rather prim Oxford dictionary definition. "Steroid alcohol, found in body cells and fluids and thought to promote arteriosclerosis", that definition would be a surprise to most Americans who have come or been made to think of it in two forms. The good and the bad, high density and low density lipo proteins. Thought to choke the arteries and promote heart attacks would come closer to the general American definition.

Anyway, for 40 years we've been warned and lectured about the dangers of high cholesterol. Millions of Americans who don't know their pulse rate or their blood pressure, can tell you off hand their cholesterol count. Apart from a ceaseless flood of medical articles in newspapers some food writers rarely fail to bring it up in a given dish and there are restaurants that print alternative low cholesterol choices.

A month ago there was a move in Congress happily stalled in first gear to make the cholesterol testing of small children compulsory in the public, that is the public, schools. I don't believe anybody has yet done a study counting the huge numbers of Americans who suffer from high blood pressure from worrying over their cholesterol count. The crusade the scare, whatever you care to call it has had some effects that are bound to be permanent on well for one thing, American eating habits, already having a noticeable effect.

For example, the other day it was a shock to read in the business section of a distinguished newspaper that one of the world's largest fast food chains is, in this country, though not yet in cholesterol-innocent Europe, beginning to show serious declines in profits. A chain you would have said had guaranteed black ink through to the millennium. Why? Because those yummy juicy television ads for hamburgers dripping with cheese and bacon and how about mayonnaise are just what the doctor and the teacher and the food critics and the ecologists warn you to eat at your peril. The first result has been to force the chain to cut out as much of the fat from their beef as possible to make a still tasty sandwich. And of course that's a problem for the owners of every type of restaurant except the vegetarian.

Everybody knows that sirloin has more flavour than fillet, that beef is graded by the United States government, for instance, according to its marbling, the little flecks of fat in the muscle. Of the 12 billion pounds of beef graded by the government inspectors last year, only 6% were labelled prime, another 50-odd % choice, and the rest, third quality good. With the approval of the American cancer society among others, the word good for the least fat therefore the cheapest is being changed to select. They believe that more people will choose this lean grade if they think of it as select and not as good. Search me.

Of course meat, marbled meat is not by any means the only source of cholesterol, more suspect, more condemned than anything are all animal fats. So we are urged to lay off whole milk, cheese, bacon, butter, eggs, eggs are murder. The great American dairy industry is understandably depressed. Now the facts about the working of cholesterol, the stuff you yourself manufacture and the cholesterol you take in as food, I'm assured by an old expert are well understood. What is not yet understood is what makes some people with or without a highly suspect diet, absorb or dissolve the bad cholesterol and others, people who are impeccable and live on a fine diet of fruits, fish, vegetables, yoghurt, how they can have high cholesterol.

Well, if the threat the mania hits your country, take heart from the experience of an old, a very old man in Seattle on the West Coast. He says he's plagued by a compulsion; two doctors heard about his trouble, were puzzled by it, still are, and over an eight-month period studied him intensely. His problem is simple, he is a compulsive egg eater, every morning he has delivered two dozen eggs, he eats them throughout the day as additives to his regular meals, 24 eggs every day. The doctors are bothered and bewildered because, the man is 88 years old, and he has low normal cholesterol. He doesn't care, he feels he's cursed, his only comment brought the only flash of humour to an otherwise solemn medical report, he told the doctors, these damn eggs are ruining my life.

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