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We should all feel thankful that, once in a rare while, the confusing morass of pop medical journalism is broken by the occasional intelligent voice of informed reason. Last month, the media had a feeding frenzy over a lone medical study linking caffeine to increased risk of miscarriage: Pregnancy Problems Tied to Caffeine. Today’s New York Times published a doctor’s rebuttal to this study, admonishing the media for their unbridled circulation of unmerited medical scares: Coffee and Pregnancy - New York Times.

The inexcusable state of medical journalism is a long, old rant of ours: rooted in the media’s egregious lack of knowledge or understanding of the scientific method, statistical analysis, and comprehension of the holistic health implications for any one-off, myopic study. Without any real capacity for this, the media simply spits out whatever medical research comes at them. An unquestioning public then treats this flawed information as gospel. The bloggers spread it. The general public responds with exaggerated binging or purging alterations to their diets. And then we complain that we don’t know what to trust when the next reported study comes along.

Peter Klatsky wrote the New York Times:

As practicing obstetricians, we are concerned about the extensive reporting of a small study that linked caffeine with miscarriages (“Pregnancy Problems Tied to Caffeine,” news article, Jan. 21).

Unfortunately, findings like these generate more media coverage because of the interest and fear they generate, rather than the quality of the evidence (this study has profound methodological limitations).

A more robust and better designed study was also released this month that found no association with coffee consumption and the risk of miscarriage. Sadly, the press ignored this study while every major news outlet aired the less rigorous, but frightening findings.

Together this practice scares our patients, misinforms the public, and places physicians in a difficult position in counseling our patients.

The result is a freaked out public that now worries that their double-tall, four-pump vanilla caramel macchiato may as well be a dose of RU486 for inducing the abortion of their fetuses.

Sweating to the Small Stuff

Not that we feel a reason to defend coffee or caffeine. More to the point, we feel a reason to defend reason. And for some reason, the obsessive preoccupation with coffee in pop medical journalism remains a hot topic even after hundreds of years of safe human consumption of the beverage.

Meanwhile, in the past couple of decades we’ve witnessed the American diet overtaken by unprecedented, massive doses of high-fructose corn syrup and other processed foods. All of which has been been linked to our obesity epidemic and implicated in the first-time decline of the average American’s life expectancy.

But never mind that. Keep an eye on that morning cup of coffee. Clearly, that’s our real concern. Now please pass the corn flakes.

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Many of you are probably more than already aware of this, but the latest trend in consumable marketing is something of an unholy marriage between food staples and over-the-counter pharmaceuticals. It’s not just juice smoothies that promote mysterious “immunity boosts” anymore. It’s also things like fortified coffee.

And what’s with all this “energy boost” crap these days anyway? People used to plow fields and carry water 12-hours a day. When did we become such impotent, spineless wusses in need of beverages marketed like alkaline batteries?

Coffee has been safely consumed in moderation for centuries; yet some marketers cannot resist the temptation to tamper with it under the false pretense of “healthier living”. So it was little surprise to read the news today from Malaysia, where an instant coffee marketed as a “health product” (it claimed that it contained “natural herbs and ingredients” such as gingko biloba and ginseng) was instead discovered to be laced with toxic chemicals: The Electric New Paper, Singapore - The Electric New Paper News - Toxic chemical found in instant coffee packets.

Available on Malaysian store shelves for about a year, undercover agents discovered that the coffee was laced with synthetic sildenafil nitrate — the active agent in Viagra. Someone must have read our old Coffee Sugar Sex Magik post.

Must we repeat Michael Pollan’s mantra?: Never trust a food product that makes a health claim.

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Today Which? Magazine (U.K.) published a comparative review of three major coffee chains in Britain: Starbucks, Caffé Nero, and Costa Coffee: Coffee shops | Overview. Their survey examined coffee prices, beverage quality, and how much their drinks are calorie bombs.

For their taste test, they sent in an “undercover expert” — Whittard coffee buyer and taster Giles Hilton — to representative outlets in central London. (IMO, I’m a big fan of Whittard teas, which I have sampled and purchased at their London and Singapore locations, but I cannot comment on their coffee prowess — they honestly never struck me as a place to get good coffee.) Mr. Hilton sampled two coffee beverages at each shop — an americano and a cappuccino — and rated them for appearance, temperature, taste, and overall satisfaction. So while I might question his pedigree, it sounds like he at least had standard criteria.

Starbucks came up the worst among his tests — too much water in the americano, and rather anemic milk frothing on the cappuccino. And to prove that you don’t always get what you pay for, Starbucks also rated the most expensive of the lot. Meanwhile, Caffé Nero scored highest for taste — and the cheapest (surprising, given that they apparently used twice as much coffee as the others in some drinks).

U.S.-based Starbucks did win the calorie bomb contest, however. Their white chocolate mocha with whipped cream and whole milk weighed in at 628 calories — more than a quarter of the average person’s recommended daily calorie intake: BBC NEWS | Health | Morning coffee is ‘meal in a cup’.

Face it: when it comes to girth and excess, America just can’t be beat. Just look at one of these items that surfaced at the recent Consumer Electronics Show (CES) in Las Vegas this month: the Cruzin Cooler, a motorized, rideable cooler — with cup holder — that can apparently motor a 300-lb person at speeds up to 14 mph. Who said, “you should never eat more than you can carry”? My latest idea for a gluttony-themed Italian-American restaurant concept, Troppo di Tutto (”Too Much of Everything”), might have legs afterall. Just no neck.

UPDATE: Jan. 25, 2008
The BBC followed up on the big UK chain coffee showdown with an article on how independent cafés are making it in this climate: BBC NEWS | Magazine | Giving it their best shot. And while it succumbs to the lazy and inaccurate wine analogy, I particularly liked this quote: “We are in the ‘Blue Nun stage’ of coffee drinking.”

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Being popular is hard. No, this isn’t the plot for the next Legally Blonde sequel; it’s the message our society sends when changes in popular consumer tastes inevitably raise questions of product safety.

A decade ago, the advent of cellular phones inspired a wave of fear mongering when the Paranoid Whack Jobs (henceforth referenced as PWJs) stepped in to tell us all that cell phones gave us brain cancer. Today, with the proliferation of Starbucks and rising global demand for quality coffee, many of those same PWJs are aiming their sights on caffeine.

At least the excuse behind the fabricated cell phone scare was a lack of any social history with the devices. However, caffeine and coffee have been tightly woven into popular culture for hundreds of years. So why are some PWJs acting so suddenly surprised by caffeine as if by some horrible new threat?

And while too much coffee or caffeine can clearly be a bad thing, isn’t that true for most anything without sensible moderation? Even fat-soluble vitamins, such as vitamins A and D, can cause liver and kidney damage from high doses of seemingly healthy vitamin supplements.

“I’m no scientist, but I play one on my blog”

And yet we’ve noticed more frequent reports of things like “coffee rage” reaching epidemic proportions in the U.K. — as if the Queen’s tea was always herbal. And closer to home in California, yesterday a state advisory board recommended a study of caffeine for potential Proposition 65 warning labels: The Associated Press: Calif. Board Suggests Study of Caffeine.

You could argue that there’s something of an odd anti-caffeine lobby forming out there — made of born again anti-caffeine zealots hoping to refashion the Temperance Movement of the 19th & 20th centuries in the form of the double-tall, four-pump vanilla caramel macchiato. But I don’t mind those PWJs so much as the preposterous trend in this country towards mystic opinion and amateur science — if not outright anti-science.

We see this trend in the PWJs who, wielding their “far superior” armchair scientific research and statistical analysis skills, have authoritatively decided that immunizations cause rampant autism — trumping all the social benefits of child immunization programs throughout history. And while every PWJ is entitled to an opinion, it is a dangerous precedent when half-baked opinions influence public health and public policy. Just how long before we invoke the Flying Spaghetti Monster?

Fortunately, there are scientifically educated voices out there to help separate fact from fantasy: More California Dreamin’: Proposition 65 and Caffeine > ACSH > Facts & Fears > Archives. The question is if anyone is listening. Because of natural human biological wiring that’s attuned to alarm us of potential threats, sensationalism and fear mongering sells. The rational person who says, “false alarm” offers little attention-grabbing interest to compete with that.

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If you ever wondered the depths at which some people can profit from human stupidity, today’s San Francisco Chronicle underscored the point: What’s New: Fortified organic coffee. (Thanks, Cindy Lee, for spreading the unchecked stupidity.) Yes, that “healthy coffee” thing, where foolish lemmings leap off cliffs in blind faith and obedience over health claims made as a marketing strategy. Here the article tells us about how we now can get our coffee cut with mystical elements that bestow us with “Immunity,” “Clarity” and “Calm”.

First off, to paraphrase Michael Pollan, never trust a food product that makes a health claim. And this stuff is oozing with them.

Secondly, coffee has over five centuries of epidemiological evidence supporting its safe and healthy consumption by humans. That’s some 500 more years of evidence than you will get from any indiscriminate, unregulated “Immunity Boost” concoction jammed into your oh-so-healthy Jamba Juice.

So what’s really healthy and unhealthy in this picture? Does anyone know what’s really in this “immunity” snake oil formula going around? It could contain Chinese-manufactured diethylene glycol for all we know. Even worse, places like Whole Foods sell this junk.

My advice? I’m no doctor, but I play one on my blog. To avoid being a contestant for next year’s Darwin Awards, stick with the items your great-grandmother would recognize as food. Everything else is just playing toxic chemistry roulette under the marketing disguise of “health elixirs”. If it has to try that hard to convince you that it’s good for you, chances are that it isn’t.

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When PR flacks try to get their clients noticed above the crowd noise, a common and effective tactic is the city rivalry vanity/voyeurism survey. Hey, it worked for us. Which is why we’re reporting on the “news” that San Francisco/Oakland ranked #1 among least caffeinated cities in the country: Caffeine Survey Reveals Most, Least Caffeinated Cities.

OK, so their methods are completely unscientific, there were only 20 cities total under consideration, and they had the audacity to call this survey a “first annual” (talk about an oxymoron). I won’t even ask why some Mickey Mouse health care operation is behind it with quotes from their spokesperson, 1968 Olympic gold medalist and 1980s Trident gum queen Peggy Fleming.

But while Seattlites reportedly down more coffee than anyone — and Chicagoans are more amped on caffeine than anyone (largely the product of unrivaled cola and chocolate consumption) — the citizens of our fair standard metropolitan statistical area are the least caffeinated of the lot. We still drink coffee around these parts but apparently give comparatively little love to tea and energy drinks.

You know, San Francisco, I never quite understood how beverage companies could seriously market their products like alkaline batteries either…

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We are a nation of fabricated addictions. Not real addictions — to things like heroin, crack, or alcohol that require treatment programs, follow Addiction Severity Indexes, break families apart, and are highly correlated with crime and prison time. I’m talking about our inability to moderate personal consumption of relatively benign things. Things like caffeine, meat, television, sex, carbohydrates, etc.

Yes, this one is going to be one of your stereotypical “rant” blog posts; think “Andy Rooney” on 60 Minutes but without any of the talent or charm. But lately I’ve come across so many posts and articles just on the topic of people giving up caffeine and/or coffee, and the hearty ring of faux-addiction support group replies to them, that I couldn’t hold out any longer.

Moderation! - huh - yeah - What is it good for? (Absolutely nothing.)

In America these days, we seem to regularly prove ourselves incapable of consuming just about anything in moderation. And a real indicator of how bad it’s become isn’t just abuse of the word “addiction” to describe this inability, but it’s in how often we now seem to resort to cold turkey abstention as the only logical way left to control our urges and consumption habits. We’ve become a nation of people who define ourselves not in the positive — i.e., by what we do or what we are capable of — but in the negative — i.e., by the things we don’t do.

(And when I say “we”, I do include myself — as my past history of giving up coffee and caffeine for two years will attest. Though I’ve since recovered.)

A couple of online examples just in the coffee realm lately include How I Ended My Relationship With Coffee and How to Give Up Coffee and Caffeine Altogether. And the response to these posts is typically a bit of rah-rah personal-victory-over-addiction celebration — as if by skipping the four double-tall, four-pump vanilla caramel macchiatos we order every morning, we’ve just walked away from a deadly crack habit, stopped stealing cars for drug money, and demonstrated lives that are clean enough to take our children out of foster care.

If they only had a Coffee Seminary…

But what we really have is a culture that seems to make a victim of the substance abuser and blames the thing we’re consuming. What makes this particularly problematic are the substances we’re talking about. Take coffee, for example. Coffee is a substance that has proven safe for human consumption in moderation for centuries now. That’s epidemiological data for centuries more than 95% of the stuff we put into our bodies today.

Then add a person with no self-control over their gluttonous consumption — who acts like a dog locked in a closet with a two-week supply of Gravy Train. (National waistlines being just one example of our incapacity for moderation.) Suddenly there are all sorts of health concerns and paranoia over headaches, jitters, anxiety, insomnia, etc. So rather than develop self-discipline and address the core problem of consuming the substance well beyond any healthy means, we avoid the root problem by giving the stuff up entirely. And we come to define ourselves by these things we’ve “given up”; to host a dinner party today is to navigate a minefield of random food aversions and personal tics.

But is that really overcoming “addiction” to these non-addictive substances? Or is it just running away and hiding from the root problem? In actuality, giving up otherwise benign substances such as coffee or caffeine is more like a gay man who joins the priesthood, thinking his vow of celibacy somehow cures his homosexuality. This isn’t dealing with the problem at all — it is avoiding it by trying to remove temptation and thereby pretending the real problem doesn’t exist.

Moderation: I’ll raise an espresso cup and drink to that. OK, maybe tomorrow morning instead — I’m feeling a bit agitated at the moment.

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In case you need more evidence that the legal profession has an endless supply of ready-made idiot consumer lawsuits, recently a 17-year-old “unwittingly” gave herself a caffeine overdose by drinking seven double espressos at her family’s sandwich shop: BBC NEWS | UK | England | Wear | Girl overdoses on espresso coffee.

While a caffeine dosage equivalent to at least 80 espressos is required to kill a person, don’t rule out the future possibility of some accidental suicide. When it comes to consumption habits, people are behaving more and more like dogs locked in a closet with a three-week supply of Purina Chuck Wagon. Can an idiot lawsuit leading to health warning labels on espresso drinks be far behind?

UPDATE: Aug. 23, 2007
Paranoia mode: on. Like the hypochondriacs in the early 1990s who worried that their new use of cell phones was going to give them high risks of brain cancer, we now have communities new to specialty coffee that fret over one foolish teenage girl signaling a deadly coffee menace for everyone: Scotsman.com Living - Health - Danger that lurks in your mug.

Coffee has been consumed safely by humans for centuries, and yet we fret about it more than we worry about energy bars of dubious, very recent origins. Of course, the truth is that only witches drink specialty coffee — so any worries over health concerns are moot given that all specialty coffee drinkers should all be burned at the stake or drowned on boiling oil.

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Will coffee marketing atrocities never cease? Of course not! Forget the transdermal patch, apparently the drug delivery mechanism of choice today is your good old cup of joe: WebWire | VitaBrew, enters fight against Osteoporosis and Diabetes type 2 with a Free Certified GNC and Eight O’ Clock Coffee Healthy Coffee recipe. I swear, I could not make this stuff up even if I tried.

Now I remember a time back in the late 1980s/early 1990s when I was in a joint UCSF/Berkeley bioengineering graduate program. Back then, all the scientific rage seemed to be around transdermal patches as a delivery mechanism for just about anything. It wasn’t just nicotine cravings and birth control — I worked alongside researchers who were like six-year-olds who just discovered you can put other things besides water in a water balloon. Vitamins, cold medicines, cheese pizza, you name it … it seemed that everybody was working on a grant to find a way to deliver it via a patch into your bloodstream, no matter how ridiculous the idea.

Today coffee seems to be taking the place of these patches, attracting some of the biggest quacks and snake oil salesmen in the business. Weight loss, gout prevention, and now add to that anemia, osteoporosis, hyperthyroidism, and “hair, nails & complexion.”

Upon visiting VitaBrew’s sick and wrong Web site, you’ll find this unholy brew sharing on-screen real estate with books on building your self esteem, “unleashing the full potential of your mind,” and “the power of concentration.” The site has got it all. (Though I must admit, I’m a little surprised there was no mention of the coming mothership from the planet Zoltar — to take us home when the earth next crosses the debris field of Comet Kohoutek.)

Now if you’ll excuse me, I need to brew up a latte to cure my schizophrenia.

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In another fine display of health care journalism’s single-issue myopia, a report came out this week that men who drink copious amounts of coffee lower their risk of gout: Coffee Lowers Gout Risk. What I find deliciously funny about this — and sadly funny at the same time — is that the article addresses coffee and gout in the complete absence of everything else. This one coming from WebMD, whom you might think would be savvy enough to communicate how medical trivia like this fits in the bigger picture of your overall health.

Nevermind that you might blow out your kidneys in two years from the diuretic qualities of drinking too much coffee… Never mind that you might suffer cardiac arrest from a caffeine overdose… You’ve got that gout thing covered, so have another cup — or twelve!

UPDATE: June 4, 2007
Someone finally decided to regurgitate this single study with some context of how it fits in with a person’s overall health: Wake up and smell the coffee-Life & Style-Health-Our Experts-TimesOnline. It took over a week after this news bit was plastered whole everywhere before one lone doctor — writing in the UK for The Times, mind you — finally bothered to make sense of it for news consumers. It’s comforting to know that when the H5N1 avian flu virus goes pandemic, we’ll probably have all shot each other dead on the streets for a week before some doctor in the UK tells us not to panic.

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