Wednesday, November 07, 2007


Before I get to that dollar figure, let me remind you of something that has happened recently in the medical management of diabetes.

Avandia, a drug commonly used in the treatment of weight-related diabetes, was found to increase the risk of heart disease in its users. Doctors, myself included, immediately began recommending that their patients discontinue avandia in place of a less risky alternative.

Good thing that I was never paid by avandia's parent company Roche to endorse avandia, because boy, that would have been awkward and it might have even made it more challenging to change my recommendations or accept this new research. You might even say, it would be a really bad idea for someone to accept money for an endorsement or a recommendation regarding something that has the potential to change with a changing body of evidence - especially if that something had the potential to have a dramatic impact on your health.

I'm guessing you see where I'm going with this.

Health Check, the Heart and Stroke Foundation's program that with their little logo, steers patients to products in a manner that they promote as,

"when you choose foods with the Heart and Stroke Foundation Health Check symbol, it's like shopping with their dietitians."
Health Check was established in early 2000 and as the HSF CEO Sally Brown pointed out a few days ago,
"products must comply with nutrient criteria based on Canada’s Food Guide"
What she didn't point out was that the Canada's Food Guide she's referring to was the 1992 Canada's Food Guide that even Health Canada recognized as being deficient and behind the times which is why this past February they released a revised version (albeit only slightly less woefully deficient).

You know what hasn't changed since February 2007? The criteria applied to products for the application of Health Checks. A set of criteria that are therefore now effectively over 15 years old (since they're based on the 1992 Food Guide) - a set of criteria that are therefore outdated even by Health Canada's flimsy standards. The Heart and Stroke Foundation's Health Check site, since around February, has had a little information box that states due to the new Food Guide, the criteria will be revised and that they hope to finish their revisions in the next few months.

So what's taking them so long? It has been 9 months since the Food Guide's revision, and why frankly do they need to rely on a Food Guide that is not evidence-based and only undergoes revisions every decade or more? Why aren't the criteria set by an organization that is purportedly looking out for your best health interests not in a dynamic and ever changing state based on our evolving understanding of the effect of diet on chronic diseases?

Well, I've got over three million possible reasons for you, because that's perhaps how much the Health Check program generates annually.

Our Director of Operations spent a few hours yesterday (thanks Lorne!) crunching numbers and if you'd like you can have a peek at his spreadsheet here, but based on the posted Health Check fees and program participants, Health Check seems to generate a minimum annual income of $1,000,000 and a potential annual maximum of over $3,000,000 (depending on the size of the products' markets - information to which we're not privy) and have generated one-time evaluation fees of between $100,000 and $800,000.

That sure seems like an awful lot of money.

Medicine has come a long way since the days that drug representatives sent doctors gifts and extravagant vacations - we long ago recognized the risk inherent in accepting money or gifts from drug companies because we recognized that of course that would taint our ability to be objective, especially in the face of changing evidence. And those gifts by the way, were never meant to serve as explicit payments for our endorsements - the drug companies just hoped that by spending money on doctors, that the doctors on their own would be more likely to recommend their products.

Perhaps it is that $3,000,000 annually, a $3,000,000 that has explicitly purchased the Health Check seal, that prevents Sally Brown from explaining how it is the Heart and Stroke dietitians are unable to state that in fact red meat's not healthy, that refined flours lead to metabolic syndrome, that sugar contributes to calories which contributes to obesity, that using cartoon characters to promote nutritionally deficient foods to children is wrong, and that steering people to Slush Puppies (yes I said Slush Puppies - click this link if you don't believe me) by giving them a Health Check and consequently an undeserved halo of health is not in the best interests of the health of Canadians - something I might have thought the Heart and Stroke Foundation would have cared about.

Sadly, the health of Canadians is clearly not something that stands head and shoulders above all else at the Heart and Stroke Foundation. It seems that either money, politics, bureaucracy or laziness not only prevents the Heart and Stroke Foundation from changing their outdated 15 year old Health Check criteria to reflect current medical knowledge, it leads them to endorse and recommend foods and dietary practices that are exceedingly unhealthy, that increase your risks of cancer, obesity, and diabetes and thereby also increase your risks of heart attacks and strokes.


[If you'd like to hear more, tune in this Sunday to Dr. Barry Dworkin's national radio show Sunday House Call where from 3pm-4pm EST we will be discussing Health Check and other issues. You can also listen online at]