Health

Triumph of the Data Hoarders

James Bailey3 Comments

Several major datasets produced by the federal government went offline this week. Some, like the Behavioral Risk Factor Surveillance Survey and the American Community Survey, are now back online; probably most others will soon join them. But some datasets that the current administration considers too DEI-inflected could stay down indefinitely.

This serves as a reminder of the value of redundancy- keeping datasets on multiple sites as well as in local storage. Because you never really know when one site will go down- whether due to ideological changes, mistakes, natural disasters, or key personnel moving on.

External hard drives are an affordable option for anyone who wants to build up their own local data hoard going forward. The Open Science Foundation site allows you to upload datasets up to 50 GB to share publicly; that’s how I’ve been sharing cleaned-up versions of the BRFSS, state-levle NSDUH, National Health Expenditure Accounts, Statistics of US Business, and more. If you have a dataset that isn’t online anywhere, or one that you’ve cleaned or improved to the point it is better than the versions currently online, I encourage you to post it on OSF.

If you are currently looking for a federal dataset that got taken down, some good places to check are IPUMS, NBER, Archive.org, or my data page. PolicyMap has posted some of the federal datasets that seem particularly likely to stay down; if you know of other pages hosting federal datasets that have been taken down, please share them in the comments.

Beware the Impactful Gastro-Intestinal “Norovirus”

Scott BuchananLeave a comment

This is about something unpleasant which I never heard of before this month, but I am sharing in case readers may benefit from a bit of intel here.

In a family I know with two kids under five, it started with the youngest child after he was likely exposed to unclean water. He vomited once, and then was apparently fine. I may be a bit fuzzy on the timeline, but I think it was the next day that the father came down with symptoms. Besides violent emptying of the GI tract from both ends, he was flat in bed for over 24 hours, hardly able to move. This was initially blamed on food poisoning from a restaurant seafood meal, but by the following day, the mom was feeling weak and shortly succumbed, with similar effects.

A woman went over to help this family. She wore a N-95 type mask and washed her hands diligently. Within a few days, the full symptoms suddenly overtook her, as well.  But her husband never got it.  The older child in the original family seemed to have escaped, but a couple of days later he came down with similar symptoms, which lasted off and on for several days.

Most likely the culprit here was the “norovirus”. The virus is named after the city of Norwalk, Ohio, where an outbreak occurred in 1968. It bears the charming nickname, “the winter vomiting disease.” Although the effects of the virus are very unpleasant, fortunately they usually last only a couple of days, with full recovery being the norm.  The sufferer should acquire immunity to that strain of the virus for six months to two years. Some people may escape becoming symptomatic, based on the bacterial populations in their gut biome.

Since this is an economics blog, here are some quick stats. In the U.S. the norovirus is estimated to cause about 20 million illnesses a year and about half of all foodborne disease outbreaks. Norovirus causes some 900 deaths and 100,000 hospitalizations annually, mostly among adults aged 65 and older. It also leads to nearly 500,000 emergency department visits, mostly involving young children.

 A model of the worldwide economic burden of the disease found:

Globally, norovirus resulted in a total of $4.2 billion (95% UI: $3.2–5.7 billion) in direct health system costs and $60.3 billion (95% UI: $44.4–83.4 billion) in societal costs per year. Disease amongst children <5 years cost society $39.8 billion, compared to $20.4 billion for all other age groups combined. Costs per norovirus illness varied by both region and age and was highest among adults ≥55 years. Productivity losses represented 84–99% of total costs varying by region. While low and middle income countries and high income countries had similar disease incidence (10,148 vs. 9,935 illness per 100,000 persons), high income countries generated 62% of global health system costs.

Once it shows up in a family, it is hard to avoid. A reason is that you can be sickened by exposure to as few as ten viral particles, compared to billions that are expelled in a bodily fluid incidents. A doctor reported:

She once acquired a norovirus infection by simply using the same bathroom that had been used earlier in the day by a visiting in-law who was recovering from a recent bout with the stomach bug.  That’s because “people who have norovirus can shed the virus for up to two weeks after their symptoms are gone.”

In another case, a diner in a restaurant vomited on the floor. The mess was quickly cleaned up by staff, and other diners continued eating. In the next few days, 90% of the people at the same table as the sick person fell ill, along with 70% of the diners at an adjacent table, and 25% of the folks at a table across the room.

OK, that’s the bad news. How can we fight back? Lengthy handwashing with soap should help, along with quarantining as much as possible. It turns out that alcohol is not very good at killing this bug, so the usual hand sanitizers may be ineffective.  Better results can be had cleaning surfaces with a bleach-water solution.

The main care needed is hydration. From what I have read, most Gatorade-type sports drinks do provide needed electrolytes (e.g., sodium and potassium), but probably have more sugar that is optimal for this situation. Gatorade Zero has sucralose in place of sugar, if you are OK with that. Pedialyte is designed for rehydration after diarrhea, and has less sugar and more electrolytes than Gatorade. Avoid “Gatorade Water” – it is just water, with the tiniest “infusion” of sodium and potassium.

If you find yourself stricken, it is reportedly wise to have a wastebasket or other receptable at hand in the bathroom, in case you face urgent activity from both ends at once (trying to word this delicately).

Fun fact I learned researching this topic: if the GI tract has been emptied, best avoid dairy for 48 hours after symptoms stop. That allows lactose in the gut to build back up again.

I have never gone on an extended cruise, partly because I don’t think I could resist the frequent offerings of desserts and snacks. But reading of norovirus outbreaks on cruise ships has given me another reason to stay on terra firma.

Seven Reasons Why Americans Pay So Much for Health Care

Scott Buchanan4 Comments

Ken Alltucker at USA Today recently published a piece titled Seven reasons why Americans pay more for health care than any other nation. It starts off:

Americans spend far more on health care than anywhere else in the world but we have the lowest life expectancy among large, wealthy countries.

A lot of that can be explained by the unique aspects of our health care system. Among other things, we reward doctors more for medical procedures than for keeping people healthy, keep costs hidden from customers and spend money on tasks that have nothing to do making patients feel better.

“We spend more on administrative costs than we do on caring for heart disease and caring for cancer,” said Harvard University economist David Cutler. “It’s just an absurd amount.”

The article notes that the whole system is skewed towards high costs. It is not just profiteering insurance companies. Seven factors are listed. I will excerpt them in italics below, and close with a few of my comments.

Reason 1: Lack of price limits

U.S. hospitals have more specialists than do medical facilities in other nations. Having access to 24/7 specialty care, particularly for hospitals in major metro areas, drives up costs… Patients have more elbow room and privacy here. U.S. hospitals typically have either one or two patients per room, unlike facilities abroad that tend to have open wards with rows of beds, Chernew said. He said differences in labor markets and regulatory requirements also can pack on costs.

Of the $4.5 trillion spent on U.S. health care in 2022, hospitals collected 30% of that total health spending, according to data from the Centers for Medicare & Medicaid Services. Doctors rank second at 20%. Prescription drugs accounted for 9% and health insurance − both private health insurance and government programs such as Medicare and Medicaid − collect 7% in administrative costs.

Reason 2: Hospitals and doctors get paid for services, not outcomes

Doctors, hospitals and other providers are paid based on the number of tests and procedures they order, not necessarily whether patients get better.  The insurer pays the doctor, hospital or lab based on negotiated, in-network rates between the two parties.

Critics of this fee-for-service payment method says it rewards quantity over quality. Health providers who order more tests or procedures get more lucrative payments whether the patients improve or not.

Reason 3: Specialists get paid much more ‒ and want to keep it that way

Doctors who provide specialty care such as cardiologists or cancer doctors get much higher payments from Medicare and private insurers than primary care doctors.

Some see that as a system that rewards doctors who specialize in caring for patients with complex medical conditions while skimping on pay for primary care doctors who try to prevent or limit disease.

[My comment: There is a saying in management science that your system is perfectly designed for the results you are getting. In other nations with a fixed pot of money, doled out by the government, to mainly non-profit health providers, there is (in theory, at least) an incentive system that would work towards minimizing overall health expenses. In the U.S., though, we have a mainly for-profit system, that collects more moolah the more health problems we have, and the more expensive are the treatments. Most healthcare providers try to be noble-minded and work for the good of their patients, but still the overall financial incentives are what they are.  The health insurance companies are one of the few forces working against endless upward spiraling of healthcare costs. ]

Under the current system, doctors are chosen or approved by the American Medical Association to a 32-member committee which recommends values for medical services that Medicare then considers when deciding how much to pay doctors. Some have compared the idea of doctors setting their own payscale to the proverbial fox guarding the henhouse.

Reason 4: Administrative costs inflate health spending

One of the biggest sources of wasted medical spending is on administrative costs, several experts told USA TODAY….Harvard’s Cutler estimates that up to 25% of medical spending is due to administrative costs.

Health insurers often require doctors and hospitals to get authorization before performing procedures or operations. Or they mandate “step therapy,” which makes patients try comparable lower-cost prescription drugs before coverage for a doctor-recommended drug kicks in.  These mandates trigger a flurry of communication and tasks for both health insurers and doctors.

Reason 5: Health care pricing is a mystery

Patients often have no idea how much a test or a procedure will cost before they go to a clinic or a hospital. Health care prices are hidden from the public. …An MRI can cost $300 or $3,000, depending on where you get it. A colonoscopy can run you $1,000 to $10,000.

Economists cited these examples of wide-ranging health care prices in a request that Congress pass the Health Care Price Transparency Act 2.0, which would require hospitals and health providers to disclose their prices.

Reason 6: Americans pay far more for prescription drugs than people in other wealthy nations

There are no price limits on prescription drugs, and Americans pay more for these life-saving medications than residents of other wealthy nations.

U.S prescription drug prices run more than 2.5 times those in 32 comparable countries, according to a 2023 HHS report…. Novo Nordisk charged $969 a month for Ozempic in the U.S. ‒ while the same drug costs $155 in Canada, $122 in Denmark, and $59 in Germany, according to a document submitted by Sanders.

[My comment: Yes, this disparity irks me greatly].

Reason 7: Private Equity

Wall Street investors who control private equity firms have taken over hospitals and large doctors practices, with the primary goal of making a profit. The role of these private equity investors has drawn increased scrutiny from government regulators and elected officials.

One example is the high-profile bankruptcy of Steward Health Care, which formed in 2010 when a private equity firm, acquired a financially struggling nonprofit hospital chain from the Archdiocese of Boston.

… Private equity investors also have targeted specialty practices in certain states and metro regions.

Last year, the Federal Trade Commission sued U.S. Anesthesia Partners over its serial acquisition of practices in Texas, alleging these deals violated antitrust laws and inflated prices for patients. …FTC Chair Lina Khan has argued such rapid acquisitions allowed the doctors and private equity investors to raise prices for anesthesia services and collect “tens of millions of extra dollars for these executives at the expense of Texas patients and businesses.”

[ This also concerns me. That anesthesia monopoly should never have been allowed, in my opinion. The reason the PE firm paid to acquire all those individual practices was so that they could raise prices while minimizing services. Duh. That is the PE gamebook. When they do a corporate takeover, they nearly always fire employees and raise prices on products, to goose profits. This would not be a problem if the business were, say, selling pet rocks, but healthcare is different.

In many metro areas now, nearly all healthcare providers (even if they seem to retain their private practices) have become part of one or two mega conglomerates that cover the area. I feel fortunate because at least on of the mega conglomerates in my area is a high-quality non-profit, but I pity those whose only choice is between two for-profits.]

Final comments: I think another factor here is in our private enterprise system, it is so costly to become a doctor that they have to charge relatively high fees to compensate. This leads to a system where there are layers and layers of admins and nurses to shield you from actually seeing the doctor. As an example, I sliced my finger a couple of years ago, and went to an urgent care facility. There was an admin at the desk who took down my insurance info and relayed my condition to the back. Some time later, an aide took me back and weighed me and took my blood pressure. I think a nurse swung by as well. Finally, The Doctor Himself sailed in, to actually patch me up. And of course there were layers of administrative paperwork between me, the care facility, and my insurance company, to settle all the charges.

In contrast, a friend told me that when he broke his arm in the UK, he went to the local clinic, which was staffed by a doctor, and no one else. The doc set his arm, charged him some nominal fee, and sent him on his way.

There are other factors, I’m sure, such as the unhealthy lifestyle choices of many Americans. Think: obesity and opioids, among others.  I suspect that is to blame for the poorer health outcomes in this country, more than the healthcare system.

In favor of the current U.S. system, although we pay much more, I think we do get something in return. It seems that with a good health plan, the availability of procedures is better in the U.S. than in many other countries, though I am open to correction on that.

The Mythology of Rice and Beans

Zachary Bartsch3 Comments

I’ve written about proteins twice before. Once concerning protein content generally and then another concerning amino acid content of animal proteins. The reason that I stuck to animal proteins initially was because I held a common and false belief: Singular vegetarian foods aren’t complete proteins. The meat-eaters gotchya claim is that meats contain complete proteins. After all, we’ve heard a million times that beans and grains are often eaten together because they form a complete protein. The native North Americans? Corn and beans. Subcontinent Indians? Rice and Lentils or chickpeas. Japan? Rice and soy. Choose your poor or vegetarian population in the world, and they combine beans and grains. We’ve always been told that it’s because the combination constitutes a ‘complete protein’.

But you know what else constitutes a complete protein? Any of those foods all by themselves. What the heck. I haven’t been lied to. But I’ve certainly been misled. Let me briefly tell you my research journey. My recommended daily intake (RDI) are from the World Health Organization and the amino acid data is from the US Department of Agriculture. Prices are harder to pin down in a representative way, but I cite those too.  

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The Price of a Complete [Animal] Protein

Zachary Bartsch2 Comments

I wrote about the protein content of different foods previously. I summarized how much beef versus pea and wheat flour one would need to eat in order to consumer the recommended daily intake (RDI) of ‘complete proteins’ – foods that contain all of the essential amino acids that compose protein. These amino acids are called ‘essential’ because, unlike the conditionally essential or non-essential amino acids, your body can’t produce them from other inputs. Here, I want to expand more on complete proteins when eating on a budget.

Step 1: What We Need

To start, there are nine essential amino acids with hard to remember names for non-specialists, so I’ll just use the abbreviations (H, I, L, K, M, F, T, W, V). The presence of all nine essential amino acids is what makes a protein complete. But, having some of each protein is not the same as having enough of each protein. Here, I’ll use the World Health Organization’s (WHO) guidelines for essential amino acid RDI for a 70kg person. See the table below.

Step 2: What We Need to Eat

What foods are considered ‘complete proteins’? There are many, but I will focus on a few animal sources: Eggs, Pork Chops, Ground Beef, Chicken, & Tuna. Non-animal proteins will have to wait for another time. Below are the essential amino acid content per 100 grams expressed as a percent of the RDI for each amino acid. What does that mean? That means, for example, that eating 100 grams of egg provides 85% of the RDI for M, but only 37% of the RDI for H.

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We’ve Got You Covered

James Bailey1 Comment

That’s the title of a recent book by Liran Einav and Amy Finkelstein, subtitled “Rebooting American Health Care”. I reviewed the book for Independent Review; the short version of my review is that while I don’t agree with all of their policy proposals, the book makes for an engaging, accurate, and easily readable introduction to the current US health care system. Here’s the start of the review:

Liran Einav and Amy Finkelstein are easily two of the best health economists of their generation. They have each spent twenty years churning out insightful papers published in the top economics journals. As a young health economist, I would read their papers and admire how well they addressed the technical issues at hand, but I was always left wondering what they thought about the big picture of health care in the United States….

The book’s prologue describes how Finkelstein’s father-in-law finally bullied her into writing on the topic, using almost the exact words I always wanted to: “I know these are hard issues. But come on … You’ve been studying them for twenty years. You must be one of the best placed people to help us understand the options. Do you really have nothing to say on this topic?”

The conclusion:

I learned a lot reading the book, despite having already studied U.S. health financing for over a decade—for instance, that the first compulsory health insurance program in the U.S. was a 1798 law pushed by Alexander Hamilton to cover foreign sailors. While the authors are more used to writing math-heavy academic papers, We’ve Got You Covered reads like the popular press book it is. Perhaps the highest endorsement comes from a non-academic family member of mine who picked up the book and noted, “These are not dry writers … this doesn’t sound like a book written by economists, no offense.”

The full review is free here, the book is for sale here.

Weight Lifting is for You

Joy Buchanan1 Comment

This is a guest post by Mary Buchanan, a Board Certified Behavior Analyst. Here she explores the intersection of behavioral economics with her own health and fitness behavior change.

My childhood dentist often said, “Take care of your teeth, or they’ll go away.” As I approach my 40th birthday, I’m learning the same is true of my muscle mass. I can use it or lose it. And I can lose it faster or slower based on my lifestyle choices. 

As a behavior analyst, I have spent many years practicing the science of behavior, specifically teaching others how to master new, meaningful skills. I see myself as my own client now as I work to replace my old aimless approach to fitness with evidence-based eating and exercise interventions. 

I wish I could say I embraced strength training as soon as I heard about its benefits. Instead, as I noticed more and more recommendations for women to “lift heavy”, I kept filing that information away for someday in the future. When I joined a gym last January, I returned to what I used to do in years past: Pilates classes or cardio machines. After 9 months of that approach with no benefits to show for my efforts, it was time to change my behavior.

Behavioral economics has a term for what causes people to resist changing their behaviors without a significant incentive for doing so: status quo bias. 

Another behavioral economics term, loss aversion, helps to explain what moved me into action. Loss aversion refers to how people are often more motivated not to lose something they have than they are motivated to gain something similar. All humans start to lose muscle mass around age 30, but that fact was not on my radar until recently. I wasn’t interested in building muscles when I thought mine were adequate to my daily tasks. Now that I realize my muscle loss has been underway for years and the liabilities of that loss are clear to me, I’m motivated to rebuild and mitigate future muscle loss. How? By doing heavy lifting 2-3x per week and eating enough protein for my body to keep the muscle it makes. 

There are many great resources that provide advice in this area, but I’ve decided to begin
with learning from Dr. Stacy Sims since she specializes in what works for women. Based on what I’ve learned, here are my target behaviors for increase:

  • Practice strength training for at least 30 minutes, 2x per week.
    Dr. Sims says 3x per week is better, but 2x is an acceptable minimum that I can commit to either through classes at a gym or YouTube videos. As a behavior analyst, I know that I’m more likely to maintain a new behavior pattern when it is easy to feel successful early and often.
  • Continue to challenge myself throughout strength training by adding weight as I get stronger.
    To stimulate muscle growth you must challenge your muscles so they break down and repair stronger. How heavy is enough? If you lift a weight 10x and it’s difficult to lift on the last two reps, but still possible for you to maintain good form, that is an appropriate weight for you to train with. When that weight gets easy to lift, it’s no longer heavy enough for your training purposes.
  • Increase my healthy protein intake.
    In Roar, Dr. Sims suggests that women aim for .75-0.8 grams of protein per lb. on a light or non-training day, and increase to 1-1.2 grams of protein per lb. on strength training days. 

Working on these goals together creates synergy. I am more motivated to make healthier eating choices because my eating is connected to my strength training goal. Strength training has also become more exciting for me the more I’ve learned about its benefits, including:

  • Increased metabolic rate
  • Improved posture and stability
  • Stronger bones
  • Better blood pressure control
  • Improved immunity
  • Maintenance of healthy body composition (lifting heavy helps maintain lean muscle and reduce fat gain)

As if that weren’t enough, I have another reason to keep going. As soon as I started resistance training, my sleep improved! I’ve had difficulty sleeping for many years already, both with falling asleep and staying asleep, and honestly, if sleeping through the night was the only benefit available to me from resistance-based workouts, I would still be all in.

While none of this constitutes professional medical advice, it is worth looking into, especially if you, like me, never saw role models strength training as a young person. Once you understand how it works in your favor now and as you age, the benefits are too good to pass up.

RESOURCES

Stacy Sims, MSC, PHD is an exercise physiologist and nutrition scientist. She specializes in teaching women what works for their bodies based on their body type, stage of life, and fitness goals. 

My first introduction to her work and recommendations was this 26-minute interview: https://www.youtube.com/watch?v=APwKKUtjINo

Her book, Roar, is helpful for those who want to learn about general women’s health, though it is especially geared towards female athletes. https://www.amazon.com/ROAR-Revised-Fitness-Physiology-Performance/dp/059358192X/

Next Level focuses on the physical changes women experience with the natural aging process. It clearly presents how we can use the latest research to work with what is happening in the body instead of against it. https://www.amazon.com/Next-Level-Kicking-Crushing-Menopause-ebook/dp/B091JVW6QR/

Pistol Squats Complete the Home Workout from James

National Survey of Drug Use and Health State-Level Data: Now Cleaned in Excel and Stata

James Bailey1 Comment

I offer a cleaned version of the state-level NSDUH in Stata .dta and Excel .xlsx formats here.

The NSDUH is mostly quite good as government datasets go- they share individual-level data in many formats and with the option to get most years together in a single file. But due to privacy concerns, the individual-level data doesn’t tell you what state people live in, which means it can’t be used to study things like state policy. SAMHSA does offer a state-level version of their data, but it is messy and only available in SAS format. So I offer the 1999-2019 state-level NSDUH Small Area Estimation Dataset in Stata .dta and Excel .xlsx formats here.

If you have Stata I recommend using that version, since the variables are labelled, making it much easier to understand what they represent.

This is the latest addition to my data page, where you can find cleaned/improved versions of other government datasets.

Protein, Protein Everywhere

Zachary Bartsch8 Comments

If you’ve ever been vegetarian or if you have ever spoken to a vegetarian about their diet, then you have probably heard or asked “How do you get enough protein?”.  While it’s important for health and economic achievement to get adequate protein, not too long after comes the questions about types and sources of protein. This question is relevant for vegetarians and vegans, but also people with meat allergies and people with religious dietary guidelines that prohibit meat always or seasonally. Let’s break it down.

Some omnivores are incredulous that vegetarianism can provide adequate protein or protein quality. But protein itself is relatively easy to get and any judgmental attitudes on both sides are mostly just vibes. Legumes and nuts tend to have a lot of protein. But relative to what?

The World Health Organization recommends that an 80-kilogram (176 lb) adult should get 66.4 grams of protein per day (0.83g per kg). That’s the protein content of about a 9oz of peanuts. Protein is super important and it’s luckily not that hard to get if you eat a variety of foods. Even if you’re trying to consume double the WHO recommended daily intake (RDI), it’s an easy feat.

Below is a table of some popular protein sources. The table includes the grams of protein per 100 grams of food, which makes the protein content a percent. The table also includes the number of grams needed in order to achieve the WHO protein RDI of 66.4 grams. The last column is for our American readers who need the serving to be in ounces.

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The Dietary Salt Wars

Scott BuchananLeave a comment

For many years, it has been stated as settled science that Americans need to cut back their sodium intake from the current averages of about 3400 mg/day to less than  2400 mg sodium (about 1 teaspoon of table salt). The 2400 mg figure is endorsed by the National Academies, as described in the 164-page (we’re from the government and we’re here to help) booklet Dietary Guidelines for Americans published by USDA and HHS. The reason given is that supposedly there is a roughly linear relationship between salt intake and blood pressure, with higher blood pressure correlating to heart disease. The World Health Organization (WHO) recommends less than 2000 mg.

The dietary salt boat has been rocked in the past several years by studies claiming that cutting sodium below about 3400 mg does not help with heart disease (except for patients who already incline toward hypertension), and that cutting it much below 2400 mg is actually harmful.

The medical establishment has come out swinging to attack these newer studies. A 2018 article (Salt and heart disease: a second round of “bad science”? ) in the premier British medical journal The Lancet acknowledged this controversy:

2 years ago, Andrew Mente and colleagues, after studying more than 130000 people from 49 different countries, concluded that salt restriction reduced the risk of heart disease, stroke, or death only in patients who had high blood pressure, and that salt restriction could be harmful if salt intake became too low. The reaction of the scientific community was swift. “Disbelief” was voiced that “such bad science” should be published by The Lancet.  The American Heart Association (AHA) refuted the findings of the study, stating that they were not valid, despite the AHA for many years endorsing products that contain markedly more salt than it recommends as being “heart healthy”.

This article went on to note that, “with an average lifespan of 87·3 years, women in Hong Kong top life expectancy worldwide despite consuming on average 8–9 g of salt per day, more than twice the amount recommended by the AHA recommendation. A cursory look at 24 h urinary sodium excretion in 2010 and the 2012 UN healthy life expectancy at birth in 182 countries, ignoring potential confounders, such as gross domestic product, does not seem to indicate that salt intake, except possibly when very high, curtails lifespan.”

A more recent (2020) article by salt libertarians, Salt and cardiovascular disease: insufficient evidence to recommend low sodium intake, stated in its introduction:

In 2013, an independent review of the evidence by the National Academy of Medicine (NAM) concluded there to be insufficient evidence to support a recommendation of low sodium intake for cardiovascular prevention. However, in 2019, a re-constituted panel provided a strong recommendation for low sodium intake, despite the absence of any new evidence to support low sodium intake for cardiovascular prevention, and substantially more data, e.g. on 100 000 people from Prospective Urban Rural Epidemiology (PURE) study and 300 000 people from the UK-Biobank study, suggesting that the range of sodium intake between 2.3 and 4.6 g/day is more likely to be optimal.

… In this review, we examine whether the recommendation for low sodium intake, reached by current guideline panels, is supported by robust evidence. Our review provides a counterpoint to the current recommendation for low sodium intake. We suggest that a specific low sodium intake target (e.g. <2.3 g/day) for individuals may be unfeasible, have uncertain consequences for other dietary factors, and have unproven effectiveness in reducing cardiovascular disease. We contend that current evidence, despite methodological limitations, suggests that most of the world’s population consume a moderate range of dietary sodium (1–2 teaspoons of salt) that is not associated with increased cardiovascular risk, and that the risk of cardiovascular disease increases when sodium intakes exceed 5 g/day.

The keepers of orthodoxy fired back the following year in an article with an ugly title Sodium and Health: Old Myths and a Controversy Based on Denial  and making ugly accusations:

Some researchers have propagated a myth that reducing sodium does not consistently reduce CVD but rather that lower sodium might increase the risk of CVD. These claims are not well-founded and support some food and beverage industry’s vested interests in the use of excessive amounts of salt to preserve food, enhance taste, and increase thirst. Nevertheless, some researchers, often with funding from the food industry, continue to publish such claims without addressing the numerous objections.

Ouch.

I don’t have the expertise to dig down and make a ruling on who is right here. But I do feel better about eating my tasty salty chips, knowing I have at least some scholarly support for my habit.