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Dr. Do-Gooder

First smoking, now trans fats. Health czar Thomas Frieden is determined to save our lives, whether it’s good for us or not.

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You got mine,” says Dr. Thomas Frieden. We’re having lunch at Big Wong’s, in Chinatown, and we’ve both ordered No. 31: roast-pork noodle soup. Frieden asked for his with a side of bok choy instead of noodles, and they’ve mixed up the dishes. As we pass them over the table, he pauses and gives me a look. He knows he’s been accused of being a legislator of lifestyle, a Fascist of no fun, and he doesn’t want to come off like some anti-pleasure crusader just because he didn’t want some damn noodles. “I just find the noodles very filling,” he explains, and smiles a little ruefully.

Since he took the job of health commissioner in 2002, Frieden has been one of the most visible and aggressive public-health officials in New York City history, the driving force behind a strikingly activist policy that attempts to curb chronic diseases—such as heart disease, cancer, diabetes—by reducing their contributing factors. Thus, you can no longer smoke in bars and restaurants in New York, and soon—as of next July—you will not be able to enter a restaurant and eat anything that was cooked with more than trace amounts of partially hydrogenated vegetable oil, no matter how much you want to.

Frieden’s ban on restaurants’ use of trans fats—the industrially created unsaturated fats that occur in the oils many restaurants use to cook and fry doughnuts, French fries, even pizza dough—has produced a hysterical debate about the dangers of both fatty foods and activist public-health policy.

The smoking ban was one thing: The links between smoking and cardiovascular disease, lung cancer, and other ills were not in question. Nor was the assertion that smoking affected not only smokers but also those around them. Frieden estimates that 11,000 lives have been saved from the smoke-free initiative.

But trans fats are a trickier issue. The National Academy of Sciences, the Department of Health and Human Services, and the FDA all take the position that trans fats are no worse for you than the saturated fats they were designed to replace. Which leads to the argument that Frieden is singling out one ingredient, somewhat randomly, when the real issue is reducing the consumption of all of these fats. Trans fats will just be replaced with saturated fats, and we’ll still all be obese and die early.

Frieden says the health department decided to move forward with the initiative because the data on trans fats has become clearer and clearer in recent years. Recent studies—in the New England Journal of Medicine, for instance—assert that trans fats are in fact worse than saturated fats because they not only raise bad cholesterol but also lower the good kind. At a public hearing on the ban in October, Dariush Mozaffarian, a Harvard epidemiologist, said that 6 percent of heart attacks in the U.S. were due to the consumption of trans fats, corresponding to 1,200 deaths from heart disease in New York City a year. Frieden believes the ban will save at least 500 people a year—and perhaps all 1,200. (And trans fats will not necessarily be replaced with saturated fats, he points out. KFC managed to drop trans fats and reduce saturated fats by 20 percent at the same time.)

But let us stipulate that trans fats are bad for us and we’d all be better off if they weren’t in our diets. This is where the libertarians wade in, claiming the inalienable right to eat food that’s bad for them. What’s wrong with the right to have your own private heart attack? It’s not hurting the guy at the next table eating sprouts.

“Trans fats is about a person making a trade-off between flavor and longevity,” says Edward Glaeser, a professor of economics at Harvard who has written against paternalism. “These are well-meaning people. But they’re doctors! And doctors tend to think that health is overwhelming. The point of life is not to maximize mortality reduction.”

This is hard for someone like Frieden to accept. His basic philosophy is that each time a New Yorker dies a premature death from a preventable disease, he has failed. “Whenever he sees anybody smoking in New York City,” his former communications director, Sandra Mullin, told me, “he considers it his fault.” (She also said that several members of the staff were smokers when Frieden took office—he never pressured them to quit, Mullin said, but they all did.)

What Frieden argues is this: With trans fats, it is the restaurants that are giving people no choice. “In a restaurant, it’s not labeled, and there’s no practical way to do it. Nobody goes into a restaurant and says, ‘I’ll have a plate of trans fats.’”


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