PURE Validation of sodium excretion is flawed

In this section, we present compelling experimental evidence and authoritative methodological critiques demonstrating that:
(a) the principal findings of the PURE-Salt sub-study are methodologically invalid, as they are driven by biased exposure measurement rather than true physiological relationships; and
(b) despite clear, repeated, and unequivocal warnings from the scientific community, these fundamental flaws have been persistently ignored or dismissed. Consequently, studies employing the same discredited methodology continue to be conducted and published, often without adequate acknowledgment of their limitations, thereby propagating misleading conclusions within the literature.

This pattern represents a systemic failure of methodological rigor and editorial oversight, with significant implications for scientific integrity and public health policy. By allowing flawed exposure assessment methods to underpin influential conclusions about sodium intake and cardiovascular risk, the literature risks misinforming guidelines, undermining decades of high-quality experimental evidence, and confusing both clinicians and policymakers.