23 January 2011

Unhealthful News 23 - Thou shall not enjoy being healthier

I will continue my practice of making Sunday posts a little different.  For this sabbath, two observations about the religious sides of public health.

I watched a few documentaries about beer brewing over the last few days, and decided to look for a health news story about beer.  WebMD favored my search with this story, which is currently on their front page, though there is nothing new in it.  What is special about the story is that it is called "The Truth About Beer" and, much to my surprise, it was almost the truth about beer.  Credit is shared between the author, Kathleen M. Zelman, and the researcher who she seemed to get most of her information from, Eric Rimm, who has been writing about this topic since I was in school.

Here was the best part:
It might seem unlikely, but beer (just like any wine, spirits, or other alcohol), when consumed in moderate amounts, has health benefits.
I hope the anti-alcohol disinformation has not been so effective that this actually still seems unlikely to most readers, but at least the message was accurate, which it usually is not.  For some reason, a myth persists that red wine, alone among alcoholic beverages, reduces heart attack risk and has other benefits, but there is no benefit from other drinks.  The evidence that all sources of alcohol have similar effects been clear for decades.  There was originally a hypothesis, ages ago, that the French Paradox (the fact that the French have better cardiovascular health than would have been predicted from naive models from many decades ago that over-emphasized the badness of dietary fats) might be explained by a benefit from red wine.  Red wine indeed turned out to be beneficial, but no more so then the more plebeian brown liquids that most of us prefer.

I said "for some reason", but I suppose the persistence of the myth is neither a mystery nor an accident.  Similar to the myth that all tobacco/nicotine use causes large health risks, the myth about red wine is used by moralizing activists, who pretend to be motivated by their health "sciencey" claims but are really using the language of science to support their purification campaigns without admitting their political motives.  In this case, studies of isoflavones and such, and biased reviews of the data that cherry-pick any statistics that favor wine over beer, are used to try to convince people that the benefits are from a few stray molecules left over from the grape skin, rather than the ethanol.  Since relatively few of the unwashed masses that these activists are trying to manipulate have red wine as their drink of choice, the activists can continue to pretend that almost all drinking is bad.

I really do think there is a class issue at work here, and it affects why this news story (which also waxes about the quality of current American brewing) admits the truth.  When I came of age, there were only 60 breweries operating in all of America, and 99.9% of what they produced was little more than cheap slightly-alcoholic bubbly water.  Most anyone reading about the benefits of alcohol for a decade and a half after that saw nothing but the red wine myth, and those of us who knew enough to know the science and that there was such a thing as good beer did our own brewing (I was pretty good at it) and research (I published one paper about this ages ago).  Eric Rimm has been communicating the same message contained in the WebMD story for at least 20 years.  But now, with more than 1000 craft breweries and dozens of fairly large high-quality operations in the U.S., people who would have been wine snobs a generation ago now drink fancy beer, so the health news is no longer entirely anti-beer. 

The article also points out that beer provides the health benefit of hydration because it contains plenty of "fluids", by which they actually mean "water"; the other fluids in it – alcohol and carbon dioxide (fyi, the word "fluid", despite its misuse by medics and health reporters, means "any liquid or gas") – do not aid hydration.  This is a rare response to the myth that any drink that contains alcohol is magically dehydrating no matter how much water it contains.  Wine and undiluted liquor probably do increase your need for more water to rinse out your system, and certainly do not offer the hydration benefits of beer.  They also seem to have the downside of increasing the risk of oral cancer due to topical exposure to the concentrated alcohol, though this was not mentioned in the article.

The article has a few gaffes (e.g., the alcohol content of beers cannot rise to 40%, a level that is only possible – at least with any yeast that has been invented to date – via distilling; even Sam Adams's Utopias only makes it up to the mid-20s).  But the biggest problem with even accurate summaries of the health effects is this:
Health experts don't recommend that anyone start drinking beer, or any other alcoholic beverage, for health benefits.
One of my readers pointed this oddity in a Facebook post a couple of weeks ago.  Of course, as he noted, it can be easily explained by the moralizing.  It is perfectly acceptable to recommend a pharmaceutical that also has unfortunate side effects, but we cannot recommend something that people actually enjoy.  Doing so might ruin the reputation of public health.  (The moralizers probably actually think that, and they probably do not recognize the bitterly ironic truth of it.)

On a completely random and unrelated note, I ran across this from the Journal of Policy Practice and just had to post something about it:
Deconstructing Social Constructionist Theory in Tobacco Policy: The Case of the Less Hazardous Cigarette
Author: Michael S. Givela
Abstract: Scholars in tobacco control have utilized a social construction approach to test and explain tobacco control policy and advocacy. Some recent tobacco control policy research has contended that Philip Morris's support of the U.S. Food and Drug Administration (FDA) regulation of tobacco (including purportedly reducing the harm of cigarettes) is to obtain the social construction goal of a socially responsible company. However, the primary motivation for Philip Morris's support of proposed FDA regulation and harm reduction for cigarettes was to maintain the company's market stability and profitability implemented by U.S. political process and institutions. In tandem with this, Philip Morris also sought political stability, a new company image, and federal preemption of conflicting and costly state requirements for harm reduction and tobacco ingredients. Social construction theory did not explain Philip Morris's motivation for seeking FDA regulation of tobacco. Only by reducing tobacco industry markets and customer use will there be a significant reduction in tobacco consumption.
As my readers know, sometimes I am embarrassed to be associated with epidemiology or particular subfields.  But when things seem to be at their darkest, I can always look on the bright side and realize that no matter how bad the literature in my areas is, at least it is usually caused by researchers not understanding and making a hash of what is an inherently legitimate science.  It is not actually a parody of science.

I honestly could not stop laughing after reading that abstract out loud to someone.  Try it, it is fun.  It is like trying to recite the dialogue from Star Wars – until you try to say it out loud it is not obvious how funny it is.  (In fairness, having heard my blog posts being read out loud by my "editor", what I write sounds pretty funny too, at least when read to the baby in a Winnie-the-Pooh storytime voice.)

It is interesting to see that last sentence of the abstract in something that is not standard anti-tobacco health science (or health pseudo-science); it is apparently a cross disciplinary part of anti-tobacco as a religion.  It obviously does not follow from the analysis.  Instead, it is a version of the mandatory "amen" that you have to attach to the end of any paper to maintain membership in the anti-tobacco activist congregation.   Still, it is a pretty funny version of the amen:  It says that reducing consumption depends on reducing sales and consumption.  I guess it is difficult to argue with that.

To add a little bit of substance to this analysis, I suspect this is an example of the Mythbusters fallacy that I explained in Unhealthful News 4.  Saying that "social construction theory" cannot explain PM's behavior was based on looking at a particular possible interpretation of the theory and its implications.  I am quite confident that social construction theory can produce a just-so story to explain anything someone wants it to explain with it (read: it seems to be pretty much just made up on the fly).  Thus, declaring that it does not explain a particular action seems rather, well, convenient.  Of course, any serious analysis of PM's actions in this matter would note that pretty much every one of the motives mentioned probably played some role, so the conclusion "their actions cannot be entirely explained by X" is undoubtedly true.

Still, I think my class-discrimination-based theory of public health disinformation about alcohol stands up pretty well as a sociologic theory.  So, I will conclude with:  Only by reducing the elite's monopoly on information will we be able to increase the democratization of information. 

And seeing how it is now after 5:00pm somewhere, may I recommend that if you like a medium-hoppy amber that tends a little bit toward scotch ale, that you reduce your heart attack risk with Gordon Imperial Red from Oskar Blues Brewery in Colorado (which is SKU 8 19942 00008 1, not that I have one in my hand right now).  Also, if you have ever actually spent the three-figures per bottle price to try Sam Adams Utopias could you drop me a note and tell me how it was; I am really curious.


  1. Actually, Phillips might at least have read the entire article on social constructionism, like I have, rather than making less than informed comments about an article simply based on an abstract. As a Ph.D., I would assume that Phillips knows full well that abstracts are just bare bones summaries of scientific and peer reviewed journal articles. The article examines social constructionist theory in tobacco control, which argued that the motive for Philip Morris supporting FDA regulation of tobacco in 2009 was to repackage its corporate image (a social construction explanation). The article shows that this is not primarily the case and presents a *different* theory called social policy realism to explain what this was all about. Simply put, this was about profits and markets. Curious there was no mention in this blog entry about this theory. While ad hominem attacks on an abstract may be standard fare for a blog entry and is even entertaining in some quarters, I think this article, if you care to read it, has something very important to say.

  2. Actually, this is not entirely an accurate definition of social construction theory. Social construction theory is about using metaphors, symbols and text to explain a social reality.

    As noted in the new article and abstract, some tobacco control researchers in a past article had concluded PM was primarily attempting to change or socially construct its corporate image through public relations and communications and this is why PM supported FDA regulation of tobacco. The article just published shows by comparing social constructionist theory with another theory through scientific research social constructionism was not the primary reason for PM's stance. Why? It cites hard evidence in the article--not just opinion or "possible interpretations."

    By the way, the rest of the blog entry comes off sounding like offputting locker room humor and sneering and does not help to make the case.

  3. Um, Preed, I think you kind of made my main substantive point (based on more information than I had): If this was a response to someones claim that SCT said that PM was doing that to try to improve their image then my point, that SCT could be used to support that claim if someone wanted, seems to be supported. Honestly, I have observed these sociological theories enough to become convinced that they might be slightly useful frameworks for analysis, but that they barely tell you more than just looking at the unstructured facts on the ground. Again, I think it is pretty obvious to everyone who watched this closely that it is a safe bet that each of the proposed motives played some role and any attempt to rule one out as a partial motive (perhaps based on the fallacy that big corporations take actions as if they were rational unitary actors) is going to have to provide more evidence than these theories can offer.

    Also, I do not think you mean "ad hominem" (which would mean I was saying something bad about the author as if it took away from the content of the analysis) or "locker room" (which usually refers to anatomical or sexual references). I believe what you were looking for was something like "childish". I will grant that what I found amusing did not represent a sophisticated analysis of the content, and was probably annoying to anyone who takes a sting of phrases like that seriously. On the other hand, this was not some student submission to a conference, that calls for some restraint -- it was from a published article, and thus is pretty much fair game. But what really made it a fair target was that tacked-on statement (and I do not mean the fact that it was circular): it implicitly says what ought to be done about tobacco consumption, a conclusion that does not even remotely follow from an analysis of what PM did in this one case. If someone wants to say "based on my expertise, this is what a particular social theory says", whatever. If they want to say "based on my expertise about social theories, this is what ought to be done in the world" then they invite a response.

  4. Actually, we're not really making the same point. The article indicates that SCT had a minor role in explaining PM's motivations and it was not primarily about repairing a very tarnished corporate reputation through media and PR. Rather the primary reason, was profits and markets linked to US politics. Not all factors were equal. SCT was a secondary reason linked to profits.

    Whether you want to call what you wrote ad hominem (attacking the author personally) locker room (interesting that you use the sexual angle as that is not what I was thinking as I thought this to be more along the harshly taunting lines that sometimes happens in a locker room) or childish is really semantics, as far as I am concerned. If you want myself and probably many others to take you a lot more seriously I would suggest you stick to your points on the substance and clamp down on the public ridicule.

    In that regard, I appreciate your last post although I still don't agree with it entirely.

  5. If I might weigh in on this, or perhaps the more appropriate expression would be to wade into this, my curiosity led me to the full article (http://works.bepress.com/cgi/viewcontent.cgi?article=1021&context=michael_givel).

    I see that that last phrase in the abstract has no relation to anything anywhere in the article which makes it even more mystifying (and risible).

    Overall I found the actual article somewhat of a "emperor's cloak" in that the history of quite a transparent even if multi-sourced corporate response to a regulatory challenge was dressed up in unneeded theoretical elaborations. Everything worth saying could have been addressed quite pragmatically and adequately in a fairly short standard business analysis.

    The much more interesting question that arose and was ignored in the paper was why the FDA would be pursuing constituent regulation and implied reduction when everyone seemed to agree that there was no such thing as a safer cigarette.

    Perhaps, and I claim no expertise in these theories, SCT or SPT would be of use in dealing with some very complicated sequence of events with a confusing context but I doubt it. Here they functioned as the source of the complication. (Quite honestly, I feel as if I am recovering from an unpleasant experience and am just coming back from that "how not to think clearly" land.

  6. I think Paul pretty well reiterated the points I was making, adding information from reading the article. I really doubt anyone has anything more of significance to add, so I think that will be the last word on this one.


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