26 January 2011

Unhealthful News 26 - the State of the Union is uninspired

I was hoping that President Obama would give me something good to write about today, but there was no mention of public health (only a bit about medical financing) and pretty much no reference to science (vague calls to improve America's competitiveness, education, and immigration policy do not count).  But since I do not have much time to blog today, I will just write a bit about what he did say.

The one claim about public health that I noticed was wrong, that wind energy (implicitly: wind energy using our current technologies) is "clean".  He did not make a big deal about the claim, and obviously he personally does not have time to know anything about it, so I will not harp on it.  But I wonder why no one in his administration has not figured out that it might be a good idea to not be too closely associated with that particular technology.  Even someone who insists on believing, against all the evidence, that the current industrial wind turbines do not cause serious health problems for local residents, create aesthetic damage, lower property values, and tear apart communities, surely they must realize that a lot of us are of the studied opinion that they do cause these problems.  Oh, and they are very inefficient (read: expensive and do not provide the reliable generation that the power grid needs.)   (If you are curious, there is a lot written about it; start here.)

Thus, we have to wonder why his energy advisors, who must know about the controversy, are letting him be directly associated with the issue.  It is not like tax policy, the wars, or even abortion rights, where it is difficult to avoid taking a stand; it is easy to just never mention it.  It is difficult to believe that anyone is a strong enough proponent that this would win him votes, but I know a lot of people who are strong enough opponents to consider it a voting issue.  Perhaps this is an example of people thinking they understand an issue because they only listened to the proponents of a particular belief.  Let's see… this is day 26 of Unhealthful News, so I have probably offered more than 10 previous examples of someone making the same error, and will probably provide more than 100 more before the year is over.

More relevant to scientific analysis of health, though you probably would not realize it, is that Obama pledged to end the terrible Bush education policy called "No Child Left Behind" (NCLB).  That Bush administration policy imposed brainless standardized tests and other restrictions on the nation's school systems, resulting in years where millions of children spent enormous amounts of their time drilling to do better on the test rather than actually learning.  The policy was widely condemned as terrible for the education of the kids, insulting to teachers' status as trained professionals, and even corrupt (cronies of those who put it in place, including one of Bush's brothers, were suppliers of the test-related materials to the schools).

The bit that makes this a health science story (other than the fact that focusing teaching on what can be included on a standardized test pretty much ensures that no one will learn to think scientifically) is that many proponents sowed confusion by insisting that NCLB was better because it followed a "scientific medical model".  It was a complete misrepresentation of how health science really works, but few of the opponents of the policy had the expertise to argue this point.  (I toyed with writing some papers to help out with this, but never managed to organize the necessary collaboration.) 

It is not entirely clear whether the proponents who were using this rhetoric knew that they were misleading people or whether they actually thought they understood how health science is done.  I am guessing that they mostly committed the standard intellectual crime of hearing some claim that they vaguely understand and translating that into definitive (false) statements.  Other examples include things like the first topic of this post, and my personal favorite, "we need to run this university more like a business."  The latter is quite similar to the "scientific medical model" rhetoric, since it usually comes from someone who either understands almost nothing about running a business or almost nothing about what a university is (first, we lay off everyone at all the unprofitable departments, like liberal arts; then, we cut back needless frills like student community building, seminars, and non-contract research; then we abandon rules that might impede our marketing efforts and IP, like free and open inquiry – hmm, come to think of it….)

The mythical "scientific medical model" that the NCLB proponents invoked was that only randomized trials are informative.  Since that has been the theme for much of January (I will write less about it in the future), I will not add to what I have already written about how wrong that is in general.  It was a wonderfully convenient claim for NCLB proponents because only very rigid interventions that anyone can do, like imposing simple uncreative classroom methods, are amenable to trials.  Moreover, trials tend to be very simplistic research and require a simple endpoint – like the scores on a standardized test.  The observational research, which can examine the value of various teaching methods that cannot be easily imposed as part of an experiment, is far more difficult to do, but has the advantage that we can try to assess what we actually care about.

Funny how most everyone who pretends to think that only RCTs are informative are those who stand to profit from either doing the RCTs or claiming that the lack of them means we have no evidence.  Going back to the first example, the consultants hired by the wind power industry are fond of trying to mislead people into believing that there is "no scientific evidence" of health effects, when what they are really pointing out is that the evidence has not been published in journals.  Even this is not entirely true, but it is true that the majority of the evidence we have takes the form of adverse event reports of specific problems.  But within another year, I expect there will be a fair bit of evidence published in journals, and at that point I expect the industry consultants to start claiming "we cannot really know anything because there are no randomized trials" (indeed, I went up against someone who was claiming that in one hearing already).

This ignorance (or pretend ignorance in the case of many of those profiting from it) is indeed a medical model.  For decades physicians drew bad conclusions as a result of conducting very bad observational research.  The solution was to teach them that they should do (or only trust) randomized trials to overcome the problems of their bad observational research (and, occasionally, problems of good observational research).  Many of them mis-learned the lesson (the problem is not observational research is not useful in general, just that physicians were really bad at it and, for some areas of inquiry like medical treatments, trials are almost always better) and somehow their misunderstanding spilled over to other non-scientists. 

The result is indeed model medical behavior: someone having the kind of practiced arrogance that makes him certain about everything, no matter how little he knows and how many mistakes he and his colleagues have made before.  Not too different from the political model of macroeconomics right now – I kind of shrugged when Obama made the mistake about wind power, but I yelled at the television when he got things so wrong about what economic policy we should pursue (and was not at all surprised when the Republicans responding to him took these same errors a lot further).  But others are much more expert at explaining those points, so I will leave it to them.

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