Unhealthful News 153 - An odd collision of politics and science

Usually when politics and science collide, it is a case of the politicos overruling what the scientific evidence suggests is best.  This week, there was the odd event of a US Congress committee trying to define what science is.  They did not do so well.

The story was reported by the Washington Post as one of the dozens of legislative events that happen everyday and that most Americans have no idea about.  But this one was picked up by various bloggers, interested in agriculture and especially tobacco.  

House Republicans are pushing back against a series of public health measures, including school lunch standards and tobacco regulation, teeing up a confrontation with Senate Democrats and the White House over the reach of government in daily life.

The action was a committee vote about restrictions on what the Food and Drug Administration can do.  The WaPo headline emphasized stopping Obama from trying to make school lunches healthier (horrors! this dictator must be stopped!!), but a lot of observers focused on the implications for tobacco regulation.  In particular it seemed to be about (and was widely interpreted as being about) stopping the possible ban of menthol in cigarettes.  It is not exactly clear to those of us reading the public record that it was really mostly about that.  But the insiders seem to have interpreted it that way, and since this is all about insider politics and the games played by those who want to rule our lives, their assessment is probably accurate.

The most intense reaction was generated by a provision offered by Rep. Denny Rehberg (R-Mont.) that would block the FDA from issuing rules or guidance unless its decisions are based on “hard science” rather than “cost and consumer behavior.” The amendment would prevent the FDA from restricting a substance unless it caused greater harm to health than a product not containing the substance.

The phrasing there definitely seems to fit the menthol question.  For those who do not follow the issue, the FDA advisory committee issued an opinion (which, in a huge surprise to many of us given the blatantly political committee, was scientifically accurate) that there is no strong evidence that smoking menthol cigarettes is any better or worse than smoking non-menthols, but that because menthol makes smoking more attractive, its presence increases the number of people who smoke.  The enabling legislation for FDA regulation of tobacco allowed action if something caused health harm at the population level (which would include by increasing exposure by attracting, on net, at least a few users who would otherwise be abstinent) even if it did not matter for an individual user, given that he is using.  For months, pundits protested that menthol did not cause harm (in the second sense) and therefore FDA could not ban it.  They did not seem to pay any attention to my observations (what else is new!) that the "population level" criterion meant that they could ban anything that increased the quality of cigarettes to the user or, similarly, mandate anything that lowered the quality, like ugly packaging or requiring a minimum content of spider legs.

Ok, so fine.  The legislature has the right to decide that the population health standard is cancelled and "less healthy" has to mean less healthy for any given individual user.  That is what our primary branch of government can do:  Change the rules if they do not like them.  They also could have just said "you cannot ban menthol", but they probably thought this was slicker.

Oh, but wait.  What is that about "hard science".  Uh oh.  I fear they are getting in over their heads.

“The FDA is starting to use soft sciences in some considerations in the promulgation of its rules,” said Rehberg, who defined “hard science”, as “perceived as being more scientific, rigorous and accurate” than behavioral and social sciences.  “I hate to try and define the difference between a psychiatrist and a psychologist, between a sociologist and a geologist, but there is clearly a difference,” he told the committee.

Yup.  They are getting in over their heads.  I think the lawyers are going to have a difficult time figuring out how to implement that "hard" and "soft" bit.  This starts to border on a legislature defining pi to be exactly 3.0 because it is more convenient.

Some people who are not scientists or scholars of science tend to think that anything they are told that sounds scientific and is completely baffling to them must be right.  So you could tell them pretty much anything about geology, acoustics, or nuclear physics and they would probably believe you.  But the real problem is that for the sciences that they think they understand – just because they know the words, I suspect – they think that the information must be weaker.  Or worse still, they think they understand enough to critique the specifics.

But in this particular case, it is the social science that is much clearer than the natural science (which is what those of us who study science itself call what some lay people call "hard science").  The economics is that there is absolutely no doubt that the existence of menthol causes some people to smoke who would not otherwise do so.  Most people who smoke menthols would smoke non-menthols if there was no other choice, but a few would not, and even one is sufficient since obviously no one avoids smoking due to the existence of menthols.  Case closed; hooray for "soft" science.  By contrast, the epidemiology (let alone the completely sketchy toxicology) about whether menthol causes extra health problems for the individual user, either by causing physical damage itself or changing how people smoke, is fairly unsure.  Undoubtedly smoking menthols is either better or worse than non-menthols (the chance of being exactly the same is zero), but we are not sure which.  In fairness, we do know a lot: that the difference is not great, and so is probably smaller than the "soft" effect from raising the quality of the product.

He did get it right when he said that some sciences were perceived more rigorous and accurate (I am not sure exactly what it means to be "more scientific").  He just may not grasp which ones are more rigorous and accurate.

As for the difference between a psychiatrist and a psychologist, it is a prescription pad and attitude.  As for sociologist vs. geologist differences, I have dated both (notice that he made this about the people, not the disciplines) – and no, I am not going to give an answer.

In addition to protecting menthol, the new amendment:

would also prevent the FDA from restricting the widespread use of antibiotics in feed for farm animals, which many public health experts believe has led to the development of antibiotic-resistant bacteria that threaten human health. …. Groups including the American Medical Association and the Infectious Diseases Society of America have called on the FDA to ban the feeding of antibiotics to healthy animals.

Well, the AMA does practice a rather "soft" version of science much of the time.

Agricultural interests oppose those limits, saying there is no scientific proof that farm animals are the problem.

Here is another observation:  There. Is. No. Scientific. Proof. Period.

Sigh.  We need a press corps with enough education in science to not allow such nonsense to pass without comment.  And such a Congress too.

The banning of menthol, or not, will probably have a trivial effect on public health.  Mostly a ban would just fuel a black market to supply the higher quality (and tax free) product that could no longer be sold legally.  Banning antibiotics in animal feed, however, could help preserve the few remaining effective antibiotics we have, possibly averting the public health disaster that would occur if much more resistance develops and someone does not develop some new antibiotics soon (there have been few successes for a very long time).  I find it surprising to find myself agreeing with Congressman Henry Waxman (who has vowed to defeat the amendment once it is out of committee) and anti-tobacco extremist Matt Myers, who led the outcry about this.  If they succeed, though, they might actually strike a blow for public health due to the antibiotics and other implications of the amendment.  They might even do something I am not sure they have ever done before:  Strike a blow in favor of good scientific thinking.