29 December 2011

Unhealthful News 196 - Reports on censoring bird flu research lack realistic context

A lot has been written already about the recent request(?) by the US government for a couple of journals and researchers to censor the discovery of how the "bird flu" virus (influenza H5N1) can be changed to allow airborne transmission (it is currently believed that the only transmission vector to humans is contact with birds) and related research.  The press has reported this being a case of "biosecurity" (which Phil Alcabes appropriately ridicules) concerns about an incredibly deadly flu, pitted against the problem of censorship and losing the free exchange of valuable scientific information.  The thing is that almost none of these exciting motifs accurately describes the situation.

First is a point I have written about at greater length before, so I will offer just an abbreviated version here:  People who write about infectious diseases, including most of the ostensible experts, never seem to learn that when a novel disease appears, there is a huge bias toward identifying only people who have gotten extremely sick from it.  After all, who shows up in a hospital to get diagnosed, thus leading to the discovery of a brand new or rare disease?  This is even more true in extremely poor populations where medical care is mostly limited to when someone is on the verge of death.  So the observation that half the people who get the disease die from it (a common claim in the hype about H5N1 right now) really means that only half the people die from it among those who are treated after they are on the verge of dying from it, when combined with those diagnosed on autopsy who could not afford any medical care.

How many others got/have the virus, having suffered only an everyday bout of illness, or perhaps nothing at all?  No one knows.  Only the rarest of nasty diseases would not have 100 like that for every one that went to the hospital, and 1000 or 10,000 is quite plausible.  A million is possible.  So is bird flu an utter terror, that is deadlier than contracting Ebola, or is it a fairly typical disease of its kind that kills perhaps as many as one out of every 100,000 that get it?  And for that matter, might it already be airborne in the wild, but just not virulent enough to notice?  We really do not know.

On top of that, there is no evidence that there are any significant and capable international terrorists who are waiting to use information like this.  (Indeed, the place to end the previous sentence might be before the qualifying phrase, "who...".)  There are lots of ways to engage in untargeted random destruction, and no one seems to be employing them.

So, the possibly low risk might argue for protecting the tremendous value of communicating the new discoveries and avoiding the horror of censorship.  Except that avoiding publishing the details represents be almost no loss of useful communication or genuine censorship.  I would guess that there are a couple of hundred people in the world who could make good use of the information that is being kept secret, and I would bet that most of them will still have access to it if they want.  In a matter of years, technology will evolve so that more people could make use of that information somehow, but by then it will inevitably be common knowledge.

As for censorship, this qualifies in only the most technical sense.  Censorship matters when it results in suppression of information, not the mere suppression of someone's words.  Everyone is being told the publicly relevant information, and indeed the dispute has called far more attention to that information than it otherwise would have gotten.  It is government suppression of useful health science when, for example, the CDC quietly hides relevant data it has about the benefits of tobacco harm reduction, as they do, and people are widely misled.  But if they reported the general result or the data and merely refused to tell us some highly technical detail about how they did the research, that would be a welcome relief from the self-censorship.

Or consider an analogy:  It was suppression of the worst kind that the US military prevented any reporting about a gunship crew gleefully killing a group of civilians in Iraq until Bradley Manning (or if not him, whatever hero actually did it) leaked the video.  It would not have been censorship in any important sense of the word if the they had allowed the incident to be reported, but prevented publication of some technical details about the weapons used that could benefit an actual enemy.  All the useful information would be out there, and the withholding would have been explicit and purposeful.

So what we really have is a case of withholding information that probably is no threat, and that will inevitably be public before long anyway, but that is probably actually still available to those who really need it, and is a situation where preventing the technical information from being made public does not constitute the kind of censorship we should fear.  Yawn.  Now I forget why this seemed important to write about.

27 December 2011

Unhealthful News 195 - "News" about effects of alcohol and the HPV vaccine: misleading readers while accurately reporting the science

Two stories in this morning's New York Times inspired me to get back to Unhealthful News blogging.  They are both great examples of bad reporting that takes something that is obviously true and manages to report it in a way that communicates something that is false, and not by misrepresenting the results.  One story offered the headline, "Prevention: Beer and Martinis: As Healthy as Wine?" and the other, "Patterns: HPV Vaccine Is Not Linked to Promiscuity".  They were both authored by Nicholas Bakalar.

So, you might ask, what is misleading about reporting the following?
Now an analysis in the January issue of The Journal of Studies on Alcohol and Drugs suggests that martinis and beer may be just as effective at extending life [as wine]. Wine may have appeared to be better only because the people who choose it are generally healthier.
A survey has found that girls ages 15 to 19 who are vaccinated against human papillomavirus, or HPV, are no more likely to be sexually active or to have more partners than unvaccinated girls.
The answer is that there is absolutely nothing misleading about these reports.  What is terribly misleading is the implication that there was ever any question whatsoever that these claims were true.

The fact that alcohol, without regard to which of its many delightful forms it is served in, is beneficial has been well-established for about two decades.  In fact, it was never the case that the evidence supported the claim that wine or red wine was more beneficial.  There was, once upon a time, a hypothesis that red wine had some particular properties, offered as a possible explanation for the "French paradox" in which it was observed that the French were much healthier than their macronutrient mix would suggest they ought to be.  (The real explanations:  Fats, particularly milk fat, are not actually worse for you than carbohydrates as was believed for a while; the French eat reasonable portions, slowly, and mostly whole foods; and they are less often physically inert compared to their Anglo peers.)

The original research that discovered that alcohol was beneficial (reducing cardiovascular risk) was partially inspired by the that French non-paradox, but as soon as the epidemiology started coming in, it became clear that there was no measurable difference in effect between different sources of alcohol.  A few bad studies, those that failed to control for the fact that in the USA wine drinkers tend to eat and otherwise behave healthier, sometimes did show an advantage for wine.  But it was always clear that this was the confounding.  More generally, there was the confirmation bias in which the studies that showed the opposite (random noise happens) were ignored.  Sometimes in the history of a scientific discovery, there is a moment where the best evidence of the day strongly supports a claim that later turns out to not be true.  This is not one of those cases.

For the case of the HPV vaccine, there was never any doubt that the vaccine would improve the benefit-cost tradeoff for having sex, but the effect would be slight.  Very slight.  When compared to the many huge benefits and costs of choosing to have sex, the very small risk of cervical cancer thirty years in the future and the even smaller though potentially sooner risk of oral cancer are absolutely minuscule.  This is especially so when we consider that adolescents are not exactly focused on the distant future when making decisions, and that the more proximate oral cancer risk is pretty much never mentioned in the pro-vaccine information (if people realize that most non-geriatric oral cancer seems to be caused HPV, it will be difficult to blame it on smokeless tobacco, and the "public health" people do not want to risk that).

So, the vaccine ought to create a tiny increase in someone's probability of choosing to have sex with more partners, but nothing that could possibly be picked up in the data from a survey of 1243 girls/women.  And that is even if there was not the huge confounding problem due to girls who get the vaccine coming from very different families from those who do not.  The effect would have to be more than a 5% change in probability to have any hope at all of showing up in a study that small (even with impossibly perfect control for confounding).  The availability of contraception and HIV prevention (i.e., condoms) ought to make that big a difference, but it would be irrational of girls to react to that extent to the HPV prevention (and irrational in the opposite direction from normal teenage irrationality).

So why were these study results portrayed as surprising discoveries, and why is it so non-surprising that Bakalar and the press more generally reported them this way?  Because the press, science and otherwise, can be counted on to carry water for well-funded extremist liars, reporting their claims as if they had merit and never calling bullshit.  Usually the dishonest extremism comes from what gets called the political right wing, like the economic claims of the Republican party or pseudo-Christians who oppose the HPV vaccine because they want to punish people for having sex.  But what usually is thought of as the political left, "public health" people, can be equally extremist and dishonest.  In this case the pseudo-Christians and the pseudo-public-health people have basically the same goal:  To mislead people, and thereby keep their health risks greater, in order to support an abstinence-only agenda.

The good news is that manipulating people with lies like those is really tricky, and most of the prohibitionists are just not that smart.  The playing up of red wine gave wine makers license (almost literally) to make health claims, promoting the category, without preventing knowledgable people from learning that other drinks are healthy too.  When it became clear from Swedish studies that snus caused no measurable cancer risk, American anti-tobacco extremists tried to claim that this did not apply to similar American products, though the evidence suggested no difference.  Finally the marketers realized they could not overcome that propaganda, so they just started selling "snus" in America.  Truth that improves the public's health will usually eventually win out over its opponent in "public health".

09 December 2011

Unhealthful News 194 - Public health terrorism, Pennsylvania date rape edition

In my last post I wrote about (and plan to revisit) a pseudo-public-health campaign to vilify the common practice of parents co-sleeping with their infants, which might cause a net increase in risk when done properly, but might not, and the net effect is clearly very close to zero.  I pointed out that this type of destructive extremist behavior by nanny-state actors seems to trace to anti-tobacco extremism emerging, since the 1990s, as the tail that wags the dog of public health.

Chris Snowdon recently posted a scathing takedown of an extreme (which is not to say rare) commentary that argued that since society has accepted policies that deny people the freedom to use tobacco, therefore government should take the same action with regard to other health-affecting choices.  Not every health affecting choice, of course -- just the ones that a certain ilk of people does not approve of.  As Snowdon has argued at length, this is one of the dangers of allowing an exceptional set of actions (government restrictions on free choice) to deal with an "exceptional" problem (the high risk from smoking).  Granting such exceptions to the ethical standards of free Western society almost inevitably creates a situation where extremists want to use the same tactics to deal with any similar phenomenon that they declare to be a problem.

A related but slightly different concern about such disregard for ethical public policy, beyond curtailment of personal autonomy via prohibitions, is curtailment of autonomy via manipulative messaging.  The worst of this, along with simply lying, is emotional violence that is designed to hurt people (for their own good, of course) and usually harms orders of magnitude more people than it causes to behave differently.  The most obvious example is the disturbing, often gory graphics on tobacco packages, which proponents have managed to trick everyone into calling "graphic warnings", even though they are most certainly not.  (A warning communicates accurate information that is not already known for the purpose of facilitating better informed decision making.  The tobacco graphics fail the "communicate information", "not already known", and often the "accurate" bits.)

The authors of the anti-co-sleeping campaign clearly drew inspiration from (and maybe even apprenticed in) the lavishly funded anti-smoking emotional violence campaigns which adopted a mentality of "say/show anything that might accomplish the goal, regardless of whether it is true or what damage it does."  In the case of the anti-co-sleeping, the damage includes the problem that it is impossible to offer advice about how to safely co-sleep (specifically, don't do it when you are under the influence of mind-altering drugs, legal or otherwise).  When the over-the-top message that co-sleeping is as bad as putting baby to bed buried in covers and cuddling a large sharp knife, there is not room to say "but if you do, make sure to...."  Further damage comes from making some of the many co-sleeping parents feel bad about their choice based on incorrect information.  And for any parent whose child died while co-sleeping the message might as well be "nyah nyah, you were an idiot, you deserve to be grieving for the rest of your life".

Fortunately there are very few such parents.  But, a lot more women have suffered date rape, and that is a lot of nasty flashbacks resulting from this (pictured) anti-drinking message that depicts a disturbing image of the legs and half-removed clothes of a young woman lying on what appears to be the floor of an low-quality institutional bathroom.  The guilty organization in this case was the Pennsylvania Liquor Control Board, which pulled the ad after one day following an outcry by rape victims and advocates.  At least that agency does not claim the mantle of "public health" in their title, though it is kind of annoying that the state secures for itself a monopoly over liquor and wine sales, and this agency that is the monopoly seller is using the profits for nasty messages like this.  (Fortunately there is something of a free market for beer and, for those of us living in the southeast of the state, there is the state of Delaware, home of low price booze, only a few minutes away -- something that seems even more worthwhile given this fiasco.)

Is our state liquor monopoly an extremist "anti" organization that is just trying to twist women to their agenda.  Well if you go to their webpage that is linked from the rape graphic, you will find such statements as:
Heavy drinking is usually defined as consuming an average of ... more than 1 drink per day for women
Also you will find such demonstrates of knowledge as:
...binge drinking is a pattern of alcohol consumption that brings the blood alcohol content (BAC) level to 0.08% or more. This pattern of drinking usually means 5 or more drinks on a single occasion for men or 4 or more drinks on a single occasion for women, generally within about 2 hours.
For most men and most drinks, less than 3 drinks in 2 hours is enough to get above 0.08%.  My personal favorite, though, was:
The more alcohol you consume, the more intense the effects 11.
What makes it funny is that "11" there is a reference note.  They felt the need to cite to some FAQ at the CDC website to make that claim.  For amusement value, this just edges out this one, in their list of "myths":
MYTH: Alcohol is an aphrodisiac.  Alcohol reduces inhibitions and may stimulate your interest in sex...
But apparently that does not mean it is an aphrodisiac or anything.

In short, the PLCB behave like the typical pseudo-public-health nannies when it comes to this messaging, both in terms of the message and the intelligence with which it is delivered.  On the website, their message is the usual scattershot collection of claims about how terrible a behavior is; date rape risk is a minor part of the arguments they heap on.  So why do they emphasize that in their graphic?  Because it evokes visceral horror among many women, more so than does the threat of choking to death in one's sleep or dying in a car crash.  The action being taken is ostensibly one of communication and warning, not prohibition or regulation.  But the act is actually designed to terrify the audience, through creating fear and other emotional reactions to a memorable image, into being less likely to drink, regardless of whether they might make that decision based on a rational calculation of the risk.  Even setting aside the practical problems with this (e.g., those most likely to be terrified are those who are already most cautious), this is not a legitimate role for government or anyone supposedly acting in the public interest.

In contrast with the anti-co-sleeping message, where the advice is not actually supported by the science, it is undoubtedly true that less drunkenness will result in less rape.  But that does not justify a tactic that is designed to provoke as much reaction as possible (even if it is paranoid overreaction).  As with the anti-co-sleeping message and tobacco, the prohibitionist approach makes it impossible to offer useful harm reduction advice.  This is particularly striking since the text accompanying the graphic is actually addressed not to the victim, but her friends ("when your friends drink, they can end up making bad decisions...that leave them vulnerable....").  So here's a thought:  If you see your friend drinking about to pass out, do not let her go unaccompanied toward the bathroom with a man she just met.  Even better, the message could be "as with a designated driver, make sure someone in your group has the job of guarding against such occurrences (and avoid fraternity parties entirely)."

And speaking of that man, the ad campaign did not acknowledge his existence  Due to the apparent lack of a perpetrator and blaming the booze, the rape can only be seen as the victim's fault entirely.  The outrage about that is probably what got the ads pulled in a day, as reported by the Philadelphia Inquirer and via the Associated Press, though the stories also tell us of the outrage the victims of date rape expressed about having that imagery forced on them.  It is tempting to say the news reports were good, because they report the complaints and the sensible outcome.  But thinking about it more, the stories failed the basics of news reporting.  There was no inquiry into what possessed those idiots to create this in the first place, or to think it was acceptable.  The report is about one battle, without realizing that it is part of a war.

Returning to the message, why did the PLCB not offer advice about how to avoid date rape even when you are drinking?  Because they do not actually care about date rape.  Their mission was just to discourage drinking, by any means available.  The typical current behavior of "public health" told them that exploiting the existence of date rape was ok.  Yes, they folded when someone insisted that it was not ok, but their willingness to fold may have been because they were not quite as committed as the extremists are; the funding for the effort comes from the profits of the agency's liquor stores, after all.  It is not difficult to imagine the extremists (the Milwaukee public health unit in the co-sleeping case, most everyone in the business in the case of tobacco, and quite a few in the anti-alcohol groups) arguing that the importance of their cause justifies terrorist tactics, blaming the victim, and causing flashbacks for thousands of previous victims.

I do not want to imply there is some huge divide between these tactics and direct government control over people's actions.  Indeed, the prohibitionists depend on disinformation and emotionally violent messages to create the social situation where they can impose policy-enforced restrictions on behavior.  Demonization and abuse of smokers would not be possible if a couple of generations had not been "taught" how evil they are and how they really all just want to quit but are too weak to do so without "help".  But the two bits should not just be lumped together, if for no other reason because the messaging approach is commonly practiced by ostensibly respectable people.  As a real and credentialed public health person, I am more bothered by them than by the prohibitionist extremists that they empower and cover for.  It is like the southern "gentlemen" in Washington for over a century talked about states' rights and such to provide cover for lynchings and other acts of racism that they pretended to not support.  There are always thugs out there for any cause; there are not always credentialed, skilled, and apparently respectable propagandists making it possible for them to act.

06 December 2011

Unhealthful News 193 - Public health extremists try to arm babies with cleavers

If you are reading this in a way that does not display pictures, you will want to click to the original to see the image.  Yes, that is a real anti-public-service poster/ad from the city of Milwaukee's department of health, intended to inflict emotional violence on mothers who make the possibly maybe slightly risky (bear with me -- I discuss the evidence and other specifics of the message below) lifestyle choice to co-sleep with their babies, a radical behavior that is practiced by crazy cultists like... well, like the majority of humans alive today or who have ever lived.

Most of my regular readers who are familiar with my writings about tobacco harm reduction and its extremist prohibitionist opponents (and the related issue of the free-choice rights of smokers or other drug users) will find this hauntingly familiar.  Those who are not familiar (and I have been told that writing on this topic will draw some new readers even though I am late to the story) need a bit of background:

Anti-smoking started as a legitimate and properly modest public health effort to educate people about risk and try to persuade them to reconsider their choice to smoke.  But by the late 1990s, anti-tobacco had transformed into a multi-billion-dollar extremist industry, bent on eliminating not just smoking, but low-risk smokefree alternatives (which are about 99% less harmful), and willing to use any tactics, no matter how destructive.  It became the tail waving the dog of public health, and the result has been terrible for public health's social and scientific reputation.  Even though smokers in Western countries are well aware of the risks (indeed, most of them actually overestimate the risk) the extremists push for inflicting more and more emotional violence on them, in the form of general abuse and denigration, as well as disturbing ad campaigns and labels.  If people will not choose to quit if they know the truth, the extremists will pursue other avenues to make them so miserable that they have to quit.  For their own good, of course.

To those of you, dear new readers, who may be adamantly anti-smoking and may not have thought this through before, and so perhaps are thinking "yeah, that sounds reasonable", think about the classic "first they came for..." warning.  As soon as it became acceptable, as well as a comfortable career path, to exaggerate risk and inflict emotional violence on people who do not conform to the demands of the "public health" community, it was no longer just about smoking.  It metastasized.

There is little doubt that the authors of the nasty anti-co-sleeping poster drew their inspiration and got their tutelage from anti-tobacco propaganda.  As anti-tobacco has trained a generation of activists who believe it is ethical to do whatever it takes to "improve" people's behavior, they have moved into other areas of what used to be public health.  Various observers have done a good job of showing how anti-tobacco extremists are actively and openly tutoring anti-alcohol extremists to aid their prohibitionist efforts, and it is trending toward overweight and fast food.  But even if you are not an aficionado of nicotine or alcohol or junk food, and so you do not feel like speaking up, because you are not among the targeted, they might well be coming for you if you do anything they do not approve of.  Like eating salty food, or not exercising, or choosing to raise your baby in a particular way.  So far, the decidedly dangerous act of transporting your baby by car, or crossing the street with him, is not in their crosshairs.  So far.

In terms of justification for the cleaver graphic, every news story (examples) seemed to quote only one statistic, in various forms:
"Is it shocking? Is it provocative?" asked Bevan Baker, the Milwaukee health commissioner.  "Yes. But what is even more shocking and provocative is that 30 developed and underdeveloped countries have better infant death rates than Milwaukee."
Should we be impressed?  Center-city Milwaukee is a pretty awful place, as America goes.  I would guess that 50 countries have higher average income and better health outcomes in general, and probably 100 have better educational attainment.  So on a propensity score basis, the city might actually be doing better than expected on infant deaths.

But the biggest issue is that hyping the magnitude of a problem, the typical tactic of public health activists, is a fundamentally dishonest method of trying to justify a particular intervention.  The intervention needs to be defended based on whether it will meaningfully contribute to solving a problem, not whether there is a problem.  (Readers who are familiar with tobacco policies will be finding this to be quite familiar.)  The high infant death rate in Milwaukee is mostly due to premature births to young poor mothers.  Even if one accepts the morally dubious "ends justify the means" claims, there actually need to be some ends.

So, does proper co-sleeping increase infant deaths?  The evidence supporting that claim is, at best, weak.  There are definitely infant deaths that are directly caused by being in an adult bed.  These seem to most often involve a parent who is passed out from drugs (be they FDA approved, legal, or illegal), or piles of fluffy bedding.  That is where the "proper" in the previous sentence comes in; all advice about safe co-sleeping makes clear that these situations are bad.  If we take out those cases -- which should be blamed on parents not knowing how to be safe or not being competent to follow advice, which bodes ill for their babies wherever they sleep -- it is not entirely clear what the net effects are.  There are still some identifiable deaths caused by co-sleeping, even absent a stoned mother or inappropriate blankets.  But there is also evidence that mysterious sudden infant death (crib death, cot death) is reduced by co-sleeping.  The data is so poor (the stigma created by anti-co-sleeping campaigns makes it very difficult to find out the prevalence of incident-free co-sleeping) that it is difficult to be sure.  But it is pretty clear that the worst that can be said about co-sleeping is that it creates a small risk, in the same range of such risky behaviors as running errands with the baby in his car seat.  The only obvious candidate for the title of America's leading scientifically competent source of advice about raising babies, Barry Sears and company, recognizes co-sleeping as a very reasonable option and offers some recommendations for keeping it safe.

"But," gasp and sputter the self-appointed masters of our health-affecting decisions, "if even a single life can be saved, this is justified" (to paraphrase statements in many of the stories about this).  Really?  Would saving a single life justify a strict nighttime curfew for everyone in the violent city of Milwaukee?  How about banning driving for a month -- that would almost certainly save some lives, including kids.  Oh, what's that you say?  There are other considerations that mean we should not blindly attack any freedom that might cause one person to die?  Oh, I see.  So the "if even a single life" game only applies when someone is doing something that you personally would not choose to do, Mr. Public Health Official.

Co-sleeping -- like nicotine use, drinking, other drug use, playing sports, travel, eating junk food, etc., or having a baby in the first place -- is a major lifestyle decision that involves health risk.  Different people make different decisions, and some find that making one particular choice is extremely important, and worth the small risk.  In the case of co-sleeping, there is not only the important choice about how to relate to one's child, but for some babies and mothers there are important health benefits (better feeding, mother or baby able to get enough sleep, etc.).  Providing misleading information, like claiming co-sleeping is as dangerous as a baby cuddling with a sharp knife, will result in suboptimal decisions.  Moreover, telling parents that they are being criminally irresponsible by making a particular (common, reasonable, culturally acceptable) choice will often not change their behavior, but might make them feel bad about what they have done, thereby inflicting gratuitous emotional harm.  And in those rare cases where a death seems to be attributed to co-sleeping, this messaging starts to seem a lot like those who tell parents that their decision to vaccinate caused their infant's death -- nothing but harm comes from such lie-based sensationalism.

Moreover, there is the classic prohibitionist problem:  If you try to prohibit something it becomes very difficult to regulate it.  One result is that banned drugs are often contaminated or used in needlessly dangerous ways.  In the present case, by staking out a position that co-sleeping is an unacceptable evil, it is impossible to offer the nuanced advice about how to do it most safely.

How did the unhealthful news handle this story?  Badly, of course.  As is typical, the health reporters presented random useless claims on both sides of the issue, typically the claims above from the "public health" people and the equally useless counter quoting one mother who co-slept with her babies without incident.  Worse, many reported the story of one recent death in Milwaukee that was attributed to co-sleeping without ever mentioning whether the mother was stoned.  Accompanying these uninformative factoids was absolutely no mention of the evidence of whether there was net risk, or even an acknowledgment that such evidence might be a bit useful in the discussion.  This absence was glaring even in the few good articles about the incident and issue, like those in Time Magazine's health blog (which has somehow become one of the most complete sources of health news out there, exemplifying both the good, like these, and the bad, as in the link about overweight above).

The worst unethical behavior from anti-tobacco activists often traces to funding of the anti-tobacco industry by Big Pharma, which profits from selling their (almost useless) quit-smoking products.  Could there be a Big Crib that is (ir)responsible for these ads?  Strangely enough, the answer is sort of yes.  The phone number printed on them rings to a QUANGO called "Cribs for Kids", which offers to provide cribs for those who cannot afford them (as if that lack is the main reason for co-sleeping!).  Gee, I wonder who is paying for such giveaways and who profits from it (kidding of course -- there is no need to wonder).  Presumably the Big Knife industry, though prominently featured, contributed nothing, since if we take away the misleading words we can just interpret the posters as suggesting "do not sleep with an armed baby".  That seems like good advice.

[Update:  The first comment by KMN and my reply have some content that I wish I had included in the original post.]

05 December 2011

Unhealthful News 192 - "Public health" oligarchs trying to hijack anti-oligarchy movement

A recent commentary by my friend Jeff Stier inadvertently called my attention to a disturbing behavior by some nanny state types, trying to imply they are akin to the Occupy movement, and how the media (including Jeff!) seem to be letting them get away with it.

In the commentary Jeff heaps justified ridicule on the "Food Police" who sought to ban Happy Meals in San Francisco by banning the giving away of toys with food.  This rule affected only McDonald's, as far as anyone could tell, but in a bit of dishonest policy making was written to try to hide its targeting.  So, since there was no actual ban on Happy Meals, McDonald's responded to the ban on free toys by charging a dime for the toys and donating that money to their own children's charity.  This caused the law's proponents to go berserk about McDonald's subverting or skirting the law, which is to say, about McDonald's obeying the law.  Personally, I think that it is a bad thing that people eat at McDonald's, but it is quite funny to see dangerous and destructive policy initiatives fall on their face.  (Chris Snowdon also wrote about this humorous incident.)

Elsewhere in the editorial, Jeff stakes out a stance against regulations that require chain restaurants to post the calorie counts of their menu items, a rule that I think is pretty much a perfect public health intervention (information for better decisions; no coercion for those who do not want to change their decisions).  But that is a story for another day.  But the most striking bit was that the Food Police are trying to claim that their cause is somehow akin to Occupy, declaring their efforts to be #OccupyBigFood.  It is easy to see why the Food Police might want to try to steal some of the legitimate cache of Occupy.  It is not so obvious why the press and other commentators let them get away with it.

As far as I can tell, the only thing the Food Police have in common with Occupy is that they do not like something that is being done by some large institutions.  Occupy is about protecting the 99% from the confiscation of the commonwealth by a growing oligarchy of barely-regulated financiers, the corrupt or otherwise mis-aimed government, and a few tens of thousands of other masters of the universe types.  While it certainly attracts people who have various political views and plenty of radicals, the Occupy message itself is not opposed to the free market or supportive of particular regulations.

The nanny state wing of public health is mostly orthogonal to Occupy, but to the extent it runs parallel, it seems to run in the opposite direction.  The nanny staters want to be masters of a tiny little universe and deny opportunities to the rest of us -- i.e., they are like those that Occupy is fighting.  To put it most charitably, they want to "protect" the 99% from our own propensity to make "bad" decisions.  The financial oligarchs and associated politicos inflict harm on people and our society that individually we can do nothing about, so muscular collective action is needed.  No such action is needed for someone to avoid any harm that might be inflicted upon them or their Happy Meal-aged children by McDonald's food.  Rather, those who would restrict choices are trying to exercise power, and some popular action is needed to keep them from banning salt and otherwise lowering people's welfare.

(Note that this analysis does not address arguments that particular foodways contribute to environmental damage, cruelty to animals, and other external costs, and should be regulated based on that.  The "Food Police" activism is based on trying to enforce particular behaviors based on the health effects on those making the decisions, a restriction of freedom not an attempt to correct for external costs.)

A randomly related note is this news story about how some of those "just pour in boiling water" instant soup cups have a propensity to tip over, and how reported research shows that products on the market with other perfectly functional package shapes are much safer.  Given the surprisingly large number of serious burns caused by spilling these cups, as reported in the story, this seems like a great candidate for regulation.  Unlike unhealthy food, which someone might rationally choose because of other benefits (price, yumminess), no one wants a cup of soup that is more dangerous than it needs to be because of its shape, but few people are aware of the hazard so the market does not solve the problem.

So can we agree to intervene to solve an obvious simple problem?  Probably not, because of how rare the clear thinking of the core message of the story is.

The comments posted on the story quickly degenerated into bickering about the healthfulness and naturalness of the instant soup itself.  Given that inability to focus on the remarkable simple observation that is the story, I suppose it is little wonder that the press cannot tell the difference between activism that is about collective action to protect us from avoidable external threats and activism that is designed to prevent us from exercising our preferences.  Meanwhile, it is probably a safe bet that if someone does propose a regulation on cup-of-soup container shapes, the usual suspects will start screaming about the oppression inflicted by Big Government, taking away our right to decide to needlessly risk severe burns.  And when this hypothetical story is reported, you can bet they, along with those who want to ban instant soup entirely because it is salty, will be given as much ink as the sensible analysis about the tipsiness of containers.

I guess there is one thing that Occupy's calls for economic action and regulation and discussions of product regulation have in common:  Both of them suffer from the widespread popular ignorance that is caused by the media reporting scientific information as if was a sporting match or a celebrity scandal.