29 February 2012

The latest in "tobacco candy" research

under review at Tobacco Command
(29 Feb 2012)

Demonstrating that children believe that deadly tobacco products are harmless candy, an experimental study

C.V. Phillips, P.S. Heavner-Phillips, I.Q. Burstyn, P.L. Bergen
Populi Health Institute, Wayne, Pennsylvania USA
UASPH, Edmonton, Alberta Canada

FDA = United States Food and Drug Administration
NRT = Nicotine Replacement Therapy
OR = Odds Ratio
OTC = Over the Counter
QUANGO = Quasi-non governmental organization
SES = Socioeconomic Status
TCACS = Tobacco Control Alarm-Call System
UASPH = Unaffiliated Alberta Scientific Public Health researcher

Figures and Tables
Table 1
Figure 1
Figure 2

Background: There has been concern expressed about children mistaking smoke-free tobacco products for candy.  There is evidence that anyone doing a study on the topic will have an inappropriately great influence on policy, and meta-regression suggests an inverse association between study quality and impact on public health discourse.
Methods: Children of aged 15 months to 15 years were presented with a tableau of smokeless tobacco products, along with benign alternatives like candy, breath mints, dietary supplements, and medicine.  A second experiment presented the younger children with sippy cups that contained water, nicotine solution (e-cigarette refill liquid), and other liquids.  A third experiment presented the older children with selected products in de-branded original packaging.
Results:  The children could not distinguish between tobacco products and candy (p=0.86).  The younger children were more likely to reach for a cup of nicotine solution than a cup of water (OR=2.2645, p<.0314).  When products were presented in their original packaging, subjects successfully identified medicine, but half the tobacco products were still most often identified as candy.
Conclusions: Smokeless tobacco products should be stored with the same care recommended for other somewhat hazardous items found in the household, rather than displayed on plates or stored with candy.  Children should not be presented with toxic substances in contexts that send the message they should eat them, and should not be told to think of them as candy. 

Dissolvable tobacco products consist of finely ground or powdered tobacco in a confectionary base that are held in the mouth while they dissolve, thereby delivering nicotine and perhaps other psychoactive alkoloids in a similar manner as other low-risk oral smokeless tobacco products.  These include products that have been available in the United States for about a decade (Stonewall and Ariva lozenges), as well as several new products that have entered the market or are expected to do so soon (new lozenge and toothpick-shaped products from the tobacco companies RJ Reynolds and Altria).  None of those products have sold widely to date.  However, trend analysis by TCACS indicates that the major-brand products will gain in popularity.  Moreover, one popular form of dissolvable tobacco product that is known by the street name "NRT" or "nert", which are the same as the others except that the nicotine is extracted from the tobacco and then put in the confectionary base, are already widely consumed.

There has recently been an explosion of organized concern about the risk of accidental poisoning of children who mistake dissolvable smokeless tobacco products for candy.  It is already known that that young children may be at risk of ingesting small objects that come within their grasp.  However, since tobacco is completely unlike any other consumer product, previous research on other products cannot be considered informative.  The nicotine lozenge variants of dissolvable tobacco products have already been implicated in a significant number of toxicant exposure events, which suggests that there is risk that one of the tobacco company products might someday poison someone also. 

Several previous studies demonstrate that there is a view that the public health community should encourage worry about the poisoning risk:

An anti-tobacco QUANGO of the Virginia state government calling itself "Virginia Foundation for Healthy Youth" issued a press release [1] reporting that when teens were presented with dissolvable tobacco products without any context, they often thought they were mints or candies.  While it might be considered a minor limitation of the study that the methods and actual results of the study were never reported or that the research was designed and conducted by high school students without any apparent supervision by scientists, the subsequent wide coverage in the popular press confirms that it was credible, important, high-quality research.

The Indiana Department of Health has mined social networking comments and otherwise gathered comments from teens about dissolvable smokeless tobacco products.  Some commentators have expressed concern that they have never reported their methods and their results appear to be unrepresentative cherry-picked out-of-context quotes.  However, these concerns can be ignored because the importance of this research is demonstrated by the production of high aesthetic quality slideshows that have generated repeated invitations to report to government agencies and public health gatherings [e.g., 2]. 

Additionally, there is even one study where a vague description of the methods and results was published, though unfortunately it has still never appeared in a scientific journal [3].  The study, from a research group calling itself "Harvard School of Public Health", was widely cited in the popular press.  (Note that while this organization does not seem to be related to the prestigious research institution called "Harvard University", the allegations in the literature that it is actually a lobbying front group for shadowy government agencies and industry have not been proven, and so cannot be considered a reason to doubt their research.  Thus, we consider their work to be just as credible as the other studies cited herein.) 

News reports, based on the highly touted press release from the "Harvard" study authors, indicated there was a dire risk of accidental poisoning from "tobacco candy".  One possible limitation of this work is the almost complete lack of correlation between the study results and the claims touted to the press (p=.984).  For example, popular media reports based on what was communicated to the press by the research team leader include the claim that "600 children a year" are poisoned by "tobacco candy" [e.g., 4], though this differs (p<0.001) from the actual study results by 600/yr.  This lack of correlation should be interpreted as further evidence of the seriousness of the public health worries.  Creating fear as a substitute for evidence is a standard invocation of the Precautionary Principle, which should be applied in situations where it appears there will never be enough evidence to support the necessary warnings.

Related research from several government and activist organization has looked at children's perceptions of flavored (though not necessarily dissolvable) tobacco products.  For example, work conducted by the Utah Health Department used an innovative method in juvenile research, in which a researcher disguised as Santa Claus first tricks the children into thinking they are in a benign situation, and then warns them about the dire risk the researchers just exposed them to [5].

There is evidence that these results are being taken very seriously.  For example, a spokesperson associated with the Indiana studies was invited to present for half an hour at recent FDA hearings on dissolvable tobacco products, while the experts on the public health benefits of introducing new low-risk tobacco products were restricted to three minutes each.  The lead author of the "Harvard" study is frequently invited to participate in policy discussions, including in some forums that normally restrict participation to people who draw only those conclusions that are related to their research results.

A group of US Senators recently wrote a letter to the FDA urging removal of a "dangerous loophole" about dissolvable tobacco products [6].  Once again, concern was so great that the fact that the "loophole" was irrelevant to the concern (it was a legalistic trick by FDA to delay acting on a statutory requirement that they recognize certain products as less harmful than smoking) and the "solution" did not address the "danger" (the matter had no relevance to whether young children could be given access to the products) posed no obstacle to decisive action by respected politicians. 

Given that concern about this matter is so intense even in the absence of supporting evidence, it is clear that this is an important public health issue.  It is established practice in modern public health that the assessment of a risk is most reliably determined by those who express the most concern.  This is especially true in cases where, if action is not taken immediately, the concern might be proven unfounded.  Thus, a public health activist Code Gamma Alert has already been issued, including the monthly television news stories and invoking of the mandatory opinion-alignment rules for professors at public health schools and employees of public health advocacy organizations. 

While further evidence may be unimportant now that policy action is underway, we were curious about whether the results about children confusing dissolvable tobacco products with candy could generalize.  In particular, we were interested in whether they could be replicated in a scientific paper authored by real researchers with scientific skills.

A convenience sample of 42 children, aged 15 months to 15 years was recruited.  They were divided into the "younger" (n=25) and "older" (n=17) subsamples based on a cutpoint of age 7 years, as measured by a validated birthday frequency questionnaire.

In the first experiment, a tableau was created that included a collection of the candy and candy-like items listed in Table 1.


Table 1. Product list

Dissolvable Tobacco Products
Ariva (Star Scientific)*
Camel Orbs (RJ Reynolds)
Nicorette Lozenges (GlaxoSmithKline)*
Nicorette Mini-Lozenges (GlaxoSmithKline)*
Stonewall (Star Scientific)

Medicines and Supplements
Pepcid AC 10mg*
Tums Extra-Strength tablets
Zicam Cold Remedy "homeopathic"*

Junior Mints
M&Ms dark chocolate mint
Mentos mint*
SweeTarts giant chewy
Tic Tac mint*

All listed products were used in the first experiment.  Those noted with * were also used in the third experiment.
Brand names are given for identification purposes only and do not represent an endorsement of any listed product.


Each subject viewed tableaus of 10 items.  The first that was presented included positive and negative controls.  The positive control consisted of a marshmallow Peep candy, chosen because of its history as a model species in research [e.g., 7].  The negative control was a rubber ducky.  The other items were chosen at random in each trial, thus eliminating any bias that might have been created by the grouping of particular products.  An example of one of the the tableaus, as presented to the subjects, appears in Figure 1.  The objects were always arranged in an attractive pattern (e.g., the circle in Figure 1); this served no scientific purpose, but it amused us. 

Figure 1.  Example of one random tableau from first experiment

Note: Pictured items are, clockwise from bottom center (numbers correspond to order of list in Table 1): 14, 12, 11, 3, positive control, 9, 4, 7, negative control, 6, 13.
Older subjects were individually presented with a tableaus and asked "what are these items"; if answers were not provided for each item, they were prompted to respond about the remaining items.  A second tableau was then presented, for a total of 20 observations (which generally included some duplicate items) per subject.  Results were recorded as open-ended answers and coded as "candy" if the the word "candy", "mint", "breath freshener", "sweet", "sugar", or the product name of a specific candy was offered as part of the answer.

The younger subjects, for whom the former methodology would not be age-appropriate, were grouped into pairs and presented with a tableau.  The were asked "candy! who wants candy? pick out a piece of candy!"  Results were recorded for which items were reached for or picked up.  After grabbing ceased, another tableau was presented and this was repeated until a total of 20 grabs were recorded.  When some pairs of the younger children demonstrated hesitation about reaching for any of the objects, the protocol was quietly rewritten to require that the researcher reach for and pretend to eat a random (non-ducky) item until the children complied.

A second study expanded the target of the study to include e-cigarettes.  The failure to ban these new devices, so far, demonstrates that more research is needed about them and their components.  The younger subgroup were presented with six sippy cups, that contained (pictured from left to right in Figure 2) e-cigarette refill liquid (a 6mg/ml nicotine solution), water, vodka, antifreeze, fruit juice (white grape), and e-cigarette refill liquid (a 20 mg/ml nicotine solution).  Inclusion of milk and soy-based formula were considered, but concerns about the allergies mandated their removal.  Coke and Sunny Delight were also eliminated from the experiment because of the recent discovery that sugary drinks are the world's most dangerous public health threat.  The cup(s) that each child reached for or picked up were recorded.  Picked-up cups were immediately removed from the children's hands and returned to the tableau.  Children that started crying at that point were removed removed and thanked for their contribution.

Figure 2.  Sippy cup arrangement

Note: Contents ordered as listed in text.
For the third study, the older subgroup were presented with some of the products (noted in Table 1) in their original packaging, with the branding and labeling information obscured with olive-green paint or tape.  A disposable e-cigarette that closely mimics the appearance of a real cigarette was added as a positive control.  Subjects were then asked to classify each into the categories candy/mint; medicine/vitamin; tobacco product.

No incentives were offered to the study participants, no matter how much they begged (though the Junior Mints and vodka mysteriously disappeared).  All of the recovered study materials were disposed of following appropriate biohazard protocols.  The liquids were returned to their bottles; most of the solid objects were consumed by the research team; the drooled-on products from the young children tableaus were autoclaved and put in the municipal trash (there was no budget for analyzing biological samples); the NRT products, considered too unpalatable to consume but too expensive to throw away, were saved for future research.  A count of the tobacco and medicine products revealed that approximately all of them had been recovered from the children (the measurement error was at a level that does not affect the study results).

Statistical analyses were conducted using SAS (vers. 9.1.3, SAS Institute, Cary NC), the preferred choice for researchers who want to show off that they are real scientists, but do not understand the statistics they are using well enough to just do the calculations in the spreadsheet where they recorded the data.

During the first experiment, five of the youngest children had to be dropped (from the experiment).  Two refused to participate, wandering away and/or crying.  Two others were apparently unfamiliar with candy, and thus did not produce reliable results.  Another seemed to be claiming that every object in the tableau was a cat. 

The remaining 37 subjects completed the first experiment, and all members of the younger and older subgroups completed their other experiment.

Subjects in the older subgroup all correctly identified the negative control (rubber ducky) as something other than candy/food, and 16 (94.1176%) correctly identified the positive control as either "candy", "a Peep", or "those things are so gross".  The younger children were more likely to pick up the Peep than the rubber ducky at a rate that was borderline statistically significant after correcting for latent confounding by race, gender, and SES (p<0.1).  Older children were more likely to volunteer an observation that the experiment seemed to be designed to intentionally trick them (p-value for trend = 0.03 after correcting for mutations in the data).

In the first experiment, the rate at which the tobacco (82%) and other non-candy products (78%) were identified as candy was the same as the rate for candy products (86%).  The faster grabbing younger children demonstrated a preference for the larger items, but the trend did not achieve statistical significance.  However, at a statistically significant rate, the older children identified the Vicodin (which had a distinctive pill shape, including scoring for breaking in half) as non-candy.  The older children also identified the Stonewall (which has a color and shape that are unusual for candy) and Pepcid (smaller than most candies) as non-candy more often, but the difference was not statistically significant.

In the second experiment, the younger children were significantly more likely to reach for a nicotine solution cup than any of the other liquids.  Compared to water, the odds ratio for reaching for the nicotine was 2.2645 (p<0.0314).  The other liquids were chosen at rates that were statistically identical to the water.

In the third experiment, all of the older children recognized the positive control as a tobacco product and the Vicodin (in a prescription bottle) as medicine.  For other non-candy products, most identified them as something other than candy: 94% for the Ariva and for the Pepcid (both are in a distinctly medicinal blister pack and do not look like typical candy).  65% identified the Zicam (in a distinctive supplement pill style OTC bottle) as non-candy and 35% as candy; given that it is a fruity sugary tablet, sold as homeopathic remedy, it is not clear who is correct, and in retrospect we realize that its inclusion in the study introduces unnecessary ambiguity.

Most important, for several tobacco products with the labels hidden many subjects still thought they might be candy, including 53% for Orbs (in a unique package, clearly meant to be childproof, but not similar to packages normally used for medicines) and 94% for the Nicorette products (non child-proof packages that are quite similar to mint or candy packages).  One subject appeared to subconsciously mimic the Nicorette television ad where a consumer jauntily pops open the plastic tube with his thumb and smoothly pours a lozenge into his mouth one-handed.  (Note: fearing this possibility, we replaced the content of the Nicorette packages with Tic Tacs and Mentos; since this part of the experiment was focused on the packages and those candies are almost visually identical to the tobacco products, we believe this precaution did not bias the results.)

The accurate identification of the positive and negative control items proved that our methodology was scientifically valid.  Both older and younger children can differentiate candy from other objects, and older children can clearly identify tobacco products that are not shaped like candy.  Given the reliability with which products can be made to not look like candy, even to young children, the persistent refusal of tobacco companies to employ non-candy shapes (e.g., plastic water fowl morphology) is evidence that they are marketing to children.

Our results replicate the previous research that showed that children can be convinced that non-candy tablets/lozenges are candy when they are presented in a context that suggests candy and lacks any clues that some products are not candy.  This is the first study to demonstrate that children apparently cannot distinguish dangerous nicotine solutions from water or other liquids when they are presented in translucent vessels.  It follows immediately from these findings that all smoke-free tobacco products that could lead to accidental poisoning should be banned, unless they have been approved by the FDA as a smoking cessation aid.  In particular, those who use e-cigarette refill liquid -- "modders", as they are called in gang patois -- should not be allowed to continue to exploit a loophole that allows adults to legally possess poisonous liquids so long as they are not explicitly marketed as children's beverages.

Our findings suggest that package design might reduce the risk of mistaken identity and accidental toxification events.  In other areas of consumer product regulation, there is a belief that in such circumstances, clear labeling and distinctive packaging should be required for potentially toxic products, with shapes and markings that make clear they are not food.  For example, minimalist plain labels that would be similar to the obscured labels that we used to trick the children are generally forbidden.  However, because tobacco is unlike any other consumer product, different standards should apply.

Nicotine lozenge manufacturers should not be required to change their packaging:  If smokers were not able to flip the attractively-shaped bottle open with one hand and stylishly pour one (or all) of the lozenges into their mouths, then these products might no longer be considered "cool".  That could, in turn, interfere with their proven ability to increase users' chance of quitting smoking by 0.0027%.

Packaging-based regulation is also an inappropriate approach for tobacco industry products, since reducing risk is never acceptable for health-affecting choices when prohibition is an option.  Moreover, there is no evidence that younger children understand the cues from packaging.  While it is possible that children might be less likely to try to drink nicotine solution if it is not in a sippy cup, there is no scientific proof of this claim.  The only proven method of reducing the risk from these products is eliminating them entirely.

Strengths of this study compared to previous research on the subject include the fact that the authors understand irony and are not lying fanatics.  Moreover, only one of them is functionally illiterate, and even he apparently understands scientific inference better than many of the authors of previous studies.  Additionally, we have introduced to this field, for the first time, the methodologic innovation of not sending out a press release containing conclusions that are in no way supported by the content of the study.  We consider this to be an important scientific breakthrough in itself, and suggest that future tobacco product researchers attempt to replicate the methodology.

This study has a few possible limitations.  The older children proved surprisingly adept at detecting that they were being manipulated for some political purpose.  This may have resulted from selection bias, since this work was carried out in a community of educated professionals with high-quality schools.  The same demographic selection bias may explain why some young children were not practiced consumers of candy.  If the experiment were repeated in a community where most of the teens were poorly educated, raised by public health officials, or otherwise never taught to think critically, we expect the results would be different.  This would further strengthen our conclusions.

An additional factor that might be considered a limitation of the study, though it provides several important advantages in the context of tobacco research, is that we did not actually do it.  That is, the methods narrative is pure fiction and we just made up the data (however -- and we realize it is difficult to believe, given that even one of the authors of this paper was sure we were making it up -- the literature review in the introduction is all true, down to the name of the author of reference #2).  There were multiple reasons for not actually doing the study.  First, we do not have access to a Romanian orphanage or a sample of foster children, and no halfway decent parent would ever allow their children to participate in such research.  Second, we did not want to ruin perfectly good sippy cups and the Russian member of the research team would not allow us to waste vodka. 

Third, we would never conduct experimental research on children without getting human subjects ethics approval, and no legitimate ethicist would ever consent to an experiment like this.  Human subjects ethics requires a balancing of possible costs to the subjects against the potential benefit of the knowledge gained.  Since it is obvious to any casual observer that it is possible to trick children into thinking that small pill-like items are candy, and to generally concoct situations that create confusion about objects that look, are scented, or are flavored like comestibles (be they medicine, cosmetics, tobacco products, air fresheners, industrial chemicals, etc.), there is no knowledge to be gained by these studies.  While the risks of such a study would be reasonably low (assuming the children were carefully monitored and restrained from consuming any of the products), the mere act of including children in research, as well as taking actions that might convince a group of children that a collection of non-food objects are candy, creates a cost.  Thus, such research could never be ethically justified.

Fortunately, such concerns did not create fatal limitations.  Even though we did not recruit subjects or make observations, we carefully predicted what imaginary subjects would have said and done.  While this may have created some confounding and measurement error bias in the results, it is well known in epidemiology that when a result is really strong, like most of ours are, it cannot be explained by study errors.  Additionally, we conducted a sensitivity analysis that proved that our results are would have been similar had we actually gathered data (details omitted). 

Moreover, in social science research related to tobacco, the drawing of conclusions based on how the researchers think subjects should act, rather than actual observations, is an established and accepted practice.  For example, it is well documented that discussion and conclusions sections are frequently written before any data is collected.  Furthermore, even patently false statements are so common in this field's research reports that it appears that they are mandatory.  Thus, neither our methodology nor the fictional statements in this paper are outside the bounds of anti-tobacco research.  Indeed, had we actually carried out the field study and adhered to legitimate scientific standards in our analysis and conclusions, our results would have been less useful, as such methodology would render our work incommensurate with the existing public health and tobacco research literature.

This study provides clear evidence that children can be persuaded to consume dissolvable tobacco products.  The risk is clear even though -- in contrast with nearly every other toxic or small object in the world -- it does not appear that, so far, any children have suffered serious harm from these products (other than the NRT versions), or that they have frequently mistaken them for candy when encountering them in natural situations.  Because they pose a risk, these products should be banned, as is appropriate for any product that causes risk but serves no necessary medical purpose.

Smokeless tobacco and e-cigarettes are not a safe alternative to smoking, and smokers should use only clinically proven cessation methods like NRT, social stigmatization, and lung cancer.  Giving adults legal access to low-risk, affordable, appealing, satisfying nicotine products creates the risk that they might decide they are better off using nicotine rather than being abstinent, but without offering any profits to the pharmaceutical industry.  Such a risk is not considered acceptable by public health authorities, even if the availability of the products might cause thousands of smokers to quit smoking.  Tobacco harm reduction is a serious threat to public health officials and other career activists, and the tobacco industry must be stopped from making misleading claims such as "some nicotine products are much lower risk than cigarettes" and "citizens in our society have free choice".

Additionally, we conclude that it is unethical and dangerous, and should be criminal, for anyone to try to create confusion between dissolvable tobacco products and candy.  This would include such actions as a parent putting the tobacco products in a candy jar, or activists constantly referring to the products as candy and encouraging the popular media to do the same.

Finally, we conclude that anyone who would actually carry out an experiment on children like the one described herein is in violation of basic rules of human research ethics, and may be guilty of criminal offenses.  There is no evidence that previous researchers who carried out and published similar experiments sought human subjects ethics approval; indeed, it seems impossible that they would have gotten such approval.  We recommend that national and local authorities consider whether sanctions are appropriate against the authors and sponsoring organizations.

Acknowledgments and author contributions: Support for this study was provided by Blue Cross (paid for the pharmaceuticals), Populi Health Institute (paid for the candy), and random donations of products from companies and advocates received over the years.  CVP conceived of the study and wrote the manuscript.  PSHP watched the process with fascination, contributing random strings of characters to the manuscript; he is responsible for any typos that appear in the text.  IQB contributed statistics and words; he offered some amusing suggestions for embellishing the stories about the previous research, and was utterly floored to learn that we could not make those changes because the reported background was actually an accurate description of reality.  PLB contributed content to the manuscript.  The following bears repeating:  None of the authors every seriously considered carrying out the human subjects research described herein; to do so would have been criminally unethical.


1. Virginia Foundation for Health Youth (2010). Press Release: More than 1/3 of Teens Surveyed ID Flavored Tobacco as Candy.

2. M Spitznagle (2012). Indiana’s Experience: Marketing of Dissolvable Tobacco Products.  Invited slideshow, FDA Tobacco Products Scientific Activism Committee (TPSAC), available at http://1.usa.gov/yuB1MO

3. GN Connolly, P Richter, A Alequas, TF Pechacek, et al. (2010). Unintentional Child Poisonings Through Ingestion of Conventional and Novel Tobacco Products. Pediatrics 125:896-899.

4. The Week (2010). Fact Sheet: What is 'tobacco candy'? Available at theweek.com/article/index/202095/what-is-tobacco-candy

5. M Cortez (2010). Santa demonstrates danger of 'sweetened' tobacco products. Deseret News, available at http://www.deseretnews.com/article/705362953/Santa-demonstrates-danger-of-sweetened-tobacco-products.html

6. J Merkley, S Brown, T Harkin, B Mikulski, et al. (2011). Senators to FDA: It's Time to Close the Door on Tobacco Candy.  Available at http://www.merkley.senate.gov/newsroom/press/release/?id=ea7b14e4-c4aa-490f-bc98-19713218acaf

7. www.peepresearch.org

17 February 2012

Unhealthful News 204 - Governments openly conspire to lie

Today I will defer to my clever colleagues, and link to two very brief and insightful posts.  (I am just too much the philosopher to do brief, so I have to delegate that :-)

First, check out Chris Snowdon's expose of UK government plans to lie to the public as they try to implement minimum alcoholic beverage pricing and an anti-alcohol social engineering plan.  (Further explanation and analysis can be found in some of his previous posts.)  What is interesting about it is that it is not just the usual catching the government in a lie, but watching de facto government actors overtly present their plan for lying, almost like they figure they can so easily get away with it that they do not have to cover it up.

Second, read Kristin Noll-Marsh's empirical economic analysis of the effects of smoking bans on bars.  Those fancy words, by the way, mean that unlike the government and those who control it in this area, who assert that the bans benefit the bars, she went out and made a couple of observations to figure out cui bono, or rather cui malo (note: I depended on a translate bot to figure out how to say "who loses", so corrections are welcome) [Update: corrected per comment].

It is just such a shame that we do not have some major institution whose job includes monitoring government (and its allies) and reporting when it is lying to us.  Oh, wait.

Well, at least we have bloggers and a few good reporters.  On the latter note, and off topic, check out Jeremy Scahill's reporting on Yemen, about the Obama administration's stupid little war that you may have never even heard of.

Anyway, how did they get these scoops?  Snowdon looked at materials posted on the web from a 2010 meeting.  Noll-Marsh apparently thought about the implications of one news report, unlike those reporting it, and drove down the road with a camera.  No wonder health reporters have so much trouble seeing through governments' lies -- who has time to do complicated research like that when there is so much transcribing to be done?

14 February 2012

Unhealthful News 203 - Malaria: how many killed? Decent science reporting: what killed it?

Last week I was struck by one line from a news story about a new study that claims that the death toll from malaria may be underestimated by half.  The claim is based on revising the current conventional wisdom that basically only young children die and everyone who survives childhood in malaria zones has immunity that keeps all but a very few from dying.  I will admit to a soft spot for any study that that seems to claim "it has generally be believed that X, but that was not really based on evidence, and now we show Y" -- perhaps it is because I have contributed a tiny bit of that in my own work and found it to be a real high point. 

The new study depends on the controversial method of "verbal autopsies", which is just a silly medical-speak way of saying that when a cause of death cannot otherwise be determined, it is based on interviews with those who were around the decedent toward the end and can describe his symptoms.  The authors obviously believed that this works; others (such as in this very well-reasoned and balanced news story about it in Nature) have argued that there is a huge amount of measurement error.  (On the other hand, official death certificates have a lot of measurement error too, but that is another story.)  At the WHO, which kind of owns the malaria issue, the head of the malaria unit responded to the article with a memo that said the agency stood with its estimate and believes the study is importantly flawed.

The subject matter is very important and the question of that methodology interesting, but I have to concede that I am unlikely to learn enough to judge either -- certainly not this month.  So I am one of those educated non-experts who I try to empower to judge.

What I can judge for sure is that this remark by an advisor to the UN envoy for malaria about the scientific disagreement, reported in the NYT article, is really really dumb:
Some experts were dismayed. The dispute “is a little like Gingrich and Romney going at each other — it’s only going to hurt the whole field,”
Huh?  The act of scientists seriously debating scientific beliefs and offering divergent positions about the merits of a key research method is like two exceptionally dishonest politicians talking past the issues, misrepresenting the state of the world and their opponents' beliefs, and launching attacks on each others' character with a level of sophistication reminiscent of a grade-school brawl?  Really?

Exactly how does science advance, except for someone making a new claim based on their best analysis, criticizing the old beliefs, and (a minority of the time) turning out to be right?  And what do we expect from those who believe the current view and that the evidence supports it when confronted with a radical new claim?  We should hope that they respond by acknowledging the new analysis and pointing out why it is inferior to the basis for the existing belief.  In totally political realms, they would just ignore the new result; we should praise them for identifying points of disagreement.  And we should hope that their beliefs are based on enough information that they are inclined to defend them.  There are, in science, rare "head smack" moments when someone points out a previous error in such a definitive way that any honest expert has to say "yup, they're right; we were wrong all this time", but rare is the key word there.

Part of the problem was created by the editor of the journal that published the new paper, The Lancet, who in advance of the article tweeted "a revolution is about to strike" about malaria.  A tendency of big name journals to traffic junk science (and that kind of hype about a single inherently uncertain paper is junk science, even if the analysis in the new paper is spot on) is a lot of the problem.

How about the contribution to the bad science by the politicians, like the UN envoy.  Nothing to see there, it turns out.   It sounds like the envoy offered the sensible observation that the optimal intervention tactics are not affected, so it does not matter much which claim is right.  Similar sentiments were expressed by other officials in anti-malaria, as reported in the various news stories.

Anyway, whatever the stupid hype by the Lancet editor, that quote by the advisor is still the worst bit.  It really exemplifies the difficulties in getting non-scientist people to understand scientific debate.  It is hard enough to get lay people to realize that genuine scientific debate is...

(a) ...not like elections, and especially not like how they are reported.  Election coverage should really be more scientific -- there is analysis about what promised policies would really cause and the truth about someone's past policies.  But the press likes to report on football matches, so they turn election coverage into that, and convince everyone that it is just a silly bickering match between scientifically and ethically symmetrical opponents even when it is not.  Then they cover science as if it were just like such an election. 

(b) ...not all whiny and weepy.  Scientists say "you got that wrong; that method has been shown to produce bad data" not "I understand that this claim is important to you, and since everyone is entitled to their own belief, we might have to agree to disagree, but I feel that your new method -- which is creative and clever, and represents a really good effort that I have the utmost respect for -- does not cause me to change my own feelings about this, which should be seen as valid also."  It is so damn frustrating to try to talk through a scientific disagreement in the company of people who are clueless about how science works, who think that things are just "discovered" and everyone agrees.  The worst is when they freak out about typical patterns of disagreement, clutching their pearls and fanning themselves to try not to faint.  It is like a voter getting mad at a candidate for "going negative" because he points out that his opponent's economic plan is based on making up numbers -- it's just arrogant and mean to say something like that in polite company!

So, anyway, who was the advisor who offered up the quote that played so well into all the reasons people do not understand science?  You are probably figuring it is some political hack or public relations guy who himself does not understand science.  You may well be right, but it is attributed to Jay A. Winsten; no affiliation or any other information attached to the name, but the "Jay A. Winsten" who dominates a web search is Associate Dean for Health Communication and Director for the Center for Health Communication at the Harvard School of Public Health.  Not that this disproves your original hypothesis (though shame on you for saying such disparaging things about a presumably respected professor from a unit that is often considered by some to kinda sorta be part of Harvard University).

I wish it was harder to figure out why the reporting of public health science is as bad as it is, and I wish we could just blame the reporters.

They just cannot believe their opponents have more honest motives than they

A random observation for the day.  The NYT reported that an American of Chinese birth recently traveled to China and was detained and tortured by state security officials (fortunately, just in an ad hoc street cop kind of a way, not sent-to-Guantanamo style) because he engages in the mildest of human rights activism, particularly posting to Twitter.  Apparently they mostly wanted his Twitter password, which could only serve to let them hijack his account and mimic him, since public broadcast of all the info that is there is kind of the point of Twitter.

What struck me about the story, beyond the always useful reminder about the behavior of governments and our "important partners" in China, was the following:
In a phone interview on Monday from his home in Fremont, Calif., Mr. Ge described how the agents, infuriated by his assertion that bloggers in the United States were volunteers and not government-sponsored agitators, demanded that he turn over his Twitter password.
That seemed vaguely familiar.  Kind of like the cries from members of the anti-tobacco extremist industry when confronted with human rights or good-science activists who challenge their bullshit, accusing people of doing it under the secret employ of industry.  Low-lifes like Chinese government thugs or paid astroturf activists simply cannot understand that someone might take a principled position and devote their time because they simply care about the world.  Since said thugs personally would never do something they were not getting paid for, they reason (to the extent they are able), no one else would either.

Of course, I realize that this is not the story for everyone.  Some pro-government thugs in China etc. might be decent people who simply have no access to honest information and have been brainwashed -- it is not that difficult to persuade idealistic young men to become monsters.  Western "public health" activists have no such excuse, though in fairness to them, presumably many of them are just lying as part of their jobs and do not genuinely believe that everyone who calls them out is as dishonest as they are.

As a side note of warning from that story:
In the end, Mr. Ge and his captors came up with a compromise: he did not reveal his password but logged on to Twitter and allowed them to peek inside his account. “The truth is I have nothing to hide,” he said.
Unfortunately, he might as well have just given them his password, because he undoubtedly did so, as the reporter should have known if he read his own newspaper's article about how Chinese and Russian officials are adept at installing password stealing software and otherwise breaking into computers.  Companies with security concerns have taken to not allowing employees to take their computers or phones to these countries or log in from there, bringing only temporary burner devices that they sometimes then forbid from ever plugging into the company network based on the assumption that the spyware is so good that it cannot be removed.  A good lesson for all of us.  And don't forget that the border guards even from "free" countries sometimes seize and search computers, your email, etc. when you come through customs, even entering your own country -- Canada did it to me once.

10 February 2012

Unhealthful News 202 - Annoyed by demand, attacking supply

My colleagues in the UK are currently reporting on the disturbing proposed regulation that would impose a minimum retail price on drinks, on a per-unit-of-ethanol basis.  This is justified based on (false) claims of increasing public health impacts of alcohol, but it is immediately obvious to any clear thinker (a group which apparently includes 0.3% of members of that country's parliament) that the penalty will fall on those who buy inexpensive drinks, not those who drink inadvisably.  That is, this interference in the market by rich people will have almost no effect on rich people who already choose expensive drinks instead of the bargain brands (including those who are problem drinkers), but it does take money from the poor and gives it to corporations.  It would probably financially punish poor people who drink too much without substantially changing their behavior, though I suspect that inflicting punishment is what a lot of the proponents really want anyway.

In the US we famously love the free market.  Unfortunately those who want to intervene to stop demand they do not like still think they should blame supply, but the free market leaves them using the free-market version of regulation, lawsuits.  Specifically, it was reported that a Native American nation located in the state of South Dakota
sued some of the world’s largest beer makers on Thursday, saying they knowingly contributed to devastating alcohol-related problems on the Pine Ridge Indian Reservation. The tribe said it wanted $500 million in damages for the cost of health care, social services and child rehabilitation caused by chronic alcoholism on the reservation. The suit ... also names four beer stores in Whiteclay, a Nebraska town near the reservation that, despite having only about a dozen residents, sold nearly five million cans of beer in 2010. The suit names Anheuser-Busch InBev Worldwide, SABMiller, Molson Coors Brewing Company, MillerCoors LLC and Pabst Brewing Company.
Make no mistake:  Being concerned about problem drinking in many North American aboriginal population is reasonable.  But the solutions lie with the consumers or the circumstance that create the demand, not the merchants.

What exactly were the defendants in this case supposed to have done?  What would have happened if one of those manufacturers had refused to supply towns near the reservation?  No doubt their local distributor would raise an outcry, prompting concern nationwide about possible future arbitrary cutoffs.  Moreover, there would inevitably be cries of racism, quite possibly by the same people who are leading the lawsuit.  But the most important effect would be that the others on the targeted list would increase their shipments to the area to make up the shortfall.

So, could all manufacturers agree to stop the shipments?  That would almost certainly be a violation of US antitrust laws, for good reasons.  And even if they could, this would all depend on the assumption that no one in Nebraska owns a truck and can figure out the nearest place that they are still shipping to.  I have seen Nebraska, and there are a lot of trucks.

What about those retailers.  Surely they must have known that most of their sales were going to people who live on the reservation and not the other eleven guys in town.  Of course they did.  So should they have been saying "we don't serve your kind in here" when someone from the reservation walked in?  Yeah, that would be a great plan. 

But, the argument might go, it was not that they were treating Native Americans equitably, but that they existed to serve them.  Fair enough.  But what could any of the four do?  Shut down?  That would just boost the sales of each of the others by 25%.  What if they all agreed to shut down (setting aside the problems of illegal collusion, accusations of racism, etc.)?  Well, gee, I wonder if perhaps there might be another enterprising soul around who might want to open a new store.

Of course, all of these speculations are absurd, because these merchants had no reason to want to curtail their operations, even apart from the fact that it would not work.  The suppliers responded to the demand created by the residents of the reservation.  When the tribal elders decided that their own people were not being properly obedient about drinking, they decided to re-aim their commend-and-control approach.

Undoubtedly the lawsuit will invoke a comparison to the gun manufacturers who supply a few retailers with an absurdly huge quantity of their product (a product that is intended to kill people, despite that silly claims you hear about cigarettes being "the only...when used as intended").  But in the gun case, it is evident that the sales are being illegally diverted.  The huge supply of alcohol is arguably used unwisely much of the time, but this is not illegal activity that the suppliers are obliged to stop.

So that brings us back to the UK solution:  Since the private market will not (indeed, cannot) attempt to thwart these consumption choices that someone in power does not like, some believe is up to government to use force.  Government could theoretically shut down sales in Whiteclay, Nebraska, or impose a minimum price there.  That would make the aforementioned guy with the truck a black marketeer, but that would not change his existence as a profitable entrepreneur. 

So they would need a bigger law, like the one we have that keeps people from unwisely consuming heroin.  Oh wait, oops.  Well perhaps, as with heroin, the US military could just invade and occupy the place that grows the raw material.  So where do they produce the raw materials for beer?  Really?  Nebraska and South Dakota?  Well I suppose that is convenient.  Maybe as long as they are there, they could pick up where they left off in the 19th century and massacre those annoying problem drinkers, solving the problem once and for all.

I can hear my colleagues in the UK cringing as they read that, fearing that someone in their government might read it and think it is a good plan.

08 February 2012

"Ethical Eating" mini-course syllabus

To my regular readers: This is obviously not a regular entry for this blog.  I needed somewhere to post an outline and reading list for this three-session course, and this blog seemed like the easiest place.  Moreover, someday it might be useful for someone else, and maybe some of you will want to read it, so I might as well put it someplace easy to find.

To those outside the primary target audience who might find this:  The class is being taught at Main Line Unitarian Church, in response to a Unitarian Universalist initiative, and thus the emphasis on UUA document and other faith-based material which I would not include for a different audience.  However, the UUA approach is very much a secular activist-left approach to the topics, and I believe that anyone who is interested could study or borrow this curriculum without even noticing the provenience of the documents if the letterhead was stripped off (for those not familiar, the UU is probably the least religious of any American church, if that makes sense).

Disclaimer: This is my own volunteer work; it does not represent the views or official curriculum of MLUC, UUA, the Humane Society of the United States, or any other organization.

I will update this throughout February 2012 as a working tool (without flagging what is an update) but it will then become a regular published fixed document.

To those participating in the class or considering it:  I understand that this is a casual discussion-oriented evening gathering, and you are not my graduate students, so please do not panic about how much I have here.  I like to be organized and to provide extra background and reading for anyone who wants to really delve deeper, but I am not going to assume that anyone did all, or indeed any of the readings.

Course Overview

The Unitarian Universalist Association of Congregations (UUA) recently made "ethical eating" part of the discussion about worldly and spiritual ethics that UU congregations are asked to consider.  The ethics of choosing food involves its impacts on treatment of agricultural animals, on the natural environment, on the human-affecting environment, on producers and other consumers, and on one's own health and social life.  As worldly ethical questions go, dietary choice tends to be relatively simple technically (it is easy to understand the suffering experienced by food animals, though the environmental impacts are a bit more complicated).  But it tends to be particularly thorny from the perspective of ethical judgment.  As a result, this class will necessarily include some technical material, but will mostly focus on ethical conundrums.

My relevant background includes two decades of studying (teaching, writing about) animal well-being, agricultural and environmental economics, and the study of ethics, as well as a passing background in nutrition and consumer behavior.  Content will draw upon the UUA statement about ethical eating, material from my colleagues at the Humane Society of the United States, my own research, and lots of other material, highly distilled down to three classes.

The format will be primarily led discussion, based on some information from suggested readings and brief background talks.  Topics will include:

The environmental impacts of food choices
-dietary choice is among the most important choices people like us make, in terms of environmental impact; for most middle-class Westerners it is the most important
-in particular, a meat-centered diet causes greater environmental impact than most any choice you can make, including land use and causing more energy use and greenhouse gas emissions than anything other than flying a lot
-choices like eating organic or more "natural" foods turn out to have minimal impact; eating locally and in-season helps, though, as do some other choices

The ethics of eating animals
-the secular ethical concepts of animal rights and animal welfare, and religious concepts such as dominion
-understanding animal agriculture practices and differences

Food as a standard consumption choice
-food as a consumer good comes from companies that differ in how they treat workers (the same is true for all other goods, but we consume more food, so it is arguably more important)
-treatment of slaughterhouse workers is among the worst in the US, and that of migrant harvesters is quite bad too
-food can be produced by people who have no access to other productivity options, so food markets have greater effects on the world's poorest poor than other goods; public policies matter a lot more, but individual choices can have a small impact

-the UUA statements include the common misconception that there is a strong connection between dietary choice and hunger; however, it turns out that others' hunger is caused by forces that have nothing to do with our food choice
-food policies can affect hunger, but probably not in the way you think
-we will cover the basic economics needed to understand what really causes or reduces hunger

The conundrum of making ethical choices that affect social norms, health, comfort, and family values
-unlike most actions we might take to as acts of ethics, dietary choice is impossible to look at as a technical matter or simple contribution of one's resources
-how far does it make sense to personally deviate from common practice in pursuit of more ethical actions?

Session 1 - Overview 

The first session will touch briefly on all of the points in the above outline, and the following material.  My plan before the start is to focus the second session on issues relating to food animals and the third session on environmental impacts (both of which will be briefly addressed in the first session.  I will also prepare follow-up material on other topics based on what generates the most interest in the first session.

As an opening point, it is useful to figure out what ethical behavior means (hint: many of the points in the UUA documents have little or not ethical importance by any standard notion of the term).

The UUA statements about ethical eating is the motivation for this class. This consists primarily of a Statement of Conscience and a longer Study Guide.  These documents are almost perfect for teaching about issues related to food and ethics; unfortunately, this is because the perfect teaching tool includes the most important good points, but also all of the common errors.  The Statement presents idealistic goals, which combine well-presented critical ethical issues with politically popular red herrings, combined with proposed solutions that include the most promising and important options, but mostly would do nothing to further the goals.  (The Guide almost seems to intentionally take the weakest points from the Statement and takes them even further, while almost expressing hostility toward the most useful point.  I plan to avoid it entirely unless there is interest in dissecting it.)

The Statement of Conscience includes the following passages (indented material) which seem like a good way to organize the initial discussion.  Discussion points follow each quotation.
We acknowledge that aggressive action needs to be taken that will ensure an adequate food supply for the world population; reduce the use of energy, water, fertilizer, pesticides, and hormones in food production; mitigate climate change; and end the inhumane treatment of animals. These steps call for an evolution of our eating habits to include more locally grown, minimally processed whole foods.
For most of us, our food uses more energy and water (and land), and impacts climate greenhouse gas emission than any other consumption.

It is not clear that the proposed "evolution" actually would improve the stated problems rather than making them worse.  Eating locally offers the valuable benefit of minimizing transport costs.  However, most processing also reduces transport and other input costs (fresh food uses a lot more energy than frozen, canned, and concentrated).  The treatment of animals is better some places than others, but proximity promises nothing; a slab of meat wrapped in plastic is "minimally processed", but likely involves the inhumane treatment of animals and workers and much greater environmental impact than a Clif Bar.

However, proper use of pesticides, and even hormones and antibiotics whatever other impacts they might have, decreases how much of the macro inputs are needed.  Fertilizer use is also critical for productivity, though it is on both sides of the equation (it largely derives from petrochemicals).  Eating "organic" matters little; it reduces some environmental impacts, but it increases others and is not "sustainable" in the sense of being able to feed everyone.

And so long as we employ modern methods, there is no conceivable risk of us not being able to produce an adequate food supply for everyone.  Hunger is not caused by global shortages of food, but by local shortages of wealth (and modern famine is always caused by a complete failure of government).  The Study Guide devotes almost half its content to issues of hunger without any apparent realization that it is not caused by supply shortages.

Food production involving growing, processing, packaging, transporting, and distributing food has become a vast worldwide industry. The mass production of food often maximizes production while minimizing price. This mass production has greatly increased food supply, but has resulted in the overuse of fertilizers and pesticides with crops and the mistreatment of animals and workers in food production. Both this overuse and the large waste streams from concentrated animal feeding operations (CAFOs) result in pollution of water, land, and air.
Environmental concerns include the use of fertilizers, herbicides, pesticides, and hormones and high volumes of animal wastes produced by CAFOs, all of which can contaminate soil, air, and water. Contributors to global warming include the overreliance on fossil fuels for food production; the methane produced by animals, including but not limited to cattle, sheep, and pigs; and the long-distance transport of food. Expanding agriculture and animal farming often removes natural habitats and reduces natural biodiversity. An additional environmental concern is the deterioration of the oceans and their life forms due to overfishing and pollution.
Human Health concerns include producers' use of growth promoters, pesticides, and antibiotics that can affect child development, antibiotic resistance, and other health conditions.
Which concerns are photogenic and chemophobic, or just an anti-industry bias, and which are real ethical (or health) concerns?  packaging hardly matters, but transporting is expensive; "overuse" of pesticides has little impact; lakes of manure are impressive, but an even greater environmental impact of intensive animal agriculture is growing feedcrops; use of hormones can hurt animals but has no measurable evidence of effects on those who eat them; antibiotic use, on the other hand, can help the animals but is bad for human health

What is the relationship between minimizing price (not always a good thing) and maximizing productivity (hard to complain about)?

There is a remarkable amount of confusion about what characteristics of your food really matter in terms of your health, to say nothing of whether these represent ethical issues in the first place.  However, it is interesting that there is no mention at all in the documents of food allergens, which do have effects on others (think: letting your kid go out with a peanut butter sandwich).

We...recognize that many food decisions will require us to make trade-offs between competing priorities. These priorities include: taste, selection, price, human health, environmental protection, sustainability, adequate food supply, humane treatment of animals used for food, and fair treatment of farm and food workers.
We acknowledge that this evolution must respect diversity in cultures, nutritional requirements, and religious practices. 
Funny how the choices we make that have the biggest ethical implications tend to be the ones with the biggest other implications too.  (actually, it is not at all surprising)

The document's list of complications about food choice still manages to overlook some of the most important points, particularly ease of functioning in society, self identity, and group identity (particularly family).

Policy concerns include agricultural subsidies that reward the production of certain crops and animal products that are less healthful and environmentally friendly than unsubsidized ones and that penalize small to moderate-sized farming operations. Agricultural subsidies of exported crops have driven small farmers in developing countries off their land.
This is only tangentially related to ethical eating, since our dietary choice has no impact on these policies.  The points are valid, however.

Some of us will not be able to pay more for ethical food. Others of us will.
There is little chance that anyone who reads or is directly influenced by that document (or the present one) cannot afford more ethical food.  Some of us can definitely afford nicer food than others can.  But except in cases where poverty limits access to markets, it is not difficult to consume cheap ethical food.

Lack of funding is similarly not the reason that school lunches (mentioned elsewhere) are so awful.

The "Call to Action" at the end of the document, which follows, would make an excellent exam on the topic:  Which of these could have a major positive impact, which are positive but of minimal impact, which actually would cause more harm than good, and which seem to have little to do with ethical eating?
Recognizing that individual circumstances vary, we aspire to buy, raise, and consume food for ourselves and our families that:
increases our proportionate consumption of plant-based foods, which increases the global access to calories, provides health benefits, and prevents injuring animals;
minimizes the pain and suffering of animals by purchasing meat or seafood produced under humane conditions, for those who choose to eat meat or seafood;
minimizes the negative environmental effects of raising animals or plants by purchasing organically produced food, and seafood certified as responsibly farmed or harvested;
minimizes transportation-related carbon dioxide emissions by obtaining foods locally produced through home or community gardens, farmers markets, or community supported agriculture (CSA);
provides farm workers with living wages and safe working environments;
contributes to social harmony by encouraging communal eating;
promotes health, consuming food in quantities that do not lead to obesity;
We advocate for the benefit of animals, plants, food workers, the environment and humanity by:
purchasing fair trade--certified products as available.
asking food sellers and producers to label where their products come from to determine distance of transport and whether the products were irradiated or contain Genetically Modified Organisms (GMOs);
pressing food sellers to require that their suppliers certify the humane treatment of animals;
supporting legislation that requires the labeling of products that are irradiated or contain Genetically Modified Organisms (GMOs), distribution of adequate ethical food supplies, effective safety inspection of food production, and realignment of agricultural subsidies to support growing more produce and the viability of small farmers; and
protecting and encouraging organic food production and its producers.

Session 2 - The ethics of eating animals; Issues or how far to go (and follow up on topics from previous session)

The basic facts about the treatment of animals in agriculture
For those who might not be familiar with how almost all agriculture animals are treated (or who have learned but followed the natural tendency to put it out of their heads), some background:

From HSUS (which tend to include calls for political action, just so you know):
-Links to information about specific species
-Confinement of animals

-the HSUS brokered plan to reduce the cruel treatment of laying hens (short video)
-links to science and research on various farm animal welfare topics

From other organizations that exhibit what we might call mainstream values, and that provide honest and generally accurate information (links to info about various species)
-Farm Sanctuary
-Royal Society for Prevention of Cruelty to Animals

Organizing principles for ethical decisions
There are countless secular tracts on why we should care about the well-being of animals.  Unfortunately, the short tracts tend to mostly just state things that you already agree with or not.  Many longer pieces are definitely more persuasive; I always liked the works by Mason, Singer, and Regan in addition to those mentioned in the next link below.

Here are some short pieces that focus on somewhat religious arguments (though the departure from basic American secular ethics is not substantial):

-UU Animal Ministry Reverence for life manual (follow link; it is a real shame that those who wrote the Ethical Eating material did not defer to the content and authors of this publication)

-HSUS Animal protection ministries: A guide for churches (mostly not about food, but the last few pages are about eating and have some good points; the perspective is Christian, but not so much so that it is foreign territory to UUism)

-M Scully, A religious case for compassion for animals (read "religious" as "Biblical"; this is adapted from his excellent book on the topic; what is interesting about this is that it makes the case that conservative-minded Christians should support humane treatment in agriculture)

When pursuing an ethical choice, how far is rational / sensible / ethical to go?

Follow-up on last week's topics
-nice analysis of some of the reality of organic farming - not a definitive work, but a minimally rhetorical informative easy read that happened to appear this week

Session 3 -  Environmental impacts (and follow up)