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.

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