28 March 2012

How can you tell Simon Chapman is mucking about over his head?

March is coming to an end, and since this seems to be unofficial "make Simon Chapman regret his habit of saying really dumb things on Twitter" month, I figure I am running out of time to join the party.  It started out with blogs about some of Chapman's tweets, with an absolutely hilarious post by Chris Snowdon, followed by Dick Puddlecote a week later.  Meanwhile, Dave Atherton presented him with a barrage of direct tweets asking Chapman to defend some of his positions in the face of the evidence (Chapman offered no response, as far as I can tell, and I would guess had none).

For those who do not know, Chapman is the Worst "Public Health" Person In The World.  (Like Olbermann, I reserve the right to pick different "Worst Persons" later, but I find it likely that others will remain runners up.)  You can learn a lot more by searching for his name in Snowdon's blog, or mine, but to summarize:  He is the perfect storm of a card-carrying "public health" person who is harmful to both public health science and the public's health:  terrible at scientific/analytic reasoning, and freely promotes junk science; believes that top-down authority, particularly promoting prohibition, is the defining characteristic of public health; will make any sciencey claim that seems to support his political positions, regardless of the lack of scientific support; displays no apparent humanitarian concern despite working in a field that can only be justified by such; is the worst kind of gadfly (parachuting in to topic areas he clearly knows nothing about and making sweeping declarations as if he is an expert); and does not even seem to display much more scientific expertise on tobacco, the subject he has been working on for decades.

None of that would matter much (there are tens of thousands of teenage bloggers who are characterized by all but the last of those, after all, and some write much worse things than Chapman), but for his last characteristic:  He has been granted an inexplicable measure of authority over public health in his country.  Fortunately for 99.5% of us, that country is Australia, but we should worry about people even when they are a minority living in some remote shark-infested flooded desert.  Besides, there is the matter of the spillover via telecom.

[Aside:  I suspect some readers might be thinking, "Worst? But what about Stanton Glantz, who occupies a fairly similar niche and makes even more absurd pseudo-scientific claims."  I see your point, but I have become convinced that Glantz is actually an extended "bit", like Stephen Colbert -- someone playing a character by the same name that is a parody of an absurd group of people.  I mean, seriously, no one could actually believe what he claims to believe and be able to get through the day without some sort of custodial care.  Like Colbert, he has been asked to give sworn testimony while acting in character, and has some clueless followers who believe that the character is actually a real person making those claims.  So "Glantz" is not really in the running unless I turn out to be wrong about this.  Moreover, Chapman claims personal credit (i.e., blame) for the ban on low-risk alternatives to smoking in his country, making him the person responsible for the most pointless deaths of his countrymen since the guy who ordered the army to Gallipoli, and Glantz is never going to be able to touch that "accomplishment".]

Getting back to Chapman, I do not have quite the writes-itself quality material that Snowdon did (if you have not read his post, do so -- it is great) and I doubt I can come up with a phrase as catchy as Puddlecote's "Swivel-Eyed Loon", so the following (pictured) is what I have.  It is from just before "make Simon Chapman...month" began, and I have not experienced any cyberstalking from him since then, so maybe the project has already succeeded.  Still, I want to get in on it.

The background is that my government, specifically U.S. FDA's new tobacco regulation unit, has a badly misused Twitter feed.  Keep in mind that this unit of the government is not some third-rate "public education" operation at a county health department.  It has no mandate or expertise to engage in general public education.  Its role is entirely to regulate corporations, making supposedly science-based decisions and issuing top-down edicts.  Despite this, about 20% of its tweets from @FDATobacco are inane anti-tobacco statements, whose style suggests they are intended to target the many fifth-graders who are reading the feed.  (The latest one, at the time I am writing this, is "True or False: Every day, approximately 1,000 youth under age 18 become daily smokers."  That is the full content, down to lack of a question mark and the apparent failure to understand that such a statistic only makes sense if you tell us what population you are talking about.)

About 70% of the traffic from @FDATobacco seems to be thanking others by name for following the feed or for retweeting (funny, they have never once thanked me for any of my retweets -- it might have something to do with the fact that I usually add some analysis).  That leaves maybe 10% that is the actual legitimate activities of this taxpayer funded official government communications channel from an agency that regulates commerce, telling us about what is going on that relates to the intersection of FDA and tobacco.

By far the biggest story of this year in that intersection was the court ruling that blocked FDA's plans to put emotionally violent gory images (often mischaracterized as "warning labels") on cigarettes.  Funny thing: @FDATobacco completely ignored the story, while continuing to post the wastes of space I noted above.  I am fairly certain that most of my readers recognized the intention of my post: biting sarcasm about how completely inappropriate the FDA Twitter feed is.  I hope the subtext was clear, that our government's official communication channels should not be acting as a cheerleader for a particular political position, intentionally ignoring the important news that the government's ultimate authority in the matter has taken an opposing position.  When the agency's efforts fail, it should be reported by the agency; if whoever writes @FDATobacco does not like that, s/he should leave government and get a job in advertising.

So, let's look at the tweet that Chapman sent in reply.  Start with the last line.  I am not sure exactly what "your descent" means.  Tweets are necessarily terse, but he had some slack to explain with a few more words, so I suspect he did not really know either.  Perhaps he is pointing out that my first foray of any significance into the scientific field that he claims expertise in, epidemiology, won several awards and helped redefine the discussion among the real scientists in field about how epidemiology should be done and what is fundamentally wrong with it.  The next topic I pursued was an even more important problem in the field, in my mind, though it did not generate much buzz.  So, most of the directions I could go after my debut were indeed down.  I would be the first to agree that after 13 years, and efforts by me and others, what I tried to promote with that work is still an unfulfilled promise, and epidemiology has not improved.  And I have given up on pursuing improvement from within.

Perhaps that was what he was trying to say.  But I kinda doubt it, given that he is not part of the scientific branch of the field, did not contribute to the attempted revolution I was part of, and seems to be thoroughly ensconced in the "part of the problem" side.

So what did he mean?  Did he think my criticizing the FDA was a descent?  That seems like a strange claim, since the aforementioned debut paper used as its main example an indefensible FDA decision.  Could it be the fact that I am criticizing someone?  Part of the reason epidemiology is so bad is because the non-scientists in the field have an attitude that you should never criticize anyone's work (I am not kidding).  But I have never hesitated to criticize, coming from a scientific background, so there is no trend.

It is unclear, but my best guess is that the claim reflects Chapman's activist zealot mentality, which often manifests in assuming that people in "your" group must agree with you on everything, and refusing to consider that they might have a good reason for not doing so upon finding out otherwise.  In this context, I speculate, he incorrectly assumed, when he followed my early contributions, that I agreed with him on everything, such as favoring emotionally violent labels on cigarettes.  But he interpreted this tweet as being a declaration that I now disagree with his goals, which is the zealot's only basis for judging someone.  Thus, descent.

That takes us to his first sentence.  Setting aside the very incorrect implication that we are on a first-name basis, consider the claim.  I sounded happy?  I am not sure it is possible to sound happy in 140 characters without using words that explicitly declare happiness.  Surely if I had just posted the "Judge blocks..." headline, there would be no basis for a claim about sounding happy.  So it must come from the "Hey @FDATobacco...." part.  But, of course, what I expressed there was my dis-happiness with the high school intern or secretary who controls the @FDATobacco feed (I am going to give them the benefit of the doubt and assume the problem is that the agency is simply not taking it seriously), for their abuse of government authority.

Chapman's misinterpretation of that is a perfect example of what makes him such a bad excuse for a scientist, and not because he misinterpreted (though I am still really not sure how that "you forgot" construction could be interpreted as happiness).

A scientist/scholar would have read and understood the actual analyses of opponents of his position, particularly people he presumes to pick fights with, rather than just their feeds.  Had he done so, he would surely have been aware that I have repeatedly argued that those graphic labels are bad public policy for numerous substantive reasons.  The last of the above links is to the testimony I offered about FDA's plans which made the same core arguments used in the judge's ruling.  Indeed, some of the phrasing in the ruling is so familiar that I suspect that one of the judge's clerks must have read that or something else I wrote and used some of it in drafting the ruling, which is gratifying.

Thus, my tweet could convey no information about my happiness about the ruling, because anyone familiar with my work would already know I was happy about it.  It was a defense of freedom of speech, a repudiation of pseudo-science, and a push-back against perverse "public health" measures that are designed to harm people who are choosing to do something unhealthy rather than to help them.  Chapman's behavior suggests that he does not care about any of these, but before he presumes to criticize me, he ought to be aware that I do.

Moreover, even allowing for his failure to understand the sarcasm I was conveying to/about the author of @FDATobacco, someone who thinks scientifically would have automatically wondered about the meaning.  There are plenty of ways to express happiness, and I employed none of them.  But apparently it never occurred to him (like it automatically would to someone who thinks scientifically), "wait a minute; my immediate impression of this does not add up; there is something I am not understanding."  Leaping to the conclusion that I was expressing happiness might be another result of his activist mentality:  If everything is measured only in terms of whether it is good for The Cause or bad, and there are no complications other concerns in the world, then someone must either be expressing happiness or sadness about a policy decision.  Of course, if I had more data, I could perhaps do better, and might well figure out that my guess is wrong.

I wonder if Chapman has ever expressed that last thought.

I am tempted to say something about watching Chapman's descent, but I think perhaps he has acted this way since I first became aware of him, and I just did not notice it at first.  A big difference is that he has gained power, and thus his folly is clearer.  And really terribly harmful.  I do not mean some abstract point about his behavior harming the science itself (though it does) or parochial point about his content-free personal attacks on people who are doing good science that he does not like; I refer to harm to the welfare of lots of people.

Oh, and of course the answer to the question in the title is the internet-age variation on the old canard about how you know a politician is lying:  "His fingers are moving."

27 March 2012

Unhealthful News 210 - Values and science (featuring more lunacy from Wisconsin)

A couple of weeks ago, I posted about a move in the Wisconsin legislature that would basically declare that being a single mother (however that situation came about) constitutes negligent behavior that contributes to child abuse.  Understandably, there was an uproar about this; not surprisingly, it pretty much overlooked the epidemiology of the situation that I mentioned.

It was pretty clear that the epidemiologic observations (that a child is indeed better off in a two parent household all else equal, and that children in a household with a male partner of their mother who is not their biological father are at enormously greater risk of suffering physical abuse), while based in evidence, were rationalizations, not the real motives.  Other statements by the bill's sponsor made it pretty clear he was not actually trying to improve the lives of the children, let alone their mothers.  A few days ago, that was compounded by a comment by a co-sponsor of the bill, which finishes off any doubt that this has to do with caring about people:
Instead of leaving an abusive situation, women should try to remember the things they love about their husbands, Representative Don Pridemore said. "If they can re-find those reasons and get back to why they got married in the first place it might help,"
(h/t to epidemiologist blogger Tara C. Smith for finding this, though I cannot quote her tweet about it without risk of getting my post censored by vocabulary-based filters)

This madness is fascinating in the context of the buzz about the new book by psychologist-turned-political-analyst Jonathan Haidt, The Righteous Mind.  The gist of the buzz (admittedly an oversimplification of the ideas, though so is the book -- if you want a more complete summary, this review provides one) is that behavior of many voters on the American political right baffles thinkers on the left.  The latter think the former are just being duped by the 1% to vote against their interests.  Haidt argues that the conservatives just have a broader set of "moral" concerns.  The claim is that conservatives understand liberals' values of compassion and fairness, and share them to some extent, but also consider as moral values such things as order, loyalty, authority, sanctity, tradition, and feelings of disgust.  These latter concepts are sufficiently foreign to liberals, the claim goes, that it is very difficult for them to even recognize these as morals that someone might have. 

One conclusion that gets drawn is that those on the right just have a richer and deeper moral sense than those narrow thinkers on the left.  I realize that Haidt's intention is to offer a useful positive (i.e., descriptive) analysis, not a normative one, but there is something remarkably disturbing about the moral relativism that leaks through in the the conversation.  Ironically, American liberals are often characterized by or criticized for cultural/moral relativism.  But, this story claims that they do not extend that to a large portion of their fellow citizens. 

Whatever you might think of that observation, it should be clear that there is a good case to be made against relativism in the Wisconsin case.  Some "moral values" are just not, well, moral -- they are not defensible under any set of modern Western moral guidelines I can think of, other than appeals to out-of-context statements from ancient Hebrew mythology.  A taste for sanctity, order, tradition, and authority might explain the urge to support public policies of denying reproductive freedom or encouraging a woman to keep an abusive family together.  Similarly, a sense of disgust and authority leads some people to want to punish tobacco users or deny rights to homosexuals.  But remember that a taste -- for wealth and power at the expense of others -- also explains the behavior of the 0.1%.  All are understandable, can be put in evolutionary terms, etc. but that does not make any of them ethically defensible.

Bringing this back to the epidemiology, I would argue that the use of epidemiologic claims as rationalization for a motive that is in no way motivated by the science is deplorable.  Moreover, it is evidence of the moral bankruptcy of the position.  If someone is not willing to stand up and say "I think people should not be allowed to use tobacco or cannabis, regardless of its effect on health" or "in-tact families are the only moral way to live, even if they are unhealthy on net", then let them do so and see how their ideas stand up with the polity.  But if they are going to twist the evidence to try to pretend they are motivated by creating better physical or social/emotional/developmental health, then we should cry bullshit.

Importantly, from where I sit, it is pretty clear that Haidt and the others who try to put this in terms of standard American party politics are working along the wrong spectrum.  The most ridiculous cases seem to come from Republican state officials.  But Democratic officials and the Democrat-leaning permanent government (the long-term employees in the bureaucracy) pursue their taste for non-humanistic principles with (often junk) epidemiology rationalizations -- they are just usually better at disguising it. 

I follow the comments and observations of hundreds of people who share my inclination to condemn junk science and disingenuous rationalization in pursuit of personal "moral" tastes.  It is fascinating to observe that for the substantial portion of them whose political identity is tied to these feelings, there are remarkably similar numbers who believe that the worst offenders are the political right and who believe it is the political left.

25 March 2012

Unhealthful News 209 - Maybe it is sometimes about the caffeine. Maybe.

Previously I have posted about the media hype about energy drinks and there is a bizarre fixation on caffeine, to the exclusion of the other ingredients, either when they combined with alcohol or not.  The most criticized drinks -- the original, Red Bull, and the controversial alcopop versions (which seem to have largely disappeared from the market following controversy) -- actually have/had fairly modest amounts of caffeine, less than a small coffee.  But the "energy drink" label general means something contains other active ingredients, including other herbal stimulants (guarana, a source of caffeine and a other identified and perhaps unidentified stimulants; ginseng), taurine (an amino acid that is believed to usually be beneficial, but high doses of an isolated single amino can sometimes do weird things), and megadoses of some vitamins.

Personally, I have always been more worried about the other ingredients, though I hasten to add that there is not solid evidence indicting them.  I based my concern on the observation that (a) there is reasonable evidence that sometimes some people have a bad reaction to these drinks and (b) very few people have a very bad reaction to that quantity of caffeine, as evidenced by the tens of millions of people who drink that much caffeine every day.

This week it was widely reported that a 14-year-old Maryland girl, Anais Fournier, died after drinking two extra large energy drinks in December.  Was it caused by the drinks?  Quite possibly, though if so it seems most likely that they triggered a time-bomb condition rather than being like, say, a car crash that struck down someone who otherwise should have expected a 80 more healthy years.  Blogger Radley Balko suggested on Twitter the Huffington Post (which he writes for) should have headlined it, "Energy drinks demonized after girl w/ heart condition dies." 

But if it was caused by the drinks, was the caffeine to blame? 

Unlike many of the other drinks, this is at least plausible in the recent case because the estimated amount of caffeine she consumed was 480 mg.  Alarmists in the press chose to point out that this was equivalent 14 cans of Coke.  They did not bother to mention that Coke is not really a very potent caffeine delivery system, and that this is in the neighborhood of a large Starbucks coffee.  Drinking a large coffee would not necessarily be the best thing for a girl with a diagnosed heart condition to be drinking, but hardly outside the realm of normal teenage behavior based on my observations at the local Starbucks.  (They also did not mention that volume of the Monster energy drink Fournier consumed was that of 4 cans of Coke or more than two large Starbucks -- far short of downing more than two six-packs, but definitely a deliberate ingestion of a lot.)

We have no information on whether she had ever before drunk a large coffee, so the caffeine alone might have been too much.  But it still seems that there should have been some press mention of the other ingredients of the drink.  A search of the name of the girl or the drink in recent news yielded dozens of news stories, but when adding in the name of the other active ingredients, the only story that repeatedly appear was a post by a marijuana legalization advocate wondering why the drinks with all of these ingredients are legal and their drug of choice was not.  (Note to advocates of drug legalization:  Trying to embolden those who want to ban other substances is probably not your best strategy.)  Guarana showed up in longest story about the girl's death, from her local newspaper, but only in the context of it being a source of caffeine; its several other active chemicals were not mentioned.

Fourneir's death was officially attributed to cardiac arrhythmia due to caffeine toxicity.  Presumably this will be cited as evidence that the caffeine content in these drinks is toxic.  It will no doubt be used to make that claim about energy drinks that contain a more typical 80 mg. of caffeine.  But, obviously no such conclusion can be drawn, even about the 480 mg.  The epidemiology of caffeine is clear:  so few people die from it that we cannot even detect the effect. 

I also dread watching commentators pick up on the word "toxicity" in the diagnosis (which is strictly accurate, assuming it was the caffeine: death due to the acute effects of a chemical taken into the body) and start screaming "this is evidence that caffeine is toxic!!!!!"  Yes, people, of course it is -- how could it be any different than every other chemical or compound, all of which are toxins in some form and quantity.

However, I am not the slightest bit worried that this will result in attacks on our society's (and my personal) favorite caffeine delivery system, coffee (except, perhaps, at some fringe health kook sites, which don't really worry about evidence anyway).  There will be actions in state capitols to ban energy drinks because of the caffeine -- if not now, then after a couple of other headlined deaths.  But no one will give coffee a second thought.  The funny thing is that the people leading the charge are undoubtedly the same ones who worry about "chemicals" in food and the environment (not particular chemicals, just chemicals), and who are overlooking the list of untested chemicals that might really be causing a problem.

23 March 2012

Quick statistics lesson - difference of two proportions and limits of frequentist stats

Someone just asked me the following.  Since I have not covered how to interpret such things in a while, I though I would put it in a post.
Someone tweeted about some segment of Oregon's youth smoking rate going up.

95% confidence interval for 2008 was 8.0% - 9.3%

95% confidence interval for 2009 was 8.7% - 11.2%

Doesn't this mean we can't be 95% sure that the smoking rate actually increased?
First, I will answer a fundamentally different, but similar sounding question that is consistent with the numbers provided:  Is the change statistically significant at the .05 level, or equivalently, does the 95% confidence interval for the difference between the two percentages include zero?

A quick answer to that requires only observing that the (unreported) point estimate for 2008 is in the range of 8.6 or 8.7, the middle of the confidence interval (note for other cases if you do this: for a ratio measure, "middle" means the geometric mean, and when the CI pushes up toward a limit of possible values -- like 0% in this case -- it gets more complicated).  If it was 8.7, even if that were perfectly precise with no random sampling error, the difference would not be statistically significant since that point falls within the CI for the 2009 value -- that is, the random error for the 2009 number alone is enough to make the difference not statistically significant.  Since the point estimate might be a bit below that, it is not quite so clean, but it is still easy to conclude that the difference is not statistically significant because it is so close and there is random error for the 2008 figure.

If you want to do a better job of it, you can back out the missing statistics (the whole thing would be cleaner and easier if they reported the actual data, so you could just compare the sample proportions).  After calculating the point estimate, you can calculate the standard error because the ends of the CI are 1.96*SE away from the point estimate.  With those estimates you can use the formula (e.g., here) for the SE of the difference, giving us the CI for the difference (multiply by 1.96, add to and subtract from the difference), which is -0.1 to 2.7.

But much more interesting than "is the difference statistically significant?" is some variation on the question actually asked, how sure are we that there is a increase.  The answer to that is not available from these statistics.  You see, frequentist statistics never answer the question "how likely is...?  (If "frequentist" is meaningless jargon to you, suffice to say it includes p-values, confidence intervals, about 99.99% of the statistics about error you see in medicine or public health, and about 100% of those you see in the newspaper.)  A 95% confidence interval is defined by an answer to a complicated hypothetical question (you can find it in earlier posts here, or look it up) about what would happen if a particular number (the one at the border of the CI, not the point estimate) were the true value.  It does not address what the chances of particular values being true are.  Indeed, it is based on an epistemic philosophy that denies the validity of that question.

But the thing is that such a question is what we want the answer to.  This is true to such an extent that when you see someone try to translate the frequentist statistics into words, they pretty much always phrase it in terms of the answer we want -- i.e., incorrectly.  But it should be obvious this is wrong if you just think about it:  What if the survey that produced those percentages is known to be of terrible quality?  Then it obviously should not make you feel extremely sure of anything, regardless of how low the random sampling error might be (which would happen if it were a large sample, even if the survey was fatally flawed -- size matters, but a lot less than other things).  Or, what if you had a boatload of other evidence that there was a decrease?  Then you might be quite sure that was true, even though this result nudged you in the direction of believing there was an increase. 

Drawing conclusions about the probability of a worldly phenomenon requires taking into consideration everything we know.  It also calls for Bayesian statistics, the need for which is usually mentioned first, but really this is a technical layer on top of the need to consider everything you know.  This has all kinds of annoying features, like the probability existing in your thoughts rather than having any "real" existence.  Which is why it is tempting to focus on the much less useful, but well-defined, probabilities that appear in frequentist statistics, which are then misinterpreted.

As for what I believe knowing the little that I learned from the question I got, combined with other knowledge about how the world is:  It seems really unlikely that the smoking rate would go up (or down) by 15% in one year.  It is mostly the same population, after all, and smoking behavior is highly serially correlated (i.e., what an individual does in 2008 is very predictive of 2009).  Thus, I am pretty confident the change is overstated, whatever it really was.  Based on this, any government official or other activist trying to make a big deal about this number must not understand statistics, though I would have been 95% sure of that even before I heard what they had to say.

Second-order preferences and the ethics of nicotine vaccines

A couple of weeks ago, I taught a class in which I used a study about the new nicotine vaccine as an example, and posted the class outline (which I will shortly update with a few talking point notes for guiding the discussion, just in case anyone is interested in borrowing the curriculum).  This prompted a few questions about my general thoughts about the "vaccine", which I said I would answer.

Those scare quotes reflect that this is a sketchy use of the word:  The technology consists of introducing a substance into the body in order to stimulate the immune system to react to the target, which indeed describes the workings of a vaccine.  However, most definitions of the word include a "to prevent future disease" component, while this "vaccine" only prevents nicotine from affecting the brain in ways that clearly do not constitute disease.  The ability to experience the effects of nicotine is considered a disease only in the minds of a small tribe of aggressive political activists, and even they offer no definition of "disease" that supports such an interpretation.  (Please spare me "logic" like "smoking causes dozens of diseases, and therefore nicotine consumption is a disease"; by that twisted logic, the ability to derive benefit from driving a car or to enjoy sex constitutes a disease.)

Some definitions of "vaccine" specify that the stimulated immune response is to infectious agents.  Moreover, the immune reaction does not destroy the nicotine, as it would an infectious agent, but merely binds to it, making it too big to get into the brain.  Given these departures, it seems best to think of "vaccine" as a metaphor rather than a literal use of the word.  With that in mind, I will just go ahead and use it without quote marks.

(Keep in mind when reading this that nicotine can be delivered in ways that, unlike smoking, do not cause substantial risk of actual disease.  However, that only amplifies the points I am making; this analysis would still be valid even if all nicotine use created measurable risk of disease.)

So, it is improper to think of this vaccine as something that destroys a disease agent, but how should we think about its impact?  I think it is best characterized as a way of changing your preferences, something that is often desired.  Having a preference for having different preferences, while a bit awkward to write and read, is not unusual at all.  I definitely prefer drinking Coke to water, though if I could switch how much I enjoyed them, I most certainly would:  I would prefer a world in which I liked water as much as I currently like Coke and vice versa, and would pay thousands of dollars to cause that change.  The reasons for this should be fairly obvious, as they are for the preference pattern that most of us experience sometimes, "I really want to take a nap (or play a video game, or whatever) right now rather than working; I wish I could get inspired to work".  Put another way, I might prefer to not work at a particular moment, but I would prefer to prefer to work.

Such preferences about your more basic preference ordering are called "second order preferences".  My colleague at THRo, Catherine Nissen, and I have thought a lot about this concept in the context of smoking.  It seems pretty clear to us that it explains several phenomena (though as far as we can tell, we are the only ones arguing this viewpoint).  One example is the disparity between the common claim that almost all smokers want to quit and the fact that they have not acted on that preference.  It is because the claim about preferences naively misconstrues a second order preference for a basic first order preference. 

The research that produces those "almost everyone" statistics represents standard tobacco research sloppiness, asking questions like "do you want to quit smoking?"  Anyone who is any good at designing surveys, or who merely read this post, should see the flaw in that phrasing.  A question like "would you rather smoke later today or not?" is well defined and if most smokers answered "not", it would be legitimate to say "they want to quit".  But the actual vague questions will often get translated by respondents into something along the lines of "compared to continuing smoking, would you prefer a future that includes you not smoking and being happy to be in that state?"  That is a question about second order preferences, and is no more realistically interpreted as "they want to quit" than my above observation can be read as "I do not want to drink Coke".

So, circling back to the vaccine, if someone has a second order preference to be a non-smoker -- he would prefer to be someone who prefers to not smoke -- but he really prefers to smoke rather than abstain because he likes the effect of nicotine, then he might choose the vaccine to align his preferences (the first order, or basic preferences) with his second order preferences.  The vaccine takes away the effect of nicotine which, in this scenario, leaves him no reason to prefer to smoke. 

There are two important complications with this:

The first is that the vaccine merely lowers the welfare from being in one possible state, using nicotine, without raising the welfare enjoyed in the alternative.  Indeed, such lowering is typically the only available option for reordering our preferences.  After all, if we had a chance to raise our welfare when in a particular state, then we would just do it.  Setting a loud alarm clock across the room does not make us any happier to be awake on time -- it merely makes continuing to lie in bed so unpleasant that it is no longer our preferred option. 

Notice how I phrased my second order preference about drinking Coke: how much I liked the two beverages would be swapped, so drinking water would become as pleasurable as drinking Coke is now.  That would be a win-win.  If there was an option to make that change, I obviously would have already done it.  So, if I wanted to "self-command" (to use Schelling's term) myself to give up Coke in the real world, if somehow I thought that I would be much better off without it but were unable to resist, the best I could hope for would be to make it unappealing.  There is no obvious way to make plain water seem that yummy.

So, the vaccine takes away the pleasure (focus, stimulation, etc.) you get from nicotine when smoking, lowering the benefits to the those you get from nicotine when not smoking -- that is, down to zero.  One's preferences are reordered by taking away benefits from one of the options.  This does not seem like a great deal.  It might be desirable, however, if someones second order preference for wanting to prefer not smoking to smoking was sufficiently strong.  He could rationally choose to take the vaccine, so long as he knew what he was getting himself into.  But he should be clearly told "you know how you feel when you don't smoke?  Well, if you take the vaccine, that is going to be how you feel, whether you smoke or not.  So, you will not want to smoke, but you will not have the option of feeling like you currently do when you smoke."

So, as long as that is honestly communicated, the choice is an informed autonomous one and could be rational.  (And we can have faith that physicians and advocates will make this clear, right?  Of course they would never gloss over the bit where the vaccine will not make you any better off when you became abstinent than you are when you abstain without the vaccine.)  Fortunately, the vaccine's effects appear to mostly or entirely wear off, at least when used for a short period, so if someone tried it once and discovered it was a mistake, they could reverse the choice.

That brings us to the second issue:  Most of the discussion about the topic is not about the rational adult making an informed decision, but about involuntarily inflicting the vaccine on kids.  Those proposing it tend to gloss over that "involuntary" bit, and failure to even address this is a serious ethical problem in itself.  But, of course, unless we are talking about a current user who is wanting to quit, this is the only interpretation.  Either the kid is already choosing to not use nicotine, in which case he would see no reason to accept the side effects, or he is currently choosing to use nicotine, in which case he would prefer to avoid the vaccine.

Of course, we take actions that restrict kids' choices all the time.  But there is something rather different when the method involves altering their bodies to make it impossible to enjoy a particular choice (and that choice is not "inflict violence on others" or "commit suicide" or something of that nature).  If the effect were permanent, I think this would be an ethical no-brainer.  I suspect that a permanent effect is the goal of those pursuing research on this vaccine, and inflicting that on someone would clearly be unethical.  No, that is too mild -- it would be utterly appalling. 

Consider the other example (the only other one I can think of) in which adults permanently alter the body of a child to prevent the child from engaging in a behavior that entails some costs, and where they (the adults) do not approve of the kids enjoying the benefits:  the mutilation of girls' genitals practiced in some African communities, which you have no doubt read about.  Before anyone who cannot follow a logical argument flips out, I will point out that I am not claiming that either the damage done or the loss of benefits from the vaccine is as great as that from genital mutilation.  But the motivation and implications are otherwise similar:  enjoyment of sex/nicotine by youth is considered evil by those in power for some reason; the benefits of sex/nicotine result in temptation that can be removed by altering someone's body to diminish the benefits; yes, the behaviors that are thus prevented can increase risks of disease, but this does not appear to be the genuine motivation (e.g., because there are other ways to avoid disease that the proponents oppose).  I suspect that never in my life have I had a conversation with someone who thinks that genital mutilation is anything other than appalling, so why is there no hint of such ethical concern directed at the nicotine vaccine?

There is a real difference to the extent that the vaccine's effects will wear off completely once someone reaches the age that they can make rational choices about their own health.  But even then, this is pretty scary ethical ground.  Plus there is no solid evidence that years of vaccination can be completely reversed.

There is room to ethically defend the vaccine with an argument along the lines of the yet-to-be proven, "we have solid evidence that this will wear off in time for an adult to make her own choices" along with "teenagers using nicotine is so unacceptable because ... that we can justify altering their bodies to prevent it".  Or an argument could be made, "yes, we realize that this is basically like genital mutilation, but it differs in the following ways such that we think it is ok...."  I have seen no such justifications offered, presumably because (a) they would be utterly unconvincing and (not "or") (b) the vaccine proponents are so fanatical about their goals that they are unaware that there is any need to defend them.

Until the proponents of giving the vaccine to kids admit that they are treading on very dangerous ethical ground, and upon recognizing that present a compelling argument to defend their position, I believe we have to consider this, alongside genital mutilation, as an unethical infliction of physical damage and loss of liberty on innocents, motivated by goals that are based entirely on quasi-religious beliefs that are believed only by a minority that happen to hold power over some children.  The term "vaccine" is a bit strained, but the term "child abuse" seems to apply unambiguously.

21 March 2012

Unhealthful News 208 - Putting a fairly bad risk in perspective, fairly badly

Most of you probably read something about the most recent study that concluded that eating red meat is bad for you (the one from a few days ago about all-cause mortality risk, not the one reported today that claimed red meat protects against depression -- I just can't keep up with all of them).  I was asked what I thought of a BBC article that tried to put the risk in perspective.  (h/t to Igor Burstyn for asking and discussing the answer)

First, to just mention a few points tangential to that:  Most nutritional epidemiology is among the biggest jokes in the field -- not as bad as tobacco research, but worst than most other subfields.  The big cohort study projects, like the source of this particular study, are notorious for publication bias.  In other words, had they not gotten the "right" answer, there is a good chance the result would have been censored, so on average the results overstate the case for the consensus beliefs.

Additionally almost all nutritional epi is based on "food frequency questionnaires", which ask dozens or hundreds of questions about what someone eats and are notorious for having a huge amount of measurement error (i.e., the data might be useful, but it is always quite wrong).  Have you ever noticed almost every such study takes pains to point out it was a validated food frequency questionnaire.  Notice that they never tell you what this impressive-sounding adjective means.  (Hint: it means that one time they checked to see whether the instrument produced results close to those from some more careful measurement method; notice that they never tell you how that checking worked out.)  One of the more inside/subtle jokes in my "tobacco candy" research parody was a dig at the silly term "validated food frequency questionnaire".

That said, the observation that meat seems to be bad for your longevity and red meat seems to be worse than average has been replicated enough that it is unlikely to be wrong.  Indeed, in despite the new round of headlines, the new study really told us nothing new -- which means that it stands a much better chance of being approximately right than something that made a novel claim.  So, for today, take the result as True and see how people did at explaining what it means.

The main result was that eating red meat increases the hazard rate for dying by 13% for each serving-per-day that you eat.  (I am going to set aside the fact that that fixating on the exact 13% implies far more precision than the research provides -- a common error of those who do not understand study error.)  Note that this is very different from a lot of the results you see in epidemiology in several ways:  
  • That "hazard" thing means that whatever the risk of having died would have been this year or next year, it is increased by 13%, and that continues for future years.  It does not just mean that the chance of some bad thing occurring sometime in your life has increased by 13%.  (Note: usually studies that calculate this "hazard ratio" just assume that this pattern -- the same x% change every year -- and force the data to fit it.  In the present case they actually tested that assumption but allowing the curve to wiggle, and while it was clearly not a perfect fit, it was not terribly wrong.)
  • Often risks you hear about are an increase in the chance of getting one particular disease, often one that is rather rare, while this is about an increase in a risk for mortality in general.
  • The reported change in risk was for a realistic level of change in behavior that someone could make.  Indeed, they could move by multiple increments, like going from 3 servings down to 1, for two increments of benefit.  This contrasts with many studies that only report the comparison of those with the greatest exposure to those with the lowest exposure (ignoring the majority of the population in between), so someone could only see the theoretical change described if they were at the worst extreme and somehow could move clear to the other extreme.
Taken together, that makes this a stand-out risk but the standards of single-item behavioral choices.  It is a lot smaller than that for complete lack of exercise, smoking, or many other patterns of drug use.  But it is a lot bigger than almost every other hazard, like transport, most drug use, and other nutritional choices.

So props to the BBC for taking it seriously and trying to put it in perspective.  Too bad about the answer they got:
The easiest way to understand it is to think of how this might affect two friends who live very similar lives, according to David Spiegelhalter, a Cambridge University biostatistician, and the Winton Professor of the Public Understanding of Risk.

Imagine that the two friends are men aged 40, who are the same weight, do the same amount of exercise and do the same job.  The only difference between them is that one eats an extra portion of red meat every day - an extra 85g, or 3oz.  "Let's say that every work lunchtime one of them had a hamburger and the other didn't.  "What the study found is that the one who likes the meat had a 13% extra risk of dying. They're both going to die in the end, but one has got this extra annual risk of dying."
So far, that really adds nothing, other than maybe explaining "hazard ratio" and telling you what "a serving" is, if that jargon was neglected in a news report.  So, continuing:
But what does that extra risk amount to in practice - for these two average people? The paper doesn't say.  Spiegelhalter has been working it out.

"The person who eats more meat is expected to live one year less than the person who doesn't eat so much meat. You'd expect the 40-year-old who does eat the extra meat to live, on average, another 39 years, up to age 79, and the person who doesn't eat so much meat, you'd expect him to live until age 80."

So all those headlines, and it turns out we are talking about whether you might live to age 79 or 80.  Maybe you feel willing to sacrifice that year in order to enjoy a life full of roast beef and steak sandwiches.
Unfortunately, that simplification, though tempting, is not a very useful way to think about this risk.  Indeed, it is quite misleading.  Someone might well make the suggested choice, to sacrifice their 80th year.  But that is not the choice.  The choice includes having a 13% greater chance than your peer of losing your 50th year (and every one thereafter).  Obviously this is still unlikely -- a 13% increase in dying at that age still results in a small increase because it is merely 1.13 times a fairly small risk -- but it might result in different motivation.  Most people are a lot more willing to give up a year of old age than risk the same expected value (statistics talk for "the probability averages out to the same total") of loss across their middle and old age.  Whatever the merits of that preference, it is the predominant preference, so saying "don't over-worry about it -- it is just one fewer years of retirement" understates the real risk.

But the story is not over yet.  The BBC and their consultant go on to propose an error that probably tends toward the other direction to make up for this:
But Spiegelhalter says there is another way to look at the statistics, which might make the issue seem more urgent. That one year off the life of this 40-year-old hypothetical burger eater is equivalent to losing half an hour a day.

"On average, when he's sitting eating his extra burger, that person is losing half an hour of life because of that meal. On average, it's equivalent - scaled up over a lifetime - to smoking two cigarettes a day, which is about half an hour off your life.
That may well make it seem more urgent for some people -- but too much so.  Someone who is urgently trying to succeed in school, launch a business, or be a single parent might rationally consider half an hour a day right now to be incredibly urgent, such that they would gladly borrow it from the later in their life.  (I have certainly had those years.  You?)  The loss of half an hour per day would thus be enormously more daunting than a 13% hazard ratio, let alone losing her potential last year. 

On the other hand, many of us who are pretty secure in our day-to-day performance might choose to trade a half hour per day, or even several hours, for getting to see how the next generations turn out for a few extra years (assuming our healthfulness over the years averages out the same).  So this simplification does not work either, overstating the loss for someone who is intensely busy with important stuff, but perhaps understating it for others.

The real mistake here, I believe, is assuming that this is something that people cannot understand if you tell it straight.  Many percentages require some kind of "professor of public understanding of risk" treatment because the risk is of a magnitude that people cannot understand.  People do not understand how truly small something like "a 54% increase in lifetime risk of esophageal cancer" is, and so resorting to one of these misleading simplifications might be an improvement over "ooh, 54% is a big number! -- that must be bad!".  Even worse are environmental exposure risks that are down in the one-in-a-million range; telling someone, "the total lifetime risk from this adds up to losing a minute and a half off the end of your life" is useful because it transforms "there is a risk!!!!" to the rational "oh, never mind."

But the red meat risk is actually big enough that people can understand the numbers and might legitimately care about the difference.  If you tell someone "based on your demographics, there is an X% chance you will die before age 65, and if you eat one fewer servings of meat per day, it will drop to X/(1.13*X)% those are numbers someone can understand.  They would be in the order of 4% and 4.4%.  Ok, not everyone will be able to understand that, but anyone who cannot probably cannot make much sense out of the suggested equivalencies either.

So, if the BBC and their Cambridge consultant cannot figure out how to sum that up, who can?  Credit to Rob Lyons at Spiked:
The authors claim that 9.3 per cent of deaths in men and 7.6 per cent of deaths in women could be avoided by eating little or no red meat. To put that into some back-of-an-envelope statistical perspective: multiplying that 9.3 per cent by the 20 per cent who actually died [by age 75 during the course of the study] shows that about 1.8 per cent of red-meat eaters would die by the time they were 75 because of their meat-eating habit. Even if that claim were absolutely accurate (and even the authors call it an estimate), would you really give up your favourite foods for decades on the slim possibility of an extra year or two of old age?
Often the answer is "yes", of course, despite the implication of the phrasing.  Indeed, if you are going to change your behavior to try to live longer, as many people try to do, this change may well have the greatest benefit:effort ratio available.  But that aside, if you ask the question this way (and perhaps extend the same calculation to give the numbers for ages 65 and 85 also), you are answering the right question when you make the choice.

19 March 2012

Unhealthful News 207 - Red Bull RIP (but it's still not about the caffeine)

I have five somewhat complicated posts I would really like to write, so naturally I am going to take the easy way out and write a quick and easy one based on today's news.

The inventor of Red Bull (the original Thai concoction, as well as canned phenomenon), Chaleo Yoovidhya, died.  Sorry, no irony about it being sudden cardiac death at an early age -- he lived a full life and sounds like he was generally an impressive guy.

Not so impressive is the press's persistence in talking about his invention as if it were about caffeine.  For example, this NYT article.  At least there is some mention of the what is really different (and perhaps risky) about the drink, though it was subordinated to the caffeine:
...a beverage that was loaded with caffeine, as well as an amino acid called taurine and a carbohydrate called glucuronolactone.
However, this appeared in the third paragraph after caffeine (only) was already highlighted in the first paragraph and was emphasized again later.

Those of you who remember my posts about Four Loko and other alcoholic versions of Red Bull will recall me railing about the proposed pathetic, silly, paranoid, out-of-touch, unscientific prohibitionist proposals (we need a name for the construct "pathetic, silly, paranoid, out-of-touch, unscientific prohibitionist" -- it is rather unwieldy but it comes up so often), which focused on the combination of caffeine and alcohol.  The politicians, commentators, and, yes, the health reporters seemed completely oblivious to the fact that what made these drinks different from any other soda were those other stimulants -- you know, the ones for which we do not have billions of person-years of data about the effects.

The Red Bull obituary author, as is typical, seems to think it is mainly about the caffeine.  Twice as much as in Coke!  Wow, hold on to your socks if you drink that.  It will be like what happens when you tell a waiter "I'll have another Coke".  And you know that once you do that, you will probably finish the evening at an all-night dance party, screaming at the top of your lungs -- unless your heart explodes first.

Or, put another way, that much caffeine is like having a cup of coffee as you sit down at your desk in the morning. 

At least this article gets credit for mentioning the other stimulants, the ones that are the difference between Red Bull and coffee.  NYT obit writers are rather better than most health reporters.  Still, it would have been nice to see something about health other than one throw-away sentence that invokes an old newspaper article that warned about mixing Red Bull with vodka.

Can you imagine an obituary about someone involved with inventing or promoting snus or e-cigarettes not spending paragraphs about the controversy and made-up health claims?  And yet everything we know suggests that Red Bull is probably more hazardous for your health than either of those products.  We will presumably never have definitive epidemiology to support that claim, but the smart money would be on that conclusion if we had a sealed envelope from an omniscient being who could settle the bet.

Of course, if Mr. Chaleo had become the 205th richest man in the world (yes, really) in part by selling an alcoholic version of Red Bull, rather than leaving that innovation to others, you can bet that the danger of that evil product would have been the focus of his obituaries.  I really do hope that taurine and glucuronolactone and other under-studied stimulants are not damaging anyone's cardiovascular system, but I am pessimistic enough that I am going to stick with the well-studied drugs -- i.e., all the other ones that are mentioned in this post.

14 March 2012

Unhealthful News 206 - Does journalism school un-teach people how to count, "Shisha Clampdown" edition

H/t to @cjsnowdon for pointing out the BBC article reporting the oh-so-shocking turn of events, that bans on shisha cafes (hookah bars) have resulted in them going underground.  I mean, who would have ever thought that banning the social component of a popular legal activity might cause people to gather clandestinely instead?  Or that by banning something, the ability to properly regulate it -- e.g., to minimize fire risk -- would vanish?

But what struck me about the article was the claim,
The World Health Organization has advised that a 40-minute session on a waterpipe is the equivalent to the volume of smoke inhaled from at least 100 cigarettes.
Yet 84% of those surveyed thought it was fewer than 10.
Now maybe Sarah Sturdey (the author of the article, who deserves to be shamed by name for this) could have just transcribed that first bit from somewhere without engaging her brain at all -- basic reporter behavior.  But you would think that immediately following it by a radically different belief would cause her to think "wait, do I believe that?"

The WHO claim is pure fiction.  It is an n-th generation telephone game miscopy of some claims that were basically made up from whole cloth, tied to a tiny bit of reality.  Snowdon wrote an extensive report about the apparent provenance of the disinformation, I have written a couple of brief comments about it, and there are plenty of other analyses out there too.  But let's set aside the crazy option of Ms. Sturdey doing some research before writing her article, and just consider what would happen if she had a third-grader's command of math and had thought about what she was writing during a quick trip to the restroom (or rather, I suppose, it would be the loo):
Hmm -- "volume of smoke inhaled".  To smoke 100 cigarettes in 40 minutes would be more than two per minute.  That is much faster than anyone smokes, and indeed would require more total inhaling then someone normally does in that much time, and for every breath to be smoke.  That is close to physically impossible.
She would then have time during her inevitable hand washing -- she is a health reporter after all -- to think:
Smoking even 10 cigarettes in 40 minutes would require about 1/5th of all breaths to be a solid drag.  Smoking that much that fast would be an extreme intense session, whatever was being smoked.    Gee, maybe "those surveyed" are not morons after all.
Notice that this requires no subject matter knowledge about the relative harm of a lung-full from a cigarette as compared to a hookah.  Someone could believe the common claim that hookah smoke is much worse for you (an absurd claim, given what we know about heat-not-burn smoking, and one not supported by any evidence), but still be able to do the simple "volume of smoke inhaled" arithmetic.

Frankly, I am a bit concerned about the 16% who thought that it was typical to smoke a greater volume than 10 cigarettes' worth in 40 minutes.  But I guess that is why society has a place for people who are just really bad with numbers and are willing to make claims about matters they are clueless about, like taking a job as....

[You know, just forget it.  It is too easy a parting shot.  I will just let readers finish the sentence themselves if they want.]

09 March 2012

Unhealthful News 205 - Mother abuse as a solution to child abuse (yes, its about Wisconsin again)

The health science aspect of the story has hardly been mentioned, but it should be.  And besides, how can anyone resist writing about this story, even if in the form of a few disjointed snippets.

The story in question is that Republican Wisconsin state senator Glenn Grothman has proposed a bill that would define being a single mother as a "contributing factor" in child abuse.  As far as I can tell, the main implication of this would be that state anti-child-abuse messaging and such would start delivering this declaration.  There might also be some implications for court cases where "contributing factors" are being considered.  The proposal would fortunately not declare that single motherhood is child abuse, in spite the inevitable misinterpretations to that extent (example).

Given that inevitability, though, you have to wonder what Grothman was thinking.  One might think that this is a publicity ploy.  But he is already notorious in his home state, because of his prominent role on attacks on collective bargaining and the other issues that have turned that state's government into such a mess, so there is not much notoriety to be gained at home.  Maybe he is going for national-level loonyness, angling to be Santorum's VP pick or something.  (This was before Tuesday's primaries that pretty much assured Romney of the nomination.  Of course, simple biology means that Santorum still has a chance:  If I could be a major party's nominee for president if and only if my 64-year-old opponent died in the next few months, I would stick around and take that shot.  Well, I would if I wanted to be president anyway -- what a bad idea that would be, huh?)

As you might guess, the outcry against this is coming from the American political left.  Yet once you get past the naive outcry that misinterprets the proposal, it actually looks remarkably similar to the wars on drugs/tobacco that are pushed by the Democrats and increasingly opposed by the right-wingers

Note: in pointing out that most of the outcry is naive, I am not implying that the outcry against the proposal that was actually made is not justified -- I certainly think it is.  But just because someone is attacking a bad idea does not mean they are right.  Also, I sympathize with those who cannot figure out what is actually being proposed and claims, given what an utter muddle the press coverage has been.  I had to read a half dozen different reports before I started to figure out what was really going on.  On the other hand, without that, I might have missed such gems as "single mothers far outnumber single fathers in the state and in the rest of the country".  (Yes, I realize that the "outnumber", though not the "far", is probably true, since some unsavory men make a disproportionate contribution; also I realize that they almost certainly failed to notice they had meant to say "custodial" but left it out.  Still, it is pretty funny.)

One of the underlying claims used to justify the proposal is certainly true, and has been known for quite a while (despite implications in some of the coverage that this is a new discovery):  A child is an order of magnitude more likely to be physically abused by a male partner that is living with him and his mother (regardless of marital status) as compared to the risk of abuse from the biological father.  No doubt that biological instinct, the socio-demographics of the women in that situation, the types of men that are more willing to enter into that situation, and other factors all contribute to that.

So, by the standards of modern "public health" making a choice that has negative health effects -- no matter how strong the motivations or how difficult the alternative would be -- deserves to be condemned, aggressively "educated" against, stigmatized, and when circumstances are just right, to be actively punished.   If good, honest, healthy, hard working, moral Americans are going to be subsidizing these no-good smokers/unwed mothers/fatties/junkies, then it is only right that we make it clear that they should shape up. 

Remember back when "public health" identified people at high risk of disease and tried to fix the problem rather than fixing the people?  Actually, I don't either.

What makes this worth writing about in this series  is that it is such a perfect case of identifying a problem (child abuse), identifying a condition that is strongly associated and almost certainly does cause some of it (single motherhood), and then trying to address the problem by trying to punish the condition.  Keep in mind that a government banning, discouraging, and condemning are fundamentally the same thing, differing only in the quantity of punishment imposed for not conforming.

Note to politicians/FDA/DEA/police/etc.:  You need to punish people who do things that hurt others but enrich themselves, like armed robbery, banking, or factory farming.  You do not need to punish people for things that hurt themselves (and their immediate families) far more than they affect anyone else -- they are already suffering plenty of incentives to not be in that condition.  Since, in spite of those incentives, they are choosing that condition as the best of their alternatives, perhaps you might want to try to help by creating better alternatives or by improving that condition.  Of course, some people argue that you have no business at all involving yourself in those personal/family matters.  But even if you do not buy that, how the hell do you justify actively trying to make someone's personal situation worse, so that a previously inferior alternative starts to look better for them?

By saying that, though, I risk being as bad as the press coverage of this matter, just looking at some extreme or our-team-vs.-their-team aspect and not delving into the interesting legitimate issues.  There is a scientific literature that suggests that a highly-imperfect (though not disastrous) two-parent family is better for kids than the alternative, which means that its positives incentives can be created for staying together in spite of the imperfections, action might be warranted.  It is also worth working to try to reduce the abuse from (obviously a small minority of) non-biological father figures.  Some serious exploration of where to draw the line to maximize welfare would also be interesting (and I am sure it has been done -- this is just way outside of my areas of great expertise).  Leave it to the press (at least the 20+ reports and blogs I read) to fail to grapple with any of this.

I was also a little disappointed that no one thought to characterize the proposal as the Santorum approach to single motherhood (condemning and punishing it without offering a solution) and suggested that an alternative would be the Romney solution: allowing polygamy to make up for the shortage of available father figures.  So I guess that is up to me.  (And before my oh so many Mormon readers write to me about that, yes I know, the official LDS church no longer supports polygamy etc. etc.)

Finally, in case what I have written about the issues made the political action seem balanced and thereby suggested that Grothman is not toxic, misogynistic, evil, or loony (and that is not an exclusive or), I should mention that looking at his full agenda makes it clear he is trying to punish single parents and their kids.  He all but says that women become single parents to cash in on the sweet deal offered to them by the state (he apparently thinks he is living in Sweden, or at least Massachusetts -- dude, you live in fracking Wisconsin, and what you offer is a sweet deal only in comparison to central Africa and Afghanistan).  He calls for making public-supported housing more cramped, forbidding those on housing assistance from accumulating more than than a trivial amount of material goods (a limit set so low that someone would have a hard time owning a laptop and mobile phone to try earn a living), and denying those on assistance the right to school choice (it really says something when a government official basically says that forcing someone to attend the public schools is a good way to punish them or at least incentivize them to get off of assistance).  He also has apparently fought the notion that the logic of his position calls for making contraception more available, and takes a Limbaugh-esque position on the matter.

I notice that most every article on the topic notes, without further comment, that Grothman, who appears to be about 55, has never been married or had kids.  This is in spite of his clear commitment to family values (*cough*).  Hmmmmm?  It is too bad that beating up on single mothers is not an "outable" offense.  (For those who do not know, some gay advocacy groups keep files on which politicians and officials are in the closet, and makes clear that such choice will be respected -- so long as they do not take official actions that are actively harmful to GLBT community.)

Oh, wait:  This would apply to all lesbian mothers.  Oh, this could be fun.

07 March 2012

PBHL647 Occupational and Environ Epi (Drexel Univ), CVP Guest Lecture, 13mar2012

[As is probably clear from the title, the primary purpose of this post is as a pre-read for a class.  However, I have composed it so that my regular readers might also find it interesting/useful/entertaining to read.]

Overview:  Epidemiology exists almost entirely to aid in decision making.  Other sciences seek timeless knowledge or to fulfill deep curiosity, but almost every result in epidemiology varies wildly across popular and circumstances, and is frankly not all that inherently interesting.  Yet epidemiologic analysis and education typically ignore most of what should be considered when making a decision.  This is a very (very! -- I would normally spend 30 class hours on this, not 2) brief skate through the considerations that need to be part of any policy recommendation or decision that is informed by epidemiology.  The two breakout session and debriefings will be about half an hour each, and the other points will divide the remaining time.

1. If you only come away from this with one lesson, it should be:  Any statement in a research paper (or a press release, or anywhere else) that paraphrases to,
This study demonstrates that E causes D, and therefore we should....
is wrong.   No example reading for this; you have seen it hundreds of times.

Perhaps even worse is the phrase "unintended consequences", as it is typically used with "might exist" phrasing.  Together, such statements call into question the intellectual integrity of not just those who write them, but any field in which they are common in the journals.

2. Every policy, proposed or existing, has costs (aka "unintended consequences").  Almost every policy has benefits (ideally that would also be "every", but there are some really stupid policies out there).  "Should" statements require a consideration of all of those costs and benefits, as well as the ethical standards and quantification needed to trade them off.  Generally, about 95% of that is missing from epidemiology papers that conclude with "...should...".

3. First group exercise breakout:  List the important costs and benefits that should be considered when making policies related to the background readings: installing IWTs; promoting THR; giving the nicotine "vaccine" to teenagers (optional if you have time: other anti-smoking measures touted to the press by Gartner et al., at the end of the popular press article).   Just list them -- do not attempt to compare or quantify.  Hint: costs and benefits are just words that both mean "resulting changes in the world that people care about", and differ only in sign; figuring out the sign for a particular change is useful, but identifying what changes is the first step.

Background readings:
Note: you are reading this to gain a familiarity with the issues (i.e., proposals, costs, benefits, ethical concerns, etc.) involved in these topics.  You are not trying to fully understand the details (of the two research papers -- the rest are pretty casual reading anyway); for purposes of the class, you can ignore the model details in the nicotine paper and epistemic arguments in the IWT paper.

(a) Industrial Wind Turbines
(b) Anti-smoking methods
  • FAQ re concept of Tobacco Harm Reduction (a bit outdated and simple, but useful if you have never even heard of the concept)
  • Gartner et al. (2012) Would vaccination against nicotine be a cost-effective way to prevent smoking uptake in adolescents?
  • What Gartner said to the popular press (aside: it is always an interesting exercise to observe how this differs from what the paper actually looked at)
(c) A bit of each

4. A ridiculously brief discussion of public health policy ethical considerations (but probably more than you will get in your public health ethics class):  What costs and benefits should be considered when making a policy recommendation?  What other ethical concerns should also be considered (hint: think about the non-childish bit of the American "pledge of allegiance", the last few words).

5. How can we deal with difficult-to-compare and completely incommensurate considerations:  money spent vs. lives saved; present vs. future; rights vs. consequences; the needs of the many vs. the needs of the few?

6. Second group exercise breakout:  Pick one of the policy decisions that is addressed in the readings and sketch out (very brief and abbreviated, of course) what you would want to consider in making a decision or recommendation.  Identify quantifiable factors you would want to quantify (using epidemiology or other methods).  Identify tradeoffs that are not merely matters of adding-up that need to be considered (extra if you have time: Discuss how you might try to deal with one or more of the tough tradeoffs).