Monthly Archives: August 2010

UCLA School of Public Health votes to fire Jim Enstrom

The faculty at UCLA School of Public Health apparently voted to fire Prof. James Enstrom.  I am not quite sure what the full story is yet, but those writing about it seem to think it is enforceable (however, I can tell you from experience that there are people who think they can subvert academic freedom and fire a faculty member because they do not like what he writes, but discover they actually cannot).

The claim is that Enstrom’s work was unsound, which I can assure you is not the case.  Besides, anyone who pays attention can see that doing the worst imaginable junk science will not get you fired from a school of public health.  This was obviously political.  Enstrom’s recent foray into controversy had to do with outdoor air pollution, mostly associated with diesel engines (read the above link – it is quite a story).  It seems unlikely, however, that anti-diesel people have the combination of firepower, egocentrism, and lack of ethics to bring about the firing of a senior academic researcher.  While they undoubtedly played a part, I have to assume that this was substantially the long-sought revenge of the anti-tobacco extremists for him daring to publish good research that suggests that any health effects of second-hand smoke are trivial.  He and I have both written about how his story epitomizes the anti-scientific attitude of the anti-tobacco movement and of public health researchers more generally.  Universities and real academic departments consistently stand up for academic freedom and free scientific inquiry, and favor good research over bad, but public health programs have generally descended – in scientific quality and ethics – to the point where they might as well be the “health promotion” people at county health departments, or Mad Men.

One result of this action, I predict, is that it will become impossible to keep up the narrative that Republicans or the right in America are the ones at war with good science.  Whatever you might believe about that generalization’s accuracy (it certainly never applied to public health where the junk science tends to come from the left), it is likely to be replaced by the story that, “under Obama, professors who dare challenge the liberal propaganda get fired”.  I assume that enough Chamber of Commerce types follow Enstrom’s work that they will not overlook this event or its symbolic importance.  It would be quite interesting to see UCLA or schools of public health in general get the full Fox News treatment.

I will follow the story, try to talk to Jim, and update this post.

Update (17 Aug – morning):  The original ACSH email that broke this news (i.e., that went international the Bakersfield newspaper article linked above) now has a URL.  Ben linked to it in his comment, but here it is again.  Also, Chris Snowdon goes into more detail about why the information reported in the Bakersfield article is rather a smoking gun about this being more about the tobacco research than Enstrom’s current controversies.  I will be talking to Enstrom as soon as it is morning in California.  I will report more if I learn anything I can repeat.

Update (17 Aug – afternoon) A new article appeared in the Sacramento newspaper which does not even mention Enstrom’s previous work on tobacco.  It attributes the vendetta against him entirely to him having a non-politically-correct position on diesel exhaust alone.  This does not mean that is necessarily right, of course — note that Beate Ritz, the only one involved in the proceedings against Enstrom who did not refuse to offer any explanation, cited only the tobacco research.  But it still might mean that I am wrong and California is so far gone down the anti-science road that scientific opinions that in multiple areas (not just tobacco and the usual hot-buttons), including the relative arcane study of particulate matter pollution, disagreeing with the political power will arouse censorship attacks.

Regarding Prof. Ritz, Enstrom mentioned that she is the one person involved with the purge who has the skills and potential for objectivity to weigh in on the research.  I am attempting to reach her for comment through my own connections.  She refused to respond to Enstrom directly and he asked me what I could find out.  Unfortunately, as Geoffrey Kabat forcefully noted (scroll down)  in a comment on the Bakersfield article, she apparently did not attempt to play that role.  I will report her comments or her refusal to talk.

As for my conversation with Jim, he was not ready to go on the record with much information yet.  But given the questions he asked me about my experience, it is pretty clear that this was every bit the blindside that some of the comments about it portrayed.  He did not know this was coming and has literally a matter of days to figure out how to appeal it.  He mentioned the connections to the usual suspects in tobacco (Glantz, ACS), but was more interested in discussing the context of his recent work, which seems to have a similar collection of dishonest actors.  He offered the phrase “total hypocrites and just plain bad scientists” (this was generic about the type of people he is dealing with — he was not referring to anyone specifically).

He noted, in particular, the experience of the small and medium businesses (in transport, construction, etc.), getting slammed with these new health regulations — based on debatable science — and having no idea what to do.  There are reports of the guys who run these firms just despairing and confused, trying to deal with the situation.  My take on this is that even if the science were indisputable, this is clearly a horrible regulatory process, that disregards all the basic principles of ethics, transparency, due process, and incrementalism.  The targets of the diesel regulations are not big pharma companies or some other entities that are used to dealing with arbitrary regulatory decisions and adjusting to them (and fighting them effectively if so desired).  If there were a viable transition strategy in place, one that did not just heap the costs onto existing businesses and drive business to other jurisdictions, and the costs of transition were thus fully recognized, I have a feeling that genuine doubts about the science would be taken much more seriously.  This seems to be a classic case of deciding that the way people have been doing things for decades is wrong, and thus any suffering they experience as a result of changing the rules should be counted as just dessert, a benefit of holy vengeance, not the real cost that it is.

Enstrom noted to me that he has been forced to sacrifice doing new epidemiologic research in order to be a watchdog for good government.  Since good epidemiology gets ignored when it gets the “wrong” result, this is probably an efficient choice, and an impressively altruistic one, though the repercussions are pretty awful.

Update (18 Aug – very early a.m.)  I exchanged messages with Beate Ritz through a mutual friend.  She declined my invitation to correct or clarify anything she was quoted as saying, or to explain to the world or to Enstrom what she knows of what happened.  I get the impression that she did not actually play any substantive role in this matter and wants her association with it to just go away.  She is not in the same department (i.e., was not part of the vote) and does not play any role in the decision making.  However, if it is really the case that she was not asked to weigh in it would mean that members of the faculty who (like her and just a few others) were best qualified to assess the substance of Enstrom’s work that was supposedly the basis for the attack were not asked to do so.

Chris Snowdon put a face to the irony of the claim that the basis for censoring Enstrom was that he drew conclusions beyond the results of his research.  I notice that he, like I, could not really find words to follow that claim.  Sometimes actually adding a punchline to a joke simply cannot be as funny as leaving the set-up hanging.

On a more serious note, I wonder if U.S. whistle-blower protection laws cover this matter.  Enstrom clearly blew the whistle on some serious ethics violations by one arm of the state of California, and his employer is another arm of the state.  And then, there is that whole free speech thing.  I cannot begin to guess what the law actually says about such matters, but it would be interesting to find out what federal authority over the states (laws created to try to protect black people from oppression by racist local governments) might apply here.

Update (18 Aug – afternoon) To fully understand the ironic (to put it kindly) ramifications of how the firing was justified, and some of the politics of the California air pollution authorities, be sure to read Mike Siegel’s analysis.

A new newspaper article reports that 22 members of California’s legislature have written a letter demanding an accounting by UCLA officials.

There is a rumor (I cannot confirm) that the story has been picked up on national talk radio.  Perhaps Fox News is indeed right around the corner.

(22 Aug) I have now continued this analysis here.

FDA is behaving normally (unfortunately)

There has been much discussion about whether FDA’s regulation of tobacco will go down a reasonable and sensible path, and whether decisions will be based on whether they improve the human condition.  Little to none of this discussion has paid any attention to the political science issues of institutional culture that strongly suggest an answer.

This probably passed below most everyone’s notice (because FDA are not yet very good at being activists), but the FDA tobacco regulators recently tried to launch an activist campaign against no-longer-called-light cigarettes.  This is significant not because it had any impact, but because it is non-science-based activism of the sort that we and others predicted would occur if FDA took on lifestyle nicotine products, leading them beyond their competence and lowering the credibility of the entire organization to that of political activists rather than trusted scientists.  (Our comments about this during the FDA comment period were reprinted here and in Tobacco Harm Reduction 2010.)  FDA’s activist campaign dovetails with overtly activist organizations who attacked the cigarette companies for rebranding their formerly “light”, “mild”, etc. brands with new recognizable packaging that removed the banned words (just what else were they supposed to do???).

If I wanted to write a two paragraph post, I could just notice that FDA seems to be at risk of smoking their credibility as scientists to pursue an activist agenda.  But there is more to it.

The problem is not that this particular activist message is a bad one.  “There is no safe cigarette” is clearly literally true and, moreover, unlike “smokeless tobacco is not a safe alternative to smoking”, it is actually honest.  (The latter quote is a clear case of substituting truth for honesty, a lie by any realistic measure, as I have written about extensively.)  But the message is clearly a departure from regulation into social engineering.  FDA cannot be so out of touch as to think that anyone still believes there is such thing as a safe cigarette, so this is not the type of factual warning that is FDA’s institutional competence and designated role.  The epitome of activism behavior was FDA’s junk-science attack on e-cigarettes, but the latest foray into activism — clearly institutionalized and planned — shows that the former was not an isolated fit of pique.

FDA’s history of pharma regulation shows that they (a combination of government employees and the outside consultants/advisors they choose and then yield most decisions to) is already quite bad at appropriately assessing tradeoffs between medically-defined risks and other human preferences.  They do fairly well with questions of whether a life-saving disease treatment does more harm than good, but tend to fall down when the benefit is something other than saving lives.  To illustrate with just the most recent failure to understand that there is life beyond mere longevity, FDA recently prohibited the introduction of a drug to combat low female sex drive, based on the evidence that it sometimes caused dizziness and other passing minor ailments, and does not provide much benefit to many users.  Their panel said that the benefits did not justify the costs.  For whom?  This was not a question of hidden health costs or a ticking bomb — the benefits and the costs were both immediately evident to the consumer, who could thus make her own choice.  If she is one of the ones with unpleasant side effects or for whom it does not work, she does not need to take it twice — no serious harm done; if it works for her, she can figure that out too.  But, no.  FDA decision makers decided, in effect, that they personally would not choose to take the drug and so therefore no one should be allowed to see if it works out for them.  FDA’s institutional culture does not really approve of letting people choose tradeoffs for themselves.

To counteract this narrowness of vision, getting Viagra approved required a junk science study that “showed” that the average man would accept a 1/3 chance of dying immediately rather than suffer from complete erectile disfunction.  This allowed the message to be not just “lots of people really want this a lot” (which FDA is not good at understanding) but “there is a big loss in quality adjusted life years”, just like there is with premature death.  And all it took to do this was an utterly absurd quantitative claim.  As I always told my classes when I used that study as a teaching example, if that is really true then most men’s lives are either far less interesting than mine (because they would so easily give them up) or far more interesting than mine (because, well….).

Another example that I used for teaching was the ban of the decongestant phenylpropanolamine (PPA) based on some sketchy evidence that maybe it caused an occasional stroke.  FDA’s position was that millions of people getting relief from cold symptoms was of no consequence and since there was suspicion (little more) that a few users might die from it, this trumped all of the benefits.  Never mind that it was easy to show that even if the strokes were occurring at the rate claimed (which seemed very unlikely), the benefits of PPA were enormously greater than the costs.  If FDA had the authority and followed their script, caffeine, rock climbing, and compact cars would be banned, and non-procreative sex would be at serious risk; alcohol might be allowed, but only because it protects against heart attack.

Of course, you might respond that FDA would not follow the usual script when it came to rock climbing.  But therein lies the problem.  Scripts matter.  Habits matter.  Put the police in charge of enforcing drug laws and they arrest and jail a lot of people because that is what they know how to do.  Put the military in charge of nation building and they end up killing a lot of people and creating more rebels than they actually get rid of; it is not that there is something wrong with the military, it is just that they are very good at some things, but nurturing institutions is not one of them.

So, the FDA follows their script.  People’s preferences for anything other than longevity are ignored, and utterly absurd science carries the day so long as it conforms to a set of stylized rules.  If the latter makes it sound like a sporting competition to you, then you understand.  This is the game the FDA plays.

But as odd as it may seem, this is not usually such a bad system.  FDA makes policy decisions in a way that violates any accepted ethical standard (note that a lot of what gets called “ethics” in the discussion of health has little to do with real ethics, but that is another story).  But FDA has evolved in a way, to particular narrow purpose and narrow-minded action, that means that this is not as wasteful of human welfare as it might be.  It would be crazy to design an agency that plays by FDA’s rules, but it is actually pretty much impossible to create a well-functioning large institution by design.  The beauty of institutional evolution is that incremental changes yield something good that never could have been designed from scratch.  If FDA’s methods were bad at regulating new medicines and their other charges, they would have been changed due to pressure, but such evolutionary pressure does not exist to create methods that would be good for regulating other products.  This nice evolution only works, however, when changes are kept incremental, which is why political science advice tends to favor incremental changes over utopian plans.  Massive top-down changes are likely to create havoc, such as putting this narrow way of doing things in charge of something that does not fit the mold.

In the case of tobacco regulation, it is easy to see how that can play out.  FDA’s institutional failure to recognize human wants beyond longevity is a very bad sign for FDA’s ability to regulate tobacco.  Tobacco/nicotine is a product whose costs include life-threatening disease but whose benefits are psychological and lifestyle.  But it gets worse:  FDA is used to having police powers and being obeyed, and it is easy to predict the same frustration that leads cops and armies to lash out at people who will not do what they are told.  When FDA called for the removal of PPA, pharmacies locked their doors and started pulling the many popular products containing it off the shelves as if they were poisoned.  So when people did not just do what The Authorities wanted them to do — to magically forget which new brands were their old preferred “light” cigarettes and stop buying them — FDA launched an astroturf campaign to fight people’s choice.  The e-cigarette junk science study was clearly a case of lashing out:  FDA is used to unquestioned police powers, and when someone dared challenge them, FDA lashed back with a blatant propaganda campaign (for those who do not know, the two brands of e-cigarettes FDA tested and attacked were made by the companies that were suing FDA for overstepping its authority, and while the study results showed nothing relevant to health risk, they were touted as showing that e-cigarettes are as unhealthy as smoking).  You can see where this is going.

And it gets one step worse than that.  You might argue that since the FDA tobacco unit was created from scratch, the FDA culture would be weakened by new hires.  The problem is that not only is this unlikely to eliminate an institutional culture, but also that most people interested in working there are part of the anti-tobacco industry which has many of those same ethical failings of the FDA script (when it is applied to anything other than disease treatment), only more so.  The dominant attitude among those activists is to ignore all ethical concerns, causing whatever harm is necessary to support the anti-tobacco extremist goal of eliminating all self-administration of nicotine regardless of other concerns.  (No, that is not hyperbole — they basically say that themselves, with pride.)

So where does that leave us?  An institution that is used to being obeyed, and that does not function well in a realm where that does not happen, and that primarily measures life years saved and dollars spent and ignores most other human desires.  Merge in a political movement that has been itching for more police powers and tends toward utopian (i.e., overly optimistic fascism) extremism.  I am not sure whether the better metaphor is The Drug War or Afghanistan.  Either way, I fear that even most of the pessimists have not predicted just where this is going to end up.