Monthly Archives: March 2011

(1) In UN81 I commented on the American Academy of Pediatrics’ new recommendation that babies should ride in backward-facing car seats until a later age than one year (which is good advice) in which they tried to claim that there was no benefit to having the kid facing forward (which was typical AAP behavior:  pretend that a policy has no costs rather than go to the trouble to argue that the benefits warrant the costs).  Well, being a good scientist, I gathered some additional empirical evidence and can report that at least some babies under one year of age love to ride facing forward.  It does not change the fact that the recommendation seems good, but it is further evidence that AAP is completely incompetent at policy analysis (and ignorant about parents and children) even when they get the policy recommendation right.

(2) According to an email I got from another baby advocacy organization, planningfamily.com (which is not actually a nutcase group, though it kind of sounds like it, doesn’t it?),

On average, children two to five years old spend 32 hours a week in front of a TV and they will have watched an average of 8,000 murders before they finish elementary school.

The first problem with that is, of course, that young children watch TV for 4.5 hours per day.  But setting aside that madness, I have to wonder why no one is out there claiming that these portrayals of murder’s are causing half of the horrible number of murders in American.  After all, there must be some anti-violence-in-entertainment activist who is as nutty as Stanton Glantz, and I would bet that the evidence comes closer to supporting this claim than Glantz’s claim that smoking portrayed in movies causes half of all smoking.

Oh, and I have to say that the 8000 number has got to be more-or-less made up and obviously arbitrary (though at least I give them credit for rounding their fake number rather than acting like most health activists and reporters and saying 8132.5 – you have to like them for that).  Does it count the Coyote (of Road Runner fame)?  If so, how many times per episode?  How about if they just find the body on CSI?  How about the 1.97 billion people on Alderaan?  (That is a good piece of bar trivia, by the way.  The movie with among the largest number of homicides – surpassed only by a few “aliens invade Earth c.2000 and kill almost everyone” flicks – is the kid friendly Star Wars that most of those kids will see at least once, pretty much burying that 8000 number.)

I thought it was bad when health reporters seemed to do nothing more sophisticated than a Google search about the topic they were writing about.  Perhaps asking for even that standard would be a good start.

As discussed in more detail by Chris Snowdon, the BBC reported the “news” about an e-cigarette user who died (it happens) of lung disease and his medic claimed that it was due to the e-cigarettes rather than, say, his former heavy smoking.  It is, of course, possible that e-cigarettes could cause lung disease (though not very likely – not only are the chemicals in e-cigarette liquid unlikely to cause lung disease based on what we know, but not much actually reaches the lungs).  But when a reporter says the following, it is pretty clear he did not even do the Google search: 

[E-cigarettes] contain a cartridge of liquid nicotine

(that would indeed be bad – it would be a contact poison!)

and the product the decedent used

 seemed to involve a mixture of nicotine and some oil

(there are very tiny bits of flavoring oils in some products, but a basic knowledge of e-cigarettes or chemistry would reveal that nicotine+oil could not have been the recipe)

and,

there’s no systematic research assessing the overall safety of inhaling these chemicals deep into the lungs over an extended period

(which is fairly obviously true, since people do not actually inhale the chemicals deep into the lungs – not the ones that are actually in e-cigarettes, let alone the made up oil that appeared in this story).

If the reporter had decided to spend a second five minutes learning about his topic (after the first five minutes it would have taken to gain a basic literacy about e-cigarettes), he would have discovered what Snowdon, in his role as unpaid investigative reporter not employed by the BBC, reported:  That the medic in question is an activist anti-nicotine extremist who was presumably looking for an excuse to attack tobacco harm reduction.  Hmm, should that have caused a reporter to question what he was reporting, or at least be worth mentioning?  Nah, if you do something other than just transcribe allegations, it takes work and then you would not be able to spend most of the day, after submitting your story, working on your lousy novel on the company’s time.

I honestly do not have anything more to add to what Chris and others have already mentioned about how dumb the analysis in this report was.  I just thought this deserved to be highlighted not just as anti-tobacco/nicotine propaganda disguised as science, but also as Unhealthful News.

There is a lot to say about how lame most statements about “conflict of interest are”.  To summarize most of what needs to be said:  (1) COIs among researchers are real and matter.  (2) Most (not all) of the time when someone screams “he has a conflict of interest!” it represents a political ploy to try to advance a particular agenda rather than a genuine concern about COI.  (3) The conflict of interests generally identified are not really the ones that matter; often they are not really even COIs, and typically they ignore most of the most important COIS.   I have written a lot more about these points in the past and will likely do so in the future.  For today, I will just comment specifically on the problem definition in an Archives of Internal Medicine article that was reported in the medical news today.

The abstract reports that the study totaled up the number of what they called conflicts of interest:

Using disclosure lists, we cataloged COIs for each participant as receiving a research grant, being on a speaker’s bureau and/or receiving honoraria, owning stock, or being a consultant or member of an advisory board.

They looked at cardiology guidelines advisory boards, though what amounts to a COI there is basically the same as what is a COI for reporting research results.  They concluded that “Fifty-six percent of the 498 individuals reported a COI”. 

Let’s think about that list.

Owning a substantial amount of stock in a company with an interest in a study’s result or board’s recommendation is obviously a glaring financial conflict of interest, perhaps second only to owning intellectual property whose value will change dramatically based on those results.  Being on a speaker’s bureau tends to mean a continuing flow of outrageous fees for repeating some party line, which would tend to have the same pull as owning a lot of stock.  Someone’s belief in that party line my have been come to honestly, but the financial incentive to not waver is a strong interest.  However, “receiving honoraria” can mean anything from basically the same as the speakers bureau concept to having gotten a reasonable compensation for taking the time to go to a meeting and present one’s honest views.  The latter will have little or no influence on someone’s opinion and create little or no incentive.

Being a consultant or advisor is also pretty tricky to interpret.  This can be anything from working as a corporate hired hack, writing whatever the corporation asks to support filings, litigation, etc.  Or it could mean that you are the best in your field and scrupulously honest, and so corporations want your honest opinion.  Or anything in between. 

Similarly, receiving a research grant can mean doing funder-directed research (typical for government grants, for example) with an implicit promise about what the results will be (often offered in grant proposals for those funder-directed projects), or giving the funder the right to suppress the result if they do not like it (common for some industries’ funding).  Those actually do not cause a conflict of interest:  They are dishonest and/or bad scientific conduct, but only when there is a hope of future funding is there a COI (and that is regardless of whether there was past funding).  Otherwise there is no remaining interest once the funding is in place (unless the funder has the right to take it away if they do not like what the researcher is doing; that is a much worse, but slightly different, problem).  One of my colleagues insists that out of consideration for this, he will take grant money from anyone, but never more than once.  That way, there is no way that hoping to get more funding from the particular organization can influence the ongoing research.

Alternatively, a research grant can be largely free of COI, consisting of designing investigator-initiated projects and then asking for money to support them, not changing anything to please the funder.  Or anything in between.

These observations barely scratch the surface of the topic, but they should be sufficient to show that simply identifying one of these phenomena tells us little, let alone arbitrarily adding them up.  The authors of the article seem to want to make a big deal about how some members of the boards do not have any of these COIs, implying that the boards should be made entirely of such individuals.  But their list of types of COIs ignore the ones (political preferences) that are next most important behind a chance to make a personal fortune.  Moreover, ensuring that a board has no apparent COI with respect to an issue is an easy matter of picking members who have never said anything important about the subject or had any significant involvement.  After all, do you really want your experts to have done so little work on a topic that they have never received a grant or consulting fee?  Not too expert, I suspect.

Oh, wait.  It turns out that the authors are interested only in grants, honoraria, etc. that come from industry sources.  They do not bother to mention this in the abstract, apparently believing that only industry money can create COI.  That is an incredibly naive notion of COI.  They do not tell us “we are only concerned here with the COIs that result from industry ties, not those resulting from government grants, advocacy group funding or involvement or even being employed by an interest group, personal inventions, pet theories, and many other sources of COI”.  That would be a very partial analysis, but at least it would be an honest portray of what it was.  Rather than admitting that, however, the authors try to imply that one specific source of COI is all of COI.

The people with the most expertise and interest in a topic inevitably have some of the listed COIs and others too, unless they are extremely anti-social.  Indeed, for many medical or health matters, the greatest experts, who could contribute the most to an advisory board, work for an interested industry.  Why not include them as panelists if they are willing?  Better still, include several, whose employers have differing interests to get the crucible of scientific inquiry boiling.  They might tell us something useful, and if they simply demand actions that are in their employer’s interest without justification, there is no obligation to pay attention to what they say.  A good open fight among the most invested parties is generally a good way to figure things out, so long as those evaluating the results have the competence to recognize which arguments are more compelling (and if they do not, they should start reading my Sunday posts).