Monthly Archives: December 2011

Unhealthful News 196 – Reports on censoring bird flu research lack realistic context

A lot has been written already about the recent request(?) by the US government for a couple of journals and researchers to censor the discovery of how the “bird flu” virus (influenza H5N1) can be changed to allow airborne transmission (it is currently believed that the only transmission vector to humans is contact with birds) and related research.  The press has reported this being a case of “biosecurity” (which Phil Alcabes appropriately ridicules) concerns about an incredibly deadly flu, pitted against the problem of censorship and losing the free exchange of valuable scientific information.  The thing is that almost none of these exciting motifs accurately describes the situation.

First is a point I have written about at greater length before, so I will offer just an abbreviated version here:  People who write about infectious diseases, including most of the ostensible experts, never seem to learn that when a novel disease appears, there is a huge bias toward identifying only people who have gotten extremely sick from it.  After all, who shows up in a hospital to get diagnosed, thus leading to the discovery of a brand new or rare disease?  This is even more true in extremely poor populations where medical care is mostly limited to when someone is on the verge of death.  So the observation that half the people who get the disease die from it (a common claim in the hype about H5N1 right now) really means that only half the people die from it among those who are treated after they are on the verge of dying from it, when combined with those diagnosed on autopsy who could not afford any medical care.

How many others got/have the virus, having suffered only an everyday bout of illness, or perhaps nothing at all?  No one knows.  Only the rarest of nasty diseases would not have 100 like that for every one that went to the hospital, and 1000 or 10,000 is quite plausible.  A million is possible.  So is bird flu an utter terror, that is deadlier than contracting Ebola, or is it a fairly typical disease of its kind that kills perhaps as many as one out of every 100,000 that get it?  And for that matter, might it already be airborne in the wild, but just not virulent enough to notice?  We really do not know.

On top of that, there is no evidence that there are any significant and capable international terrorists who are waiting to use information like this.  (Indeed, the place to end the previous sentence might be before the qualifying phrase, “who…”.)  There are lots of ways to engage in untargeted random destruction, and no one seems to be employing them.

So, the possibly low risk might argue for protecting the tremendous value of communicating the new discoveries and avoiding the horror of censorship.  Except that avoiding publishing the details represents be almost no loss of useful communication or genuine censorship.  I would guess that there are a couple of hundred people in the world who could make good use of the information that is being kept secret, and I would bet that most of them will still have access to it if they want.  In a matter of years, technology will evolve so that more people could make use of that information somehow, but by then it will inevitably be common knowledge.

As for censorship, this qualifies in only the most technical sense.  Censorship matters when it results in suppression of information, not the mere suppression of someone’s words.  Everyone is being told the publicly relevant information, and indeed the dispute has called far more attention to that information than it otherwise would have gotten.  It is government suppression of useful health science when, for example, the CDC quietly hides relevant data it has about the benefits of tobacco harm reduction, as they do, and people are widely misled.  But if they reported the general result or the data and merely refused to tell us some highly technical detail about how they did the research, that would be a welcome relief from the self-censorship.

Or consider an analogy:  It was suppression of the worst kind that the US military prevented any reporting about a gunship crew gleefully killing a group of civilians in Iraq until Bradley Manning (or if not him, whatever hero actually did it) leaked the video.  It would not have been censorship in any important sense of the word if the they had allowed the incident to be reported, but prevented publication of some technical details about the weapons used that could benefit an actual enemy.  All the useful information would be out there, and the withholding would have been explicit and purposeful.

So what we really have is a case of withholding information that probably is no threat, and that will inevitably be public before long anyway, but that is probably actually still available to those who really need it, and is a situation where preventing the technical information from being made public does not constitute the kind of censorship we should fear.  Yawn.  Now I forget why this seemed important to write about.

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Unhealthful News 195 – "News" about effects of alcohol and the HPV vaccine: misleading readers while accurately reporting the science

Two stories in this morning’s New York Times inspired me to get back to Unhealthful News blogging.  They are both great examples of bad reporting that takes something that is obviously true and manages to report it in a way that communicates something that is false, and not by misrepresenting the results.  One story offered the headline, “Prevention: Beer and Martinis: As Healthy as Wine?” and the other, “Patterns: HPV Vaccine Is Not Linked to Promiscuity“.  They were both authored by Nicholas Bakalar.

So, you might ask, what is misleading about reporting the following?

Now an analysis in the January issue of The Journal of Studies on Alcohol and Drugs suggests that martinis and beer may be just as effective at extending life [as wine]. Wine may have appeared to be better only because the people who choose it are generally healthier.

and

A survey has found that girls ages 15 to 19 who are vaccinated against human papillomavirus, or HPV, are no more likely to be sexually active or to have more partners than unvaccinated girls.

The answer is that there is absolutely nothing misleading about these reports.  What is terribly misleading is the implication that there was ever any question whatsoever that these claims were true.

The fact that alcohol, without regard to which of its many delightful forms it is served in, is beneficial has been well-established for about two decades.  In fact, it was never the case that the evidence supported the claim that wine or red wine was more beneficial.  There was, once upon a time, a hypothesis that red wine had some particular properties, offered as a possible explanation for the “French paradox” in which it was observed that the French were much healthier than their macronutrient mix would suggest they ought to be.  (The real explanations:  Fats, particularly milk fat, are not actually worse for you than carbohydrates as was believed for a while; the French eat reasonable portions, slowly, and mostly whole foods; and they are less often physically inert compared to their Anglo peers.)

The original research that discovered that alcohol was beneficial (reducing cardiovascular risk) was partially inspired by the that French non-paradox, but as soon as the epidemiology started coming in, it became clear that there was no measurable difference in effect between different sources of alcohol.  A few bad studies, those that failed to control for the fact that in the USA wine drinkers tend to eat and otherwise behave healthier, sometimes did show an advantage for wine.  But it was always clear that this was the confounding.  More generally, there was the confirmation bias in which the studies that showed the opposite (random noise happens) were ignored.  Sometimes in the history of a scientific discovery, there is a moment where the best evidence of the day strongly supports a claim that later turns out to not be true.  This is not one of those cases.

For the case of the HPV vaccine, there was never any doubt that the vaccine would improve the benefit-cost tradeoff for having sex, but the effect would be slight.  Very slight.  When compared to the many huge benefits and costs of choosing to have sex, the very small risk of cervical cancer thirty years in the future and the even smaller though potentially sooner risk of oral cancer are absolutely minuscule.  This is especially so when we consider that adolescents are not exactly focused on the distant future when making decisions, and that the more proximate oral cancer risk is pretty much never mentioned in the pro-vaccine information (if people realize that most non-geriatric oral cancer seems to be caused HPV, it will be difficult to blame it on smokeless tobacco, and the “public health” people do not want to risk that).

So, the vaccine ought to create a tiny increase in someone’s probability of choosing to have sex with more partners, but nothing that could possibly be picked up in the data from a survey of 1243 girls/women.  And that is even if there was not the huge confounding problem due to girls who get the vaccine coming from very different families from those who do not.  The effect would have to be more than a 5% change in probability to have any hope at all of showing up in a study that small (even with impossibly perfect control for confounding).  The availability of contraception and HIV prevention (i.e., condoms) ought to make that big a difference, but it would be irrational of girls to react to that extent to the HPV prevention (and irrational in the opposite direction from normal teenage irrationality).

So why were these study results portrayed as surprising discoveries, and why is it so non-surprising that Bakalar and the press more generally reported them this way?  Because the press, science and otherwise, can be counted on to carry water for well-funded extremist liars, reporting their claims as if they had merit and never calling bullshit.  Usually the dishonest extremism comes from what gets called the political right wing, like the economic claims of the Republican party or pseudo-Christians who oppose the HPV vaccine because they want to punish people for having sex.  But what usually is thought of as the political left, “public health” people, can be equally extremist and dishonest.  In this case the pseudo-Christians and the pseudo-public-health people have basically the same goal:  To mislead people, and thereby keep their health risks greater, in order to support an abstinence-only agenda.

The good news is that manipulating people with lies like those is really tricky, and most of the prohibitionists are just not that smart.  The playing up of red wine gave wine makers license (almost literally) to make health claims, promoting the category, without preventing knowledgable people from learning that other drinks are healthy too.  When it became clear from Swedish studies that snus caused no measurable cancer risk, American anti-tobacco extremists tried to claim that this did not apply to similar American products, though the evidence suggested no difference.  Finally the marketers realized they could not overcome that propaganda, so they just started selling “snus” in America.  Truth that improves the public’s health will usually eventually win out over its opponent in “public health”.

Unhealthful News 194 – Public health terrorism, Pennsylvania date rape edition

In my last post I wrote about (and plan to revisit) a pseudo-public-health campaign to vilify the common practice of parents co-sleeping with their infants, which might cause a net increase in risk when done properly, but might not, and the net effect is clearly very close to zero.  I pointed out that this type of destructive extremist behavior by nanny-state actors seems to trace to anti-tobacco extremism emerging, since the 1990s, as the tail that wags the dog of public health.

Chris Snowdon recently posted a scathing takedown of an extreme (which is not to say rare) commentary that argued that since society has accepted policies that deny people the freedom to use tobacco, therefore government should take the same action with regard to other health-affecting choices.  Not every health affecting choice, of course — just the ones that a certain ilk of people does not approve of.  As Snowdon has argued at length, this is one of the dangers of allowing an exceptional set of actions (government restrictions on free choice) to deal with an “exceptional” problem (the high risk from smoking).  Granting such exceptions to the ethical standards of free Western society almost inevitably creates a situation where extremists want to use the same tactics to deal with any similar phenomenon that they declare to be a problem.

A related but slightly different concern about such disregard for ethical public policy, beyond curtailment of personal autonomy via prohibitions, is curtailment of autonomy via manipulative messaging.  The worst of this, along with simply lying, is emotional violence that is designed to hurt people (for their own good, of course) and usually harms orders of magnitude more people than it causes to behave differently.  The most obvious example is the disturbing, often gory graphics on tobacco packages, which proponents have managed to trick everyone into calling “graphic warnings”, even though they are most certainly not.  (A warning communicates accurate information that is not already known for the purpose of facilitating better informed decision making.  The tobacco graphics fail the “communicate information”, “not already known”, and often the “accurate” bits.)

The authors of the anti-co-sleeping campaign clearly drew inspiration from (and maybe even apprenticed in) the lavishly funded anti-smoking emotional violence campaigns which adopted a mentality of “say/show anything that might accomplish the goal, regardless of whether it is true or what damage it does.”  In the case of the anti-co-sleeping, the damage includes the problem that it is impossible to offer advice about how to safely co-sleep (specifically, don’t do it when you are under the influence of mind-altering drugs, legal or otherwise).  When the over-the-top message that co-sleeping is as bad as putting baby to bed buried in covers and cuddling a large sharp knife, there is not room to say “but if you do, make sure to….”  Further damage comes from making some of the many co-sleeping parents feel bad about their choice based on incorrect information.  And for any parent whose child died while co-sleeping the message might as well be “nyah nyah, you were an idiot, you deserve to be grieving for the rest of your life”.

Fortunately there are very few such parents.  But, a lot more women have suffered date rape, and that is a lot of nasty flashbacks resulting from this (pictured) anti-drinking message that depicts a disturbing image of the legs and half-removed clothes of a young woman lying on what appears to be the floor of an low-quality institutional bathroom.  The guilty organization in this case was the Pennsylvania Liquor Control Board, which pulled the ad after one day following an outcry by rape victims and advocates.  At least that agency does not claim the mantle of “public health” in their title, though it is kind of annoying that the state secures for itself a monopoly over liquor and wine sales, and this agency that is the monopoly seller is using the profits for nasty messages like this.  (Fortunately there is something of a free market for beer and, for those of us living in the southeast of the state, there is the state of Delaware, home of low price booze, only a few minutes away — something that seems even more worthwhile given this fiasco.)

Is our state liquor monopoly an extremist “anti” organization that is just trying to twist women to their agenda.  Well if you go to their webpage that is linked from the rape graphic, you will find such statements as:

Heavy drinking is usually defined as consuming an average of … more than 1 drink per day for women

Also you will find such demonstrates of knowledge as:

…binge drinking is a pattern of alcohol consumption that brings the blood alcohol content (BAC) level to 0.08% or more. This pattern of drinking usually means 5 or more drinks on a single occasion for men or 4 or more drinks on a single occasion for women, generally within about 2 hours.

For most men and most drinks, less than 3 drinks in 2 hours is enough to get above 0.08%.  My personal favorite, though, was:

The more alcohol you consume, the more intense the effects 11.

What makes it funny is that “11” there is a reference note.  They felt the need to cite to some FAQ at the CDC website to make that claim.  For amusement value, this just edges out this one, in their list of “myths”:

MYTH: Alcohol is an aphrodisiac.  Alcohol reduces inhibitions and may stimulate your interest in sex…

But apparently that does not mean it is an aphrodisiac or anything.

In short, the PLCB behave like the typical pseudo-public-health nannies when it comes to this messaging, both in terms of the message and the intelligence with which it is delivered.  On the website, their message is the usual scattershot collection of claims about how terrible a behavior is; date rape risk is a minor part of the arguments they heap on.  So why do they emphasize that in their graphic?  Because it evokes visceral horror among many women, more so than does the threat of choking to death in one’s sleep or dying in a car crash.  The action being taken is ostensibly one of communication and warning, not prohibition or regulation.  But the act is actually designed to terrify the audience, through creating fear and other emotional reactions to a memorable image, into being less likely to drink, regardless of whether they might make that decision based on a rational calculation of the risk.  Even setting aside the practical problems with this (e.g., those most likely to be terrified are those who are already most cautious), this is not a legitimate role for government or anyone supposedly acting in the public interest.

In contrast with the anti-co-sleeping message, where the advice is not actually supported by the science, it is undoubtedly true that less drunkenness will result in less rape.  But that does not justify a tactic that is designed to provoke as much reaction as possible (even if it is paranoid overreaction).  As with the anti-co-sleeping message and tobacco, the prohibitionist approach makes it impossible to offer useful harm reduction advice.  This is particularly striking since the text accompanying the graphic is actually addressed not to the victim, but her friends (“when your friends drink, they can end up making bad decisions…that leave them vulnerable….”).  So here’s a thought:  If you see your friend drinking about to pass out, do not let her go unaccompanied toward the bathroom with a man she just met.  Even better, the message could be “as with a designated driver, make sure someone in your group has the job of guarding against such occurrences (and avoid fraternity parties entirely).”

And speaking of that man, the ad campaign did not acknowledge his existence  Due to the apparent lack of a perpetrator and blaming the booze, the rape can only be seen as the victim’s fault entirely.  The outrage about that is probably what got the ads pulled in a day, as reported by the Philadelphia Inquirer and via the Associated Press, though the stories also tell us of the outrage the victims of date rape expressed about having that imagery forced on them.  It is tempting to say the news reports were good, because they report the complaints and the sensible outcome.  But thinking about it more, the stories failed the basics of news reporting.  There was no inquiry into what possessed those idiots to create this in the first place, or to think it was acceptable.  The report is about one battle, without realizing that it is part of a war.

Returning to the message, why did the PLCB not offer advice about how to avoid date rape even when you are drinking?  Because they do not actually care about date rape.  Their mission was just to discourage drinking, by any means available.  The typical current behavior of “public health” told them that exploiting the existence of date rape was ok.  Yes, they folded when someone insisted that it was not ok, but their willingness to fold may have been because they were not quite as committed as the extremists are; the funding for the effort comes from the profits of the agency’s liquor stores, after all.  It is not difficult to imagine the extremists (the Milwaukee public health unit in the co-sleeping case, most everyone in the business in the case of tobacco, and quite a few in the anti-alcohol groups) arguing that the importance of their cause justifies terrorist tactics, blaming the victim, and causing flashbacks for thousands of previous victims.

I do not want to imply there is some huge divide between these tactics and direct government control over people’s actions.  Indeed, the prohibitionists depend on disinformation and emotionally violent messages to create the social situation where they can impose policy-enforced restrictions on behavior.  Demonization and abuse of smokers would not be possible if a couple of generations had not been “taught” how evil they are and how they really all just want to quit but are too weak to do so without “help”.  But the two bits should not just be lumped together, if for no other reason because the messaging approach is commonly practiced by ostensibly respectable people.  As a real and credentialed public health person, I am more bothered by them than by the prohibitionist extremists that they empower and cover for.  It is like the southern “gentlemen” in Washington for over a century talked about states’ rights and such to provide cover for lynchings and other acts of racism that they pretended to not support.  There are always thugs out there for any cause; there are not always credentialed, skilled, and apparently respectable propagandists making it possible for them to act.