Monthly Archives: July 2014

The hazards of anti-tobacco stupid to the stupid themselves are well known. The loss of judgment that allows someone to participate in the tobacco control industry, and thus lose their ethics and humanity, are tragic. The images of their suffering — the compulsion to blatantly lie about the facts, the desperation resulting from trying to rationalize how they are helping the people they are actively inflicting harm upon, the doublethink — are horrible to look upon. But in some sense, these are victims of their own free choice, and they have made this lifestyle decision for themselves. The Circle of Hell that is reserved for them is chosen and accepted by those who choose to stupid.

Of course that cannot be said of the innocent children recruited by the industry’s endless stream of propaganda, which they need to replace ranks that are constantly thinned by sudden attacks of common sense. They should be protected from the marketing. And the billions of dollars in direct costs that the stupid inflict on society need to be compensated for by imposing high taxes on tobacco control, of course.  We might also feel something for the families of the stupid; it must be horrible for a child to come of age in the information era and learn that her father is as widely despised as Kim Jong-il.  Still, ultimately, stupid is a matter of adult choice, and must be allowed in a free society.

Second-hand stupid inflicted on innocent bystanders is an entirely different matter, and its harms have also been well documented. Hard-working people doing real public health work, on the ground in county offices or poor villages, suffer from tobacco control misappropriating the term “public health”. They suffer the spillover stupid when most of the world comes to think of public health as stupid. Similarly those working in epidemiology and other public health sciences suffer from second-hand stupid when tobacco control abuses these sciences. The entire fields are tarnished and seen as stupid by many observers. On the other hand, most victims of the second-hand stupid are voluntarily accepting their exposure. No one needs to go into a field that exposes them to tobacco control stupid, and many who choose such fields also choose to actively indulge in the stupid themselves. If there were a pushback from real public health people, honest epidemiologists, et al. against their exposure to stupid, we might be inclined to rally around them. But so long as they seem to accept it, who are we to question their choices?

But it has become apparent that a previously unrecognized exposure to stupid causes far more harm than previously realized. Third hand stupid — the exposure of countless people to residual stupid that has been deposited in the environment by tobacco control — is a serious hazard in itself. This was proven today by two responses to a tweet I posted. [nb: This is actually better evidence than was used to “prove” that “third-hand smoke” is a health hazard. You can look it up.]

In that tweet, I ridiculed a tobacco control “research” paper that claimed to quantify the hazard from third-hand TSNA exposure from deposited cigarette smoke — never mind the fact that no one has any idea what the dose-response function is for TSNAs (or, indeed, if TSNAs really are an independent cause of cancer, let alone whether they are in the environmental form — but the character limit stopped me from mentioning those). Alas, by doing this, I allowed two of my innocent followers to be exposed to the third-hand stupid from the deposition of the original toxin into our environment. One of them noted the exorbitant purchase price required to be able to read the article, suggesting he had the urge to read it and perhaps even pay for it. Another challenged the claims based on specific reported results, showing that the residual stupid had already entered his system and he was momentarily deluded into thinking that the original deposit was subject to rational analysis.

Do not fear for my two correspondents. They are both bright and healthy and have undoubtedly already recovered from their exposure to third-hand stupid. I am confident that following my twitter feed gives them sufficient immunity in any case. But following the usual “public health” practice of multiplying zero by a very large population to get an absurdly large number, we can see that the blanket of residual stupid that is deposited in the environment by tobacco control will cause thousands of innocent people to suffer serious outcomes. Moreover, the residual stupid lingers in the environment long after a the tobacco controller who deposited it has departed for his well-deserved Circle.

In conclusion, of course, won’t someone think of the chiiiildren?

A few days ago, I offered some very brief advice (“don’t!”) to a health provider who was considering going back to school for an MPH.  I promised to follow up, and have now decided to write down the thoughts that bubbled up.  I will start with my summary answer (which is actually far more serious than it might sound):

Reasons to go to MPH school:

• You are a third-world-trained physician and are trying to get a foot in the door that might lead to medical licensure in the USA, Canada, or other rich countries.  People in this category are a large portion of applications to North American MPH schools.  It is good for us (we need more primary care physicians) though the brain drain is bad for the rest of the world.
• You are the scion of a rich family living in a place that is so violent or otherwise hellish that your family wants to buy you out of there for a while, but you do not have the skills to get into a Western engineering, economics, public policy, philosophy, etc. program.
• You work for a health department or similar institution, have settled for a career there, and getting promoted is aided by having an MPH.
• You desperately want to go to medical school, but your undergraduate performance was so poor that you could not get into even the worst such program.  So you are willing to spend another two years, basically to give yourself an excuse for applying again with a patina of having become better qualified.
• You have an undergraduate degree in sociology and aspire to be a moralizing preacher, but do not have the math skills to get through seminary school.

The last one might be a tad hyperbolic, though it is based on reality.  The others are, as far as I can tell, the only good reasons to enroll, as I explain below.  And it is worth realizing that this means that if you enroll in an MPH program, these will describe most of your classmates, the people you might hope to learn something from in the program.  On the bright side, those in the first category are sometimes quite insightful.

To expand on this…

I write this from a slightly guilty perspective, having been a professor in several MPH programs for many years.  But I will defend myself — and support my answer to the question — based on what I tried to do in that role.  I offered a class on how to critically make sense of scientific evidence and make optimal public policy based on it.  It was modeled on courses I had in Master’s in Public Policy school, which offered a good and extremely valuable education.  You might think that this would be standard fare in MPH school, but as far as I know, the only versions of this class offered in that realm were the ones I offered at each of the schools where I happened to be on the faculty (and that disappeared when I left).  The course covered critical scientific analysis, the ethics of policy making, and goals and practical issues of policy making.  I cannot count the number of times a student in my class said something along the lines of “why, in the last semester of the program, is this the first I am learning about any of this?” or even “this is the only useful class I had during my entire time in this program.”

And then there was “why is this only an elective, rather than part of the core curriculum?”  Well, for a brief moment, at the University of Alberta, when the Department of Public Health Sciences was run by a chair who was a serious scientist and educator, and the faculty happened to included a group of people who were far better than MPH faculty generally are, we tried to revise the curriculum and make it so.  But the politics of “public health” intervened, and the department was turned into a School of Public Health with an ousted politician (literally — he was not an academic) at its head, and he immediately put the deadwood hacks on the faculty in charge of everything.  I would not mention this if it were a mere isolated anecdote, but such downward tendencies are the rule in public health units, not the exception.  The genuinely high-quality faculty I know that are still in public health units (and there definitely are some good ones — perhaps dozens) have basically just bunkered in to finish their careers, doing good work and trying to just live with how bad the curriculum is.

So what is that curriculum?  It mostly consists of ersatz sociology (sociology at its best is pretty sketchy; this is far worse), freshman-level history and civics classes (and I use the high-school term “civics” intentionally), some freshman-level natural science classes (toxicology mostly), and tiny bit of badly-taught epidemiology.  And that is it.  I am not exaggerating about the freshman-level bit.  I don’t recall ever seeing an MPH class that I could not have stepped in and taught on a day’s notice, self-teaching in realtime enough about the subject matter to be able to cover it at the level taught.

In fairness, the epidemiology is sometimes pretty good if there happens to be a decent epidemiologist on the faculty.  But because the courses have to be taught down to the level of typical MPH students, they cannot be very good.  The joke about not being able to handle the math to get through seminary was not random; most of the students going into public health programs lack the skills to do well in a decent high-school math or science class (which goes to show that we do not have very many decent high-school math and science programs, but that is a different tragedy).

I recall one occasion when I taught some guest sessions in an MPH core epidemiology course, and the students openly complained that (a) I sent out two hours’ worth of extra reading for them, and (b) when I presented calculations, I did not use the same variable names and ordering of terms the course instructor did.  In my exasperation I finally responded, “you do know that you enrolled in graduate school, don’t you?”  Then they complained about that.  But perhaps they had a point — they had enrolled in an MPH program, not real graduate school.

If you want to learn epidemiology or another real science that is associated with public health, there are good MS or PhD programs available.  That is where almost all good teachers in those areas devote their efforts, not to the hopeless MPH classes.  If you are more interested in the policy side, there are good public policy programs, many of which offer a health policy specialization (those tend to focus on medicine and not the rest of public health, but you can often work around that).  But if you are savvy enough to have found this essay, and have the attention span to have gotten this far in it, you almost certainly do not want to waste your time in an MPH program.

[P.S.  I know that readers of this blog include people who are still on the faculty of MPH programs.  I invite any of them to speak up if they think I am wrong.  I will not hold my breath.]