How public health promotes bad science

There's a pretty good article in Nature about the 'obesity paradox'. This is the consistent finding that, especially as people get older, being overweight seems not to be quite the health problem that we thought it was. The problem is that this sort of finding confounds the efforts of the public health business to push out a message around obesity - so they want those presenting this science to be silenced:

Some public-health experts fear, however, that people could take that message as a general endorsement of weight gain. Willett says that he is also concerned that obesity-paradox studies could undermine people's trust in science. “You hear it so often, people say: 'I read something one month and then a couple of months later I hear the opposite. Scientists just can't get it right',” he says. “We see that time and time again being exploited, by the soda industry, in the case of obesity, or by the oil industry, in the case of global warming.”

The person making this statement is a leading public health academic at Harvard not some sort of local council junior. The campaign message - being fat is unhealthy - cannot be undermined by inconvenient evidence that says this:

A team led by Katherine Flegal, an epidemiologist at the National Center for Health Statistics in Hyattsville, Maryland, reported that people deemed 'overweight' by international standards were 6% less likely to die than were those of 'normal' weight over the same time period.

This approach undermines science and results in bad policy-making. If it's the case that being overweight but not obese doesn't represent a health problem in most older people (in fact quite possibly the opposite) then we should say so not try to suppress the evidence because the public might be confused.

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Quote of the day - what addiction isn't...

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From Chris Snowdon:

As a general rule of thumb, if someone tells you that cupcakes or smartphones are "as addictive as cocaine" on the basis that they all produce dopamine in the brain, walk away. They're saying no more than that pleasurable activities stimulate the brain's pleasure centres, which is a banal tautology.

Do take note all you health reporters.

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Misrepresenting, misleading, manipulating? Ah, that would be public health then...

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From Chris Snowden:

Be under no illusions about what this guy is up to. He is prepared to defame academics and misrepresent data in a conscious bid to mislead politicians and manipulate the public. He is not just prepared to do this, he has already done so.

Very sadly, this is the absolute truth about public health. Do go and read about Dr Willett.

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Just as salt doesn't cause heart disease, sugar doesn't make children hyper...

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Or so it seems...

Let’s cut to the chase: sugar doesn’t make kids hyper. There have been at least twelve trials of various diets investigating different levels of sugar in children’s diets. That’s more studies than are often done on drugs. None of them detected any differences in behavior between children who had eaten sugar and those who hadn’t. These studies included sugar from candy, chocolate, and natural sources. Some of them were short-term, and some of them were long term. Some of them focused on children with ADHD. Some of them even included only children who were considered “sensitive” to sugar. In all of them, children did not behave differently after eating something full of sugar or something sugar-free….

Pretty simple and conclusive.

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Is this really science?

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It seems that smokers have impaired short term memory - or at least that's what Dr Tom Heffernan, who leads Northumbria University’s Collaboration for Drug and Alcohol Research Group, said! It is reported that a major piece of research has shown this to be so - research like this:

The study involved more than seventy 18 to 25-year-olds and included a tour of the university’s campus.

Now that's what I call science! But maybe the Daily Mail (for it is then reporting) are wrong - it is not unheard of.  But no the "scientists" did this:

Research conducted by scientists from the Collaboration for Drug and Alcohol Research group at Northumbria University in England tested 27 current smokers, 18 previous smokers and 24 who had never smoked on a real-world prospective memory task – which refers to one's capacity to store and retrieve intentions for future actions.

And claim to have found this:

After screening out heavy drinkers or those who had used alcohol recently and controlling for differences in other drug use, mood and IQ, smokers performed worse on the real-world prospective memory task than previous smokers and the never smoked group. The previous smokers performed at similar levels to the never-smoked group – suggesting some recovery in function associated with smoking cessation. 

 Apparently having applied lots of statistical tests to this tiny sample the authors conclude:

These revealed no significant between-group differences on self-reported PM; however smokers recalled significantly fewer action-location combinations than the never smoked and previous smoker groups on the objective RWPMT (Real World Prospective Memory Task)

I may not be a scientist but even I can see that this is nonsense. But then these are the guys who are planning more research:

The research will now investigate the effects of of passive smoking on memory, while Dr Heffernan and Dr Terence O’Neill will look into the effects of 'third-hand smoking' - toxins left on curtains and furniture.

 I rest my case.


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Why does no-one in the media ever question what these people say?

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The "salt is evil' lobby have found a new target - bread:

A third of breads contain more salt than recommended under guidelines being introduced next year, a survey found.

Most breads were within the current guidelines of 1.1g of salt per 100g - but this is being cut to 1g per 100g.
Campaign for Action on Salt and Health (Cash), which looked at 300 breads, said it was "outrageous" that bread contained even the current level.

This is more junk science - there's very little evidence that fingers salt as a cause of high blood pressure yet the  media and worshippers at the Church of Public Health persist in the 'salt is bad for you line.

People who ate lots of salt were not more likely to get high blood pressure, and were less likely to die of heart disease than those with a low salt intake, in a new European study.

The findings "certainly do not support the current recommendation to lower salt intake in the general population," study author Dr. Jan Staessen, of the University of Leuven in Belgium, told Reuters Health.

Perhaps one day we'll start looking at the science?

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Friday Fungus: Mushrooms, psychedelia and depression

These days we are trained from our youth to respond with terror to the idea of psychedelic drugs - including our dear old friend the magic mushroom. However, we need to keep an open mind - to keep in mind the possible benefits of these substances. And since - as far as we know - nobody has died from eating magic mushrooms, they seem a fair place to start. And here's New Scientist reporting on research into the effect of using mushrooms:

Psychedelic drug users throughout the ages have described their experiences as mind-expanding. They might be surprised, therefore, to hear that psilocybin – the active ingredient in magic mushrooms – actually decreases blood flow as well as connectivity between important areas of the brain that control perception and cognition.

The same areas can be overactive in people who suffer from depression, making the drug a potential treatment option for the condition.

The study is the first time that psilocybin's effects have been measured with fMRI, and the first experiment involving a hallucinogenic drug and human participants in the UK for decades.

Leaving aside the issue of hallucinogenic effects, the piece suggests that the real benefit does not lie with this immediate effect:

Franz Vollenweider, who works in a similar field at the Psychiatric University Hospital Zurich, Switzerland, says that the immediate effects of psilocybin are not as important for clinical benefit as the longer-term effects. That's because psilocybin increases the expression of genes and signalling proteins associated with nerve growth and connectivity, he says: "We think that the antidepressant effects of psilocybin may be due to a possible increase of factors that activate long-term neuroplasticity."

We tend to associate drug use with the onset of mental health problems - the oft told link between cannibis use and schizophrenia, for example - so it is good to see the other side of the story. Indeed, drugs such as nicotine are also beneficial in providing a small stimulus - how many folk will tell you how a fag and a coffee act to get things going! Perhaps, the prevalence of drug use among people with mental health problems is them searching for remedies or for methods to cope?

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Maybe Ben Goldacre should stick to science?

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I got into an exchange with the sainted Ben Goldacre regarding a tweet he sent about the paying of bonuses to Barclays Bank employees (and one presumes specifically the multi-million pound package of bonuses for the bank’s Chief Executive, Bob Diamond):

bored of ppl tweeting that because barclays benefited from the taxpayer bailout, but didn't specifically receive bailout money into its own accounts, its ok for them to pay £m bonuses. anyone written a piece on why this is obviously a stupid argument, to save me the bother?

It’s a tweet so I won’t criticise the grammar but it seems to me a disappointing argument from someone who puts so much faith in evidence-based assessment of science. It seems to me that Ben needs to apply the same discipline to his analysis of business and economics.

There are three specific observations in this comment:

1.       Did Barclays benefit from the taxpayer bailout directly?

2.       What is the link between the bailout and the payment of bonuses?

3.       Is it OK to pay bonuses?

Did Barclay’s benefit? Well there is no doubt that, along with the rest of the financial sector of our economy, Barclays benefited from the decision to “bail out” some of the banks. The former Chief Executive of the banks admitted as much:

"There are two ways I would say the system as a whole benefited generically. One was in the injection of liquidity undertaken by the Bank of England and a new structure put in place in March 2008. And the other was the making available of guarantees from government for funding undertaken by banks.

"It is important to recognise that in each case the banks were encouraged to use these new structures that were put in place and we did.

"It is also important to recognise that we were required and we did pay a price for these things but I'm not trivialising the importance of the intervention. It was important.”

However, the benefit to Barclays was not direct and, as we know, it cost the bank (and its shareholders) dearly not to play a full part in the bail out.

Barclays has said it is to raise £6.5bn of new capital. The bank is to raise the money from private investors, rather than going to the government. Barclays also said it would scrap its final dividend payout for 2008, saving it £2bn.

We do not know what would have happened to Barclays had the government not bailed out other banks – certainly the view of the industry was that the bailout acted to stabilise an unstable situation. The bank benefited through that stabilisation rather than in a direct way – most of the “Barclays’ benefited arguments are “what if” arguments: had the bailout not happened Barclays would have suffered greater losses. Which, of course, may be true but those additional losses are not quantifiable and the Bank shares this with most other businesses in the UK!

Linking the bailout and paying bonuses. Let’s be straight here, Barclays is a private business owned by private shareholders – indeed, those shareholders (and I am one of them) could be critical of the bank for rewarding executives over delivering return on investment. However, the core of the argument is that the level of Barclays’ recent profits was only possible because of the ‘bailout’. This may indeed by the case – we’ve seen how the previous chief executive acknowledged that the bailout was helpful to the company. However, to ascribe the whole of the profits to the bailout is clearly a misplaced argument and we have no way of assessing what proportion of the profits actually did relate to the bailout.

To understand this let’s look at what is said about the recently published figures which seem to show that the reason for the profit rise is only marginally connected to the ‘bailout’. Indeed reductions of bad debts and other impairments in places like Spain and the USA are cited as leading reasons in the statements from the Company. The only part where the bailout may have help is in UK domestic banking – where the uplift is around £300m.

And, despite the increased profits, the amount of bonus paid is down:

Barclays announced a new compensation system following its Project Merlin deal with the government which will see it pay 7% less in performance awards than last year. At its investment banking arm Barclays Capital, which saw pre-tax profits excluding own credit increase by 2% to £4.4 billion, the bonus pool will be 12% lower than last year.

Given that these bonuses are part of the typical remuneration package for many bank employees (and not just a few ‘masters of the universe’) it is hard to see why bonuses shouldn’t be paid when profits are increased. And I see nothing in the results that suggests a link between bonuses and underperformance or bonuses and the ‘bailout’.

The real point of Ben’s tweet is my third question – is it OK to pay bonuses? And the discussion has to be stopped there since it is plainly inequitable to say, for example, that science journalists can earn bonuses whereas bankers cannot. So Ben must be opposed to the paying of bonuses – in the case of banks, until some specified period of post-bailout penance has been completed.

Ben is entitled to feel uncomfortable – even angry – at high bonus payments but the evidence does not support his contention of stupidity. It shows a misunderstanding of business, of microeconomic incentives and a careless assumption that a £20,000 bonus to a classified advertising salesman on the Guardian is morally different from a £3.4 million bonus to a banking boss. Or for that matter a £10m plus remuneration package for a jug-eared football player.

As I said - Ben should either apply the same rigour to business as he does to scientific research. Either that or stay away from economics!

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