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Sunday, April 17, 2016

Tobacco control vs AIDS prevention

I just finished Chris Snowdon's excellent book Velvet Glove, Iron Fist. One of the points Snowdon emphasizes repeatedly throughout the book is that the anti-smoking lobby is actually more of an anti-tobacco industry lobby. The primary concern is not the health of smokers, it's bringing down the cigarette companies.

Over the years, this mindset has led public health crusaders to demonize anything that may shed a positive light on smoking or the tobacco industry, whether it deserves such treatment or not. Big public health's reaction to the advent of e-cigarettes is a great example of this. But this unwavering disdain for anything perceived as pro-smoking extends even to genuinely good deeds the tobacco industry may do. And as if on cue a "study"* released just this week gives me a perfect example to dissect.

On Monday researchers writing in the Journal of Social Aspects of HIV/AIDS pointed out that the tobacco industry's extensive funding of AIDS groups, often called AIDS service organizations (ASOs), is part of a conspiracy to stave off further regulation of tobacco:
A new paper claims the historical involvement of tobacco companies during the early days of the response to the AIDS epidemic was just a cynical marketing ploy to distract the public from the dangers of smoking.
On this point there is little to debate. The tobacco industry has tried everything to shift the state's attention away from cigarettes; funding the fight against AIDS and other infectious diseases fits perfectly within that strategy. Indeed it was a brilliant move, and big public health rightly saw it as an attempt to co-opt their fundraising efforts. This "study," therefore, is just an example of one public health cause attempting to muscle another one out of funding, and using the tobacco industry's dishonesty as a justification.

Health writer and filmmaker Tom Naughton notes in his documentary Fathead that disparate public health groups, anti-smoking and anti-obesity groups in this case, have to lobby for government funding. They campaign incessantly for sin taxes and research grants, both of which sustain their efforts to fight smoking or obesity. But another way they secure funding is by attacking each others causes, claiming that their own cause is far more serious a threat to the public.

This makes sense, too. If tobacco isn't public enemy number 1, the government will be less enthusiastic about taxing cigarettes and funding anti-tobacco initiatives and research. Every dollar spent on obesity or infectious diseases is a dollar not spent on tobacco control, after all. The authors of the "study" expend a lot words dancing around this point in hopes of dismissing it. They write that following the outbreak of the AIDS epidemic
there were arguably more pressing health matters [than infectious diseases in the third world] as the majority of child and adult deaths continued to be caused by non-communicable diseases, many of which were related to the growing use of tobacco products.

Arguable indeed. According to Baylor College of Medicine,

"three infectious diseases were ranked in the top ten causes of death globally in the most recent survey by the World Health Organization ... lower respiratory infections (3.1 million deaths), HIV/AIDS (1.5 million deaths), and diarrheal diseases (1.5 million deaths)." 

These numbers slightly outpace the deaths WHO attributes to smoking-related illnesses, so the claim that smoking is the greatest threat to health worldwide is incorrect. And when we add in the fact that infectious diseases aren't lifestyle choices (nobody chooses to get AIDS, people choose to smoke), we have a pretty solid case that the tobacco industry was serving the greater good by channeling resources towards AIDS prevention and awareness, whatever their motivations.

But I urge you to make note of that sneaky dependent clause at the end of that quote: "...the majority of ... deaths continued to be caused by non-communicable diseases, many of which were related to the growing use of tobacco products." Smoking certainly contributes to this category of disease, but the WHO also admits that lack of exercise, excessive drinking and poor diet kill more people than smoking.

The problem is further compounded because all of these behaviors are risk factors for many of the same diseases. For example, high blood pressure can kill you, but globally how do we know which risk factor led to the most cases of high blood pressure? The WHO fact sheet doesn't say, probably because it's impossible to separate them out accurately.

But assume the "study" is right that money shouldn't be diverted from tobacco control. Who funds ASOs? Anybody but tobacco companies. The "study" vaguely refers to "alternative resources" and "other donors." My guess is that those donors will ultimately be taxpayers in first world countries, since few other private enterprises have an incentive to fund AIDS prevention. Whoever ends up footing the bill, though, the point of the "study" is that there should be more funding for public health all around: "... there is a need for more collaborative, rather than competitive, approaches to increase societal resources for health needs overall."

Such a conclusion ignores the economic reality that governments have only so much money to throw into the black hole of public health, and what they do spend is influenced by a host of political concerns. Ultimately this is why ASOs are willing to take tobacco money, and it also explains why big public health feels the need to stop them.


*I put "study" in quotes because anti-smoking crusaders have made a habit of copying and pasting content from internal tobacco industry documents into medical journals, adding a bit of commentary and calling it original research. That sounds more like an 8th grade book report to me than a scientific study, but I figured it was worth pointing out.

Wednesday, April 6, 2016

Red meat causes cancer, not as dangerous as previously thought

For the nth time the media is warning us that eating red meat is dangerous. It could be any major publication and any science writer sounding the alarm, but this time it's the Huffington Post and their food and health editor Kate Bratskeir.

Bratskeir's piece isn't just an example of sloppy science writing, though. It's a great example of the newspeak that many health journalists deal in; they comfortably embrace contradictory ideas as they construct a narrative that fits their agenda. In this case, research that should deflate Bratskeir's argument just becomes background noise while she encourages her readers to eat less red meat, because veganism:

Major studies have shown a diet rich in red meat can contribute to a host of maladies, yet emerging research muddies this picture, suggesting that not all saturated fat is created equal...eating red meat in excess can be costly for your health. Plus, there are some really delicious meat-free alternatives in the world...

So with that blatant contradiction in mind, let's deal with the rest of her arguments. The piece begins with an observation that the price of ground beef has dropped, which has encouraged us to eat more of it. And "this is happening despite everything we know to be true about red meat consumption." I know this was meant as a "Come on, guys, red meat gives you cancer!" style warning, but her exasperation at people eating more sliders at Chili's is unnecessary.

Bratskeir cites a Harvard Medical School article summarizing some of the research supporting her claim, which includes several epidemiological studies (worthless surveys) and a small clinical study from England that lasted just 21 days. The limited amount of data provided here is enough to dismiss the conclusion, but there's actually some important methodological reasons to reject these studies.

 But if the science is out there for anyone who wants to see it, why are we still being told to fear red meat? Well, you see, "the World Health Organization went so far as to classify red meat as a ‘probable carcinogen,’ meaning there is some evidence that eating a lot of red meat could contribute to cancer."

Starting with their ignorant stance on secondhand smoke, which required them to ignore their own data, the WHO made it clear long ago that they're a political organization, not a scientific one. And they're misrepresenting the evidence in this case, too. The WHO reported a 17% increased risk of colorectal cancer per 100 grams of red meat consumed. That seems like a significant increase, but the absolute risk for developing colorectal cancer is less than 2% for someone at 50 years old, when the disease is most likely to strike.

Given those numbers, I'm not concerned in the least about eating red meat. If you are, though, be sure to add spices to your burgers, which reduces the risk of consuming compounds called heterocyclic amines (HCAs) that can cause cancer. Before you start to sweat at my admission that red meat may actually contain some cancer-causing compounds, I came across a study courtesy of Mark's Daily Apple which, comically enough, tells us that "associations with cancer risk or benefits have been claimed for most food ingredients."

I don't think there's a better way to some up my point about cognitive dissonance.






Wednesday, February 10, 2016

Fat acceptance: still stupid, still dangerous

I've been very critical in the last few years of fat shaming, the practice of berating overweight people into a healthier lifestyle and a slimmer waistline. What I find equally troubling, however, is the recent effort to ignore or downplay the risks posed by obesity for the sake of people's feelings, often referred to as fat acceptance.

There are dozens of excellent reasons why the fat acceptance movement ought to disappear forever, but I want to focus here on the negative influence it exerts on science. As a society, we're letting our preconceived ideas about discrimination against fat people influence our interpretation of public health research. The dishonesty alone should discourage us from this practice, but there are more important consequences. Most importantly, we're encouraging people to make poor choices in order to spare their feelings, and making their lives worse in the process.

Let's start with the example that prompted this blog post to illustrate the point. A study published last week in the International Journal of Obesity suggests that the BMI is incorrectly labeling fat people as unhealthy based solely on how much they weigh. Most of the news reports on the paper, NPR's for example, highlighted the paradox presented by the study: a lot of fat people are healthy, while many slim people are not.

The news outlet pointed out that "47 percent of people with an overweight BMI, 30 percent of those considered obese, and 16 percent of those labeled extremely obese" were just as healthy as 70 percent of people in the normal weight range, based on metabolic health markers like blood pressure and insulin resistance.

 Data like that makes for a provocative headline. If it's accurate, though, it means that 70 percent of obese people are metabolically unhealthy based on the same markers, and that 84 percent of extremely obese people are also in the same category.

The trend, should you have missed it, tells us very clearly that excess body weight is correlated nicely with poor metabolic health. The dividing line between an unhealthy and a healthy weight has been poorly defined over the years, no doubt. But the fact that we have trouble pinpointing exactly when someone's weight becomes a risk to their health doesn't mean that weighing 300 pounds is perfectly healthy.

It may sound like I'm creating a straw man, but this is precisely what fat acceptance advocates preach, and their message has gained a wide audience thanks to feminists who have wrongly taken up the argument that anti-fat bias is part of a patriarchal assault on women.

Their arguments may not seem entirely baseless; there is some research that can be used to support the notion that you can be fat but fit. This assertion ultimately misses the mark, unfortunately, because it ignores a fundamental fact about human metabolism: weight gain is one of the body's responses to a poor diet. Or as science writer Gary Taubes is fond of pointing out, eating junk food spikes your blood sugar to dangerously high levels, which would kill you absent the intervening factor of excess fat accumulation. Taubes hypothesis is based on basic biochemistry, and it's only grown more convincing thanks to a whole bunch of research published in the last decade.

But beyond politically-motivated denial of science, what's so dangerous about fat acceptance? As outlets like NPR are wont to point out, obesity disproportionately affects racial minorities in the United States. This means that a significant and ever-growing portion of the population is at risk for serious diseases like type 2 diabetes, and they're being told that their weight isn't a factor in the equation, when it's actually the most important factor.

We should look at this issue on an individual level as well, though. Being fat is a miserable experience. The social isolation and resulting anxiety it causes are enough to drive people into depression. Popular TV shows like The Biggest loser and the endless bestseller list of fad diet books are ample evidence that people despise being fat, or even looking at fat people.

Had I been told as an overweight teenager that I shouldn't lose weight, I would have been worse off in every measurable way today, because we live in a world where people evolved to judge each other based on physical appearance. Bitch all you want, mother nature doesn't care. What matters is that there are millions of people, young and old, in the same position I was a few years ago. And they're being told by their teachers, journalists and celebrities that weight loss is not only unnecessary but undesirable, that they can't improve their lives by losing weight. And that is far worse than any amount of fat shaming.