Saturday, October 8, 2016

Corporate funding = bad science? Not really

I've long been an advocate of low-carb eating, and there are a few websites I frequent for information on the subject. But every once in a while, even the people you trust make mistakes. The researchers and physicians who promote low-carb and paleo diets usually ground their arguments in good science, though many of them, sadly, also love a good conspiracy.

News recently came to light that the sugar industry paid several researchers, Dr. Fred Stare probably being the most prominent, in the 1960s to minimize the health effects of consuming sugar, and it appears that food companies have had science talent on their payrolls ever since.

Predictable outrage from the low-carb world followed this revelation: a torrent of angry tweets, facebook comments, and blog posts from thinkers I usually respect who were just beside themselves with rage. My two favorites, from Tom Naughton and Dr. Andreas Eenfeldt: "The Harvard scientists were not only whores, they were cheap whores," and "Big Sugar was ... enticing Harvard scientists ... to sell out their independence and conduct its paid research."

This all makes for entertaining reading, but the facts are far less sexy, I'm afraid. Scientists, just like the rest of us, don't work for free, and they have bills to pay, too. So when industry offers to fund their research, they happily accept. This economic reality may be the basis for awful Russell Crowe movies, but it doesn't automatically produce corrupt science, and it often, in fact, produces good science.

"Follow the money" doesn't disqualify scientific research for a variety of reasons, but the most important one is this: science rises and falls on its merits, regardless of who paid for it and how evil they may be. The Nazis, for example. produced some of the earliest studies linking smoking to lung cancer. Yet by the same silly logic used to disqualify sugar industry-funded research, we could ignore German tobacco research from the 1940s, because it was financed by a source we dislike.

Now one could respond to this by arguing that Stare and his Harvard colleagues were ultimately wrong that sugar isn't harmful, while the Nazis were correct about smoking. But that rebuttal misses the point entirely. The quality of your research isn't necessarily an indicator of your integrity. For every widely-accepted scientific theory, there are dozens more that have been discarded. Getting things wrong is just part of science. Stare et al. were wrong, but their work didn't spring into existence when big sugar cut them a check, and we only know they were wrong because better science told us so.

Microbiologist Dr. Alex Berezow adds some weight to this argument with a very important detail. People give money to causes they already support; they don't attempt to buy compliance from people who disagree with them. This is precisely why radical environmentalists donate to left-leaning politicians and trade unions give to senators who represent their members.

 In our current context, this means that big sugar simply went and found scientists who already agreed with them. Fred Stare, for instance, had a reputation as an iconoclast before he co-authored the sugar industry-funded review article. He had it out for advocacy groups who shilled bullshit dietary advice to the public, which probably stemmed from his time working in war-torn Holland following World War II, where starvation was rampant. For my low-carb friends reading, Stare also came to the defense of eggs when mainstream nutritionists began to shriek about the dangers of cholesterol.

But there's another side to this debate that is often overlooked. Disqualifying research based on who funded it could cause you to ignore good science. I'd like to use Dr. Eenfeldt as an example, who sells dieting advice on his website, by the way. Last December he lambasted a meta-analysis which found that diet soda could help obese people lose weight because the soda industry had given grants to the authors.

The article was published in a prestigious medical journal and authored by scientists from impressive schools around the world. The researchers cataloged hundreds of studies, grouped them by study  design (animal study vs human intervention etc.) and reviewed their methods and results in excruciating detail. This would be an excellent starting place for anyone curious about the health effects of artificial sweeteners. Moreover, the article's conclusion mirrors the opinion of scientists I know don't take corporate money. But Eenfeldt's conclusion is that we should dismiss this paper out of hand, because "It’s like reading marketing material for the beverage industry."

Open and honest debate is how we make scientific progress. Heated disagreement, therefore, is a good thing and people are welcome to say that Ancel Keys and Fred Stare were bullshitters, bad scientists or egomaniacs who wouldn't admit they were wrong about heart disease. But, those kinds of comments ought to go hand-in-hand with a thorough debunking of Keys and Stares research. That's not what's happening here.

Moreover, we need to acknowledge that confirmation bias affects everyone, even the scientists who agree with us.So we shouldn't pretend that "it's only the other guy who's greedy" as economist Milton Friedman put it. We can all be greedy, dishonest and otherwise imperfect in pursuit of our goals to make the world healthier and safer. Complaining that people were paid shills after they're long dead and gone and dismissing their work doesn't advance those causes whatsoever.

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.