Tuesday 31 August 2010

Kate Pickett on More or Less

One of the few podcasts I subscribe to is BBC Radio 4's More or Less, which looks at the facts behind well publicised statistics. The show is presented by the author of The Undercover Economist, Tim Harford, who has been mentioned before on this blog.

So I was intrigued to hear that the first show of the new series was promising to 'decode The Spirit Level debate'. For a show dedicated to debunking junk statistics it was obvious subject matter, but I wondered how Harford could 'decode' such a voluminous topic in the space of ten minutes.

In the end, he didn't need to. From the outset, Harford admitted there were too many competing claims to fit into a magazine show, and instead interviewed The Spirit Level's co-author Kate Pickett, who did more damage to the reputation of The Spirit Level in the space of ten minutes than any number of supposed "idea wreckers".

The interview (listen here for the next couple of days, or subscribe to the podcast) is essential listening if you've been following the controversy, as Pickett struggles to answer some fair and simple questions. Strangely enough, Wilkinson and Pickett's Equality Trust website—which is normally so quick to let people know when The Spirit Level has been mentioned in the media—have yet to post a link to this interview. And since the audio file won't be available for much longer, I've transcribed some of the key moments for posterity...

Falling back on other people's research

Wilkinson and Pickett's first line of defence is to claim that there are 100s of peer-reviewed studies which support their conclusion. As I have said before, this is just not true. Most of the studies they reference in The Spirit Level do not even mention income inequality.

In the More or Less interview, Kate Pickett once again claimed there was a "vast body of research" behind The Spirit Level. Tim Harford picked her up on it...

KP: We wrote a book that's intended to be a synthesis of a very vast body of research. Not only our own, but those of other people... There is a consistent and robust and large body of evidence showing the same relationship.

TH: That's an interesting point that you make. Often, in response to critics, you have referred not to your own book, not to your own data but to other published research. I'd really like to focus on the research that's presented in your book. It's very easy to say there are 50 papers, there are 200 papers, that support our research but we don't really know how you've selected those papers.

KP: We actually have completed a systematic review of all of the studies of income inequality and health, and we reference that in our book. We do examine things systematically and certainly—when we are doing our own research, publishing in peer-reviewed journals—we have to be aware of all the literature in the field. But that doesn't mean that every paper in the field has good methods, comes to the right conclusion, studies the right thing.

TH: I absolutely agree. One of the papers that you refer to in support of your argument on women's empowerment and women's status which was published in 1999 by Kawachi and some other authors, you claim supports your findings on women's status and income inequality. I've looked at their abstract. It doesn't seem to attack that question at all. It's simply on another subject—a somewhat related subject but not on the subject of income inequality.

KP: They've definitely published and we may have inadvertently put the wrong reference into that document [laughing nervously]. But Kawachi and Kennedy have certainly published finding a relationship between income inequality and women's status. The paper is Women's Status and the Health of Women and Men: a view from the States and it was published in Social Science and Medicine in 1999.

TH: That's the one I'm looking at.

Note: On page 58 of The Spirit Level, it states: "Researchers at Harvard University showed that women's status was linked to state-level income inequality. (36)"

Reference 36 is the Kawachi study ('Women's status and the health of women and men: a view from the States', 1999). As its title suggests, this study compared women's status with health, not with inequality. Indeed, the authors found a correlation between women's status and health even after controlling for income inequality.

Failure to look at other variables

The Spirit Level relies on the conceit that countries are fundamentally the same, with income inequality being the main variable that distinguishes them. This allows Wilkinson and Pickett to disregard other variables such as income, culture, history, demography, ethnicity, geography, law, politics and climate. Ignoring other variables and confounding factors would be a flaw in any study—as Harford points out, it breaks a basic rule of epidemiology—but when entire countries are being studied, this flaw becomes overwhelming. Pickett's response is revealing: she and Wilkinson do not "believe" that factors other than income inequality have an effect on a country's performance, so they don't bother looking at them.

TH: All of your studies are what are called bivariate analysis. In other words, they're all income inequality plotted against some other variable. Now, my understanding of best practice in social sciences is that you would always control for other variables. You would include 2, 3, 4, 5, 6 other variables and...

KP: Well, you wouldn't do that arbitrarily. You would do that if you believed those variables were potential alternative explanations of the relationship you're looking at.

TH: So, if I understand your statement correctly, you didn't include any multiple variable analysis because you just think that actually none of these variables are of interest—none of them are potential alternative explanations and you can just do the simple income inequality versus x analyses?

KP: That's right, but of course, again, other researchers have conducted studies that do control for more, where, as well as examining the effect of income inequality at the level of the whole society, people include individual's own levels of income or levels of education in those analyses and, again, those bear out our findings in relation to health.

TH: We come again to...you're basically rowing back from your analysis and saying...

KP: No. Indeed I'm not...

TH: "Don't look at our analysis, look at these other people because they support us."

KP: We believe that to control for individual income is actually over-controlling, so we would not consider that best practice.

Academic criticism

Although well received by some journalists and politicians, The Spirit Level has received a much cooler reaction from academics. One of the few serious academics to have reviewed the book was John Kay, Professor of Economics at London Business School and former Director of Institute of Fiscal Studies. Pickett's response to Kay's review speaks volumes...

TH: When John Kay reviewed your book in the Financial Times —and I believe John Kay would be broadly sympathetic to your idea that egalitarianism is important—he wrote: "The evidence presented in the book is mostly a series of scatter diagrams with a regression line drawn through them. No data is provided on the estimated equations, or on relevant statistical tests. If you remove the bold lines from the diagram, the pattern of points mostly looks random, and the data dominated by a few outliers." Do you think that's fair?

KP: No, I don't think it's fair. [Testily] He didn't read the book thoroughly, obviously.

Outlandish claims 

In the last chapter of The Spirit Level, Wilkinson and Pickett make some extraordinary claims about what could happen if Britain reduced income inequality to Scandinavian levels. These include: teen births falling to a third of current rates, mental illness being halved, life expectancy rising by a year and the murder rate falling by three-quarters. Harford asks her about the last of these predictions.

TH: Clearly your book is a systematical analysis and partly also a political book. You have a political case to make—there's nothing wrong with that. You have public policy actions that you would like to see taken. But do you think you may have overstated some of those? Let me give you an example. On page 268 of you book—towards the conclusion—you say that if Britain became as equal as Japan, Norway, Sweden and Finland, homicide rates could fall by 75%. But as I'm sure you've had pointed out to you by now, the UK's homicide rate is already below the average of those four countries.

KP: It's not actually. It's been pointed out that it's below Sweden. It's not below the average of those countries. Those claims [ie. in The Spirit Level], they're based on regression models and of course they're only as good as they're model they're based on.

TH: [Incredulously] But.. sorry... but you've made that claim!

KP: Yes, yes, we do...

TH: And you stand by it?

KP: Yes. That Britain would become a much healthier and more socially better functioning place if it were more equal.

TH: You said that if Britain became as equal as these four countries, homicide rates could fall by 75%. Do you not feel that's really overstating the case, or do you stand by that?

KP: That's based on the model. I mean, I think we could try it and see.

[end of interview]

TH: Kate Pickett, co-author of The Spirit Level. We did go to her Equality Trust website, by the way, and downloaded the data on homicide rates in the UK and in the relevant four countries and it does seem that I was right to say that the UK's homicide rate is already below the average of those four countries. You're listening to More or Less...

Stuart Austin has also blogged about this here. You can buy The Spirit Level Delusion here or here.

Monday 30 August 2010

On the level about epidemiology

[This is a guest post by Rob Lyons, deputy editor of Spiked

Richard Wilkinson and Kate Pickett have made great play of the fact that The Spirit Level is based on what they see as a science: ‘social epidemiology’. Leaving aside the dubious nature of their conclusions, it is worth noting that since the field of epidemiology has expanded, its explanatory powers have shrunk. While the ability to examine the spread of infectious disease has been invaluable, employing epidemiology beyond this has been - for the most part - bad news for our understanding of health. It's even worse as a method of understanding society.

The most famous early example of the application of epidemiological ideas is the ingenious manner in which John Snow, a London physician, managed to identify the source of a cholera outbreak in Broad Street, Soho in 1854. Simply by mapping the cases of cholera, he found they were clustered around one particular well. Whether Snow’s intervention to disable the well by removing the handle of its pump really saved the day is a matter of some dispute, but his method of plotting cases and looking for concrete causes was inspirational.

Fast forward to the 1950s, where a classic study by Austin Bradford Hill and Richard Doll identified for the first time (at least, outside Germany) the link between smoking and lung cancer. Bradford Hill and Doll sent a questionnaire to doctors to measure their smoking habits, then followed up the questionnaire some years later. Those doctors who smoked were much more likely to have developed the disease and no one would seriously disagree now that active smoking is a very significant risk factor for lung cancer.

There is a proviso, however: even with smoking, the most famous of these epidemiological connections, most of those engaged in the risky behaviour - smoking - do not die from lung cancer while there are a small number of non-smokers who die from lung cancer, too. Other explanatory factors, like a genetic predisposition to developing certain cancers, a less-than-ideal diet and sheer luck seem to come together, too.

Despite the search for other similar environmental health risk factors, from passive smoking to bacon butties, epidemiology has proven to be a fairly crude tool. Austin Bradford Hill, despite the success of his groundbreaking study, advised that epidemiological methods should be applied cautiously. He listed a variety of tests that should be applied to any putative connection between a risk factor and a disease, summarised in John Brignell’s book The Epidemiologists (see my review here: http://www.spiked-online.com/index.php/site/article/2446/).

1. Strength: Is the association strong enough that we can rule out other factors?
2. Consistency: Have the results been replicated by different researchers, and under different conditions?
3. Specificity: Is the exposure associated with a very specific disease as opposed to a wide range of diseases?
4. Temporality: Did the exposure precede the disease?
5. Biological gradient: Are increasing exposures associated with increasing risk of disease?
6. Plausibility: Is there a credible scientific mechanism that can explain the association?
7. Coherence: Is the association consistent with the natural history of the disease?
8. Experimental evidence: Does a physical intervention show results consistent with the association?
9. Analogy: Is there a similar result to which we can draw a relationship?

When these tests are applied rigorously, nearly all the postulated links between risk factors and harmful effects fall apart. For example, in the case of passive smoking and lung cancer, the association is weak, it is not consistent, exposure is usually assumed rather than measured, and so on. In other words, an association between passive smoking and lung cancer is either non-existent or too weak to worth worrying about.

Let’s now turn to this new field of ‘social epidemiology’. We can see in The Spirit Level that Wilkinson and Pickett’s claims fall flat on their faces when Bradford Hill’s tests are applied. The associations are not strong, rarely rising much above ‘apparently random’; other explanations are usually both available and more plausible than the idea of inequality leading to status anxiety; other researchers, simply by minor tweaks in the data, have seen the associations disappear; and the wide selection of social problems deemed to arise from inequality is a long way from ‘specific’.

As someone who would broadly see themselves as left-wing, I find there is a more pressing problem with The Spirit Level: that it dumbs down the fight between different groups in society over the carving up of the wealth we produce from a genuine struggle for material betterment to a psychological disorder demanding intervention from on high. Seeing inequality in terms of status envy is thus actually disempowering rather than liberating. But regardless of our attitude to the political question of wealth distribution, The Spirit Level is well worth criticising as bad epidemiology, too.

Sunday 29 August 2010

15 with a bullet

I never got around to mentioning the Total Politics blog awards when the voting was taking place a few weeks ago, so it's all the more gratifying to find myself 15th in the list of top libertarian blogs. The full list is below (sorry, I can't be bothered to put in all the links but do take a butcher's here).

1 (1) Guido Fawkes
2 (3) Old Holborn
3 (2) Devil's Knife
4 (4) Obnoxio the Clown
5 Charlotte Gore
6 (13) Anna Raccoon
7 (5) Underdogs Bite Upwards
8 (6) Tim Worstall
9 (9) Dick Puddlecote
10 (7) Samizdata
11 Adam Smith Institute
12 (17) Charles Crawford
13 Captain Ranty
14 (8) Boatang & Demetriou
15 Velvet Glove, Iron Fist
16 (19) Frank Davis
17 (15) Rantin' Rab
18 (12) Constantly Furious
19 (14) Freedom2Choose
20 Big Brother Watch
21 Crash Bang Wallace
22 UK Libertarian
23 Taking Liberties
24 Corrugated Soundbite
25 (18) An Englishman's Castle
26 And There Was Me Thinking
27 (11) Last Ditch
28 Appalling Strangeness
29 (10) LPUK Blog
30 Libertarian Alliance

A big thank you to all those who have read, bookmarked and commented on this blog since it was set up in September of last year. I hope you've enjoyed it.

And for all the people who stumbled across it while searching for niche websites involving fists and gloves, I'm sorry if this blog left you unfulfilled but I hope you found what you looking for elsewhere on the internet.

Saturday 28 August 2010

Competing interests?

The staff of the UK Centre for Tobacco Control Studies have written a letter to The Lancet calling on the government to continue its funding of tobacco control organisations:

The Government is reducing the size of the tobacco policy team in the Department of Health and closing most of the regional offices of tobacco control...

Improving public health is something that we all need to take seriously, and since the prevention of smoking has more potential to improve public health, and to do so quickly, than any other intervention, tobacco control should be a key government priority.

They say that the cost-cutting is surprising "given Lansley's wish to base policy on evidence" (stop giggling at the back). This all looks like standard rent-seeking, but what took my eye was this:

We declare that we have no conflicts of interest.

Really? Some people would say that working for a state-funded tobacco control group necessarily constitutes a competing interest if you're writing in support of state-funding of tobacco control groups. Be that as it may, we know that many of the authors have competing interests because they have already declared them on their website:

John Britton chairs the Royal College of Physicians Tobacco Advisory Group and is a member of the board of trustees of Action on Smoking and Health.

Peter Hajek undertakes consultancy for and has received research funds from a number of companies developing and manufacturing smoking cessation products.

Paul Aveyard has accepted hospitality from the pharmaceutical industry. He has done consultancy and research work in smoking cessation for Pfizer, McNeil, and Xenova Biotechnology that has led to payments to him and his research account.

Linda Bauld is vice-chair of the Cancer Research UK Tobacco Advisory Group and serves as Scientific Adviser to the Department of Health on tobacco control.

Tim Coleman has, within the last 5 years, done occasional consultancy work for companies that manufacture NRT products (Johnson and Johnson, Pierre Fabre Laboratories). He has also advised a Public Relations company on the strength of the evidence for using Nicobloc as an aid for smoking cessation.

Robert West undertakes research and consultancy for companies that develop and manufacture smoking cessation medications. He has a share of a patent for a novel nicotine delivery device. He is a trustee of QUIT. His research is funded mostly by Cancer Research UK.

So what gives? Does The Lancet have a more relaxed policy on the declaration of competing interests thatn the UKTCS? Did the authors not consider their competing interests relevant in this instance? Or did they just forget?

Thanks for Michael McFadden for the tip.

Tuesday 24 August 2010

A review of Nudge by Richard Thaler & Cass Sunstein

I first came across the term 'libertarian paternalism' in 2008 when Julian Le Grand proposed making smokers buy smoking permits. Le Grand was, and is, a classic Blairite—Eton-educated, champagne socialist, illiberal, wonk—and like all Blairites, he was obsessed with branding. Specifically, he was obsessed with finding friendly buzz-words to help sell unpleasant ideas.

Libertarian paternalism sounds better than authoritarianism. Nudging sounds better than shoving. And so it was that one of the least liberal public health policies imaginable was allowed to be prefixed with the word 'libertarian'. As I wrote in Velvet Glove, Iron Fist, this was an oxymoronic piece of doublespeak if ever there was one.

The idea did not go down well. As Julian the Great later said:

My e-mail inbox exploded. Mostly with pictures of Hitler, I have to say. People were very hostile to that sort of idea. So, although the nudge agenda, I think, does have possibilities I think care has to be taken that people don't feel that it's the nanny state, indeed the nanny state squared.

It is interesting that Le Grand has no voice on his shoulder telling him when he's crossed the line, and instead has to rely on the quantity of hate-mail he receives. Perhaps it's his focus-group mindset. Maybe he just lacks a moral compass. Most likely, as with many public health protagonists, he is an opportunist, lurching towards prohibition but drawing back when the public's apathy turns to disgust.

Le Grand was inspired by the ideas presented in Nudge, a book on behavioural economics written by Richard Thaler and Cass Sunstein. Thaler and Sunstein invented the phrase 'libertarian paternalism'. They also invented the phrase 'choice architecture'. You can see why this kind of management-speak appealed to the political class.

And not just in the Labour party. Nudge is said to be one of the Conservative party's favourite texts at the moment. Nudging is back in fashion and, in a shameless attempt to embrace the zeitgeist, the UK Faculty of Health titled its latest manifesto for authoritarian paternalism 'Healthy Nudges'. This document—which, in reality, is a glorified opinion poll—asserted that:

Sometimes legislation and regulation of the so-called ‘choice architecture’ are important tools for nudging people into making healthier choices.

As far the UK Faculty of Health are concerned, the kind of 'nudges' required are a ban on 'junk food' advertising, raising the minimum age of alcohol purchase to 21, reducing the speed limit in towns to 20mph, a minimum price on alcohol, banning smoking in cars and banning buy-one-get-one-free offers on food.

Since this was all I knew about Nudge, I began reading it this weekend fearing the worst. Nudging, I assumed, would be the latest euphemism for banning and prohibiting. But I was wrong. Nothing in Nudge justifies the kind of prohibitions being mooted by public health campaigners. Authoritarians will find little to console them in this book.

The underlying assumption of Nudge is that human beings are fallible, easily influenced and not always best-placed to judge what is in their own interests. Libertarians will find this a worrying premise from which to start. It echoes the Marxist concept of false consciousness and could be a charter for those who think they know what's best for people. But Thaler and Sunstein never view the public as unwitting dupes of corporations and peer-pressure. Rather, they view people as fundamentally sensible, if not always well informed. As such, they set significant limits on the kind of nudging that can be considered tolerable in a liberal society.

Libertarian paternalism, as defined by Thaler and Sunstein, aims to help people make the best decisions without obstructing those who still wish to make the 'wrong' decisions. In any government intervention, the costs to liberty and the economy should be close to zero. They would like people to save more for their retirement, take out the right mortgage, take advantage of pension schemes, save electricity and not get ripped off by high-pressure salesmen. In practice, this means making information readily available and comprehensible, cooling off periods, warnings and easy opt-outs.

When they talk about making 'good' choices easier, they actually mean it. Unlike the UK Faculty of Health and the last British government, they do not mean banning 'bad' choices. A paternalist solution to stop foreign tourists getting run over in central London would be to ban jaywalking. The libertarian paternalist solution would be to paint 'look right' on the street. It is difficult to see this as an unnecessary intrusion on personal freedom.

Nor do they appeal to the majority to decide the fate of the minority. Nudge almost exclusively deals with helping people avoid situations they could not conceivably desire. If asked, people would generally welcome a safer, healthier or cheaper option. You want to use a sun bed? No problem, but how about we fit the sun bed with a dial to make sure it turns off after ten minutes in case you fall asleep under it? You want to gamble? No problem, but if you know you have a gambling problem how about we enable you to be able to go to a casino and ask them to ban you?

It is hard to see even hardcore libertarians objecting to most of the ideas presented, although there are exceptions. Paying teenage girls a dollar a day to not get pregnant might save the taxpayer money in the long-term but it smacks of the nanny state and encourages public to see themselves as (to quote Alexis de Tocqueville) "a flock of timid and industrious animals, of which the government is the shepherd." Presumed consent for organ donations also sits uneasily with many people—me included—who are uncomfortable with the notion of the state owning its citizens bodies. 

Presumed consent is a classic Nudge problem. There is little doubt that many people would be happy to be organ donors but have not yet registered and will never do so. There is also little doubt that presumed consent would increase the number of organs available and save many lives. If opting out was as easy as making a one-off phone call or visiting a website (as the authors propose), it is difficult to muster up too much antipathy towards it. Presumed consent is not something I am fervently against, but I would like to see a more proactive attempt to get people to register voluntarily before we contemplate coercion. Years ago, I remember donor cards being available at shop counters. All you had to do was pick one up, fill it in and keep it with you. I haven't seem them for years and I doubt this is because budgets have been slashed. There are, in other words, better ways to help make choices easier without the presumption of consent.

The strongest argument against nudging is the slippery slope. Although most of Thaler and Sunstein's ideas would be of no practical detriment to either the target group or the wider public, they do concede that the impact cannot always be reduced to zero. Having accepted that small impositions on liberty and choice are not always avoidable, where does it end?

To be fair, Thaler and Sunstein address the slippery slope argument towards the end of the book, using an apt example:

Governments that start with education might end with stiff fines and even prison terms. The case of cigarettes offers a possible example. Some nations have gone from modest warning labels to much more aggressive information campaigns to high cigarette taxes to bans on smoking in public places, and a smoker would not have to be paranoid to think that the day might eventually come when one or another nation heavily regulates or even bans cigarettes altogether... Faced with the risk of overreaching, critics might think it is better to avoid starting to slide at all. (p. 235-6)

Thaler and Sunstein's counter-argument is that (a) individual proposals should be judged on their own merits; (b) their philosophy automatically puts a limit on further legislation by insisting on low-cost opt-outs; (c) some kind of action is inevitable, so it is better for it to be a nudge than a shove.

I am not fully convinced by these assurances. It seems to me to they overlook how the slippery slope works in practice. In reality, policies are not always judged on their own merits and the appeal to precedent is powerful. How often do we find campaigners demanding that 'loopholes' be closed, despite the fact that these 'loopholes' are actually deliberate exemptions created to make the legislation reasonable in the first place? And how easy has it been for health campaigners to apply the policies first used against the "unique case" of cigarettes to a whole range of products that carry an element of risk?

It may be fallacious to claim that because we are forced to wear seat-belts, we should be forced not to smoke or eat fatty foods, but campaigners who call it 'the next logical step' are not wholly wrong. Those who opposed seat-belt laws in the 1970s did indeed warn of a slippery slope and, what's more, they turned out to be right. One needs to look no further than 'Healthy Nudges' to see the truth of this. It refers to seat-belts no fewer than six times in eight pages. The message is clear—it was for your own good then and it's for your own good now.

When the idea is raised of regulating against allowing smoking in cars when children are on board, politicians are often concerned about legislation in the “private space”. Of course, there are clear parallels with seat-belt legislation...

It is often far cheaper and longer-lasting to introduce regulations or change the law. The classic example of this is the use of seat-belts...

Did politicians of the 1970s intend compulsory seat-belts to be used as a precedent for smoking bans and tax rises? Surely not. Would they have passed the legislation had they known what it would lead to? Probably not. Saying 'we did that therefore we must do this' might be fallacious, but people are susceptible to fallacious arguments. Since Nudge revolves around the idea that human beings are fallible, this point could have been more thoroughly explored.

But perhaps this is to blame the leader for the sins of his followers (see here for an amusing example of how nudging can be abused for malign purposes). If politicians stuck to both the spirit and the letter of Thaler and Sunstein's philosophy, the nudge agenda would be largely benign and almost certainly beneficial. Far from supporting the kind of policies being pursued by the UK Faculty of Health, any British government that was genuinely committed to the Nudge agenda would have no choice but to repeal whole swaths of legislation that already cross the line between libertarianism and paternalism. But as Le Grand and the UK Faculty for Health amply demonstrated, once an idea reaches the mainstream, you no longer get to make the rules.

[Elsewhere, The Guardian (which originally gave it a glowing review) has turned against Nudge for being too libertarian. For an alternative view, Spiked criticised Nudge for being too paternalistic. Who you agree with will depend on your politics.]

Monday 23 August 2010

Start the week

More blogging later. Until then, a few articles worth reading...

In The Independent, Nigel Hawkes takes on the argumentum ad peer-review. While I think it's a bit much to say that "peer-reviewed journals aren't worth the paper their printed on", it is certainly true that peer-review does not bestow a stamp of truth, nor was it ever intended to be. And, as regular readers will know, there are plenty of individual studies that aren't worth the paper they're printed on.

The truth is that peer review is largely hokum. What happens if a peer-reviewed journal rejects a paper? It gets sent to another peer-reviewed journal a bit further down the pecking order, which is happy to publish it. Peer review seldom detects fraud, or even mistakes. It is biased against women and against less famous institutions. Its benefits are statistically insignificant and its risks – academic log-rolling, suppression of unfashionable ideas, and the irresistible opportunity to put a spoke in a rival's wheel – are seldom examined.

This didn't matter much when peer review was just a private game for academics. If it made them feel better, that was nice. But in a sinister development, people who have published provocative or implausible claims in peer- reviewed journals have started arguing that they won't listen to criticism unless it has undergone the same laying-on of hands.

The most notorious example of this comes from the authors of The Spirit Level, a book that argues that everything from health to the level of crime, and from happiness to the quality of the toast, is better in societies that are more equal.

Professors Kate Pickett and Richard Wilkinson may well be right in this claim, though I dare say that we can all think of a few exceptions.

What isn't right, however, is their claim that as "almost all" the research that went into The Spirit Level was peer-reviewed, all future debate on the subject should take place in peer-reviewed publications. Come off it, profs, you're pulling our leg, surely? If you're writing a book about a hugely political subject such as inequality, you've surrendered any right to hide behind the flak-jacket of peer review.

I wrote in the comments:

As one of the aforementioned critics of The Spirit Level, the 'argumentum ad peer-review' falls flat for two reasons:

Firstly, the claim that "almost all" of the research in the book has been peer-reviewed is deeply misleading. It is not the research, but the conclusions, that count. Most of the studies cited do not even mention inequality. Instead, they say x has gotten worse, x is associated with y, and then Wilkinson and Pickett jump in to say that y is caused by inequality. That crucial third assumption is where it breaks down. Making conclusions based on other people's work is not the same thing as having those people on your side. There is a much larger body of peer-reviewed research telling us what really causes x and y, but it goes unmentioned in The Spirit Level.

Secondly, it is foolish to think you can take your message directly to the public with a populist paperback and a media blitz, and then demand the public reply only via peer-reviewed journals. Either you stay in the academic ivory tower or you engage with the people. You can't have it both ways.

Hawkes is the director of Straight Statistics (straightstatistics.org), which is a new site to me but looks worth keeping an eye on. The most recent article questions to claims made about the effect of banning 16 and 17 year olds from buying cigarettes. See what you think.

And finally, blogger Anna Racoon is leading a campaign to help a 70 year old widow who has been told to pay £2,500 (plus expenses) for dropping what can only be described as a tiny bit of cigarette ash in the street. Words fail me.

Friday 20 August 2010

For those born yesterday

As a coda to the previous two posts...

From Katherine Huntly of the British Lung Foundation, in a letter in today's Guardian:

Smoking just one cigarette, even with the car window open, creates a greater concentration of second hand smoke than a whole evening smoking in a pub or a bar.

And from ASH's latest smoking-in-cars 'fact sheet':

Opening a window does not reduce the levels of secondhand smoke in a car to a safe level as the smoke simply blows back into the vehicle, often lingering for hours.

As Frank Zappa once said, it's not getting any smarter out there.

Thursday 19 August 2010

Glass onion

After yesterday's discussion of the "secondhand smoke in a car is x times more toxic than in the home", I've been looking again at the origins of this claim.

My first port of call was the ASH website, which has changed its fact sheet on the subject since I last visited in March. It's at the same URL because ASH have a slightly Orwellian tendency to delete old information as if it had never existed. Nevertheless, the old page said:

According to a report by the Ontario Medical Association, secondhand smoke levels in cars can be 23 times greater than in a house.

As I mentioned yesterday, the Ontario Medical Association's figure has been exposed as bogus. On their new page, ASH say:

In 2005, The State of California’s Air Resources Board (CARB) conducted a comprehensive review of studies which measured secondhand smoke particle concentrations in a variety of environments. The review found that in-car concentrations were up to 60 times greater than in a smoke-free home, and up to 27 times greater than in a smoker’s home.

And this time we have a reference: Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant, a document prepared by the California Environmental Protection Agency (Cal-EPA). It is indeed thorough, and although it never uses the "27 times" figure, it does rely on a study that came close to doing so.

The study (Offermann et al., 2002) is one I've seen referenced before but had never found. Today, after much searching, I did. It's obscure because it seems never to have been published or peer-reviewed, but it was presented at the 9th International Conference on Indoor Air Quality and Climate (book early to avoid disappointment!) in Monterey in 2002. And in it, Offermann makes a nearly-familiar claim:

The calculated exposure for a five hour automobile trip with the windows closed/ventilation off and with a smoking rate of 2 cigarettes per hour is 25 times higher than the same exposure scenario in a residence.

Given the lack of ventilation and the small size of the smoking environment, this is certainly plausible. Offermann measured respirable suspended particles (RSP) in a moving car under three different conditions and got the following readings:

(1) Windows open/ventilation off: 92 µg/m3

(2) Windows closed/ventilation on: 693 µg/m3

(3) Windows closed/ventilation off: 1,195 µg/m3

(In experiments of this kind, the idea of drivers having the windows open and the ventilation on is apparently considered too far-fetched to be worth studying.)

It is worth noting that although Scenario 1 says 'windows', it is clear from the text that only the driver's window was open. The driver also held the cigarette in his right hand despite being in a left-hand drive vehicle. And RSP levels fell to nearly zero within 60 seconds of the cigarette being extinguished.

In any case, it is not Scenario 1 that Offermann focuses on; he prefers to dwell on the much more unlikely Scenario 3. This is what he bases his "25 times higher" figure on.

Offermann's unpublished study forms the basis of Cal-EPA's own figures. Offermann didn't measure RSP in the home, but Cal-EPA found some other studies to piece the picture together. Their summary is shown below (click to enlarge):

As you can see from the top line, average RSP concentrations in smokers' homes were found to be between 44-125.6µg/m3. Average RSP levels in nonsmokers' homes were between 20-87.8µg/m3. The reason these two sets of figures are so close together is that a smoker's home is not necessarily a home with a smoker smoking (and there are other sources of RSP other than cigarettes). Studies in rooms with people actually smoking found much higher RSP concentration of between 160-5,500µg/m3—much higher than anything recorded in Offermann's car (actually it was a minivan, but let's not get bogged down in the detail.)

As I said, Cal-EPA never use any of this to say that smoking in a car is x times worse than smoking in a home or a pub. But let's speculate for a moment and say that someone (from ASH?) looked at these figures, picked the lowest home reading (44µg/m3), compared it with the highest vehicle reading (1,195µg/m3) and did a quick calculation. 1,195 divided by 44 = 27. Bingo!

And let's say they picked the lowest nonsmoking home figure (20µg/m3) and did the same thing. 1,195 divided by 20 = 60. And so, once we unravel all the layers, I think we may have found the original source of what was written in The Guardian yesterday:

Second-hand smoke can be 27 times more toxic in a car than a smoker's home, it says in a report published today.

And, to be fair to the UK Faculty of Public Health, they did mention that this was a completely unventilated car:

In a closed car, levels of second-hand smoke can be extremely high – the concentration in cars can be up to 60 times higher than in a smoke-free home, and up to 27 times greater than in a smoker’s home.

It's cherry-picking, of course, and the words "up to" should always ring alarm bells when statistics are involved. Such calculations make no attempt to find the average readings under average (real life) conditions. We could use the same set of figures to make the claim that there is nearly as little secondhand smoke in a smoky car (92µg/m3) as in a completely smoke-free house (87.8µg/m3) and, even then, only while the cigarette is burning. After that, a smoky car is less smoky than a smokefree house! 

That would be a dodgy use of statistics as well, and—lest we forget—it all hinges on an unpublished study which neither ASH nor the Faculty of Public Health appear to have read (ASH only reference the Cal-EPA report, the Faculty didn't even do that.)

Nevertheless, I owe ASH and the Faculty of Public Health an apology. I accused them of falling for someone else's bogus figure. In fact, they came with their own.

The frustrating thing is that even after all this we are no closer to getting to the source of the "23 times" claim that conquered the world on the back of a brief report in Rocky Mountain News. Offermann's study came out in 2002 and the Cal-EPA report is from 2005. But Rocky Mountain News published its story back in 1998 and the trail has long-since gone cold. Some mysteries are destined never to be solved.

UPDATE: This is a comment from Carl V. Philips, e-mailed to me after he was unable to post in the comments section:

[This is an attempt to recreate a comment I wrote but somehow managed to lose rather than submit. I am not going to redo the calculations, so I will try to do it from memory, and also try to write my long comments offline from now on!]

First, I want to say that this is great research work, Chris. Thinking of the silly attempt to hush you up re: The Spirit Level Delusion, I have to say that if half the people publishing in health science journals were even half the scientist that you are, the field would be improved enormously.

As for the ventilation in cars study itself, if you are taking this further I think there must be some problems with the numbers. Such problems do not compare to the extremists lying about what the numbers mean, of course, but it is a separate problem.

I know this is not my field, but the statistics should be pretty straightforward, and they do not seem to add up. Comparing tests 1 and 2, the air exchange rate is very similar. The half-life for a bit of air (and thus a bit of smoke) is somewhere between half and 3/4 of a minute for both of them (assuming perfect mixing). That is, a particular smoke molecule has a 50% chance of being gone in that much time. It does not seem plausible that there would be such a difference in concentration then.

But the more important one is the difference between test 3 and 2. If 3 is really right, and it is the one that the antis want to say is right, then 2 and 1 do not seem plausible. The air exchange rate in 3 translates into a half life of about eight minutes. If someone smokes a cigarette over the course of four or five minutes then the vast majority of the smoke is still in the car at the end of the period.

This compares to the other scenarios when, by the time of the last puff, almost all the smoke from the first few puffs is gone and even half the smoke from the previous puff is gone. It does not make any sense, then, that the concentration is only reduced by half in 2 compared to 3. This suggests that the numbers for a ventilated car – i.e., the worst realistic-case scenario, since as you point out, no one turns the ventilation off – are exaggerated.

An interesting comparison is that the air exchange rate (according to what I looked up) for a room in a house is in the order of 10/hour (a pub is in the range of twice that). So, though the space is much larger, the smoke lingers a lot longer. Thus, it is not entirely clear to me that the exposure in a car is actually worse. Since in a realistic car situation, the smoker who is not trying to annoy others in the car at least cracks the window, holds the cigarette near there, and exhales toward the opening (harm reduction!), typical exposure will be even lower than the best case of the tests run. It may be that momentarily the concentration is higher, but drops lower than a room fairly rapidly. The question would be “is it worse to have a higher peak exposure or lower exposure for longer” – an interesting question, but one we will never know the answer to because the millions of dollars spend studying these matters are never directed at anything practical. (Actually, we might know. There is physiologic research on effects of smoke being done by industry, even though the “health” people are not interested in gaining useful knowledge about reducing effects, and so someone might find something relevant.)

Anyway, the bottom line is that the actual difference between smoking in a car with someone or a room of a house is not actually large and it is not even clear which is a greater exposure under realistic conditions.

Wednesday 18 August 2010

Before the truth could get its shoes on

There's a sense of deja vu in the air today. This, from The Guardian:

Second-hand smoke can be 27 times more toxic in a car than a smoker's home, it says in a report published today.

The report in question comes from the UK Faculty of Public Health, which says:

In a closed car, levels of second-hand smoke can be extremely high – the concentration in cars can be up to 60 times higher than in a smoke-free home, and up to 27 times greater than in a smoker’s home.

60 times smokier than a house with no smoke in it? Don't ask me, I've given up trying to figure out their logic. Presumably it has something to do with measuring nanograms of some biomarker—not what you or I would call 'smoke'.

But let's ignore that, and let's ignore fact that people very rarely smoke in a "closed car". The main point, as Dick Puddlecote has pointed out, is that this "27 times greater" myth has been thoroughly debunked. Or rather, the "23 times greater" myth, as it seems to have been further embellished since I discussed it back in March, when I traced it back to an obscure article in that prestigious scientific journal Rocky Mountain News.

Two months later, the Canadian Medical Association Journal published an article by Becky Freeman and Ross MacKenzie which not only concluded that the figure had no basis in fact, but actively encouraged fellow anti-smoking campaigners not to use it.

We recommend that researchers and organizations stop using the 23 times more toxic factoid because there appears to be no evidence for it in the scientific literature.

The CMAJ article is behind a pay-wall, but it tells the story with this graph (click to enlarge). [UPDATE: You can read it here.]

This little tale of Chinese whispers does not just involve local newspapers not bothering to check their facts. After the "23 times" claim appeared in Rocky Mountain News, it was used in a Tobacco Control editorial and then mentioned in Nicotine and Tobacco Research. From there, it spread to the Ontario Medical Association and the British Columbia Ministry of Health.

By 2009, it had gone global. The Australian Medical Association, Action on Smoking and Health (Ireland), the European Lung Foundation and Action on Smoking and Health (England) were all taken in. The Sunday Times, the Irish Times and the Irish Medical Times quoted the figure. And they were not alone. Take this, for example, from the Irish Independent :

Dr Angie Brown, chairwoman of ASH Ireland, said the ban has been already introduced in several regions in Australia and the United States, while it is being considered in the Netherlands and South Africa. "There is irrefutable evidence to show that a car can be 23 times more toxic than a home environment in the context of passive smoke," she warned.

When the Royal College of Physicians campaigned for a total ban on smoking in cars in March 2010, they insisted that levels in cars were "20 times higher" than in smoky bars—a claim that fails the basic test of believability.

All of this based on an indirect quote that once appeared in a now defunct Denver newspaper.

And, despite being comprehensively and explicitly exposed as a myth in a major medical journal, here it is again, still unreferenced in a public health report and now exaggerated still further. And still, of course, appearing in national newspapers to sway public opinion.

All of which means that (a) the UK Faculty of Public Health has carried out some new research which it's keeping very quiet, (b) they don't keep in touch with what's being written in the medical journals, even when it's written by prominent tobacco control figures like Becky Freeman, or (c) they don't care about getting their facts right.

As it says in the CMAJ paper:

Unfortunately, inaccurate reporting of health information is not an uncommon phenomenon.

To put it mildly.

Car crash TV

Excellent, it's on Youtube already. From last night's That Mitchell and Webb Look, an exquisite skewering of Diana conspiracy cranks:

What's Swedish for 'appeal to authority'?

This morning saw the launch of the Swedish edition of The Spirit Level Delusion and an accompanying debate. If you speak Swedish, you can watch it here. I don't, so I've had to rely on reports of what was said, and was amused to see that The Spirit Level's Scandinavnian defenders resort to the same fallacious reasoning as those closer to home. With a mass of empirical evidence to discuss and dozens of questions to answer, this was the socialist response:

Journalist Ulrika Borg, who praised The Spirit Level as a new science, stressed that Wilkinson was a professor at three universities and has written for several major scientific journals, while the critics do not have such qualifications. She returned full time to what the majority of established scientists believe, and argued that critics are not worth listening to. Instead of discussing The Spirit Level, she seemed to imply that we should trust those with the finest qualifications and leave everything for them.

That's us told, then. Shut up and trust two social epidemiologists.

Alternatively, of course, you could listen to what these highly qualified academics have said...

"The bottom line is that this is a well-written, stimulating polemic. It nevertheless suffers from the same problems as one-trick ponies: if the one trick does not impress you, the show is a failure. Wilkinson and Pickett’s trick simply does not hold up to empirical scrutiny. When assessing this book as a contribution to the debate on the “right” level of income differences in modern society, it is a highly interesting, sympathetic attempt at addressing some of the important problems of Western societies. Yet, when assessing this book from a scientific point of view, one is forced to conclude that it is a failure."

Christian Bjornskov, Professor of Economics, University of Aarhus

"Wilkinson and Pickett have no time for nicely balanced judgements.  They believe that the evidence they present shows beyond doubt that more equal societies ‘do better’, and they are also confident that they have the right explanation for why this is so... Their case is by no means so securely established as they try to make out... it has been called into question by other leading figures in the field – a fact that WP might have more fully acknowledged... WP’s inadequate, one-dimensional understanding of social stratification leads to major problems in their account of how the contextual effect is produced."

John Goldthorpe, Emeritus Professor of Sociology, Nuffield College, Oxford

"The book [The Spirit Level] will probably irritate most economists, including those like me who are sympathetic to its basic stance... One source of irritation is the authors’ apparent belief that the application of regression methods to economic and social statistics is as novel to social science as it apparently is to medicine.  The evidence presented in the book is mostly a series of scatter diagrams with a regression line drawn through them.  If you remove the bold lines from the diagram, the pattern of points mostly looks random, and the data dominated by a few outliers...

An obvious conclusion is that there are many societies which perform well in terms of their own criteria.  America, Sweden and Japan are just different from each other.  Their achievements are not really commensurable. But Wilkinson and Pickett are not content with this relativist position."

John Kay, Professor of Economics at London Business School and former Director of Institute of Fiscal Studies

"The evidence in The Spirit Level is weak, the analysis is superficial and the theory is unsupported."

Peter Saunders, Emeritus Professor of Sociology, University of Sussex

"I had strong suspicions about [The Spirit Level's] hypothesis and now a book has come along which I strongly recommend. The Spirit Level Delusion not only successfully and dramatically undermines much of the evidence in The Spirit Level, but also takes on the other fashionable opponents of economic growth. Author Christopher Snowden finds that social ills have many causes and that we need an economic system – free-market capitalism – that encourages economic growth if we are to have a flourishing society. His engaging discussion unpicks the evidence of the anti-growth brigade and demonstrates that it is selective and partial."

Professor Phillip Booth, Institute of Economic Affairs

“The analyses reported here have provided strong evidence that Wilkinson’s ecological approach to the study of the links between income, income inequality and health status is potentially flawed; his claim for a contextual relationship is not sustained when an underlying compositional relationship is also tested for... Wilkinson’s argument regarding contextual influences was based on a statistical artifact.”

Min Hua Jen, Imperial College, Kelvyn Jones, Professor of Human Quantitative Geography, Univ of Bristol, Ron Johnston, Professor of Geography, University of Bristol

"Although many aspects of this debate are still unresolved, it has recently become clear that the findings of that paper [Wilkinson, BMJ, 1992] were an artifact of the selection of countries... the evidence for a correlation between income inequality and the health of the population is slowly dissipating’

Johan Mackenbach, Professor of Public Health, University of Rotterdam

"Much of the literature needs to be treated sceptically, if only because of the low quality of much of the data on income inequality. Although there are many puzzles that remain, I conclude that there is no direct link from income inequality to ill-health; individuals are no more likely to die if they live in more unequal places.”

Prof. Angus Deaton, Professor of International Affairs and Professor of Economics and International Affairs at the Woodrow Wilson School and the Economics Department at Princeton

"The preponderance of evidence suggests that the relationship between income inequality and health is either non-existent or too fragile to show up in a robustly estimated panel specification.  The best cross-national studies now uniformly fail to find a statistically reliable relationship between economic inequality and longevity."

Andrew Leigh, Professor of Economics, Australian National University, Christopher Jencks, Malcolm Wiener Professor of Social Policy, Harvard Kennedy School, Timothy Smeeding, Distinguished Professor of Public Affairs, University of Wisconsin (The Oxford Handbook of Economic Inequality, 2009)

The choice is yours.

[PS. If any Swedish visitors do watch the video, can you let me know how it went?]

Quote of the day...

...comes from Jeff Stier of the American Council on Science and Health, discussing the sacking of James Enstrom:

“They fired him because he allegedly went beyond the science of his paper, and inserted his own opinion,” says ACSH’s Jeff Stier. “If that were the standard that the University of California system used for firing people, they’d be left with no professors.”

Indeed. And, for no particular reason at all, here's a photo of UCSF's Prof. Stanton Glantz with the newly promoted Prof. Anna Gilmore:

Tuesday 17 August 2010

Equality bluff

It's time to say hello to the Swedish visitors to this blog (yes, we have some). Hej! I greet you with the following message:

Välkommen till boklansering: Jämlikhetsbluffen.

Årets akademiska kioskvältare, Jämlikhetsanden av Richard Wilkinson och Kate Pickett, har hyllats i Sverige för sina "forskningsunderbyggda argument" och för "övertygande och välargumenterade förslag". "Jämlikhetsforskarna" menar att graden av ojämlikhet i ett samhälle påverkar hur vi mår både fysiskt och psykiskt; hur länge vi lever; hur mycket kriminalitet och våld som finns; kort och gott är orsak till alla samhällsproblem.

I boken Jämlikhetsbluffen granskar journalisten Christopher Snowdon dessa påståenden. Han visar hur forskarna jämfört äpplen och päron. Och hur de konsekvent undvikit siffror och obekväma sanningar som riskerar att underminera deras tes. På sida efter sida smular Christopher Snowdon metodiskt sönder Wilkinsons och Picketts undermåliga argument och ofullständiga underlag.

På seminariet presenteras Jämlikhetsbluffen av välfärdsforskaren Andreas Bergh som skrivit förordet. Boken kommenteras av Ulrika Kärnborg och Daniel Suhonen. Moderator är Håkan Tribell.

Andreas Bergh är välfärdsforskare vid Lunds Universitet, Ratio och IFN. Föreläsare i nationalekonomi och författare till ett flertal böcker.

Ulrika Kärnborg är journalist och författare. Hon var länge litteraturkritiker i Dagens Nyheter och är i dag frilansskribent.

Daniel Suhonen är chefredaktör för SSU:s tidskrift Tvärdrag. Han är redaktör till antologin Vårt sätt att leva kommer att ändras (Leopard 2010).

Håkan Tribell är chef för Timbro Idé.

Roughly translated, that means that The Spirit Level Delusion is published in Sweden this week (as Equality Bluff, Equality Scam or, most likely, Equality Delusion). There is a book launch and a debate in Stockholm tomorrow. I won't be there because, despite the millions I supposedly rake in from Big Tobacco, Big Oil, Big Burgers and all of the other cigar-chomping capitalists who secretly run the world, I haven't got a penny to my name.

However, the publishers have assembled a distinguished panel who will debate the issues. Let's hope it relies a bit less on paranoid and unfounded ad hominem attacks than the current debate in the UK. Details here.

James Enstrom sacked by UCLA

Very worrying news from the People's Democractic Republic of California, where James Enstrom has been fired from the University of California, Los Angeles because "your research is not aligned with the academic mission of the Department". Readers may know Prof. Enstrom from the British Medical Journal study (Enstrom and Kabat, 2003) which found no association between secondhand smoke and lung cancer and heart disease.

That study is not the official reason for his dismissal—he has recently been studying air pollution—but it seems that it has cast a long shadow:

Beate Ritz, a leading air pollution scientist with UCLA who works in the Epidemiology Department, did respond.

She said she hadn't read Enstrom's 2005 study on air pollution.

But, based on his 2003 findings that second-hand cigarette smoke doesn't kill people, she said she knows him "for letting his interpretations go beyond the data and his personal biases to be strong enough to not allow for a balanced and appropriately cautious interpretation of the numbers."

Her attitude wasn't surprising to Enstrom, who said his 2003 paper, published in the British Medical Journal, was widely attacked.

"Not a single error was ever identified in that paper and I refuted all claims made against me and my research," he said. "My work isn't about being politically correct, it's about honest research and being faithful to the science."

Frankly, I don't know what's been going on. The news is here and Carl V. Phillips has this to say. Please read both.

Thursday 12 August 2010

A dark day for satire

Do my eyes deceive me or is public health jumping the shark yet again?

This, from the Beeb:

'Give out statins with junk food'

Fast food outlets should consider handing out cholesterol-lowering drugs to combat the effects of fatty food, say UK researchers.

Taking a statin pill every day would offset the harm caused by a daily cheeseburger and milkshake, the Imperial College London team said.

It would only cost 5p a customer - similar to a sachet of ketchup.

Doesn't look good, does it? But before we over-react, we all know how the media can exaggerate research findings for dramatic effect. So let's have a look at what was written in the actual study...

Routine accessibility of statins in establishments providing unhealthy food might be a rational modern means to offset the cardiovascular risk. Fast food outlets already offer free condiments to supplement meals.

A free statin-containing accompaniment would offer cardiovascular benefits, opposite to the effects of equally available salt, sugar, and high-fat condiments.

Okay. Checked it, and that's what it says. WTF? Have these people have gone stark staring mad? Prescription drugs handed out in McDonalds to any random person that wanders in off the street?! Prescription drugs (made by GlaxoSmithKline) which have prescription-level side effects being equated with sachets of ketchup?! Hell, let's just pump the stuff into the water supply and be done with it.

It is now officially impossible—even in the depths of an absinthe-induced hallucination—to come up with a spoof that would out-parody the schemes of public health. These people are going to put The Onion and The Daily Mash out of business.

UPDATE: As if to prove my point, I see that my little joke about pumping statins into the water supply has indeed been seriously mooted, way back in 2004: Statin-fortified drinking water?

Wednesday 11 August 2010

The swine that flew

So, it's out with the old and in with the new...

August 10th 2010:

Swine flu pandemic over, says world health body

The swine flu pandemic has been declared officially over by the World Health Organization.

Millions of people were affected across the world by the infection after it emerged in April last year. But the pandemic - the first for 40 years - proved much less deadly than many had feared.

In the UK, more than 450 people died, but that was well short of the 65,000 predicted as the worst-case scenario.

August 11th 2010:

Superbug NDM-1 To Kill Millions Unless New Antibiotics Found

A new superbug NDM-1 which is resistant to almost every antibiotic is poised to spread and wreak havoc across the world unless new antibiotics are developed quickly warns the UK Health Protection Agency.

As we now know, swine flu was a scandalously expensive health scare. Aided and abetted by that self-aggrandising, fear-mongering old crank Sir Liam Donaldson, a relatively mild influenza bug was turned into a multi-billion dollar cash cow for the pharmaceutical industry (this being his second attempt to generate panic in this way).

Donaldson's eagerness to have a bona fide pandemic on his hands was shared by the World Health Organisation, who—according to Tom Jefferson, a researcher for the international Cochrane Centre—changed the very definition of the word:

"On 1 May the WHO's global pandemic website had the old definition of an influenza pandemic, which included very large numbers of cases, complications and deaths," he said.

"By 4 May that definition had disappeared and what remained was simply a new virus which spreads rapidly and infects very many people."

By September, the grim reaper remained conspicuous by his absence. Donaldson ratcheted up fears as winter drew closer, resolutely ignoring the fact that the Australian flu season had come and gone with a mere 162 deaths—a fraction of the 3,000 lives that normal flu typically claims. Virologists could see that a winter epidemic was never on the cards:

Dr Stoehr believes that, over the course of last summer, after a Phase 6 pandemic was declared, the WHO failed to read the signs about swine flu coming from the southern hemisphere winter.

"In July and August the Australia and New Zealand national influenza centres were indicating the southern hemisphere outbreak was mild," he said.

"Virologists, myself included, thought well, it's not so likely that this virus will become more severe."

Nevertheless, Donaldson described swine flu as the "biggest challenge [to the NHS] in a generation" and predicted that a third of the UK population would come down with the virus in the winter. In an act of near-insanity, the British government ordered 110 million doses of the swine flu vaccine Tamiflu, the Department of Health ordered 32 million face masks and the Home Office made plans to dig mass graves.

In the event—despite the coldest winter for 30 years—there were fewer deaths than in the average flu season. The final death toll was 450—0.7% of the 65,000 predicted in Donaldson's worst-case scenario. Of these 450 deaths, only 70 could be solely attributed to swine flu.

Like all disciples of the precautionary principle, Donaldson could attribute the low death toll to his own policies. But there were even fewer deaths in Poland, whose government did not buy a single dose of Tamiflu.

In truth, it was obvious within a week of the initial outbreak that swine flu was not going to be a major killer. If it was going to slay millions, it would have done so in crowded and poverty-stricken Mexico City, where the scare began. Clearly, this was a fairly contagious but not very potent disease. Swine flu single-handedly brought the phrase "chronic underlying health problems" into the popular lexicon, as they seemed to be a prerequisite for any swine flu-related death. The chance of dying from the disease once you contracted it was 0.0001%.

There is now a substantial body of evidence that the over-reaction was largely due to the excessive influence of Big Pharma. This from The Guardian:

Scientists who drew up the key World Health Organisation guidelines advising governments to stockpile drugs in the event of a flu pandemic had previously been paid by drug companies which stood to profit, according to a report out today.

Wolfgang Wodarg, former chairman of the Council of Europe Health Committee called the swine flu frenzy "one of the greatest medicine scandals of the century."

"It's just a normal kind of flu. It does not cause a tenth of deaths caused by the classic seasonal flu. The great campaign of panic we have seen provided a golden opportunity for representatives from labs who knew they would hit the jackpot in the case of a pandemic being declared.

"We want to clarify everything that brought about this massive operation of disinformation. We want to know who made decisions, on the basis of what evidence, and precisely how the influence of the pharmaceutical industry came to bear on the decision-making."

So what of today's news? Firstly, let's remember that the NDM-1 bug is not in the news because there has been a sudden outbreak. The media are only reporting a paper that has just been published in The Lancet, which studied 37 of the approximately 50 cases that have been reported in the UK over the last two years. According to the BBC: "For some of the patients the infection was mild, while others were seriously ill, and some with blood poisoning." The low infection rate and very low mortality rate do not suggest we are looking at an epidemic. The Lancet study emphasised the need to monitor NDM-1, which would obviously be sensible. The more hysterical claims are the media's alone.

Don't go digging any mass graves just yet.

Monday 9 August 2010

Regressive taxation

I'll be damned if I can find anything in the news to blog about today, so here's a link to a study that was tweeted by Ben Goldacre yesterday:

Smoking and Ill Health: Does Lay Epidemiology Explain the Failure of Smoking Cessation Programs Among Deprived Populations?

The resistance of disadvantaged groups to anti-smoking advice is remarkable. In relation to the study of differing cultures, there is a long-standing academic tradition assuming that behavior that may otherwise be difficult to understand is indeed rational within particular cultural contexts.

Persistent smoking among the most deprived members of society may represent a rational response to their life chances informed by a lay epidemiology. Health promotion initiatives designed to reduce smoking among members of these groups may continue to fail unless the general health and life chances of such individuals are first improved.

The study (from 2003) confirmed the fairly obvious observation that those on the lowest incomes are most resistant to anti-smoking campaigns. There is a strong social gradient to smoking prevalence which didn't exist fifty years ago.

Although not explored in this study, one result is that taxing cigarette is about the most regressive form of taxation imaginable. Anti-smoking campaigners argue that those on low incomes benefit disproportionately from higher tobacco duty because, since they are least able to afford it, they will be most likely to quit smoking. They say that "a disproportionately number of lives of the poor are likely to be saved by a cigarette tax." It's a nice piece of rhetoric and for most products it would hold true (price relative to income affects consumption).

But tobacco is not most products and this simple economic formula does not take into account why people smoke. The proof of the pudding is in the eating and history is a better guide than economics on this issue. Decades of experience have shown that raising tobacco duty widens both health inequalities and financial inequalities. And while smoking is obviously linked to poor health, so is poverty. 

Few politicians are eager to acknowledge, let alone address, this thorny issue. Tobacco duty raises around £13 billion a year in the UK.

Thursday 5 August 2010

Peer review, The Spirit Level and the appeal to authority

Brendan O'Neil has written a great piece at Spiked on the subject of peer review (with a few quotes from me). The article was inspired by the ongoing debate about The Spirit Level, and its authors attempt to confine it to peer reviewed journals.

The irony is that the authors owe their success in spreading their political message to writing a book for the mass market. This book was not peer-reviewed (obviously - although it refers to peer-reviewed studies, as mine does), and many of the statements they have made in the mainstream media would never get past peer review. Having engaged with the real world, they seem keen to withdraw to the confines of academia at the first sign of trouble.

Since it was published last year, The Spirit Level – Kate Pickett and Richard Wilkinson’s book on why equal societies do better than unequal ones – has become a sparkplug for heated, testy debate. Not one, not two, but three pamphlet-length critiques of it have been published, while others have rushed to man the book’s intellectual barricades (‘This book’s inconvenient truths must be faced’, said a Guardian editorial).

Yet now Pickett and Wilkinson have imposed an extraordinary condition on future debate about their book. Because much of the criticism of The Spirit Level has consisted of ‘unsubstantiated claims made for political purposes’ (in their view), ‘all future debate should take place in peer-reviewed journals’, they decree.

Wow. In one fell swoop they have painted any criticism of their book that appears in non-peer-reviewed journals as somehow illegitimate. They snootily say that ‘none of [the] critiques are peer-reviewed’ and announce that from now on they’ll only engage in discussions that ‘take place in peer-reviewed journals’. So any peep of a critique that appears in a newspaper, a book published by a publishing house that doesn’t do peer review, a non-academic magazine, an online magazine, a blog or a radio show – never mind those criticisms aired in sweaty seminar rooms, bars or on park benches – is unworthy because it hasn’t been stamped with that modern-day mark of decency, that indicator of seriousness, that licence which proves you’re a Person Worth Listening To: the two magic words ‘Peer Reviewed.’

This is not to say that peer review isn't important. It is clearly better than the alternative. The problem, as Brendan says, is more to do with public perception and the inclination of some researchers to appeal to authority.

Being peer-reviewed no longer simply means that you wrote an academic report that was considered by other academics to be serious enough for publication – it means you possess the truth, Pure Knowledge, elevated insights that are not available to mere mortals who have not been PR’d...

To be peer-reviewed is to have the right to speak publicly on important matters – to be non-peer-reviewed makes you immediately untrustworthy, a bit of an intellectual charlatan, possibly even suspect in your motives.

The Spirit Level provides a useful example here. It owes much of its success to the simplicity of its evidence, but this simplicity—and the fact that all the data used are publicly available—makes it easy for anybody to check. It doesn't require a PhD in social epidemiology to take data from the United Nations website and plot it on a graph. And, as I show in my most recent book, the evidence simply doesn't stand up (and, if you want to appeal to authority, several distinguished professors have said the same thing).

Remember, we're not talking nuclear physics here. We're talking about the most basic statistical fact-checking of the most basic type of epidemiological study. If a scientist tells me there are black holes in the Universe I'm happy to take his word for it. If a social epidemiologist tells me that life expectancy is higher in Cuba than it is in America, I'm going to check it. And if she's wrong I'm going to say so.

As Brendan concludes:

It is ironic that Pickett and Wilkinson, so very keen on the idea of equality, don’t like the idea of an equal right to speak and critique. In this area of life, their attitude is: ‘If you’ve been peer-reviewed, let’s talk. If not? Screw you.’

Go read.


More Spirit Level-related discussion at The Taxpayers' Alliance. There is also an exhaustive list of links covering the debate of the last month on the right-hand side of The Spirit Level Delusion website.

Wednesday 4 August 2010

New Zealots

Having mentioned yesterday the anti-tobacco extremism in the Antipodes, it is timely that ASH (New Zealand) have popped up to make my point for me. New Zealand is one of the few places in the world where anti-smoking campaigners don't even bother pretending not to be prohibitionists, hence...

Smoking: Majority of NZers want sales banned

The majority of New Zealanders support an end to commercial tobacco sales by 2020, a UMR Research survey has found.

You can guess who commissioned this survey.

ASH spokesman Michael Colhoun said the results released today showed the public believed "enough is enough" and it was time for strong action to be taken on tobacco.

"The momentum has been built up over the past year, including the tobacco excise increase and I think we've reached a tipping point," said Mr Colhoun.

Now then. It is possible that the majority of New Zealanders do want smoking banned in the next 9 and a half years (although the comments to this article suggest that perhaps they don't). Admittedly, it would make New Zealand rather unusual since every survey since the 1960s has shown that only 30% or so of the population harbour such prohibitionist thoughts.

But even if there is now a Kiwi majority, I'm not convinced that this question is sufficiently robust to separate the hardcore from the merely confused:

The survey, for anti-smoking group Action on Smoking and Health (ASH), asked 750 respondents if they agreed or disagreed that "New Zealand should be a completely Smokefree nation by 2020. This means smoked tobacco would not be widely available for sale."

Fifty-nine percent of respondents "agreed" or "strongly agreed" with the statement, ASH said.

"Tobacco would not be widely available for sale"? What the hell does this mean? It wouldn't be widely available in playgrounds? It wouldn't be widely available in tobacconists? And didn't New Zealand become a 'smokefree nation' when it brought a smoking ban in back in 2004? Weren't they told, like we Brits were, that that was what 'going smokefree' meant?

To ASH, it seems, "not widely available" means completely illegal and "smokefree" means banning the sale, purchase and consumption of smoked tobacco. So if that's what they mean—and if that's how they're going to spin it in a press release—why don't they ask people if they want tobacco to be completely illegal? Could it be because they wouldn't get quite the same answer?


These people are deadly serious.

Mr Colhoun says while the crackdown on tobacco will be heavy; people who wish to grow their own tobacco can continue to do so.

“At the moment you can grow up to 15kg a year for personal use; people who want to put tobacco plants in their backyard – they can do that and we’ll never end that,” he says.

Of course not. Why, that would be excessive.

So there you have it—a cast-iron guarantee from ASH (New Zealand) who, 25 years ago, were calling for a smoking ban on domestic flights. Not on international flights obviously. Or in bars and restaurants. That would have been excessive.