Quotulatiousness

June 25, 2014

“The only serious black mark against the NHS was its poor record on keeping people alive”

Filed under: Australia, Britain, Cancon, Europe, Government, Health, USA — Tags: , — Nicholas @ 07:25

Britain’s NHS came in for rave reviews in a recent study that compared healthcare systems in several European countries and the Anglosphere. There was, as John Kay points out, only one minor flaw in the way the measurements were weighted:

“NHS is the world’s best healthcare system” was a headline last week in The Guardian newspaper. However, six paragraphs in, the authors observed: “The only serious black mark against the NHS was its poor record on keeping people alive.” Further investigation was clearly required.

The newspaper was reporting a survey of health provision by the US-based Commonwealth Fund in 11 advanced countries: seven European states, the US and Canada, Australia and New Zealand.

The findings use measures of service quality, mainly derived from judgments by patients. The effectiveness of care is judged by the intensity of preventive activity – whether necessary tests are carried out, whether doctors advise on a healthy lifestyle – and the reliability of management of chronic conditions.

The safety of care is judged by the frequency of medical mistakes, and the incidence of hospital-induced infection. Good care is patient-centred and timely, with necessary treatment easily accessible. The survey also reports measures of efficiency, or more often inefficiency – how great is the burden of medical administration, how much unnecessary use is made of emergency services, how reliably test results reach medical professionals.

The UK’s National Health Service is at or close to the top on almost all these indicators, and its health spending per head is the second lowest in the survey. The US system scores badly on everything except preventive care, and US medical costs are off the scale when compared with other countries.

The problem, however, is that when it comes to keeping you alive, the World Health Organisation puts Britain tenth out of 11; only the US is worse. If your objective is to live a healthy life, go to France. Medical outcomes are judged by reference to three measures: avoidable mortality, infant mortality, and healthy life expectancy at age 60. And the NHS does not do well on these metrics.

June 23, 2014

QotD: Modern Autism

Filed under: Health, Quotations — Tags: , — Nicholas @ 00:01

There are, I believe, a few reasons to suppose that autism is a particularly fascinating area to be studying at the moment. What are those reasons? Firstly, prevalence rates of autism have soared in recent decades, from 1:2,500 in 1978 to around 1:100 today: a staggering 25-fold increase. Secondly, and simultaneously, the nature of those receiving a diagnosis of autism has changed considerably. To give just one example, in the 1980s no more than twenty percent of individuals diagnosed with autism had an I.Q. above 80. Today, by contrast, it is widely argued that “intellectual disability is not part of the broader autism phenotype… [and] the association between extreme autistic traits and intellectual disability is only modest” (Hoekstra et al. 2009: 534). Whatever you make of I.Q. scores, this changing profile means that it is reasonable to assume that when you meet somebody with autism today they are quite unlikely to be similar to someone you would’ve met with the same diagnosis just thirty years ago. Thirdly, as the number of people diagnosed with autism has increased, and as the capabilities of those individuals has increased, a (self-)advocacy network of enormous importance and influence has arisen, perhaps on a scale hitherto unseen. When woven together, these dynamic elements have led Ian Hacking to claim that, in autism, “we are participating in a living experiment in concept formation of a sort that does not come more than once in a dozen lifetimes” (Hacking 2009: 506). This, I think, is quite exciting.

Gregory Hollin, “Autism, sociality, and human nature”, Somatosphere, 2014-06-18.

June 18, 2014

QotD: Obesity and the federalization of food

Filed under: Bureaucracy, Food, Government, Health, Quotations — Tags: , — Nicholas @ 06:35

One of the problems with scrupulously “sanitized” food is that it doesn’t taste of anything very much, which may be why people consume it in large quantities: With food, if the taste doesn’t satisfy you, you chow until the sheer quantity does. I’ve no research on the subject and my theory may be as full of holes as a Swiss cheese, but the fact is that the federalization of food has coincided with the massive expansion of obesity in America, and I’m inclined to think these two things are not unrelated.

Mark Steyn, “Cheeseboarder Patrol”, SteynOnline.com, 2014-06-12.

June 12, 2014

QotD: Regulating cheese

Filed under: Bureaucracy, Food, France, Health, Quotations, USA — Tags: , , — Nicholas @ 07:00

France, for all its faults, has genuinely federalized food: a distinctive cheese every 20 miles down the road. In America, meanwhile, the food nannies are lobbying to pass something called the National Uniformity for Food Act. There’s way too much of that already.

The federalization of food may seem peripheral to national security issues, and the taste of American milk — compared with its French or English or even Québécois equivalents — may seem a small loss. But take almost any area of American life: what’s the more common approach nowadays? The excessive government regulation exemplified by American cheese or the spirit of self-reliance embodied in the Second Amendment? On a whole raft of issues from health care to education the United States is trending in an alarmingly fromage-like direction.

Mark Steyn, “Live Brie or Die!” SteynOnline.com, 2014-03-13

June 8, 2014

Regulating cosmetics

Filed under: Business, Government, Health — Tags: , , — Nicholas @ 11:43

Jeffrey Tucker discusses the coming crash in the world of make-up:

The organization Campaign for Safe Cosmetics doesn’t just want you to be able to have new choices about the makeup or other products you buy. It wants the FDA to be able to ban and recall products. It will decide for you what is and isn’t safe.

And it is prevailing against the industry itself, which has no interest whatsoever in selling unsafe products, but precisely the opposite. The industry is already ridiculously overregulated.

What’s the excuse? The usual nonsense about safety and security and health, along with predictable headlines about how your shampoo is giving you cancer. There is a crowd of lobbyists backed by regulators who seem to believe that all of modernity is corrupting and horrible and must be reversed until we are living in the most-primitive state of being, sans makeup, of course.

In other words, cosmetics are going the way of everything else. The quality of the product will be depleted by regulations, just as with indoor plumbing, electricity, cars, light bulbs, soaps and gas-powered tools. Entrepreneurship will be hindered and truncated. Innovation will stop. In a few years, you will wonder: Whatever happened to makeup and deodorant and hair spray that actually works? Prepare: The end is near!

Already, I’ve heard many women complain that cosmetics today are far worse than they were 10 years ago. The colors don’t behave they way they should, and color is mainly what the FDA currently controls. I don’t doubt that whatever problems exist are due to government regulations. Whenever you see consumer products that decline in quality to the point that you have to pay vastly more for something of good quality, or that high quality suddenly becomes completely unavailable, you will find the hand of government if you look hard enough.

June 2, 2014

Six “red flags” to identify medical quackery

Filed under: Health, Media — Tags: , , — Nicholas @ 10:01

Dr. Amy Tuteur shares six things to watch for in health or medical reporting, as they usually indicate quackery:

Americans tend to be pretty savvy about advertising. Put a box around claims, annotate them with the words “paid advertisement” or “sponsored content” and most people approach those claims warily. Unfortunately, the same people who are dubious about advertising claims are remarkably gullible when it comes to quackery.

That’s the bad news. The good news is that it is surprisingly easy to tell quackery apart from real medical information. Quack claims are typically decorated with red flags … if you know what to look for. What follows is a list of some of those red flags.

1. The secret knowledge flag: When someone implies they are sharing secret medical knowledge with you, run in the opposite direction. There is no such thing as secret medical knowledge. In an age where there are literally thousands of competing medical journals, tremendous pressure on researchers to publish papers, and instantaneous dissemination of results on the Internet, nothing about medicine could possibly be secret.

2. The giant conspiracy flag: In the entire history of modern medicine, there has NEVER been a conspiracy to hide lifesaving information among professionals. Sure, an individual company may hide information in order to get a jump on competitors, or to deny harmful effects of their products, but there can never be a large conspiracy because every aspect of the healthcare industry is filled with competitors. Vast conspiracies, encompassing doctors, scientists and public health officials exist only in the minds of quacks.

[…]

4. The toxin flag: I’ve written before that toxins are the new evil humors. Toxins serve the same explanatory purpose as evil humours did in the Middle Ages. They are invisible, but all around us. They constantly threaten people, often people who unaware of their very existence. They are no longer viewed as evil in themselves, but it is axiomatic that they have be released into our environment by “evil” corporations. There’s just one problem. “Toxins” are a figment of the imagination, in the exact same way that evil humours and miasmas were figments of the imagination.

June 1, 2014

Healthy eating … the Woody Allen moment approaches

Filed under: Food, Government, Health, Media, USA — Tags: , , , — Nicholas @ 10:22

The “prophecy”:

And in The Economist this week:

Ms Teicholz describes the early academics who demonised fat and those who have kept up the crusade. Top among them was Ancel Keys, a professor at the University of Minnesota, whose work landed him on the cover of Time magazine in 1961. He provided an answer to why middle-aged men were dropping dead from heart attacks, as well as a solution: eat less fat. Work by Keys and others propelled the American government’s first set of dietary guidelines, in 1980. Cut back on red meat, whole milk and other sources of saturated fat. The few sceptics of this theory were, for decades, marginalised.

But the vilification of fat, argues Ms Teicholz, does not stand up to closer examination. She pokes holes in famous pieces of research — the Framingham heart study, the Seven Countries study, the Los Angeles Veterans Trial, to name a few — describing methodological problems or overlooked results, until the foundations of this nutritional advice look increasingly shaky.

The opinions of academics and governments, as presented, led to real change. Food companies were happy to replace animal fats with less expensive vegetable oils. They have now begun abolishing trans fats from their food products and replacing them with polyunsaturated vegetable oils that, when heated, may be as harmful. Advice for keeping to a low-fat diet also played directly into food companies’ sweet spot of biscuits, cereals and confectionery; when people eat less fat, they are hungry for something else. Indeed, as recently as 1995 the AHA itself recommended snacks of “low-fat cookies, low-fat crackers…hard candy, gum drops, sugar, syrup, honey” and other carbohydrate-laden foods. Americans consumed nearly 25% more carbohydrates in 2000 than they had in 1971.

It would be ironic indeed if the modern obesity crisis was actually caused by government dietary recommendations intended to improve public health (and fatten the bottom lines of big agribusiness campaign donors).

May 31, 2014

“The smoke from this plant causes a brief state of euphoria, immediately followed by permanent insanity”

Filed under: Government, Health, Media — Tags: , , , , — Nicholas @ 10:29

Paula Bolyard says that this collection of TV public service announcements from the 1970s may go a long way to explain why as parents they obsessively over-protect their kids (the Millenial generation). I loved this one:

In an effort to communicate a hip-sounding anti-drug message that teens could relate to, this PSA probably achieved the opposite of its intended effect. It made drugs seem fun and cool and glamorized drug use more than demonizing it.

Here are some gems from this hilarious PSA:

    I know what you’re thinking. What is marijuana? What makes it so dangerous? Where can I get some marijuana? Well, brother, I’m not going to nickle and dime you. I’m not like ‘the man’ all you kids are rebelling against. I’m hip. I know what young people are dealing with these days.

Yes, he actually said “nickle and dime you.”

    Rolled in Zig Zags or puffed from 7th period wood shop projects, the smoke from this plant causes a brief state of euphoria, immediately followed by permanent insanity. Users are prone to unpredictable behavior including junk food binges, joy rides, and a sudden urge to wear sunglasses at night.

At long last I now know why my brother was so interested in wood shop in junior high.

    Long term use of marijuana can lead to a psychological dependency. Soon you’ll be taking all sorts of measures to get your fix. People will start calling you names like ‘pothead’ or ‘Smokie McBongwater.’ Losing all motivation, it’s likely that you will drop out of school take a sudden liking to sitar music and maybe even get felt up by a cop or two.

This explains basically everything about the 70s.

    Is marijuana really where it’s at? Is it really as righteous as you think? There is more to life than grass. There are fulfilling careers and grrrr000vy beach parties. The closer you look the more seeds you find in your stash. Follow your hopes and dreams. Be someone. Do yourself and your country a favor. Don’t let this happen to you.

Raise your hand if you’re convinced.

May 27, 2014

The argument against raising minimum prices for alcohol

Filed under: Economics, Government, Health — Tags: , , — Nicholas @ 08:37

Earlier this year, A Very British Dude explained why “evidence-based” policy making isn’t actually what it says on the label, and illustrates it with the example of minimum pricing for alcohol:

Who could possibly be against “evidence-based” policy?

The problem is very simple. It’s almost impossible to conduct experiments in the social sciences. No government can alter one economic variable and measure the outcome. The noise to signal ratio is absurdly high. What you’re left with is explanations of the data that may or may not stumble on the actual causality.

Some things are obviously and self-evidently stupid. Socialism for example — high marginal tax-rates, nationalisation, closing down markets where possible in favour of state monopolies failed. And in as perfect an economic experiment as any undertaken, two nations, both shattered by war and populated by Germans went head to head. The Capitalist system turned out to be much, much less shit than socialism. Yet many social “scientists” still seem intent on manufacturing evidence that the solutions once tried in East Germany are not only feasible, but that any other approach is both doomed to failure and wicked.

Instead of evidence-based policy, what you often get is policy-based “evidence”. You have the same political arguments, dressed up in a kind of pseudo scientific hocus-pocus.

Take the “debate” about minimum pricing as a classic example.

First make a heroic assumption. Assume a fall in alcohol consumption per head is desirable (it isn’t, what we want to do is reduce “problem” drinking). Second, ignore the fact that your desired outcome is happening anyway. Third, ignore all the evidence that “problem” drug-takers have a lower elasticity of demand and assume that minimum pricing will mostly affect the consumption by alcoholics. Fourth, express these assumptions in a spreadsheet, with no real-world evidence. Fifth, describe this spreadsheet as a “model“. The zeroth step is, of course to get a university to describe you as “professor” first. Then you’re able to tout your guesswork and call it “evidence”, to politicians, and unmolested by any critical thought on the Today program and be paid handsomely from tax-payers’ funds to make this “evidence” up into the bargain.

So you have an “evidence-based” policy to impose a minimum unit price on Alcohol. It’s regressive, and probably won’t work. It will reduce moderate drinking by sensible people, making them at the margin, unhappier. It is unlikely to reduce problem drinking, but may make problem drinkers substitute clothes, or food, or heating for their more expensive booze. Nice one. Everyone’s poorer.

May 23, 2014

He was for the Veterans Health Administration before he was against it

Filed under: Bureaucracy, Government, Health, Military, USA — Tags: , , , , — Nicholas @ 08:33

The Wall Street Journal‘s James Taranto rounds up some amusing-in-hindsight bloviations by Paul Krugman about the efficiencies of the Veterans Health Administration:

There was no ObamaCare in January 2006, when former Enron adviser Paul Krugman wrote this:

    I know about a health care system that has been highly successful in containing costs, yet provides excellent care. And the story of this system’s success provides a helpful corrective to anti-government ideology. For the government doesn’t just pay the bills in this system — it runs the hospitals and clinics.

    No, I’m not talking about some faraway country. The system in question is our very own Veterans Health Administration, whose success story is one of the best-kept secrets in the American policy debate.

The “secret” of the VA’s “success,” Krugman argued, “is the fact that it’s a universal, integrated system.” That saves on administrative costs and allows for efficient record-keeping. Krugman acknowledged that the VA had a history of mismanagement and mediocre care, until “reforms beginning in the mid-1990’s transformed the system.” But wait. Hasn’t it been a universal, integrated system all along? Maybe the secret is something else. At any rate, the Phoenix revelations suggest it’s the system’s failures that are being kept secret.

Krugman lamented that his argument “runs completely counter to the pro-privatization, anti-government conventional wisdom that dominates today’s Washington.” That was 2006, remember, when Republicans had the White House and both houses of Congress. If Krugman is to be believed — a big “if,” to be sure — the Bush administration did a far better job running the VA than the Obama administration is doing now. Which reminds us of something Waldman wrote: “There’s an old saying that when they’re out of office, Republicans argue that government is inefficient and incompetent, and when they get in office, they set about to prove it.”

Krugman concluded that 2006 column as follows:

    Ideology can’t hold out against reality forever. Cries of “socialized medicine” didn’t, in the end, succeed in blocking the creation of Medicare. And farsighted thinkers are already suggesting that the Veterans Health Administration, not President Bush’s unrealistic vision of a system in which people go “comparative shopping” for medical care the way they do when buying tile (his example, not mine), represents the true future of American health care.

“Good Glitches,” anyone?

Krugman managed to get two more columns out of the glorious VA. One, in September 2006, also damned Medicare Advantage and complained that the administration opposed the idea of letting elderly vets use Medicare benefits at VA hospitals:

    “Conservatives,” writes Time, “fear such an arrangement would be a Trojan horse, setting up an even larger national health-care program and taking more business from the private sector.”

    Think about that: they won’t let vets on Medicare buy into the V.A. system, not because they believe this policy initiative would fail, but because they’re afraid it would succeed.

OK, but think about this: According to The-Military-Guide.com, “if you’re eligible for any level of VA care, whether it’s high-priority or low-priority, you’re no longer eligible for ACA exchange subsidies.” (ACA is an abbreviation for PPACA, in turn an abbreviation for the Patient Protection and Affordable Care Act, ObamaCare’s official title.) There are worse things than being excluded from ObamaCare, of course — but the VA may be one of them.

May 21, 2014

“The VA really is a good example of a single-payer, socialized health system”

Filed under: Bureaucracy, Government, Health, USA — Tags: , , , — Nicholas @ 07:22

J.D. Tuccille on the Veterans Health Administration:

Just a couple of years ago, Paul Krugman pointed to the Veterans Health Administration (VHA) as a “huge policy success story, which offers important lessons for future health reform.” He gloated, “yes, this is ‘socialized medicine.'”

Similarly, a letter touted by Physicians for a National Health Program trumpeted “the success of 22 wealthy countries and our own Department of Veterans Affairs, which use single-payer systems to provide better care for more people at far less cost.”

How could a bloated government bureaucracy achieve such low-cost success? As we found out recently, it’s by quietly sticking veterans on a waiting list and putting off their treatment for months — sometimes until the patients are far too dead to need much in the way of expensive care. Which is to say, calling it a “success” is stretching the meaning of the word beyond recognition.

And, while the White House insists it learned from press reports about the secret waiting lists, Press Secretary Jay Carney acknowledges that the administration long knew about “the backlog and disability claims” that have accumulated in the VHA.

This should surprise nobody. Canada’s government-run single-payer health system has long suffered waiting times for care. The country’s Fraser Institute estimates [PDF] “the national median waiting time from specialist appointment to treatment increased from 9.3 weeks in 2010 to 9.5 weeks in 2011.”

Likewise, once famously social democratic Sweden has seen a rise in private health coverage in parallel to the state system because of long delays to receive care. “It’s quicker to get a colleague back to work if you have an operation in two weeks’ time rather than having to wait for a year,” privately insured Anna Norlander told Sveriges Radio.

[…]

So the VA really is a good example of a single-payer, socialized health system. Just not in the way that fans of that approach mean.

May 14, 2014

Another area for freedom of choice – the “right to try”

Filed under: Bureaucracy, Health, Science, USA — Tags: , , , — Nicholas @ 11:32

Amity Shlaes talks about a movement to allow more freedom of choice, but in an unusual and tightly regulated sector:

For decades now the Food and Drug Administration has maintained an onerous and slow approval process that delays the debut of new drugs for fatal diseases, sometimes for years longer than the life span of the patients desperate to try them. Attorneys and scholars at the Goldwater Institute of Arizona have crafted legislation for the states that would allow terminally ill patients to try experimental drugs for cancer or degenerative neurological diseases earlier. These “Right to Try” bills are so scripted that they overcome the usual objection to delivery of such experimental drugs: safety. Under “Right to Try,” only drugs that have passed the crucial Phase 1 of FDA testing could be prescribed, thereby reducing the possibility of Thalidomide repeat. Second, only patients determined to have terminal cases would be eligible to purchase the drugs, making it harder to maintain that the drug will jeopardize their lives.

Representatives in Colorado, Louisiana, and Missouri approved the “Right to Try” measure unanimously. Citizens of Arizona will vote on the effort to circumvent the FDA process this fall.

Why the popularity? The phrase “Right to Try” appeals especially in a nation that senses all too well the reductions in freedom that come as the Affordable Care Act is implemented. The recent success of The Dallas Buyers’ Club, a film about a man who procured experimental drugs for AIDS patients, also fuels the “Right to Try” impulse. Some of the popularity comes from our culture of choice. In Colorado, where citizens have choice about abortion, and now the choice to use marijuana, they may also get what seems an elemental choice, that to try to save their own lives.

But of course “Right to Try” also sails because of the frustration of tragedy. Years ago a man named Frank Burroughs founded the Abigail Alliance after conventional options failed to cure his 21-year-old daughter’s cancer. Abigail’s oncologist tried to get Abigail newer drugs, Erbitux or Iressa from AstraZeneca, the company with which Pfizer hopes to merge. But the drugs were not available in time to save the girl. The Abigail Alliance is attempting on the federal level what Goldwater is trying for states: The federal bill’s name is the Compassionate Care Act. “Those waiting for FDA decisions, mainly dying patients and those who care for them, view the agency as a barrier,” co-founder Steve Walker explained simply. And who can disagree? Many of the supporters of “Right to Try” or the Abigail Alliance are businesspeople or scientists who are motivated to honor ones they have lost to illness; others are racing to save sick family who are still living. Yet others labor for patients in particular or science in general.

May 11, 2014

QotD: Longevity

Filed under: Health, Humour, Quotations — Tags: , — Nicholas @ 00:01

It is not, naturally and generally, the happy who are most anxious either for prolongation of the present life or for a life hereafter; it is those who never have been happy. Those who have had their happiness can bear to part with existence, but it is hard to die without ever having lived.

John Stuart Mill, Three Essays on Religion, 1874

May 7, 2014

“I’ve been an oncologist for 20 years, and I have never, ever seen anything like this.”

Filed under: Business, Health, Science — Tags: , , , — Nicholas @ 15:30

In Forbes, Matthew Herper looks at how Novartis is transforming itself in an attempt to conquer cancer:

“I’ve been an oncologist for 20 years,” says Grupp, “and I have never, ever seen anything like this.” Emily has become the poster child for a radical new treatment that Novartis, the third-biggest drug company on the Forbes Global 2000, is making one of the top priorities in its $9.9 billion research and development budget.

“I’ve told the team that resources are not an issue. Speed is the issue,” says Novartis Chief Executive Joseph Jimenez, 54. “I want to hear what it takes to run this phase III trial and to get this to market. You’re talking about patients who are about to die. The pain of having to turn patients away is such that we are going as fast as we can and not letting resources get in the way.”

A successful trial would prove a milestone in the fight against the demon that has plagued living things since dinosaurs roamed the Earth. Coupled with the exploding capabilities of DNA-sequencing machines that can unlock the genetic code, recent drugs have delivered stunning results in lung cancer, melanoma and other deadly tumors, sometimes making them disappear entirely – albeit temporarily. Just last year the Food & Drug Administration approved nine targeted cancer drugs. It’s big business, too. According to data provider IMS Health, spending on oncology drugs was $91 billion last year, triple what it was in 2003.

But the developments at Penn point, tantalizingly, to something more, something that would rank among the great milestones in the history of mankind: a true cure. Of 25 children and 5 adults with Emily’s disease, ALL, 27 had a complete remission, in which cancer becomes undetectable. “It’s a stunning breakthrough,” says Sally Church, of drug development advisor Icarus Consultants. Says Crystal Mackall, who is developing similar treatments at the National Cancer Institute: “It really is a revolution. This is going to open the door for all sorts of cell-based and gene therapy for all kinds of disease because it’s going to demonstrate that it’s economically viable.”

H/T to Megan McArdle for the link.

May 3, 2014

Fat’s negative health impact reconsidered

Filed under: Food, Health, Science — Tags: , , , — Nicholas @ 09:19

Hmm. Today seems to be health news day. In the Wall Street Journal, Nina Teicholz looks at the dubious science behind the saturated fat demonization we’ve all seen in so many health stories:

“Saturated fat does not cause heart disease” — or so concluded a big study published in March in the journal Annals of Internal Medicine. How could this be? The very cornerstone of dietary advice for generations has been that the saturated fats in butter, cheese and red meat should be avoided because they clog our arteries. For many diet-conscious Americans, it is simply second nature to opt for chicken over sirloin, canola oil over butter.

The new study’s conclusion shouldn’t surprise anyone familiar with modern nutritional science, however. The fact is, there has never been solid evidence for the idea that these fats cause disease. We only believe this to be the case because nutrition policy has been derailed over the past half-century by a mixture of personal ambition, bad science, politics and bias.

Our distrust of saturated fat can be traced back to the 1950s, to a man named Ancel Benjamin Keys, a scientist at the University of Minnesota. Dr. Keys was formidably persuasive and, through sheer force of will, rose to the top of the nutrition world — even gracing the cover of Time magazine — for relentlessly championing the idea that saturated fats raise cholesterol and, as a result, cause heart attacks.

[…]

Critics have pointed out that Dr. Keys violated several basic scientific norms in his study. For one, he didn’t choose countries randomly but instead selected only those likely to prove his beliefs, including Yugoslavia, Finland and Italy. Excluded were France, land of the famously healthy omelet eater, as well as other countries where people consumed a lot of fat yet didn’t suffer from high rates of heart disease, such as Switzerland, Sweden and West Germany. The study’s star subjects — upon whom much of our current understanding of the Mediterranean diet is based — were peasants from Crete, islanders who tilled their fields well into old age and who appeared to eat very little meat or cheese.

As it turns out, Dr. Keys visited Crete during an unrepresentative period of extreme hardship after World War II. Furthermore, he made the mistake of measuring the islanders’ diet partly during Lent, when they were forgoing meat and cheese. Dr. Keys therefore undercounted their consumption of saturated fat. Also, due to problems with the surveys, he ended up relying on data from just a few dozen men — far from the representative sample of 655 that he had initially selected. These flaws weren’t revealed until much later, in a 2002 paper by scientists investigating the work on Crete — but by then, the misimpression left by his erroneous data had become international dogma.

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