Quotulatiousness

October 28, 2015

The WHO’s lack of clarity leads to sensationalist newspaper headlines (again)

Filed under: Health, Media, Science — Tags: , , , , , — Nicholas @ 05:00

The World Health Organization appears to exist primarily to give newspaper editors the excuse to run senational headlines about the risk of cancer. This is not a repeat story from earlier years. Oh, wait. Yes it is. Here’s The Atlantic‘s Ed Yong to de-sensationalize the recent scary headlines:

The International Agency of Research into Cancer (IARC), an arm of the World Health Organization, is notable for two things. First, they’re meant to carefully assess whether things cause cancer, from pesticides to sunlight, and to provide the definitive word on those possible risks.

Second, they are terrible at communicating their findings.

[…]

Group 1 is billed as “carcinogenic to humans,” which means that we can be fairly sure that the things here have the potential to cause cancer. But the stark language, with no mention of risks or odds or any remotely conditional, invites people to assume that if they specifically partake of, say, smoking or processed meat, they will definitely get cancer.

Similarly, when Group 2A is described as “probably carcinogenic to humans,” it roughly translates to “there’s some evidence that these things could cause cancer, but we can’t be sure.” Again, the word “probably” conjures up the specter of individual risk, but the classification isn’t about individuals at all.

Group 2B, “possibly carcinogenic to humans,” may be the most confusing one of all. What does “possibly” even mean? Proving a negative is incredibly difficult, which is why Group 4 — “probably not carcinogenic to humans” — contains just one substance of the hundreds that IARC has assessed.

So, in practice, 2B becomes a giant dumping ground for all the risk factors that IARC has considered, and could neither confirm nor fully discount as carcinogens. Which is to say: most things. It’s a bloated category, essentially one big epidemiological shruggie. But try telling someone unfamiliar with this that, say, power lines are “possibly carcinogenic” and see what they take away from that.

Worse still, the practice of lumping risk factors into categories without accompanying description — or, preferably, visualization — of their respective risks practically invites people to view them as like-for-like. And that inevitably led to misleading headlines like this one in the Guardian: “Processed meats rank alongside smoking as cancer causes – WHO.”

October 8, 2014

Pakistan’s public health emergency

Filed under: Asia, Health — Tags: , , , , , — Nicholas @ 10:07

The number of reported cases of polio is now the highest it has been for more than a decade, and at least some of the blame has to go to the CIA for using health workers as a cover for some of their covert operations.

As world health officials struggle to respond to the Ebola epidemic, Pakistan has passed a grim milestone in its efforts to combat another major global health crisis: the fight against polio.

Over the weekend, Pakistan logged its 200th new polio case of 2014, the nation’s highest transmission rate in more than a dozen years. The spread has alarmed Pakistani and international health experts and is prompting fresh doubt about the country’s ability to combat this or future disease outbreaks.

By Tuesday, the number of new polio cases in Pakistan stood at 202, and officials are bracing for potentially dozens of other cases by year’s end. Pakistan now accounts for 80 percent of global cases and is one of only three countries at risk of exporting the disease outside its borders, according to the World Health Organization.

[…]

In far-flung areas of the country, some parents and religious leaders are skeptical of the vaccine, requiring considerable face-to-face outreach by vaccination teams.

But the Pakistani Taliban and other Islamist militants have waged a brutal campaign against those teams, killing more than 50 health workers and security officials since 2012. The attacks began after it was discovered that the CIA had used a vaccination campaign to gain information about Osama bin Laden’s whereabouts.

August 13, 2014

Pessimism from the Rational Optimist

Filed under: Africa, Health — Tags: , , , , , , — Nicholas @ 00:02

Matt Ridley is somewhat uncharacteristically concerned about the major Ebola outbreak in west Africa:

As you may know by now, I am a serial debunker of alarm and it usually serves me in good stead. On the threat posed by diseases, I’ve been resolutely sceptical of exaggerated scares about bird flu and I once won a bet that mad cow disease would never claim more than 100 human lives a year when some “experts” were forecasting tens of thousands (it peaked at 28 in 2000). I’ve drawn attention to the steadily falling mortality from malaria and Aids.

Well, this time, about ebola, I am worried. Not for Britain, Europe or America or any other developed country and not for the human race as a whole. This is not about us in rich countries, and there remains little doubt that this country can achieve the necessary isolation and hygiene to control any cases that get here by air before they infect more than a handful of other people — at the very worst. No, it is the situation in Liberia, Sierra Leone and Guinea that is scary. There it could get much worse before it gets better.

This is the first time ebola has got going in cities. It is the first time it is happening in areas with “fluid population movements over porous borders” in the words of Margaret Chan, the World Health Organisation’s director-general, speaking last Friday. It is the first time it has spread by air travel. It is the first time it has reached the sort of critical mass that makes tracing its victims’ contacts difficult.

One of ebola’s most dangerous features is that kills so many health workers. Because it requires direct contact with the bodily fluids of patients, and because patients are violently ill, nurses and doctors are especially at risk. The current epidemic has already claimed the lives of 60 healthcare workers, including those of two prominent doctors, Samuel Brisbane in Liberia and Sheik Umar Khan in Sierra Leone. The courage of medics in these circumstances, working in stifling protective gear, is humbling.

Ebola outbreak in west Africa

March 28, 2014

Putting the WHO global pollution death figures into perspective

Filed under: Economics, Environment, Health — Tags: , , , — Nicholas @ 07:56

James Delingpole agrees that the most recent WHO report on deaths due to pollution is shocking, but points out where the press release does a sleight-of-hand move:

Even if you take the WHO’s estimates with a huge pinch of salt — and you probably should — that doesn’t mean the pollution problem in some parts of the world isn’t deadly serious. During the 20th century, around 260 million are reckoned to have died from indoor pollution in the developing world: that’s roughly twice as many as were killed in all the century’s wars.

Here, though, is the point where the WHO loses all credibility on the issue.

    “Excessive air pollution is often a by-product of unsustainable policies in sectors such as transport, energy, waste management and industry. In most cases, healthier strategies will also be more economical in the long term due to health-care cost savings as well as climate gains,” Carlos Dora, WHO Coordinator for Public Health, Environmental and Social Determinants of Health said.

    “WHO and health sectors have a unique role in translating scientific evidence on air pollution into policies that can deliver impact and improvements that will save lives,” Dr. Dora added.

See what Dora just did there? He used the shock value of the WHO’s pollution death figures to slip three Big Lies under the impressionable reader’s radar.

First, he’s trying to make out that outdoor pollution is as big a problem as indoor pollution. It isn’t: nowhere near. Many of the deaths the WHO links to the former are very likely the result of the latter (cooking and heating in poorly ventilated rooms using dung, wood, and coal) which, by nature, is much more intense.

Secondly, he’s implying that economic development is to blame. In fact, it’s economic development we have to thank for the fact that there are so many fewer pollution deaths than there used to be. As Bjorn Lomborg has noted, over the 20th century as poverty receded and clean fuels got cheaper, the risk of dying of pollution decreased eight-fold. In 1900, air pollution cost 23 per cent of global GDP; today it is 6 per cent, and by 2050 it will be 4 per cent.

But the third and by far the biggest of the lies is the implication that the UN’s policies on climate change are helping to alleviate the problem.

May 12, 2013

Influenza: the trade-off between virulence and contagion

Filed under: Health, Media, Science — Tags: , , , , , — Nicholas @ 10:34

Matt Ridley explains why the breathless claims that this or that flu outbreak could rival the Spanish Flu pandemic of 1918-19 should not be taken too seriously:

Here we go again. A new bird-flu virus in China, the H7N9 strain, is spreading alarm. It has infected about 130 people and killed more than 30. Every time this happens, some journalists compete to foment fear, ably assisted by cautious but worried scientists, and then tell the world to keep calm. We need a new way to talk about the risk of a flu pandemic, because the overwhelming probability is that this virus will kill people, yes, but not in vast numbers.

In recent years flu has always proved vastly less perilous than feared. In 1976 more people may have died from bad reactions to swine-flu vaccine than from swine flu. Since 2005, H5N1 bird flu has killed 374 people, not the two million to 7.4 million deemed possible by the World Health Organization. In 2009, H1N1 Mexican swine flu proved to be a normal flu episode despite apocalyptic forecasts.

No doubt some readers will remind me that, in the story of the boy who cried “Wolf!”, there eventually was a wolf. And that in 1918 maybe 50 million people died of influenza world-wide. So we should always worry a bit. But perhaps it’s not just luck that has made every flu pandemic since then mild; it may be evolutionary logic.

Of course, just about every story about influenza you’ll encounter goes the Chicken Little route:

There’s no mystery as to why we talk up the risk every time: All the incentives point that way. Who among the headline-seeking journalists, reader-seeking editors, fund-seeking scientists, contract-seeking vaccine makers or rear-end-covering politicians has even a modest incentive to say: “It may not be as bad as all that”?

March 15, 2011

“Obesity crusaders” use “inherently flawed instruments, such as BMI and apple-body shapes, to misinform the public”

Filed under: Government, Health, Media — Tags: , , , — Nicholas @ 12:50

Patrick Basham and John Luik address the manifest failings of the public health crusade against obesity:

Since the anti-obesity campaign is allegedly motivated by scientific findings, it would seem reasonable and prudent to make doubly sure that those claims are factual and trustworthy. Yet, we continue to find that the case against obesity is significantly flawed. Not only are the claims of an obesity epidemic often wildly exaggerated, but the science linking weight to unfavourable mortality outcomes is also frequently nonexistent or distorted.

[. . .]

As Danesh suggests, other researchers have suggested concentrating on a measurement of the waist alone, while many cling to BMI, which calculates obesity based upon a weight-to-height ratio. Because of its easy applicability, BMI is universally used in officially defining obesity, despite its manifest shortcomings. The BMI is wholly arbitrary and has no scientifically valid connection with mortality.

“Obesity crusaders” are what we call the individuals who manufactured the obesity-epidemic story in the first place and continue, through application of inherently flawed instruments, such as BMI and apple-body shapes, to misinform the public. They are a relatively small group of public-health officials in the US, the UK, the EU, and the World Health Organisation, assorted academics (very many with close ties to the weight-loss and pharmaceutical industry), the International Obesity Task Force, and a collection of so-called public-interest science groups.

How are these obesity crusaders reacting to the unambiguously good news published in The Lancet? Surely, they rejoice at the fact there is one less thing for a health-conscious population to fret over? No, they are not in celebratory mood. Quite the contrary. The obesity crusaders did not waste any time on the New Good News; after all, the Old-Time Religion continues to serve them so well.

It gets worse for the “fat=early death” meme:

There is little credible scientific evidence that supports the claims that being overweight or obese leads to an early death. For example, Katherine Flegal of the Centers for Disease Control and Prevention found that in the US population there were more premature deaths among those who are normal weight than those who are overweight. Indeed, in this study, Americans who were overweight were those most likely to live the longest.

In the American Journal of Public Health, Jerome Gronniger found that men in the “normal” weight category exhibited a mortality rate as high as that of men in the moderately obese category; men in the “overweight” category clearly had the lowest mortality risk.

January 7, 2011

How not to handle public health issues like influenza

Filed under: Bureaucracy, Health, Media — Tags: , , , , , — Nicholas @ 09:38

I was astonished to hear a radio reporter yesterday admit that much of the reason for the drop in people getting flu shots is the massively overblown oh-my-god-we’re-all-going-to-die media panic last year over Swine flu H1N1. In case you somehow managed to miss out on it last year, every news broadcast seemed to feature yet another doctor or public health official telling us that we faced a worldwide pandemic of H1N1 which was the invincible, all-conquering Überflu to top all plagues we’d ever faced before. Death tolls in the millions were confidently predicted. Every individual who died seemed to be mentioned personally . . . because there were so relatively few compared to those poor folks who died of “ordinary” seasonal flu.

Lorne Gunter gives a bit of credit where it’s due:

Give Allison McGeer credit for being frank about what’s behind this winter’s flu outbreak in Ontario: unnecessary panic over last year’s swine flu “pandemic.” Dr. McGeer, head of infection control at Toronto’s Mount Sinai Hospital, says flu cases are way up this season because vaccinations are way down; and vaccinations are way down, likely, because too much was made of the swine flu by media and officialdom last winter.

It is a medical case of the doctors who cried wolf, in other words.

[. . .]

There is a fine line between erring on the side of caution and crying wolf. And last year, the UN’s World Health Organization (WHO) blew through that barrier with abandon.

Just as it had on SARS and bird flu and the Ebola virus, the WHO overreacted to swine flu, issuing cautions that were out of all proportion to the risk the disease posed to the public. (Remember in 2003 when the WHO recommended people from around the world stay away from Toronto because the city was host to a few hundred SARS infections?)

But unlike those earlier panics, the WHO pulled out every stop on swine flu. It was as if the UN agency had been surprised that its earlier scares had failed to grow into full-blown pandemics; and so they figured that, finally, swine flu was due to become a worldwide infection requiring a dramatic response from international health officials.

As I wrote last year in May, when even the most panic-stricken media outlets were no longer playing the JuggernautOfDoom theme:

This would have been a good opportunity for de-escalating the panic mongering (and perhaps even attempting to rein-in the media, who were equally to blame for the tone of the information getting to the public). They chose, instead, to actively hide the fact that H1N1 cases were running below the level of ordinary seasonal flu cases (total H1N1 deaths: approximately 18,000 — typical annual death toll from seasonal flu: 250,000-500,000).

The biggest problem isn’t that they over-reacted this time, it’s that it has reduced their credibility the next time they start issuing health warnings. And that’s a bad thing. Unless they pull the same stunt next time, too. In which case, we may start hearing talk about setting up competing organizations to do the job the current entities appear to have given up on.

May 26, 2010

The pandemic juggernaut of doom . . . that failed to materialize

Filed under: Bureaucracy, Cancon, Health, Media — Tags: , , , , — Nicholas @ 17:07

Lorne Gunter has a good wrap-up of the bone-headed approach of public health officals in Canada to the Swine H1N1 flu “pandemic”:

Good on ordinary Torontonians. Despite all the H1N1/swine flu hype this past winter, just 28.2% of that city’s residents bothered to get vaccinated against the “pandemic;” that’s less than the 35% who usually get shots each year against the seasonal flu.

Even Toronto health care workers couldn’t be stampeded into getting the shots. Only 60% of them bothered.

[. . .]

Even from the start, the World Health Organization and other experts where told this strain of flu was weak and easily defeated. Infection rates never came remotely close to forecasts and death tolls were thankfully much, much lower than for typical seasonal infections.

The trouble, I think, was that so many public health officials have predicted so many pandemics for so long — SARS, bird flu, swine flu — that they simply got caught up in their own warnings and projections. They wouldn’t listen to contrary evidence.

The relevant public health authorities would have served the public interest (and their own credibility for the future) if they’d been much more forthcoming as the early stages of the pandemic showed H1N1 not to be the second coming of the Black Death. Instead, they doubled-down and raised the propaganda bar even higher.

October 27, 2009: Given that regular seasonal flu causes thousands of deaths annually, you’d think it would be good statistical discipline to count the cases of H1N1 separately, both the gauge the severity of the disease and to chart the effectiveness of the vaccination program. Lumping seasonal flu and “flu-like symptoms” together with H1N1 seems a big step backward from normal public health practice.

This would have been a good opportunity for de-escalating the panic mongering (and perhaps even attempting to rein-in the media, who were equally to blame for the tone of the information getting to the public). They chose, instead, to actively hide the fact that H1N1 cases were running below the level of ordinary seasonal flu cases (total H1N1 deaths: approximately 18,000 — typical annual death toll from seasonal flu: 250,000-500,000).

The biggest problem isn’t that they over-reacted this time, it’s that it has reduced their credibility the next time they start issuing health warnings. And that’s a bad thing. Unless they pull the same stunt next time, too. In which case, we may start hearing talk about setting up competing organizations to do the job the current entities appear to have given up on.

April 15, 2010

“Wolf! Wolf! Wolf! Oh, never mind . . .”

Filed under: Bureaucracy, Health, Media — Tags: , , , , , — Nicholas @ 09:04

Marni Soupcoff points out that the World Health Organization should have been far more forthcoming after their intial “the sky is falling” announcements caused panic last year over H1N1:

Admit your mistakes before others exaggerate them. That’s the oft-quoted wry advice of writer and retired surgeon Dr. Andrew V. Mason. Perhaps the World Health Organization (WHO) was trying to follow it this week by convening a three-day meeting of outside experts to review the organization’s handling of the recent swine flu outbreak. The problem is, despite claiming to want to know what went wrong as much as what went right, the WHO seems unwilling to even entertain the possibility that it created a counterproductive panic by labelling H1N1 a pandemic of the highest order (“level 6”).

Swine flu, as you’ve probably realized by now, has turned out to be a mild, not particularly deadly virus — it’s certainly far less deadly than the regular seasonal flu that most of us consider a mundane part of everyday life. If one were feeling charitable toward the WHO, one could point out that it didn’t know back in the spring of last year — when it shouted “level 6!” from the rooftops — that H1N1 would prove to be such a relatively innocuous bug. But it’s precisely because it didn’t know that the WHO should have been more cautious with its labelling. You don’t shout “fire” in a crowded theatre just because it smells like the popcorn might be a little on the burnt side. It’s not worth the chaos and alarm you might cause. (Or in this case, the run on vaccines and the resorting to quacks and sketchy “home” remedies.)

Between the unrestrained use of the term “pandemic” and the noted ability of the mass media to hype real and imagined risks, it’s almost surprising we didn’t have doomsday-style cults spring up over H1N1.

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