Monthly Archives: April 2017

What is peer review really? (part 9 — it is really a crapshoot)

by Carl V Phillips

I haven’t done a Sunday Science Lesson in a while, and have not added to this series about peer review for more than two years, so here goes. (What, you thought that just because I halted two years ago I was done? Nah — I consider everything I have worked on since graduate school to be still a work in progress. Well, except for my stuff about what is and is not possible with private health insurance markets; reality and the surrounding scholarship has pretty much left that as dust. But everything else is disturbingly unresolved.) Continue reading

Real implications of the RSPH “sting” of ecig vendors

by Carl V Phillips

So apparently there is a UK organization known as the Royal Society of Public Health which presumably had some importance back when the East India Company was not just a retail brand. And apparently they did some secret shopper research of vape stores for purposes of generating publicity for themselves (like a retail brand would). The main payload was the breathless observation that half the shops did not interrogate the customer about their smoking status before selling e-cigarette products to them, and that most of the rest did not refuse to sell upon learning the faux-customer was playing the role of a nonsmoker. The RSPH then portrayed this as a violation of a largely-nonexistent “code of conduct” and managed to get this non-story all over the press in the UK.

I write that so dismissively — about the organization and the research — for a reason. This was much ado about nothing (as Paul Barnes entitled his post about it, which you can read for more of the basic details; see also Clive Bates’s post in which he dismisses it as a “cheap publicity stunt”). But despite this just being a blast of silly throwaway junk — what we observers of the public health industry simply call “Friday” — blogs and Twitter just lit up about it.

Part of the heightened reaction, as compared to all the other bullshit press releases, can be explained by the strange British obsession with anything containing the word “Royal”. Partially it is because the core failure — the notion that legal retailers of a consumer good should be policing their adult customers to see if they were “the right kind of people” — is something everyone can spot the flaws in; it is not some arcane matter of sample selection bias or confounding. So, for example, we can observe that no retailer ever checks to make sure an adult customer is a smoker before selling her cigarettes. This also makes it particularly easy and fun to satirize. (Incidentally, if a retailer in the USA discriminated in the way RSPH demands, refusing to sell to a potential customer because of his nonsmoker status, there is a good chance it could be successfully sued.)

But I also think the widespread reaction to this silliness, even among those who recognized it was just a publicity stunt, reflects a gut-level feeling that there is something more nefarious here than the surface level reaction implies. Since I try to point out the forest that is hidden among the trees (or should I use the royal “amongst” today), I will point out three deeper issues here. As I often do, I am trying to make a case that just responding to attacks like this at the level of their specific merits, even when the response is that they have no merits at all, is a fail. It is a terrible strategy to treat research like this as if it were fundamentally legitimate but merely flawed, as if it exists in isolation, and as if it were the work of decent ethical people who merely erred. That remains true no matter how effectively you eviscerate it on the surface. Continue reading

LA Times editorial about dishonest public health (ok, not really)

by Carl V Phillips

I have already noted on this page the “welcome to my world” feeling of the press and others complaining about the Trump administration, and its deluge of disinformation and dumb policy proposals, fueled by both unforgivable ignorance and ideological extremism. When newspapers and pundits complain about this, I often find myself thinking, “gee, why don’t you exercise these critical skills when you report on the issues I work on?”

Example:

(For those who might not know why that was fake news and want to learn, see this.)

Today the Los Angeles Times published a scathing critique of Trump and his administration, “Our Dishonest President”, which is getting an enormous amount of attention. Actually, I (and those tweeting that it pulls no punches) probably overstate that a bit; let’s call it “scathing by the standards of insider elites who seldom say anything that is brutally honest, no matter how much it needs to be said.” Anyway, several parts of struck me as just so “welcome to my world” that I thought maybe I should rewrite it a bit. What I came up with appears below. You might not fully appreciate just how similar to the original it is reading them serially, so I have also posted a marked up version that shows all my edits to the original.

The latter is a bit of a pain to read, of course; if you choose to read just the clean version below, know this: Every single sentence is from the original work that I am criticizing and parodying, pointing out their hypocrisy in not offering similar scrutiny elsewhere (just a little note there for LAT’s copyright enforcers :-). No sentence has been omitted. My version of every sentence maintains the theme of the original (but re-aiming it, of course).


OUR DISHONEST PUBLIC HEALTH ESTABLISHMENT

a parody and critical political commentary by Carl V Phillips, based on a work  By THE TIMES EDITORIAL BOARD

It was no secret for years that many in tobacco control and similar branches of U.S. public health are narcissists and demagogues who used fear and dishonesty to appeal to the worst in people. (The Times, however, and in common with every other major news outlet, has allowed this to pass without seriously criticizing it; it never called them unsuited for the job they do, and certainly never said that a particular policy would be a “catastrophe.”)

Still, nothing prepared us for the magnitude of this train wreck. Like millions of other Americans, we clung to a slim hope that public health activists would turn out to be all noise and bluster, or that the people around them in universities and governments would act as a check on their worst instincts, or that they would be sobered and transformed by the awesome responsibilities of influencing policies that have huge effects on people’s lives.

Instead, about two decades into the time of extreme activist public health — and who knows how much time to go before they are stopped — it is increasingly clear that those hopes were misplaced.

Public health social activists have taken dozens of real-life steps that, if they are not reversed, will continue to rip families apart, lower people’s welfare, in many cases actually harm public health, and profoundly weaken the quality of American public education.

Their attempt to ban e-cigarettes for millions of people who had finally quit smoking and, along the way, enact a massive transfer of wealth from tobacco product users to the government and cigarette manufacturers might still be stopped. But they are proceeding with his efforts to grant further arbitrary powers to the government’s regulatory agencies and bloat their budget.

These are immensely dangerous developments which threaten to weaken the moral standing of our government and real public health, imperil freedom and reverse years of slow but steady gains by marginalized or impoverished Americans. But, chilling as they are, these radically wrongheaded policy choices are not, in fact, the most frightening aspect of the ascendence of this brand of “public health”.

What is most worrisome about these people are these people themselves. They are so reckless, so petulant, so full of blind self-regard, so untethered to reality that it is impossible to know where their policies will lead or how much damage they will do to our welfare. Their obsession with fame, wealth and success, determination to vanquish enemies real and imagined, craving for adulation — these traits were, of course, at the very heart of their David-Goliath-myth outsider campaign; indeed, some of them helped them secure the power they have today. But in a real position of power, they are nothing short of disastrous.

Although the activists’ policies are, for the most part, variations on classic real public health positions, they become far more dangerous. Many people, for instance, support restrictions on where you can light-up and educational efforts to encourage healthy eating, but modern public health’s cockamamie tobacco “endgame” fantasies and impracticable campaigns to change human nature turn presumptuous and pushy policy into appalling imposition of an extremist minority view.

In the days ahead, The Times editorial board will look more closely at this, with a special attention to three troubling traits: [Editor’s note: …and so I suspect I might do this again. –CVP]

1. Shocking lack of respect for those fundamental rules and institutions on which our government and scientific community is based. They have repeatedly disparaged and challenged those entities that have threatened their agenda, stoking public distrust of essential institutions in a way that undermines faith in science and democracy. They have questioned the qualifications of scientists and the integrity of their analyses, rather than acknowledging that politics must submit to the rules of nature. They have clashed with their own honest experts, demeaned consumers and questioned the credibility of anyone who does not share their politics. They have lashed out at bloggers and other journalists, declaring them “industry shills,” rather than defending the importance of a critical, independent free press. Their contempt for the rule of law and the norms of government are palpable.

2. Utter lack of regard for truth. Whether it is the easily disprovable boasts about the miraculous effects of smoking bans or the unsubstantiated assertion that soda taxes improve health, they regularly muddy the waters of fact and fiction. It’s difficult to know whether they actually can’t distinguish the real from the unreal — or whether they intentionally conflate the two to befuddle the public, deflect criticism and undermine the very idea of objective truth. Whatever the explanation, they are encouraging Americans to reject facts, to disrespect science, documents, nonpartisanship and the mainstream media — and instead to simply take positions on the basis of ideology and preconceived notions. This is a recipe for a science-free power struggle in which differences grow deeper and rational compromise becomes impossible.

3. Scary willingness to repeat conspiracy theories, misleading memes and crackpot, out-of-the-mainstream ideas. Again, it is not clear whether they believe them or merely use them. But to cling to disproven “alternative” facts; to retweet celebrities with nothing useful to contribute; to make unverifiable or false statements; to buy into discredited conspiracy theories first floated on fringe websites and in deranged University of California blogs — these are all of a piece with antivax or miracle-cure claptrap that, but for some quirk of fate, these same individuals might now be peddling to come to political prominence. It is deeply alarming that a supposedly respectable and science-based movement would lend credibility to ideas that have been rightly rejected by every honest expert who has looked closely.

Where will this end? Will public health moderate their crazier positions as time passes? Or will they provoke a permanently destructive loss of faith in real science and health advocacy? Or, alternately, will the system itself protect us from them as they alienate more and more allies, step on their own message and create chaos at the expense of real public health goals? Already, the approval rating for their policies, among people who really know about them and the alternatives, has been hovering in the mid-30s, a shockingly low level of support for rules that are ostensibly intended to benefit the public. And that was before the new “war on sugar” that is bleeding over from the UK.

Fifteen years ago, it was not yet time to declare a state of “wholesale panic” or to call for blanket “non-cooperation” with the public health activists. Despite plenty of dispiriting signals, that is still our view. The role of the rational opposition is to stand up for the rule of law, the scientific process, and the role of institutions; we should not underestimate the resiliency of a system in which laws are greater than individuals and voters are as powerful as presidents. This nation survived John Harvey Kellogg and Carrie Nation. It survived bloodletting therapy. It survived Prohibition. Most likely, it will survive again.

But if it is to do so, those who oppose the reckless and heartless agenda must make their voices heard. Protesters must raise their banners. Voters must turn out for state and local hearings. Members of Congress must find the political courage to stand up to them. Courts must safeguard individual liberties. State legislators must pass laws to protect their citizens from meddling. All of us who are in the business of holding leaders accountable must redouble our efforts to defend the truth from their cynical assaults.

Science-based policy is not perfect, and it has a great distance to go before it fully achieves its goals. But preserving what works and defending the rules and values on which it depends are a shared responsibility. Everybody has a role to play in this drama.