Monday, March 26, 2012

Epidemiology: Killing Thousands With Science

This latest variation does come with a caveat, however, which could have been made at any point in this history. While it is easy to find authority figures in medicine and public health who will argue that today’s version of H.R.T. wisdom is assuredly the correct one, it’s equally easy to find authorities who will say that surely we don’t know. The one thing on which they will all agree is that the kind of experimental trial necessary to determine the truth would be excessively expensive and time-consuming and so will almost assuredly never happen. Meanwhile, the question of how many women may have died prematurely or suffered strokes or breast cancer because they were taking a pill that their physicians had prescribed to protect them against heart disease lingers unanswered. A reasonable estimate would be tens of thousands.

Does this mean I hate epidemiologists?  No.  Does it mean I think that epidemiologists and the entire medical profession that began selling these "killer" pharmaceutical products hate women and wanted to profit by injuring their health?  No.  It also does not mean that I think there's no role for their work.  I'm also not convinced anyone should care what I think, but what I think is that if you happen to be a highly paid, influential epidemiologist, you can only remain one if you get funding and do studies.  And even if the studies you do are not needed, you will do them.  And having done them, it's not likely that you will then say to the clueless "reporters" (aka those employed by the profit seeking publishers who need a story, dammit, any story) "You know, it's actually not possible to determine causality from this study, and it was really just a waste of time and money, but I sure enjoy these things, it's what I'm good at."

Although, this one sort of did:
Richard Peto, professor of medical statistics and epidemiology at Oxford University, phrases the nature of the conflict this way: “Epidemiology is so beautiful and provides such an important perspective on human life and death, but an incredible amount of rubbish is published,” by which he means the results of observational studies that appear daily in the news media and often become the basis of public-health recommendations about what we should or should not do to promote our continued good health.

In short, it's the misrepresentation that I hate.  Epidemiologists should admit the limitations of their work (as Peto did/does).  Reporters are great, but we should all just call them what they are - information entertainers, hustling for a buck like the rest of us.  Likewise, I'm all good with the "media" being for profit and behaving however they legally can to make a buck - but shame on us for ever thinking they were anything but that.  I remember announcing to a casual lunch conversation the obvious - ""News Company X" is owned by General Electric, and its purpose is to make a profit." The stunned stares followed, and even one awesomely naive person said "You ARE a cynic!"  No, I have the totally unremarkable ability to recognize the blatantly obvious.  For an inexplicable reason, many of our fellow citizens look at the news and believe the claims they make about themselves that they have more than an accidental relationship to truth.  This is as strange to me as believing General Mills' claims that their foods are "healthy".

So when the epidemiologist looks earnestly at the reporter and says "the data say red meat is killing you" take it for what it is worth.  And if you leave all the red meat for me, thank you.

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