Category: Denialism

My recent post on a local “holistic” doctor brought a number of considered and interesting comments (all of whom are quite polite and patient, even when I disagree with them).

Some of the issues deserve fleshing out.

Heart disease is a major killer. Hypertension is one of the strongest risk factors for heart disease. In some people, salt contributes to hypertension, and reduction of salt intake reduces bad outcomes. In people with congestive heart failure, salt-restriction is crucial.

The statement of this idea led to some interesting objections, with a good helping of goalpost-shifting.

The objections raise some important points, but also engage in some typical denialist tactics.

I’ve just been looking for basic information, and coming up empty-handed, so I hope you can understand my frustration. I’m not one to hold on to bad ideas in the face of evidence, but I’d like to see a prima facie case made first.

and

I’ve also seen a study in the news in the last few months that was reported to show a significant increase in mortality among high-risk patients over a 10-year period for those who maintained a high salt intake. That raises questions that weren’t answered in the news article, such as: How did the diets compare otherwise? It’s reasonable to assume that someone who reduces their salt intake because of blood pressure is going to make other dietary changes as well, and vice versa. If other variables were controlled, then by what mechanism does salt increase mortality? What do those results mean for individuals with normal blood pressure?

and

The correlation between sodium intake and heart disease doesn’t prove anything. This is a classic example of correlation not equalling (sic) causation. Processed and fast food, the biggest sodium offenders, also tend to be loaded with saturated fat and cholesterol. Could these not also be the cause of the artery disease, and the salt just be a relatively innocent bystander?
I am not saying that there is no place for a low-sodium diet, I’m just saying that I’ve yet to see any evidence for one in general. (emphasis mine –PalMD)

This is simply an argumentum ad ignorantiam. The fact that the commenter doesn’t know the answers does not affect the validity of the conclusions stated. Does he think that researchers have never asked these questions?

How about a plausible method by which salt causes ateriosclerosis?

and

We have no convincing evidence that blood pressure increases resulting from salt intake contribute substantially to heart disease or stroke. You, and the medical profession in general, are taking a giant illogical leap.

Actually, I gave references. If he can’t be bothered to check them, it’s hardly my fault, or the fault of the medical profession.

High salt intake may raise blood pressure in some groups, but it does not necessarily lead to chronic or dangerous hypertension. And chronic hypertension might be an effect, rather than cause, in many cases. We don’t really know.

I already said that there is great variability to patients’ susceptibility to salt, so objection noted. Actually, we do know that hypertension is a cause rather than an effect of heart disease.

We do know that the major causes of artery disease leading to heart attacks and strokes are cigarette smoking and type 2 diabetes. So we do not have any clear connection between a high salt diet and artery disease. And you have admitted that.

In addition to cigs and diabetes is hypertension. As cited, in many patients, high salt intake leads to hypertension. Hypertension leads to heart disease. To require the most proximate cause is an absurd argument. Medical science looks for correlations, and tries to explain them. Much of the time we understand the specific mechanisms involved. To ask for more and more detailed explanations is simply moving the goalposts—if you don’t like the answer, just ask more detailed questions until everyone is tired of answering you.

Unfortunately, I am not a member of the AMA, so I don’t have access to that article. I did want to read it given the alarmist wording of the headline, but it wasn’t $15 of want, especially since I’d need to pay for the references, ad infinitum….

If the commenter is unwilling to accept my expert status, that is quite reasonable. But then to be unwilling to dig up the data himself, well, that’s just silly. To gain information, you can either listen to an expert or try to interpret the data yourself. To be unwilling to do either is simply intentional ignorance. To then expect others to buy that as a legitimate argument is not just unfair, it’s asinine.

The point here is not about individual commenters—it’s about strategy and errors in thinking. For complex information, we trust in experts—we have no choice. If we are curious about going deeper, we look up the primary sources.

Salt may or may not be an important cause of heart disease, although evidence favors the connection; there are certainly more important causes. But in some people, salt very directly causes increased blood pressure, and high blood pressure most certainly does lead to heart disease. That fact does not negate other causative factors (which is another non sequitur brought up in some comments).

Denialism involves, well, denial. If you don’t like a fact, then just keep looking for ways around the truth. Or plug your ears and go, “la la la la la.” Either has the same effect.

Politically, I’m a leftie. That should be no surprise to anyone who knows me. But when it comes to science and medicine, my politics are irrelevant. Given that John McCain has already made some questionable public statements regarding vaccines and autism, this seems like a good time to see what the democrats are saying.

Over at Hillary’s website, we can examine her positions on health care. She makes special mention of autism. Some of her recommendations sound quite reasonable and good, such as improving access to services for autistic children. But she repeats the questionable though popular idea that there is an “autism epidemic”, something that is far from proved. She makes mention of providing funding for evidence-based treatment, but also gives a shout-out to finding “environmental factors”, which is code for “toxins, mercury, vaccines” and all other kinds of hogwash. Sure, politicians have to appeal to everyone, but in appealing to everyone, it’s possible to appeal to no one strongly. Compromise over how to spend defense or highway money is one thing, but science should be guided by science, not the mercury militia.

Obama’s statement on autism is far more vague.

What I find interesting about both candidates’ websites is that they both feature autism prominently. That’s nice—we certainly need to learn more about autism. But why pick that over, say, heart disease, stroke, tobacco abuse, and cancer, which affect the health of far more Americans than autism ever will?

So what of McCain? His health care info also focuses on economics, which is fine.

McCain makes a very interesting statement about health education. He invokes personal responsibility, which is a common Republican phrase that happens to be important to health care. He then says:

Childhood obesity, diabetes and high blood pressure are all on the rise. We must again teach our children about health, nutrition and exercise – vital life information.

Does anyone see what he left out here? Sexually transmitted diseases are on the rise. What about sex education as part of health education? You can’t teach children about obesity, blood pressure, and diabetes, and then leave out one of the nations biggest health problems—unless you are trying to appease a certain constituency.

And like the Dems, he has an entire link to autism, something he doesn’t have for heart disease, cancer, or anything else. In his blurb, he also gives lip-service to “environmental factors”.

The point is not that autism doesn’t deserve funding. It most certainly does, as long as that funding is directed into evidence-based investigation, and not more studies looking at disproven hypotheses such as vaccines and “toxins”. The real point is that all three candidates, when speaking of health care, need to focus on what harms and kills most Americans. The Dems are actively speaking out on access. All three should at least include realistic plans to encourage health care initiatives that make use of evidence and not emotion.

I generally enjoy Bill Maher. I mean, he seems like an ass, but I enjoy his shows—except when he talks about medicine. As any regular viewer knows, he regularly spouts the usual denialist canards about medicine. This week, he was interviewing Senator Arlen Specter, who, among other accomplishments, has survived Hodgkin’s Disease, a form of blood cancer. Maher had the bad taste to ask him is he was disgusted that health care is the third leading cause of death in the U.S. Had he said this to me, I would likely have responded, “Look, asshole, the American health care system just saved my fucking life!”

This is of the more popular canards propagated by cult medicine leaders and their followers. According to the wackos, modern medical care kills and injures more people than, well, just about anything. Joe Mercola and Gary Null have very long articles on their websites bemoaning the dangers of medicine versus the safety of woo. They love to make statements like, “It is now evident that the American medical system is the leading cause of death and injury in the US.”

What does this all mean? Should we, as the cultists suggest, abandon medicine for the cults of homeopathy, naturopathy, and chiropractic?

Probably not. Why do I say that? Because I’m a paid shill for the Big Pharm/AMA/FDA juggernaut? Well, no. Abandoning modern medicine for the cultists doesn’t make sense, either medically or statistically.

When cultists cite their terror statistics they leave out a few important facts. There is no doubt that medical errors, and even medical therapy without errors, can harm. No one would argue otherwise. The flip side is, it also helps—a lot. For example, one of the statistics often cited from the Institute of Medicine’s landmark study on medical error is that somewhere between 44,000 and 98,000 deaths yearly in the U.S. may be due to medical errors. Now, to put that in perspective, advances in the treatment of coronary artery disease reduced the number of deaths by over 340,000 in 2000 alone. And that’s just one disease. Of course there are risks to modern medicine—it’s active treatment, not placebo, so it can be expected to hurt some people. But it helps far more. Returning to the era of roots and berries is not likely to improve quality of life or longevity. Reducing medical errors is important, and is an active field of research. The solution to medical errors isn’t voodoo, it’s science. Anyone who tells you different is trying to sell you something.

Scientologists apparently have the answers to mental illness. HIV denialists swear that HIV doesn’t cause AIDS. But very few people are actually buying it—enough to cause trouble, surely, but the Tom Cruises and Peter Deusbergs of the world aren’t winning any Nobel Prizes. Why not?

Because they offer nothing. HIV researchers and clinicians have emptied out the AIDS wards, but the denialists have done nothing. Psychiatrists (and yes, their medications) have helped people lead normal lives. Scientologists have done, well, nothing but sue critics.

The difference between the scientific approach to medicine and the denialist approach is that one offers solutions, while the other does the intellectual equivalent of leaving a flaming bag of poo on the front porch.

Remember this—denialists offer no solutions, only conflict.

To continue to explain how terribly misguided Mooney and Nisbet are about ignoring denialist campaigns I think it’s time to go over the history of one of the most effective denialist campaigns ever. That is the concerted effort by the major tobacco companies (RJ Reynolds, Brown & Williamson, Lorillard, Phillip Morris, and British American Tobacco) to spread misinformation about the health risks associated with smoking.

Fortunately for those who study denialism, one of the results of the Tobacco Master Settlement all the internal memos of four of the largest tobacco companies have been released to the public and exist as free searchable databases.

Within these documents one can find some true gems of denialist strategy second only to Wedge Document for their unintentional disclosure of their dishonest tactics. For instance from “NEW DIRECTIONS” A presentation of the tobacco institute staff June 25th, 1981:

And:

And this gem from Brown and Williamson “Smoking and Health Proposal” from 1969:

Throughout these documents you see a similar theme every time. Science comes out that is harmful to their profits, such as the 1964 Surgeon General’s report on tobacco and health was to be opposed no matter what the results. The writing is schizophrenic, while they seem to be convinced of their righteousness and the safety of smoking, they write about actively pursuing and eliminating the carcinogens in tobacco smoke, making filters that will be safer, and consider strategies of admitting to the danger of cigarette smoke. As the science becomes more damning they just shift the message to one of righteousness of personal liberty while their own research confirmed the risks to nonsmokers from environmental tobacco smoke.

What does this have to do with Mooney and Nisbet telling us to ignore the cranks like the DI or the Heartland Institute? It shows that even when the majority of people understand and believe the science – for instance the evidence showing cigarettes cause cancer has been believed by around 90% of Americans for decades – well-funded denialist campaigns can still be highly effective in disrupting appropriate regulation, legislation, and dissemination of accurate public health information.

Global warming denialists using some of the same think tanks the tobacco companies used, and even some of the same shills such as Steven Milloy and Fred Singer (now working for the Heartland Institute) are capable of waging the same kind of war on legitimate science as they did for the tobacco companies. Only after years of work from public health authorities, scientists and interest groups, as well as vicious fighting over legislation, civil litigation and the actions of whistleblowers were the tobacco companies largely declawed in their campaign against scientific truth. It certainly wasn’t by ignoring them, and letting them act unopposed, or letting the polls dictate a non-existent victory that they were finally defeated. And that is the danger of the message we’re currently getting from the framers. It’s the worst possible strategy for opposing denialism, it’s dangerous, historically-ignorant, and will lead to disaster.

Despite the fact that the majority of Americans believed in the link between cigarettes and cancer the the tobacco companies’ denialist campaign worked for a long time, and here’s how they did it…

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Although we discussed this issue earlier, I can’t help to point to a new segment on 60 Minutes exploring the issue of whether big chain restaurants should have to disclose the amount of calories in their food products (Video).

The denialism from the industry on this issue is pretty clear, but what’s interesting about the segment is the explanation of consumer biases that prevent the market forces from addressing this problem. One of the most basic forces here is optimism–consumers don’t think bad things will happen to them, generally, and in this context, optimism translates into seriously underestimating the caloric value of foods. And that optimism operates more strongly when a consumer thinks that the food is healthy (i.e., because they saw Subway commercials or the like):

Brian Wansink is a nutrition and marketing professor at Cornell University. He uses the mall as a laboratory, observing the food-court crowd like other scientists study rare tribes.

Wansink, who even wrote a book called “Mindless Eating,” finds that people always underestimate calories, but they get it especially wrong when they’re eating something they think is healthy.

On one of his recent “observation trips,” Wansink concentrated on meals from Subway, which markets itself as the healthy fast-food alternative. He asked people to estimate the calories of an especially caloric combo: a foot-long Subway sandwich with mayo, chips and juice.

“Now for this you estimated that it had about 300 calories,” Wansink pointed out to a man. “In reality it has 1,390.”

“When people are eating in a restaurant that they think is healthy, people grossly underestimate how much they eat by about 50 percent,” Wansink explains.

What’s interesting is that the standard business line is that more information is good for consumers, but here, they don’t want consumers to have ready access to information that could help them make better decisions about what to eat.