John Snow is a legend of public health. In the 1850s he investigated a cholera outbreak in London and noticed that the victims' houses were clustered around one particular water pump. He removed the pump's handle and the epidemic came to an end. This led him to conclude that cholera spread through contaminated water and not, as was widely believed, through the air. In one fell swoop, he had invented epidemiology and discovered germ theory.
A lesser known fact about Snow is that he was reviled by much of the medical establishment in his lifetime and germ theory was not accepted as fact until after his death. Wedded to the miasma theory of disease (which, put simply, says that disease is spread by bad smells), doctors were intent on closing down polluting industries in Britain's cities. These industries protested their innocence and found common cause with Snow, who used the issue to promote germ theory.
The editor of The Lancet, a leading medical journal, treated Snow with undisguised contempt. In so many words, he portrayed him as a crank and a hired gun of big business. "The theory of Dr. Snow tallies wonderfully with the views of [industry]", he wrote in a scathing and sarcastic editorial. Snow's theory, he said, was "a mockery of science" and a "wretched crudity". Appealing to the authority of the existing consensus, he said that the belief that cholera was a waterborne disease was not "in accordance with the experience of men who have studied the question without being blinded by theories".
The Lancet was right about Snow being a hired gun. He had received money from the threatened industries to give testimony to a parliamentary committee. But neither his links with business, nor the fact that the establishment disagreed with him, stopped Snow being right and the establishment being wrong. Although doctors eventually came round to Snow's way of thinking and now idolise him, the fact remains that Snow's heresy was not addressed by coolly assessing the evidence, but by appealing to authority, appealing to consensus and dismissing Snow as a tool of big business.
For all his troubles, Snow got an easy ride compared to those who step out of line in the field of public health today. Take Katherine Flegal, a statistician at the US Centers for Disease Control. Last year, she and her colleagues published a systematic review of 97 studies in the Journal of the American Medical Association which found that mild obesity produced no extra mortality risk and that being merely overweight resulted in a small reduction in mortality risk.
Despite being supported with a ream of data, the study was savaged by the public health lobby. Walter Willett, one of the world's most prominent anti-obesity campaigners said: “This study is really a pile of rubbish and no one should waste their time reading it.” A spokesman for the National Obesity Forum said “It’s a horrific message to put out at this particular time" and absurdly suggested that Flegal's "message" was that we can "eat ourselves to death with black forest gateaux.” Willett later organised a symposium in which speaker after speaker lined up to denounce Flegal and her work.
Or take James Enstrom, a vastly experienced and respected epidemiologist who had been working at UCLA since 1976. In 2003, he and a colleague published a study in the British Medical Journal that found no association between secondhand smoke and lung cancer. Many other studies had come to the same conclusion and Enstrom's research had no substantive flaws. Nevertheless, when anti-smoking campaigners heard about the findings, they breached the journal's embargo and hastily organised a press conference in which they slated the study (which they they not yet read) and described the study as "crap" and Enstrom as "a damn fool".
In 2005, Enstrom further blotted his copy book by conducting research on fine particulate matter which cast doubt on the scientific basis of new air pollution laws proposed by the Californian Environmental Protection Agency. Although Enstrom's findings have since been replicated in other studies, he was later sacked by UCLA because his research was "not aligned with the department’s mission”.
Or take the 2011 study by Brand-Miller and Barclay which claimed that sugar consumption had been falling in Australia while obesity had been rising. They and their study - titled 'The Australian Paradox' - have been viciously attacked by anti-sugar campaigners, with the usual accusations of being in the pay of industry. The researchers were eventually charged with scientific misconduct and have only recently been exonerated.
All of these examples involve scientists of good standing whose studies have been published in peer reviewed journals. It is hard to believe that any of them would have been attacked with such vigour had they not been dealing with red button issues that are of great importance to public health pressure groups.
In the 1850s, doctors were committed to make cities smell better. In the 2000s, they were committed to smoking bans. Today, they are committed to fighting obesity, with a particular focus on sugar.
To put it bluntly, the policies had already been decided. The campaigners want to send a clear, unambiguous message to the public while persuading politicians to act. Any research suggesting that a policy is misplaced or directed at the wrong target brings down a firestorm upon the heretical scientist, regardless of the quality of the research or the credentials of the researcher. In each case, the response from the establishment is visceral rather than rational. The implications of dogmatic groupthink and intimidation for the pursuit of sound science - and sound policy - are chilling.
The theme here is, I hope, pretty clear. I am arguing that the establishment often reacts to challenging evidence by resorting to ad hominem attacks (typically based on alleged funding from industry) and appeals to consensus (eg. 'the debate is over') rather than addressing the evidence directly.
With that in mind, let me explain that whilst in the antipodes I had a couple of days in New Zealand where I gave a talk to the NZ Food and Grocery Council about the abject failure of taxes on food to reduce obesity. This was largely based on the report I wrote about the rise and fall of the Danish fat tax for the IEA.
Four days after my visit, the Association of Salaried Medical Specialists came back with their rebuttal (to a speech they hadn't heard). The organisation carefully picked apart my arguments, proving beyond doubt that any loss of utility from such taxes would be more than offset by benefits. They demonstrated that indirect taxes on essentials were not, in fact, regressive. They showed that the money raised by sin taxes could not possibly be more effectively spent on anything else. They identified crucial flaws in all studies that have claimed that soda taxes have little or no impact on obesity. And they showed that the Danish fat tax had actually been a success.
I'm joking of course. What they actually did was release this...
Tired attempt to pass off venal campaign as debate“The decision to bring British anti-tax spin doctor Christopher Snowdon [!?! - CJS] to New Zealand last week was just another tired disingenuous attempt to dress up a venal campaign as a genuine debate,” says Ian Powell, Executive Director of the Association of Salaried Medical Specialists (ASMS).“Snowdon’s attacks on credible medical and social research have been well documented so it was disappointing but hardly a surprise to see him singing to the choir within the NZ Food & Grocery Council about the evils of taxing sugary soft drinks, etc. The Council obviously gives much greater priority to the food industry’s profits than the risk of poor health of New Zealanders.“What is surprising is that the Food & Grocery Council obviously hasn’t realised the New Zealand public’s distaste for propaganda masquerading as evidence and genuine debate.”As noted in media coverage http://www.stuff.co.nz/life-style/wellbeing/10443122/Anti-sugar-campaigners-wowsers, the Food & Grocery Council has been at the centre of ‘Dirty Politics’ allegations that it ran sponsored posts on the Whale Oil blog. Both Katherine Rich from the Council and Christopher Snowdon have been referred to in glowing terms on this blog. When Mr Snowden’s [sic] strongest supporters are the Cameron Slater ‘gang’, what more can one say. [I have been mentioned on the Whaleoil blog twice in its entire history - CJS]“All of this raises questions about the real intent of these people and organisations. Issues like obesity are very important for New Zealand and any discussion of possible solutions, such as taxes on soft drinks, needs to be based on evidence rather than the commercial desires of opaque vested interests.”Mr Powell says Snowdon’s arguments on diet and obesity have been comprehensively demolished over the years, including in video interviews and articles such as these: http://blogs.channel4.com/tom-clarke-on-science/obesity-crisis-sorting-fat-fiction/1221 and http://www.theguardian.com/society/2014/aug/30/child-poverty-link-malnutrition-rickets. [The first of these links is a video of me talking about obesity, but not sugar/soda/fat taxes. The second just says that the UK Faculty of Public Health supports a sugar tax - CJS.]He also noted that despite numerous calls to do so, the organisation Christopher Snowdon works for, the UK Institute of Economic Affairs, has consistently failed to reveal its funders. This is despite evidence of its support from the tobacco industry which has been revealed in that industry’s internal documents: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60480-3/fulltext.“Mr Snowden [sic] is little more than a front for vested business interests seeking to make profits by increasing poor health,” says Mr Powell. “We have enough ‘Dirty Politics’ in New Zealand already without being subjected to the bile of one of their English imports.”
That's more like it, guys! Who needs empirical evidence and logical deduction when you've got unsubstantiated smears, innuendo and personal abuse? Or, if you prefer, 'dirty politics'.
Viva public health!
PS. Whilst in Auckland, I was interviewed by the Sun Star Times. The article ('Anti-sugar campaigners "wowsers"') isn't too bad, but it included a mild attack from one of the sugar tax lobbyists. On this occasion, the man throwing brickbats was Tony Blakely. I was booked to debate with Blakely on television, but he bottled it at the last minute.
You can listen to me talking about the Grit in the Oyster on ABC Radio here. Quite a sensible discussion, this one.