Reviews of The epidemiologists

Some early comments

 From

The Sunday Telegraph
September 12, 2004

Why must medical research resort to quackery?

Dr James Le Fanu

It is difficult to know how to respond to the sheer idiocy of what nowadays passes for medical research. Even the most distinguished centres of learning are at it – such as the investigators at Harvard University who last year offered some further so-called "insights" into the causes of breast cancer.

Now this, as we all know, is a most grievous illness, which though more readily treatable than in the past, still blights the lives of thousands of women every year. It is also, perplexingly, becoming increasingly more common, especially in younger women, and clearly it would be very useful to understand why, the better to do something to prevent it.

The Harvard researchers reported their findings from an investigation into the lifestyle of 120,000 nurses, from which it emerged that those eating on average one egg a day could reduce their risk of the disease by almost 20 per cent.

They also found, by some extraordinary coincidence, precisely the same effect in those eating on average one hot dog every day. This was, however, eclipsed by broccoli, where apparently every additional serving reduced the risk by a quarter.

That is the good news; the bad is that every glass of wine a day increases the risk by six per cent, although, if correct, a woman would have to knock back 12 drinks a day for 30 years for this to be a serious threat – by which time no doubt she would already have succumbed to a combination of brain damage and liver failure.

These findings cannot possibly be true and, indeed, the insouciance with which the Harvard researchers report them suggests that they think so too. It would, after all, be very important indeed if alcohol really did increase the risk of breast cancer, and a daily diet of eggs, hot dogs and broccoli reduced it.

This parody of science has been a familiar lament in this column over the years but now, thanks to John Brignell, a former professor of industrial instrumentation, we know why. Prof Brignell has, as his field of expertise would suggest, always been concerned with the value of precise measurement, on whose integrity and accuracy so much of human society depends. If we don't get the measurements right, buildings will fall down and machinery grind to a halt.

There are clear parallels here with medicine, where accuracy is equally important, but when Prof Brignell came to investigate the research examining the links between lifestyle and disease,

he discovered such "systematic lying on a grand scale", such a "complete travesty of the truth", that he decided to write a book about it.

It is, he points out, intrinsic to the human condition to want to understand why things happen: why the sun rises and sets, why the tides ebb and flow and why one person gets a particular illness and another doesn't.

The problem of course is that "causes" in nature are invariably concealed from view and it is necessary to find some way of making them apparent. Hence the enormous success of the microscope in the 19th century, allowing scientists to visualise for the first time the minuscule bacteria that cause infectious diseases.

The modem-day equivalent is the search for the causes of illness in the infinite complexity of people's lives by comparing those with and without some condition and then inferring that any obvious difference must be a contributory factor. This clearly works when comparing the disease profile of smokers with non-smokers, but when "the cause" is due to some unknown biological agent, such studies will be unable to identify it and, instead, wrongly infer that some aspect of lifestyle is responsible.

The interest of Prof Brignell's book is his lucid exposition of the many ways the researchers, deliberately or otherwise, fail to distinguish truth from mere conjecture, providing the never-ending stream of health scares with which we are by now so familiar.

This type of scientific research not only trivialises a serious matter but also manages to obscure what is known about the causes of breast cancer and what can or cannot be done about it.

Thus the rise in incidence in recent years is clearly related to changing patterns of reproduction, and the effect that this might have on the exposure of the tissue of the breast to female hormones. There seems no doubt that those who delay having children until their thirties and then breastfeed them for just a few weeks have a moderately increased risk of the disease. But this is not necessarily something that one can do much about.

It is scarcely realistic to suggest that all women should have their first baby early, before the age of 20, produce lots of them and breastfeed them all for several months. So, instead, medical researchers advise that they should avoid alcohol and eat more eggs and hot dogs. Quackery rules OK.

From Warning Signs by Alan Caruba

Manufacturing Scares for Profit and Power

Some years ago I discovered a website, Number Watch, maintained by a Professor Emeritus of Industrial Instrumentation who resides in England. It was and is devoted to debunking the many scare campaigns that assail and afflict us daily via idiotic headlines in newspapers and other stories broadcast on radio and television. John Brignell, like myself, was so incensed by these deliberate lies, many of which have caused the needless deaths of millions, that he has devoted himself to attacking them.

When his book, Sorry, Wrong Number, was published a few years ago, I was pleased to enthusiastically endorse it for the way he demonstrated the distortion of statistics to advance bad and false "scientific" claims. He has recently published The Epidemiologists: Have They Got Scares for You! The best and easiest way to purchase one or both is to visit www.numberwatch.co.uk. Suffice it to say they both have garnered great reviews.

I have come to know Prof. Brignell via his lively, witty, monthly commentaries on his website, through his books, and the occasional exchange of emails. In his most recent book, he initially guides the reader through to an understanding of how "scientific" data can and is routinely distorted or simply invented out of thin air to achieve short-term fame or long-range campaigns to ban anything or force lifestyle changes on people by getting politicians to write bad laws based on bad "science."

"After a couple of centuries in which science, representing the triumph of reason, had revolutionized human life and tripled life-span, it was now reduced to the status of necromancy or astrology", writes Prof. Brignell in his new book. "As I researched the subject I began to discover a systematic lying on a grand scale, reaching into the upper strata of our society."

One branch of science, in particular, receives the attention of his new book. Epidemiology began as an effort to determine the real causes of epidemics that took hundreds and thousands of lives. In our modern era, many are unaware of the effect on history that disease has had. From the Bubonic plague to Malaria, Smallpox, Influenza, Typhus ad Typhoid, Cholera and Tuberculosis, among others, disease has decimated vast populations and still has the capacity to do so. The recent outbreak of SARS in China sent shock waves of fear through the entire world.

At a time when neither physicians, nor the public had any idea of what germs were or how rapidly they multiplied given the right circumstances, people believed such epidemics were the result of "bad air" poisoned by the emissions from swamps or other sources. Indeed, Malaria comes from the Italian translation for bad air. Sanitation in large cities and small was virtually non-existent.

Not until the scientific methods were developed to identify the true sources of disease, along with the development of the statistical testing of scientific hypotheses, were these diseases identified and the means found to avoid their spread. This took several centuries, beginning seriously in the 1700s with the rise of the Age of Reason.

Today, however, the media spread the contagion of "junk" science based on the most worthless claims made, as often as not, in formerly respected science journals. Often, the claims are nothing more than a public relations "news" release by some institution that wants to gain attention for its "researchers" and "scientists." Time and again, when such claims are found to be baseless, that news goes unreported.

Throughout his new book, Prof. Brignell repeats, "Correlation is not causation." It is the one lesson he wants to reader to retain because all junk science claims are replete with the words, "might", "may" and "could." Something might cause cancer. Something may trigger heart disease. Something you eat could make you fat. Over and above all these claims is the most obvious condition of mankind. As one gets older, they become more likely to become ill from some cause.

The corruption of science is vast. As Albert Einstein once pointed out, "Only two things are infinite, the universe and human stupidity, and I’m not sure about the former."

Stupidity or just plain old ignorance contributes greatly to these "modern times" in which millions of people succumb daily to the latest or most on-going scare generated by environmentalists and, in the case of Prof. Brignell’s new book, scares by epidemiologists concerning diet, i.e., food and drink of every description, campaigns waged against the proper use of pesticides, chemicals that attack disease-spreading insects and rodents, or herbicides, chemicals that attack weeds that reduce the capacity for farming large quantities of wheat, rice, corn and all the other food products available through modern agriculture.

Then there are the lies about radon, chlorine, salt, and even vitamin supplements, to name just a few of the campaigns cited in The Epidemiologists.

Behind all this scare mongering is the quest for power and profit. The many organizations that have proliferated to control our lives, our choices, our freedom to enjoy anything and everything that tastes or feels good, exist for both the gratification of exercising power and, in many cases, for the millions of dollars that can flow to such organizations through donations, sales, and government grants.

Learn how to spot fallacious logical arguments. Develop your capacity for critical reading, and discover how emancipating it is to free yourself of the endless stream of lies that passes for science in the public interest these days.

Referring to one such study, Prof. Brignell calls it "a festival of numerical prestidigitation."

It is this combination of rock solid knowledge, a raging skepticism, and a talent for the felicitous phrase that makes his latest (and previous) book so worth reading.

 

From Spiked

An epidemic of epidemiology
by Rob Lyons

Fifty years ago, we discovered that smoking is bad for us. In 1954, Austin Bradford Hill and Richard Doll published a preliminary report on a study showing the very strong correlation between smoking and premature mortality (1).
However, this classic study has in many ways sent medical science up a blind alley. While the dangers of smoking have been demonstrated in numerous subsequent studies, the attempts to find the New Smoking - another example of an environmental or lifestyle factor that causes substantial health problems - have largely failed. But the many pieces of junk science that have been produced in the process have provided the ammunition for unwarranted health scares too numerous to mention.
This state of affairs is well described in John Brignell's new book The Epidemiologists. Hill and Doll were given the task of trying to find out why cases of lung cancer had increased 15-fold in only 25 years. Their first attempt was to ask 649 lung cancer patients, and 649 matched controls, about their habits. What they found was a correlation between smoking and lung cancer, albeit not a very strong one. However, it was strong enough to warrant a fuller study, starting with a large group of healthy individuals, assessing their smoking habits and then monitoring them to see what diseases they developed.
This study began in 1951. Their method was to write to every doctor in the country - around 35,000 doctors replied, of whom only 17 per cent were lifelong non-smokers (how times change). The doctors were asked just a few questions about their smoking habits. Three years later, Hill and Doll published their first analysis of the results, and were already able to indicate how strong the link was between smoking and lung cancer.
What they found was that persistent smokers were 24 times more likely to develop lung cancer than non-smokers. Moreover, the risk of death from heart disease in any particular year was roughly doubled. This study has been followed up every few years, and these results have been confirmed time and again.
Hill made it clear, however, that such a study had to comply with some pretty strict criteria in order to be considered valid. These criteria are worth restating, because they stand in sharp contrast to the bulk of epidemiological research:
  1. Strength
    Is the association strong enough that we can rule out other factors?
  2. Consistency
    Have the results been replicated by different researchers, and under different conditions?
  3. Specificity
    Is the exposure associated with a very specific disease as opposed to a wide range of diseases?
  4. Temporality
    Did the exposure proceed the disease?

  5. Biological gradient
    Are increasing exposures associated with increasing risk of disease?

  6. Plausibility
    Is there a credible scientific mechanism that can explain the association?

  7. Coherence
    Is the association consistent with the natural history of the disease?
  8. Experimental evidence
    Does a physical intervention show results consistent with the association?

  9. Analogy
    Is there a similar result to which we can draw a relationship?

 

Above all, as Brignell emphasises, correlation does not prove causation. He draws an analogy with growing tomatoes and fertiliser. It can easily be shown that increasing use of fertiliser will increase tomato yields. But fertiliser does not cause tomatoes, it merely promotes the process of growth. The same goes for smoking and lung cancer. Smoking may massively promote the growth of lung cancer, but from this we cannot conclude that smoking causes the tumours. We can only draw conclusions about causation if we actually investigate the mechanisms that lie behind the link between smoking and lung cancer. Hill and Doll had nothing to say about why cancer occurs, they just provided us with a very valuable lead in the investigation.
Nonetheless, it is an entirely reasonable conclusion to draw that smokers will, on average, die younger than non-smokers, and we do not need to know the precise mechanism to conclude that giving up smoking is prudent from a health viewpoint.
What is not reasonable is the response to this one, classic study. First, it has provided the justification for state intervention in lifestyle in a previously unprecedented way. Secondly, it has encouraged the proliferation of other studies, which make grand statements about disease based on correlations far weaker than those found by Hill and Doll.
Brignell's book is a handy demolition of the science and statistics behind this epidemic of epidemiology. He shows how statistical tests were originally developed, based on certain assumptions. However, these assumptions have long since been forgotten, so that meeting certain abstract criteria has been elevated above whether the results are actually of any real-world importance.
The most important of these is the test for statistical significance. The idea behind this is that patterns can be found in any set of random results. For example, in the spiked office, there are a number of people who were born in May or June, but none were born in July. It would be possible to draw the conclusion that there is something special about being born in May or June that predisposes people to become journalists. This would be a bizarre conclusion to draw from just a handful of people. In fact, the spread of birthdays is completely coincidental.
In research it is therefore useful to have a preliminary statistical test of results, to see how likely it is that they could be due to blind chance. The usual benchmark is that if the chances of a set of results being coincidental are less than five per cent, it is reasonable to go on to assess whether the results are actually meaningful.
First, just because a study passes this test does not mean its results aren't a complete coincidence. In fact, by definition, five per cent of studies could pass this test even though the results are meaningless.
Secondly, just because the results are statistically significant doesn't mean they are practically significant. Brignell gives the example of a book called The Causes of Cancer, written by Richard Doll and Richard Peto. Illustrating Doll's fall from previous high standards, the book describes some deaths of people in their 80s and 90s as 'premature'.
The public health agenda is justified by research that is often completely worthless
These days, however, it seems that any result that passes this 'p-test' is increasingly regarded as significant. Five per cent sounds like a low risk of results being meaningless, until you realise that researchers often plough through many, many potential risk factors (what Brignell calls a 'data dredge'), look for an apparently significant result, then try to speculate some kind of mechanism to explain it, no matter how bizarre. So a test designed as an initial filter to weed out spurious results is used to give credence to them.
Thus he provides a huge list of different factors that have, at one time or other, been accused of causing cancer: abortion, acetaldehyde, acrylamide, acrylontiril, agent orange, alar, alcohol, air pollution, aldrin, alfatoxin, arsenic, asbestos, asphalt fumes, atrazine, AZT…and that's just the letter 'A'.
There are also a number of techniques in epidemiology for imposing assumptions on to data. The best of these is trend fitting. No set of data will exactly fit a pattern but often a clear trend can be found nonetheless. However, many studies appear to resort to drawing a line through an apparently unconnected series of measurements to demonstrate an underlying effect.
Epidemiology can be an effective tool when applied to the spread of infectious disease. Unfortunately, there really isn't anything like enough infectious disease in the developed world to justify the existence of so many departments and researchers. In fact, the overwhelming cause of death in the developed world is old age - a factor that is, incredibly, frequently ignored by researchers. A person in their eighties is a thousand times more likely to develop cancer than someone in their thirties. This factor is so powerful that for most of the causes of disease studied, a very minor underestimation of the effect of age can wipe out any putative effect from the factor in hand.
Age is obvious - but many other confounding factors are not. Therefore, we return to Hill's first criterion: to be sure there is actually something going on, the effect must be strong. Otherwise, any apparent effect may prove to be entirely illusory.
A topical example of this is passive smoking, and in particular what Brignell calls 'the greatest scientific fraud ever'. In 1992, the US Environmental Protection Agency published a meta-study, bringing together many other studies on passive smoking. Unfortunately, the results were negative. It appeared that passive smoking was not a health risk at all. Mere facts could not be allowed to get in the way of a health scare, so some imagination was applied to the problem. One negative study was removed - but the meta-study still produced no statistically significant result.
So the goalposts were not so much moved as widened. The organisation found that there was a greater than five per cent chance that the results were coincidental, but less than 10 per cent - so they accepted them anyway. In other words, the EPA accepted a bigger risk that the effect they found was purely due to chance, quite at odds with standard practice.
The increased risk of lung cancer they found - 19 per cent - was frankly too small to have been conceivably detected given the methods they used. There are lots of ways in which inaccuracy could have crept into this final result. For example, is it really possible to merge the results of many different studies, all with different methodologies and subjects, accurately? How could someone's actual exposure to environmental smoke be measured over the course of years? Were all the people who said that they were non-smokers absolutely honest? As indicated above, were other possible contributory factors such as age, gender and income controlled for accurately?
We can be pretty confident about Hill and Doll's conclusions about lung cancer because the effect they found is massive - an increased risk of 2400 percent. To suggest that such a small effect as 19 per cent could be accurately measured in this way is like trying to time a race with a sundial.
That has not prevented smoking being banned in public places on the grounds that thousands of people might die from inhaling second-hand smoke. The public health agenda is therefore driven and justified by research that is more often than not completely worthless.
It is undoubtedly the case that Hill and Doll's study has caused people to give up smoking and extended many lives as a result. But it has also inspired a heap of unnecessary panics based on dodgy research, and public health campaigners only too willing to tell us how to live our lives.

From Henry Thorton

Epidemiologists and charlatans
Date 6/19/2004
Member rating 5/5
Author: Louis Hissink
Introduction
Review of a scarey book about quacks, charlatans and junk-science.
 
The epidemiologists – Have they got the scares for you! By John Brignell, Brignell and Associates, Great Britain, 2004.

Hot of the press, this latest book by John Brignell outing the charlatans amongst us is most disturbing. Disturbing because what I, and I suppose most of us, read in the newspapers and assume to be accurate, is anything but - the amount of rank bull dust masquerading as scientific fact published by the media is astonishing.

John Brignell retired early from his Professorship of Industrial Instrumentation at the University of Southampton to write about the abuses of measurement – leading to his first book – Sorry – wrong number! Published in 2000.  Since then he has set up his website “www.numberwatch.co.uk” where hapless individuals and organisations are roundly castigated for various numerical crimes.  I inadvertently scored a hit there too – which arose from a misunderstanding of how we in the mining industry compute statistics – but it did lead to a very succinct analysis of global warming statistics and another demonstration that global warming is a sham.

But back to this book – as the title suggests, it has something to do with epidemics and hence the medical profession and the health-care industry. The book starts off with a good start by repeating two newspaper headlines in the UK – The Independent , June 5 2001 - “Pets double children's risk of asthma attacks” and the from the BBC a few days earlier “Keeping pets prevents allergies”.

Assuming that the both The Independent and the BBC got their information from the same source, how could such contradictory statements be published? Or how about “Pain killers prevent cancer”, yet at another time “Regular pain killer use linked to cancer”.  Clearly the newspapers are obviously quoting scientific studies, perhaps it was because scientists were contradicting each other, or is it.

Damning as it is, Brignell sums it up nicely by writing that “science, ..had revolutionised human life and tripled life-span, ..was now reduced to the status of necromancy or astrology.  Brignell's expertise was in avionic instrumentation and from what one reads, it was the published baloney in his daily morning newspaper which prompted his first opus - “Sorry, wrong number”.  Having finished that area of science, he then discovers another branch of science that also seemed to have degenerated into a corrupt travesty – epidemiology – the science of epidemics.

What concerned him more than anything was how the very people who sought to introduce scientific rigour into the science of epidemiology inadvertently provided the means of its corruption.  In order to do that, of course, one needs to go back into history and discover how it all began, and when and why it started to go wrong, and who the villains were.  Epidemiologists are not always the bad guy, it seems, and to find that out, you will of course have to buy the book.

The early chapters deal with the early history of epidemiology, the terrible epidemics which plagued humanity. Then follows the discovery of what actually caused disease, and importantly a summary of one of the pioneers of statistics, and the irony of his legacy.  The came Social Theory – which turned scientific medicine upside down and changed the world.

The second half of the book deals with the overwhelming amount of material available to us on almost every imaginable topic of medicine. Of course the author also shows how the present situation came about, looking at the tools of the trade and the fallacies. And of course nothing like picking the bones of a few pertinent examples.

Inside the cover, or at least on page ii of the flyleaf we find a Time Chart of disease – starting from 2000 BC to today, and covering everything in between. How, one would think, could all this be covered in such a slim volume of some 200 pages? Well fortunately Brignell doesn't, but he does focus on the essentials and some pertinent real case histories.

Most importantly he does spend some time on Social Theory – and don't make the mistake I made by looking up a dictionary – my Chambers does not have an entry for it, and googling on the Internet doesn't yield anything precise either. And that is precisely the problem – what on earth is Social Theory?  Having suffered the requirement myself in my undergraduate days to do one or two “humanities” subjects, I guess Social Theory had to have its origins in that part of Academia, and as Brignell puts it “The study of kings and queens had been largely replaced by the study of the masses, Social History,..”.  Just this little instance of the difficulty to get a precise meaning of Social Theory starts to explain what has happened over time.

Brignell points to one individual Thomas McKeown who wrote two influential books, “The role of Medicine” and "The Origins of Human Disease”.  It seems that McKeown accidentally became Professor of Social Medicine, as the result of some funding of a Trust which wanted a specific chair of Social Medicine.  The best way of showing what then happened was the disease of Tuberculosis (TB) – which if I read Brignell right, was regarded by McKeown as a disease of poverty, being one of infectious type, while those of affluence were non-infectious diseases. Personally this categorisation of disease is a load of nonsense, which Brignell then expertly shows to be so in the rest of his chapter on Social Science.  (Social Theory can be thought of as one of the most influential philosophical developments in human history bequeathing us the Nanny State and the environmental quangos).

Usually diseases are caused by something, and Brignell rightly uses the furphy of cigarette smoking causing lung-cancer as his next demolition job.  My late father, a physician and surgeon, always maintained that individuals who developed cancer of the lung, also tended smoke cigarettes, and that the cigarette smoking was a symptom, and not the cause of lung-cancer.

Other chapters discuss statistics, in a highly readable form, then a brief description of the tools of the trade, essential knowledge to unravel the pronouncements of science published in the mass-media,  while the chapters Body parts, Substance Abuse, Tobacco Road, and Cancer are pretty obvious what they deal with.

The Chapter Holocaust was another matter – and what, I thought, has this well known WWII event to do with the subject of his book – and of course it wasn't what you think it was, it was actually Foot and Mouth Disease in the UK and how the Brits managed to completely stuff it up – veritably a holocaust of the intelligence type.  They and they alone, with their stupid scientific advisors decided to cull all the culprits, with the equally culpable epitome of bureaucracies, the European Commission.

A rather interesting observation was made on page 96 when the author discusses SIP's Single-Issue-Parties where groups of fanatics form political parties. This is usually a non event except in societies in which proportional representation operates, and then indeed we are politically affected by these minority fanatics.  The Greens, for example, managed to gain a virtual monopoly of the environment ministries of Europe and forced environmentalism onto those hapless Europeans.  As the Ice age doom theory literally froze in the middle 1960's, the Greens then reversed direction and starting screaming the opposite – global warming.

“The ease with which a specious theory such as global warming can be imposed on the world constitutes a textbook example of political chicanery”. And once a theory reaches a critical mass of acceptance, no matter how stupid or scientifically specious, it becomes established fact.

The rest of John Brignell writes about means you have to buy the book from his website but I can assure it was a riveting read – I finished it in two nights in bed.

This book is a welcome relief for the usual pseudo-science we are deluged with in the media. It is an excellent source of fact, and lists and explains important concepts so that anyone can separate the wheat from the chaff in their daily newspaper.

All in all a significant contribution to the demolition of quacks, charlatans and junk-science.
 

From Bookviews

John Brignell has devoted his life to the art of measurement in science and engineering, teaching initially at the City University of London and later the University of Southampton where, for twenty years, he was Professor of Industrial Instrumentation. He has a raft of awards and fellowships, but what caught my attention was his dedication to debunking the many environmental, food, energy, and other hoaxes intended to influence our lives through legislation and other mandates. His website, www.numberwatch.co.uk is an opportunity to discover that Great Britain is as much awash in mindless regulations and failed government programs as our own. His first book, Sorry, Wrong Number, reflects how this affects both Brits and Yanks. I was delighted to recommend it when it was published and am now twice as pleased to recommend The Epidemiologists: Have They Got Scares for You! ($29.00). Published in the UK, you can purchase a copy by contacting Prof. Emeritus Brignell via his website. His new book educates the reader to a better understanding of how science is frequently deliberately corrupted and then used to frighten people into believing that everything they eat, drink and breathe is going to kill them. Thus, initially, the reader gets a crash course in some fundamental scientific concepts. Thereafter, he demonstrates how the public is led astray by weasel words and twisted data. This is an extraordinarily entertaining book!