Wednesday, 7 June 2017

'Public health' versus science

I have used this image before to illustrate the relationship between 'public health' advocacy and science and medicine.

In short, 'public health' as we know it today has nothing to do with either science (the search for truth) or medicine (curing disease). It is a political movement with fixed prior beliefs. It has some of the accoutrements of science and medicine - its own journals, its own PhDs and its own systematic reviews - but, as Eric Crampton says, is it not science. It is 'sciency'.

In truth, it is a grotesque parody of science. Grotesque because it seeks to do the opposite of science by confirming dogma and narrowing thought.

Put in simple terms, the scientific method involves developing a falsifiable hypothesis and putting it to the test. Seeking to disprove - rather than prove - a hypothesis is at the heart of the scientific method, as Peter De Forest explains...

The core of the scientific method is the rigorous testing of hypotheses. Hypotheses that endeavor to explain the event are put forward, and then an earnest attempt is made to disprove each. A hypothesis that fails this testing is discarded. A modified hypothesis or new alternate hypotheses are developed and tested in turn. Only a hypothesis that survives repeated vigorous testing develops into an explanatory theory of the event. The scientific method and hypothesis testing is a cyclical, iterative process. The key to the process is the vigorousness and rigorousness of the testing. There is a human tendency to identify with a hypothesis that one has developed and to subconsciously overlook observations or data that do not fit the hypothesis. This is antithetical to good science and must be avoided. Scientists must be involved in actively attempting to disprove their own hypotheses

This is not how it works in 'public health'. In 'public health', the activist-researchers 'know' the truth before they turn on their lap top. They 'know' what the problems are (availability, advertising and affordability) and they know the solutions (bans and taxes). There is ample evidence that these beliefs are wrong-headed or, at the least, overly simplistic, but this evidence is never published in journals that are sympathetic to the cause.

One clue that 'public health' is not scientific is that their hypotheses are always proven correct (for example, take this risible attempt to claim that policy-based computer models pass the Bradford Hill criteria for causality). Its policies always work. This suggests a degree of infallibility that is beyond the reach of mere mortals.

Insofar as hypotheses are altered by 'public health' research, it is only by purporting to show that the problems are even worse than was previously believed and the solutions are even more effective than was previously believed. It is no coincidence that this is what the media and politicians want to hear. It is not science. It is PR.  

Occasionally, an activist-researchers will speak a little too freely and give the game away. Anti-smoking campaigner and Californian 'public health' professor Stanton Glantz once told an audience: 

'…that’s the question that I have applied to my research relating to tobacco: If this comes out the way I think, will it make a difference? And if the answer is yes, then we do it, and if the answer is I don’t know, then we don’t bother. Okay? And that’s the criteria.' ('Revolt Against Tobacco' conference, Los Angeles, 2/10/92. Transcript, p. 14)

And here is Gerard Hastings speaking today at a neo-temperance meeting...

When Hastings talks about consumption, he does not mean the consumption of specific brands, but of the overall category. So, for example, he thinks that an increase in Heineken advertising leads to an increase in per capita alcohol consumption.

Acres of economic evidence based on real world data suggest that he is wrong about this, but he 'knows' he is right. He has known it all his career. To him, it is the 'bleeding obvious' and he has spent 30 years trying to prove it to everybody else.

In truth, the only thing that is bleeding obvious is that real scientists do not proceed on the basis that their hypothesis is self-evidently true and then spend years looking for evidence to confirm it.

Hastings is not a real scientist. He is a professor of social marketing, whatever that means, but that does not stop him being commissioned by the WHO to give his jaundiced view of the evidence and being treated as if he were an expert by parliamentarians. And while his statement today - assuming it has been correctly reported - was a little too candid for a public event, there are plenty of others on the 'public health' gravy train who will say the same in private.


As you can see from the photo below, Hastings sees his next task to be 'proving' that banning alcohol advertising works. You almost have to admire the shamelessness of the man.


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