It is little wonder that people are confused by health messages and the latest discovery. As I have observed before when you are certain that what causes cancer this week was a cure for cancer last week, you are not imagining it.
We need medical research as it does lead to discoveries and progress. Unfortunately, over 80% of medical research is useless but we don’t know in advance which is the worthwhile 20%.
However, there are clues. A study from Denmark has “found” that children who are shorter at age are 11% more likely to have a stroke. As usual, relative rather than absolute risk was quoted. Over a 31 year period some 4.16% of the people observed suffered a stroke. The 11% increase essentially means that the “shorter” people had a 0.42% higher rate than everyone else.
This is a very small increased risk and we don’t even know if a repeat study on a different group of people would yield the same result. Necessarily no mechanism was identified for this finding which may be statistically significant but has no clinical significance. Even if we assume that this is a genuine finding what is the solution – tell people to grow more?
To be fair, the researchers advised parents not to panic and suggested that those” at risk” tried to reduce their chance of a stroke through sensible diet, not smoking and regular exercise. Yet this advice applies to all of us.
The question arises, why was this study done and who paid for it?
Childhood obesity exercises the minds of public health. One study suggested that children born by Caesarean section were more likely to be overweight at age five! Had it been considered that quite a lot may have happened between birth and the age of five?
Meanwhile another study found that a home visit program to assist socially disadvantaged mothers led to lower rates of obesity in children at age two. It is possible that having a nurse visit and chat about healthy eating may be of benefit. But these arbitrary cut offs of two or five years begs the question about what happens in the long term.
Epidemiological studies which observe one issue and seek to link it to another are fraught with potential for false conclusions. Whilst researchers may try to allow for confounding (interfering) factors, this can never be done satisfactorily. This would be fine as part of a learning process.
The problem is that most public health edicts come from these types of studies. Low fat dietary advice is the most egregious example.
Furthermore, if they were prepared to admit error when proven wrong then one could say fair enough. But they are never wrong. As Dr Saurabh Jia observed on Kevin MD “Science is at its weakest when scientists are most certain and the science is settled”. He wondered when did scientists go from demanding more freedom to demanding more funding?
In Australia, public health continues to oppose reducing harm from smoking by smokers switching to vaping. Richard Horton writing in The Lancet observed that “public health science needed to pay more attention to the lived experiences of people in societies”.
Smokers who have switched to vaping and those who have lost weight or markedly improved their diabetes management by going on to a low carb diet are at best ignored and at worst abused by public health.
They often claim there is a lack of evidence whilst ignoring that much of the evidence that exists in medicine is flawed. And of course, as has been noted in the BMJ there has never been a randomised control trial to establish the role for the use of parachutes when jumping from a plane.
Whilst we have much in common we are all different and across the board edicts do not suit everyone especially when it comes to lifestyle issues. We need a more nuanced approach which recognises the differing situations and experience of real people.
I will give the last word to Richard Horton “Public health today is crudely reductionist, often ignoring or denying the lives of those it purports to defend. Public health has evolved into an elitist endeavour, more concerned with its own power, reputation, and survival”.
This article first appeared here.