 | | | | |  | An antidote to panics based on dodgy statistics and dubious arguments.
Edited by Rob Lyons. |  | | |  |  |
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| | | 2 September 2004 | Unhappy meals
Panic: As children return to school after the summer break, the UK government's food watchdog is telling parents to make lunches healthier. 'Lunchboxes still packed with fat, salt and sugar', declares the Food Standards Agency (FSA) in response to its annual survey of lunchbox contents across 28 schools.
The FSA says that 'children are eating double the recommended lunchtime intake of saturated fat and sugar, and up to half their daily recommended salt intake'. FSA nutritionist Sam Church said: 'We all know that what children eat now can have a big impact on their diet and health in the future and that there is nothing wrong with children having the odd snack, but these should be eaten in moderation and as part of a varied and balanced diet.'
Don't panic: The only reason this story is newsworthy is because of the ongoing panic about obesity. Yet there is little evidence to suggest that what we eat as children has a direct connection with later eating habits or weight.
Children are notoriously fussy eaters, refusing to eat anything they don't like. Parents are mostly concerned with making sure that their kids eat enough at lunchtime, as long as there is some goodness in it, on the basis that they can exercise the usual carrot-and-stick discipline at mealtimes in the evening. So what features in a lunchbox isn't necessarily reflective of children's diets as a whole - nor does it make sense to assume that adults will eat the same things they did when they were kids. Adults usually have enough sense to realise that eating a variety of foods is important both for health and pleasure.
But even if all these assumptions were accurate, there is little reason to believe that eating more than a certain level of fat, sugar or salt is in itself harmful. Human beings around the world, and throughout history, have eaten a variety of different foods, in smaller or larger quantities, and thrived. It beggars belief that a little more salt or sugar could be a major health risk, except perhaps for very young children. And there is no clear relationship between obesity in childhood and obesity in later life. Only 30 per cent of fat children will become fat adults - and even then, only the most extremely overweight and unfit are likely to suffer serious health consequences as a result.
In fact, the FSA report itself accepts that any rise in obesity is unlikely to be due to increasing food consumption. 'The most plausible underlying explanation is a fall in energy expenditure due to the explosion in sedentary computer games, hours spent watching television and parental safety concerns resulting in curtailed activity outside of school hours. Added to this is a fall in time devoted to activity within the national curriculum and a four-fold increase in the numbers of children driven to school.' But facts won't be allowed to get in the way of a good panic. Unlike our kids, it seems, this one will run and run.
Read: |  | Lunchboxes still packed with fat, salt and sugar, | | Food Standards Agency, 1 September 2004 | | Thinking outside the lunchbox, | | by Rob Lyons |
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| | | 25 August 2004 | Cigarettes and youth
Panic: 'Young smokers are five times more likely to have heart attacks', says The Times, reporting on work by Finnish researchers published in the journal Tobacco Control. World Health Organisation (WHO) statistics were studied for 132,000 men and women between the ages of 35 and 64 in 21 countries. Of these, 23,000 suffered non-fatal heart attacks. In the 35-39 age group, 80 per cent of heart attack patients were smokers. The researchers emphasised the importance of helping younger smokers to quit, especially since they may believe that their risk of heart attack is little different to that of non-smokers. 'Our data indicates that half of non-fatal heart attacks in men and women younger than 50 years - even more in younger age groups - would be preventable if smoking cessation programmes were successful.'
Don't panic: Smoking is certainly not good for you. It massively increases the risk of lung cancer in later life and substantially increases the risk of many other conditions, including heart attacks. However, even with smoking it is important not to overstate the risks, especially where younger people are concerned.
The most significant factor in both heart attacks and lung cancer is age. Of the 23,000 heart attacks in this study, just 800 - about three percent - were among people in the younger age group. But even this underplays the degree to which age is a factor. In England and Wales, for example, around 80 per cent of coronary disease deaths occur after the age of 65 - in other words, older than anyone covered by this research. So in 2002, around 2,500 people under the age of 44 suffered heart attacks in the UK - or about one in 7,000 of the 17million people between 25-44 years of age. Even if a disproportionate number of these people were smokers, the risk was still very low.
Even the term 'younger people' is rather disingenuous. Most of those in the 35-39 age group will have been smoking for 20 years. However, today there is a particular spin put on any reported research that emphasises the future risk to young smokers, to try to scare them into giving up now. This is misguided, because it fails to appreciate that young people consider themselves, with some justification, indestructible - and it misrepresents the content of the research. What this research actually reminds us is that the absolute risks of smoking, as opposed to the relative risks, are quite low for younger people, and that quitting before your thirties will probably mean your misspent, nicotine-ridden youth has little long-term impact on your health.
Read: | | 'Young smokers are five times more likely to have heart attacks', | | The Times (London), 24 August 2004 |
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| | | 17 August 2004 | Pollutants and brain disease
Panic: 'Pollutants cause huge rise in brain diseases' declared the UK Observer, headlining a report from researchers at the University of Southampton Medical School published in the journal Public Health. The study compared rates for two categories of deaths (including dementia and Parkinson's disease) across 10 countries, contrasting figures from the period 1979 to 1981 with 1995 to 1997.
They found a big increase in most countries across both categories. For example, there were around 3,000 deaths from these diseases per year in the 1979-81 period in England and Wales - which rose to 10,000 deaths per year in the 1995-97 period. Given that genetic changes could not have occurred this quickly, the researchers conclude that there must be an environmental explanation.
'This has really scared me', said Professor Colin Pritchard, the lead author of the study. 'These are nasty diseases: people are getting more of them and they are starting earlier. We have to look at the environment and ask ourselves what we are doing.'
Don't panic: This study does not examine any pollutant or even any single disease. It merely examines recorded deaths for these groups of diseases over two periods to look for trends, and then speculates about what might be causing these trends. The 'tentative explanation' the authors put forward is just that - tentative. It certainly does not warrant banner headlines.
The first thing to be pointed out is just how rare these diseases are. Consider the figures for England and Wales: in 1979-81, there were 171 deaths per million of the population from these diseases - or 0.017 per cent of the population. In 1995-97, this had increased to 0.034 per cent. As a percentage of deaths from all causes in women, the rise was from 1.67 per cent of all deaths, to 3.54 per cent - more than double what it was before, but still a small number given that this includes dozens of different diseases. (The equivalent figures for men are lower: 1.23 per cent and 2.61 per cent.)
Secondly, these diseases are overwhelmingly diseases of old age. In the 1979-81 period, in England and Wales, someone over the age of 75 was 13 times more likely to die from one of these conditions than someone in the 55-64 age group. In 1995-97, the over-75s were 24 times more likely to die than the 55-64 year-olds. The incidence of these diseases below the age of 55 is even smaller.
Thirdly, the authors are quite wrong to assume that environmental factors are key to the increase. The most important factor in the rising numbers of people dying from these conditions is that the population is getting older. To that extent, there is a real, but manageable problem of coping with an increasing number of people living with these conditions in the future.
But the next most important factor is surely one of labelling. The figures for Italy are quite dramatic in this regard. In 1979, in the 75+ age group, the rate of death from dementia-like illness was 45 per million. In 1995-97, the rate was 1,211 per million for the same age group. We can either conclude that there has been a marked change in diagnosis and death certificate practice in Italy - or that someone has been going round attacking Italian pensioners with a special dementia gun. The idea that any factor in the Italian environment could engineer a real 27-fold increase in a particular cause of death is laughable.
The cross-national comparisons are almost as bizarre. In the 1990s in Italy, 1.2 per cent of deaths were due to these dementia-like illnesses. In Canada, the figure was 2.6 per cent. Are people really more than twice as likely to die from these causes in Canada? Again, it is much more likely that differences in labelling and healthcare practice are to blame.
There may be changes going on in the death rates from these diseases, but the methods used in this report are simply incapable of detecting them - and a panicky search for some external cause is unnecessary.
Read: | | Changing patterns of adult (45-74 years) neurological deaths in the major Western world countries 1979-1997 | | Public Health, June 2004 | | Pollutants cause huge rise in brain diseases | | Observer, 15 August 2004 |
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| | | 10 August 2004 | An injection of perspective
Panic: 'Chaos over 5-in-1 jab' declared the UK Daily Mail, reporting that the government plans to replace an existing four-in-one jab, protecting against diptheria, whooping cough, Hib and tetanus, with a new one that adds protection against polio. The new vaccine will also not contain the preservative thiomersal, a mercury compound, which has been linked to autism by studies in the United States - leading to suggestions that the current vaccine is not safe. Campaigners also raised fears of immune system overload in infants coping with five different vaccines at once. Jackie Fletcher, founder of the support group Justice, Awareness and Basic Support (JABS), told the Guardian: 'Increasing the combinations increases the potential for an adverse reaction and restricts choice for parents.'
Don't panic: There are two panics here. The first is that mercury in the old vaccine, in the form of thiomersal, is harmful. The evidence against thiomersal is based on reports condemned by the American Academy of Paediatrics as containing 'numerous conceptual and scientific flaws, omissions of fact, inaccuracies and misstatements'.
The amount of mercury involved is so tiny that it simply could not be toxic, even to an infant. There is no evidence that it is harmful. It is not used in the new vaccine simply because it is incompatible with the polio element that has been added. However, by even implying that vaccines containing mercury should be withdrawn on a precautionary basis, the government has lent credence to the notion that thiomersal could be harmful.
The second panic is that the immune system of infants could be overloaded by a new multiple vaccine. This is similarly without substance. Newborn babies face a large number of potential infections, even in the process of being born. To counter this they already have the capability to deal with many different threats, a capability which develops further within a few days of birth. On the other hand, immune responses to some infections, like Hib, are much weaker in babies than they are in adults. For that reason, the vaccines used are specially designed to encourage immunity by stimulating well-developed parts of the immune system instead. This is also the reason why early vaccination is very important.
A review published in the journal Pediatrics concludes: 'Current studies do not support the hypothesis that multiple vaccines overwhelm, weaken, or "use up" the immune system. On the contrary, young infants have an enormous capacity to respond to multiple vaccines, as well as to the many other challenges present in the environment.'
While it is assumed that multiple vaccines must be more harmful, developments in protein chemistry mean that all the usual vaccines taken today, 11 in all, use fewer immunity-triggering proteins than just one vaccine (smallpox) did in the past. It seems that problems are found even where there has been progress.
Any conceivable harm caused by these vaccines is far outweighed by the harm done by the diseases they prevent. As Jennie Bristow notes elsewhere on spiked, we can fret about the slim possibility of vaccine damage precisely because of the remarkable success of the vaccination campaign. What this debate requires is an injection of perspective.
Read: | | Doctors try to head off new vaccine row, | | Guardian, 10 August 2004 | | Addressing parents' concerns: do multiple vaccines overwhelm or weaken the infant's immune system?, | | Pediatrics, 1 January 2002 (pdf format) | | Three cheers for the five-in-one jab, | | by Jennie Bristow |
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| | | 6 August 2004 | Return of the mad cow panic
Panic: 'Experts warn of wider CJD threat', reports BBC News. The CJD Surveillance Unit has looked into the case of a man infected with the prion protein suspected of causing the disease. The man, who had no symptoms of vCJD when he died, had received a blood transfusion from someone who had died of vCJD. The new report says that his genetic make-up was not the same as those who have developed symptoms, suggesting that more people may be carrying the disease. Professor James Ironside told BBC News, 'It's absolutely possible that there may be a new epidemic, because the cases we've seen so far may only be those who are unusually susceptible or have the shortest incubation periods'.
Don't panic: The number of deaths from vCJD has been in decline over the past four years - not that there were very many to start with. The first cases, three in total, were identified in 1995. The number of deaths rose to a peak of 28 in 2000, but has fallen since. There have been three deaths this year, and 142 in total over the course of a decade.
Far from suggesting a new epidemic, the latest report seems to indicate that even if the prion protein thought responsible for the disease is present in an individual, some other factor must also be present for the disease to develop. In March, researchers presented the results of tests done on 12,000 tissue samples at Derriford Hospital in Plymouth. Just three showed signs of prion infection. If only a small proportion of the small number infected actually develop the disease, that would be one explanation for the tiny number of cases to date - and why we need not worry about a wider outbreak.
Despite protestations from CJD researchers to the contrary, the spin put on this latest report seems like scaremongering at a time when it is becoming apparent that vCJD is not the mass killer suggested in the past. At one time, epidemiologists suggested that millions would die from vCJD - but a more recent estimate is that 540 people would die in total. At the current rate of cases, even that revised figure seems a long way off.
While there is much fretting about potential epidemics, the measures taken to prevent an epidemic have been disproportionate and occasionally have caused more harm than good. For example, the use of disposable surgical implements may have led to one death while the risk of transmission by this route was described as 'theoretical'. Rules on who can give and receive blood have been tightened up, and some blood products are now imported specifically because of the vCJD threat. Schemes to eradicate BSE from cattle, while not solely concerned with human health, have cost billions of pounds.
It is suggested that 'mad' cows have spread vCJD - but it is the panic attached to this rare disease that is truly bonkers.
Read: | | Experts warn of wider vCJD threat, | | BBC News, 6 August 2004 |
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