Tuesday, October 19, 2010

A Fat Stamp of Rejection

The ill-conceived effort of Mother Mike to micro-manage what food stamp recipients eat is called out this morning by Dr. Michael Kaplan, a medical professional who knows, unlike the flailing busybody mayor, that the so-called experiment has absolutely no scientific rationale: "The Unites States is suffering from an obesity epidemic: Obesity rates have more than doubled over the past 30 years. Mayor Bloomberg hopes to blunt this epidemic by proposing that the 1.7 million recipients of food stamps in New York City be banned from using them to buy soda and other sugared drinks. Without question, an intervention to curb obesity is desperately needed, but will this proposal really be effective? According to the best scientific evidence available, it will have no impact on the obesity rate."

This won't stop the Bloomberg health intrusion express, however-because the mayor's obesity prevention adventures have never been really about health at all; and have little to do with science. After all, the entire calorie posting experiment-an effort that has proven to be a total failure yet continues nonetheless-was based on the ideological enmity of Center for Science in the Public Interest toward the entire fast food industry. CSPI's calorie posting mania had no basis in public health research, as the failure of the NYC initiative confirms.

So, don't expect Bloomberg to be deterred by the lack of scientific data-after all, this is really all about controlling people's lives. Still, it is up to the opponents of the proposed food stamp dictate to make Dr. Kaplan's case to the policy makers-and, at the same time, debunk the unscientific conflation of correlation with causation: "Many well-meaning but misguided health officials sincerely believe that sugared drinks are contributing to the obesity epidemic. Certainly, numerous observational studies have shown that obese people are more likely to drink sugared beverages, and sugared beverage consumption has increased in recent decades. For many, this correlation is proof that sugared beverages are a cause of obesity, but every good scientist knows that correlation does not equal causation."

This isn't some simple prejudice on the part of Dr. Kaplan-and we can't wait for the Bloombergistas to attack the man for being a tool of Big Soda (animadversion being the last refuge of scoundrels who have lost the debate). The research has been done, and the results don't point fingers at soda: "In medicine, the universally accepted gold standard used to determine if an intervention works is the randomized controlled trial. To date, there have been four long-term randomized controlled trials done to determine if specifically discouraging the consumption of sugared drinks will reduce obesity. Each of these studies was done on schoolchildren over the course of a year. Each study ended in failure."

The reason why there was a failure to demonstrate causality lies with the complexity of the disease itself: "We need to understand the real cause of obesity. Far too often, the misleading conventional wisdom is that people eat too much. Every one's body weight has a setpoint that can be altered within only a very narrow range. Lose too much weight, and your body - concerned that starvation is approaching - frantically fights back by burning fewer calories and increasing hunger. If we're honest, we'll admit that some unknown factors are affecting people's metabolism in a way that makes their bodies maintain a higher average weight. In other words, people are getting more obese, and we are not sure exactly why."

But Dr. Kaplan points to a real danger here-the misuse of science to advance public policy goals: "There is no direct harm in Bloomberg's proposal to place restrictions on food stamp use, but there is indirect harm in government trying to enact scientifically unfounded health policies. I laud the mayor for his heroic policies to reduce smoking, and I even respect his well-intentioned though futile efforts against obesity. I reserve my criticism for the public health authorities who are, apparently, giving him poor information."

But we really shouldn't blame the advisers-they are simply telling the mayor what he wants to hear; and the danger is greater than Dr. Kaplan realizes, because health policy goals can easily camouflage a more sinister attempt to restrict individual liberty and freedom of choice. It can will lead to the kind of, "soft tyranny," that Tocqueville warned us about.

The Bloomberg attempt to experiment on the NYC public, however, is a fallacious use of scientific method-and nothing he could possibly find in a two year time frame, with no controls, could offer anything in the way of scientific validity. As Kaplan says: "If Bloomberg insists on going forward with this plan, then let me suggest a modification: Take 2,000 people and randomly assign half of them to receive food stamps that cannot be used to buy sugared beverages, while the other half receives conventional food stamps. After one year, see if the obesity rate is different between the two."

Kaplan goes on to say that he doubts that any good data will come from this controlled experiment, given the studies already done in the past. Still, we would add one important caveat. Should the mayor take Dr. Kaplan's advice, the study should be farmed out to an independent team of scientists-and not be done under the auspices of the NYC DOH.

All of this is, however, useless speculation since Mike Bloomberg isn't about science and the search for real solutions. The food stamp proposal is all about posturing, and the mayor's search for national issues to advance his own personal agenda. The entire idea should be given a vigorous stamp of rejection.