Weapons of Mass Distortion

Roger Clemens, DrPH, CFS, CNS, FACN, FIFT, FIAFSTAdj Professor, Pharmacology and Pharmaceutical Sciences

USC School of Pharmacy, Los Angelesclemens@usc.edu

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“The single biggest problem in communication is the illusion that it has taken place.”

George Bernard Shaw 1856-1950

"El problema más grande en la comunicación es la ilusión que ha tenido lugar".

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Common Distortions of Health Science in the Media

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Associations reported as causation Animal findings extrapolated to humans Relative risks without absolute risks Proxy outcomes extrapolated to clinical

outcomes/disease/death Ecological fallacy Pumped up press releases Publication bias – negative findings don’t make

the news Issues with small sample sizes ignored New finding often not set within wider body of

knowledge …many more Book image from

Amazon, 2004, Weapons of Mass Distortion: The Coming Meltdown

of the Liberal Media.

Risk Communication and Public Health

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HealthTargets

PublicHealthStatus

Assessmentof

Risk

RiskManagement

AssessEnvironmental

Exposure

AcceptableRisk

http://www.who.int/water_sanitation_health/dwq/iwachap14.pdf

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Hazard vs Risk Communications

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Communication Bias

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Are there biases in the reporting of food, nutrition and health relationships? Bias is ‘‘a tendency to believe that, for example, some

people, positions and ideas are better than others” Universities have attempted to monopolize certain kinds of

information, as have professional associations such as doctors or engineers or lawyers [or nutritionists and dietitians], as have governments, individuals or groups who control access to those points wield great power.

Rowe S, Alexander N. Nutr Today 2015;50(1):8-11

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“Cracking the Code on Food Issues: Insights from Moms, Millennials and Foodies”

Who’s the most trusted scientist?a. Mom scientistb. Federal scientistc. Peer scientistd. Celebrity scientist

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http://www.foodintegrity.org/research/2014-research

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“Cracking the Code on Food Issues: Insights from Moms, Millennials and Foodies”

What’s the most trusted information source?a. Televisionb. Newspapersc. Websitesd. Food networks

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http://www.foodintegrity.org/research/2014-research

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Science Denied The Challenge of Introducing Complex, Controversial

Issues into the Food Conversation Cultural Cognition: reinforce values Confirmation Bias: confirm exiting beliefs Tribal Communication: internet created silos Science is Hard: not qualified to evaluate It’s Complicated: bad news bias (1:5)

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http://www.fccouncil.com/files/CFI2014%20Research%20Book.pdf

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The Decision-Making Maze

Sensationalism and Exaggeration

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http://www.theatlantic.com/health/archive/2014/12/as-academia-melts/383570/Posted December 10, 2014; Accessed July 10, 2016

"If You've Ever Eaten Pizza, You'll Want to Read About the Toxin That Is Pretty Certainly Ravaging Us From the Bowels Outward."

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What is it?

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3,7-dimethlocta-1,6-dien-3-ol (E,Z)-2-6-nonadienal geraniol butanoic acid methyl 2-methylbutanoate ethyl hexanoate

2,5-dimethyl-4-methoxy-3(2H)-furanone (DMMF)

2,5-dimethyl-4-hydroxy-3(2H)-furanone (DMHF)

methyl butanoate

γ-decalactone (E)-2-hexanal

Major aroma compounds(more than 500 in mature strawberries)

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What is it?

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dimethyl trisulfide 2,3,5-trimethylpyrazine 2-ethyl-3,6-dimethylpyrazine 2-ethyl-3,5-dimethylprazine 3-isobutyl-2-methoxypyrazine propanoic acid linalool methylpropanoic acid

2-methylpropanal 2- and 3-methylbutanal ethyl 2-methylpropanoate ethyl 3-methylbutanoate 3-methyl-1-butanol 1-octen-3-one 2-heptanol 2-acetyl-1-pyrroline

Major aroma compounds(more than 100 in Criollo cocoa beans)

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Ecological Relation of Water Intake with Prevalence of Overweight/Obesity: 1961-2000

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Liquid vs Solid Carbohydrate Intake on Body Weight

Bailey, McDougall & Thomas. Montclair State University. Experimental Biology 2015 (Poster Presentation)

0

0,7

3,6

23,9

14,9

10,7

46,2

44,8

51,8

7,7

20,9

25

0

34,8

34,1

23,1

9,7

8,9

0 10 20 30 40 50 60

Editorials/Commentaries (%)

JournalArticles (%)

Review Articles/Book Chapters (%)

Accurate Mildly Misleading Moderately MisleadingExplicitly Misleading Unscorable Other

Misleading references or distorting results can negatively influence policy, future research, and beliefs of the public community

Citation Analysis and Results

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Press Release Spin

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Spin identified in 40% in scientific article abstract conclusions, and 47% press releases.

RCT-based press releases were overestimated for 27% of reports About 51% combined spin in article conclusions and news releases

Yavchitz A, Boutron I, Bafeta A, Marroun I, Charles P, et al. (2012) Misrepresentation of Randomized Controlled Trials in Press Releases and News Coverage: A Cohort Study. PLoS Med 9(9): e1001308. doi:10.1371/journal.pmed.1001308

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Medical Reporting Bias?

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Newspaper coverage more likely to be observational vs RCT (75% vs 47%, p<0.001) regardless of number of subjects or study length

Observational studies used smaller sample sizes, and more likely to be cross-sectional (71% vs 31%; p<0.001) while no differences were observed for RCTs.

Selvaraj S, Borkar DS, Prasad V (2014) Media Coverage of Medical Journals: Do the Best Articles Make the News? PLoS ONE 9(1): e85355. doi:10.1371/journal.pone.0085355

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Science News and Academic Press Releases

18Sumner et al., BMJ 2014; doi: 10.1136/bmj.g7015

• Exaggeration: 40% of press releases contained more advice that the journal article

• Association: 39% of news statements were more deterministic than the journal article

• Translation: 47% of news contained inflated inference to humans

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This is Your Brain on Gluten A No. 1 bestseller by a respected physician argues

that gluten and carbohydrates are at the root of Alzheimer's disease, anxiety, depression.

“All of the neurodegenerative diseases are really predicated on inflammation. Who knew?”

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http://www.theatlantic.com/health/archive/2013/12/this-is-your-brain-on-gluten/282550/Posted December 20, 2013

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Grain Evaluation “He has so many theme in there it’s hard to know what to talk about. It’s

like a field that has good plants, some you are not so sure of and weeds.”

“He talks about the carbohydrates in grains and in fruit setting off the inflammatory pathways. If it is a brain disorder, the diet is the problem. He appeals to groups like older people who are afraid of losing it. He appeals to young parents who are afraid their children might turn out to be autistic.”

“Luckily, diets that optimize health for the body also optimize it for the brain and mental health.”

http://www.foodnavigator-usa.com/Regulation/Misleading-and-sensationalist-Grain-Brain-book-distorts-science-and-confuses-public-with-advice-to-avoid-grains-say-criticsPosted September 18, 2013; Accessed July 10, 2016

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Media Assessment

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Fox News Health, October 26, 2015

Expert Testimony

Group 1Carcinogenic to Humans

Group 2AProbably

Carcinogenicto HumansGroup 2B

PossiblyCarcinogenicto Humans

Group 3Not Classifiable

as to Carcinogenicityto Humans

Group 4Probably notCarcinogenic to Humans

IARCInternational Agency for Research on

Cancer

WHO Press Release Personnel: 22 experts from 10 countries Studies: 800 studies across populations Conclusions Red meat:

Classified as probably carcinogenic (Group 2A) Association mainly for colorectal cancer (CRC) Associations observed for pancreatic and prostate cancer

Processed meat: Varied intercountry consumption patterns Classified as carcinogenic to humans (Group 1) Concluded 50 g portion 18% risk of CRC Strongest association with CRC and stomach cancer

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http://www.iarc.fr/en/media-centre/pr/2015/pdfs/pr240_E.pdf

CRC Within the USA

http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdfAccessed August 3, 2016

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CRC Among Latinos

0%

20%

40%

60%

80%

All Latinos Mexican Puerto Rico Cuban Central/South American

NOS NHW

Frequency of Demographic Characteristics for CRC Cases Diagnosed Between 1995 and 2011 in

California

< 50 50-65 >65NOS – Country not specifiedNHW – Non-Hispanic WhiteStern et al., Cancer Causes Control 2016; doi: 10.1007/s10552-015-0691-4http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-046405.pdf

Carcinogenicity of Consumption of Red and Processed Meat

Red meat Nutrient rich, e.g., protein, iron and B vitamins

Consumption 5-100% of diet; mean = 50-100 g/d > 200 g/d Greatest association between highest and lowest consumption levels Highest concentration of N-nitroso-compounds, polycyclic aromatic

hydrocarbons, heterocyclic amines in well-done products Inadequate evidence in animal models for the carcinogenicity Rat models develop colon cancer when exposed to promoters and low Ca

diets among 75% of studies

Bouvard et al., Lancet 2015; doi: 10.1016/S1470-2045(15)00444-1

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Carcinogenicity of Consumption of Red and Processed Meat Processed meat Cured, smoked N-nitroso-compounds, polycyclic aromatic

hydrocarbons, heterocyclic amines Cooking improves microbial safety and digestibility, yet produces

undesirable compounds Consumption 2-65% of diet Greatest association between highest and lowest

consumption levels Inadequate evidence in animal models for the carcinogenicity Rat models develop colon cancer when exposed to promoters and low Ca

diets among 75% of studiesBou

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A Look at the EvidenceEpi Studies Search

(n=800)

Epi Studies Excluded (other than CRC)

(n=771)

CRC Epi Studies Informative for Red meat

(n=29)

CRC Cohort Studies(n=14)

CRC Case-Control Studies(n=15)

CRC Epi Cohort Studies Processed Meat

(n=18)

YES association

(n=7)

NO association

(n=7)

YES association

(n=7)

NOassociation

(n=8)

YES association

(n=12)

NOassociation

(n=6)

Carrageenan

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Food grade vs degraded Health implications Degraded (low MW; polygeenan) GI inflammation IARC possible human carcinogen

IRAC – International Agency for Research on Cancer (WHO)http://www.cornucopia.org/wp-content/uploads/2013/02/Carrageenan-Report1.pdfMarch 2013; Accessed July 2016

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What is the Science? Studies among rodents, when injected with carrageenan and co-administered

6% and 15% of various forms of carrageenan increased colon tumor burden.

Animals in these studies were fed diets that were nutritionally insufficient.

Physical and toxicological properties of carrageenan and poligeenan differ.

Poligeenan does not have any functional properties; carrageenan is typically used at < 0.1%.

Current evidence indicates dietary carrageenan is not absorbed, hydrolyzed, or converted to poligeenan following ingestion by rodents, dogs, and nonhuman primates, or by intestinal microflora.

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Risk in the News

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Risks: More Red Meat, More Mortality(NY Times, 3/12/2012)

Red Meat and Cancer: What’s the Beef? (Medscape Oncology, 6/20/2013)

Red meat possibly linked to breast cancer, study says.(FoxNews 6/11/2014)

Red meat strong association with increased risk for CRC, but not other forms of cancer. (DGAC 2015; AICR/WCRF, 2014)

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Assessing the Risk

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Fundamental questions

How does this study fit with the existing literature on red meat?

Are there any issues with using mice to extrapolate health conclusions to humans?

How does the quantity of Neu5Gc that was tested fit with the amount people typically consume?

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Food Colorants in the News

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Will Nestlé's move to cut out artificial colors be the tipping point in the U.S. candy market? (February 23, 2015)

Mars explores natural colors but says artificial dyes are safe. (February 26, 2015)

Goodbye to artificial colors? (Marion Nestle, March 4, 2015)

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A Natural Mess?

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“Natural” does not have a clear definition

Consumers: Natural = OrganicNatural = Safe

FDA “natural” colorants and flavors (21CFR101.22)

FDA (1988) “nothing artificial or synthetic included or added…not normally expected

Petition and public meeting to define “natural” (71 Fed Reg 70502; Dec 5, 2006)

FDA “natural” definition pending (since 2008)

November 2008

Are raisins unnatural?

March 17, 2009

Is Natural Safe?

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1. Lectins (insecticide)2. Avidin (biotin binder)3. Tetrodotoxin (potent

neurotoxin w/o antidote)4. Furocoumarins

(photosensitizer)5. Glycoalkaloids

(cholinesterase inhibitors)6. Carotatoxin (Falcarinol)7. Phytolaccatoxin (triterpene

saponins; antidote unknown)8. Alpha-amanitin (inhibitor of

RNA polymerase)

Matching ExerciseA

B

C

D

E

F

Potato

Kidney Beans

ParsnipsEggs

Mushroom

Apricot with seeds

Fugu

G

Carrots

H

Caffeine: Politics vs Public Health?

37Adapted from respective corporate websites, March 1, 2015

McDonald’s Large Coffee: 16 fl oz (473.2 mL) = ~145mg Caffeine [30.6 mg/dL]

Starbucks Caffè Mocha: Espresso with bittersweet mocha sauce and steamed milk. Topped with sweetened whipped cream.16 fl oz (473.2 mL) = ~175mg Caffeine [37 mg/dL]

Pepsi Max: 12 fl oz (354.9 mL) = ~ 69 mg Caffeine [19.4 mg/dL]

Red Bull: 8.4 fl oz (248.4 mL) = ~ 80 mg Caffeine [32.2 mg/dL]

Coca-Cola Classic: 12 fl oz (354.9 mL) = ~ 34 mg Caffeine [9.6 mg/dL]

Caffeine Sources

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http://www.health.gov/dietaryguidelines/2015.asp

Caffeine Intake

39http://www.health.gov/dietaryguidelines/2015.asp

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Caffeine Consumption Among University Students in Mexico

0%10%20%30%40%50%

Btwn 17-20 yrs Btwn 21-24 yrs Above 24 yrs

Perc

ent

of P

arti

cipa

nts

(n=2

15)

1-4x/wk 1-2x/d > 3x/d No Hay …

Tannous M, Al Kalash Y. Public Health Res 2014; doi8: 10.5923/j.phr.20140405.0440

Does the Mexican Coca-Cola have More Caffeine Than the Regular 12 oz. Can of Coca-Cola Marketed in the USA?

USA – 32 mg/12 oz (9.7 mg/100 mL) Mexico – Same as USA

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“Cracking the Code on Food Issues: Insights from Moms, Millennials and Foodies” What did we learn?

a. Believability is a key driverb. Identify the groups to engagec. Meet those groupsd. Develop values-based engagement – listen and

embrace skepticisme. Commit to remain engaged over time

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http://www.foodintegrity.org/research/2014-research

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The Media

Conflict Criticism Controversy

Where’s the story relative to…

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