Taxing Cigarette Butts and the Buttheads Who Flick Them

San Francisco Mayor Gavin Newsom has proposed a $0.33 tax on cigarettes to address the problem of cleaning up butts! This follows an audit (PDF) of litter in the city that found cigarette butts to be a major problem (along with chewing gum, and unbranded napkins).

The cigarette companies are against it:

“Obviously we think people should follow the littering laws, in California and elsewhere,” said Frank Lester, a spokesman for Reynolds American Inc., the nation’s second-largest manufacturer of cigarettes. “But we oppose any additional taxation on smokers to pay for that.”

But, isn’t this a rational response to the problem? The city performed an audit of a costly problem and found that smoking was a major contributor to the problem. A tax on smokers (so long as proportionate) seems like a good way to address the problem. The alternative proposed by Frank Lester would be to use our police resources on enforcement of a minor criminal law, and thus subject his own customers to citation and possible arrest!

Anyway, our culture has become much more sensitive to littering. None of us would throw a Coke can out the car window. But so many of us would flick a cigarette butt, even when there is a receptacle for butts nearby. Why?

Denialism in the Literature

ResearchBlogging.orgIt’s good news though! A description of the tactics and appropriate response to denialism was published in the European Journal of Public Health by authors Pascal Diethelm and Martin McKee. It’s entitled “Denialism: what is it and how should scientists respond?” and I think it does an excellent job explaining the harms of deniailsm, critical elements of denialism, as well as providing interesting historical examples of corporate denialism on the part of tobacco companies.

HIV does not cause AIDS. The world was created in 4004 BCE. Smoking does not cause cancer. And if climate change is happening, it is nothing to do with man-made CO2 emissions. Few, if any, of the readers of this journal will believe any of these statements. Yet each can be found easily in the mass media.

The consequences of policies based on views such as these can be fatal. Thabo Mbeki’s denial that that HIV caused AIDS prevented thousands of HIV positive mothers in South Africa receiving anti-retrovirals so that they, unnecessarily, transmitted the disease to their children.1 His health minister, Manto Tshabalala-Msimang, famously rejected evidence of the efficacy of these drugs, instead advocating treatment with garlic, beetroot and African potato. It was ironic that their departure from office coincided with the award of the Nobel Prize to Luc Montagnier and Françoise Barré-Sinoussi for their discovery that HIV is indeed the case of AIDS. The rejection of scientific evidence is also apparent in the popularity of creationism, with an estimated 45% of Americans in 2004 believing that God created man in his present form within the past 10 000 years.2 While successive judgements of the US Supreme Court have rejected the teaching of creationism as science, many American schools are cautious about discussing evolution. In the United Kingdom, some faith-based schools teach evolution and creationism as equally valid ‘faith positions’. It remains unclear how they explain the emergence of antibiotic resistance.

In particular I found their inclusion of a tactic of inversionism interesting:
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The Good and Fragile Egos

Following up on my earlier post about Beyond Google and Evil, I just came across this article from the Wall Street Journal on one of Google’s detractors, Consumer Watchdog. Believe it or not, Google went after their funding!

…In January, Consumer Watchdog circulated a press release alleging a “rumored” lobbying effort by Google to enable it to sell personal medical data stored on its Google Health service. Simpson said the organization merely wanted to examine whether Google was trying to avoid new regulation under the Health Insurance Portability and Accountability Act, or HIPAA, which guards the confidentiality of patient data.

But Google was incensed. “That’s when Bob Boorstin went ballistic,” Simpson said, referring to Google’s director of corporate and policy communications in Washington.

Simpson defended the use of hearsay to make public allegations, arguing that it was appropriate for an advocate. “I don’t see any obligation in particular to call up the other guy and get his side of the story,” he said, adding, “We don’t lie, but we put out the facts we think are interesting.”

Google, however, was prompted to take the unusual step of asking the Rose Foundation to reassess its funding for Consumer Watchdog.

“In 17 years as a grant maker, that’s never happened to me before,” the Rose Foundation’s Little said. “Nothing Google has done has discouraged us from follow-up funding” for Consumer Watchdog, Little said, though no decisions have yet been made. He added, “Google would be much better off engaging with them.”

If you are proposing products that would put individuals’ health records online, you have to be ready for some criticism. But Google responded by trying to shut down Watchdog, and by trying to link Watchdog to Microsoft! (Microsoft is not linked to Watchdog.) Way to go, Google. That’s a standard PR tactic. I wonder whether it is good or evil.

In a sense, Watchdog did have the right intuition about Google. Google health is all about capturing the DTC drug advertising market away from the TV networks. Just imagine the types of targeting that will be possible when you’ve decided to upload your health information to Google!

Beyond Google and Evil

I apologize for the infrequent blogging. A tough semester. I did have time, however, to publish an essay about Google’s rhetoric that might be of interest to Denialism readers.

No, I’m not calling Google denialist, but am trying to explain what Google means when the company talks about privacy (most companies interpret information privacy to mean security). And it’s not all bad for Google–the company’s rhetoric has created confusion, and clarifying it would help Google communicate why search advertising might be better for the consumer than other forms of targeting.

Nature Reviews “Denying AIDS: Conspiracy Theories, Pseudoscience, and Human Tragedy”

Seth Kalichman has written a book on HIV AIDS denial and Nature has a book review that’s got me excited to get my copy. From the review:

Inadequate health policies in South Africa have reportedly led to some 330,000 unnecessary AIDS deaths and a spike in infant mortality, according to estimates by South African and US researchers. This carnage exceeds the death toll in Darfur, yet it has received far less attention. Seth Kalichman, a US clinical psychologist, shows in Denying AIDS how words can kill. His marvellous book should be read alongside Nicoli Nattrass’s Mortal Combat, covering similar ground but from the perspective of a South African.

The tragic events in South Africa have been exacerbated by AIDS ‘denialists’ who, Kalichman alleges, assert that HIV is harmless and that antiretroviral drugs are toxic. The author discusses the psychology of denialism, which he says is “the outright rejection of science and medicine”.

These attitudes are not unique to HIV. Denialism, notes Kalichman, is “partly an outgrowth of a more general anti-science and anti-medicine movement”. Groups that support intelligent design, doubt global warming, claim that vaccines cause autism, argue that cigarettes are safe, believe that the terrorist attacks of 11 September 2001 were an intelligence-agency plot or deny the Holocaust all use similar tactics.

As Kalichman says, denialism “will not break until the public is educated to differentiate science from pseudoscience, facts from fraud”.

Excellent! These are the points we’ve been trying to get across for years and I’m excited to see others catching on and emphasizing this point. It’s not about differing opinions it’s about different tactics. The tactics of the pseudoscientists are easy to spot, and don’t require expert knowledge of science. If people know about them, and recognize them, then fighting against insidious ideas like HIV/AIDS denial or evolution denial gets that much easier.

Get yourself a copy!

Angels and Demons – Feeding our love of conspiracies

Tomorrow Angels and Demons comes to theaters across the country. One in a long series of movies that profits from the idea that underneath our regular, ordinary world, there are powerful forces controlling the scenes. I understand the appeal of these movies, it’s an entertaining concept. A fictional conspiracy engages your intellect, creates a mystery, makes you think about the world and who is in control. But we have to remember when we see these films that these are works of fiction for entertainment. The Illuminati are not real, this sadly ludicrous belief still persists for some people but fortunately for most of us has become a joke. The Priory of Sion was conclusively demonstrated to be a hoax decades ago. These groups are, of course, not real because such conspiratorial groups and actions could never be kept secret or hidden in the real world.

The reality of conspiracy theories is very different. These don’t represent any kind of healthy thought process at all. They require one to reach a conclusion, then ignore any information that contradicts it. They attempt to explain, but only create more questions. I like to say they are non-parsimonious. And worse, rather than make people think, they tend only to enforce bigotry and ideology. It is the intellectual equivalent of self-lobotomy.

Films often seem to reinforce non-skeptical thought. We like to be entertained, or scared, or shocked. Hence, every time someone is introduced as an atheist or “skeptic” in a film they’re inevitably exposed to ghosts, or aliens, or whatever unlikely boogeyman serves the script. The skeptic never turns out to be right, as they are in real life. What would be the fun in that? Every movie would turn into an episode of Scooby Doo. It was just old man Withers with a flashlight after all, and a multi-million dollar CGI budget.

So the question is, do films like these make the situation worse? Do they encourage conspiratorial thought or are they recognized by film goers appropriately as entertainment?

I suspect that to some degree our fascination with, and desire to be entertained by conspiracies is encouraged by these films, but for most of us, seeing 1408 or the X-files is just entertainment and that’s OK. I read Angels and Demons and I gotta tell you, it’s a pretty silly, unbelievable book. But that never precludes it from being a good movie.

If instead you want to spend this weekend watching an entertaining movie that deals with conspiracies in a realistic way, those exist too. I can highly recommend Burn After Reading which is the antidote to government conspiracy theories. In a hysterical way it mocks how little we are in control of anything. Or if you like the murder-mystery types, try Blood Simple. Really, anything by Joel and Ethan Coen will be highly entertaining while keeping your skeptic’s circuits sharp. Any other skeptical suggestions for entertainment? Leave them in the comments.

Have you written your letter to Oprah yet?

If you have been keeping up with Pal or Orac in my absence, you already know the bad news. Oprah has decided to up her woo quotient from promotion of the Secret and relatively harmless nonsense to actively promoting anti-vaccine conspiracy theories in the form of a Jenny McCarthy TV show. Gawker suggests a good title, “Finding Someone to Blame When Bad Things Happen”.

Jenny McCarthy is an insipid, dangerous idiot. And a Wacko. Oprah’s move isn’t just some harmless addition to the drivel that occupies our screens known as “daytime TV”. This is actively dangerous. This is, as Pal says, infectious disease promotion. I don’t want the proof that we’re right about vaccines (other than thousands of scientific papers and the last 100 years of human history) to be a bunch of dead kids or more kids born with birth defects due to a reemergence of congenital rubella. I don’t think Oprah is a bad person, she certainly doesn’t have malicious intent. I’m sure McCarthy even has good intentions behind her lies and misinformation. But that doesn’t mean such dangerous idiots should be tolerated, given airtime, and their own TV shows. If Oprah does not work to actively reverse this deal, and undo the harm that Jenny McCarthy does as an infectious disease advocate, the resulting illness and deaths will be her responsibility.

Young Australian Skeptics have written their letter to Oprah. Go here and write your own. Mine is below the fold.
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Obesity – A new study and what it means to be a “healthy weight”

ResearchBlogging.orgIn response to the conversation on “Obesity, Evolution and Delayed Gratification” on the main page and Razib’s coverage of a fascinating new study on the relationship to the lactase gene and obesity, I thought now would be a good time to write about an important new study that helps define the boundaries of what normal and healthy weights are in humans.

This study, entitled Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies is a whopper of a meta-analysis. That is, a study that increases the power of other similar studies by combining their results so that, in this case, data from hundreds of thousands of patients can be aggregated. Meta-analyses have their flaws, and I criticize them frequently when poorly-done or poor-quality studies end up being averaged-in with the results of better-designed studies, but this one is large enough and thorough enough that its results should not be dismissed.

What this study describes is the mortality, and causes of mortality, one observes when one sorts people by body mass index. Body mass index also has it’s flaws but it is a useful, if imperfect method of describing one’s relative contribution of body fat to their total mass. It is calculated by taking and individual’s body weight in kilograms and dividing by the square of their height in meters. “Normal” is defined between 18.5-25, overweight is 25-30, and obese is greater than 30. These numbers do not describe all people well, and you may be an exception to these predictions. This usually occurs if you have a large amount of muscle mass relative to your height, so Arnold Schwarzenegger would be obese according to these scales. However, most people are not Arnold Schwarzenegger and the scale fits, it’s better not to let the perfect spoil the good. One must also remember that it would be unethical to design a study in which we prospectively made people overweight or obese, since we suspect that will cause poor health, so this is necessarily a correlative study of BMI and health. But this information combined with what we know about mechanisms of cardiovascular disease, diabetes, etc., makes a lot of sense, and I believe in the context of the literature we can make a safe assumption the effects we see are causal.

Overall what the study suggests is that the current 18.5-25 recommended BMI is probably about right, BMI of 25-30 marginally increases morbidity and mortality, and BMIs much greater than 30 significantly shorten one’s life. The reason I like this study is that they have aggregated such a huge data set, they demonstrate a clear dose-response curve between obesity and mortality, and they’ve done a better job than most in teasing out the relationship between health, weight, smoking and other co-morbidities at all BMIs.

Let’s take a look at some of the data.
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What should a national health care system look like?

I was pleased to see president Obama deliver this address yesterday:

I was even more pleased because he has gathered the traditional opponents of healthcare reform around him and has convinced them to commit to reform in the US system. This is a positive sign. However, I’m concerned because, as with all political debates that challenge a dominant ideology – in this case free-market fundamentalism – we will soon see the denialists come out of the woodwork to disparage any attempt at achieving reforms that may result in universal health care coverage. This has, in fact, already begun, and typical of the tactics they selectively mention the British NHS. If you care to read a balanced article on the history and function of the NHS, you’ll probably agree it is wrongly demonized. What you will also see is that the denialists will ignore a few key facts which include:

1. The United States is the last industrialized nation that lacks a universal healthcare system. Once again, thanks to obstructive policies led by the free market fundamentalists, the US is trailing the rest of the world.
2. The US spends more per capita on healthcare than any other nation in the world.
3. Despite spending more, we get less. We have tens of millions who are uncovered – which does not mean they do not receive healthcare at all. They instead are treated in ERs, urgent care centers, or receive substandard care, and the state ends up picking up the bill anyway. So even without a planned universal health care system, you end up picking up the (higher) bill because the state has a vested interest in protecting hospitals from the economic collapse that would occur if they had to pick up the tab on every impoverished patient who doctors are ethically and legally obligated to treat.
4. Many national healthcare systems work. We will not hear about this from the ideologues who will soon harangue us with cherry-picked horror stories of long wait times and underfunded hospitals. You will likely not hear about Sweden or Italy or France, and I promise you will never hear them talk about Australia. For them to do so would be to admit to defeat of their fundamental premise that universal health care can not work.
5. Failures of national health systems are not related to universality but instead are due to chronic underfunding by government. If the British spent as much per capita as we did, they wouldn’t have the shortfalls in manpower and beds that they do.

We will of course hear a lot of chest thumping from the thick-browed morons about how the US is already perfect and can not learn anything from the rest of the world. We will hear how every other system in the world is imperfect, and that is why any reform is impossible. We will hear how this will lead to communism and socialism despite the fact that every other industrialized nation in the world has universal healthcare and amazingly they didn’t all go commy. In short, we are about to hear a bunch of denialist garbage designed to delay, to obstruct, to block, and drag down any meaningful action in healthcare.

But before that happens, let’s have a more balanced discussion on what a universal healthcare system could look like in the US.

Any discussion of changes in the US medical system must begin with a statement of principles guiding reforms in the system. Let’s start with some of the principles I would include, and I think most of us could agree on:
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