How healthy is "healthy"?

Mmmmm Donuts

The above picture is a real product, recently announced by Dunkin' Donuts. As you can see, it is an egg and bacon sandwich served on a glazed donut sliced in half. It's quite brilliant really, but I don't want to evaluate this on it's culinary merits. Instead, I want to take a look at some of the efforts made by Dunkin' Donuts to help their customers make "Better-for-you choices that keep you running." Now the Glazed Donut Breakfast Sandwich is not one of these "better-for-you choices," but what is surprising is that, at 360 calories, the Glazed Donut Breakfast Sandwich has 30 less calories than one of these DDSmart choices, the Turkey Sausage Breakfast Sandwich, which has 390 calories. Furthermore, the Turkey Sausage Breakfast Sandwich is advertised on the Dunkin' Donuts website with the following copy:

Turkey Sausage Done Right

Eating right can still taste great. Our Turkey Sausage Breakfast Sandwich is under 400 calories, and big on taste.

The clear implication here is that the Turkey Sausage Breakfast Sandwich is "right" and is a "smart" choice (or at least "DDSMART"), but it is, in many respects, a less healthy choice than the Glazed Breakfast Donut Sandwich. We can certainly argue about what counts as "healthy." The Turkey Sausage Breakfast Sandwich has less fat and sugar and more protein and fiber, but it is also higher in sodium and cholesterol than the Glazed Breakfast Donut Sandwich. The point is, it is very misleading for Dunkin' Donuts to identify one item as "smart" or "right" (as near as I can see they don't ever use the words "healthy" or "healthier"), because this creates the impression in an uninformed consumer that by eating this piece of junk food they are being healthy. This highlights the importance of applying critical thinking to all aspects of our daily life, as well as the importance of understanding how words are defined and used. The folks at Dunkin' Donuts (or their ad agency) are purposely using deceptive language and Weasel Words to create the impression that eating some of their products is part of a healthy lifestyle; a claim that is controversial at best.

h/t to the New York Daily News

Sen. Paul, perhaps you should educate yourself before you get angry.

We live in a very interesting time in American politics. We live in a time when people who are the most outraged about an issue are also the people who know the least about it. As a case in point, watch this exchange between Sen. Rand Paul and Paul Krugman about the number of public employees in the US under Bush and Obama:

Sen. Paul is very concerned about the size of the government, but as Krugman notes in the video and at his blog, the size of the government has shrunk dramatically under Pres. Obama. In fact, as Krugman argues, this is one of the major reasons the recession has dragged on for so long. Now in fairness to Sen. Paul, employment at the federal level has increased slightly from about 2.77 million in 2008 to about 2.8 million now, but that certainly isn't an "enormous" growth of government as Sen. Paul suggests. Furthermore, given that state and local governments have been slashing jobs at an enormous rate, the total number of government employees (Federal, State and Local combined) is down about 600,000.

Yet, despite these facts, Sen. Paul seems outraged at the size of the government. What are we to do when people become outraged about topics they appear to know nothing about? Our post-truth election continues.

Lies, damn lies, breast cancer, and statistics

One of the most infuriating things about statistics is that one can generally find a statistic to support whatever claim one is trying to make. In many cases, this isn't necessarily a matter of dishonesty, but merely a choice one makes about which statistics to include, or which method of calculation one uses. This point was really brought home to me while reading a post from Orac on the benefits or lack thereof of mammography.

The issue at question is whether or not regular mammography screenings for women in their 40's with no risk factors for breast cancer are beneficial in terms of detecting cancers early and thus allowing women with breast cancer to live longer. Orac's post has an enormous amount of detail on this debate (in his real life, he is a clinical oncologist specializing in breast cancer), but the issue I want to focus on is a passage in which he discusses the impact regular mammography screenings have on reducing the risk of death from breast cancer. He writes,

Woloshin and Schwartz also point out that for women between the ages of 40 and 49, mammographic screening is associated with a reduction in risk of dying of breast cancer over 10 years from 0.35% to 0.30% (a relative risk reduction of 14%); between the ages of 50 and 59, from 0.53% to 0.46% (a relative risk reduction of 13%); and between the ages of 60 and 69, from 0.83% to 0.56% (a relative risk reduction of 33%). When examined on a relative basis, a risk reduction of 13 to 33% looks impressive. However, when examined on an absolute basis, these risk reductions sound a lot less impressive. It is generally a truism in medicine that, if you want to make the apparent benefit sound as good as possible, you use relative risk reductions but that if you want to make relative risk reductions sound as unimpressive as possible you use absolute risk reductions. That’s because absolute risk reduction incorporates the risk a person has of developing the condition being intervened against. This is the same issue that comes up when discussing improvements in five year survival brought about by chemotherapy in cancer. For instance, I can tell you that, if you have a stage I cancer, chemotherapy will improve your five year survival by 30%. That’s a relative number. However, if I cite it in terms of absolute risk reduction (rounding to make the numbers easy), it is a 3% absolute improvement in survival (from 90% to 93%). Personally, I believe in quoting both figures.

The key take away from this is that one can take the same piece of data, the reduction in risk of dying from breast cancer with regular mammography, and present that information in two different ways that could support two diametrically opposed conclusions. If one wants to argue that mammography is not very useful, then one can use the reduction in absolute risk, say from 0.35% to 0.30%, a reduction that appears insignificant. By contrast, if one wants to argue that mammography is beneficial, one can focus on relative risk and say that mammography reduces the risk of death from breast cancer by 14%. In either case, one is accurately reporting the same information, but one is looking at it in different ways, the difference between absolute and relative risk reduction, and potentially reaching different conclusions.

So, statistics can be illusive, but they are also extremely valuable tools for taking a great deal of data (the death rates from cancer in the US) and making it easily accessible and comprehensible. As critical thinkers, however, we must exercise caution when using and discussing statistics to make sure that we are being honest and that we are not being taken in by dishonest manipulations of statistics. We must make sure we know exactly what the statistics we are confronted with actually mean as well as how they were calculated, and we most always look and see if there are other ways to accurately present the information in question. I find Orac's strategy of presenting both figures to be the right way to go.

SCOTUS and the Principle of Charity

I have talked quite a bit in several posts about the principle of charity. By this I mean that when reading someone's argument, you shold assume the most charitable interpretation of that argument possible. In many cases doing this will still yield a lousy argument, but it is a good idea nonethless.

I was reminded of this while skimming through the Supreme Court's decision (PDF) on the Affordable Care Act:

The text of a statute can sometimes have more than one possible meaning. To take a familiar example, a law that reads “no vehicles in the park” might, or might not, ban bicycles in the park. And it is well established that if a statute has two possible meanings, one of which violates the Constitution, courts should adopt the meaning that does not do so. Justice Story said that 180 years ago: “No court ought, unless the terms of an act rendered it unavoidable, to give a construction to it which should involve a violation, however unintentional, of the constitution.” Parsons v. Bedford, 3 Pet. 433, 448–449 (1830). Justice Holmes made the same point a century later: “[T]he rule is settled that as between two possible interpretations of a statute, by one of which it would be unconstitutional and by the other valid, our plain duty is to adopt that which will save the Act.” Blodgett v. Holden, 275 U. S. 142, 148 (1927) (concurring opinion).

Here, Chief Justice Roberts (the author of the majority opinion) notes a long precedence for the Court to employ a legal principle of charity in assessing the constitutionality of a law. Essentially he is arguing that if there is an interpretation of a law that is constitutional, the court must assume that interpretation.

This is more than a mere tangent in that the Court's decision to uphold the constitutionality of the individual mandate turns on this point. The Court actively ignores the text of the law (which specifically describes the consequences for not having insurance as "a penalty, not a tax"), and instead interprets the mandate as a tax on non-compliance rather than as a law requiring certain behavior. According to the Court, the government can't mandate the purchase of a certain product (in this case health insurance), but can tax individuals who don't. And this interpretation is a product of employing the principle of charity in interpreting the Affordable Care Act.