Nothing left to cut?

The Boston Public Health Commission runs a class for teens on how to manage social media when you break up.

Note also the public health imperialism. Though these behaviors have nothing direct to do with health, the teens were nonetheless trained to describe them in those terms rather than in terms of what is nice or thoughtful.

Even the New York Times struggles (and ultimately fails) to remain serious when describing the program.

Hat tip: Jessica Goldberg, back inside the beltway after six years in Ann Arbor

Evidence-based medicine: flu vaccine

This Atlantic piece, now a few months old, shows the difficulty in really, really using the evidence to drive public health policy. Many of these same phenomena carry over into the world of labor market policy, such as the existence of dozens of studies, only a handful of which should receive non-zero weight in any serious synthesis of the evidence.

School desegregation and adult health

I've been meaning to blog for a while that I quite liked this paper by Rucker Johnson that I saw him present at the Institute for Research on Poverty Summer Research Workshop this past June.

The thing that struck me about the results , that is not emphasized that much in the paper, is that he finds that being subject to school desegregation, in addition to positive effects on blacks, does not have much in the way of effects on whites. Given all the upset at the time about the school desegregation, this is surprising, if only because it must have been a stressful experience for all the students involved.

Cough, cough, eh.

For Adam Cole: the current state of play on evasion of cigarette taxes in Canada.

The cutting edge of AIDS prevention in Africa

From the Nyasa Times and from my colleague Rebecca Thornton.

Note the role of simple, and in this case as in so many others misleading, bivariate correlations in confusing the Malawian policy discussion.

NYT discovers selection bias

A not-too-bad report from the NYT on the potential for selection bias in studies that show health benefits from alcohol consumption.

My comments center on this bit:

Meanwhile, two central questions remain unresolved: whether abstainers and moderate drinkers are fundamentally different and, if so, whether it is those differences that make them live longer, rather than their alcohol consumption.

Dr. Naimi of the C.D.C., who did a study looking at the characteristics of moderate drinkers and abstainers, says the two groups are so different that they simply cannot be compared. Moderate drinkers are healthier, wealthier and more educated, and they get better health care, even though they are more likely to smoke. They are even more likely to have all of their teeth, a marker of well-being.

What matters is not whether the mean characteristics differ but whether there is what in the technical literature is called "common support", which just means overlap. Are there some non-drinkers who have the characteristics of moderate drinkers? If so, that is enough.

More important than overlap is, of course, measuring all the relevant confounders. A different, and perhaps better, way to frame the article given the likely impossibility of doing a major random assignment study on moderate alcohol use would have centered on the importance of having a large data set that contains information on all the variables that might confound the effect of alcohol on health.

The NYT piece, unfortunately, does not really make it clear how good a job the existing literature does at including all the possible confounders. I suspect the answer is "not very well" and that there is room for improvement here even without a randomized trial, though obviously that would be helpful if one could be fielded.

Hat tip: Jessica Goldberg

Discouraging Danes from drink

From the Danish newspaper POLITIKEN an account of the terror in the hearts of public health commissars as they ponder the reality of Danish alcohol consumption. One bit:

Minister of Health and Prevention Jakob Axel Nielsen (Cons) [says:] “Danish attitudes to alcohol are much more liberal that I care to see. This doesn’t mean that the government is preparing a ban on red wine, but we want to work on Danish attitudes to alcohol – not least in relation to our young people. In other countries around us, young people have a different attitude to drink”

Yes, we would not want any liberal attitudes, to be sure.

What is the remedy? Home visits by government temperance workers:

As a result, the Commission says that the obligatory doctor’s examination of three-year-olds should be changed to a home visit by a nurse to determine whether there is a negative alcohol culture in the family. If so, information and help can be offered to reduce consumption.

Seems to me it is the public health people with the "negative alcohol culture" not the people who responsibly enjoy consuming it. Maybe if the Danish program is successful enough they can match the binge drinking culture of the UK and the US which feeds on conflicting social messages about alcohol and the additional lure added to alcohol by its status as both a religious and a public health sin.

Hat tip: the anonymous Dane