Is smoking plunging children into poverty?

If we feel it necessary to characterise ourselves as being “pro” or “anti” certain things, I would unambiguously say that I am anti-smoking. Smoking is a vile habit. I don’t like being around people who are smoking. And as a medical statistician, I am very well aware of the immense harm that smoking does to the health of smokers and those unfortunate enough to be exposed to their smoke.

So it comes as a slight surprise to me that I find myself writing what might be seen as a pro-smoking blogpost for the second time in just a few weeks.

But this blogpost is not intended to be pro-smoking: it is merely anti the misuse of statistics by some people in the anti-smoking lobby. Just because you are campaigning against a bad thing does not give you a free pass to throw all notions of scientific rigour and social responsibility to the four winds.

An article appeared yesterday on the Daily Mail website with the headline:

“Smoking not only kills, it plunges children into POVERTY because parents ‘prioritise cigarettes over food'”

and a similar, though slightly less extreme, version appeared in the Independent:

“Smoking parents plunging nearly half a million children into poverty, says new research”

According to the Daily Mail, parents are failing to feed their children because they are spending money on cigarettes instead of food. The Independent is not quite so explicit in claiming that, but it’s certainly implied.

Regular readers of this blog will no doubt already have guessed that those articles are based on some research which may have been vaguely related to smoking and poverty, but which absolutely did not show that any children were going hungry because of their parents’ smoking habits. And they would be right.

The research behind these stories is this paper by Belvin et al. There are a number of problems with it, and particularly with the way their findings have been represented in the media.

The idea of children being “plunged into poverty” came from looking at the number of families with at least one smoker who were just above the poverty line. Poverty in this case is defined as a household income less than 60% of the median household income (taking into account family size). If the amount families above the poverty line spent on cigarettes took their remaining income after deducting their cigarette expenditure below the poverty line, then they were regarded as being taken into poverty by smoking.

Now, for a start, Belvin et al did not actually measure how much any family just above the poverty line spent on smoking. They made a whole bunch of estimates and extrapolations from surveys that were done for different purposes. So that’s one problem for a start.

Another problem is that absolutely nowhere did Belvin et al look at expenditure on food. There is no evidence whatsoever from their study that any family left their children hungry, and certainly not that smoking was the cause. Claiming that parents were prioritising smoking over food is not even remotely supported by the study, as it’s just not something that was measured at all.

Perhaps the most pernicious problem is the assumption that poverty was specifically caused by smoking. I expect many families with an income above 60% of the median spend some of their money on something other than feeding their children. Perhaps some spend their money on beer. Perhaps others spend money on mobile phone contracts. Or maybe on going to the cinema. Or economics textbooks. Or pretty much anything else you can think of that is not strictly essential. Any of those things could equally be regarded as “plunging children into poverty” if deducting it from expenditure left you below median income.

So why single out smoking?

I have a big problem with this. I said earlier that I thought smoking was a vile habit. But there is a big difference between believing smoking is a vile habit and believing smokers are vile people. They are not. They are human beings. To try to pin the blame on them for their children’s poverty (especially in the absence of any evidence that their children are actually going hungry) is troubling. I am not comfortable with demonising minority groups. It wouldn’t be OK if the group in question were, say, Muslims, and it’s not OK when the group is smokers.

There are many and complex causes of poverty. But blaming the poor is really not the response of a civilised society.

The way this story was reported in the Daily Mail is, not surprisingly, atrocious. But it’s not entirely their fault. The research was filtered through Nottingham University’s press office before it got to the mainstream media, and I’m afraid to say that Nottingham University are just as guilty here. Their press release states

“The reserch [sic] suggests that parents are likely to forgo basic household and food necessities in order to fund their smoking addiction.”

No, the research absolutely does not suggest that, because the researchers didn’t measure it. In fact I think Nottingham University are far more guilty than the Daily Mail. An academic institution really ought to know better than to misrepresent the findings of their research in this socially irresponsible way.

Chocolate, clueless reporting, and ethics

I have just seen a report of a little hoax pulled on the media by John Bohannon. What he did was to run a small and deliberately badly designed clinical trial, the results of which showed that eating chocolate helps you lose weight.

The trial showed no such thing, of course, as Bohannon points out. It just used bad design and blatant statistical trickery to come up with the result, which should not have fooled anyone who read the paper even with half an eye open.

Bohannon then sent press releases about the study to various media outlets, many of which printed the story completely uncritically. Here’s an example from the Daily Express.

This may be a lovely little demonstration of how lazy and clueless the media are, but I have a nasty feeling it’s actually highly problematic.

The problem is that neither Bohannon’s description of the hoax nor the paper publishing the results of the study make any mention of ethical review. Let’s remember that although the science was deliberately flawed, there was still a real clinical trial here with real human participants.

What were those participants told? Were they deceived about the true nature of the study? According to Bohannon,

“They used Facebook to recruit subjects around Frankfurt, offering 150 Euros to anyone willing to go on a diet for 3 weeks. They made it clear that this was part of a documentary film about dieting, but they didn’t give more detail.”

That certainly sounds to me like deception. It is an absolutely essential feature of clinical research that all research must be approved by an independent ethics committee. This is all the more important if participants are being deceived, which is always a tricky ethical issue. There is no rule that gives an exception to research done as a hoax.

The research was apparently done under the supervision of a German doctor, Gunter Frank. While I can’t claim to be an expert in professional requirements of German doctors, I would be astonished if running a clinical trial without ethical approval was not a serious disciplinary matter.

And yet there is no mention anywhere of ethical approval for this study. I really, really hope that’s just an oversight. Recruiting human participants to a clinical trial without proper ethical approval is absolutely not acceptable.

Update 29 May:

According to the normally reliable Retraction Watch, my fears about this study were justified. They are reporting that Bohannon had confirmed to them that the study did not have ethical approval.

Also, the paper has mysteriously disappeared from the journal’s website, so I’ve replaced the link to the paper with a link to a copy of it preserved thanks to Google’s web cache and Freezepage.

Are strokes really rising in young people?

I woke up to the news this morning that there has been an alarming increase in the number of strokes in people aged 40-54.

My first thought was “this has been sponsored by a stroke charity, so they probably have an interest in making the figures seem alarming”. So I wondered how robust the research was that led to this conclusion.

The article above did not link to a published paper describing the research. So I looked on the Stroke Association’s website. There, I found a press release. This press release also didn’t link to any published paper, which makes me think that there is no published paper. It’s hard to believe a press release describing a new piece of research would fail to tell you if it had been published in a respectable journal.

The press release describes data on hospital admissions provided by the NHS, which shows that the number of men aged 40 to 54 admitted to hospital with strokes increased from 4260 in the year 2000 to to 6221 in 2014, and the equivalent figures for women were an increase from 3529 to 4604.

Well, yes, those figures are certainly substantial increases. But there could be various different reasons for them, some worrying, others reassuring.

It is possible, as the press release certainly wants us to believe, that the main reason for the increase is that strokes are becoming more common. However, it is also possible that recognition of stroke has improved, or that stroke patients are more likely now to get the hospital treatment they need than in the past. Both of those latter explanations would be good things.

So how do the stroke association distinguish among those possibilities?

Well, they don’t. The press release says “It is thought that the rise is due to increasing sedentary and unhealthy lifestyles, and changes in hospital admission practice.”

“It is thought that”? Seriously? Who thinks that? And why do they think it?

It’s nice that the Stroke Association acknowledge the possibility that part of the reason might be changes in hospital admission practice, but given that the title of the press release is “Stroke rates soar among men and women in their 40s and 50s” (note: not “Rates of hospital admission due to stroke soar”), there can be no doubt which message the Stroke Association want to emphasise.

I’m sorry, but they’re going to need better evidence than “it is thought that” to convince me they have teased out the relative contributions of different factors to the rise in hospital admissions.