TCS Daily

A Precautionary Tale

By John Luik - June 1, 2005 12:00 AM

If the World Health Organization's problems were limited to its bureaucratic structure, its pandering to several special interest groups, many with leftist orientations, and its fundamentally mis-ordered priorities, there might be some hope for its eventual recovery. But what makes this so unlikely and indeed might signal WHO's terminal decline are a set of deeper problems that go beyond structure and priorities to the way in which WHO understands risk, science, health and even democracy itself. Unfortunately none of these made it onto the agenda of the 58th Annual World Health Assembly recently held in Geneva.

Running throughout WHO, like so much of the United Nations, is a consistent, though often unarticulated and unargued for commitment to the precautionary principle as a basis for risk analysis and health protection. What started life as nothing more than a footnote at the 1982 Stockholm environmental conference has gradually come to dominate WHO's thinking about risk and its relationship to science. What is disturbing about WHO's commitment to precaution is that it appears to suggest that dealing with risk is always a choice between risk and no risk instead of assessing competing risks. Blocking promising new technologies or new medicines, which is what precaution often amounts to at WHO and its sister agencies, always carries risk. Indeed, the choice is between the risks associated with innovation and change and the risks associated with not innovating. For instance, the introduction of electricity over a hundred years ago obviously carried some novel risks like electrocution, but it also resulted in reducing or eliminating some existing risks such as fires caused by oil lamps. Good risk assessment attempts to present us with an accurate picture of what this balance might look like, rather than simply asserting, as WHO's commitment to precaution maintains, that the risk calculus is impossible as long as there is any risk to humans and the environment.

At bottom then, the precautionary principle to which WHO appears wedded is profoundly anti-scientific. It is anti-scientific because the logic of scientific knowledge is always contingent -- it tells us what the future might be like-based on the observations of the past -- but it cannot guarantee that future as precaution demands. Risk assessment is about making the most intelligent choice possible in the midst of the uncertainty that is an inescapable part of the human condition. No responsible scientist can guarantee that a product or process will NEVER harm humans or the environment for such predictions lie outside the compass of science. All that he can say is that based on these facts, this or that outcome is most likely. In effect the precautionary principle asks of science what it cannot provide -- a god-like omniscience.

WHO, of course, would disagree, by claiming that the precautionary principle is really the foundational principle of the new world health. But this is curious since foundational principles, in health or elsewhere cannot be self-contradictory, which the precautionary principle clearly is. For instance, apply the precautionary principle to itself. Is it clear that using the precautionary principle as the basis of risk regulation and health protection will not harm either humans or the environment? Obviously it isn't as preventing change and innovation on the basis of an unknown future can be profoundly risky.

But WHO's problems with science go beyond its commitment to precaution and extend to its willingness to provide an institutional home and a certain measure of legitimacy to politicized, corrupt science. By corrupt science we mean bogus science, science that knows that its data misrepresents reality and its processes are deviant, but that nonetheless attempts to pass itself off as the genuine article. It is science that has an institutionalized motivation and justification for allowing ends outside of science to determine the findings of science, for allowing science to be subject to a political agenda. It is science that believes that it is more important for people to believe and the policy process to support the "right" things than those things which are true. It is science that wishes to claim the public policy advantages of genuine science without conforming to the scientific process or doing the work of real science except in the most superficial way.

Two things in particular signal the presence of corrupt science. The first is the fact that rather than working from hypothesis and data to conclusion, corrupt science starts with a mandated political conclusion and then uses this conclusion as the basis for determining what evidence, what data is to count as relevant. It is science that begins not with a question but with an answer and which sees its only task as providing the evidence that supports that answer. The second is that corrupt science misrepresents the nature of what it seeks to explain. Rather than acknowledging alternative evidence, or problems with its evidence, or admitting the complexity of the issue and the limits of evidence, it presents what is at best a carefully chosen partial truth as the whole truth necessary for public policy. Public policy is effectively manipulated into reaching a predetermined outcome on the basis of data that has been carefully chosen, falsified or massaged so as to speak in a fashion that is at odds with the ways things really are.

Three health issues demonstrate the hold that corrupt science has on WHO -- warnings about pathogenic microorganisms in infant formula, opposition to DDT to control malaria, and claims that obesity significantly effects mortality. The move to require warnings about the risks associated with infant formula is clearly based not on science but on a political decision that except in rare circumstances breast feeding is to be preferred to bottle feeding with infant formula. While infant formula is not sterile, if used in accordance with the already existing instructions, the scientific evidence shows that it is perfectly safe. To require a warning that says that formula contains pathogens that can kill is to distort reality through presenting a carefully chosen half truth -- formula can harm if not used correctly -- in a way that manipulates people's decision-making.

Corrupt science has a similar hold on WHO's malaria policy which refuses to consider the use of DDT for malaria control despite the effective failure of its Roll Back Malaria campaign. Despite the fact that DDT was originally banned because of its threat to birds and despite the consistent scientific evidence that the current application of DDT inside houses, as opposed to its previous massive agricultural use, does not pose a significant threat to the environment and saves lives, WHO's politicized malaria science continues to be based on the science of the UN's Persistent Organic Pollutants Convention. Indeed, WHO's malaria policy appears to not recognize that DDT's reputation was founded on its killing birds through its staying power in the environment, something impossible under today's application procedures nor the fact that most environmental groups no longer oppose its use for malaria control.

And then, of course, there is WHO's fat strategy, the global strategy on diet, physical activity and health which has as its objective the reduction of the "risk factors for noncommunicable diseases that stem from unhealthy diets and physical inactivity by means of essential public health action and health-promoting and disease-prevention measures". Here again is a strategy that is based to a large extent on politicized, indeed on nonexistent science. To take but two examples, the recent findings by the US Centers for Disease Control that obesity does not cause significant increases in mortality except at the extremes and that the overweight actually had a slightly lower risk of premature mortality than those of normal weight and the findings from several intervention studies over the last fifty years that show that weight control measures seldom work or result in decreased mortality -- both show that the "science" supporting obesity as a serious population health issue is more political hype than credible research.

The third problem plaguing WHO is its stubborn belief that through health promotion which somehow changes an individual's lifestyle, diseases like cancer and heart disease can be prevented. The mantra of prevention runs throughout WHO like a golden thread in which lifestyle related disorders from what one eats, who one marries, what one does for a living, where one lives -- the list is endless -- are supposed to provide the key to disease prevention. Less cholesterol, fat, coffee, salt, more exercise -- take your pick, as the advice changes constantly -- supposedly hold the key to longevity. This means that health for all -- one of WHO's central objectives -- can only be realized through vigourous interventions to change how people live. In effect, the elimination of noncommunicable diseases can only be achieved through a good bit of lifestyle salvation, social engineering by WHO's bureaucratic elite.

For instance, many at WHO are already talking about a global treaty on diet, which would legally bind countries to take mandated steps to deal with diet and obesity issues. Given WHO's alliance with so many activists, the "obesity treaty" represents a dangerous erosion in the free and democratic government in which a handful of unelected and unaccountable bureaucrats could impose their health, political and social preferences on the citizens of democratic societies without their consent. Unlike national legislative bodies which are subject to electoral mandates and the pressures of the political process, including give and take, WHO's bureaucrats are potentially imperial regulators with enormous powers wholly unanswerable to and largely unremoveable by those affected by their health decisions.

But what is most worrying about WHO's idea of health promotion and lifestyle salvation is how it intersects with WHO's problem with politicized, corrupt science. While attractive as a theory, health promotion is highly questionable as a science-based practice. Take, for example, one of the most extensive and publicized efforts in preventive medicine of all times, the MRFIT (Multiple Risk Factor Intervention Trial) which was designed to showcase how well lifestyle intervention prevented disease by demonstrating that heart disease and cancer could be reduced through reducing blood pressure, cholesterol and smoking. After sixteen years of study, the intervention group, which had received help with exercise, diet and smoking cessation, had results that were no better than the group that received none of these things. What MRFIT showed was precisely how lifestyle intervention failed to prevent diseases like cancer and heart disease. Nor was MRFIT a fluke. In some 19 studies from around the world, including WHO's own massive Collaborative Trial, which looked at lifestyle interventions to prevent disease, not one produced a significant beneficial result. Indeed, three of them of found significant increases in premature mortality risk. These inconvenient results are rarely discussed in public and officially health promotion is pushed as a scientifically-based success story.

The WHO tragedy is not simply that an organization with great promise and pockets of excellence has lost its way. It is rather that its culture is now so deeply infected by precaution, bad science and the illusions of health promotion that it might no longer be worth saving.

The author is a writing a book about public health and lives in Canada.


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