Bring Your Beef to the Source!

Red Meat Blamed for One in Ten Early Deaths” – newspaper headlines following the publication of “Red Meat Consumption and Mortality” in Archives of Internal Medicine this week.  But this MiniBlog is not about red meat, it is about the practice of science (specifically, epidemiology) to inform public health, and reactions and re-reactions to it when particular interest groups like or do not like the findings of a particular study.

But first, the study itself. It found an association between eating red meat (transparently defined in the paper) and elevated risks of all-cause mortality.  Numerous potential confounders (eg, that red meat eaters tend to be smokers or do less exercise) were accounted for, and the association was still there.  Overall there was about a 12% increase in risk of all-cause mortality associated with eating one additional portion of red meat per day.  However, and here’s the reason not to worry about this study, in rounded terms the risks outlined in the paper before eating red meat are only circa 10 in 1,000 per year, so an increase of 12% elevates this to 11.2 in 1,000 per year, and it is likely that the vast majority of the population do far more risky things than this – driving a car 10,000 miles a year would be one example of a behaviour that elevates all-cause mortality risk way beyond eating red meat.

So, reactions to the study…  Firstly, the media.  Well, of course, this is just the sort of study that the media loves: “Red meat is not only unhealthy but can be positively lethal, according to a major US study”.  Needless to say, this is scaremongering, and an elevated risk from 10 in 1,000 to 11.2 in 1,000 is hardly “positively lethal”.  Irresponsible reporting of science, yes!  But bad science….?

This is where the second tranche of reactions to the study come in.  Numerous bloggers, nutritionalists, newly expert science methodologists and other assorted malcontents who dislike the study findings have been queueing up to tell each other that the science is flawed largely, it seems, because they have some sort of nutritional axe to grind (or in some cases, advice to sell).  These ‘critiques’ largely conclude that because not all potential confounders can be adjusted for and/or because the study is evidence of an association not causation, epidemiology itself is a flawed approach, and that only evidence from randomised controlled trials should be allowed to contribute to understanding. Well, not really:

(a) Epidemiology is an established practice that is responsible for many of the health improvements in society over the last half century.  Epidemiology first unearthed the association between smoking and several diseases – remember, smoking was good for you in the 50’s and 60’s.

(b) Epidemiology provides important sources of evidence when experimentation is not possible, particularly areas where negative health outcomes are expected.  It is simply not ethically feasible to randomise people into two groups and to ask one of them to undertake behaviours that you know or suspect to be detrimental to health (eg, smoke 40 cigarettes per day) simply so you can measure what happens.  In such cases, epidemiology provides our best sources of public health evidence.

(c) Epidemiology is a key part of the armoury of scientific endeavour to inform public health outcomes.  This discussion piece in The Lancet is clear about that.

(d) Epidemiology has a role to play in both forming hypotheses about causation AND in contributing to the volume of evidence about public health impacts and issues.  This meta-analysis of 22 studies on non-vigorous physical activity is an example of the latter that resulted in a dataset of almost one million people.

(e) In some high profile cases, neither epidemiology nor randomised controlled trials can claim to have settled public health issues.  In the long-controversial case of HRT, coronary heart disease and breast cancer, a commentary in The Lancet noted that “Recent reanalyses have brought results from observational and randomised studies into line.  The results are surprising.  Neither design held superior truth.  The reasons for the discrepancies were rooted in the timing of HRT and not in differences in study design”.  This discussion is a really nice illustration of the respective contributions that randomised controlled trials and epidemiology can make.

There is nothing in the red meat study that merits trashing the science or value of epidemiological research.  Epidemiological research is an important contributor to our understanding of a vast range of public health issues.  However, if anyone believes that they can demonstrate or effectively argue that the science of the red meat study is flawed, Archives of Internal Medicine (the journal that published the study) actively encourages high quality comments and critiques on the research it publishes in its peer-reviewed ‘Letters to the Editor’ section.  So if you have a “beef” with the conduct of the study why not take it to the source?  Here’s the submission link for you.

But beware!… science is hard!  It is hard because the fundamental requirement of science is to convince those with whom you most strongly disagree of the voracity of your arguments.  Self-published online critiques of science, targeted at and endorsed by those who already share your world view, are nothing more than holding court in the pub…. and that’s about as far from science as it gets!

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A Primer on Olympic Physical Activity, Sport & Health Legacies

Evidence suggests that the London 2012 Olympic and Paralympic Games could have boosted the nation’s physical activity levels, given the right strategic approach and investment.  Furthermore, this evidence has been available for three years, following the publication in January 2009 of a comprehensive review of the international evidence on the role and potential of the Games, commissioned from the Centre for Sport, Physical Education & Activity Research (SPEAR) at Canterbury Christ Church University by the Department of Health.

Despite this commissioned review, there is little indication that policy has been based on evidence, with legacy aspirations largely being pinned on the hope that there will be an inherent inspiration effect from the Games across the population as a whole.   But the one area in which the evidence is clear and unequivocal is in showing that there is no inherent effect – legacies must be leveraged.

However, there is evidence for the potential to leverage a Demonstration Effect (the use of elite sport, sports people and sports events to inspire others to participate), but such an effect must be supported by initiatives and investments to stimulate demand by using Olympic and Paralympic themes to engage people.  Furthermore, the Demonstration Effect only works with those who are already positively disposed towards sport.  As such, it can encourage those who participate a little to participate a little more, or encourage those who have participated in the past to participate again.  But what it does not do is get those who do not and never have participated in sport to start playing.  The problem is that people can feel daunted, they see someone like Kelly Holmes winning double Olympic gold and think that is so far removed from what they feel they could do, that it’s not even worth trying.  This is called a competence gap.

For those that are not sporty, effort should be focused on harnessing a Festival Effect, which taps into an individual’s sense of community and desire to be part of something bigger than and beyond the sporting competition, by emphasising the cultural and creative value of the Games, and not mentioning sport at all.  This has the potential to reach the less active or even the sedentary, but for it to work, initiatives must be rooted in local cultural and community activities, and tap into pre-exisiting ‘hooks’ such as family or eco values.  One example might be the use of the commitment some individuals’ have to green values, which can be matched with the sustainability agenda of the 2012 Games, to get people involved in initiatives that clear and enhance local parkland, thus getting such people active, almost without them realising it.

The key, however, is to ease up on health and exercise messages, and in particular to tone down what might be called ‘finger wagging’, especially where it is directed at the less active and sedentary.  Among such people, messages that are overtly about the science of health and exhorting people to become healthier fall on deaf ears, as the less active and sedentary are wholly fed up with being told they are unfit and unhealthy, and so tend to disconnect from the content of such messages.

In short, simply hosting the London 2012 Olympic and Paralympic Games does not generate a legacy.  This is not Field of Dreams – there is no evidence to suggest that if you host it, a legacy will come.  Olympic physical activity, sport and health legacies need to be leveraged with specific targeted investment focusing on using the Games to stimulate demand.  Unfortunately, the vast majority of government investment in legacy initiatives such as Places People Play is focused on supply: of facilities, of fields, of leaders, and of opportunities.   But the most recent data from Active People, the most robust rolling survey of sporting demand ever conducted in England, shows that in the year before the London 2012 Olympic and Paralympic Games, demand for sport (as reflected in participation data) has actually started to fall.

Are International Sport Legacy Promises a Bribe by Any Other Name?

According to London 2012, International Inspiration is the flagship international legacy promise for the London 2012 Olympic and Paralympic Games. On it’s own markers and outcomes it has been a success, reaching 12 million young people in 17 countries around the world. Even for skeptics, is this not evidence that London 2012 is delivering on Lord Coe’s promise in his 2005 bid presentation that “London 2012 will reach young people all around the world and connect them to the inspirational power of the Games so they are inspired to choose sport”?

Lord Coe would certainly appear to think so, because as Chair of the London 2017 bid for the World Athletics Championships (for which the host will be decided tomorrow), he is promoting LEAP 2017, which is vaunted as being based on London 2012’s International Inspiration programme. Lord Coe suggests: “At a time when fewer young people are participating in sport, LEAP 2017 will connect more young people around the world with the opportunity to experience, play and practise sport in their communities”. The programme is intended to reach 2 million young people in 17 developing countries, and suggests, does it not, that London is committed to connecting young people around the world with sport opportunities?

But how have these international sport legacy outcomes been achieved (in the case of London 2012), or how are they intended to be achieved (in the case of London 2017)? Are children in Uganda, Mozambique and Jordan really flocking from their seats to sport only because the Olympic and Paralympic Games are being held in London in 2012, and will more such children flock to athletics only if the 2017 World Championship is awarded to London? Highly unlikely! In fact, there is no evidence that a 2012 Games held in London, or a 2017 World Championship held in London, can be any more or less inspirational to the youth of the world than a Games or World Championship held in any other city.

However, if London 2017, like London 2012 before it, promises to invest millions of dollars in an international sport legacy programme when other candidate cities do not (although Doha 2017 has offered to “donate” $7.9m to the IAAF), then undoubtedly London 2017 will connect more young people around the world with sport than other candidate cities. But what this amounts to is: vote for London and we’ll subsidise sport initiatives in your country and on your continent. Like Doha 2017’s offer of a $7.9m “donation”, is this not a bribe by any other name?

London 2012: Nine Legacy Questions We Should Be Asking With One Year to Go!

Although there have been discussions about the impacts of previous Olympic and Paralympic Games, the London 2012 Games are unique in presenting ‘legacy’ as the overarching rationale for hosting the Games. No previous host has been so ambitious about seeking to use the Olympic and Paralympic Games before, during and after the events to contribute to economic and social good across the country as a whole. From the presentation of the London bid in Singapore in July 2005, through the five promises of the Legacy Action Plan in 2008, to the updated Plans for the Legacy from the 2012 Olympic and Paralympic Games published at the end of 2010, the London 2012 organising committee and the UK government has very publicly stated that they will use the Games to leave a legacy for sport and physical activity, for regeneration in London, for young people and culture, for sustainable living, for the economy and tourism and for disabled people. Of course, the prospect of legacy is a key justification for the £9.3billion cost of the Games, which is roughly £150 for every man, woman and child in the UK.

But with one year to go until London 2012 “welcomes the world”, what are the questions we should be asking about Olympic and Paralympic legacies?  Setting aside the balance sheet and economic legacies, the following nine key questions are those that we might quite legitimately ask of the UK government, of LOCOG, and of Olympic and Paralympic sponsors, each of which have, at some point, made promises in relation to one or more of the following:

  • Will London 2012 inspire more people to play more sport?
  • Will London 2012 get the nation moving and help increase physical activity levels?
  • How can any Olympic and Paralympic effects on sport participation be measured?
  • Can meaningful Olympic and Paralympic legacies be delivered in nations and regions beyond London?
  • Will the London 2012 ‘Live Sites’ bring the Games alive around the UK?
  • Will the tourism generated by the Games in London have a negative impact on the rest of the UK?
  • Will the Paralympic Games improve understanding of, and attitudes towards, disability?
  • What impact will London 2012 have on learning, physical activity and sport in schools?
  • How will we know if the London 2012 Olympic and Paralympic Games have benefited young people?

Of course, the most significant question is whether any of these questions will be addressed as the media focuses attention on the one year countdown to the Games during the coming week.

If not, as the Games approach in 2012 the Centre for Sport, Physical Education & Activity Research (SPEAR) at Canterbury Christ Church University will be releasing an evidence-based legacy digest that will answer each of these nine questions.  Look out for the release of Understanding Olympic and Paralympic Legacies in mid-2012.

Do Big Crowds Mean a Royal Resurgence or a London 2012 Legacy? No! Its the Occasion, Stupid!

Today at 11.25am, Associated Press announced some breaking news: “Prince William and Kate Middleton declared husband and wife”.  Breaking news?  Really?  Those of us with foresight greater than a goldfish might have been able to predict this.  What we might also have been able to predict is the crowds on the Mall, the party in Hyde Park, the Royal Wedding “Live Sites”, the street parties around the country, the media obsession, and so on.  But what will this mean after 29th April 2011?  Will there be a legacy for the Monarchy, or for Britain, from the Royal Wedding in 2011?

VisitBritain certainly hopes so.  It’s strategy is focused on the triumvirate of the Royal Wedding, the Queen’s Diamond Jubilee and the London 2012 Olympic and Paralympic Games.  Of course, what each of these occasions have in common is that the nation will stop, everyone will want to feel involved, and there will be a big party.  This desire to get involved in something, to be part of something big where the whole nation comes together, is called a “festival effect”.  Undoubtedly we will see it in July and August of 2012 when the whole nation will be captivated by the Olympic Games, and hopefully in September 2012 when the Paralympic Games will take place.  However, having a great party, no matter how memorable, will not be enough to encourage millions more people to take up sport, nor to encourage millions more people to visit Britain, nor to encourage millions more people to respect people’s disabilities.  To harness the festival effect to achieve these goals requires a long-term strategy building on people’s anticipation of the event to achieve clearly articulated and planned for health, economic and social goals.  Achieving a health, economic and social legacy is not the same as having massed crowds enjoying the greatest national party since….the last one.  For both the Royal Wedding and London 2012, the big crowds and the party are not indicators of a legacy of a resurgent Monarchy or of a newly active nation.  People just love a celebration – its the occasion, stupid!

They Shoot Horses Don’t They?…Grand National Odds of 5/4!

Two horses, Ornais and Dooney’s Gate, died very visibly at this year’s Grand National, and in the days since the race a range of statistics about horseracing in general, and the Grand National in particular, have been circulating. Animal Aid quote 33 deaths at the Grand National Meeting in eleven years, or 20 deaths on the Grand National course since 2000. Conversely, the British Horseracing Authority quote six deaths in the Grand National race between 2000 and 2010. The problem with these statistics is whilst they are each correct, they are not comparable. However, finding year-on-year independently compiled horse death statistics for the Grand National is all but impossible. As such, the following data is compiled from multiple sources and individual reports of the deaths of specific horses.

It seems that an obvious, if somewhat arbitrary, period for comparison is the last ten years. In the last ten years of the Grand National race itself, eight horses have died. This means that if you are an Owner or Trainer, you are entering your horse in an event where it has a 2% chance of dying. And even if your own horse survives, there is an 80% chance that somebody’s horse will die in the race. If the same 2% risk of death held for one of the world’s most famous human endurance races, then in next Monday’s papers we could expect to read about 72 dead runners at next Sunday’s London Marathon.

But the British Horseracing Authority argues that society accepts that humans use animals in leisure, sport and for food, and that the issue is the minimisation of risk. According to the British Horseracing Authority, data shows that the risks of flat racing result in 0.6 deaths for every 1000 horses that start a race, and for races involving jumps the risks are such that four in every thousand horses starting a race die. The equivalent statistic for the last ten years of the Grand National is that the risk is such that 20 horses in a thousand will die. This means that it is FIVE TIMES MORE LIKELY THAT A HORSE WILL DIE IN THE GRAND NATIONAL THAN THE AVERAGE RISK FOR JUMP RACES!

The British Horseracing Authority argue that rather than banning horseracing outright, risks should be minimised. Even though the Aintree course managers claim they have improved safety in recent years, four horses have died in the last five runnings of the race, which is exactly the same as the five years before that. The problem, therefore, is that the Grand National appears to inherently be five times more risky than the average jumps race. You don’t have to be one of the animal rights campaigning abolitionists that the British Horseracing Board appears to be seeking to demonise to see that the only way to minimise the risk to animals in this particular case is to stop running the Grand National. Unless, of course, you wish to argue that because the Grand National provides a greater spectacle than the average jumps race, it is worth a (five times) greater risk. But in the 2011 Grand National, the deaths as well as the risk became part of the spectacle, as evidenced by THIS WIDELY CIRCULATED PICTURE of Dooney’s Gate’s fatal fall.

They shoot horses don’t they? Pictures like that of Dooney’s Gate’s fall is why you’ll get no better odds than 5/4 of a positive answer to that question for next year’s Grand National!

LOCOG v BOA… Don’t take sides – It only encourages them!

Billy Connolly famously says of politicians: “Don’t Vote – It only encourages them!”

The dispute between the British Olympic Association (BOA) and the London 2012 organising committee (LOCOG) about the distribution of the surplus following the Olympic (and possibly Paralympic) Games, has been characterised by some as being due to the money-grabbing avarice of the BOA. But LOCOG, who have pursued butchers around the country for selling “Olympic” sausages because it infringes McDonalds’ sponsorship rights, are not averse to a bit of aggressive commercialism. Yet equally, the BOA, characterised by some as being hard-done-by and exploited by LOCOG and it’s political influence, is far from innocent. The BOA, whilst lobbying for “Team GB United” to take part in the London 2012 football tournament, does not seem to see the Team GB United concept as applying across the Olympic and Paraympic competitions, as it wants it’s share of the surplus from the Olympic Games before the Paralympic Games are paid for.

They’re as bad as each other… Don’t take sides – It only encourages them!

Policy and Politics for Public Health, Physical Activity, Sport, Physical Education, Tourism, Transport, and the Olympic & Paralympic Games. ————————————– MiniBlog has comments too long for Twitter, but not fully formed, thought out or detailed enough for my FULL BLOG.