Distortions: Navigating the message and the messaging

When the Canadian Centre on Substance Use and Addiction released its Guidance on Alcohol and Health (opens in a new page so you can follow along) it was after a period of public consultation. I spent a lot of time reading the report released in August, talking about it with colleague and friends, and generally becoming frustrated at the heavy handedness and distortions in the data.

When I read the final report, my frustration increased, but as a teacher it also provided a remarkable “teaching moment” about knowledge translation (ie: how to make complicated information comprehensible to the general public) and manipulation.

The funny thing about a scientific body releasing a report for “public consultation” is that it suggests that there needs to be some kind of general consensus on the “truth” of this data before it becomes a firm guideline. However, what was actually going on was consultation on how to make this message more powerful.

The data speaks for itself, one says, but sometimes the data has a rag in its mouth, is tied to a chair, and is shouting something you can’t quite understand:

“What’s that? Sorry? You’re saying ‘its really bad’?” says the temperance minded expert. “No,” thinks the hostage data “I’m saying ‘it’s not really bad’! Get this damn rag out of my mouth you terrorist.”

Ok, maybe that wasn’t fair, but you tell me. Last time I talked about relative versus absolute risk. this time I want to point out some ways that data can seem pretty freaking bad if you don’t know what they’re talking about, and if they are banking on that.

First: proportions. I mentioned last time about the way the data on pp 25-26 showed increased number of drinks per week and adjusted the scale so that after 7 drinks the number increased by 7, then 14 (this is a distortion of a logarithmic scale, which is used by data minded folks to compress time scales to show change over time when it takes a long time to change.

I’ll give the CCSA some credit. It was way better to use the idea of drinks per week than the earlier data that showed grams of alcohol per day, because most people don’t measure their alcohol by grams (!) and also the standard drink the CCSA mentions is 13.45 grams, so it’s tough to make a quick calculation to know what that means. Thank you for clearer information.

They also removed the deaths per year data which was not a good comparison. If you’re talking about likelihood of death over a lifetime, deaths per year is not useful (however, they may have dropped it because things like tuberculosis, which is strangely top on their list of harms, accounts for very few deaths per year. I’ll be talking about Tb another time)

But flip the page. Here we have a new table, something called “lifetime years of life lost (YLL).” This is probably new to you. It was new to me and I consulted an epidemiologist who does not do booze research and who said this is an unusual way to use this data, but maybe in this field it’s standard.

YLL per 1000 people basically means if you take 1000 people, over the course of their lives their lives will be reduced by that many years. So 500 YLL per 1000= 500/1000 years lost per person = half a year lost.

They don’t tell you this. But that is what it means.

So now let’s look at the table. According to the data (and again, I’m taking the data at its face value, I don’t have the wherewithal or the funding to dig deep into it to contradict the findings as data) a woman who has 14 drinks per week (still within the previous guidelines of 2-3 drinks a day but at the upper end) might lose 54 years per 1000 people. In other words, 0.05% of a year… carry the one… that’s 1.36 days.

This means she would die 1.36 days earlier.

And I can’t help but say if she doesn’t drink at all, she might have wanted to die even sooner. Sorry, dark humour is my drug of choice.

Apply this to every disease and you see that the risks are so incredibly low that we have to wonder why the hell they even generated this report. (I will try to answer that question but I can’t really assume I know their motivations)

The other thing to consider is that scale. I showed it last blog but I want to show it again:

(Source: Canada’s Guidance on Alcohol and Health, Final report, p. 27.)

It is weird to me. The report, er, guidance, is trying to make an argument about low risk drinking. It is also trying to argue that the previous limits of 2-3 drinks a day 14-21 drinks a week, (which is a lot, I’ll admit, and a heroic commitment to drinking) are too high. But they include 35 drinks a week. I am not sure why. If you are drinking 35 drinks a week, I applaud your boldness and hope you have egg salad sandwiches and those little pickles at your funeral (but seriously, that is a lot and I shouldn’t be making jokes, but I do love those sandwiches).

To me it seems to be a sort of predictive model. It suggests that people at 14 drinks/week might be on their way to 35. (5 drinks a day, wow). Or it might be another way of distorting data in order to make a broader policy statement about the dangers of drink.

Here is the problem. If you ask someone who likes to have a few drinks with friends, and might drink, say, 14 drinks a week, if they’d cut back to, say, seven in order to extend their life by, I dunno, four days, what do you think they’d say? Have you heard of a “spit take?”

By the way, on p30 the CCSA indicates the YLL based on the old guidelines. It is 755/1000 for men and 336/1000 for women. So nine months less for men and 4 months less for women. It also talks about “acceptable risk” which suggests that someone else should tell you what risk you should take with your life. That’s patronizing. There are all sorts of risks in life. It is your choice to take them, and as long as you don’t hurt other people in the process, have at er.

Next blog: temperance in historical perspective. I promise it will be short and not boring.


Distortions: Relative risk and cirrhosis of the liver

In the new “Guidance on Alcohol and Health” the Canadian Centre on Substance Use and Addiction includes some shocking tables of risks of death by certain conditions (on pp25-26), dividing the data by biological sex (male and female) and colour coding higher risk in screaming red shading. No attempt at panic building here (I’m being facetious), but it is somewhat patronizing to assume people can’t see 55% and think it is high (I’m not being facetious).

The problem is, 55% increase might not be all that high. The table shows relative risk, so if you have a very low risk of a condition and it increases by 55%, you still have a pretty low risk.

But one thing I want to note is the information on liver cirrhosis. According to the CCSA, Men who drink 14 drinks a week have a 114% increase in liver cirrhosis; for women it is 444.7% increase. Holy shit! Let’s imagine this is absolutely accurate. You’d immediately stop drinking, right?

Hold my beer for a second. Let’s go back to the source: The study upon which this conclusion is made studied likelihood of cirrhosis as an outcome by comparing people who drank to people who did not drank. Taking this information, the CCSA then developed a formula (notice how the increase is gradual? For example, for women: one drink= 61.5%, two drinks=94.3 (32.8% difference), three drinks= 124.3 (34% difference) etc.

From Guidelines, p 25.

By the way, as an aside this is presented differently from the previous report which was released for public consultation. In that report the CCSA presented grams of alcohol per day and the scale increased by 5 grams. In this one the CCSA presents standard drinks per week, and the scale is distorted as follows:

This is why the 225.5% increase is followed by nearly double. It’s double the number of drinks per day.

Ok, that ham fisted data interpretation aside, what does this mean? Do women really have a 444.7% chance of developing cirrhosis of the liver if they drink 14 drinks a week?

I don’t want to make a mealy mouthed politicians answer, but I will start with context: this is a comparison of drinkers with non drinkers. In other words, it is a number relative to a non-drinker’s risk of developing cirrhosis of the liver.

We know that the main cause of liver cirrhosis is alcohol consumption. But you gotta drink a lot. If you compare the likelihood of someone who drinks alcohol to someone who does not, yes you are going to see a higher likelihood (aka risk) for a drinker. That’s because a non-drinker has almost NO chance of developing cirrhosis.

Ok so take a breath. Let’s continue.

The other thing to think about when looking at this particular data is the process of developing cirrhosis. Liver cirrhosis is irreversible. Once those scars develop, they don’t undevelop. However, unlike cancer, which can develop with few signs, cirrhosis comes after other changes that are reversible. The most discussed one is “fatty liver.” If you are diagnosed with fatty liver, yes, you probably should back off on your drinking and do other things that will help (talk to your physician for goodness sake, I’m not that kind of doctor).

This is the power of generating panic using relative versus absolute risk. A moderate drinker’s absolute risk of developing cirrhosis is not 125% higher if they drink 3 drinks a week. It’s nearly impossible to do that unless you have a liver that has some other problems in processing alcohol. The data presented here is the worst example of distortion of data, and an indicator of an attempt to manipulate the public in an unconscionable way.

Next blog entry: how to adjust your messaging and blur your data to freak people out.

Distortions: Alcohol harms in perspective

I’ve been spending a lot of time reading, thinking, and talking about current “low risk alcohol guidelines” released by the Canadian Centre on Substance Use and Addiction. This is an organization that is at least partly funded by Health Canada and has government representatives on its board, so when people internationally look to these guidelines and say “Canada is recommending…” or “Canadians are recommending…” they are not entirely incorrect. Initially on twitter I would correct that this is a group of Canadian researchers, not the government or Canadians in general. I would have to modify that statement because there is a lot of government involvement in the CCSA and it even claims Vice Regal Patronage (the governor general supports its work).

That said, there is so much wrong with the report that I wrote a twitter thread that seems to have gone viral (is over 300,000 views and 1000 retweets viral?). And although some viral tweets might achieve that status because they upset people, I think in this case my comments provided an alternative viewpoint that people craved, because, let’s be honest, much of the media just took the evidence as fact and interviewed CCSA reps as experts interpreting that fact. That initial approach, I will say, has begun to change, although I’ve had to have some pretty impassioned conversations with reporters to explain how data works, what moralistic discourses are, and why alcohol might not be as bad as it seems.

In the next few blog entries I am going to address a few discrete elements of the report in an attempt to unpack some things. You can follow along by downloading a copy of the report here (this will open another tab in your browser). First topic: relative risk and the example of cirrhosis.

Cannabis and liquor legalization on the road again

Cross posted from drughistorycanada due to the connections between drink and drug history.

If the weather holds I’ll be off to Saskatoon tomorrow for a symposium on cannabis legalization.  I have been asked to do a keynote based on my observations and research on the connections between liquor control and cannabis legalization.  It’s something I have looked at a few times, so it will be fun to bounce these ideas off an audience in a city where cannabis has been an especially hot topic of consideration and debate for a while now.

Here is the poster. If you’re around, come by!

Cannabis Symposium Poster

Cannabis legalization, liquor control, and bias

I’m cross-listing this blog post from drughistorycanada.com because cannabis legalization has connections to liquor control.  

Just an update on the cannabis file. There has been considerable interest in this topic since, well, the past few years I suppose. But after the Liberals came back to power, with Justin Trudeau making a clear argument for legalization, not just decriminalization, the attention has been ramped up.

I’ve had a chance to speak to the media quite a bit on this, and several articles have come out about the topic.

As a historian, of course I take the long view. I relate current cannabis legalization challenges to the challenge of legalizing liquor after prohibition. These views have come out in several pieces in the past little while

First, I’ll let my ego soar and mention articles that I’ve written or been involved in:

Toronto Star‘s Chris Reynolds 22 Dec 2015

Prohibition: A history lesson 

My Op ed on this topic from 15 Dec 2015 The Globe and Mail

Why should liquor control boards sell cannabis?

My op ed in National Post over a year ago (5 November 2014)

How to legalize pot?

Of course there is more, and some of it does not take a historical focus apart from looking at the last few months or years’ experiences.  These are important perspectives, but a longer view gives us more insight.  After all, both the Colorado and Washington state regimes are still being established.

So consider the following documents

Centre for Addiction and Mental Health releases its policy framework supporting legalization based upon harm reduction principles

Canadian Medical Association Journal advocates a similar perspective but is much more circumspect.  If you can’t access that material (it may be behind a paywall) then check out the CBC’s coverage here 

My concern with this editorial was this fixation on “big cannabis” which rhetorically links it to other industries presented as conspiratorial and out to mess with the public’s health, such as “big tobacco” and “big pharma.” Let’s leave the rhetoric aside, since it does nothing more than perpetuate myths that may not be valid.

Yet although I advocate cannabis legalization (and note, I have never smoked the stuff and have no interest in consuming it in any way) I should note that there are many voices of caution. I’m not going to post them all, but a quick jump into the newspapers will reveal a range of angles.  As a caution, remember to read through the rhetoric and into the evidence.

Here is a good example of rhetoric trumping content, as presented in the Toronto Star also on 22 December.

More young adults in Ontario would smoke pot if feds legalized drug: Poll

Pretty alarming title, huh?  And given that many people may see this on the front page in large type it could sway opinions.  But read on.

The president of Forum Research, which ran the study, noted that “He noted that overall, it doesn’t appear that legalization would prompt a sharp uptake in marijuana use.” Moreover, he said “When you look at how many are using it now and how many would use it when it’s legal, it’s not that many people at the end of the day.”

Yet the Star’s title, histrionic as it is, suggests something more dire.  It is literally correct, but does not provide anything like the nuance that the study found.

I’m not surprised (and wrote to the Star about this, a letter which appeared 4 January 2016) because the Star is historically a prohibitionist paper.  That angle persists, just manifested in different ways.

While we are talking about rhetoric, I’d like to point out the rhetoric of opponents. This is the problem I find, that people internalize the intense moralism of those who disagree with cannabis legalization. Like the temperance forces a century ago, they write as if the substance itself will bring down Western society.

After my op ed in the Globe, I received the following letter:

I’m totally shocked that you have allowed yourself to be brainwashed by potheads’ lies and propaganda.

Pot is definitely more harmful than pot. While cigarette smoke harms only the lungs, pot smoke harms both lungs and brains (especially young brains). And cigarettes don’t cause impaired driving resulting in injuries and deaths, like pot does.

According to columnist Michael Den Tandt, “Data gathered by the Rocky Mountain High Intensity Drug Trafficking Area (Colorado), established to monitor the effects of legalization, shows a dramatic increase in impaired driving due to marijuana. In 2014, according to a report released in September, the rise in pot-related road deaths was 32 per cent. From 2010 to 2014, the rise in marijuana-related traffic deaths was 92 per cent, compared with an eight per cent increase in all Colorado traffic fatalities over the same period.”

For more news, articles and info about the harms of pot, visit: http://harmsofpot.blogspot.com

And the much-ridiculed old film “Reefer Madness” has been proven to be truthful and correct after all by news and evidence.

I was so excited to have someone engaging in my editorial that it took me a while to write the following response (originally I’d decided not to engage, but how could I resist?):

Thank you for your interesting message.

I’m not sure where you’re writing from or what aspects of my recent discussion on cannabis legalization you’re responding to and choose not to engage you beyond pointing out one thing.

You may wish to look beyond blogs and journalists for your evidence.  I prefer getting my information from respected sources written by researchers whose jobs it is to ask critical questions and then look at the evidence available, like CAMH, or the Lancet, or the CMAJ, all of which come out in favour of legalization due to the way it will reduce associated harms.

I don’t think these peer-reviewed journal article authors are “potheads” nor that their evidence can be called “propaganda.”  I think they are critical scholars who also seek to figure out if a perspective is supported by evidence or not.

I am also not a pothead. I don’t smoke the stuff, never have, and never will. I find people who smoke pot boring, and the smell is disgusting.

I’d rather have a beer.

What I didn’t point out is the fun you can have with stats.  If deaths rise from 2 to 3, that is a 50% increase, but only one additional death (not that any single death should be acceptable, but again, we’re dealing with histrionics). If deaths rise from 1 to 2, that’s a 100% rise.

That said, the RMHIDTA data deals with larger numbers, but the meanings behind those numbers are shaded with caveats about limits to data and the way it’s reported. this, of course, is lost on the correspondent, and also on Den Tandt, the National Post article’s author. (BTW, the RMHIDTA is a passionate anti-drug collective of policing agencies, so don’t expect their stats to be clear or unbiased.

The story is always the same: dig deeper.  

Be critical.  Always.  Ask where the information is coming from, and whether it makes sense.

That also applies to the information I provide here.

After all, this is just another blog.

(c) 2016 Dan Malleck

Welcome to drink history Canada

This site is dedicated to discussing issues in the history of the manufacture, regulation, and consumption of alcoholic beverages in Canada.  It is written by a professional academic historian, so it can get a little cerebral and seem snooty at times, but really I’m just trained to write that way.

It is important to use history to inform current policy. For this reason, I often find myself speaking to media about the current state of drug and alcohol regulation in Canada.

If you have questions about policy, or history, or policy history, or the place of history in policy, don’t hesitate to ask.