Critical Thinking: When to be Skeptical (Part 2)

Last time I wrote about a case where ill-advised skepticism leads to dangerous decisions, what the World Health Organization calls “vaccination hesitancy,” one of the ten threats to global health. About 1.5 million deaths per year could be avoided if global coverage of vaccinations improved.

In the case of vaccines, that skepticism is based on faulty evidence and discredited research promoted by unreliable sources. But in many other cases, with access to reliable sources, it makes sense to be a little skeptical of all the threats and warnings we encounter on a daily basis. After all, no one has enough time to be scared of everything the media warns us about.

Sometimes it’s a health issue where the underlying data is insignificant, e.g., when a certain habit is shown to increase the chance of getting a condition by 50%, when the original chance of getting it was miniscule. Sometimes organizations raising money and the media selling advertising space don’t present the full story. For example, data from the early 2000s on missing children shows that 99.8% of those children return home. “Only about 100 children (a fraction of 1% [of all missing children]) are kidnapped each year in the stereotypical stranger abductions you hear about in the news.” More die in swimming pool accidents, yet “stranger danger” gets much more attention than pool safety. It is very likely that the data have not changed since that original study.

Things are not always as they seem. Here is one example I intend to keep an eye on. At sciencemag.org a feature titled “Dubious Diagnosis” asks, “The war on ‘prediabetes’ could be a boon for pharma—but is it good medicine?”

The piece points out that the term prediabetes originated only about ten years ago as a “public relations catchphrase” to raise awareness at a time when the American Diabetes Association (ADA) “needed a pitch to persuade complacent doctors and the public to take seriously a slight elevation in blood glucose, which might signal a heightened risk of type 2 diabetes.” Indeed it has a catchier sound than impaired fasting glucose or impaired glucose tolerance. And notice the expression might signal in the explanation. Further along, the article tells, “the CDC's own data show progression from prediabetes to diabetes at less than 2% per year, or less than 10% in 5 years. (Other studies show even slower rates.)”

This increased public awareness probably benefited the ADA, but other health-oriented organizations such as the World Health Organization (WHO) along with some diabetes specialists argue “medical and epidemiological data give weak support, at most, for increasingly dire prediabetes admonitions.” One diabetes researcher goes so far as to characterize the effort as scaremongering directed at approximately 48 million Americans.

The result is that billions of dollars have been spent on “research, education, and health improvement programs – generally focused on weight loss and exercise – that have generated lackluster results, according to critics.” So far no drugs are effective, but some of those research dollars include “drug companies…testing dozens of drugs aimed at prediabetes in hopes of tapping a potential worldwide market of hundreds of millions of people.”

And the rising costs are already compounded by additional doctor visits, off label prescriptions, and the sale of continuous glucose monitor devices – all very likely unnecessary.

Meanwhile, the ADA continues to ratchet down the standards for various blood sugar measurements with the potential of adding another 72 million new patients to the prediabetes rolls in the United States and many more worldwide.

The article includes several interesting timelines showing changes in those standards and other key events. It then discusses at length the scientific and financial conflicts. So despite some very confident statements favoring prediabetes screening and treatment, the jury is still out. “Many public health organizations believe a mainly clinical approach to diabetes prevention [endorsed by the ADA and CDC] is ineffective.”

There seems to be plenty of reason to remain skeptical about this issue. (It does not affect me, but I find it very interesting from a critical thinking point of view.)

Critical Thinking: When to be Skeptical

It is usually better to be a little skeptical than to be gullible or credulous. A good way to do this is to question everything until several trusted sources have confirmed an idea. Lately journalists have often overlooked this safeguard of finding several trusted sources, allowing the drive to be first to block out the need to be accurate. A sarcastic comment used to be, “I know it’s true; I read it on the Internet.” But that can apply today to what were at one time reliable sources as they cite a single “unnamed source.”

One area where skepticism has run amok is the resistance to vaccinations. The anti-vaccination movement is becoming stronger, even as it continues to be the poster child for misinformation. Those opposed to vaccinations are not using critical thinking when they continue to question and challenge the safety of vaccines basing their position entirely on faulty evidence and discredited research promoted by unreliable sources.

The debunking of any connection between measles vaccinations and autism is old news, over a decade old. The original study was discredited; the doctor promoting the idea was accused of falsifying data and had his license to practice revoked. Yet some still believe.

Those believers are not just a bunch of ignorant crackpots. Less than six months ago, a chiropractor in Canada was under investigation by the regulatory authority for spreading anti-vaccination views. The CBC described her as making “unfounded claims about vaccinations and the negative effects they can have on people's health, including the disproved theory linking vaccinations with autism.” She did this through public speaking, her blog and social media page. 

Last November she was formally notified by those regulators that they “considered advice about vaccination and immunization on her Web site and social media platforms to be (a) outside the scope of chiropractic, (b) untruthful marketing activity, and (c) contrary to the chiropractic regulations [regarding] vaccination and immunization policy, code of ethics....” You can’t get more definitive than that! Rather than undergo a hearing, she surrendered her license.

The anti-vaccine movement deals in what is so obviously misinformation that even the Internet media giants are taking action. Google is very blunt: “Under YouTube’s Advertiser-Friendly Content Guidelines, we are and have been demonetizing anti-vaccination content under our longstanding harmful or dangerous advertising policy.” Facebook’s stated goal on this subject “is to reduce the spread of inaccurate information about vaccines by reducing its distribution in News Feed, removing groups and pages that promote misinformation from recommendation surfaces, and providing authoritative information to people who might encounter it.”

Likewise, Amazon removed “at least five anti-vaccination documentaries questioning the safety of vaccines from its Prime Video streaming platform.” These decisions are not motivated by a political agenda. They are made in recognition that the misinformation is dangerous.

Even with all the evidence that anti-vaccination sentiments are misguided, dangerous, untruthful and disproved, and even in the wake of the recent measles outbreak, state lawmakers have not gotten the message. With at least 333 cases reported in 15 states and discussions in Washington calling it “a growing public health threat," at least 20 states have introduced bills this year that would make it easier for people to opt out and for parents to exempt their children. Yes, they would pass laws to make it easier to put their children and others in danger.

Refusal to believe such well supported evidence, instead reacting emotionally to unsubstantiated horror stories, is not critical thinking. Critical thinking should lead to the proper, scientifically sound conclusions, but the fight against misinformation and irresponsibility continues. 

Irresponsibility: Finding Excuses

Last time I was very pleased to find an example of strong behavior in the dimension of responsibility. The woman attacked by the jaguar at the zoo admitted her part in the incident and hoped that others would learn from her mistake. 

When someone is in the wrong, the common reaction seems to be denial or making excuses. The news lately is filled with celebrities, politicians and their defenders quick to deny a charge, downplay the seriousness of a charge or call attention to all the celebrities or politicians in the past who did the same or worse without ramifications. So it’s OK?

Making excuses covers a multitude of sins, and it serves as a convenient, and often accepted, way  if covering up for behavioral slip-ups in any of the five key dimensions.

One area where this comes into play is when weak behavior in the area of discipline leads to unwanted consequences, for example, lung cancer from smoking, retirement insecurity from failure to save during the working years or obesity.

Along the lines of the latter I found this article on line: “10 Reasons Why Obesity Is NOT About Gluttony and Sloth.” First, the author obviously used the most provocative words possible to describe a situation characterized by a simple lack of discipline, too little exercise or too large portion sizes. Use of the terms gluttony and sloth, boarders on name-calling; they arouse a sense of resentment to prepare the reader to be receptive to a litany of ready-made excuses.

And here they come, all the reasons an unmotivated person can fall back on:

• Obesogenic Environment: where living in an area without sidewalks or safe walking routes coupled with a lack of accessibility to fresh fruits and vegetables along with other environmental factors may add challenges. (People would be thin as rails if only they had sidewalks.)
• Culture of Beauty: drives people toward an unattainable standard, encouraging “self-starvation, exercise abuse, and other eating disorders. It really only serves those who make money off of it.” (This stems from a perspective problem, being manipulated by external values.)
• Mental Health problems “from depression and anxiety to chronic stress and past trauma” can become an issue. “Weight gain can be the result of emotional eating as a way to cope or a result of medications.” (See addiction below for the same excuse in different words.)
• Genetics: While genetics does not predict obesity, over time the combination with other factors may predispose individuals to have obesity issues (though that doesn’t explain why it would suddenly become a factor in the last 50 years.)
• Social Networks: Social influences “play a role in our health behaviors including eating, exercise, weight loss or gain.” (Blame it on your friends.)
• Food Addiction: works like other addictions as “a way to cope with uncomfortable feelings and situations in life.” (Is it realistic to expect life to be comfortable all the time? How easy to forget that life in this century is more comfortable than at any other time in history.)
• Lack of Awareness: too many confusing “messages about what to eat, how to exercise, and ways to lose fat” leave “most of us…scratching our heads.” (But most of these confusing messages come from the purveyors of easy solutions, miracle diet plans and magic answers or from scientists trying to secure funding.)
• Family Income: “Soda is less expensive than water…” (Last I checked water is so inexpensive that I take a shower in it! It falls from the sky! Unless you live in a place like Flint, MI, this argument is as bogus as they come! See here for more about the expensive healthy food myth.)
• Environmental Chemicals in lab experiments alter the metabolism and increasing “the size and number of fat cells in animal exposed to chemicals.” (Blame it on the chemicals, while ignoring the difference between lab experiments and reality.)
• Fat Shame: causes the internalization of society’s fat phobia…creating the most harm. (But change is hard; it doesn’t happen without some discomfort as a motivation. If anything, society has become overly sensitive to the idea of fat shaming and many other attitudes labeled as intolerant.)

So there they are, ready-made excuses to maintain an unhealthy lifestyle. Just spouting off one or two of these (and ignoring the comments in parentheses) is a lot easier than taking responsibility for lapses in discipline.

Responsible Behavior

At the beginning of last week CBS (and several others) reported on a big cat attack at an Arizona zoo. “A jaguar attacked a woman who crossed a barrier to take a photo with the animal at an Arizona zoo Saturday evening, officials said. The woman sustained non-life-threatening injuries in the attack at the Wildlife World Zoo in Litchfield Park, about 20 miles outside of Phoenix.”

The woman, not identified at the time of the incident, had severe gashes on her arm and was taken to a local hospital. She had stepped over a barrier to lean against the cage to get a better picture with the jaguar. The 3-foot barrier was separated from the cage by approximately four feet and intended to keep visitors far enough away from the cage, but people could still get over it if they chose. The zoo officials, who apparently decided the cat was not at fault or particularly dangerous under normal circumstances, temporarily removed it from the exhibit.

Refreshingly surprising was the woman’s reaction in an interview the following day, also on CBS. How easy would it have been to blame the zoo and run out to fetch a lawyer to sue them for negligence? Things like that happen every day in America. Surely a sympathetic jury would have focused on her injuries and distress, ignoring the part she played in the incident and possibly granting her a substantial award. Otherwise, the zoo might have offered to settle for undisclosed damages just to avoid the hassle of litigation. News like this is commonplace.

Actually, she told the interviewer, “I was in the wrong for leaning over the barrier.” She did suggest that the zoo modify the design to make it less tempting and more difficult for others to make the same mistake. She is hoping to turn her frightening experience into an example for others. As a closing comment she added, “I never expected this. I feel like we're all human, we make mistakes and I learned my lesson.”

A good sign of responsibility is admitting your mistakes or your contribution to a problem. It’s refreshing, and all too rare, to see this kind of behavior in the news.

Parental Responsibility and Education

Relative to the behavior model with its five dimensions, the problem is that so many other books and articles touch only on one of the dimensions or even a subset of a single dimension. They all come to the same conclusion in a more limited way. They agree that American society is handicapped by poor individual choices and faulty decisions; but only here, at Real American Solutions, is right behavior in all five key dimensions seen as the only way to get out of the hole that Americans keep digging for themselves and their country.

One example comes from John Rosemond, a columnist, public speaker, and author on parenting. “His weekly parenting column is syndicated in approximately 225 newspapers, and he has authored 15 books on the subject.” A common theme of many of his columns is the problem of parental responsibility.

Here is a recent example about eroding discipline in the schools. A “steady stream of missives from teachers, ex-teachers, and other folks who have insider knowledge of America's schools” tells him that “classroom discipline is falling apart” and no one seems to have the answer.

One factor adding to the problem is lack of support from school administrators. When a disruptive student is sent to the principal's office, they often return to class having “received a cookie or some other treat while they talked about their 'feelings.'” On top of that “almost every teacher says that when they call a parent about a child's behavior, the parent makes excuses or blames the teacher." As the problem gets worse, teachers demand smaller class size, increasing overall cost to taxpayers.

Compound those behaviors with teacher unions that have been given legal power to game the system, federal aid to education with strings attached and administrators too timid to back up teachers, and he predicts “that by 2030 nearly every public-school student will have a diagnosis of one sort or another.” This will be a strategy to increase the number of special needs children to maintain funding as responsible parents, many of them teachers themselves, continue to pull their kids from the public schools to send them to available alternatives. 

Ultimately, it all comes back to the parents. They are the ones who side with the child. They are the ones who put the fear of legal action on the administrators. They are the ones who take too little interest in their children’s education in general, passing it off to the teachers and after-school programs. Parental responsibility is at the heart of the problem; it's the answer everyone is looking for.

Taking a Perspective Break

One of the least accurately used words in the English language is need. It is used as a substitute for want, in the sense of really wanting something. The logic of need is one thing, but the emotion kicks in to make that substitution of need for want so often that two very distinct terms become interchangeable. Losing the sense of that difference leads to unhappiness.

One of the core skills behind successful behavior in the dimension of perspective is the ability to clearly see the difference.

This idea was reinforced by a recent interview in the business section of The Atlantic, “Why So Many Smart People Aren’t Happy” with the author of a book by the same title. After basic needs are met, research shows that there are just three things needed for happiness: “having meaningful social relationships, being good at whatever it is one spends one’s days doing, and having the freedom to make life decisions independently.” These are not necessarily related to intelligence, level of education or wealth.

You may remember news from a 2017 Princeton University study presenting evidence that happiness increases with earnings only up to about $75,000 per year. "The lower a person's annual income falls below that benchmark, the unhappier he or she feels. But no matter how much more than $75,000 people make, they don't report any greater degree of happiness."

Additional intelligence, education or success does not keep people from making common mistakes like comparing themselves to others. Whenever there is a comparison, there will always be a winner and a loser. More ambitious people tend to compare themselves to others with higher levels of accomplishment and across more fields of interest. They end up the loser more often.

In terms of these faulty comparisons, having a grasp of economic understanding comes into play. With a scarcity mentality, people assume that any gain must be offset by a loss for another, and conversely they believe that someone else only comes out ahead (or gets rich) by taking from everyone else. This kind of thinking is demonstrably wrong, but it is convenient fodder for politicians and groups trying to stoke discontent against successful businesses or individuals. (This discontentment does not lead to happiness.)

Working for big rewards and recognition are not advisable. Not only do you put yourself at the mercy of other people’s opinions (and biases), the thrill of the award or pay raise soon wears off leaving you yearning for the next one.

All these false and unadvisable comparisons, this jealousy of someone doing better and this yearning for the next prize or reward, lead to mistaking wants for needs. Using a very Spartan definition, basic needs include air, water, food, basic shelter and adequate clothing. All else is a luxury.The new dress or bigger car is not a need. People lived for centuries without electricity, indoor plumbing and handheld entertainment. Not too many years ago, if you wanted to make a phone call while driving, it required a stop to find a pay phone. Little more than one hundred years ago a major problem in big cities was dead horses abandoned in the street!

Remembering facts like these from time to time gives the perspective to moderate the yearning, to identify, or at least prioritize, the wants.

An extreme example come from the news last week where “an 11-year-old northern Indiana boy shot and wounded his state-trooper father because he was upset that his parents took away his video games.” He got the gun from his father’s locked police vehicle. 

That shows poor perspective – even for a young boy; but how many older and more mature Americans have similar, if less violent reactions, when their wants are blocked or hampered? How many have trouble distinguishing wants from needs? A walk through the mall on a weekend afternoon (at a time when personal debt is at an all-time high) gives a pretty good picture.

The Robots are Coming!

Picking strawberries is hard work. Pickers spend a lot of time on their hands and knees peeking under leaves and straw to find and pick the ripe ones. I know first hand. A few years ago a small team of Master Gardeners at my local Demonstration Garden picked and donated over 500 pounds of strawberries to local food banks in a matter of about three weeks. We spent a couple of hours, three days a week, working our way down the rows. (The following year about half of the older rows were plowed under and not replaced with strawberries! It was too hard to find interested volunteers.)

Picking strawberries is also exacting work. Each picker must determine which strawberries are ready and which to wait on. Unlike bananas and many other fruits and vegetables, strawberries will not continue to ripen after harvesting. And if you don’t get them at the right time, they will rot on the plant. That’s why coming back day after day is necessary.

Besides being difficult and exacting, picking strawberries is delicate work. No one wants to eat a squished strawberry. People who buy them in the stores are usually even fussier than people getting them for free at a food bank.

Why all this discussion of strawberries? A robot is coming to do this difficult, exacting and delicate work and may be in limited operation on strawberry farms within three years. As the article points out “a robot that can pick strawberries may ease the industry’s labor problem and revolutionize the way crops are harvested.” It’s getting harder to find workers, and the ones that show up often move on to other crops before the job is complete.

Some machines are pictured in the article, but a search on “strawberry harvesting robot” yields a number of YouTube videos. Once in operation they will run for about 20 hours a day with the ability to pick up to 8.5 acres in that time. If there is an abundance of fruit, they automatically slow down to get them all. The robots will be able to do the job with more precision than humans; and will be able to pick at night, when cooler fruits are more resistant to bruising and when lower temperatures at picking time increase shelf life and reduce cooling costs. In addition, the “machine is going to know exactly where each plant is in the field” and “be able to have yield data at the plant level.”

Based on personal experience, I was fascinated by the idea of machines harvesting strawberries. Seeing pictures and videos of the huge robotic arms working in auto assembly where hard work and precision are so important is one thing, but having robots do the delicate work of harvesting fruit and vegetables adds another dimension. As one spokesperson for the robot designer says, “We’re not going to stop with strawberries.” 

Fewer jobs are safe anymore from automation. It’s something to keep in mind as the minimum wage debate rages on. As labor becomes more expensive, the option to substitute machines becomes more attractive – especially if they can do the job with more precision while simultaneously collecting meaningful data. Economic understanding reminds us that every day we are selling our skills in competition against others worldwide with those same skills, and more and more in competition against the threat of substitution by machines.

Kids can no longer bank on the idea of working the same low skill job as their parents and retiring after thirty years with a union pension and healthcare. More skilled robots are coming, and they are coming fast.

Stoking the Fear (Continued)

This is a brief follow-up to last Friday’s comments on how news and advertising use fear, especially the fear of death and illness, to sell products and capture viewers' attention. (When a study can point out that toasters and air purifiers cause indoor air pollution, eyebrows shoot up.)

Now comes another story highlighting how companies use the same tactics to sell products and services to fight aging.

“A company that charged patients thousands of dollars for infusions of blood plasma from younger donors said [recently] that it had stopped treating patients after the Food and Drug Administration warned consumers against such treatments, purported to prevent aging and memory loss.” That’s right, a company called Ambrosia, cleverly named after “the food or drink of the Greek gods, often depicted as conferring longevity or immortality upon whoever consumed it,” offered customers over the age of 35 an infusion of one liter of blood donated by 16- to 25-year-olds, all for only $8,000.

The FDA said that there was “no proof that plasma from young donors can be used as a treatment for dementia, Parkinson’s disease, multiple sclerosis, Alzheimer’s disease or post-traumatic stress disorder, as some companies have claimed.” Plasma infusions are only approved for treating blood-clotting deficiencies in patients who are bleeding and in a few other very specialized cases. (Only one small study showed a slight benefit to Alzheimer's patients.)

Furthermore, the FDA warns that no matter how well screened they may be such treatments can result in: infections; serious allergic reactions, including anaphylaxis, which can manifest as hives and airway obstruction; transfusion-related acute lung injury; overload of the circulatory system leading to swelling of the body and difficult breathing.

This company and others are operating outside of FDA guidelines and are charging big bucks for an unproven technology. These companies are capitalizing on that fear of aging and dying to prey on unwitting customers.

This one is just a single example. So many ads and news stories use the same tactics. Our only defense, as I wrote last time is to use critical thinking and perspective. If it seems too good to be true… 

It’s also odd that when people get outraged at corporations, they typically attack big companies such as banks, food conglomerates, Wal-Mart or McDonalds. At least these companies deliver a product that has some benefit. Companies like the ones above that offer products of zero or questionable value get little pushback, and it takes a government agency to warn everyone of potential dangers and about how they are wasting their money. Despite the lack of evidence and possible dangers, many still continue to patronize these and so many others like them. (See, for more evidence, all my previous blogs on dietary supplements.)

Stoking the Fear

Teenage boys are not afraid of dying – or at least don’t think about it very much. That’s evident by the number of stupid-trick videos that have been posted over the years. Everyone else though, seems to be thinking about it quite often – if not consciously, it lingers just below the surface making them a target for all the shocking news and advertising that comes our way. (Note that I often lump news and advertising together. The tactics of one is often to scare us into buying things; the tactics of the other is often to scare us into staying tuned in for the next story.)

One such scary story comes from a Duke University study. “Children living in homes with all vinyl flooring or flame-retardant chemicals in the sofa have significantly higher concentrations of potentially harmful semi-volatile organic compounds (SVOCs) in their blood or urine.” This is a family of chemicals widely used in the manufacture of electronics, furniture and building materials. Exposure is widespread among adults and children.

Exposure to the chemical used as a flame retardant in sofas “has been linked in laboratory tests to neurodevelopmental delays, obesity, endocrine and thyroid disruption, cancer and other diseases” and that used in vinyl flooring “has been linked to respiratory disorders, skin irritations, multiple myeolma and reproductive disorders.” 

Remember, the term linked to does not mean causes and laboratory tests are usually a very early step. At Duke they studied only 203 children over 3 years to see if the presence of the kind of sofa and flooring led to increased levels in their blood and urine, not to find any link. They assumed the link already existed based on previous studies. 

It’s likely that most people never heard of SVOCs or those specific chemicals before. But the news agencies pass this along as if it poses an imminent danger and may require immediate action. What are the alternatives – non flame retardant sofas? Vinyl flooring replaced linoleum that contained asbestos. Clearly this has to wind its way through the scientific community to establish safe exposure levels before it can make sense to anyone. Yet the news is quick to report it without qualification.

But it gets even nuttier!

About the same time I found the headline: “Toasters may expose you to more pollution than a busy intersection.” That’s right, that seemingly innocent appliance that we put bread in and push down the handle is trying to kill you. “A new study from the University of Texas at Austin warns that toasters, candles, and other household smoke makers expose people to more air pollution than standing in a busy intersection does.” Included on the list of indoor polluters are house cleaners, air purifiers and sprays, but toasters are the worst offender unless we only lightly singe the bread.

The information from both sources that I linked to also appeared in several other places. Some reporting was more thorough than others – it probably depends on time and space available. The main point, however, seemed to be an attempt to capture attention by warning that our sofas and toasters are hidden dangers.

Think of all the universities in the US and all the professors and graduate students at these universities looking for things to study, competing for funding and attention. They get attention by coming to ominous-sounding conclusions. A study saying, “Don’t worry about your air purifier” wouldn’t fly. That behavior by the researchers makes it so easy for the news media to fill space with dire warnings any time they want to. Without critical thinking and perspective a person could easily worry himself to death about all those things that might kill him.