‘Infographics’ seem to be the hot thing lately and they really, really bother me. I am usually fine with funny ones, but too often they portray a warped view of the world which is designed for the advancement of an agenda. I may even agree with that agenda, but whenever I see summations with percentages and shocking titles, my skeptical senses tingle.

My example is not quite an ‘infographic’, but the problems are the same: where do the numbers come from and do they mean what they appear to mean? Campaigns rely on the fact that people, in general, are cognitive misers. We generally will not go out of their way to analyze information, especially if it speaks to our world view.

Today a friend posted this on Facebook with the comment that we should be able to trust the data because the source is UNICEF. As usual, the headline itself is grossly misleading, but this is not apparent unless you click through it. I did and found myself on another non-UNICEF page which included more details and a link to the UNICEF press release.

First, let me make the point that the accuracy of data are not usually the biggest problem. Yes, people make up stuff and that stuff gets quoted, etc., but you don’t need to make up numbers to mislead people. How the data are manipulated and framed are the more common problems with these kinds of reports. Looking at the report that my friend posted, although data may be accurate, the frame is questionable and should be insulting to someone who is actually living in poverty. It is not, in my opinion, a measure of the proportion of children “living in poverty”.

I was prepared to take on the information in the press release, but when I read it I discovered that there was a layer of ‘warping’ between UNICEF and the other reports. The release describes a combination of two measures of ‘poverty’. Of course, one needs to download and at least skim the full report to get the big picture, and who is going to do that? Well, I will, of course, but first let me address the report that was posted to my friend’s page.

Image provided in the UNICEF press kit for their "Report Card" on poverty.

This report cherry-picked one of the measures – the one they could most easily use to twist into an image of the U.S. as not-so-child-friendly.

I take issue with such manipulation. Science is too easily abused for the purposes of selling something, even with good intentions. Although evoking sympathy may prompt people to act, it also warps our views of reality. If we cannot view information objectively, we cannot make the best decisions about how to use the resources at our disposal to meet our goals. In the end, everyone loses.

The definition of ‘poverty’ used in this situation is “living in a household in which disposable income, when adjusted for family size and composition, is less than 50% of the national median income”. In other words, they took the income for each household in the country, subtracted an estimate of the cost of basic expenses and adjusted it for family size/structure to determine ‘disposable income’ (more on that later), divided all of the households in half according to the resulting value, then counted the children in each group. They did this for each country separately. Then they ranked the countries accordingly.

There was no standard for ‘poverty’ applied to all countries, so the comparison is severely limited in terms of what it can tell us. The UNICEF report notes a number of justifications for their choices, mostly related the problems associated with alternative measures. I agree with many of their notes about other measures, but that does not solve the problems associated with this measure. In addition, their methodology for determining disposable income and adjusting for family size and structure was very questionable and involved a complicated formula that I will not even attempt to explain.

They found that, in the U.S.A., just over 23% of the children live in households in the bottom half. Frankly, I was surprised by this number. I thought that it would be much higher. It means that more than 3 out of 4 children live in households with an above-average amount of disposable income!

The comparison states that there are 34 other countries in which the proportion of children in the top half of the country’s households in terms of disposable income is higher than the proportion in the U.S.

Poverty, in this analysis, does not mean what the dictionary or Wikipedia say it means (“…an economic condition of lacking both money and basic necessities needed to successfully live, such as food, water, education, healthcare, and shelter.”), yet people will still think of it as such.

This is poor perspective.

The report provided justifications for the 50% threshold, however, I cannot help but be reminded of how often someone is shocked when they hear a report that 50% of people are below average in some desirable measure. It seems to me that no matter how much is done to improve the lives of those children, we will always have a ‘bottom half’. This is one of the problems with framing things in relative terms.

Of course we want all children to prosper, but just as we want everyone to have an above-average IQ, we cannot achieve such a thing when we define our goals in relative terms. The only way to increase the number of children in the upper half of that distribution is to increase the number of adults in the lower half. That’s tough when you consider that adults need to care for children, so nobody who cares for children can be in the lower half, either.

Perhaps that bottom half should be made up entirely of childless, middle-aged people? Or the elderly?

As the press release noted, the UNICEF includes two measures of ‘poverty’. The other measure defined poverty in a standardized manner which was more consistent with the traditional definition. They listed 14 items which were considered essential and considered a child to be “living in poverty” if they lacked two or more of those items. However, this analysis was limited to European countries. So, there is nothing in the report that tells us the proportion of children in the U.S. who are living in poverty as it is traditionally defined. Nothing.

Furthermore, the original post and the one it linked to suggest that we don’t take care of our children. Programs like National School Lunch Program (established in 1946), Head Start, and even basic public assistance are designed to provide those basic necessities, yet receiving them does not affect whether they are considered “living in poverty” by the UNICEF definition, which considers reported income.

Whether or not you believe those programs are sufficient is not something I am even qualified to argue about and not the point. I think that efforts to promote social programs, something which requires some political maneuvering and framing, have redefined what “poverty” means. That may have helped sell those programs, but in the long run we need to readjust in order to see things the way they are. My point is that losing perspective is never a good thing. In the end, we need to see reality if we are to determine how best to distribute resources and services to achieve goals like reducing economic disparity.

When we talk about poverty, I would like to see a more nuanced approach. For example, the most common measure of need used by public schools is whether a child qualifies for the National School Lunch program. Children who are homeless are lumped in with kids whose parents may struggle to make ends meet, but have enough to eat, clothing, shoes, a roof over their heads, and even cell phones. I do not mean to minimize the problems of people who are barely scraping by, but when their problems are not distinguishable from those who are literally going without essentials, that is shameful.

In my last post, I took issue with the a number of problems with a particular straw man complaint that organized skepticism is too narrow. As part of that post, I wrote:

…skepticism, secularism, and atheism are different things. Among them, secularism has the closest ties with liberal ideology, but even secularism is not liberalism.

Shane Brady left a comment which included:

The one panel from last year’s TAM that DJ seemed to take the most criticism for, seemed to be because he resisted an overt support of a particular political idealogy, not a hesitance to attack claims.

The intersection of these two strikes me as important.

That post addressed a specific comment in a much longer piece by Ashley Miller, a comment made my many, so I did not identify the author in order to focus on the issue. However, the broader theme of that piece now comes to mind as I think about this issue: do secularist efforts need to be careful here?

Skeptical activism must ignore ideology in order to maintain its integrity. Science – the method, anyway – is ideally ideology-free. Now, how that works out in practice is another issue. The point is that if we promote scientific skepticism and the idea that science is the best way to find out what’s true about the world, we must follow the rules of science.

Arguing against this is like arguing that some of the Bible is meant to be literal, some of it is symbolic, and that one’s own religion is the single religion which knows which is which.

Most readers know the definition of “secularism”, of course, but humor me. Merriam-Webster defines it thus: “indifference to or rejection or exclusion of religion and religious considerations”.

Secular organizations seek to remove religious influence from public life, mostly through the separation of church and state. In the United States, the separation of church and state is designed to promote freedom of religion and, by extension, freedom from religion. We are free to practice any or no religion because the government does not endorse or favor one or more religions. This, at its core, is a liberal concept. The extreme of this, the eradication of religion, is a conservative one.

Secularism tends to be promoted most by those who subscribe to liberal ideology. However, the terms “liberal” and “conservative” carry a fair amount of baggage and self-contradiction. In this country, for example, self-identified liberals tend to support gay marriage, but also support gun control and welfare and some even oppose capitalism. The most extreme of the self-identified conservatives today have formed the “Tea Party” movement, which opposes what they consider to be excessive taxes. In other words, while the political parties may have formed around a narrow idea of how much involvement government should have in the lives of the governed, they have morphed into something else entirely.
Quite frankly, I find both parties oppressive, just in different ways. Each seems to think that they know what is best for the rest of us and each insist on imposing their platforms on the rest of society. Neither is truly liberal or conservative. Both, in my opinion, are oppressive to those who disagree with them.

One problem we face in both skeptical and secular activism is that the larger the movement, the more pluralistic it is. If an organization does not maintain focus and begins to endorse specific political or social ideology, its stances on complex issues will be less and less internally consistent. In a movement based on the concept that reason is the most valuable tool we have, internal consistency is absolutely vital.

I think that people who find these communities see a ready-made audience – an audience whose members appear to share more values and ideologies than the one around which the community was formed. As I noted in my last post, it is easy to wave the liberal flag of “helping people” and rally this audience around another cause, but where is the line drawn?

If, for example, secular conferences take on gay marriage, why not polygamy? Do all skeptics, secularists, and atheists agree with me that polygamy should be legalized? How about an effort to eradicate marriage altogether? What about government-run health care? How about education? Is privatization the answer? What about charter schools? Education, after all, is a central issue for those who care about social justice, so why should skeptics and secularists talk about it?

I’ll tell you why: we do not agree on the solutions, nor do we agree on what is “fair” or “moral” in these areas. These are issues of values. Skeptics can discuss evidence regarding specific questions (e.g., whether outcomes-based teaching is effective), but skepticism cannot tell us whether or not the education of children should be the responsibility of the government. When groups endorse specific values and conclusions which cannot be empirically supported, they’re endorsing ideologies and, in the case of skepticism at least, rejecting the very methods they claim to promote.

I have already made it clear that failing to understand and apply the differences between skepticism, secularism, and atheism makes one a poor skeptic, but does it also make one a poor secularist? Maybe it does. It appears to me that many secular groups today fail to maintain those fences between themselves and atheist groups or individuals with large audiences (e.g., PZ Myers) who have made it clear that their goals go beyond securing the rights of atheists and eliminating social stigmas attached to atheism. Their goal is to eradicate religion. So, the liberal ideology of “freedom of/from religion” is shifting toward the conservative “my belief system is king”. The oppressed become the oppressors, the victims of bigotry become the bigots.

This is what happens when missions drift. Sometimes the righteous mission becomes the immoral one.

You may think that the direction you want to take it is the best and the most righteous, but everyone thinks that about their own ideology.

Just some food for thought.

Since health care reform has been in the news lately (wonder why?) and NCCAM has been popping up on the blogosphere, I thought it might be a good time to repost this one.

Originally posted on February 16, 2009

NCCAM = National Scam

Reading the blogs of others I have noticed that one entry often sparks another and chains of commentary develop. I now understand how this works; one quickly has more to say than is appropriate for a simple comment when a hot topic is discussed. This, IMO, is a great way to converse and spread the word about important issues that warrant wide attention. Alternative medicine is certainly one of these areas and a recent post stirred my anger.

Today I read a blog entry by Z at It’s the Thought That Counts which was apparently inspired by yet another blog entry by Orac, at Respectful Insolence. Z’s links then led me to some findings of my own that I feel compelled to share.

When I first heard of the National Center for Complementary and Alternative Medicine (NCCAM), I thought it was a good thing. I believed that an agency governed by the NIH would be responsible. I believed that good science which investigated the claims made by these snake oil salesmen would be conducted, and public education regarding these products would be the result. I now think that I was wrong. I am angry that my tax dollars are being spent propagating propaganda and ignorance, spreading BS and allowing swindlers make money off of the American public.

What changed my mind? Well, you can read about where the money is going and about the types of studies funded by the agency by going to the blog entries I mentioned. In the meantime, let me tell you about the “educational information” being produced by this government agency.

One of the NCCAM’s four “primary areas of focus” is “sharing news and information”. Their website describes their approach to this task:

We provide timely and accurate information about CAM research in many ways, such as through our Web site, our information clearinghouse, fact sheets, Distinguished Lecture Series, continuing medical education programs, and publication databases.

This got me thinking. What information are they sharing? Are they sharing, in their fact sheets for example, the reason why these things are classified as “complementary” or “alternative” to conventional medicine? The difference is simple to explain — medicine that has been shown through scientific evidence to the safe and effective is conventional medicine. Everything else is “alternative” (it is considered “complementary” when conventional medicine is also used). When and if evidence suggests that any treatment is effective, it is no longer considered “alternative”; it becomes “conventional”.

Let me note, however, that some of the dictionary definitions are inaccurate. For example, American Heritage Dictionary defines “alternative medicine” as:

A variety of therapeutic or preventive health care practices, such as homeopathy, naturopathy, chiropractic, and herbal medicine, that do not follow generally accepted medical methods and may not have a scientific explanation for their effectiveness.

which is misleading in that it clearly implies that these practices are effective; we just don’t know why. That’s simply untrue. There are many conventional medicines and practices that are effective, but lack strong scientific explanations for their effectiveness. The causal agents in the successful treatment of rosacea with antibiotics and many of the uses of antidepressants are not well understood, but we hardly classify them as “alternative”. That term is reserved for unproven treatments of any kind.

This definition makes one of the NCCAM other primary areas of focus utterly moot. “Supporting integration of proven CAM therapies” (never mind that they do not state what they mean by integration) is described as follows:

Our research helps the public and health professionals understand which CAM therapies have been proven to be safe and effective.

Um, by definition this statement is self-contradictory.

So, which of these therapies are they claiming are safe and effective (and should then be reclassified)? To find out, I took a look at some of their fact sheets.

Under “Herbs at a Glance”, I started with the first entry that is not considered conventional, Astragalus.

The fact sheet includes a section titled What the Science Says. There were three bullet points:

• The evidence for using astragalus for any health condition is limited. Results from small or preliminary studies suggest that astragalus may benefit heart function and help the immune system fight infections.
• A few studies have shown potential benefits for using astragalus—in combination with another herb, glossy privet (Ligustrum lucidum)—as an adjunctive therapy for cancer. In general, however, these studies were not well designed.
• NCCAM-funded investigators are studying the effects of astragalus on the body, particularly on the immune system.

The third point hardly tells anyone “what the science says”. The first two, however, immediately threw up red flags. Despite the careful wording (I may sprout wings and fly, too), it is misleading at best. Where did this information come from?

The fact sheet sites three sources, none of which are research reports published in peer-reviewed academic journals:

• Astragalus. Natural Medicines Comprehensive Database Web site. Accessed May 10, 2007.
• Astragalus (Astragalus membranaceus). Natural Standard Database Web site. Accessed May 9, 2007.
• Upton R. Astragalus. In: Coates P, Blackman M, Cragg G, et al., eds. Encyclopedia of Dietary Supplements. New York, NY: Marcel Dekker; 2005:25–30.

Could these be biased? Maybe a little?

Okay, let’s try another. How about feverfew?

Under What the Science Says we find:

• Some research suggests that feverfew may be helpful in preventing migraine headaches; however, results have been mixed and more evidence is needed from well-designed studies.
• One study found that feverfew did not reduce rheumatoid arthritis symptoms in women whose symptoms did not respond to conventional medicines. It has been suggested that feverfew could help those with milder symptoms.
• There is not enough evidence available to assess whether feverfew is beneficial for other uses.
• NCCAM-funded researchers are studying ways to standardize feverfew; that is, to prepare it in a consistent manner. Standardized preparations could be used in future studies of feverfew for migraines.

And again the sources cited fall far short of reliable or reputable:

• Awang DVC, Leung AY. Feverfew (Tanacetum parthenium). In: Coates P, Blackman M, Cragg G, et al., eds. Encyclopedia of Dietary Supplements. New York, NY: Marcel Dekker; 2005:211–217.
• Feverfew. Natural Medicines Comprehensive Database Web site. Accessed on July 5, 2007.
• Feverfew (Tanacetum parthenium L. Schultz-Bip.). Natural Standard Database Web site. Accessed on July 3, 2007.

Can you imagine citing resources like these to support your theory in application for a research grant? Or in a scientific journal article? Any otherwise respectable researcher would lose all credibility.

The fact sheet on Echinacea presents the findings as mixed:

• Study results are mixed on whether echinacea effectively treats colds or flu. For example, two NCCAM-funded studies did not find a benefit from echinacea, either as Echinacea purpurea fresh-pressed juice for treating colds in children, or as an unrefined mixture of Echinacea angustifolia root and Echinacea purpurea root and herb in adults. However, other studies have shown that echinacea may be beneficial in treating upper respiratory infections.
• Most studies to date indicate that echinacea does not appear to prevent colds or other infections.
• NCCAM is continuing to support the study of echinacea for the treatment of upper respiratory infections. NCCAM is also studying echinacea for its potential effects on the immune system.

And, finally, it actually cited two peer-reviewed research reports among the six sources. However, both reported null findings (must be those pesky studies they funded, so they had to cite them). One published in JAMA also noted an increased risk of rash and children ages 2 through 11. Findings are not “mixed” when quality research agrees and one must consult pseudoscience or research of questionable quality to find disagreement.

What I found next was comical. I followed a link to “10 things to know about evaluating medical resources on the Web“. I’ll let you peruse that on your own.

The NCCAM’s annual budget has been around $120 million for the past few years and, although I do not know how funds in the new “stimulus package” will be distributed (does anyone?), there is money for science and it seems unlikely that the NCCAM’s budget will be cut.

I wonder about NCCAM’s history and the guise under which it was built. If a special interest lobby — namely the dietary supplement and CAM industry — was primarily responsible for its birth, then it is no wonder that the only thing this agency has accomplished so far is lending false credence to the products of that industry.