Today, the news outlets are full of reports that some "common supplements" of the modern life that are believed to aid our health are claimed to be useless if not harmful. I will mention three independent major stories:
FDA against anti-bacterial soapsThe common theme is that it seem incredible to me that after so many years and after the sale of tens of billions of these products for hundreds of billions of dollars, the question whether these things are helpful seems completely open.
Papers against vitamin pills
Paper counting illnesses caused by raw milk
A typical Czech raw milk vendor machine.
This uncertainty is a stunning testimony to the low standards of the soft sciences, the hunt for 2-sigma bumps, and similar things. When some calculation says that the chance is just 97% that something is good (or bad) for you, you should treat the number 97% as pretty much the same as 50%. It is not solid enough evidence. It may be just a fluke – or a fluke that "someone helped" to arise. If there is a genuine effect, it isn't much harder to get a 5-sigma i.e. 99.9999% certainty! I do believe that if the health sciences followed some rules of particle physics or other hard sciences – e.g. the requirement of 5-sigma deviations to claim a discovery – they wouldn't be in this mess.
When we come to details, I have mixed feelings about the individual stories.
Let me start with the unpasteurized milk. In general, I have been sort of confused by this bizarre fad. I have believed that Louis Paster was a pretty important man – and shockingly enough, he was mostly important for his discovery of pasteurization.
Pasteurization means to heat up the milk (or other food) to some high temperature and then to cool it quickly. Germs get killed. It seems rather simple and I have some trouble to see why the procedure should be bad.
The decrease of nutrients such as vitamins is insignificant, of order 10%, and it may be neglected. What may be more significant is the decrease or liquidation of the "good bacteria". But this loss may be somewhat immaterial because the key home for the good bacteria are the intestines and they must be able to survive there without an external help - a vast majority of the bacteria fail to survive the stomach's acidic environment. I believe that one probiotic pill per week or month (which gets down there) would have to be equivalent to a permanent drinking of unpasteurized milk.
Ivan Mládek: A Cow in a Dairy, late 1970s. A cow becomes upset that it or she is never allowed to taste the milk products. So it or she visits the dairy. In the chorus, it is determined that after the cow ate too much of a crushed creamy blue cheese branded Niva (=Meadow, a Czechoslovak Roquefort competitor), it or she began to feel not well around the psalterium. A visit to a veterinarian will be needed. – If a trained economist and Václav Klaus' ex-classmate may analyze the detailed impact of various milk products on cows' complex stomachs, and publish the findings in a musical form, why can't tens of thousands of highly paid medical researchers do the same thing (at least without the song) with the much simpler human stomach?
One liter of raw milk costs $1 or so in Czechia – something like 50%-100% higher than the normal pasteurized milk in the tetrapack boxes. Why do people pay this extra bonus for something that looks like a disadvantage to me? I think that the rational ones among them must believe that they will avoid antibiotics or pesticides. I don't really understand why they think that they're protected against all such things just because the milk is being sold in an old-fashioned "do-it-yourself" way. Pasteurization itself doesn't add any antibiotics or pesticides. And "bio/organic" labels attached to a farm don't isolate it from all the chemicals that are around us – and that must sometimes be used, anyway.
On the other hand, a decade of the usage of raw milk has led to 93 illness outbreaks, 1837 illnesses, 195 hospitalizations and 2 deaths just in the U.S. Some data say that every sixth person drinking raw milk gets sick. It almost sounds like a joke but they are serious.
To summarize, I do tend to think that the "raw milk vendor machine fad" is just one of the Luddites' fad that isn't really good in any way. Correct me if I am missing something.
Now, the FDA demands the producers of anti-bacterial soaps to prove that they are safe. The U.S. government institution claims that there is no proof that they're helpful for anything – and there is a risk that they bring us new threats as they help resistant mutated microorganisms to evolve.
Well, I think that the evolution of antibiotics-resistant strains is an issue that the mankind will increasingly have to wrestle with. However, it seems at least questionable to me whether these soaps actually make the situation worse. The evolution of viable, resistant strains requires some "training" – the microorganisms have to face tough enough conditions for the most aggressive ones to be selected - but I believe that a sufficiently large number of the microorganisms may also be needed. If one kills a vast majority of some bacteria, he is surely reducing the room for the vulnerable bacteria but he may be reducing the living space for the more resistant strains, too.
There are two factors standing against each other – the inhospitable environment is "directly" bad for the microorganisms but it may be good for them in the long run because it forces them to become more resilient. The survival and evolution of the Nordic ethnic groups (the life is arguably harder in Norway) is something that I can't avoid thinking about when I look for a good enough mental model (I will insist that it is politically correct for the "impartial" people at the very center of Europe to think about all these matters).
The question which of the factors is more important, especially in the long run, is a very subtle question and I feel that none of the answers should be viewed as the "default one". Someone might want to use the "precautionary principle" saying that one better shouldn't train microorganisms to be more resistant. But the opposite "precautionary principle", one saying that one better shouldn't allow any bacteria to reproduce, is at least equally natural. The point is that there exists no recipe for the human behavior that makes the human – and the mankind – completely safe. In other words, the basic problem is that the precautionary principle is a fundamentally flawed way to think about the real world. In almost all real-life situations, we face trade-offs and we must think about them in terms of costs and benefits.
So I have a trouble with any policy that looks like the application of this flawed principle. A priori, the situation is symmetric but in my opinion, the Western rule of law is based on the presumption of innocence. So the producers of these hand soaps might equally well (or even more justifiably) demand the FDA or other apparatchiks to first prove that their products are dangerous. It just seems strange to ban products just because someone is "afraid" of them or because he invents a vague "story" that would imply that the products are dangerous if the story were true.
Finally, a paper says that enough is enough for multivitamin pills. They don't reduce the cancer rate, they don't protect you against the decrease of mental capacities when you get older, they don't increase your life expectancy. I don't believe such general, far-reaching propositions. I have a trouble with the "collective treatment" of all multivitamin pills if not all supplements. It seems likely to me that most of the antioxidants must be helpful as a compensation against the radicals and some extra "modern threats" in our environments. It sounds natural to me to believe that collectively, the supplements including hand soaps and vitamin pills have contributed to the higher life expectancy that the people enjoy these days.
But I don't have any clear proofs of the helpfulness of any multivitamin-like supplements (although I know many compelling "stories" that would prove that they're helpful if the stories were right) and the observation that the world of the medical and biological research doesn't seem to have proofs in one way or another seems kind of shocking to me.
What do you think?