One of the more interesting observations I learned from a teacher is this: If you think you understand something, change it.
The power of the observation is apparent. Your knowledge should permit you to move an idea forward and backward, up and down, inside out and outside in, if you truly understand it. You can make it do your bidding because you understand.
Push this observation and you realize that a persuasion orientation is a crucial part of science. If you know something, then you can take your knowledge and change things. The proof of what you know is not simply you know it, but that you can change it and change with it. If you think you know something, but you cannot change it or change with it, then you don’t know after all. As in the case of preventing Alzheimer’s.
Here’s the table. Click to enlarge if needed.
According to the analysis that produced this table, 50% of Alzheimer’s cases worldwide are preventable. Preventable. That means they don’t happen. Ever. People don’t get Alzheimer’s. Ever. Half of all cases of Alzheimer’s don’t happen. Talk about knowing something that makes a change!
Now, just take a moment and reflect. First, realize that this is not original research, but a quantitative review of the literature. Second, virtually all of that review is from Observational Research with no randomization, comparison, or control, in other words, little experimental data. Third, see the Small Windowpane effects for all the risk factors. Fourth, and hold on to your head for this.
Barnes cautioned that the findings assume that the individual risk factors actually cause Alzheimer’s, which has never been proved. “We are assuming that when you change the risk factor, you change the risk,” she said in a statement. “What we need to do now is figure out whether that assumption is correct.”
Can you imagine standing in front of your family or coworkers or neighbors and saying something like that? “There’s no proof that this works, but dammit, I think we should all pull together and . . .”
Barnes is more than willing to assert that she understands something and understands it so well that she can change half of the outcomes from a negative state to a positive state all the while asserting that her knowledge has no proof. Furthermore, realize that all of these numbers are pure speculation, that back of the envelope economics you read in advocacy columns with assumptions, historical trends, available data sets, and what ifs. There is no good scientific evidence in this report that a particular factor, like physical activity, is actually causal for Alzheimer’s prevention. And, the authors admit this.
Think about this report from another direction.
You are the persuasion maven tasked with an intervention to prevent 50% of Alzheimer’s case based on this research. Barnes and colleagues confidently assert they understand how to prevent Alzheimer’s which means we know how to change it. Okay. What you would do to create this change?
Low education is a risk factor. Think about that intervention.
Now, diabetes. Think about that intervention.
See any difference in the scale at which you’d plan and execute? Education requires a total organized effort at the national level and in the US at the state level. Changing education is essentially changing the political and cultural institutions of the nation. And, countries vary on that. Diabetes, by contrast, is slightly more under the control of specific individuals, particularly lifestyle behavior like diet and exercise. Changing that is essentially what we’ve been doing already since we know that diabetes is a serious health problem and does have controllable elements.
The list of seven factors operate at different levels of abstraction (global, cultural, individual, behavior, heredity), yet are all in the same basket called Preventable Risk Factors. The factors are so different from one another that it makes a mockery of the term, Risk Factor. There’s no rigor, clarity, or unity in the classification. Thinking about the persuasion implications of this report makes you realize just how bad the science is behind it.
What also worries me as the persuasion guy charged with making the Life Saving Intervention, is that bad science like this gives people false hope. I have no trouble with this getting published in the peer review literature. People smarter than me are thinking the same kind of critical thoughts about the vaporous analysis, but at least we’re thinking about the problem and how to solve it. This weak work might stimulate better research from someone else. Publication in peer review literature is good here.
But, this crew went out of its way to attract media attention and did a notably bad job of explaining the nuance. This is a fantasy, What If?, kind of research projection that frames a problem. Seen in that light, it might be useful, although you clearly see that I don’t walk in that light. The authors contribute to public confusion with their persuasion efforts for media attention. Various Cool Table FauxItAlls will now confidently assert that if society would wake up, We Could Cut Alzheimer’s By 50% In Our Lifetime! Of course, you could put a trillion dollars on Alzheimer Prevention and it would probably have little effect on the number of cases because this research is so weak.
Let’s shout “Cure!” in a crowded hospital waiting room. Some researchers think that their scientific speech functions the same way in public that it does in peer review literature when obviously it doesn’t. Just folks are in no position to critically evaluate this report and they assume that the Shouting Expert has enough sense, good taste, and prudence to not holler when she should whisper.
P.S. By dumb luck a new issue of Journal Watch (Aug 1, 2011, vol 31, no 15) arrived with a couple of studies on diabetes reduction. One tested for more intensive management versus normal clinical care for asymptomatic diabetics and found no improvement in outcomes for the intensive management over 5 years of testing. The other study tested the impact of adding daily exercise (walking) for type 2 diabetics over 1 year and found no benefit over a control group. Do you have any other ideas for reducing diabetes to reduce Alzheimers?