The July 18, 2012 issue of The Lancet – not to be confused with the Lancet or even just, Lancet – offers an exercise in self persuasion, reassuring itself that it is scientific, relevant, and maybe even cutting edge with a special issue on physical activity timed to ride the growing wave of London Olympics attention. Pretty clever, a British publication releasing a special issue on something related to physical activity just in front of the British Olympic Games. Almost persuasive! But, The Lancet is scientific and wants you and more importantly themselves to know it.
While the issue offers no new original research, it does offer a persuasive Lancet-Meta-Analysis® on the effects of sitting or standing on global life and death which is accompanied by a series of commentaries. Let’s start with the commentary about that Lancet-Meta-Analysis® on the effects of sitting or standing on global life and death.
There is substantial evidence to show that physical inactivity is a major contributor to death and disability from non-communicable diseases (NCDs) worldwide.
Pamela Dasa, Richard Hortona. (2012). Rethinking our approach to physical activity. The Lancet, available online 18 July 2012.
Clearly, physical activity has vast potential to improve health throughout the world.
Pedro C Hallal,Adrian E Bauman,Gregory W Heath,Harold W Kohl,I-Min Lee,Michael Pratt. (2012). Physical activity: more of the same is not enough. The Lancet – 18 July 2012.
Exercise has been called a miracle drug that can benefit every part of the body and substantially extend lifespan. Yet it receives little respect from doctors or society.
I-Min Lee, Eric J Shiroma, Felipe Lobelo, Pekka Puska, Steven N Blair, Peter T Katzmarzyk, for the Lancet Physical Activity Series Working Group. (2012). Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy, The Lancet, Available online 18 July 2012, ISSN 0140-6736,
Vast. Miracle drug. Substantial and major. Man, what’s in that persuasive Lancet-Meta-Analysis® on the effects of sitting or standing on global life and death? Here’s the headline (from the Lee, et al. cite above).
Worldwide, we estimated that physical inactivity causes 6–10% of the major non-communicable diseases of coronary heart disease, type 2 diabetes, and breast and colon cancers. Furthermore, this unhealthy behaviour causes 9% of premature mortality, or more than 5.3 million of the 57 million deaths in 2008.
Vast. Miraculous. Majorly substantial. This persuasive Lancet-Meta-Analysis® is something special. How do you do this wonderful thing?
Scan the literature on physical activity in every country of the world with a special emphasis upon WHO sources. Extract from each report estimates of: 1. Prevalence of sitting and/or 2. Risk Ratios of the mortality effects of sitting. Then you compute the Population Attributable Fraction (PAF) by essentially multiplying Prevalence times Risk Ratio and invent an estimate of how much death is caused by sitting.
Next you include all of this data in a persuasive display of numbers in various tables to inflate the length of a very short paper. Call this Killing WATTage With Meaningless Numbers. You build piles and reams and rows and columns of numbers, numbers, numbers, whether called RR or PAF, just nothing but numbers. And with all those numbers, numbers, numbers, you know you are dealing with serious people who tell the truth and maybe even the Truth – as Dr. Wakefield proved – since they are reporting at the Lancet, oops, The Lancet.
As important as what you include is what you exclude. Don’t mention an effect size. The Windowpane effect size from the INTERNATIONAL GLOBAL ANALYSIS OF EVERYONE IN THE WORLD is about one-fifth of a Small effect, about 49.999/50.001. Don’t discuss method flaws. None of the studies in this kinda report is based on a random sample. None of these studies randomly assigned participants to controlled conditions. All of these studies rely upon self report for all or most of the variables. All of the surveys use different measurement formats and are not directly comparable. Many of these studies were done in countries with lousy scientific and information infrastructure.
Vast. Miraculous. Majorly substantial. The NYTimes buys it and so do the readers who comment. It must be truly true!
Let’s pretend that we agree with The Lancet’s Cool Table attempt. Imagine that we convince world governments to pay for this so you’d have the billions needed to do whatever The Lancet thinks will actually get everyone in the world off their butts. And, of course, we are pretending that you could do an intervention at any price that would Change all those lazy Other Guys and that the Change would actually save lives. This is all pretend because there is no evidence that such an intervention would produce the congenial mortality effects that are assumed to exist.
If you were a first class maven with an unlimited budget and you created a successful intervention that got the lazy world on its feet, you’d save 5.3 million lives a year!
That sounds like a lot life, but you’re not thinking about it clearly. This imaginary intervention would only cause those 5.3 million people to die next year rather than this year because, as the researchers note, increasing physical activity would only add about 1 additional year of life. Really.
We estimated that the median years of life potentially gained worldwide with elimination of physical inactivity was 0.68 years.
Just to be tidy and The Lancet Accurate® we need to adjust our calculations from 1.00 to 0.68. So, 0.68 years of additional life works out to an extra 248.2 days except for Leap Years which add 248.8 days. At the end of life span. Or else you can take those 248.2 to 248.8 days and distribute them throughout the life span if you prefer to think of it that way. But everyone simply dies about 250 days later.
So. Yeah, you could say that your intervention saves 5.3 million lives a year.
Or you could say that 5.3 million people will die next year rather than this year.
And, you get this gain at the end of the life span, so all those guys who would have died at 81 will instead die at 81 years and 248.2 days or maybe as much as 81 years and 248.8 days.
Finally, to get that, you have to get EVERYONE IN THE WORLD off their butts all the time forever.
The only thing Vast, Miraculous, and Majorly Substantial about The Lancet is their tone-deaf self-importance. An entire issue functions as little more than an extended advertisement to encourage more grant money from governments to fund trivial research. You think I exaggerate? Here’s the previously cited Dasa and Hortona paper.
One might conclude that this Series should not be published in The Lancet. Physical activity is not a medical or pathological predicament but more a cultural challenge: to create a lifestyle inclusive of activity. It could be argued that this Series would be better placed in a national newspaper, a women’s magazine, or a television or radio programme. But the first step in what must be a social revolution towards an active, and away from a passive, physical and mental life should be to assemble the best experts in the field and the best evidence to understand what we know about the relationship between human health and physical activity. This goal is the purpose of our Series.
This is not science. This is not even persuasive. It shimmers with a veneer of polished sincerity over a hard core self promotion and regard. Think about this. That persuasive Lancet-Meta-Analysis® makes the strongest Argument against sitting and for standing that the research literature can produce without fabrication, falsehood, or fudging. Let the technique hide the bad method and the worse statistical whiz-bangery and accept the estimate: 248.2 days . . . at the end of the life span . . . if everyone in the world gets off their lazy butts all the time forever.
Vast. Miraculous. Major. Substantial.
Wow, 0.68 years. Doncha just love that kind of accuracy. Almost looks scientific, doesn’t it? Remember, the standard deviation for life span is about 15 years. Divide 0.68 by 15 and you get a d effect size of 0.04. A Small Windowpane d is equal to 0.20. Hmmm. 0.04 against 0.20. That’s one-fifth of Small.
Vast. Miraculous. Major. Substantial.
P.S. Hey, mavens, note the disclaimer at the end of the papers where everyone declares they have no Conflicts of Interest. In persuasion theory that is called Dissonance Reduction.
P.P.S. Hey, kids, read the research on the effect of getting off your lazy butt for its cognitive and emotional benefits. If you want to run, run for a clear mind and a contented soul no matter what it does to your life span.
P.P.P.S. Last one. Promise. Here’s the Google Trends on Lancet searches over the past 30 days collected on July 19, 2012. You see the weekly cycle from the publication schedule. Looks like this persuasively timed special issue gains nothing over past The Lancet issues. Sometimes PR is persuasive and sometimes it’s just PR.
P.P.P.P.S. Sorry. The Lancet Physical Activity Series Working Group is responsible for this special issue. What? A gaggle of researchers banding together under the title of a journal? Since when did scientific journals hire out researchers? What kind of peer review is that? What kind of independence is that? What next, the JAMA Soda Pop Working Group? The Science Perpetual Motion Working Group? The PsychScience Progressive Prejudice Working Group? Are we doing science or building brand synergy? Where’s The Lancet TLPASWG t-shirt? Certainly there’s a handshake and a song, too. Maybe even a password play. Two researchers who don’t know each other bump into one another at science mixer. The first one queries, “The?” The second, on that Cool Table, replies “Lancet.”