Of all the things you should bear in mind when looking at health stories, this is probably the single
most important. Association does not mean causation. The reason why this is so important is that
studies that have only found associations make up the vast bulk of scare stories in the media:
Here is a typical recent headline, which you may have seen:
“Eating red meat regularly ‘dramatically increases the risk of death from heart disease”
It is true that this newspaper headline does not actually state that eating red meat causesheart
disease. Not quite, but very nearly, and you could be forgiven for thinking that it does. Read it
again, and you will not see the word cause anywhere. It is just very implied very strongly
However, as you get into the article itself, any distinction between association and causation fades
almost to nothing:
‘Senior author Professor Frank Hu, from Harvard School of Public Health in Boston, US, said: ‘This study
provides clear evidence that regular consumption of red meat, especially processed meat, contributes
substantially to premature death.
‘On the other hand, choosing more healthful sources of protein in place of red meat can confer
significant health benefits by reducing chronic disease morbidity (illness) and mortality.’
The study found that cutting red meat out of the diet led to significant benefits. Replacing one serving of
red meat with an equivalent serving of fish reduced mortality risk by 7 per cent.’
At this point we are heading into the territory of Bill Clinton in his impeachment trial where the
meaning of words it being stretched to their very limit. ‘But what is, is?’
I defy anyone to read those paragraphs and not conclude the following:
1: These researchers proved that eating red meat causes premature death
2: The researchers further proved that cutting out red meat and replacing with fish reduced
mortality risk by 7 per cent.
I don’t think you could be blamed for thinking these two things. Because that appears to be exactly
what was said. Or was it? Were you just being fooled by a complex conjuring trick made up of
carefully chosen words designed to bewilder.
Here are the actual conclusions of the paper:
‘Red meat consumption is associated with an increased risk of total, CVD, and cancer mortality.’
Note the word associated. Where is the word cause? It isn’t there, because this study could never,
ever, prove causality. Why not? Because it was an observational study (actually it was a review of
two other observational studies).
In an observational study you do not do anything active. You just study that things that people do,
or eat, and see if any associations emerge. When you find an association the next question you
have to ask is the following. Are you looking at yellow fingers, or smoking.
It is certainly true that yellow fingers are associated with a higher rate of heart disease Does it
follow that yellow fingers cause heart disease? No, of course not, what it means is that people with
yellow fingers are usually people who smoke. And smoking vastly increases the risk of dying of
heart disease.
In this case the distinction between the cause and the association is blatantly obvious – or at it has
become so after fifty years of research made it clear Indeed, if I were now to try and claim that
having yellow fingers causes heart disease, you would look at me as though I were an idiot – and I
would be.
Yet, when a study finds that eating red meat is associated with a higher risk of heart disease, we
seem to rush headlong into the conclusion that eating red meat consumption almost certainly
causes heart disease. But red meat could well just be the equivalent of yellow fingers.
You think not? In that case you are probably thinking that red meat contains saturated fat, and
saturated fat raises cholesterol levels, and raised cholesterol levels cause heart disease. If you
played this little causal chain in your mind, you would most certainly not be alone in doing so.
It is something that our brains seem hard-wired to do…
‘….our brains and nervous systems constitute a belief-generating machine, an engine that produces
beliefs without any particular respect for what is real or true and what is not. This belief engine selects
information from the environment, shapes it, combines it with information from memory, and produces
beliefs that are generally consistent with beliefs already held. This system is as capable of generating
fallacious beliefs as it is of generating beliefs that are in line with truth.’
http://www.csicop.org/SI/show/belief_engine/
We cannot seem to help ourselves from linking things together to create causal chains, or beliefs,
that certain things cause other things to happen. This is emotional, it is exceedingly powerful, and
deconstructing such beliefs is the work of Hercules.
In this particular case, though, you would be hard pressed to use this belief as an explanation. How
do I know this? I know that because the Harvard team found that those who at the most red meat
actually had the lowest cholesterol levels. This table (figures taken from the paper itself) divides people into five groups/quintiles. Those in quintile 1 ate the least red meat, those in quintile 5 the
most.
