DAY 88: VISCUSI: Public Health Victorious Long Ago; Quit Beating a Dead Horse
April 7, 2005 12:09 am by Gene BorioApr 6, 2005, 11:53 PM
Poor Dr. Kip Viscusi couldn’t get a break on the witness stand Wednesday. Even Defense’s own attorney, Lorillard’s Michael Minton, referred to rival Harvard professor Jon Hanson as ” Dr. Hanson.” By that time, however, Dr. Viscusi had calmed down and was able to take MR. Hanson’s elevation in professional status in humorous stride.
The Hanson testimony took an interesting turn when Mr. Minton brought out a court transcript from the Falise trial, wherein US District Judge Jack B. Weinstein disallowed testimony from Mr. Hanson, then a Jr. Professor, saying, “He’s not an expert.”
Ms. Crocker objected, but Judge Kessler let the transcript in, saying she would take into account Defense’s inability to explore the section, ie, whether it was an official ruling within the transcript, whether there was a separate order, whether there were mitigating subsequent statements, etc.
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Creative Documentology
In all, Mr. Minton succeeded pretty well in reclaiming Dr. Viscusi, though he could lay on the sarcastic tone a bit too thickly when he really didn’t have much else going.
In response to a survey question that asked respondents to rank in order death rates from car accidents, aids, homicides, etc., he asked Dr. Viscusi, “Do people need to be able to estimate the death rates from auto accidents or alcohol deaths [to be aware of the health risks of smoking]?” I’m not sure what the legal term is for a rhetorical question that a witness has to answer anyway, but it would certainly apply here.
Mr. Minton then quoted from a 1988 NIH document, “Media Strategies for Smoking Control: Guidelines,” and pointed to the document’s discussion of “creative epidemiology,” defining it as, “the ability of the good epidemiologist to re-work data so that what is essentially the same information can be presented in a new and interesting form.”
In a listing of “prime illustrations of ‘creative epidemiology,’” was an entry for, “Cigarette smoking causes more premature deaths than do all the following together: acquired immunodeficiency syndrome, cocaine, heroin, alcohol, fire, automobile accidents, homicide, and suicide.”
MR. MINTON: In other words, this is just recycling old news?
DR. VISCUSI: Yes
MR. MINTON: Are you aware of any public health agency that ever suggested what NIH said was ‘creative epidemiology,’ or recycling old news, was essential in people’s understanding of the risks of smoking?” *
[Do I have to tell you Dr. Viscusi’s answer?]
Mr. Minton would smilingly infuse “creative epidemiology” with sarcasm every time he said it. While this sort of thing might be good jury-fodder, I doubt this entire line of argument went far with Judge Kessler.
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Real Surveys Don’t Have Curves
Mr. Minton was much better in illustrating some of the common-sense faults of the DOJ’s survey citations, ie (to mention just two),
–Undefined reference points. Respondents asked to say whether they are more or less likely than the average to get lung cancer often had no idea whether they were comparing themselves to others like themselves, to the population at large or to any defined group at all. Who knows what they were using as a reference point? Studies on this phenomenon say they would use their own narrow self-defined group.
–Anchoring bias. People tend to average out answers. So in multiple choice, Dr. Viscusi indicated, a study’s answers should center on the right answer. Several questions were poorly weighted to lead respondents to a lowered appreciation of the risks of smoking. For example, a question asked if the respondent felt a smoker were 1, 2, 5, or 10 times more likely to get lung cancer. The correct answer is 10. Unsure respondents would tend not to go to that, as an extreme choice, showing in the end results that people think lung cancer risks are lower than they really are. Had the question read 2, 5, 10, 20 or 40 times, respondents would have gravitated to the more realistic figure. (To me, this phenomenon indicates a far deeper problem with such surveys.)
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How To Win Friends And Influence People
Mr. Minton asserted tobacco control biases in Defense’s studies and funders, tying the Robert Wood Johnson foundation to tobacco control work, and showing study links to CTFK, Michael Cummings, and Dick Daynard’s Tobacco Products Liability Group.
In response to Dr. Viscusi’s known and extensive work for the tobacco industry, and its funding of his cited studies, Mr. Minton showed Dr. Viscusi had also worked extensively with other government agencies–extensively with the EPA, and 3 times with the DOJ itself(!)
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Dynamite Testimonial
Ms. Crocker had brought out a strong endorsement by Nobel Prize Winner and Viscusi friend Dr. Daniel Kahneman* in favor of DOJ witness Dr. Paul Slovic’s “affective heuristic” theory of decision-making [affect=emotion, heuristic=procedure for solving a problem/making a decision; thus, arriving at a decision via feelings, or as in Dr. Slovic’s term, “vibes.”].
Mr. Minton brought out again, as in the written testimony, that there is no scientific confirmation of the theory. (On the other hand, Dr. Viscusi envisions people consistently making well-reasoned, supremely rational decisions virtually in the absence of any emotion at all. This idea would not only throw out the mass of advertising theory and technique, eviscerating an entire industry, but is patently ridiculous–oh, those wascally economists!)
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Viscusi On Remedies: Don’t Bother
Judge Kessler seemed to take Dr. Viscusi’s testimony far more seriously than that of the last few witnesses. At the end of his redirect, she asked him an extended series of questions–quite unusual for her.
She asked him what a “Jr. Professor” was (this was in the Judge Weinstein transcript). Dr. Viscusi said MR. Hanson was now a tenured professor–but doesn’t have an endowed chair.
“Oh, so he’s not so lowly now,” she said.
She asked if the essential conflict between his testimony and the testimonies of Drs. Slovic and Weinstein was apples and oranges, quantitative vs. qualitative, and “never the twain shall meet?” Dr. Viscusi said, “We’ve met in print.”
JUDGE KESSLER: You concluded that in general, people overestimate the risks, and people believe they have sufficient information about the health risks of smoking.
Where does that get you in terms of any conclusions regarding public policy issues or remedies issues in this case as to either cessation of smoking or regulation of smoking in this way, and [turning to address the sudden buzz at the lawyers’ tables], I realize this is nobody’s remedies witness.
DR. VISCUSI: Mass dissemination has been a tremendous success, and people have the information. The Hutchinson and COMMIT studies found further mass communication didn’t accomplish anything. You don’t accomplish anything if you’ve already accomplished your mission (ie, informing people of the health risks of smoking). This is one area we can declare victory.
Dr. Viscusi didn’t say who exactly he meant when he said “we.”
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You’ve Been Surved
Dr. Viscusi’s testimony shows, as have many in this trial, how little science we really have– in this case, how far we are from a true, holistic understanding of, uh, well, understanding itself, and in this case, how it relates to decision-making. What is really going on in a person’s mind, for example, when they answer the question,
Do you think you have adequate information on the health risks of smoking?
94% answered yes in one not-atypical study.
Only last year I was talking with a friend–it was a bit of our usual argument, actually, all financial people seem to hate tobacco control– who is a financial advisor, talk-show host and author of 18 books, ie, well-educated, not stupid. When he told me everyone knew the health risks of smoking, I asked, OK then, what exactly are those health risks, specifically? I expected him to come back with at least lung cancer. I was amazed when he couldn’t come up with even one tobacco-related disease. And I know for a fact he would have answered that “adequate information” question, “Yes.”
I also remember when my girlfriend’s son found out the local hardware store owner had just died of a sudden heart attack at 49. His mother said, “Well, he was a chain smoker.”
Now here was a young man who was going to college, whose mother was a nurse (and whose father was a top figure in a tobacco industry law firm), and whose mother’s boyfriend was a tobacco control advocate. And his answer to her in 1993 was, “What?? You mean smoking has something to do with heart attacks??”
He could well have answered that “adequate” question yes, also.
In fact, under what bizarre circumstances would a person ever answer no? I mean really, how do we know what we don’t know?
It’s too bad Burson-Marsteller, et. al., isn’t a part of this suit. If anyone knows how people process information and absorb it, how much it has to be repeated and reinforced over and over in a variety of outlets, and how really long it takes to finally sink in, these under-cover “image management” firms should.
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*Mr. Minton’s characterization of “creative epidemiology” as a NIH statement is interesting, and it is, yes, but the document is actually a statement from a 2-day Advocacy Institute meeting of tobacco control advocates–including Stan Glantz, Michael Cummings, and other such luminaries of the movement–and of course highly lauds such “creative epidemiology” which can “marry the science of the researcher with the art and creativity of the media advocate”.
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**The evidence from Dr. Kahneman that Ms. Crocker surprised Dr. Viscusi with was extremely potent. Particularly trenchant is the field in which psychologist Kahneman won: Economic Sciences, and the reason he won: “for having integrated insights from psychological research into economic science, especially concerning human judgment and decision-making under uncertainty”
In his very Prize Lecture, from which Ms. Crocker provided this quote, Dr. Kahneman said, “The idea of an affect heuristic (Slovic et al., 2002) is probably the most important development in the study of judgment heuristics in the last decades.”