May 30, 2014

Levels of evidence

If you find that changing your diet in some way makes you feel happier and healthier, that’s a good thing.  It doesn’t matter whether the same change would be useful for most people, or only useful for you. It doesn’t matter whether the change is a placebo effect. It doesn’t even matter if it’s an illusion, a combination of regression to the mean and confirmation bias. You might check with a doctor or dietician as to whether the change is dangerous, but otherwise, go for it.

If you want to campaign for the entire community to make a change in their diet, you need to have evidence that it’s better on average for the entire community. A few people’s subjective experience isn’t good enough.  Good quality observational data might be all you can manage if the benefits are subtle or take years to appear, but if you’re claiming dramatic short-term benefits you should be able to demonstrate them in a randomised controlled trial.

The reason for mentioning this is that PETA has been making friends again. They’re trying to link milk consumption to autism. They don’t even pretend to have any evidence that milk causes autism, and the evidence that milk-free diet has a beneficial effect in people with autism is very weak.  That is, there are a few studies that suggest a benefit, but the benefit is smaller in studies with more reliable designs, and absent in the best-designed studies.  The most recent review of the evidence concluded that dairy-free or gluten-free diets should only be tried for people who have some separate evidence of food intolerance.  After reading the review, I would agree.

There are respectable arguments against dairy farming, both ethical and environmental. Scaremongering about autism isn’t one of them.

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Thomas Lumley (@tslumley) is Professor of Biostatistics at the University of Auckland. His research interests include semiparametric models, survey sampling, statistical computing, foundations of statistics, and whatever methodological problems his medical collaborators come up with. He also blogs at Biased and Inefficient See all posts by Thomas Lumley »