Passing off wrong numbers concerning public health

I first saw the news story this morning in the Times of India mentioning that “postmenopausal women are prone to fractures.” The story highlighted research presented at the European Congress on Osteoporosis & Osteoarthritis. Curiously, the research was also mentioned in a press release by the International Osteoporosis Foundation comparing the prevalence of bone fractures in obese and non-obese women. But this piece is not about the Times of India copying a press release news release nearly word for word: I leave it to you to chew on that revelation. What concerns me is that wrong information is being conveyed to the public.

Osteoporosis is a serious health concern among postmenopausal women, a major segment of the population. So naturally the story interested me. What shocked me was that because of poor math, wrong numbers are being floated to demonstrate the “a high prevalence of obesity in postmenopausal women”.

Consider for a moment the following passage found in both the Times of India story and the original press release from the International Osteoporosis Foundation from which it was copied verbatim:

“A history of fracture after age 45 years was observed in 23 percent of obese and 24 percent of non-obese women. Nearly one in four postmenopausal women with fractures is obese.”

The statement which is being floated is that one out of four (or 25%) postmenopausal women with fractures is obese. That would be abnormally high and a cause for concern. However, you don’t need to know anything about medicine to know the preceding statement that roughly 25% of obese postmenopausal women have absolutely rubbishes it.

Among postmenopausal women, there is only one logical condition which permits the statements that 1) roughly 25% of the obese have fractures and 2) roughly 25% of fractures are in the obese. And that is the number of obese and non-obese people in a population is equal.

Consider what happens if this condition is not met. If there are far fewer obese people in a population, when 25% of those with fractures are obese it means that fractures are much more prevalent in the obese. Really elementary math.

I investigated to see if this was indeed the case. Were there really the same number of obese and non-obese people in Europe? First I found that the definition of obese used by International Osteoporosis Foundation and the World Health Organization were the same (a basal metabolic index of greater than or equal to 30 kg/m2). Next, I looked at a report by the World Health Organization on the percentage of obese women in Europe. Depending on the country in Europe, anywhere from 5% to 20% of women are obese. The number of postmenopausal women in each country varies, but in no European country could the number of obese women approach anywhere near 50% of all those who are postmenopausal.

In fact, if 23% of obese and 24% of non-obese postmenopausal women are afflicted by osteoporosis, the data presented in the study shows that the prevalence is pretty much equal in both groups.

There are many reasons to avoid being obese. Based on the results presented here, however, osteoporosis is NOT one of them.

Of course the wrong headline makes for a better one. Screw the uninformed public.

Ramblings on earthquakes as “punishment” and the rescue of survivors as “miracles”

For nearly a week now I have been watching the tragedy caused by the earthquake and tsunami unfold in Japan. I have also been following the incredible human tales of suffering, heroism, fear-mongering, and apathy widely reported in its aftermath.

Some experts have loudly proclaimed that the destruction is punishment for some grave “sin” that the Japanese committed. The American media “pundit” Glenn Beck implied that the earthquake was a message from God to follow the Ten Commandments. On the other hand, Tokyo’s governor, Shintaro Ishihara called the earthquake “divine punishment” for the “egoism” of the Japanese people. Although the governor later apologized for his insensitive comment, one thing is clear: as humans, we are such a ridiculously conceited species that every natural disaster has to be a result of something we did or did not do in our insignificant lives.

Soon after the earthquake and tsunami, reports began to come in about “miracles” – lives that had been saved in the midst of overwhelming death: a four-month old baby clinging on to dear life, a 70-year old woman nearly freezing inside her home for four days, a 60-year old man found ten miles out at sea clinging to his rooftop for two days.

In a country of 127 million, when roughly 13,000 or 0.01% of the population perishes it is called “punishment”. When 1 out 13,000, or roughly 0.01% of the dead survives, it is called a “miracle.”

Why is one punishment? Why is the other a miracle?

Why of course, don’t I know! Death is punishment. Life is a miracle. Plain and simple.

Today on television I saw haunting images of a man who just stood there wearing a hard-hat, dumbfounded in the midst of absolute destruction. At the time of the earthquake and tsunami, the man was not at his home: by some stroke of luck, he was at the fire station, although he was not supposed to be there. His wife, son, daughter-in-law, and four grandchildren were at his small home in the town. They were in a home which had now been completely reduced to rubble. The man wandered around refusing to believe that his entire family lay in front of him in a stony grave. Then while the cameras were still rolling, it struck him.

“I can’t take it. I lost everything. Why did I go to the fire station?” he sobbed inconsolably. Even from the comfort of my living room thousands of miles away, I could not meet his gaze or offer myself an answer. Here was a man who wished he had been dead.

Now, my dear friend, tell me with your certitude what “miracle” saved this man? What “sin” condemned his grandchildren?

The dictionary: an obituary

o·bit·u·ar·y (-bch-r) n. A published notice of a death, sometimes with a brief biography of the deceased.

I must have been no more than thirteen when I last saw my paternal grandfather at our ancestral village, nestled in a corner of eastern India. Generations before me including my grandfather and father had grown up there in quieter times. As is the case with most thatched mud houses, the rooms had small windows and were dark inside, but each was fairly large and would have fetched a fair price as a studio-apartment on Manhattan’s Upper East Side.

Back then the few possessions that middle-class Indian families had were carefully passed on from generation to generation and I imagined that my grandmother had kept the three rooms that were our share of the larger joint-family, much the way they must have been when my father and my aunts were growing up in them. On the walls were framed examples of my grandmother’s cross-stitch works – “Pati Param Guru (The Husband is the Ultimate Lord)” and “Nama Shivay” undoubtedly shown to my grandfather’s retinue when their marriage was arranged. My grandmother had been an exemplary student and had won many prizes in school. Many of her medals for standing first in academics and recitation were in an old purple velvet jewelry box on a dressing table. She was also the eldest daughter of a Brahmin scholar who had written a book on Sanskrit (which is still used as a reference in West Bengal). My great-grandmother had died at an early age so my grandmother took care of her younger siblings until she was married at the age of sixteen, something not uncommon back then.

During my visits, after lunch which usually consisted of a few vegetable items and fish caught from our ponds every day, I’d open up a straw mat and lie on the floor. The rooms were cool during the oppressive summer months, but there was little to do but to read old moth-eaten books and rummage through tin trunks for curiosities. Some of the books were quite old. One I distinctly remember reading during the visit was Hungry Stones and Other Stories a collection of translated stories originally written by Rabindranath Tagore which my father had won for doing well in English in school. But the one book I took with me as I went back to the sleepy mofussil town I grew up in was a bound edition of the Concise Oxford English Dictionary published in the Fifties which my grandfather had given to my father when he was in school.

Every Bengali home had a dictionary up on the shelf next to the study desk, usually adorned with a bookcover from a colorful Sunday newspaper. Mine was my faithful companion through high school and college. Back then, words changed infrequently, though every now and then letters to the editor of the Statesman of Calcutta lamented how Americanized English was polluting our proper British spellings. I had that dictionary near my desk until I moved to the United States for graduate school.

I have not owned a dictionary since, and the only one I currently own came preloaded with my Kindle. Like many of you, whenever I need to look up the spelling or the meaning of a particular word, I use Google. Often when there are multiple divergent spellings, I pick the one which has more search results than the others, the rationale being that since language is an evolving democratic form of communication, the crowd defines what is appropriate. But there are certain days such as this one which makes me wistful for easier solutions.

Dictionary, you served me long and well, and I hope there is a quiet place for you where language isn’t constantly shape-shifting through internet memes, infantile acronyms, and the impolite speeches of Grammy-award presenters.

India: where there are 300 ways to cook a potato

“Sir ji, did you call for me?” asked Mishra as he entered Mirza’s office.

Mirza was twirling a round glass paperweight on the rectangular slab of cut glass covering his oversized mahogany desk and staring intently at the screen of his computer. In the right corner of the desk was a stack of files, each color-coded and bundled with red string. He was pushing back on the revolving leather chair. The chair itself was covered with a towel discolored where Mirza’s head had rested for hours as he poured over official directives.

Mirza pulled a file from the stack, opened it, and handed a printout to Mishra. “Mishraji please look at this request which was dispatched to us via email.”

Mishra took the paper from his superior with a habitual obsequiousness perfected only through practice. He gazed at the contents. A major festival to promote India to big-wigs in Washington D.C. was being arranged. The Council for Cultural Relations had drafted the brochure promoting the event with statistics mentioning the 28 states, 24 official languages, 1,600 dialects and 1.2 billion people in India as a sign of India’s vastness and diversity. There were stock passages which mentioned India as a country of cows, rickshaws, and skyscrapers jostling with shanties. To underscore India’s rich and ancient heritage there was a comment about how Indians prayed to 330,000 gods and goddesses.

None of this was new to Mishra, who knew the gig: foreigners loved that exotic stuff. And as a low-ranking babu in the Ministry of Information and Broadcasting, he was more than happy to oblige. This time because there were a couple of culinary shows planned for the festival showcasing India, the organizers needed help in finding a way to highlight India’s culinary diversity.

Mirza was the first to break the silence. “So what do you think?”

“Sir ji, I think we need a zabardast statistic which will show that our own cuisine is the best in the world. What if we highlighted one food product and how we have made it better through ingenious jugaad?” replied Mishra.

Mirza nodded. “Yes, I agree, Mishraji. But we should talk about some kind of food product which the Americans can identify with.”

“Can I ask you a question, sir ji? What do the goras eat?”

“That is a good question,” said Mirza as he rubbed his finely clipped moustache. “I’ve never been to America. I was in England for a week last year as part of a cultural delegation. Their food is horrid. Their meat isn’t bad, but it is bland. And then there are potatoes. A whole damn lot of them.”

“Oh, potatoes sir ji? I am an expert on the aloo. You see I am pure veg and aloo is the only sabzi my wife can cook,” said Mishra somewhat philosophically. “Maybe we can highlight the various ways that Indians cook potatoes?”

“Mishraji, that is quite possibly the most brilliant idea you’ve come up with! Where would I ever be without you?”

Mishra beamed. “Please… that is nothing. I can do anything for you.”

Mirza ignored Mishra’s fawning. “So tell me Mishraji, how many ways can your wife cook the humble aloo?”

“My wife is not a very good cook, sir ji. My life is a very sad one,” replied Mishra with a comic expression on his face.

“Yes, well that can’t be helped now, can it? Go to a bookshop and procure a cookbook which has a number of recipes calling for potatoes and report back with how many ways there are to cook the potato in this great country of ours,” ordered Mirza.

“Yes, very good sir ji. But the Navkiran bookshop nearest my home only has recipes from Uttar Pradesh. How will I get other recipes?” asked Mishraji.

Arrey baba, you don’t need other recipes. Just get one cookbook with recipes for Uttar Pradesh or any other state. Multiply the number of number of recipes you find with 28 – the number of states. Report back to me with a very nice round number.”

“Thank you for your guidance. I will revert back to you with just such a number as soon as possible. I will also check the number with Shri Gyanvikas Maharaj, so it is auspicious. Maharaj is a very powerful astronumerologist.”

“Well done, Mishraji! And that will be all,” replied Mirza as he looked back at his computer screen.

Last thoughts: this piece was prompted by the following passage promoting India at an ongoing cultural festival in Washington D.C.

“India is vast: 1.2 billion people; 24 languages; 1,600 dialects; 28 states; myriad cuisines; 330,000 gods and goddesses; 300 ways to cook a potato.”

This piece is fictitious. Of course.