Internal Review & Dissent
Quotes from the CDC's Analysis of its 400,000-Deaths Study
"Methods used to calculate number of deaths due to obesity were incorrect and possibly miscalculated ... The use of the improper formula is a rather serious mistake to make. At the time this study was being conducted, the scientific literature had several papers describing potential bias. Following Allison et al. [which attributed 300,000 deaths to overweight and obesity per year] in using an incorrect method was not justified. From the cross-clearance, it seems as if this bias from the wrong formula was pointed out to the authors…"
"The knowledge about inappropriate use of adjusted relative risks in certain attributable-fraction formulas was in the literature prior to the preparation of this manuscript and was apparently shared with the authors prior to publication…"
"This review has clarified that we should no longer be using the relatively simple methodology of the model used by several of those previous papers [which arrived at the estimates of 300,000 and 400,000 deaths annually]…"
"My general conclusion is that the Mokdad et al. paper [the 400,000-deaths study] makes some bold statements, bolder than the original McGinnis and Foege paper [attributing 300,000 deaths to poor diet and physical inactivity in 1990], which might have been better off being presented as a policy exercise rather than a scientific study; the estimates seemed a combination of scientific calculation and expert opinion. Furthermore, the scientific reviewers of the paper who mentioned the problems were not taken as seriously as they could have been…"
"The [CDC's] clearance process appears to have been begun in good faith, though given dissent, it veered off path. This likely happened since the Director is a co-author and presumably approved the paper. I think if the scientists had believed that their concerns were being considered, the issue of clearance may not have arisen. Estimation based on best educated guesses should be acknowledged as such up front: for this paper the experience of the authors supports their ability to make some decisions with weak data, though some decisions may ultimately be incorrect…"