““It’s really a product that’s good for some people and bad for other people, which doesn’t feel like too complex of a statement, but actually feels like something that is difficult for many to grapple with,” said Hartmann-Boyce, who is an associate professor of evidence-based policy and practice at the University of Oxford.
She led a 2022 Cochrane review — considered the best type of analysis of the available evidence — which looked at studies of e-cigarettes for smoking cessation. It found the strongest evidence yet that vaping works better than traditional nicotine replacement tools such as patches or gum to help people stop smoking. For those advocating that vaping is an effective harm-reduction mechanism, it was a significant win.
But it’s also more complicated than that.
Hartmann-Boyce said that since Cochrane first started looking at the evidence nearly 10 years ago, things have changed dramatically. The devices themselves are different now and are much better at delivering nicotine. That’s good for people trying to give up smoking but creates a problem with non-smokers like kids who are trying these for the first time.
But not everyone is even convinced it’s good for most smokers in the long term.
Jørgen Vestbo, a clinician and emeritus professor of respiratory medicine at the University Hospital of South Manchester, who recently returned to his native Denmark, agrees that the randomized controlled trials show e-cigarettes can help people quit.
But he also points to data from clinical trials that show people given e-cigarettes were more likely to use them for longer than those using aids such as nicotine gum. Vestbo said population-level evidence shows that as long as you are addicted to nicotine you are more likely to start smoking again.”
“the World Health Organization’s International Agency for Research on Cancer (IARC) declared aspartame as “possibly carcinogenic.” Another WHO committee, the Joint FAO/WHO Expert Committee on Food Additives (JECFA), independently assessed the ingredient, too, but maintained its existing recommendation — suggesting not that people cut the substance entirely out of their diets but that they limit their daily aspartame consumption to about 40 mg per kilogram (or about 2.2 pounds) of body weight. Diet soda contains about 200 mg of aspartame per 12-ounce can. By that measure, an adult weighing 60 kg, or roughly 132 pounds, would need to drink about 12 cans of diet soda a day to exceed the JECFA’s recommendation, assuming they had nothing else containing aspartame.
Making matters more confounding, the Food and Drug Administration had yet another take. It told Vox in an email that it had reviewed the information used in WHO’s assessment and “identified significant shortcomings” in the studies the agency relied on. “Aspartame is one of the most studied food additives in the human food supply,” the agency added.”
“Extreme weather events of the past few years — including the 2022 heat wave that sent temperature records tumbling across much of Europe, and the floods that devastated Pakistan last year — have surprised some of the world’s top climate scientists with just how far they sat outside the normal range.
Experts still know relatively little about when and where these types of extreme climate events will happen. Or what happens when two events, like a drought and a heat wave, hit one place simultaneously. That’s because scientists have tended to look at broader averages across regions, rather than the most intense extremes in specific locations.
“We haven’t asked the models [to] come up with an outrageously high temperature number, like 50 degrees in Canada” — a mark reached during a heat wave in 2021 — “and work out how likely that is or if that’s possible,” said Friederike Otto, an author of the IPCC report and senior lecturer at Imperial College London. “And I think that’s why these are surprises.””
“The Dickey Amendment, first attached to the 1996 omnibus spending bill, for example, famously prevented the Centers for Disease Control and Prevention from funding gun violence studies for decades. A new interpretation of that amendment in 2018 changed that, but Dickey wasn’t the only thing making it hard to study gun violence.
Instead, the researchers told me, the biggest impediment to demonstrating whether gun control policies work is the way politicians have intentionally blocked access to the data that would be necessary to do that research.”
“The wearing of masks to prevent the spread of COVID-19 and other respiratory illnesses had almost no effect at the societal level, according to a rigorous new review of the available research.
“Interestingly, 12 trials in the review, ten in the community and two among healthcare workers, found that wearing masks in the community probably makes little or no difference to influenza-like or COVID-19-like illness transmission,” writes Tom Jefferson, a British epidemiologist and co-author of the Cochrane Library’s new report on masking trials. “Equally, the review found that masks had no effect on laboratory-confirmed influenza or SARS-CoV-2 outcomes. Five other trials showed no difference between one type of mask over another.”
That finding is significant, given how comprehensive Cochrane’s review was. The randomized control trials had hundreds of thousands of participants, and made useful comparisons: people who received masks—and, according to self-reporting, actually wore them—versus people who did not. Other studies that have tried to uncover the efficacy of mask requirements have tended to compare one municipality with another, without taking into account relevant differences between the groups. This was true of an infamous study of masking in Arizona schools conducted at the county level; the findings were cited by the Centers for Disease Control and Prevention (CDC) as reason to keep mask mandates in place.”
“While individual mask wearers might get some benefit for a while if they consistently, perfectly wear masks, this does not comport with the aggregate experience.”
“That review, published by the Cochrane Library, an authoritative collection of scientific databases, analyzed 18 randomized controlled trials (RCTs) that aimed to measure the impact of surgical masks or N95 respirators on the transmission of respiratory viruses. It found that wearing a mask in public places “probably makes little or no difference” in the number of infections.”
“The authors suggest several possible explanations for these results, including “poor study design,” inconsistent or improper mask use, “self-contamination of the mask by hands,” “saturation of masks with saliva,” and increased risk taking based on “an exaggerated sense of security.””
“On a certain level, it seems intuitive that doing more for people — giving assets and training and cash — will produce better outcomes than just giving one thing, like cash. But the downside is that it takes more time, effort, and money to run a more complex intervention.
So a major question looms over the graduation program: Is it worth spending that money on the program or is it more efficient to just give all the money directly to people in need? In other words, is it really useful to teach the person to fish or should you just give them the damn fish already?”
“In recent years, development experts have moved toward an important idea called “cash benchmarking,” which basically says that cash is the benchmark against which all other anti-poverty interventions should be judged. Since giving people cash is easy, efficient, and respectful of their autonomy, aid agencies should only run a different type of program if testing shows that it works better than cash would.
Nowadays, when studies come out showing positive results for graduation programs, there’s a tendency to think that this particular combination — cash plus assets plus training — does work better than simply giving cash. But just because the graduation approach works great in some scenarios doesn’t mean it’s always the most efficient approach.
For starters, though, let’s look at the evidence suggesting that cash-plus programs work better than simple cash programs. Three studies have run this sort of comparison.
In South Sudan, a study looked at what happened to 250 households that got a full graduation program, compared to 125 households that got only cash and 274 households that received neither. Both graduation and cash increased consumption, but only the graduation group saw a significant increase in assets, a sign of more durable wealth. Although the cash group shifted a bit from agriculture to other types of work, they didn’t set up their own lasting businesses that may have been higher-paying.
In Uganda, researchers evaluated a graduation-style program run by a group called Village Enterprise. It offered training and a capital grant to extremely poor people so they could start a small business. The researchers found that it worked well, increasing self-employment income and consumption. In fact, it outperformed cash on these measures. The authors speculate that, “left to themselves — without training and mentorship — beneficiaries [of cash transfers alone] struggled to make productive investments, maintain them, and derive sustained value from them.”
In Niger, a new randomized study has highlighted the benefits of taking a multifaceted approach to extreme poverty. The study evaluated women who were already enrolled in a government cash transfer program. The goal was to understand how psychosocial issues — like feeling depressed or disconnected from your community — might make it harder to seize economic opportunities. The study found that the women who got psychosocial support showed rates of returns that were higher than those who got only cash. Offering psychosocial support was the most cost-effective route 18 months after the intervention.”
“while graduation programs appear to work great in some places, they’re dependent on the market — and they can run into problems in places where the market is either too dysfunctional or, ironically, too functional.
One randomized trial in India, published in 2012, is an example of the latter. It found that a graduation program yielded no net impact. Although it shifted participants away from agricultural jobs to other sorts of work, they could’ve earned just as much in their original agricultural jobs. While those original jobs were far from big money-makers, wages for agricultural labor had been improving in India, thanks to programs like the ambitious National Rural Employment Guarantee, so adding in a graduation program didn’t really help.
Dysfunctional markets produce their own obstacles. Abed told me about his experience trying to run a graduation program in Balochistan, an extremely dry, desert-like province in southwestern Pakistan, where participants were taught how to run a small business. One problem: There wasn’t a functional market for the businesses to thrive in. “Once they graduated, there wasn’t much to go to,” said Abed. “And there wasn’t microfinance available. So it was very, very difficult.””
“Another way a graduation program can flop is if it fails to be cost-effective. In the huge 2015 randomized study that looked at graduation programs in six countries, Banerjee and his co-authors note that although the program proved extremely cost-effective in some places, easily paying for itself within 10 years, other countries don’t have such low costs and high benefits in the short run. In Peru, for example, such a program wouldn’t break even.”
“Abed is convinced that graduation is the best approach for the ultra-poor, but he acknowledges that what makes the most sense for the moderate poor is a somewhat open question. Also, while graduation may be best for ultra-poor people who are young and healthy enough to go start businesses if given half a chance, it may not work for those who are elderly or disabled. For those groups, the answer may well be cash transfers.”