Politics of Health Midterm

What is a "medical reversal?"

B - A widely used medical practice that falls out of favor after better clinical trial evidence emerges that it doesn't work (and probably never did).

Despite a few widely cited, high-profile examples, medical reversals rarely if ever happen.

B - False

Why are medical reversals more harmful or dangerous than medical replacements, according to Prasad and Cifu?

E - All of the above

What did the randomized controlled trial of parachutes find about their efficacy?

C - Strikingly, the study found no significant differences in the rate of death or major traumatic injury between the treatment and control arms of the experiment.

What is likely to be the main reason the parachute experiment found no evidence that they protect against injury or death?

D - The only way researchers found willing participants was to have them jump from a small biplane, parked on the ground and not moving, so there was never much risk for either treatment group.

At the turn of the 20th Century, there was a scientific consensus that rates of lung cancer were increasing.

B- False

By the mid-1940s, what was the ***dominant*** scientific view about the cause of lung cancer?

A - Environmental (air) pollution due to things like the increase in tar roads

What was the main ***political*** reason for why so few people accepted the argument that smoking might be linked to lung cancer during this period?

B - The view that smoking was linked to cancer was widely promoted by the Nazi German government, and the association with Nazism made it unpopular in the United States

What is the main reason smoking rates increased dramatically in the late 19th Century?

C - The invention of the Bonsack Cigarette Machine fundamentally changed cigarette rolling, which previously was done by hand, allowing cigarettes to become a mass market item

What caused the infamous Great London Smog?

Unusually cold weather caused people to burn more coal for heat, and an anticyclone temperature inversion then trapped this pollution near the ground

By the late 1960s, most American doctors believed that that smoking was a major cause of lung cancer.

B - False

Which of the following was ***not*** a type of evidence that emerged by the mid-20th century about the causative role of smoking in bringing about lung cancer? 

Randomized controlled trials in which young people were randomly assigned to smoke or not and then followed over time to see who developed lung cancer.

Who were the primary subjects in Doll and Hill's famous 1956 study about the relationship between smoking and lung cancer?

A - Medical professionals in the United Kingdom

What was the primary ***research design*** used by Doll and Hill?

C - A prospective cohort study, in which people were asked about smoking and then tracked over time to see who would subsequently develop lung cancer and who would not.

What was the main finding in Doll and Hill's study?

E - Doll and Hill found all of the above associations

At the time of popular debate about the link between smoking and cancer during the middle of the 20th Century,  some of the world's leading statisticians and scientists were skeptical that the correlation was causal.

A - True

What alternative explanation did statistician R.A. Fisher offer to explain the apparent correlation between smoking and cancer?

Fisher made all of the above arguments to explain the correlation between smoking and lung cancer rates

What evidence did R.A. Fisher gather and provide to make the case that genetics could be a common cause of both smoking and cancer?

A - Comparing and contrasting similarity of smoking habits between identical (monozygotic) and fraternal (dizyogotic) twins.

Why may Fisher have been personally -- rather than simply scientifically -- invested in disproving the smoking-cancer link?

E - All of the above

What was the main ***methodological*** divide between scientists who accepted the link between smoking and cancer as causal and those who doubted it?

Statisticians believed that causal relationships could be proven only with randomized controlled experiments, which had not been done, while epidemiologists accepted observational data.

In the early years of the 20th century, more than a dozen states had enacted statewide bans on the sale of cigarettes.

A - True

What is the main reason support for government regulation of smoking had fallen by the 1920s?

C - By 1918, cigarettes had become identified with efforts to fight World War I, as a symbol of courage and dignity.

How did the structure and design of American government institutions serve to protect the interests of pro-tobacco political forces?

B - Members of Congress from tobacco-growing states chaired key committees in House of Representatives and the Senate, giving them tremendous influence.

Which of the following was ***not*** a member of the tobacco political "subsystem?"

E - All of the above were part of the political "subsystem"

Why did television, radio, and other media companies tend to oppose government regulation of smoking and instead emphasized other health risks in their reporting?

B - Tobacco advertisements accounted for a significant source of ad revenue for media companies.

What was the main governmental policy response in the years immediately after the Surgeon General's 1964 report on the health impacts of smoking was released?

Congress passed a bill requiring small health warnings on cigarette packaging.

Health groups and the tobacco industry both had the opportunity to veto any expert nominated to serve on the Surgeon General's advisory committee on smoking that would author the famous 1964 report.

A - True

How did the tobacco industry and its consultants try to influence federal lawmaking after the Surgeon General's report was released?

E - The tobacco industry used all of the above strategies to try to influence the policymaking process.

Which of the following was ***not*** a reason the tobacco industry ultimately supported federal legislation to add warning labels to cigarette packages?

D - New executives who took over tobacco companies in the 1960s regretted the industry's earlier efforts to undermine the scientific evidence on the link between smoking and cancer and wanted to make public amends.

What prompted the end of cigarette television and radio advertisements in 1969?

The industry decided to voluntarily and collectively stop advertising, a move that saved it considerable money.

What is "environmental tobacco smoke?"

C - "Second-hand smoke," or the exposure of nonsmokers to the smoke of others.

When anti-smoking activists began their campaign against environmental tobacco smoke in the 1970s, the evidence showing that second-hand exposure was bad for one's health was overwhelming and uncontroversial.

B - False

How did the emerging scientific consensus about the dangers of second-hand smoke affect public opinion on smoking regulation?

B - Public concern increased support to limit environmental exposure among both nonsmokers and smokers.

What is the current scientific consensus about the health risks of smoking as compared to second-hand smoke?

C - Far more people die from smoking itself than from exposure to second-hand smoke.

Why did the movement to limit second-hand smoke exposure produce the most dramatic effect on smokers themselves?

B - Limits on public smoking forced smokers to change their routines, made them face increasing stigmatization, and increased public pressure to quit.

By the early 1960s, what was the leading cause of death among Americans?

D - Coronary artery disease

According to Ancel Keys, what was the primary cause of the increase in heart disease observed among the American population during the middle of the 20th century?

C - Changes in the diet

In his research on risk factors for heart disease, what metric did Ancel Keys find to be the strongest predictor of whether someone would go on to have a heart attack?

D - Blood cholesterol levels

Ancel Keys argued that there was a strong relationship between dietary cholesterol -- how much is consumed from cholesterol-rich foods such as eggs -- and blood (serum) cholesterol levels.

B- False

Keys argued that the following macronutrient in food was  most responsible for raising cholesterol levels in the blood.

B - Dietary fats (especially saturated fat)

Why did activists and advocates who were most concerned about global poverty and hunger in the 1970s endorse policies to reduce consumption of saturated fats?

A - Saturated fats come from animal products, and these activists advocated reducing meat consumption

What development, according to Gary Taubes, was most instrumental in establishing the momentum behind Keys' diet-health hypothesis and increasing media, government, and popular attention on diet and fat consumption? 

C - Publication of *Dietary Goals for the United States* by Sen. Gorge McGovern's Senate Select Committee on Nutrition and Human Needs

The staff that worked for McGovern's Senate Select Committee on Nutrition and Human Needs and took the lead in writing the committee's report on dietary goals  were lawyers and ex-journalists, not scientists and doctors.

A - True

In contrast to the recommendations from McGovern's committee and those from the FDA, a report from the Food and Nutrition Board of the National Academies of Sciences was skeptical about the benefits of reducing fat consumption. Why were its findings largely discredited and ignored?

C - Many of the scientists on the board had taken funding from egg and meat industries, creating a perceived conflict of interest.

What did subsequent research reveal about the suggestion in the McGovern committee report that dietary fat consumption caused breast cancer?

C - Subsequent research largely debunked the claim, finding largely no epidemiological evidence linking dietary fat consumption and breast cancer.

Which advocacy coalition led the campaign for government policies to reduce palm oil imports in the United States during the 1980s?

C - Soybean growers

Which policy did Congress consider to limit the importation of palm oil from Malaysia?

D - Congress considered all of the above

Why did soy farmers and their associated interest groups argue that palm oil posed a health risk to American consumers in the 1980s?

C - They argued that palm oil was high in saturated fats, contributing to heart disease

Why did major American food companies -- including Kellogg, Pepperidge Farm, Keebler, and General Mills -- decide to stop using tropical oils and replace them with vegetable oils?

C - Popular advertising and pressure campaign by advocacy groups including National Heart Savers Association and Center for Science in the Public Interest

Which of the following was ***not*** a strategy the Malaysian government and the Malaysian Palm Growers' Council pursued to counter anti-palm oil advocacy campaigns in the United States?

They enacted retaliatory import tariffs on US-made soybean oils

What was the primary source of *trans* fats in American foods (until the recent efforts by the FDA to reduce their consumption)?

B - Partially hydrogenated vegetable oils

Why did producers of soybean oil incorporate partial hydrogenation into their manufacturing process?

E - All of the above

What motivated Philip Sokolof, who led the "Poisoning of America" publicity campaign demanding fast-food restaurants and food companies to replace saturated fats with partially hydrogenated oils? 

A - He had suffered a near fatal heart attack

Before the early 1990s, there was no scientific research suggesting potential negative health effects of *trans* fats.

B- False

How did the food industry respond to emerging scientific research by Fred Kummerow and Mary Enig suggesting harmful health effects of consuming *trans* fats?

C - The food industry commissioned high-profile scientists to carry out studies challenging the findings, creating confusion and uncertainty

What is the main goal of OSU's "15 to Finish" initiative?

Encouraging students to take 15 credit hours each semester

What was the result of the 1994 Congressional hearings on smoking?

The CEOs of all major tobacco companies testified they did not believe smoking was addictive.

How did Ancel Keys select the countries to be included in this famous prospective cohort study that became known as the Seven Countries Study?

He cherrypicked the countries he expected to produce the results he wanted

Why did the American Academy of Pediatrics shift their position on school reopening -- from in favor to opposition -- between June and July of 2020?

President Trump tweeted his vocal support for school reopening.

What is Ancel Keys known for?

All of the above

Which of the following policies is currently in place and discourages the importation of foreign-made baby formula, to the benefit of domestic manufacturers?

All of the above

What happened as a result of the experiment in which beagles had smoke mechanically pumped through incisions into their throats?

The leading medical journals rejected the study, and reviewers did not believe it showed that smoking caused cancer.

Why was statistician Joseph Berkson skeptical of observational (rather than RCT) evidence linking smoking and lung cancer?

All of the above

Why did Bill Clinton come out in support of stronger anti-smoking regulations?

His own polling showed that such regulation was popular, as long as it focused on kids rather than adults.

What is the key insight from the "bootleggers and Baptists" analogy?

Special interest groups often use government regulation to shield themselves from market competition.

Which of the following is ***not*** one of the Bradford Hill criteria for establishing causality in epidemiological research?

Is the research free of financial conflict of interest?

How did the Center for Science in the Public Interest, a consumer advocacy group focused on nutrition, respond when early research raised questions about the safety of *trans* fats in the 1980s?

\
CSPI raised doubts about the evidence, arguing that "hydrogenated oils seem relatively innocent."

What is a type of bias that can cause case-control studies to falsely conclude that a particular risk factor causes a disease?

All of the above can bias case-control studies

How did the leading causes of death in the U.S. change between 1900 and 2010?

Chronic conditions, such as heart disease and cancer, replaced infectious diseases as the leading causes of death.

What did the Cochrane meta-analytic summary of RCTs examining impact of mask wearing on the spread of respiratory viruses find?

It found no clear evidence that either masks or respirators reduced the spread of respiratory viruses

How did the committee system in Congress help prevent the enactment of anti-tobacco legislation in the 1950s and 1960s?

Committee chairs had agenda powers, allowing them to kill bills without a vote, and the chairs of key committees came from major tobacco growing states.

How were the government food guidelines revised in 2015?

None of the above

Based on the advice by its scientific committee, which changes did the federal government make to the 2020 dietary guidelines?

Recommending that children under 2 consume no added sugar

19 of the 20 members of the board that advised the government's drafting of the 2020 *Dietary Guidelines for America* had industry ties.

True

What is the name of the research design in which people hospitalized with a particular ailment (e.g., lung cancer) are compared to people hospitalized with other health problems to identify predictive risk factors (e.g., smoking)?

Case-control study

What is the name of the research design in which people are surveyed to ask about their habits or behaviors (e.g., smoking) and then followed over time to see if they develop a particular health ailment or condition (e.g., lung cancer)?

Prospective cohort study

Why did German epidemiological research find a strong correlation between a vegetarian diet and depression?

People with existing mental health issues were more likely to become vegetarians.

What are the US Dietary Guidelines for America used for?

The dietary guidelines are used for all of the above

How did the FCC's "fairness doctrine" lead tobacco companies to abandon television and radio advertisements?

Under the fairness doctrine, each tobacco ad resulted in TV and radio stations running a free anti-tobacco ad.

Which of the following fats ***decrease*** "bad" LDL cholesterol and ***increase*** "good" HDL cholesterol? 

Monounsaturated fats

Which of the following fats ***increase*** "bad" LDL cholesterol and ***decrease*** "good" HDL cholesterol? 

Trans fats

What is a "focusing event?"

A sudden, attention-grabbing event that can place an issue on the government agenda or advanced policy change.

Research published in the early 2000 found a gene that both predicted how much people smoked and also, independently, their risk of lung cancer, partially vindicating R.A. Fisher's argument.

True

The randomized, controlled trial of hormone replacement therapy that was carried out as part of the Women's Health Initiative found the same results as prior observational data based on a prospective cohort study of nurses.

False

How has population health changed since the federal government started promoting healthier dietary habits in the 1970s?

All of the above

Under the "humoral" model, what causes disease?

The four bodily liquids, known as the "humors," being out of balance

Research in the early 1990s showed that about a many 6-year-olds recognized Joe Camel as Mickey Mouse.

True

Ancel Keys argued that which of the following macronutrient in food was most responsible for raising cholesterol levels in the blood?

Dietary fats (especially saturated fat)

Which of the following is ***not*** one of Koch's postulates to establish causality?

All of the above are Koch's postulates

Most new "laws" made by the federal government are passed by Congress.

False

What was the government's approach to margarine in the late 1800s and early decades of the 1900s?

The government taxed margarine to protect dairy farmers and some states prohibited it from being yellow in color.

According to political scientists, what is the *primary* goal of members of Congress?

Getting re-elected

How did McDonald's respond in 1990 to criticisms from health crusader Phil Sokolof?

They replaced beef tallow with partially hydrogenated vegetable oils to cook their fries.

In response to heavy lobbying from meat and dairy industries, the McGovern committee changed the initial recommendation of “decrease consumption of meat” to “decrease consumption of animal fat, and choose meats, poultry, and fish which will reduce saturated fat intake.”

True

Which of the following was ***not*** one of the recommendations made by the McGovern committee report, *Dietary Goals for the United States*?

The report recommended all of the above

The original Micronite filters used in Kent cigarettes were made out of asbestos.

True

Why were the full results of the Minnesota Coronary Experiment not published for decades after the study was completed?

The researchers were disappointed with the results.

What did UK researcher Jeremy Morris argue was most responsible for the increase in heart disease observed in the second half of the 20th Century?

Sedentary life style and lack of exercise

The zero-calorie fat substitute Olestra was made by combining biodiesel, sugar, and soap.

True

What is the main reason pediatric Covid hospitalizations dramatically increased during August of 2021?

Children's hospitals instituted universal testing for all patients, resulting in more incidental ("with" Covid) positive tests.