A reasonably provocative paper which suggests that automobile drivers are impaired at a blood alcohol concentration (BAC) as low as 0.01% has recently appeared.

Phillips DP, Sousa AL, Moshfegh RT. Official blame for drivers with very low blood alcohol content: there is no safe combination of drinking and driving.Inj Prev. 2014 Jan 7. doi: 10.1136/injuryprev-2013-040925. [Epub ahead of print][Pubmed][Publisher]

When I was first told of this finding, my initial curiosity was not so much about the findings but more about the design. It is incredibly difficult to come up with ways to compare drinking driver versus non-drinking driver stats in field studies or data mining retrospectives.

The authors drew data from US traffic fatalities1 recorded in the National Center for Health Statistics database and the Fatality Analysis Reporting System database. The study sought to test the hypothesis that driver BAC would be related to the driver being determined to be solely and officially at blame for the crash. There are numerous factors that were coded for drivers including “under the influence of alcohol, drugs or medication” and “driving on wrong side of the road”. The “under the influence…” factor was dropped from all analyses for the obvious reasons that it would contaminate their test of hypothesis.

This is important for the reader to grapple with his or her most obvious complaint about this design. If the police officer is determining the responsibility and can smell (or otherwise detect) alcohol on one driver, this puts a bias in the outcome measure (responsibility for the crash) that would tend to correlate with the thing being tested (BAC). So the authors focused on the factors that were seemingly unambiguous. Such as “running off road” or “driving wrong way on one-way” versus “unsafe speed for conditions” and other ambiguous factors that depend on a police judgement.

The authors calculated the Sole Official Blame (SOB) as the number of drivers officially and solely blamed for the crash divided by the number of drivers officially assigned no blame for the crash. They also calculated the percentage of drivers blamed solely and officially for the crash divided by the total number of drivers involved. Phillips14-traffic-F1Figure 1 from the paper presents the SOB by the BAC for both male and female drivers. The solid line is the “All Blame Factors” and the dotted line is for the unambiguous factors- the far better measure2, IMO. These data do make a case that fatal crash risk is an essentially linear function of BAC. Importantly, there is no inflection of the curve at either 0.08 or 0.1 BAC which have been the US legal limits during my driving lifetime. The error bars are 95% confidence intervals and they are using lack of overlap of the 95% CI as their inferential statistic indicating a significant difference (they also include a chi-square statistic for the 0.1 BAC vs sober bin). So far, so good. BAC is linearly correlated with the risk of being the sole and officially blamed driver for a fatal accident. [UPDATE: I didn’t originally catch a bit of a dodge the authors are pulling here. The inferential analyses are conducted on the “all blame factors. Then they state “these patterns hold when one considered all blame factors or unambiguous factors”. This “pattern” language is sometimes used to skip over the fact that the inferential analysis didn’t hold up on the other variable(s). This is a big problem, given my questions about the contamination of the blame issue if the officer knows one driver had been drinking alcohol.]

An interesting side-analysis looked at the problem that BAC is not always measured which could introduce a bias. I’m assuming that the first analysis used only verified negative BAC “sober” drivers but it is hard to find this directly stated. Anyway, they looked at the correlation on a state-by-state basis between the SOB “buzzed”, aka 0.1 BAC and SOB sober (which was 2.09 for the overall dataset), and the percent of unmeasured BACs in the fatal crash listing. The correlation was negative, showing that the lower the proportion of unmeasured BACs in a state, the larger the difference between sober and 0.1% BAC drivers in fatal crash responsibility. So if anything, I guess we have to assume that a lower percentage of blood testing results in an underestimate of the crash risk.

The authors next moved on to take a crack at the question of circumstances. In essence it addressed the question of whether people driving at 0.1% BAC are doing so under risky circumstances. At night, for example.
Phillips14-traffic-F3The third Figure from the paper depicts SOB ratio and the Percent Blamed for a subset of two-car crash pairings in which one driver was sober and the other was at a positive BAC. The beauty here is that nondriver circumstances are as identical as you can get for the sober and intoxicated drivers. The authors performed 16 chi-square tests but a quick multiple-comparisons adjustment to the listed p values shows they still survive as all of them being different, BAC vs sober, for SOB and P measures. Odds of being at fault are 60/40 for 0.1% BAC versus sober and about 80/20 by the time you reach two car crashes in which one driver was at 0.08% BAC. Interestingly this is the analysis that appears to show some categorical difference between BAC of 0.1-0.3% and BAC of 0.6-0.8%. They also did a cute little comparison of paired-crashes where one driver was at 0.08 and the other was 0.5-0.7 BAC. The SOB did not differ (95% CI overlap) in this analysis.

As a final note, a bunch of supplementary analyses were provided to try to rule in or out additional driver (sex, race), vehicle (speed and model year) and circumstantial (raining, time, location) factors. The relationship of SOB with BAC persisted.

Probably my largest question about traffic risks conferred by low levels of alcohol consumption is captured by the report of the relative effect size of the “most common driver factors” in Table 1. The “Driving too fast for conditions or in excess of the posted speed limit” factor is a large contributor to SOB ratio in the 0.1-0.7%BAC drivers as well as one of the larger differences from the sober drivers. This underlines a suspicion that those who are willing to drive after a low amount of alcohol consumed are perhaps innately different from those who are not. They might be somewhat more of a risk taker. Here, we’d really want to get at the population that is willing to drive after a drink or two and look at their driving crash risk when they are sober. Methodologically, this is asking for a lot, I realize.

This is only one study, of course. There may be other data out there that show a less continuous function of fatal crash risk to BAC in this range below the current US legal limit. But this is for sure an important study.

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1authors say that there is no sufficiently detailed database for nonfatal crashes, sady.

2Still trying to wrap my head around whether these “unambiguous” factors are in fact uncontaminated by the police officer’s knowledge that one of the drivers had been drinking. Presumably they write up their reports somewhat after they have investigated. Maybe I’m searching for rigor where none is needed but it still bugs me.

As you are aware, the National Institute on Alcohol Abuse and Alcoholism has been under the care of an Acting Director for years now as the attempt to merge the NIAAA with NIDA moved along before ultimately being axed by Francis Collins.

A Press Release today announces a new permanent Director has been appointed:

National Institutes of Health Director Francis S. Collins, M.D., Ph.D., announced today the selection of George F. Koob, Ph.D., as Director of the National Institute on Alcohol Abuse and Alcoholism. Dr. Koob is expected to join the NIH in January 2014.

“With his distinguished reputation and vision, I am confident that George will encourage innovative ideas in the basic neurobiology of addiction, and will be dedicated to bridging the gap between our understanding of alcohol abuse, alcoholism, and addiction and developing new, targeted treatments,” said Collins.

As NIAAA director, Dr. Koob will oversee the institute’s $458 million budget, which primarily funds alcohol-related research in a wide range of scientific areas including genetics, neuroscience, epidemiology, prevention, and treatment. The institute also coordinates and collaborates with other research institutes and federal programs on alcohol-related issues and national, state, and local institutions, organizations, agencies, and programs engaged in alcohol-related work.

Dr. Koob comes to the NIH from The Scripps Research Institute, California Campus, where he is Chairman, Committee on the Neurobiology of Addictive Disorders, and Director, Alcohol Research Center. He earned his Ph.D. in Behavioral Physiology at Johns Hopkins University.

Dr. Koob’s early research interests were directed at the neurobiology of emotion, with a focus on the theoretical constructs of reward and stress. His contributions have led to the understanding of the anatomical connections of emotional systems and the neurochemistry of emotional function. Dr. Koob also is one of the world’s authorities on alcohol and drug addiction. He has contributed to the understanding of the neurocircuitry associated with the acute reinforcing effects of drugs of abuse and more recently on the neuroadaptations of these reward circuits associated with the transition to dependence.

A quick search of PubMed pulls up some 650 articles including many reviews staking out his “dark side of addiction” orientation to substance dependence.

His wikipedia page indicates that Dr. Koob is on the ISI Highly Cited list and a quick trip to Web of Knowledge shows an h-index of 123.

I think this selection by the NIH indicates a degree of seriousness in the recent RFAs and Supplements designed to advance the”functional integration” of research on alcohol and other drugs. While Koob has had a very substantial amount of work in alcohol over the past years, he has also maintained programs with psychomotor stimulants and opioids.

So any investigators* who were a little suspicious that this “functional integration” stuff was just to soothe feelings over all the wasted time, money and stress of the attempted merger have to walk that cynicism back a bit. The NIH could have easily appointed a pure alcohol type of researcher, even an alcoholism clinician. But the choice of a pre-clinical scientist who has research feet planted across many different substances of abuse sends the signal that there is meat behind the idea of integration.

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*I’ll raise my hand on that one.

According to a summary of a recent presentation from Francis Collins (NIH Director) to the SMRB on May 29 provided by the Research Society on Alcoholism. Key points:

Collins:

“We are hearing from some of the lobbying organizations that are involved in the use and sale of alcoholic beverages – the wine, beer and liquor industry.
They are not particularly happy about this. We are going to have to see what response comes forward from them. They are very well connected from the political side of this. We are proceeding forward, but I want to give you a heads up that there could be some noise.”

Sol Snyder asked why and Collins had this to say:

“Their view is that alcoholic beverages are an acceptable, social, desirable thing. Consider it to be a food. Noted that it has health benefits. Notion that it will be lumped with drugs of abuse, many of which are illegal, rubs them the wrong way.”

Exactly what I’ve maintained all along. This proposal to merge the NIAAA with NIDA is, scientifically speaking, a no-brainer. It makes a lot of sense and if any ICs are to be merged, this is the first thing on the table. If this can’t be done…there doesn’t seem any point to discussing any other mergers.

However. I’ve also noted that the beverage industry has a HUGE amount of pull in Congress and and HUGE interest in not seeing alcohol defined as a drug like any other. They don’t want to be mentioned in the same sentence with drug cartels! They sure as hell don’t want people discussing, matter-of-factly, that their beloved product is really not substantially different* from cocaine, methamphetamine and heroin, save by historical accident.

So this whole proposal could come crashing down if the beverage interests can buy up enough support in Congress to quash this. Personally I think all this comes down to is the extent to which they care. I believe if they throw around enough cash in Washington DC they can halt this.

Question is, will they?

Will they be bought off by some careful wording** and policy statements that preserve the special status of alcohol within the new IC?
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*by some ways of looking at things. First and foremost, addiction.
**Perhaps by keeping the word “Alcohol” in the title of the IC to distinguish it from “Drugs” and even “Substances”?

ps: as always, see Disclaimer. I’m an interested party in this process.

We convered Alcohol research fraudster Michael W. Miller in a prior post. This was following a finding of the ORI of the NIH and a note on retractionwatch. My post focused on the fact that when cheaters like Michael W. Miller are finally caught, there is no way to recover for their sins. No way to reclaim that money. No way for the person who really deserved the job or the award to be compensated.

That pisses me off.

It also pisses me off when people who do dodgy things in science, like Charles Nemeroff, get to keep on keeping on as if nothing happened. Some patsy University will happen along to hire the dude if they think it is in their interest to do so.

Well, I see from a comment at retraction watch that Michael W. Miller plans a full court press to rehabilitate his image. Online anyway.

Welcome to michaelwmiller.net. According to Network Solutions, it was registered by Reputation Changer on Mar 15, 2012.

Registrant:
Reputation Changer LLC
39 West Gay Street
West Chester, Pennsylvania 31410
United States

Registered through: GoDaddy.com, LLC (http://www.godaddy.com)
Domain Name: MICHAELWMILLER.NET
Created on: 15-Mar-12
Expires on: 15-Mar-13
Last Updated on: 20-Mar-12

The ORI finding of misconduct was published in the Federal Register on Feb 27, 2012. So this fraudster immediately used Reputation Changer to do what they do :

ReputationChanger.com specializes in helping people make their mistakes vanish from the eyes of potential clients and employers. Embarrassing arrests and unseemly articles can be pushed off of the front page of Google searches, where they are unlikely to be viewed by the majority of Google users. Because people tend to only look at the first page of results, Google searches can once again reveal the great things you or your company achieved, rather than the negative reviews overzealous and under impressed individuals have posted. People have an array of motivations for posting negative press, but the important question is not why do they post it– you should be asking yourself how to get rid of it.

How do they do it? By building a fawning self-web-presence that says crapola like:
Michael W. Miller Presents Astounding Findings or perhaps Michael W. Miller Publishes Scientific Gold. This latter conveniently omits to mention the two retracted papers that were, of course, not “Gold” but more like “made up crap”.

As far as I can tell, every link in the site points to somewhere else on the site. I’m sure this is hot stuff in repairing your Google ranks.

Wait, wait…what’s this? I tried to see if his Google presence had been improved and I found another site. michaelwmillerupstate.com was registered….by Reputation Changer …. on Mar 15, 2012. Here’s what I learned about the good Professor Miller’s attitude toward’s research:

But research is not the only component in a successful endeavor. Michael W. Miller understands that documentation—accurate documentation—is pivotal. Without this documentation, research findings could not undergo duplication. All the work that went into a study would prove wasted. This is why Michael W. Miller publishes so many different writings.

It overlooks all the “work” that other people put into trying to replicate Michael W. Miller’s faked (and now retracted) research papers. It seems that “accurate” documentation perhaps is in the eye of the beholder? or just a flagrant lie on the part of the Reputation Changer system for rehabilitating the web image?

As his career moves forward, researcher Michael W. Miller will continue to conduct research. Through his writing, Professor Michael W. Miller will share this research with the world. The result, Michael W. Miller hopes, will manifest as improved medical knowledge and techniques.

Really? He’s going to continue is he? Can’t wait to see what University is willing to hire him.

Okay, what else do you have to offer, Google? OMMFG, ANOTHER ONE!!!! michaelwmillerblog.com was registered….shall we just guess? Yep, by Reputation Changer on Mar 15, 2012.

Wonder how many more of these frigging things are out there?

Ahh, well. Just remember to keep linking to the ORI finding showing that Michael W. Miller faked data. And maybe to the retraction watch blog entry on Michael W. Miller.

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Added: I’m particularly intrigued by the michaelwmillerupstate one. His place of employment when the fraudulent papers were detected was the State University of New York Upstate Medical University. I wonder how they feel about this use of “upstate”?

Repost from a few years ago:


As we reach the pinnacle of the drinking season (Thanksgiving through New Years) many people not in the business are thinking about addiction. It may be a concerned reflection on our own behavior over the past* coming month or so. It may arise from unusual levels of contact with our distant relations or family friends. Even though drinking, even to excess, is socially approved sometimes one starts to ….wonder.

Read the rest of this entry »

Thought on Tintin

December 30, 2011

Meaning the new movie. I just saw this with a nonzero number of underage children and I have a few thoughts.

Minor to massive spoiler alert so I’ll use the jumpcode…..
Read the rest of this entry »

In a Twittersation today we arrived at the possibility that being a heroin user is a unique lyrical stimulus. The specific assertion is that while a lot of so-called ‘crack rap’ discusses *selling* crack cocaine, there are no lyrics about being a crack *user*.

So let’s broaden the call…can you think of songs that are about using drugs other than heroin? Let’s leave alcohol aside for the moment, there are a bajillion songs about drinking.