Is Bacon A Carcinogen Like Cigarette Smoking?

Much media angst has been generated by the World Health Organization announcing today that they are classifying processed meat as a carcinogen and red meat as a probable carcinogen.

Since the skeptical cardiologist has in previous posts waxed poetic on Jambon Iberico and beef brisket, I feel compelled to comment on this report.

We’ve been through this before and this announcement is not based on any new and striking data.

It is based on reviewing a lot of observational studies from the past decades. It is very important to understand that observational studies do not establish cause and effect, they only look at associations.

GaryTaubes has written eloquently on this in 2012:

“It’s this compliance effect that makes these observational studies the equivalent of conventional wisdom-confirmation machines. Our public health authorities were doling out pretty much the same dietary advice  in the 1970s and 1980s, when these observational studies were starting up, as they are now. The conventional health-conscious wisdom of the era had it that we should eat less fat and saturated fat, and so less red meat, which also was supposed to cause colon cancer, less processed meat (those damn nitrates) and more fruits and vegetables and whole grains, etc. And so the people who are studied in the cohorts could be divided into two groups: those who complied with this advice — the Girl Scouts, as Avorn put it — and those who didn’t.

Now when we’re looking at the subjects who avoided red meat and processed meat and comparing them to the subjects who ate them in quantity, we can think of it as  effectively comparing the Girl Scouts to the non-Girl Scouts, the compliers to the conventional wisdom to the non-compliers. And the compliance effect tells us right there that we should see an association — that the Girl Scouts should appear to be healthier. Significantly healthier. Actually they should be even healthier than Willet et al. are now reporting, which suggests that there’s something else working against them (not eating enough red meat?). In other words, the people who avoided red meat and processed meats were the ones who fundamentally cared about their health and had the energy (and maybe the health) to act on it. And the people who ate a lot of red meat and processed meat in the 1980s and 1990s were the ones who didn’t.

Here’s another way to look at it: let’s say we wanted to identify markers of people who were too poor or too ignorant to behave in a health conscious manner in the 1980s and 1990s or just didn’t, if you’ll pardon the scatological terminology, give a sh*t. Well, we might look at people who continued to eat a lot of bacon and red meat after Time magazine ran this cover image in 1984 — “Cholesterol, and now the bad news”. I’m going to use myself as an example here, realizing it’s always dangerous and I’m probably an extreme case. But I lived in LA in the 1990s where health conscious behavior was and is the norm, and I’d bet that I didn’t have more than half a dozen servings of bacon or more than two steaks a year through the 1990s. It was all skinless chicken breasts and fish and way too much pasta and cereal (oatmeal or some other non-fat grain) and thousands upon thousands of egg whites without the yolks. Because that’s what I thought was healthy.

So when we compare people who ate a lot of meat and processed meat in this period to those who were effectively vegetarians, we’re comparing people who are inherently incomparable. We’re comparing health conscious compliers to non-compliers; people who cared about their health and had the income and energy to do something about it and people who didn’t.  And the compliers will almost always appear to be healthier in these cohorts because of the compliance effect if nothing else. No amount of “correcting” for BMI and blood pressure, smoking status, etc. can correct for this compliance effect, which is the product of all these health conscious behaviors that can’t be measured, or just haven’t been measured. “

For more discussion on the weakness of observational epidemiology  upon which this WHO pronouncement rests see here.

Even if we were to accept the concept that red meat is a carcinogen, this does not mean everyone should end red meat consumption.

For perspective I would suggest reading this post from cancer researchUK. Although the WHO classifies both smoking and processed red meat  as carcinogens they are not in the same ball park in terms of overall cancers and deaths caused as this infographic demonstrates.

A one pack a day cigarette smoker has 20 times the risk of developing small cell lung cancer as a non-smoker.
A high frequency meat eater, on the other hand has a 1.17  time increased risk as the lowest frequency meat eater.
As cancerUK put it:

“We know that, out of every 1000 people in the UK, about 61 will develop bowel cancer at some point in their lives. Those who eat the lowest amount of processed meat are likely to have a lower lifetime risk than the rest of the population (about 56 cases per 1000 low meat-eaters).

If this is correct, the WCRF’s analysis suggests that, among 1000 people who eat the most processed meat, you’d expect 66 to develop bowel cancer at some point in their lives – 10 more than the group who eat the least processed meat.”

So keep in mind

1. Weak associations between red meat and processed red meat and cancer or heart disease do not establish that one causes the other. Such studies are good for generating hypotheses that then need to be tested.
2. If processed meats are a carcinogen they are a far, far less important one than cigarette smoking.

-ACP
NB.From the press release: