[Stoves] Air pollution kills

[Nikhil Desai]

Xavier:

How sweet and easy.

I wrote: "« in cohorts, contexts, confounding factors mean most
epidemiological studies for HAP and disease have no reliable
quantification. »"

You: "Then prove it."

Why? I respect people who choose blind faith over facts and common sense,

"The thing you could do is to write a paper, a meta-analysis of
epidemiological studies and their methodology. If there are 200 studies
attributing diseases to air pollution, show how their methodology is
flawed, show how they prove nothing. It would be really, really useful.
This would be something we can work from.

Then, with this information, we’ll be able to say: « OK, we have really no
idea what causes respiratory diseases »."

To run through alleys only to confirm they are blind is an academic
pastime.

I see nothing here worth debating. You signed off on the ISO and GACC
fantasies. Wake me up when 100 million highfalutin' generic biomass
cookstoves have been used for five years and spreading at 100 million a
year. Otherwise, continue wasting the energies of the young.


Nikhil

On May 17, 2018, at 12:18 PM, "Xavier Brandao" <xav.brandao at gmail.com>
wrote:

Dear Nikhil,



« You imagine "solutions are relatively straight-forward".  Not so.
Localized air-quality management plans take an enormous amount of
systematic work »

I’m just trying not to fall into the state of mind of: « oh, there are many
factors anyways, it is very complex, so do not bother doing anything. »



We were taking the example of Ulan-Bator. We think air pollution kills? We
replace inefficient stoves by « clean » stoves, we tar the roads, we work
with the construction sector so it limitates its emissions, we work with
the industry sector so it lowers its emissions.

Of course, this is complex and involves a lot of actors, and it represents
a lot of effort and investment, but this is feasible, there is no magic
involved. There aren’t 10 000 factors involved, there are a few big steps
to take.



« Read today's Washington Post opinion piece by Robert Hahn about USEPA's
debating of rules of scientific evidence »

Well, if Scott Pruitt’s proposal make EPA decision processes more
transparent, and make science more accessible, then I could not agree more.
I am a bit skeptical of Pruitt’s good intentions though.



But transparency and clarity in science and policies? Yes of course.



« Health is a property of an *individual* body-mind. »

OK, but what is your point? Sure individuals are all very complex, they all
have very different backgrounds. But force them to smoke 4 packs of
cigarets a day, and many will die or be severely sick. Their
individualities and complexities can’t do much against that. Because they
have a common point : human health is vulnerable, sometimes very
vulnerable, to certain external factors.

So focusing on exposure, why not, but when the source of emission is
clearly identified and there are hints it has an effect on health, it’s
understandable policy-makers focus on the source of emission.



« lumping random epidemiological studies with "meta-analysis" pretense
should be left to WHO »

It should be left to anyone who wants to do epidemiological studies. It
should be left to the critics of WHO as well.



« in cohorts, contexts, confounding factors mean most epidemiological
studies for HAP and disease have no reliable quantification. »

Then prove it.

The thing you could do is to write a paper, a meta-analysis of
epidemiological studies and their methodology. If there are 200 studies
attributing diseases to air pollution, show how their methodology is
flawed, show how they prove nothing. It would be really, really useful.
This would be something we can work from.



Then, with this information, we’ll be able to say: « OK, we have really no
idea what causes respiratory diseases ».



We’ll be able to decide *en connaissance de cause*, knowing fully our
knowledge gaps.



And since we cannot let children die of respiratory diseases, we’ll still
have to do something, and put millions of dollars somewhere.



Best,



Xavier





*De :* Nikhil Desai [mailto:pienergy2008 at gmail.com <pienergy2008 at gmail.com>]

*Envoyé :* samedi 12 mai 2018 04:41
*À :* Xavier Brandao
*Cc :* Andrew Heggie; Discussion of biomass cooking stoves; Crispin
Pemberton-Pigott
*Objet :* Re: [Stoves] Air pollution kills



Xavier:



1. PM2.5 toxicity is a theological monument, built with steel girders of
assumptions, concrete of arrogance, and glass of pretense. Read today's
Washington Post opinion piece by Robert Hahn about USEPA's debating of
rules of scientific evidence; PM2.5 is central to this debate. (Hahn was
the White House anchor for the Acid Rain and other Clean Air Act Amendments
of 1990. I knew him briefly about a decade later. An economist of sense and
integrity, which is unfortunately rather rare.) Without the PM2.5 toxicity
assumptions -- for that is what they are, estimates based on assumptions
based on estimates based on assumptions - and their questionable (and
questioned) epidemiological basis, a lot of last 20 years of talk on "air
pollution kills" would be rendered as rubble of a monument.

2. Whatever the received dogma - the fatwas we are familiar with - my
Satanic Verses are simple:

Health is a property of an *individual* body-mind.
Lifetime disease incidence and death are influenced by *individual*
genetics, nutrition, exposures to disease vectors and risk factors (in
varying intensities, durations, locations) according to age and sex, timely
identification of disease and availability of medical care.

3. In simple terms, epidemiology is a tool for studying pathways taking
into account all such influences for different cohorts, so that
pharmacology and physician/nursing care can be geared to *individual*
attention.

Yes, mass propagation of medicines or technologies does transform the
patterns of disease incidence. Hence the search for marketable "better
cooking methods", tailored to specific contexts and cohorts.

Quantification of the change in predicted disease incidence and death is,
however, subject to serious pitfalls, and lumping random epidemiological
studies with "meta-analysis" pretense should be left to WHO (as it indeed
did, in order to come up with utterly fictitious Guidelines for Household
Fuel Combustion). Differences in cohorts, contexts, confounding factors
mean most epidemiological studies for HAP and disease have no reliable
quantification. (Hence the ultra-heroic assumptions behind HAPIT and which
is also why WHO had to cook up the HAP GBD with no data on use quantities
and qualities, emission rates and concentrations, and disease incidence or
their variance by time, duration or space.)

We need an anthropologist of this Environmental Health tribe, including
Lancet editor, who seems to have very little actual experience with
experiments. Curiouser and curiouser statements have been emerging from
this tribe.

Pick ANY context. Characterize health and air pollution (emission,
exposures) baseline. Make an action plan for air quality management in
toto. It's no use debating stoves cooking fuels alone, and criminal to do
so without a well-defined context.

I just looked up NY Times website for news items from 1851 to 1988 - with
phrases "air pollution" and "cooking". The search failed to show up
anything about air pollution and cooking.

I wonder why there are no studies of avoided premature deaths due to
transition from solid fuels to gaseous fuels and electricity in Western
households from 1920s to 1980s.

Nikhil


------------------------------------------------------------------------
Nikhil Desai

(US +1) 202 568 5831
*Skype: nikhildesai888*



On Fri, May 11, 2018 at 5:31 PM, Xavier Brandao <xav.brandao at gmail.com>
wrote:

Dear Crispin,



OK, but maybe not all studies are like the Korean one.

Then, for Ulan-Bator, for Mongolia, and as well for the world, there is a
need of a serious meta-analysis, which also reviews and criticizes the
methodology of the epidemiological studies on air pollution.



Then only, we might have a better view on the current landscape of
research, of the state-of-the-art on air pollution and health.



« There is correlation between OAP and IAP and infections, but they are
associations, not causal relationships.”

Sure, I understand the difference. But from what I understand there are
fields of research where this is the best you can get. That doesn’t mean it
doesn’t have grounds.

I wouldn’t throw epidemiology with the bath water. It seems to me that it
is epidemiology which found the link between smoking and lung cancer:

https://www.theguardian.com/society/2005/apr/24/smoking.medicineandhealth



“The claim that 4.3m people ‘die from air pollution’ per annum is clearly
false”

Indeed, but they might say instead: “Based on our data and statistics and
methodology, we have attributed the death of around 4.3 million people to
air pollution. It might be less, or more. We might be wrong, but this is
the best we have, sorry. The fact is that we highly suspect air pollution
to be dangerous for human health, so beware.”

That would be more correct. Would that change the outcome, which is to take
public policy measures to try to mitigate air pollution?



« Who simple is this statement? Did anyone measure IAP in the rural areas
where they burn dung for heating and cooking? Many people in the rural
areas are reasonably well fed and clothed. A lot of people in Ulaanbaatar
were driven there by absolute poverty and live in desperate conditions,
some depending on coal vouchers to obtain fuel. How did the temperature of
the home affect the incidence, and what is the socioeconomic conditions of
the families with high occurrence? Are there bronchitis epidemics in town
that do not occur in rural areas because the possibility of transmission is
so much lower? Yes the OAP is much lower in rural areas, but is their
exposure to smoke, for example, lower or higher?”

Sure, it raises a lot of questions. But let’s say we believe the data the
doctors have. I’d say this is a fact:

”Children in Ulaanbaatar, are taken bronchitis in 1.4-2.7 times and
bronchitis asthma in 5.5-7.9 times more than children who are living in
rural areas”

Mentioning this “less air pollution.” is already attributing a cause.



“Prof Lodoysamba confirmed the ‘colder’ hypothesis this winter using a
pretty sophisticated monitoring station at his home in Nalaikh with
thermometers at different heights above the ground.”

Maybe the cold is responsible of the bronchitis in Nalaikh, but not in Ulan
Bator. Maybe the cold is responsible everywhere and that is not well
measured or known.

Then, that “colder hypothesis” would infirm what was found in this study,
that air pollution from stoves was the main cause. Prof. Lodoysamba was one
of the co-writers of this study:

http://www.urbanemissions.info/wp-content/uploads/docs/
2013-09-AQAH-Ulaanbaatar-PM-Pollution.pdf



“Attributing something as a cause does not mean that removing the
attributed cause avoids the problem. Suppose the attribution was in error
by 80%?”

Sure, it could well be that: “oh, every household has an electric stove
now, but still the number of bronchitis cases are high.”

Science is never definitive, always evolving.



“Regarding proximity to highways: who lives next to noisy and polluted
highways in California: the well fed and exercised with good medical
treatment? Or poor people with poor health coverage, bad diets and no
access to recreational facilities?  Correlation is not  causation. “

We’d need to look at the study methodology to know if they took this factor
into account. Maybe they did. Maybe they compared poor people next to
highways, to poor people remote from highways.



“There must be children for whom it is the worst environmental risk, and
others for whom it is now.”

Sure, but if there are 10 000 children in the first group and 2000 in the
second group, then air pollution is the biggest environmental risk for
children in UB.



“The major impediment to achieving this is the parade of baseless claims
that coal cannot be burned cleanly”

Sure, if coal stoves can burn cleanly like or almost like electric stoves,
that’s fine by me.



“That is unbelievable. The “main source”? The cause? That is a clear claim
that second hand smoke causes bronchitis.”

Well, cause, by association. Actually, it doesn’t necessarily makes a
hierarchy between causes, it also says: “Second, other potential risk
factors of LRTI-related hospital admissions might have been overlooked in
our investigation, such as the type of fuel used in household stoves,
nutrition, antenatal cigarette smoke exposure, and nursery attendance,
where children might contract an infection from others.Therefore, caution
should be taken in interpreting these study findings.“



”Think about that. The record low for Ulaanbaatar is -54 C (2002). The
annual average is -2C. Is it possible that people earning $2500 per year
live in a chronically underheated home? Ya think??”

If millions of dollars should go to preventing under-heating rather than
clean stoves, then that is worth a medical study, to attribute deaths to
cold. If there is no such study, it is understandable public deciders well,
decide, to focus on air pollution.

It seems to me that the good news is that solving the issue of cold in
homes and IAP go hand-in-hand.



”Some say 45% depending on where you measure it. It was improved *uuugely*.
Yet people popped up to say nothing was achieved by the programme. Short
memories.”

For sure, celebrating successes and giving credit where credit is due is
really important. Otherwise we tend to think we live in a bleak world where
nothing happens.



”I am sure asthma attacks decreased because air pollution aggravates
asthma. I do not have stats, however. It just seems likely.”

It seems to me also. And until you have a cohort of doctors, statisticians,
scientists to make more studies with a large number of variables, and
check, this is the best a public decider can get.



”Now we need to address the low pressure boilers which are more and more
common and burn 4 times as much fuel as the ger stoves, at least. They were
not included in the ger stove programme. We are working on the at the
moment.”

That seems exciting! Good luck with that.


Best,


Xavier







*De :* Stoves [mailto:stoves-bounces at lists.bioenergylists.org] *De la part
de* Crispin Pemberton-Pigott
*Envoyé :* mercredi 9 mai 2018 00:20
*À :* Discussion of biomass cooking stoves
*Objet :* Re: [Stoves] Air pollution kills



Dear Xavier



Thank you for being skeptical. Science works on challenges, *nullis in
verba*.



On the IAP matter in UB, there are generalisations one can make and
specific circumstances worth noting. There is a study of the effect on
indoor air pollution from the improved stoves (Korean study, available in
English). The concluded that the improved stoves which reduce PM2.5 output
by 90-98% *increased *indoor air pollution, which was so unbelievable that
I bothered to investigate the study quite carefully.



What I found was that they did indeed measure an increase, on average, in
IAP but: the difference was well inside their margin of error (a small
fraction of the variations measured, rendering the conclusion meaningless.
Further, on those days when they were measuring, the ambient (outdoor) air
pollution closely matched the claimed indoor air quality, save that in
every case the IAP was lower than the OAP.  In short, all the Koreans
measured was the effect on IAP from outside air.



The worst aspect of the paper was that they claimed a statistically
significant difference: the new stoves provided worse IAP than the old
stoves – which the numbers did not support at all. There *was* a difference
in the averages, and the new stove measurements were higher, but the
difference was a small fraction of the Sigma 1 of their numbers, which is
to say, the difference was *not* statistically significant.



Decent chimney stoves with a correctly fitted chimney have very little
effect on IAP. We have ample recent evidence of this in Kyrgyzstan if there
was any doubt. Improper operation can lead to fugitive emissions from the
stove – for example leaving the ash drawer open a bit ‘to give more power’
breaks the draft from the chimney and the top surfaces can leak smoke into
the room as they are no longer under negative pressure.



There is correlation between OAP and IAP and infections, but they are
associations, not causal relationships. We can ask Nikhil about which words
to use exactly. The claim that 4.3m people ‘die from air pollution’ per
annum is clearly false and a misrepresentation of the published evidence
used to support the claims that air pollution shortens lives – by
attribution (not medical evidence).



« Children in Ulaanbaatar, are taken bronchitis in 1.4-2.7 times and
bronchitis asthma in 5.5-7.9 times more than children who are living in
rural areas of less air pollution. » says Social Health institute.
http://www.unoosa.org/documents/pdf/psa/activities/
2006/graz/presentations/0102.pdf p 12.



Who simple is this statement? Did anyone measure IAP in the rural areas
where they burn dung for heating and cooking? Many people in the rural
areas are reasonably well fed and clothed. A lot of people in Ulaanbaatar
were driven there by absolute poverty and live in desperate conditions,
some depending on coal vouchers to obtain fuel. How did the temperature of
the home affect the incidence, and what is the socioeconomic conditions of
the families with high occurrence? Are there bronchitis epidemics in town
that do not occur in rural areas because the possibility of transmission is
so much lower? Yes the OAP is much lower in rural areas, but is their
exposure to smoke, for example, lower or higher?



When the Kyrgyz villagers were keeping their homes free of IAP (with
chimneys and non-leaking stoves) *and 5 degrees warmer* the incidence of
bronchitis dropped to zero (51 homes, 2016-17 season). I interviewed
parents in February in the Naryn region and they all said before they got
the new stove the children were “sick all winter” before and “much sicker
than this winter” and so on. Chronic cold spreads disease among children.
Bronchitis is a bacterial infection. PM2.5 is sterilized. So you are
looking for pre-dispositions caused by PM2.5, not ‘causes’.



It is dusty pretty much everywhere. The city is definitely smokier, and it
can be quite bad if the wind drops, because below -30 the city is colder
than the mountains around, or communities at higher elevation such as
nearby Nalaikh where the coal comes from.  Prof Lodoysamba confirmed the
‘colder’ hypothesis this winter using a pretty sophisticated monitoring
station at his home in Nalaikh with thermometers at different heights above
the ground. The city, below -30, is colder, smokier, has a poorer diet and
more fugitive dust than rural areas. But a traditional stove burning dung
can be pretty smoky, and we have zero measurement of IAP in rural homes.



«So we concluded that the level of urban air pollution in the capital city
is clearly having an adverse impact on the pulmonary health of urban
Mongolian children.»



They can conclude that but that is no proof. That is an association. It is
why Nikhil keeps pointing out that you cannot make claims for causes and
avoidances without knowing a heck of a lot about the sub-population you are
examining.  Attributing something as a cause does not mean that removing
the attributed cause avoids the problem. Suppose the attribution was in
error by 80%?



Regarding proximity to highways: who lives next to noisy and polluted
highways in California: the well fed and exercised with good medical
treatment? Or poor people with poor health coverage, bad diets and no
access to recreational facilities?  Correlation is not  causation.



“UNICEF says: « Outdoor air pollution is the most significant environmental
risk faced by children in Ulaanbaatar.”



Hmm…  Is alcohol an environmental risk? What about smoking?  The air
pollution is awful on some days, and visible, and variable from place to
place. There must be children for whom it is the worst environmental risk,
and others for whom it is now. The point is that we can remove virtually
all of it with improved combustion of the very same fuels they now use. The
major impediment to achieving this is the parade of baseless claims that
coal cannot be burned cleanly, and therefore they must ban it – the only
fuel available at a price they can afford. The sheer stupidity of blaming
the fuel for the performance of the stove cannot have a greater effect on
the people. Those advocates of fuel bans based on the misbelief that the
fuel is the problem, are partnering with the advocates of ‘alternatives’
costing multip
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