Scaling Back: A New Policy Disagreement Between Clinton and Sanders: Soda Taxes

“Making sure that every family has high-quality, affordable preschool and child care is a vision that I strongly share,” Mr. Sanders said, in a written statement. “On the other hand, I do not support paying for this proposal through a regressive tax on soda that will significantly increase taxes on low-income and middle-class Americans. At a time of massive income and wealth inequality, it should be the people on top who see an increase in their taxes, not low-income and working people.” Over the weekend, Mr. Sanders continued to express opposition to the tax, at campaign events and on Meet the Press.

The proposed Philadelphia tax would be 3 cents for every ounce of sugary drink sold by distributors, making it the highest soda tax proposed anywhere in the country. That means a tax of $4.32 on a 12-pack of soda, which typically costs between $3 and $6 at the grocery store. It would come to 60 cents of tax on a 20-ounce bottle, which usually retails for about $2. It’s not yet clear whether distributors will absorb some of that tax or simply pass all of it on to consumers, but the city budget department expects big price increases in retail stores.

Mr. Sanders also says Mrs. Clinton’s support violates her pledge not to raise taxes on those earning less than $250,000.

Mr. Sanders’s argument is in line with that of many soda tax opponents. And there’s most likely some truth to it. Tobacco taxes, in many ways the model for soda taxes, have tended to fall largely on low-income people, who remain more likely to smoke.

But tobacco is highly addictive. In Mexico, where a big, national soda tax went into effect in 2014, soda drinking declined the fastest among the poor, who felt the tax’s effects in their budgets most acutely. Consumption among the poorest Mexicans fell by 17 percent by the end of the year, compared with 12 percent in the population nationwide. As Barry Popkin, a professor of nutrition at the University of North Carolina puts it: The rich paid the tax, and the poor reduced their soda drinking. If something like that happens in Philadelphia, the poor may suffer in the form of less choice or enjoyment, but they may not bear the brunt of funding city preschool.

Republicans appear to be nearly united in their opposition to the measure, both as a tax increase and a “nanny state” intrusion on personal choice. Several prominent Republicans cheered Mr. Sanders’s anti-tax stance, including Grover Norquist, the president of Americans for Tax Reform, and an influential anti-tax advocate. But conservative opposition to soda taxes is not true world over. In Britain, the Conservative government just proposed a hefty soda tax, which is expected to become law.

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The New Health Care: A Study on Fats That Doesn’t Fit the Story Line

The Minnesota Coronary Experiment was a well-designed study that was conducted in one nursing home and six state mental hospitals from 1968 to 1973. More than 9,400 men and women, ages 20 to 97, participated. Data on serum cholesterol were available on more than 2,300 participants who were on the study diets for more than a year.

At baseline, participants were getting about 18.5 percent of their calories from saturated fat, and about 3.8 percent from unsaturated fats. The intervention diet was considered a more “heart healthy” one. It encouraged a reduction in the amount of calories from saturated fats (like animal fats and butter) and more from unsaturated fats, particularly linoleic acids (like corn oil). The intervention diet lowered the percent of calories from saturated fats to 9.2 percent, and raised the percent from unsaturated fats to 13.2 percent.

The average follow-up for these participants was just under three years. In that time, the total serum cholesterol dropped significantly more in those on the intervention diet (-31.2 mg/dL) than in those on the control diet (-5 mg/dL).

There was, however, no decreased risk of death. If anything, there seemed to be an increased mortality rate in those on the “heart healthy” diet, particularly among those 65 years and older. More concerning, those who had the greater reduction in serum cholesterol had a higher rate of death. A 30mg/dL decrease in serum cholesterol was associated with a 22 percent increase in the risk of death from any cause, even after adjusting for baseline cholesterol, age, sex, adherence to the diet, body mass and blood pressure.

Of course, this is only one study. It involved only institutionalized patients. Only about a quarter of the participants followed the diet for more than a year. The diets don’t necessarily look like what people really ate, then or now. But this is still a large, randomized controlled trial, and it’s hard to imagine we wouldn’t at least discuss it widely.

Moreover, the researchers conducted a meta-analysis of all studies that looked at this question. Analyzed together, they still found that more people died on the linoleic-acid-rich diets, although the results were not statistically significant. Even in a sensitivity analysis, which included more studies, no mortality benefit could be found with a diet lower in saturated fats.

It’s important to note that other meta-analyses both support and dispute this. A 2010 study argued that substituting unsaturated fats for saturated fats would reduce the rates of coronary heart disease. So did a 2015 Cochrane review. A 2014 study in Annals of Internal Medicine, though, showed the opposite.

People’s reactions to this news have been much as you’d expect. Supporters of a diet low in saturated fat have called the new study an “interesting historical footnote that has no relevance to current dietary recommendations.” Others have said that if this research had been published when the study was over, “it might have changed the trajectory of diet-heart research and recommendations.”

This isn’t the first time that data from long ago have run against current recommendations. In 2013, an analysis was published of recovered data from the Sydney Diet Heart Study, a randomized controlled trial of a similar nature performed in men with a recent heart attack or angina. Although the study was done from 1966 to 1973, results weren’t available publicly until three years ago. It, too, found that a diet higher in unsaturated fats led to a higher rate of death from heart disease.

Why wasn’t this research published decades ago? It’s possible that modern computer technology allows us to do analyses that couldn’t be performed then. It’s possible that researchers tried, but were unable to get the results published.

But it’s also possible that these results were marginalized because they didn’t fit with what was considered to be “truth” at the time. The two principal investigators on the Minnesota study were Ivan Frantz and Ancel Keys, the latter of whom may be the most influential scientist in promoting saturated fat as the enemy of heart health. (Mr. Keys died in 2004.)

I’m not suggesting anything sinister. I’m sure that both these scientists absolutely believed that their prior epidemiologic work established that diets lower in saturated fat led to lower cholesterol levels and better health. Research consistently confirmed the former. When that lower cholesterol didn’t translate into actual outcomes like lower mortality, though, they must have been baffled.

Like others today, they may have been able to rationalize the result away and decide that it “has no relevance.” Unfortunately, other, similar controlled trials seem to support the notion that the case against saturated fat isn’t as robust as many think.

We all must be concerned about publication bias, which occurs when results of published studies are systematically different from results of unpublished studies. Research has shown that studies with statistically significant results are more likely to be published than those without. Studies with a low-priority topic or finding may be less likely to be published.

One of the reasons that epidemiologic evidence often leads us to conclusions that can’t be supported is likely publication bias. Studies that find significant associations between foods (like meat) and scary findings (like cancer) are more likely to be published than those that don’t find those associations. When controlled trials are finally done, though, the scary results often can’t be replicated.

But the most common reason research isn’t published is because researchers don’t write it up and submit it. That could be because they think it won’t be accepted. It could also be because they don’t believe the results. In the charged environment of nutrition research, when people’s careers are built on certain hypotheses, it’s hard not to imagine our biases creeping into play.

Unfortunately, the health of Americans and others is at stake. Should we be eating more polyunsaturated fats? Should we be avoiding saturated fats? The honest answer is: I don’t know. Given my review of the evidence, I stand by my previous recommendations, which essentially focus more on foods and less on nutrients. I think the state of nutrition research in general is shockingly flawed.

It’s hard enough to debate the data we can see. Knowing there’s probably data out there that people haven’t shared makes everything much, much harder.

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Ed Talk: Angela Duckworth on Passion, Grit and Success

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Angela Duckworth was teaching math when she noticed something intriguing: The most successful students weren’t always the ones who displayed a natural aptitude; rather, they displayed something she came to think of as grit. Later, as a graduate student in psychology at the University of Pennsylvania, she defined the term — a combination of passion and perseverance for a singularly important goal — and created a tool to measure it: the “grit scale,” which predicted outcomes like who would graduate from West Point or win the National Spelling Bee. As a result of this work, Dr. Duckworth was named a MacArthur “genius” in 2013, and the notion of grit has become widely known. Her new book, “Grit: The Power of Passion and Perseverance,” will be available in May.

So why is grit so important?

My lab has found that this measure beats the pants off I.Q., SAT scores, physical fitness and a bazillion other measures to help us know in advance which individuals will be successful in some situations.

How does one develop grit?

You cannot will yourself to be interested in something you’re not interested in. But you can actively discover and deepen your interest. So once you’ve fostered an interest, then, and only then, can you do the kind of difficult, effortful and sometimes frustrating practice that truly makes you better. Another thing is really maintaining a sense of hope or resilience, even when there are setbacks.

How can parents foster grit in their children?

The parenting style that is good for grit is also the parenting style good for most other things: Be really, really demanding, and be very, very supportive. By this I don’t mean material things; I mean emotional support. If parents are warm and loving, the kids tend to feel loved. Respect, or what the parenting literature calls “autonomy support,” is also essential. That’s when parents allow their kids to make their own decisions just as soon as they are capable.

A Penn task force found that some students have unrealistic expectations about what they can achieve, even at the expense of their mental health. How might grit affect those pressured from birth to excel?

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Economic View: Why Talented Black and Hispanic Students Can Go Undiscovered

The economists David Card of the University of California, Berkeley, and Laura Giuliano of the University of Miami studied the effects of this policy shift. The results were striking.

The share of Hispanic children identified as gifted tripled, to 6 percent from 2 percent. The share of black children rose to 3 percent from 1 percent. For whites, the gain was more muted, to 8 percent from 6 percent.

Why did the new screening system find so many more gifted children, especially among blacks and Hispanics? It did not rely on teachers and parents to winnow students. The researchers found that teachers and parents were less likely to refer high-ability blacks and Hispanics, as well as children learning English as a second language, for I.Q. testing. The universal test leveled the playing field.

Multiple factors could be at work here: Teachers may have lower expectations for these children, and their parents may be unfamiliar with the process and the programs. Whatever the reason, the evidence indicates that relying on teachers and parents increases racial and ethnic disparities.

The gifted program was not a panacea. The researchers found that the district’s specialized classes had little effect on the academic achievement of students who had been specifically identified as gifted, through I.Q. tests. They are not sure why. In Broward County, as in many other places, classes for the gifted use the same curriculum and textbook as other classes. Teachers in the classes for the gifted were required to have a special certification and were encouraged to supplement the curriculum.

But the separate classes did produce enormous, positive effects for children who were high achievers but did not qualify based on the I.Q. test. A quirk in the rules helped these children: Broward requires that schools with even one child who tests above the I.Q. cutoff devote an entire classroom to gifted and high-achieving children.

Since a school in Broward rarely had enough gifted children to fill a class, these classrooms were topped off with children from the same school who scored high on the district’s standardized test. These high achievers, especially black and Hispanics, showed large increases in math and reading when placed in a class for the gifted, and these effects persisted.

What is more, while many children in the gifted program gained enormously, Mr. Card and Ms. Giuliano found no negative effects for those who remained in regular classes. Yet all of these gains came at little financial cost. The enhanced classes were no more expensive than the standard ones. They were the same size as regular classes, and teachers in the classes for the gifted were paid no more than others.

This story has twists, though.

Despite these positive results, Broward County suspended its universal screening program in 2010 in a spate of budget cutting after the Great Recession. Racial and ethnic disparities re-emerged, as large as they were before the policy change. In 2012 the district reinstated a modified version of universal screening, but it has not achieved the same results. Using data from the Florida Department of Education, I calculate that 8 percent of white students in Broward County are classified as gifted. That is twice the rate for Hispanics and four times the rate for blacks, much higher ratios than under universal screening.

One problem with the new screening program is that the previous nonverbal test, which psychologists say they believe to be culturally neutral, has been replaced with one that relies more on verbal ability. Another is that Broward parents and teachers can still influence whether children are selected. While school psychologists test students at no cost, parents can hire a private psychologist to test a child, at a cost of $1,000, and are allowed to pay for multiple tests, should a child not meet the I.Q. requirement on the first try. Mr. Card and Ms. Giuliano found evidence suggesting that private testing gives an advantage to upper-income families, who tend to be white.

Many researchers worry that I.Q. tests are biased against low-income and nonwhite children, and some recommend a more holistic approach that includes teacher referrals. But referrals produce biases, too. Matthew McBee, a psychologist who edits The Journal of Advanced Academics, which focuses on gifted education, recently called referrals “the elephant in the room,” a largely unexamined source of racial and ethnic bias in the identification of gifted children.

Given these problems, we might be tempted to abandon these programs for gifted and high-achieving children entirely. After all, distinguishing between gifted students and everybody else could lock some children, especially disadvantaged children, into a long-term track with low expectations that, too often, are self-fulfilling.

But without some method of identifying talented students, disadvantaged children may fall even further behind those from affluent families, whose parents can afford niceties like private tutors, Kumon math courses and coding camps. Low-income parents just can’t afford these extras.

That’s why the research in Broward County is so important. It shows that there is a fairer way to identify gifted children, and that placing each school’s gifted and achieving students in advanced classes can shrink, rather than expand, racial and ethnic differences in achievement. Universal screening, with a standardized process that does not rely on teachers and parents, can reveal talented, disadvantaged children who would otherwise go undiscovered. Challenging classes for these children can help them to reach their full potential.

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