The Surgeon General's Report on Smoking - which dramatically changed the smoking habits of Americans - would not have happened without epidemiology.

Biochemistry is very important. But ... 1/n https://twitter.com/raphaels7/status/1263471303983595523

Mechanisms acting at cellular levels do not necessarily give full explanations of physiological level effects & outcomes. Metabolism is too complicated for that.

Effects of smoking are seen at cellular, physiological & population levels. You can't say the same for pizza. 2/

There are other problems with comparing smoking to food/eating:

1) RRs for smoking were 10-fold greater than what is typically seen in *any* nutritional epidemiology study.
2) Individuals are quite accurate in their recall of their smoking history. 3/

2 cont'd - (Even family members can accurately report smoking habits for another family member.) Eating, well, not so much.
3) Epidemiology on smoking fits nicely into Bradford Hill criteria 4/

3 cont'd - (which makes sense, as development for arguments for causation in smoking are tightly bound to the development of BH criteria).
4) A strong epidemiological association - one that might be use to claim causation - will show dose-response effect. Few foods do. 5/

5) "Eating" is analogized to "smoking" (behaviors); "food" to "cigarettes" (things). But - and this is where your analogy falls apart at its roots: Eating is a far more complex behavior than smoking; food - any food - is a far more complex thing than a cigarette. 6/

5 cont'd - You are, I hope, allowing for the existence of "healthy" food (however you wish to define that). So far I am not aware of the existence of a "healthy" cigarette.

Ditto "healthy" eating patterns. Are there "healthy" smoking patterns?

Finally ... 7/

6) People can quit smoking and abstain from cigarettes. People can not quit eating and abstain from food. This means that your approach must divide the world up into Foods To Be Eaten and Foods To Be ??? (avoided, limited, I don't know). 8/

Dividing foods into "Okay" & "Not Okay" categories has never NOT been a moral stance.

It existed w/r/t religious & ideological constrictions long before science took over.

However, with the advent of the ideology of prevention of chronic disease via lifestyle changes, 9/

of which epidemiology of smoking was certainly a part, the moralization of food and eating dos & don'ts via "science" based rationales overwhelmed our thinking.

Within a generation, we forgot almost entirely what food and eating is for - to nourish us - and instead 10/

we began to use food and eating to blame and shame, to separate and isolate, to create hierarchies of status and "deservedness" that permeate our public health & healthcare systems - in fact, how we talk & think about food & health in general. 11/

So far, your approach doesn't strike me as diverging significantly from this. But perhaps I have misunderstood?

12/12