More on the ecig advocates’ descent toward junk science

by Carl V Phillips

There is a cliché about certain types of institutional crimes, that it is not the act itself but the cover-up that causes the real trouble. The erroneous headline claim in the recent Public Health England (PHE) paper, that e-cigarette use is 95% less harmful than smoking, would generate nothing more than a fleeting rebuttal and represent nothing more than footnote to the history were it not for the equivalent of that cover-up. But some of the more serious commentators in the e-cigarette advocacy world, along with countless others, have rushed to defend the error. And I have found this truly scary.

For context on the subject matter, see my previous post, which you can follow back for more detail. The short version is that the PHE authors repeated what is just a made-up number (and not even a made-up number that is (a) plausible or (b) even supposedly a measure of comparative risk) that appeared in a junk science paper by Nutt et al., presenting it as if it were scientifically valid; this claim appeared in the headline under which PHE published the paper. For context on what I am responding to below, you can look at my twitter feed, at the comments others directed toward me. (I trust it is obvious that while Twitter is a great medium for announcements, quips, and simple observations, it does not offer a sensible way to try to have a conversation. Thus I mostly did not try to respond there, but rather wrote this post, which has a comments section that allows for better discussion. See the previous post for a good example of such conversation. Also, you presumably realize that this extrapolates to me not intending to “discuss” this on twitter in response to the next round of quips there.)

Why is it scary? For one thing, it is difficult to not fear where we end up a year from now, moving down this path. Pro-ecig advocacy’s relationship with science went from being way ahead of the legitimate science c.2008, to mostly highly serious and science-based c.2010, to the movement becoming so large that the science was part of the conversation but was mostly treated as a weapon c.2013. But even as that last bit occurred — as is almost inevitable when a mass activist movement forms — the serious opinion leaders remained anchored in a commitment to good science. But the recent events show that there are cracks in that anchor, suggesting we may be approaching the point where many other good and legitimately science-based causes took a permanent turn for the worse, becoming both less effective and less beneficial.

In addition, down the path of even the serious opinion leaders treating science as a mere weapon for a political cause lies disdain for any good science that does not benefit the politics. Sometimes a “bad” result is correct and represents useful information for consumers. But if the responses to every concern about a possible harm from e-cigarettes degenerate into knee-jerk rebuttals — and we are getting rather close to that point — then potentially beneficial knowledge will be ignored. When scientific claims are just weapons, the ability to detect whether a concern is legitimate tends to be lost to those within the cause. Consumers need accurate health information, not claims that are most convenient for advocacy, so that they can make informed choices that are best for themselves.

Even more information is lost to those outside the cause. Consider the various “healthy eating” movements, many of which contain bits of good advice for consumers. But the useful information is embedded in a corpus of junk science that exists to defend the cause against all critique. As a result, people either subscribe to a particular food cult, buying into a lot of misinformation, or dismiss everything they say, losing some good information. It becomes something like cheering for one sports team over another, as is common for impersonal political issues (e.g., macroeconomic policy, climate change). Similarly, there are legitimate concerns about childhood vaccines, particularly for some identifiable individuals, but anti-vaxxers and their junk science have so poisoned the well that there is little useful discussion or understanding of this point.

The following are responses to some of the claims I have seen over the last few days that the 95% claim was just fine. I have ignored the ones that were less cogent and I have tried to distill them down to their best essence.

“But we need to make such claims because….”

This is nonsense at multiple levels.

First, even if this were a valid response, it would only be a response to a statement that included “…and therefore we should….” But it is being presented as a rebuttal of the mere observation that the claim is junk. If someone writes “I concede that this claim is junk science, but we should endorse it anyway because…”, then perhaps they are being serious. But instead the implicit claim is often “we need to make such claims, and therefore the scientific criticism of the claim is wrong.” Um, no.

Second, what possible good can come from making up a clearly wrong number and pretending it is scientific when the truth is sufficient to make the point? It makes no sense. Is the target audience more likely to be persuaded by junk science that is easily debunked rather than a true statement that sounds pretty much the same to the audience? It is difficult to imagine why. Meanwhile, when the specific claim is debunked by those hostile to the overall message — and it has been already — it makes it much easier for those who are inclined to dismiss the entire legitimate message to do so.

Just in case I have to repeat this five times (and I have a feeling I do), the scary problem is not the initial mistake, but the desperate response to defend it. It is my assessment, based on my knowledge of advocacy movements from the inside and via study, that the initial mistake is itself actively harmful. But even if you doubt that conclusion, it should be obvious it was not helpful compared to just substituting something accurate. So why man the barricades to defend the mistake? It reminds me a lot of the tobacco controllers’ code of omerta, to never criticize any anti-tobacco claim that anyone makes, no matter how wrong it is.

Third, if trafficking in junk science really were required to make our case, then we would face a serious ethical problem. This is not just because of the moral case against lying, though that is fairly compelling argument in itself. But if you need to lie to make your case, you should probably stop and ask yourself whether what you are trying to argue is actually right. As noted, this is moot in the present case because the truth can be used to make the same point even better. But the mere willingness to say that a junk science claim is needed suggests a rather scary degradation of ethics.

Fourth, the unstated premise is that trafficking in junk science would be good for the cause, so long as it is the right junk science. Oh, really? I cannot think of a single example of a cause like this (insurgent, narrowly focused, consumer oriented) where that was a good strategy. I suspect that most of those implicitly making this argument have little experience with such causes, either personally or by way of study. I am open to suggestions, but I cannot think of anything. I can, however, think of movements that foundered there, and reasons why we should expect exactly that to happen. Plenty of good and defensible causes have turned into fringe cults that no one outside the cult takes seriously because they pursued the junk science track.

Keep in mind that trafficking in junk science is an effective strategy for those in particular positions, but this does not generalize. It works great if you have a powerful echo chamber and are just using it to keep the useful idiots in line. The upsides (when they exist, unlike in this particular case) can outweigh the downsides when you have pet media, are a government, or otherwise have a very loud megaphone, and thus can just shout-down the debunking. Junk science is often very effective at attacking science-based insurgent movements. I trust it is obvious that none of these describe the situation for pro-ecig advocacy, though it happens that all of them describe the tobacco control industry’s situation. Wars are often asymmetric, and so adopting the enemy’s tactics can be a losing strategy. In this case, given the lack of a loud megaphone and only a tiny non-influential echo chamber which does not really need to be stoked, it is undoubtedly a losing strategy to mimic tobacco control’s dishonest tactics, even apart from the ethics of it.

It is worth noting that the anti-smoking movement started out science-based and honest. Almost all the reduction in smoking from its peak was caused by honest education. The morphing into the lie-based tobacco control industry came at the same time that they stopped succeeding at reducing smoking beyond the steady downward trend that was caused by the honest approach from past decades (not to say this is causal; it just points out that they clearly cannot be said to have become more successful when they started lying).

The modern success of tobacco control in keeping people smoking, by opposing THR, is attributable to them seizing power and money, not to some magical effect of their junk science. That is just fodder for their echo chamber. It is difficult to argue that the trafficking in junk science has itself made any difference in terms of policy: The American, Canadian, and Australian governments shovel out tons of anti-THR junk science to their people, while the Europeans and Asians basically just impose autocratic rules from on-high. Yet all of these places have e-cigarette bans or severe restrictions, either in place or in the pipeline. It is the power, not trafficking the junk science, that makes that happen.

“This is not using junk science to further a political aim”

This is really a subordinate point, but it bugs me enough that it gets its own entry. In response to arguments that it is simply never ok to employ junk science to further one’s political goals, there have been responses along the lines of “this is not political: this is an effort to correct widespread misperceptions.” Um, yeah.

If someone wants to argue that it is acceptable to use junk science to further a political aim, they can try to defend that. But claiming that this is not political is a truly awful step on the descent toward becoming a cult. If the goal is changing the world, then you are talking about a political act; that is what the word means. If someone genuinely thinks “this is not political because it is doing something good”, that is a serious problem. News flash: every political activist thinks they are doing good, including the ones who want to create the misperceptions you object to. As soon as your defense of what you are doing descends to the point of saying “whatever I do is fine because I am doing it for a good cause” — and “this is not political” claim is a version of that — there is a severe erosion of the barriers that normally provide a check against very unfortunate actions.

“The estimate is close enough to the real expert estimate”

This is actually false, and not in a harmless way. As I and others have noted, the affirmative claim that vaping causes 5% of the health risk that smoking causes is a claim that vaping is quite bad for you. Parsing that with the accepted propaganda about smoking, it means that about 1 in 40 vapers will be killed by vaping. That makes it worse than any other common behavior other than smoking — far worse than driving, worse than all but the most extreme overeating. Also keep in mind that estimates are properly interpreted as being point estimates with some uncertainty on both sides (in spite of the PHE authors reciting their claim as if it were exactly precisely right), which means this claim says that there is roughly a 50% chance the risk is worse than that. Defending that is not clever.

But if it were true, why source it to a made-up number — and one that does not even say what the PHE authors claims it did, even apart from it being just made up (see previous post) — and declare that to be a source of scientific information? Why not instead present this real expert estimate that is being referenced? (Note that I am not entirely sure what real expert estimate such claims refer to. The evidence-based expert estimate I am aware of is an analysis along the lines of: “The chemistry of vapor suggests that vaping is almost certainly only slightly worse for you than smokeless tobacco (which is our only measure of the effects of using nicotine without smoke). ST use appears to be about 99% less harmful than smoking, though it may be completely harmless or even beneficial. Therefore the risk from vaping is most likely in that same range.” Yes, it is possible that vaping is so much more harmful than ST use that it is 5% as harmful as smoking — as I noted in the previous post, some versions of it undoubtedly are — but this seems vanishingly unlikely for “normal” vaping. It is worth mentioning that the junk paper by Nutt et al. made up a number for the risk from ST use that are enormously higher than the number they made up for vaping. There is no conceivable scientific basis for making such a comparative claim, further emphasizing the worthlessness and of their made-up numbers.)

But most important, and here is the crux of all of this again, why would it ever be a good idea to man the barricades to defend the junk claim based on this? If a claim that is sourced to junk science is close enough to what the real science shows (which is not true in this case, but imagine some other case where it was true), then why defend the use of junk science, making the credibility of the whole message depend on defending the original junk source? Instead, push for the substantive claim to be based on real science. This might seem to entail a bit of short-run cost, due to not being able to uncritically embrace some particular publication, but it is far better in the long run. Moreover, it is not as if the particular publication will stand up to scrutiny, so the apparent short run cost is probably moot. It is better to get ahead of the inevitable criticism of the junk science that will come from those who wish to dismiss the entire substantive claim.  

“Just an estimate”

Some commentators have sought to excuse the reporting of a clearly inaccurate made-up number under the claim “the best estimate” by suggesting “hey, they said it was just an estimate.” But the word “estimate” does not mean “we are reporting something that is wrong.” It is a scientific term that refers to the best available scientific measure of a quantity (with an implication that we think it is a pretty solid measure), as in “the estimated speed of light in a vacuum”, or if clearly specified as such it can mean the specific measure that comes from a particular measurement effort, as in “the estimate of the increase in heart attack risk from nicotine consumption from this data and model is…..” The number reported by the PHE authors was neither of those.

Perhaps that observation gave you a sense of “where have I heard something like this before?” It is remarkably similar to the anti-scientific games played by those who deny the history of the planet and life by saying “evolution is just a theory.” Presumably if you are savvy enough to be reading this blog, you know the response is that a scientific theory is the best evidence-based understanding of a phenomenon that we have available, and moreover one that is well enough established that we are pretty confident about the core claim. But the anti-scientists think (or, more realistically, pretend to think, and try to trick others into actually thinking) that “theory” refers to a mere musing, as it is sometimes used in common language. In a scientific context, authors cannot just make up a story and call it a theory or just make up a number and call it an estimate.

“What they really meant was….”

If they really meant something different, why did they not say something different? If these same authors were previously on record as saying “at least 95% less harmful” and that is what they meant to communicate in this report, they sure picked a funny way of trying to do it. (Besides, that claim is also wrong, as explained in the previous post.) If they really meant to claim that their estimate was based on something more than the one junk science paper, why did they just cite it to that paper (along with mentions of  some commentary papers that included no attempt to construct a scientific estimate for this figure) and say nothing about any other basis for the number? In any case, saying they really meant something different is not a rebuttal of the observation that what they said was wrong, but an endorsement of it.

If they really meant something different, you would think the authors would be anxious to post a correction. Some commentators have suggested this can be found in a subsequent note by the PHE authors in which they seem to be trying to imply — without stating this as their purpose — that they were not basing their claim entirely on one junk paper. But if you look at their text, they say just the opposite. The have a couple of sentences about why we can be sure the risk from vaping is much lower than from smoking, but this is not in dispute and is obviously quite different from asserting a particular quantity. They then assert (without further methodological elaboration) that they are not aware of any new research, appearing after the number was concocted, that shows the Nutt et al. number to be wrong and state that it “remains valid as the current best estimate based on the peer-reviewed literature.” This is not a denial that they are just channeling the original made-up, clearly inaccurate, junk science claim, but an explicit confirmation of it. If they had any legitimate scientific basis for their number, they undoubtedly would have mentioned it in their note. Also — and I really hope this goes without saying — if you just make up a number and then observe it has not definitively been demonstrated to be false, this does not make it true.

“Subjective”

One of the authors of the original junk paper apparently tried to defend their “methodology” of just making up numbers on the basis of that all science is subjective, and some others have picked up on this. This is another word game. It is true that if you divide everything into objective and subjective, then all empirical work and scientific conclusion-drawing is subjective. It is done by people and includes countless human judgments. Indeed, when someone tries to claim that a scientific process is objective, or that some particular scientific process is suspect because it is subjective, they clearly do not know what they are talking about. However, the subjectivity of science is not license to just make stuff up.

As with “estimate” and “theory”, which imply a solid scientific basis for a claim, for a subjective process to be scientific some minimum standards are required. It is true that we cannot write down a set of clear rules and call it “the scientific method”; there is no such objective concept, which creates a lot of consternation for people who cannot handle complication. But that does not mean that any method of arriving at a number is as good as any other.

“But that report was great, and it is helpful, and the authors were so brave, and….”

What does any of that have to do with the issue at hand? Yes, the existence of the report is a good thing for the cause, and the vast majority of it is valid. Both of those would still be true had they not headlined it with a junk science claim. Both would still be true if others did not man the omerta barricades over that claim. Neither changes if someone agrees that the particular claim is not valid.

The fact that such non sequitur statements are made in response to criticism of a particular scientific claim is extremely disturbing. The apparent reason is the notion that we have to defend every single word written by “our team”, just like the ANTZ do. That is not a good place to be.

I assume that some of those making these “but…and…and…and…” claims are genuinely worried that this flaw is a threat to all the benefits that the existence of the PHE report offers. But it is not e-cigarette proponents challenging “our team’s” junk science that poses that threat. Opponents will run with it. They are running with it. This is the type of mistake that serious opinion leaders can easily get out in front of, conceding the flaw with a shrug and pushing the focus elsewhere. That can be done based on a moral belief that telling the truth matters or as purely a matter of political tactics. If it is the latter and you find a situation where defending some bit of junk science really seems to be tactically useful and can actually be pulled off… well, I am probably still going to argue the moral position, but you might have a case to make. But this is not that situation.

Instead, this is a situation that needlessly give opponents an opening to claim that the core scientific claims of the movement are junk science. That is not true, obviously. But since it also sends the signal that junk science will be tolerated and actively defended if presented in an important context, it also dramatically increases the chances there will be plenty more of it generated. This will make it even easier for opponents to claim that e-cigarette advocacy is not science-based. It will also dramatically increase the chances that consumers will not be able to trust their own advocates to provide accurate decision-relevant information.

A political movement that ultimately relies on scientific information cannot afford this. If sciencey talk is just used to rally the faction, then accuracy does not much matter. If the crux of the cause were, like many causes, about emotion or “morals” or zero-sum fights, then the sciencey stuff would just be window dressing and the details would not matter. Indeed, if this fight were grounded in freedom of informed choice, as I have suggested it ought to be, it might not matter so much (though I would still be deeply concerned about what this would do to the “informed” bit). But so much of the focus of this fight is selling scientific claims, so there is no room to allow the impression that the scientific basis of e-cigarette THR is fast and loose. Moreover, consumers need to be able to make informed decisions about their own lifestyles, but embracing junk science to try to manipulate the uninformed masses — even if it were an effective tactic — makes it likely that even relatively informed consumers will become immersed in bad information. The well-worn path of other insurgent consumer movements that turned to junk science suggests that this will result in most consumers making their decisions based on whichever cult guru they end up falling in with, rather than on real evidence.

 

The comparative risk of e-cigarettes — numbers, nonsense, and innumeracy

by Carl V Phillips

There have been a spate of claims about the comparative risk of e-cigarettes compared to smoking, triggered by the recent Public Health England (PHE) report which was published under a headline claiming that e-cigarettes are 95% less hazardous than smoking. My previous mentions of this are here and here. The 95% claim has led to criticisms and attempts at clarification, every single one of which, as far as I can tell, is wrong. Everyone in sight is trafficking in non-science at a minimum, and nonsense quite often. However, it turns out that a reviled tobacco controller commentary on the matter comes closest to getting it right. Continue reading

New claims about burden of disease from smokeless tobacco are utter junk (the short version)

by Carl V Phillips

There have been a spate of claims recently, stemming from this junk science paper (“Global burden of disease due to smokeless tobacco consumption in adults: analysis of data from 113 countries” by Kamran Siddiqi, Sarwat Shah, Syed Muslim Abbas, Aishwarya Vidyasagaran, Mohammed Jawad, Omara Dogar and Aziz Sheikh) that there is some huge health burden from smokeless tobacco. This piece of utter crap — bad even by the standards of tobacco control “research” — deserves a detailed point-by-point critique, but it is just so bad that I cannot stand to do it right now. So I am going to provide the short version. Continue reading

Sunday Science Lesson: So how would you estimate how many deaths are caused by smoking?

by Carl V Phillips

This continues from last week’s post. In that post, I pointed out what a death caused by smoking even means. (Recall: It technically means a death hastened by even one second. This means that basically every death in an ever smoker could be included, though this is clearly not how people interpret the figures and even those who are trying to exaggerate the number do not actually game it this way. Still, it is not clear what the claims do mean.) I then explored what data you would ask for if you could have any data you wanted to answer the question, a critically important thought experiment in epidemiology that is almost never done. (Recall: You would want to run an alternative history of the world where no one smoked but all else was the same, and compare the death counts.) Today I am going to move from that into what we can actually do with the data we can get, and why it fails to do a very good job answering the question. Continue reading

Ecig proponents need to learn lessons from other activists

by Carl V Phillips

Several recent conversations in the comments here, on other CASAA media, and elsewhere reminded me of the unfortunate fact that many pro-ecig activists have (a) little awareness of the history of fights about THR related to smokeless tobacco, (b) a hostile attitude toward pursuing their natural common cause with smokers’ rights advocates and those who oppose anti-smoking junk science for other reasons, and (c) a failure to understand that social cause activism is a well-worn path, and the habit of trying to reinvent it without seeking outside wisdom is a recipe for defeat. Point (a) largely represents simple lack of information (though this translates into unforgivable ignorance on the part of those who presume to be organizers and opinion leaders), which I am trying to address in my “Why is there anti-THR?” series. No such explanation is available for the latter two, which seems mostly driven by a lack of appreciation for what constitutes useful tactics.

One of the aforementioned conversations began when a vaper activist prominently repeated anti-smoking junk claims, specifically the claimed number of deaths from smoking and the trope that smokers cost the rest of society money. (I have covered these in depth elsewhere. The very short version is: 1. The death claims are basically made-up numbers, cooked up by anti-tobacco activists using secret methods and secret data, in blatant contravention of the principles of proper science; thus they are almost certainly biased upwards even if they are roughly accurate. I started a series that goes into greater depth on such estimates. 2. Smokers clearly save the rest of society money; claims to the contrary are utter junk. See this comment thread for more on the latter, and also an example of the problem I am addressing here.) It is easy to understand the urge to repeat these claims. But it is almost as easy to see why this is a very bad tactic.

It is very difficult to credibly argue, “we should trust whatever CDC et al. claim about smoking, but what the same people say about e-cigarettes is a bunch of blatant lies.” This lack of coherence probably does not matter much for social media sloganeering. But then again, nothing matters much there because most such material is just preaching to the choir. It can be valuable catharsis and cheerleading, but it is not advocacy action. As soon as you start trying to build a coherent case, such as writing testimony or an advocacy article, the self-contradiction becomes apparent.

Every endorsement of an ANTZ claim increases their credibility across the board. Cite them as definitive authorities on one point, and it is difficult to suggest that they are completely wrong about a similar claim about another product. This would create a dilemma if they really were providing good and useful scientific information about smoking while lying about THR products, but they are not. Their claims about smoking are as full of lies and junk science as their claims about THR products.

So, you ask, what if you want to say that smoking is really bad for you and kills hundreds of thousands of Americans every year? Just say it — everyone knows this and so you do not have to cite anyone. (Or better still, just don’t say it — again, because everyone knows it.) What if you want to give death statistics to three significant figures, or even two? Don’t do it! Such claims of precision are patently absurd on their face (even done honestly, the calculations are necessarily far too rough and assumption-laden to be so precise), and those claims are the product of professional anti-tobacco liars.

From a tactical perspective, never forget that these people are the poster children for the aphorism “give them an inch….” Perhaps you personally support smoking place bans because you would like to reduce how often you have to smell smoke (I trust you understand that it has no material health impact for you). So be it. But don’t think for a minute that such bans are good for vaping; once they are in place, the proposal to extend them to vaping will follow immediately. The core strategy of tobacco control is to seize whatever advantage they can, whenever they can, and then use that as a launching point for grabbing more. This includes getting one dubious claim established as “fact” and then building more such “facts”. They have to be fought in depth because — as everyone who has fought them before can tell you — their ambition knows no bounds. To torture the ground-war metaphor, you personally may think there is a natural line of defense (e.g., between products that contain bits of shredded tobacco leaf versus high-tech tobacco products that do not, or between high-risk versus low-risk products) where they would consider stopping their advance, but they do not.

Repeat their claims exaggerating the health effects of “second-hand smoke” and you strengthen their efforts to forbid even the lesser impacts of  “second-hand vapor”; you have endorsed their junk science, as well as their intentionally inflammatory term for environmental tobacco smoke or environmental vapor. Endorse the patently false claims about smoking costing society money, and you invite punitive taxes on e-cigarettes (because then it must be true of vaping also, so it is just a matter of negotiating the price). Suggest that smoking is never a legitimate choice but just a horrible “addiction”, and it helps them make the exact same point about vaping.

This is not to say we should never attempt to use ANTZ lies against them. That is always a good tactic (and fun!). But it needs to be done without endorsing the lies. The best way is often an “if you really believe that, then why…?” construction. E.g., “if you are really so concerned about environmental exposure, why are you not encouraging all tobacco users to switch to smokeless tobacco which has no environmental impact?” or “if you are so worried about the impoverishing effects of buying cigarettes, why do you charge smokers $7 a pack in taxes?” This challenges their inconsistencies without needing to endorse either of their claims. Indeed, it is nice little hobby to adopt to follow a few ANTZ organizations or individuals on social media and point out such contradictions whenever the opportunity presents. (The “if you smell something, say something” principle.)

But if you adopt their language, then you are playing their game. Adopt their “facts” and you are paving the way for the next “fact”, which you may not like. Endorse one of their efforts to impose restrictions and they will grab that and move on to demanding the next restriction, which you might not like. This is obviously not to suggest just being contrary. Sometimes they are right about something. But usually they are right for the wrong reason, if you see what I mean. So make sure to endorse the fact or policy without endorsing their path to it.

But all this is only half the problem. In fact, it is less than half the problem. The bigger issue is letting the other side trick you (perhaps unintentionally) into fighting the wrong battle.

I was impressed by the usefulness of Katha Pollitt’s observations in a recent a NYT op-ed about tactics in abortion rights advocacy. Whether you share her goals there or not, there is much to be learned from her tactical assessment. There are similarities with the fight and tobacco product users’ rights. Indeed, the fights are extremely similar in lots of ways, with the notable contrast being that those who would restrict abortion rights often articulate well-defined moral positions (based on the rights of other parties or theistic rules) that are shared by many, while “public health” is based on vague moralistic premises about proper behavior that involve no other parties and no religious doctrine. The “public health” moral position is never actually articulated because proponents realize that few people would support them if they were honest about their motives. (Needless to say, this observation is true whether or not you agree with the anti-abortion moral principles, and does not imply that everyone taking that political position articulates a defensible moral position. Also, I trust I do not have to mention that I am not inviting debate about claims or policies related to abortion; comments that go in that direction will not be posted.)

Pollitt writes:

To deflect immediate attacks, we fall in with messaging that unconsciously encodes the vision of the other side. Abortion opponents say women seek abortions in haste and confusion. Pro-choicers reply: Abortion is the most difficult, agonizing decision a woman ever makes. Opponents say: Women have abortions because they have irresponsible sex. We say: rape, incest, fatal fetal abnormalities, life-risking pregnancies.

These responses aren’t false exactly. Some women are genuinely ambivalent; some pregnancies are particularly dangerous. But they leave out a large majority of women seeking abortions, who had sex willingly, made a decision to end the pregnancy and faced no special threatening medical conditions.

We need to say that women have sex, have abortions, are at peace with the decision and move on with their lives. We need to say that is their right, and, moreover, it’s good for everyone that they have this right: The whole society benefits when motherhood is voluntary. When we gloss over these truths we unintentionally promote the very stigma we’re trying to combat. What, you didn’t agonize? You forgot your pill? You just didn’t want to have a baby now? You should be ashamed of yourself.

Some of her other material is equally interesting, particularly the discussion that follows about mobilizing those who she feels should actively support her position but do not. But I will stick with this passage.

To paraphrase her argument, if proponents of her view lean too heavily on arguing that abortion is a remedy for the effects of rape or a dangerous pregnancy, then they are failing to actually fight for the right to choose to have an abortion. You could imagine that if that position won the debate, then abortion would be permitted but always subject to some adjudicator deciding that the circumstances of the pregnancy were repugnant or dangerous enough. This would be considered an almost total loss for many of those who lean on the arguments Pollitt cites.

It turns out that opponents are unlikely to take advantage of that opening because many of them still find that outcome unacceptable, but the same is not true for the analogous situation for e-cigarettes. Tobacco controllers will grab anything they can. If e-cigarette proponents lean too heavily on e-cigarettes being a cure for the evils of smoking, it sets us up for a similar near-total-loss “victory”.

E-cigarettes do reduce smoking, of course. But if their use is defended almost exclusively on the basis of them being a “cure” for smoking, then their opponents can argue — and do — that their quality should be lowered or price increased so that they are just attractive enough to be acceptable to smokers but not really all that appealing. Opponents further toy with such ideas as making e-cigarettes available only by prescription, letting people who are quitting smoking use them but no one else. It does not take a lot of knowledge about tobacco control’s history to know that the next step there is to attempt to sanction such vaping for only a few months. After all, we also claim (truthfully) that many vapers who thought they would never be able to quit smoking find that they can take or leave vaping and that they would never consider going back to smoking. If this is just about providing a cure for smoking, the obvious ANTZ response to these observations is, “great! now we should go ahead and make them quit vaping too.”

What happens after a clinical trial (RCT) of usage behavior comes out that “proves” that cigalikes are just as good for smoking cessation as open systems, or that particular liquid flavors do nothing to benefit smoking cessation? (You may think that these claims are not true and therefore such a result will never occur. But the typical RCTs produce pretty much random results when the goal is to understand real-world behavior, and so it is inevitable that such a result will come out of some of them.) There is no doubt the ANTZ will then argue that open systems and those flavors should be banned. After all, this is just about smoking cessation, right? And that will just be the start. When they make some progress on one of those points, they will move on to further erode product quality.

Similarly, leaning on the “this is needed for stopping smoking” arguments facilitates the ANTZ claim that e-cigarettes are not needed because everyone should just use the “proven” “approved” methods to quit, and anti-smoking measures will soon force everyone to quit regardless. Of course, a valid response to any of these “science-based” claims is that they are wrong: RCTs in this area are junk science; those other cessation approaches do not actually work very well; total smoking in the world continues to increase. But even though these are obvious to anyone with expertise in the area, this is a layer of fight that is often lost. If the argument instead focuses on the real harm reduction philosophy — smokers’ right to choose to switch if that is what they prefer — then it is not necessary to struggle to convince everyone that the “proven” cessation methods are not promising.

The point here, in case it is not obvious, is that the choice to use e-cigarettes serves multiple purposes. Smoking cessation is one of them. But using the products also provide benefits, which is why people choose to keep using them. The real goal is protecting the right to choose to vape, and to be able to do so using one’s preferred products, without punitive taxes or unreasonable restrictions. This does not mean abandoning the smoking cessation and public health arguments, obviously. They are valid, important, and very useful, particularly when responding directly to health-based claims. But if they are emphasized to the point of not even mentioning that people just like to vape — and that letting people do what they want, in the way they want, when it does not harm anyone is a good thing, and there is no conceivable basis for denying them this choice — then the opponents have successfully seized control of the debate. It is being conducted on their terms with their messaging. If the battle is fought there, they stand a very good chance of success.

I wrote the above during the course of the last few weeks. Then events provided me with a perfect ending. Yesterday’s Public Health England report, which was very positive about the value of e-cigarettes in smoking cessation and which disputed some of the worse anti-ecig junk science, was touted by many e-cigarette advocates as The Best Thing Ever. But was it? It has obvious benefits, of course, merely by being a government report that has something positive to say about e-cigarettes. It also has junk science claims. What it does not have is any recognition of the concept of consumer choice, nor any discussion of consumer welfare, let alone of joie de vivre.

It is a document written by tobacco controllers, albeit ones who happen to think that switching to e-cigarettes should be encouraged as a method of smoking cessation, and it treats e-cigarettes as the equivalent of that agonizing choice that is necessary to save the mother’s life. Much of the discussion about the report has focused on the possibility of medicalizing e-cigarettes. It has been suggested to me that the report’s headline claim, that vaping is 95% less harmful than smoking (a made-up number that was reported as if it were science-based), was intentionally chosen to be able to claim that switching is clearly better than continuing to smoke, but still poses such a high risk that no one should do it (or be allowed to do it) unless they absolutely have to.

A standard response to these observations is that the authors took it as far as they could go, given that they could not overly offend or indict tobacco controllers, especially those at Public Health England who could have spiked the report. But how, exactly, is that reassuring? The inevitable answer is that it is a step the right direction. But does that step really suggest a trend, or is this “as far as they could go” really “as far as they will go”? It is just far enough to give tobacco controllers a nice place retrench, albeit with a definite retreat from utterly vilifying e-cigarettes and convincing people they are as harmful as smoking.

The report fits perfectly into tobacco control’s history of attempting to undermine real harm reduction by co-opting it to be just about curing smoking in people for whom all else fails. There is no choice or freedom; tobacco control is about grandees deciding what people should be doing, and the new report does not depart from that. There is no empowerment or discussion of preferences except as methods of manipulation; the report reads like a study in how to best care for livestock. There is no suggestion that someone might be better off vaping rather than quitting all tobacco products entirely; indeed, it says just the opposite.

The useful-idiot-level tobacco controllers have been decrying this report since it came out, but I suspect their puppet masters are not all that concerned. After all, the EU Tobacco Products Directive, with its anti-ecig provisions, will soon come into force, so the practical implications for the UK are limited to encouraging the use of e-cigarettes in medical or government smoking cessation interventions. (It has been suggested that this report will probably have the most value for American advocates; we are fighting a hodgepodge of local attacks and can offer this as political cover for politicians who oppose the attacks.) Even if the content of this report were undisputed, it would not stop vaping opponents from continuing to push for restrictions, product quality reduction, medicalization, and sending the message that e-cigarettes are bad except in the immediate context of smoking cessation.

They’ll take it.

It is, after all, the rough equivalent of that hypothetical pyrrhic victory of allowing abortions whenever those in power can be persuaded that the need is sufficient in a particular case.

Then they will keep pushing.

Pro-ecig scientific claims are descending toward tobacco control quality

by Carl V Phillips

I have watched with dismay as the relationship with science in the e-cigarette advocacy world has continued to descend toward that found in tobacco control: embracing anything that supports ones political beliefs and rejecting anything that does not, regardless of the validity or scientific defensibility of the claims. While we are still a ways from parity — and it is certainly the case that pro-ecig misinformation tends to move the debate closer to reality even though it is wrong (because the anti-ecig misinformation is so widely believed) — it is hard to not extrapolate the trend. And even if it stops here rather than continuing downhill, we are not in a good place. Continue reading

Sunday Science Lesson: “X people die from smoking” – what does that even mean?

by Carl V Phillips

In the comments, I was recently asked a version of the question in the title. I started an answer and was going to add more, but decided it would make a good post. So here it is. The original question (slightly edited) was:

How long must a person be a nonsmoker before his eventual, inevitable, death is regarded as unrelated to smoking? Or is it that if you ever smoked, no matter how long ago, and eventually die of something that might be smoking related, then it is counted as a smoking caused death? For example if somebody smoked, socially, for 10 years between 1955 and 1965, and then ceased smoking. If he happened to die today at age of 75 of heart disease or bladder cancer, is that death listed as smoking related?

Continue reading

On the complete absence of ethical etc. thinking in tobacco control (in the context of denicotinized cigarettes)

by Carl V Phillips

In a discussion group of scientists, policy-influencers, and other players in the world of THR (mostly e-cigarette) policy that I am a part of, there was a long discussion of mandatory “denicotinization” of cigarettes. As the discussion progressed, I ended up contributing an overview analysis of the whole matter that I think warrants a wider airing here. What appears below is the post I made there, though to protect the confidentiality of other contributors I referenced in the original I have deidentified them (following the Chatham House rule) and replaced their names with letters (W,X,Y); I am posting a note to the discussion group that those who want to claim credit for their contributions or to continue the debate here should jump in.

For those who may not know, the idea of forcing manufacturers to lower the nicotine content of cigarettes to make them less “addictive” has been kicking around from before the time there was much serious discussion about THR. The proponents of this arranged to have written into the Tobacco Control Act the provision that FDA can impose such mandatory reductions or ceilings, with the only limit being they cannot mandate complete removal of nicotine (which is really a meaningless caveat, since there is no practical difference between that and mandating a ceiling of a miniscule quantity nicotine — hey, it is not zero!). Continue reading