The @CDCTobaccoFree follies: propaganda, promotion of scientific illiteracy, and censorship

by Carl V Phillips

The twitter feed from the anti-tobacco liar branch of the U.S. Centers for Disease Control (CDC) is one of the more pathetic efforts of our government. I will circle back to its worst problems, but for now I will just observe that they rarely get 10 retweets of anything or positive comments, including from their own sympathizers. Mostly the CDC tweets just generate replies from the public, criticizing their stupid claims and lies. Those of you who follow me on twitter see my hacked MTs of their posts, translating them into what it really means.

So a funny thing happened yesterday: They were well on their way to getting 100 or more retweets of a post and numerous positive comments. We will never know how many they would have gotten because they deleted it, an act that is clearly inappropriate and pretty clearly a violation of government records and communications rules. Continue reading

Dear @FDATobacco: Stanton Glantz’s junk science reflects upon you

by Carl V Phillips

Dear FDA Center for Tobacco Products:

I know you did not create Stanton Glantz. His intense barrage of patently absurd junk science predates your existence. You did not cause him to become the combination of utterly innumerate and/or sociopathic (it has always been difficult to be sure how much his utter disregard for real science is explained by each of these). But you own him now, thanks to the fact that you fund him and his minions, and so his nonsense is now on you. You claim to be about science. Are you? Continue reading

New Phillips-Burstyn-Carter working paper on the failure of peer review in public health

by Carl V Phillips

Our new working paper is available at EP-ology, “The limited value of journal peer review in public health: a case series of tobacco harm reduction articles”, Carl V Phillips, Igor Burstyn, and Brian L Carter (all of the authors are affiliated with CASAA, for those who may not know).

Abstract:

Background: A widespread belief holds that the journal peer-review process has magical powers to ensure that published claims are correct. While this misperception has limited consequences in many fields, in public health it results in consumer, clinical, and policy decisions being based on blind faith in the accuracy of published claims. At best, the review process is merely a couple of readers — perhaps, but not necessarily, highly expert — reading through a paper to ensure the research and presentation are reasonably sound. In reality, even this is often not accomplished.

Methods: We conducted reviews of 12 articles that focused on tobacco harm reduction published in a mainstream public health journal, BMC Public Health, consecutively during 2012-15. We each wrote a reviewer report of the manuscript version that was sent to the journal reviewers, as if we were writing a review for a journal. We then compared these to the reviews written by the journal reviewers. Additionally, we reviewed the changes made to the papers as a result of the journal reviews.

Results: Almost all the papers in the dataset suffered from major flaws, most of which could have been corrected, but none were corrected by the journal review process. The journal peer reviews were almost all inadequate and many contained no substantive comments. Those that contained substantive observations still did not identify most of the blatant major flaws that we noted. In the single case where a journal reviewer identified many of the major flaws, the comments were basically ignored by the authors and the paper was published with no substantive changes. Other than cosmetic improvements, the journal review process was about as likely to make the published version worse than the submitted manuscript, rather than better. Papers with no apparent value were published by the journal and the potential value of other studies was lost because serious flaws in the paper were ignored. Unreported conflict of interest was common among both authors and reviewers.

Conclusions: Faith in the journal peer-review process is misplaced. Even at best, the process cannot promise that a published claim is correct, but in reality it does not even ensure that patent major flaws are not present. In public health, the phrase “according to a peer-reviewed journal article” seems to mean little more than “I read this somewhere.”

It should be evident from the abstract that the primary study aim is not about THR. However, readers of this blog may be interested for several reasons. Most obviously, the case studies are based on articles about THR. But also, the idolatry of journal peer review is one of the more important causes of the persistence of anti-THR lies. Analyzing the reviews of the papers, not the papers themselves, was the purpose of the research, but that required assessing the papers en passant, which means that readers interested in that aspect will should find a fair bit of the content interesting (particularly delving into a few of the appendices).

Some of the material has already been covered here. The previous post was basically written as a footnote for the paper. The post about the terrible paper by Hughes (“Associations between e-cigarette access and smoking and drinking behaviours in teenagers”, by Karen Hughes, Mark A Bellis, Katherine A Hardcastle, Philip McHale, Andrew Bennett, Robin Ireland, and Kate Pike) was basically an excerpt from that research project. The extensive analysis of the Popova-Ling travesty was incorporated as part of the analysis in the paper.

There are few other papers in the analyzed case series that also fall solidly within the anti-THR lies category. There is this one (“Portrayal of electronic cigarettes on YouTube”, Chuan Luo, Xiaolong Zheng, Daniel Dajun Zeng, Scott Leischow) whose value lies entirely in it being unintentional comedy. Strangely, despite being a useless, silly, and badly conducted study, that was then written up as a political broadside that had nothing to do with the study results, it was probably only the 10th worst of the 12 papers in our case series.

Two of the papers were written to try to vilify snus. This one (“Snus user identity and addiction. A Swedish focus group study on adolescents”, Ingrid Edvardsson, Margareta Troein, Göran Ejlertsson, Lena Lendahls) is mostly just uninteresting in terms of what it claims. This one (“Predictors of smoking among Swedish adolescents” Junia Joffer, Gunilla Burell, Erik Bergström, Hans Stenlund, Linda Sjörs, Lars Jerdén) relates more closely to recurring themes from this blog. In particular, it makes the naive gateway claim that fails to distinguish between association and causation. This is particularly pathetic in this case because the paper is ostensibly about predictors and not causes.

Comments on the working paper are welcome, either in the blog comments at EP-ology or via email.

Post publication peer-review: Correction to Burstyn (2014) and related matters

by Carl V Phillips and Igor Burstyn

[Igor Burstyn is an Associate Professor at Drexel University School of Public Health and a member of the CASAA Board of Directors. His research that is described here was sponsored by CASAA.]

Burstyn (2014), “Peering through the mist: systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks”, BMC Public Health, is probably the most read scientific paper on e-cigarettes and among the most read in the history of tobacco harm reduction. It is often described as the most important paper on e-cigarettes, being the first to point out that there is ample existing evidence that the non-novel chemical exposures from vaping – which are used to concoct alarmist propaganda — are inconsequential. So imagine our surprise when, after well over 100,000 people had viewed the paper at the journal’s website and countless more via other means (the announcement of the publication of the working paper version remains the most read post on this blog), it went through journal peer-review, and each of us poured over many revisions, one astute reader caught a bright-line error in the results. It is recounted in the following text by IB: Continue reading

“Second-hand vapor”: what tobacco controllers would say if they really believed it was a problem

by Carl V Phillips

None of the people nattering on about the environmental effects of vaping are actually concerned about what they claim.  This has occurred to me before, but it was made particularly clear at the recent FDA workshop that I recounted here and here. It is a very simple point: If there were anyone out there who was actually worried about the effects of “second-hand vapor” or (giggle) “third-hand vapor”, rather than just using claims about them to rationalize attacks on tobacco harm reduction (THR), they would be encouraging the use of smokeless tobacco (ST) instead. Continue reading

More on the FDA ecig workshop

by Carl V Phillips

Those of you who watched my contribution to the workshop (which you can do by following the link in yesterday’s post) probably found the most memorable observation to be the one about San Francisco. But I am rather prouder of not missing a beat regarding a later question. Leading into that, there was a rambling multi-part question to the panel, which a couple of others responded to bits of. I took the mic last to respond to the phrase “renormalizing smoking” in the question. Continue reading

Notes from the FDA e-cigarette workshop

by Carl V Phillips

I have several posts worth of material to cover on the themes presented here. I’ll see if I can get to them. In the meantime, some random thoughts about the third FDA Center for Tobacco Products workshop on e-cigarettes that took place on Monday and Tuesday of this week. As with the previous workshops, it was a mixed bag of good science from industry and a few others, sneaking in amidst the utter junk from the “public health” types. At this one, the mix was perhaps almost up to 50-50, which is a lot better than the previous ones.  Continue reading

Gateway effects and snus taxes in Alberta

by Catherine M Nissen

[Editor’s Note: This is a guest post by CASAA Research Associate, Catherine Nissen. –CVP]

As most readers of this blog know, the gateway effect argument has been used aggressively by anti-THR advocates against smokeless tobacco and electronic cigarettes. They claim that using the low-risk alternatives will cause people to start smoking. Recently I have been working with Carl V Phillips on his paper about detecting gateway effects. He explains the logic of the claim and why it would be unlikely to occur in natural circumstances. But, as he explains, policy actions could manage to create gateway effects, either intentionally or inadvertently. Even then, he was able to offer only a few examples of where it might have happened. I am living in the middle of one of those examples, in western Canada.

As Carl has noted a few times (example), several nonsmoker experts on low-risk tobacco products have started using snus as adults because they learned about the minimal health risk and wanted to reap the benefits of the cognitive enhancement and risk reduction in neurodegenerative diseases that tobacco offers. While I may not be among the esteemed senior scientists he is referring to, and I admit I use snus a bit more for the pure pleasure of it rather than the cognitive enhancement, I am among those who took up snus use after learning about the low costs and substantial benefits. My grandmother suffers from Parkinson’s, and the risk reduction from it that tobacco offers is definitely among my motivations for continued use. I am also among the unfortunate few who have been pushed from low-risk product use into smoking some of the time. I am not sure whether this counts as a gateway case. It certainly is not an example of what the tobacco controllers have in mind when they make the gateway claim, since they are the ones responsible for it.

I have only smoked very occasionally throughout my life, yet I enjoy using snus (smokeless tobacco). I have a firmly established preference for nicotine, but I also have firmly established boundaries on how much I am willing to pay to enjoy it. I am a nonsmoker because the cost of smoking, health-wise, was always too much for me.

After Carl established the tobacco harm reduction research and education efforts at the University of Alberta School of Public Health in the 2000s (a group that would later include me, Karyn Heavner, and several others who have contributed to the field, along with Igor Burstyn sitting in), he, Paul Bergen, and some of Carl’s students launched the first concerted attempt to widely popularize the THR message. In response to this, the anti-tobacco people in Alberta shifted their effort away from trying to discourage smoking to trying to discourage THR. It worked. Today the taxes here on smokeless tobacco are exorbitant. I pay almost $25 for a tin of snus. A pack of cigarettes is about $12, less than half the cost. The price of a tin of snus in the U.S. or overseas is about $4. Under those economic circumstances, only people who are both wealthy enough and highly motivated would choose smokeless tobacco it in lieu of cigarettes. For a person of average means, this price difference is a strong incentive not to try THR, even if they are aware of its benefits.

I have a friend who was a very avid smoker, but armed with the knowledge of THR (simply because he knew me, and despite “public health” efforts to sow disinformation) and the desire to quit smoking, he switched successfully to snus. It wasn’t easy at first, but he became a regular user. As the prices kept rising, though, he moved back to cigarettes. The balance of cost and benefit in his case gave the edge to cigarettes. Eventually, however, he moved back to snus, despite the cost, because of his desire to be smoke-free. He is being punished for that choice, at a rate of about almost $5000 per year more than he would pay for smoking. The difference is because the government is charging him over $7000 per year in taxes on snus, a price he pays for not smoking.

It was much the same with me. I found myself strapped for cash and not willing to pay the cost of snus. My initial brief thoughts on buying cigarettes instead (as I talked about here) became much more prevalent. I caved to them and did buy cigarettes for a time. However, I found I could not smoke more than a pack a week because the health effects from them were so immediate and unpleasant. At the end of a week I would cough throughout my day and my taste and smell were affected. I ended up giving up on cigarettes and now just use snus infrequently. This lowers my welfare substantially from what it would be, and provides no benefit for me or anyone else.

Still, I am luckier than many others. There are countless stories around here of people who prefer smokeless tobacco and have a history of using it instead of smoking sometimes, and being tempted to switch because of the absurd anti-THR price differential. Many of them are also victims of the disinformation about smokeless tobacco and so think there is little or no health difference between the products. For me, the punitive tax on snus made smoking a more attractive option in the short-term, but near-abstinence was more attractive because I understand the huge increase in risk with smoking and because I don’t gain as much from tobacco use as some others do. But others will just choose to smoke. I don’t personally know any smokeless tobacco users who switched to being exclusive smokers because of this tax, but I’m sure there are some because there are many smokeless tobacco users in the region.

So we have a demonstration of policy actions causing a gateway effect from smokeless products to cigarettes (for both a nonsmoker and an ex-smoker). For people uninformed about the health benefits of THR, high taxes on smokeless products (and lower taxes on the more harmful alternative) discourage it. People respond to price in the near term, especially when they are strapped for cash. This is a clear argument for making sure that THR products remain at lower prices than cigarettes, not higher.

As far as I can tell, my story is the only published testimonial of someone who was never a smoker (and clearly never would have become a smoker) who started using smokeless tobacco, and as a result of that became a smoker (though only temporarily). The proponents of the gateway claim never give any examples of people who seem to be gateway cases, which is one of the many reasons that their theory does not hold up to scientific scrutiny. I doubt that my story is what they have in mind, however, since anti-THR efforts were the ultimate cause of this. Without those “public health” policies, I would not have become a smoker.

I am sure a much more common story is like that of my friend who was encouraged to return to smoking even though he wanted to switch, which you might or might not call a gateway effect. This same effect seems to have happened with electronic cigarettes in Spain. It may be happening with electronic cigarettes elsewhere (the UK, California), because disinformation about their risk is tricking many people into believing they might as well smoke. It could certainly happen if all or most e-cigarettes are banned, as the U.S. FDA has proposed.

There is a high prevalence of “natural” smokeless tobacco use in Alberta, probably more than anywhere else outside of Scandinavia and a few rural subpopulations in the USA, because so many people work in jobs where smoking would be difficult. Most likely they don’t know they are engaging in THR (thanks to the disinformation campaigns that are ongoing here). Some may simply enjoy the fact that they are coughing less and experiencing other health benefits from reducing or quitting their smoking. In any case, giving these people a good reason to smoke instead is potentially creating a gateway effect to smoking, and yet it is created by the very people who claim to be worried about gateway effects.