Monthly Archives: September 2012

There are no “neutral” views on THR (but there are clues about who is honest)

Posted on 30 September 2012 by | 5 Comments

posted by Carl V Phillips

I run into quite a few people who want there to be some authoritative honest broker who can provide a “neutral” opinion about THR.  (Actually, we see this all the time regarding most controversial subjects, and it fails for basically the same reasons.  But I will stick to talking about THR and you can extrapolate to other topics.)  Everyone defers to authority or conventional wisdom for the overwhelming majority of what they do and think — that is the only practical way to exist.  But when there is political controversy and the issue is important to your own health (or public health, for those making public health pronouncements), it is time to stop deferring and recognize that there often (perhaps usually) are no neutrals.

This is clearly the case when it comes to THR.  While these observations are probably obvious to anyone who is invested in this topic, it might provide some useful information for those trying to begin to understand it.

A favorite target to defer to on matters of health (even by many non-Americans) is the US government.  Deferring to them in this cases consists of thinking: “They say e-cigarettes and smokeless tobacco are very very bad for you, so it must be true.  After all and they would not mislead me.”

Really?  Does anyone really believe that the government would not be biased or try to sell you on a particular belief system?  Almost no one would ever make such a claim, and yet many people act as if they believe it.

I hope it is obvious that our government is not an unbiased neutral broker of information when it comes to, say, the Department of Defense opining on the usefulness and ethics of assassination-by-drone-aircraft, or the Drug Enforcement Agency offering its assessment of the Drug War.  The retort I might expect to that is that, FDA and CDC are supposed to be looking out for our best interests, not pushing an agenda.  But I would expect that the people at DoD and DEA also think that they are looking out for our best interests.

The government, of course, is not a unitary actor, but consists of a lot of operations that each have their own mission.  When officials create a particular unit or a particular assignment, they have a goal in mind, and it is seldom to create a neutral arbiter.  But even when that is the goal, the well-known phenomenon of “agency capture” means that the people who join the agency or exert the most effort to influence it will be those who are highly focused on the issue, which is basically synonymous with “interested in a particular outcome”.

Most of the time, the capture is by an industry that stands to make or lose profit based on agency actions.  Sometimes not.  Theoretically, the government units that deal with tobacco could have been captured by the tobacco industry, but instead they were captured by the tobacco control industry.  Why that happened is no mystery, but it is sufficient to just observe that it happened.  So, there are revolving doors (people moving between the tobacco control industry and government agencies that support them) and iron triangles (a generalization of Eisenhower’s “military industrial complex” concept, which is basically the epitome of capture) everywhere you look.  No agency employee would dare contradict the government anti-THR lies, let alone say that perhaps people can rationally choose to use tobacco rather than not.

Trusting government agencies to be neutral — on most anything — is simply absurd.  It is generally safer to assume the opposite.  In this case, it is easy to see who controls the agencies.  But it should be equally clear that for an issue like this, these observations about government generalize to any supposedly neutral committee (made of people with an interest in the issue, chosen by someone who has an opinion) or organization (which generally exist to advocate a particular position).

Moreover, for the case of THR, being neutral makes about as much sense as being neutral about the shape of the Earth.  Someone who claims the Earth it is flat is an outlier who apparently is unfamiliar with evidence, or is just lying for some purpose.  But someone who “sees that both sides have merit” is also a nutcase (or worse, an irresponsible journalist trying to provide “balance”).  It would certainly be possible for someone to present the arguments from the flat-earther alongside the rest of the evidence.  But anyone who did not then arrive solidly at “spherical” should not be considered a trusted source of information.

People who learn and understand the truth about THR — and tell the truth about it — invariably come down on the pro-THR side, or at least admit that it offers clear benefits for public health, overall welfare, and individual rights.  The honest brokers might recognize nuances and caveats that are absent from extreme pro-THR positions, but frankly there are not very many people who exhibit extreme pro-THR positions.

It is theoretically possible for someone to take an honest neutral position on THR or even an honest anti-THR position, but I am aware of nobody who does.  It is possible to argue “there is overwhelming evidence that the risk from smoke-free tobacco/nicotine products is very low, and there is no reason to believe that encouraging their substitution for cigarettes will have negative effects on health, but I oppose [or, am on the fence about] providing accurate information and legal access to these products because….”  The “….” would have to be a statement like “I do not really care about health outcomes, but only care about hurting the tobacco industry” or “I am more worried about whether other people sully their bodies by using a drug then their happiness or health”.

You never hear such honestly, but it is theoretically possible.  The one version of the “….” that you almost see sometimes is “I care more about whether people are ‘addicted’ than the effects of that behavior”, but even this it is never stated so honestly, and is never coupled with the honest presentation of the health benefits.

The truth has an overwhelming pro-THR bias, and those who would attack THR implicitly acknowledge that fact by avoiding the truth.  Everyone who is anti-THR, or even claims to be neutral, whatever their real motivations might be, lies about the health science and bases their stated oppositions on those lies.  So they clearly fail the “honest broker” test.

But there is still a useful guide to finding the truth in this, but (like any other useful guide) it is not as simple as “just trust the government”:  When you observe:

  • everyone of any visibility on the anti side repeatedly makes claims that those on the pro side point out are lies, often based on easily verifiable information
  • those on the pro side consistently acknowledge and respond to the claims made by the antis
  • while those on the anti side never engage in dialog, not even so much as to dispute the substantive statements made on the pro side, but instead just keep repeating the zombie lies
  • some of those on the pro side try to police their side’s information, while those on the anti side virtually never criticize anyone on “their team”,
  • and those on the pro side can explain and document the motives of the antis to lie, while the antis can only resort to (unsubstantiated, and indeed easily refuted) sputtering protests about the other side consisting entirely of some secret industry cabal (for a non-existent THR industry, no less!),

well, then, I really think that it is not too difficult to figure out where to find the honesty.

 

 

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Aside: Something is always worst

Posted on 30 September 2012 by | 1 Comment

posted by Carl V Phillips

I recently found myself making a brief comment in a conversation about anti-tobacco activism, asking (not for the first time, as you might guess), by what right do those people presume to tell others how to live their lives?  These people have convinced themselves not just that such nannying is a legitimate and even worthy cause, but that it is so worthy that it trumps every rule of ethical behavior, such as honesty (thus the need for this blog).  By what right?

Based on the content of their monologues, I am fairly certain that if faced with that question (if those people ever entered into conversations outside of their echo chamber), the answer would often be based on the claim, “it is the leading preventable cause of death”.

I would be really interested in hearing the answer to the follow-up question, “by what right do you presume to tell others that they must avoid the leading preventable cause of death.”  But setting that aside, as well as the fact that the this “leading preventable” claim is inherently nonsense, let us just accept their logic:  If something is the leading preventable cause of death, then it warrants all manner of expensive, utility reducing, and civil liberty destroying interventions.

Now imagine that they succeed (or, if you prefer a realistic scenario, that THR succeeds) and smoking is dramatically reduced, and so use of tobacco and nicotine is no longer leading.  The activists will be loath to admit this has occurred, ending their gravy train, but posit that at some point they will have to.  After all, they keep claiming that day is just around the corner.  Once that happens, something else is the leading preventable cause of death and, by their logic, warrants the full-blown attack on welfare and freedom.  That is the way superlatives work: even if nothing is all that bad, something is still worst.

In all the arguments about the “slippery slope”, in which the anti-tobacco activists claim there is no such slope while others observe it is playing out just that way, the activists protest that there is no such risk because there is something unique about their current cause.

It is the worst.

They do not seem to realize that by making that very quasi-argument, they are undermining their own claim of uniqueness, and thus the logic (such as it is) of their own answer to the “by what right?” question.

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CDC on cigars – a great example of liar’s citations

Posted on 28 September 2012 by | 2 Comments

posted by Carl V Phillips

I will come back to FDA in a few days, but we want to cover a few other things first.  One is to point out that the behavior of the FDA — in terms of both being anti-THR and junk science about tobacco/nicotine — does not represent either new or exceptional action by the US government.  The CASAA leadership just happened to be discussing this document from the US Centers for Disease Control and Prevention (CDC).  It is about cigars, which is related to THR, though not a core part of THR efforts.

There is good evidence that cigar smoking in traditional cigar style — puffing into the mouth with minimal inhalation into the lungs — is much less harmful than cigarette smoking.  Of course, the same method can be used with cigarettes too.  However, the interest in such substitution is limited and switching to smoke-free alternatives is far healthier, so there has been little interest in pursuing this.  (In addition, a lot of cigar consumption lately has been for products that are basically cigarettes and are smoked like cigarettes, as a way to avoid the punishing cigarette taxes.  That is understandable motivation, but it is not meaningful harm reduction.)

Still, that document says a lot about CDC’s approach to tobacco.  About half of the content is cited to three sources (links appear in the original if you really want to see them):

1. Campaign for Tobacco-Free Kids. The Rise of Cigars and Cigar-Smoking Harms . Washington: Campaign for Tobacco-Free Kids, 2009.

2. National Cancer Institute. Cigars: Health Effects and Trends. Smoking and Tobacco Control Monograph No. 9 . Smoking and Tobacco Control Monograph No. 9. Bethesda (MD): National Institutes of Health, National Cancer Institute, 1998.

3. American Cancer Society. Cigar Smoking . Atlanta: American Cancer Society, 2010.

This is a great example of lying with citations — putting in little footnotes that imply that the information presented is based on the best possible evidence, when actually the sources are rather useless.

You probably noticed that the first is to an anti-tobacco extremist organization, which, among other things, opposes harm reduction.  Moreover, it is not research by that organization, or even a review paper, but is just a two-page broadside.  The third reference is similar:  While ACS is thought of as a scientific organization, when it comes to this topic, they are also an extremist activist organization with little regard for honest science.  The cited webpages have a bit more content than the CTFK broadside, but not much, and do not even cite evidence for their claims.

So basically, we have an agency of the US government sourcing its scientific claims and consumer advice about a tobacco product to activist organizations whose mission is to say anything they can think of that is negative about tobacco products.  Their job description is to be biased, and that often means dishonest.  There is no possibility that CDC does not know this.  Could you imagine the State Department citing information in its travel advisories to the Middle East to anti-Islamic activists or the Department of Agriculture citing nutrition advice to anti-GMO activists?  This is similar in terms of credibility.

[You probably could, however, imagine agencies of the government deferring to other, more powerful, players for information in their areas of interest.  That observation -- and its relation to the present topic -- will be the subject of this week's Background post in a couple of days.]

At least source #2 is a real scientific review.  The problem is that it is from 1998 — very old history in a field like this.  But, funny thing: the CTFK document cites that 1998 report extensively.  So what CDC is really doing, by citing CTFK, is trying to hide the fact that all their information traces to 1998 by citing a more recent document that cites the original.  A common sneaky trick used in undergraduate term papers, brought to you by an authoritative voice of our government.

It gets worse.  The first statements that are cited to those three sources are:

A cigar is defined as a roll of tobacco wrapped in leaf tobacco or in a substance that contains tobacco….[1][2]

The three major types of cigars sold in the United States are large cigars, cigarillos, and little cigars.[1][2][3]

There is nothing wrong with the information, of course.  What is baffling is why CDC felt a need to provide a citation for it.  What is even more baffling is that citation #1 does not even provide a definition for cigar; citation #2 probably does, but I am not going to hunt for it.  Interesting, #3 does provide a clear definition — based on tax law — but is not even cited for the first sentence.  There is also clearly no need to cite that second sentence, but if you are going to, it should be to something relevant (like the official tax or regulatory definitions).  Here is a hint for those of you who want to cite a definition:  try a dictionary.

That is mostly just amusing, but it shows a general lack of seriousness.  More serious, and equally lacking in seriousness, are the series of health and other claims that are also cited to these three sources.  And lest you think I am cherry-picking, there are no other cited sources that provide any health information.  I am not going to go into detail about the claims because, for the reasons noted above, their role in THR is limited.  Suffice it to say that there is a lot of doubt now about the conventional wisdom about the risks that existed in 1998 (that probably sounds a bit familiar for those who know the science about smokeless tobacco).

So, basically, the official word of our government is: “(a) as far as we know, nothing has been learned since 1998; (b) just go read these activists’ position statements because we just defer to them anyway.”

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FDA does not understand how science and knowing work

Posted on 27 September 2012 by | 7 Comments

posted by Carl V Phillips

Epistemology (roughly, how we know what we know) is at the core of scientific inquiry.  Some of the most profoundly anti-scientific claims that you will ever see — certainly among the most frustrating — are attempts to replace the complicated epistemic processes in science with simplistic rules of evidence.  Typically these are so oversimplified as to be suitable only for a stylized game like high school debate contests.  The rules are too simplified even for a courtroom, the context for which they are often designed.

As I noted in the first of this series of posts on the US FDA, FDA’s epistemic toolbox pretty much contains only one tool: their standard recipe for doing clinical trials of new pharmaceuticals.  That works pretty well for what it does, but it obviously represents only one little tiny corner of scientific methodology, let alone scientific knowledge.  The FDA document that I started discussing yesterday makes clear how unsuitable FDA’s limited understanding of science is when it comes to studying THR.  It includes:

Because clinical studies about the safety and efficacy of these products [e-cigarettes] have not been submitted to FDA, consumers currently have no way of knowing

This is followed by some bullet points, which I will address shortly.  But for now, just consider that sentence fragment.  No way of knowing?  Are they kidding? There is no way to complete that sentence truthfully, other than with something circular like “…no way of knowing what clinical studies submitted to FDA do say.”

The mind boggles at the arrogance.  The typical epistemic error is to claim that there is no evidence in the absence of studies that follow a particular clinical study recipe.  That is also completely wrong.  But there is something extra special about a unit of the government claiming that knowledge does not exist until it is formally submitted to them.  That is downright Soviet, or maybe even more l’état, c’est moi.

Since I cannot think of much to say about that other than shaking my head in disbelief, I am just going to pretend they said, “Because clinical studies have not been done….” and explain why this — the all-too common misconception that clinical trials are the best way to answer every single scientific question — is a lie.

The bullet points that complete the sentence are:

  • whether e-cigarettes are safe for their intended use,
  • what types or concentrations of potentially harmful chemicals are found in these products, or
  • how much nicotine they are inhaling when they use these products.

For some questions it takes a bit of work to explain why clinical studies are not the most useful method for finding an answer.  For example, clinical trials are not very good at answering the most important questions about whether smokers will switch to a THR alternative.  But that takes a bit of explaining (which I am sure I will eventually cover in this series).  But for now, FDA has provided examples that are so obviously wrong that there is no such challenge.

How do we know how much of what chemicals (nicotine and others) are in the vapor?  A clinical study is not well suited to answering this at all.  Instead, we need a method for drawing out and analyzing vapor that avoids the complication of the user absorbing some unknown portion of the chemicals (i.e., which does not include a clinical component).  And that has, of course, been done.  FDA even did it themselves (though they lied about the results).

We could replace the last point with something that actually does involve the user, like how much nicotine users are taking up?  That is possible to answer using clinical research methods.  Possible, but not necessary.  One way to measure nicotine uptake is blood chemistry.  But another is to just be the person taking up the nicotine and feeling the effects.  That will not answer some questions very well, but it is clearly a way of knowing.

How about whether e-cigarettes are safe (I am not sure what the “for their intended use” clause even means)?  Well, in that case some clinical studies would have been useful and would still be useful.  Indeed, we would have those if those in government “public health” thought of themselves as public servants (who would observe that the public wants this information and then try to provide it in order to possibly improve health) rather than public masters.  Nevertheless, clinical studies are obviously not the only way of knowing.

We have learned an enormous amount — in spite of governments’ uselessness in this matter — about the health effects of e-cigarettes.  We have ample data to rule out important negative acute effects, to be confident there are no non-rare major short-term health risks, to be optimistic about the lack of long-run effects, and to be quite sure that they are better than smoking by a lot.  This evidence comes from the experience of users as well as extensive data about other smoke-free nicotine sources and our knowledge from various sources about exposure to the other chemicals.

The general lesson here is that when someone claims “we know nothing” or “we have no evidence” about some scientific question, they either have no idea how scientific inquiry really works or they are lying.  Or both.

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