by Carl V Phillips
Yesterday, I explained what was fundamentally wrong with Stanton Glantz’s new “meta-analysis” paper, beginning with parody and ending with a lament about the approach of his critics who are within public health. Glantz posted a rebuttal to the press release from those critics on his blog, which does a really nice job of helping me make some of my points. I look forward to his attempt to rebut my critique (hahaha — like he would dare), which would undoubtedly help me even more.
Glantz pretty well sums it up with:
The methods and interpretations in our paper follow standard statistical methods for analyzing and interpreting data.
He offers this as a non sequitur response to the quote from Peter Hajek that I highlighted yesterday. Hajek’s analysis was the best thing in that press release, and it involved actual scientific reasoning, so it is little wonder that Glantz did not try to really respond to it.
But consider the ramifications of what Glantz said without pretending it is a response to Hajek. He is not wrong. Misinterpreting what studies actually show and doing inappropriate synthetic meta-analysis are indeed fairly standard practice in public health research. Notice that he did not say they are good or valid methods. This handily makes my point from yesterday: This battle against Glantz cannot be won by playing by the (awful) rules of public health academic discourse, because Glantz is playing by those rules. And winning — see his list he added to that post, of media outlets that reported his lies.
Glantz begins this reply to those critics with:
The most remarkable thing about these criticisms is their generality rather than engaging the specific substance of the paper.
This is simply false, fodder for Glantz readers who — as evidenced by the fact that they are Glantz readers — will believe anything they read. Half of the points in the critiques drill into the substance of the paper. The reason he can get away with this, however, is that the other half indeed did not engage substantively. As I noted, effective critiques need to cut to the heart of what is wrong. But of the three easily-identifiable and utterly fatal problems that I identified (and I have read the other critiques and stand by my assessment that it is really about those three), only one is effectively included in the press release. That is the second one I covered, about selection bias, and it was presented deftly only by Hajek. But this is the only one of the three where the details matter and can be debated, and thus the hardest to argue (though it is still indisputably a fatal flaw). The other two are 100% slam-dunks, but they require that public health people leave their comfortable zone [sic] to make them.
Robert West offered a weak version of my third point, that the results contradict reality:
“If use of e-cigarettes caused fewer smokers to quit, the quit rate in England would have decreased as use of e-cigarettes has increased. Data from The Smoking Toolkit Study – a large ongoing population survey of smoking in England – shows, if anything, the opposite.
Glantz responds:
Cigarette use rates have been declining since the 1970s in the UK, prior to the introduction of e-cigarettes. Simply comparing rates of cigarette and e-cigarette use does not allow for evaluation of the association between e-cigarette use and quitting (www.smokinginengland.info).
Credit where due (unlike many of those in this story, I do not refuse to recognize the validity of an argument based on who wrote it): Glantz is right. I could not have said it better. Well actually I could, and did: I noted that West’s claim is only valid if nothing else is affecting the rate of smoking cessation, which is really the point Glantz is trying to make. But he basically got it.
You will recall that I ran some numbers about the real world that show that Glantz’s conclusion cannot be right, that is utterly implausible. That is the real reason why reality contradicts the study. Playing the “I am citing a study that contradicts your study” game is not a winning strategy in general, and even Glantz can rip through it when the study does not, in fact, contradict him. Actually writing out a simple quantitative model (mine took me only a few minutes) is a great way to cut through absurdities. But if we start doing that, it becomes a threat to business-as-usual in public health research.
Circling back to Glantz’s introduction:
Despite these limitations, it is possible to draw important conclusions based on the available studies. In particular, we conducted a formal sensitivity analysis of the factors (and other factors) that the experts raise, which appears in Table 2 of the paper.
This is a type of claim that is hard to pre-rubut. That is, even though it is easy to show that it is wrong, it is hard to anticipate every absurd defense and address it specifically until after you see it. But in this case, I did address that claim, indirectly, in a couple of ways (the press release did not). In my parody version of the abstract, I pointed out that his sensitivity analysis consisted of “weak statistical stuff that we are not going to really explain or justify”. It really does nothing. Later I noted the value of comparative meta-analysis, a method for trying to explain why different studies produced different measures of supposedly the same phenomenon. There is no reason that analysis needs to be done with fancy statistics — it can be done via simple inspection.
Glantz’s Table 2 is an obvious fail because it does not identify the features of studies that produced extreme results. In fairness to him, it does actually address several of the supposed problems that the press release critics brought up, like whether the subjects were actively interested in quitting smoking. What it does not do is identify the studies that have fatal selection bias due to the “immortal person-time” problem I explained. If your “sensitivity analysis” does not actually figure out what the results were sensitive to (when it was clear that they were sensitive to something, given that they were widely scattered) it was a failure. But here we are back at the fundamental problems of public health research: Mock pro forma sensitivity analyses, that just give the illusion of robustness while avoiding the real scientific question, are the norm.
In response to most of Linda Bauld’s longish comment in the press release (19 sentences if you replace semicolons with periods), Glantz writes:
The studies of more intensive users of e-cigarettes and users of higher generation devices were specifically discussed in the Discussion as populations who might have increased rates of smoking cessation. It is important to emphasize that these people represent a small fraction of all e-cigarette users.
Setting aside the accuracy of Glantz’s statement, the real lesson here is don’t bring an essay to a soundbite fight. Bauld makes several good points. My quick count says 11 of her sentences were basically right, though not truly cutting, criticisms of the paper (6 were tangential; 2 were wrong). Glantz uses the oldest trick in the flame wars book, cherrypicking a single point to reply to, and implying it is a complete response. I made clear that I do not think highly of the soundbite fight game, but if you are going to play it, bring a soundbite. If you want to write a more complete analysis as a rebuttal, by all means write that instead. Or better still, just cite mine. :-) But pick one.
The real problem there was that Bauld, coming from a card-carrying tobacco controller perspective, suggests that the utter junk science approach is basically fine, and the problems lie in the details. For the one detail that Glantz cherrypicked to respond to, he is basically right: It is theoretically possible that some optimal users of better devices are helped to quit smoking, but most users of most devices are harmed. It turns out to be false, but it is not necessarily so. If you do not deny the validity of Glantz’s whole approach, you still lose on that point. Bauld did allude to my point 2, though she garbles it and misidentifies the problem as confounding rather than selection bias.
She also alluded to my point 1, noting the huge heterogeneity of the studies, but fails to point out that there is no possible way studies in this space could ever be homogenous enough to justify synthetic meta-analysis. Perhaps she does not even realize that is true. Or just wants to reserve the option of employing the same junk methodology when its results suit her personal politics. Indeed, earlier today a colleague messaged me with a rumor that this group of critics now wants to do their own meta-analysis of the “good” studies in the mix as a response to Glantz. It was punctuated with a headbang emoji.
I responded with two headbangs. Just what we need: an implicit endorsement of the junk methodology. I will go ahead and start writing Glantz’s post about it for him:
Several e-cigarette advocates who criticized my original study the moment the embargo lifted have now conducted a similar study. They employ the same methodology, which is the best way to answer this question, but they have purposely excluded informative studies. They have chosen to include only the studies most favorable to their political views, to bias the results in their favor. Proper research methods require including all studies. Our meta-analysis remains the most complete summary of all the available information on the topic, and thus its results are most reliable.
Ok, I write much better than Glantz, but he can dumb it down and add a random number of extra spaces between sentences.
Glantz responds to two specific points from Bauld with this (about popularity):
The fact that e-cigarettes are popular as quit aids does not make them effective. The overall conclusion from all the available data suggests that e-cigarette use is depressing quitting.
and this (about future studies that are planned):
We look forward to reading these studies when they are published. We hope that such studies are not simply limited to e-cigarettes used under “ideal” conditions, but rather are studied as actually promoted and used in the real world.
And, once again, Glantz is right. In keeping with my above observation, it is possible that e-cigarettes overall cause net harm to smoking cessation even though an identifiable subset of use is beneficial. Again, it is not true. But the best response to that is “this cannot possible be true, because….” (an example being the back-of-the envelope quantification I did). Bauld never actually does that. Glantz is not honest and has no apparent scientific skills, but he is plenty clever — he can see through a tangential observation that does not actually contradict him.
In response to another comment from the press release, Glantz writes:
Our paper is based on all the available data as of the time we wrote the paper.
I am actually at a loss to figure out why he thinks this is a response to the comment he quotes. But skip that and just look at the assertion. It is obviously not true. The paper considers only the tiny subset of the available data that takes a particular form and was published in a particular way. It is obvious to anyone who is aware of the real body of knowledge — much of which is far more relevant to assessing real-world impacts than anything Glantz considered — that Glantz’s conclusion is wrong. But once again, his critics gave him this one. They quibbled about Glantz’s game on its own terms, trying to argue about which of those studies represents reality, rather than simply pointing out that the conclusion must be wrong because it contradicts actual reality which we know a lot about. West does try to say that, but he still ties it back to a particular “standard” study result. None of them were willing to admit that most of the relevant information comes from outside the realm of their and their colleagues’ standard studies.
Finally, Glantz fails to respond to Ann McNeill’s contribution to the press release. I like what she wrote. She start off with, “This review is not scientific.”, which is a nice (and accurate) soundbite. But she does not really build on it, and so it is easy for Glantz to ignore it, and he does. The rest of her comment is about Glantz’s misinterpretation of two particular studies that she coauthored. He responds:
In the Adkison study, the measurement of cigarette use was longitudinal (from one wave to another), while the assessment of e-cigarette use was at follow-up. For the longitudinal studies, the paper was clear about the time of e-cigarette assessment, i.e. whether it was at baseline or follow-up (Table 1 and the discussion of individual studies in the appendix). The results in the Hitchman study, like any such study, are based on the behavior reported during the time of the study. In any event, the sensitivity analysis did not show an effect of the timing of e-cigarette measurement on results.
For the first of these, I actually am not really sure what McNeill’s point was, so it is hard to identify fault with the response. The second was one of the studies that had huge “immortal person-time” selection bias when interpreted the way that Glantz did. (As I noted yesterday, this is no fault of the original authors. Their study was what it was and the bias is introduced by trying to interpret the results as a measure of something the authors did not purport to be able to measure. McNeill notes they had already pointed this out to Glantz.)
So though McNeill does not cut to the heart of what is wrong with Glantz’s paper, she employs the very nice tactic of pointing out that one particular element of it was clearly wrong, and Glantz had been told that, so the reader ought to infer that the whole project is suspect. Unfortunately, she does not finish the thought, and effectively explain why you cannot use the data from Hitchmann (i.e., the selection bias). That created the opening for Glantz to write a sentence that ignored the real problem and imply it was a rebuttal. Of course, if you scroll up and read what Hajek wrote, it explains the why. But it is easy to pretend that was not there when responding to a scattershot collection of criticisms.
Overall, my assessment of the intra-public-health discussion here is Glantz won handily. Anyone who is somewhat expert or actively truth-seeking could find their way to my analysis, or Clive’s/Legacy’s, and really understand the fundamental criticisms. But trying to put myself in the minds of the press release’s actual targets (reporters and random commentators — largely people who simply cannot understand analysis that is more sophisticated than what appears in public health journals), I can’t see that many points were scored.
There was definitely some value. Reporters reading the critical press release in addition to Glantz’s, rather than just the latter, were at least somewhat immunized against just reporting the lies. As I have chronicled before, CASAA has succeeded a few times in discouraging widespread coverage in the US media of some junk science that got lots of coverage in the UK. But the critique was just too unfocused to be good counter-soundbite material and fell far short of being a solid scientific critique. (Note to UK critics of anti-ecig junk science: You might want to bring us in next time. Some of us are quite good at soundbites and we can extend your reach. I will take the liberty of volunteering our services. Oh, also you need to send it out as a press release in advance of the embargo.)
However, if a scientifically unsophisticated reader (i.e., a typical public health person, medic, or health reporter) read Glantz’s original press release or abstract, and then the criticisms, and then Glantz’s response, I would guess he would feel Glantz won the debate. He did the fancy statistical thingy, after all, and it was all peer-reviewed and published and all that. None of the criticisms clearly denied the validity of the overall methods or conclusion. And then Glantz made the criticisms appear to be all debatable little technical issues that he properly considered.
I am not saying that battles on these terms can never be won. But I seriously doubt they can ever be won by people who are trying to preserve the reputation of the their public health “brand”, pretending it is not the case that health journals regularly publish utter junk and that many common methods and behaviors in public health research produce nonsense.
[Update: I should have finished this with my tribute to Hans Snape, with a minor rewrite of a quote from one of his lesser roles. In response to “Why don’t I like you?”: “Because you think I’m an asshole, and I’m not really, I’m just a scientist”]
Tobacco harm reduction, anti-THR lies, and related topics 
The easiest way for West to refute the Glantz analysis would be to extend the published results of the Smoking Toolkit Study.
The monthly surveys collect details on:
Who has smoked in previous 12 months
Who,of these,had made a quit attempt in the last 12 months
What aid,if any,was used
Whether the attempt was successful at time of sample
The overall success rate is published but not the rate by aid
Yes, it would refute Glantz directly if there was a representative survey that either asked the right retrospective questions or was longitudinal and followed the same people, noting when they tried e-cigarettes, and then monitored their quit rate. Indeed, he implicitly assumed the studies he analyzed were just that, but they are not really that for various reasons.
Of course, once we had that clean data, we would avoid the selection bias problem, and so would have to face up to the confounding problem. Rodu and I have a study about smokeless tobacco’s role in quitting smoking in which we use some of the rare useful retrospective data. If you were to naively interpret our result (which we took pains to dissuade), you would say that switching was the most effective method of quitting smoking, having the highest success rate. But, of course, those who tried that option were those for whom it was most likely to succeed. Sadly, some of those researching e-cigarette have made exactly that mistake, ignoring the confounding. I doubt West would make that mistake — he has clearly written about it being a problem.
So the result would contradict Glantz’s claim about association (he plays the “oh, I’m not really claiming causation, just association [wink, wink]” game). We would still have a lot of work to do to quantify causation.
It seems to me, as an interested layman, that there are two distinct (but closely related) false assumptions that tend to afflict pro-vaping researchers and anti-vaping researchers in approximately equal measure:
1) That all smokers who take up vapor products wish to quit smoking; and
2) That they only start using vapor products for that express purpose.
To the anti-vaping researcher, it is thus tempting to simply add up the number of still-smoking e-cig users and proclaim vapor products as ineffective for smoking cessation. This canard is, as we well know, Stan Glantz’s bread and butter.
But it would be a mistake to pretend the same temptation doesn’t exist, in the opposite interpretive direction, for those in the pro-vaping camp. If a person stops smoking cigarettes and switches exclusively to vapor products, it is easy to assume (and it commonly is assumed) that they wanted to quit smoking, succeeded due to vapor product use, and would still be smoking otherwise.
In either case, it is assumed (falsely) that all personal decisions regarding smoke/don’t smoke and vape/don’t vape are motivated exclusively or primarily by health concerns. This assumption dooms, often fatally, the credibility of any subsequent conclusions, as a whole series of potentially confounding factors are simply ignored.
In my own case, the anti-vaping researcher could argue that I was a failed cessation attempt, as I’m not averse to still smoking the occasional cigarette if someone offers me one (“no safe level” and all that jazz). The pro-vaping researcher, on the other hand, would be eager to chalk me up as a successful quit attempt by virtue of the fact that I immediately stopped being a daily smoker after I bought my first e-cig starter kit. But they’d both be wrong. I switched because I found vaping more enjoyable and less expensive. I had no particular desire to quit smoking, and health concerns did not enter into my thinking at any time.
The first time I heard about Glantz was over a decade ago, I’m appalled that such a man can occupy a well payed job at a university for no other mission than to vilify for nothing more than their (peaceful) life style. Tell me why a university would do that if not for the ant-tobacco money he rakes in?
What a miserably life for a grown-up man.
Well, universities employ a lot of faculty who are quietly useless or somewhat malignant. But, yes, when someone becomes a spectacle and is malignant, then it is reasonable to wonder about the explanation. In this case, I suspect most of those in the power hierarchy around him support his political extremism. And, yes, of course, the fact that in brings in a ton of money from those in government who support his extremism makes it easy.
True , and people like Glantz are also, exhausting to deal with.
A few years ago I was appointed to a legislative advice committee ( for a largish community org). That committee had member who was a aged ,’authoritative ‘ ,circular, fixated, righteous, bully. It took two years of endless circular argument , simply to get that committee to the point where we could, agree that we did not agree. (And therefore that committee would not present a ‘consensus’ report, and instead a ‘ range of options’ paper.
By the end of it , simply felt exhausted, if it had not involved something that several of us felt was very important, we would have walked.
“The studies of more intensive users of e-cigarettes and users of higher generation devices were specifically discussed in the Discussion as populations who might have increased rates of smoking cessation. It is important to emphasize that these people represent a small fraction of all e-cigarette users.”
In typical Glantzian fashion, he feigns an interest in precision while introducing so many ambiguous, subjective terms that the overall implication winds up being “The results are whatever I say they are.”
“More intensive users”
“Higher generation devices”
“Small fraction”
“All e-cigarette users”
The meanings of any of these terms, individually or in combination, can be massaged and contorted into whatever sort of rhetorical pretzel Glantz feels like selling to the press. This is the same game Tom Frieden plays with the CDC surveys, where questions are engineered (or selectively included/omitted) to produce a certain set of data that will appear to dovetail perfectly with a preordained political narrative.
To be fair, that’s a standard technique used by anyone who doesn’t want to be specific; I use it all the time in customer servicey stuff as a SysAdmin; always use general terms that sound specific, qualify everything with a catchall (shoulda woulda coulda), etc.
It’s a slightly cheeky arsecovering tactic used to get you out of a hole (I learned it initially at BT doing callcentre work) but it’s not any secret sauce; just a useful, common conversational tool that can be used to multiple ends.
It doesn’t work as well in the written word however, as you note – it’s far easier to spot than in the flow of a spoken conversation, where tone of voice and body language can be used to mask it a bit ;-)
Realize that West refers to the quit rate, Glantz’s response is about the smoking rate.
In England, using ECs to quit skyrocketed to almost 40% of quit attempts (http://www.smokinginengland.info/latest-statistics/). Quit attempts are down and pharmaceutical aided attempts dropped even lower, but the actual cessation rates for 2014/15 are the highest recorded.
Yeah, ok, so Glantz garbled that worse than I suggested — further failing to say it as well as I did. Still, by invoking the first derivative of smoking prevalence (“declining”) he is alluding to quit rates (though, of course, that is not the only contributor to delta-prevalence). But it is still pretty clear he is getting at a valid point.
He responds elsewhere to the “use of ecigs to quit” statistics, pointing out that just because they are used does not make them effective. He points out (rightly in theory) that this does not actually mean they are helping. The problem here is that the reality-based points that were being alluded to were not being brought to their conclusion, with numbers backing them. Thus his theoretical points (that there are ways that both his result and those observations could be true) were valid.
The combination of observations you offer is a more robust reality-based rebuttal than from anyone in the press release, combining several statistics. It becomes more difficult to concoct a story where ecigs harm cessation success with all of that being true. But still not impossible. Also, for that to be used in a soundbite war, it would have to be better explained. It is fine for present purposes; I and other readers can fill in the logic of your observations. It would have to be something like “Successful instances of cessation have increased, and a large portion of quit attempts use ecigs. At the same time, total quit attempts (a dubious statistic, but go with it) are not up. Thus the average success of attempts must be going up as ecigs become a large portion of those. Hard to reconcile with ecigs being a detriment.”
However, if presented with that, I can guess Glantz would say that causing a reduction in serious full-on quit attempts is exactly the mechanism he is claiming — that it prevents smokers from being properly tortured by him and his colleagues in evil, and thus the motivation to quit is reduced. He probably could not articulate it so well, but to the extent that he is not just being completely random, that seems to be what he is claiming.
Even though smoking decline is related to cessation, West was referring to the absolute direction of the cessation rate, which may vary while smoking is decreasing. Indeed, STS data shows that cessation rates are rather stable while smoking is declining (smokinginengland.info). So, perhaps “noise” makes cessation rates an unreliable outcome, but Glantz’s argument misses the point.
Also, it would be difficult to use the trends to link the decline in quit attempts to dual use, as e-cigarette use is pretty stable. Only their use as quit aids are rising sharply.
Well I already agreed that I gave Glantz too much credit for his response. It was one layer further removed than I implied. Still, it in the right ballpark. My response is still the precise one, that what West said only contradicts Glantz’s result with the addition (unclaimed) assumption that nothing else was affecting the rate.
Now the more I think about this, the more I wonder if West had some actual numbers in mind. Something like what I did, but from a different angle. He could have been thinking: “If Glantz’s number were true then that would have imposed a 10+% downward shock on overall cessation over c2012-2014. But instead we saw an X% upward shock. That would mean that for Glantz’s number to be true there must have been another factor that caused a 10+X% upward shock. But there is no conceivable candidate for that — the only big change in the tobacco world is e-cigarettes.” That is a valid argument that the result is not plausible. But you do need to at least allude to the other step.
I am a new reader of you blog. I support tobacco regulation and support your effort to promote e-cigs as alternative to tobacco (though I do not support bans in open spaces). I must confess that I was not aware to what degree tons and tons of junk science is found in Public Health and “Tobacco Control” publications. Being an active theoretical physicist (specialized in Cosmology), I suspected that something had to be wrong in these publications, as I have sufficient training in the physics of gases and in the mathematical methods of statistics to doubt the validity of widespread assumptions that the medics and medical journalists (and the media) often repeat, such as “there is no safe level of exposure to tobacco” (from the WHO) or that e-cigs are “as dangerous as cigarettes”.
Yet, I had thought that perhaps the medics I spoke to could be right, or at least not completely wrong, after all (I thought) I have no medical training and I am alive thanks to modern medicine (I survived a non-Hodgkins lymphoma 8 years ago). However, the more I read on the subject, the more information I examine, the more I realize (based on my professional training) that the WHO, most of the medics, the journalists, Public Health officials and Tobacco Control bodies (including their “scientists” like Glantz) are not telling the whole truth. To put bluntly: Tobacco Control has become a collection of self preserving bureaucracies receiving millions of $$ of public funding to conduct flawed research in an effort to pursue an ideological political agenda (eliminate all forms of smoking) that goes far beyond any notion of public health.
As you argue, the journals of Public Health and Tobacco Control are not subjected to any form of public accountability. Therefore, it is useless to try to challenge them “from within”. Ignorance of medics, journalists and most lay-people, together with a misplaced notion that the authority of “experts” cannot be questioned, makes it a hopeless task. In fact, using your excellent parody of a Glantz-like article in which meta-statistics is (ab)used to argue that “all forms of airplane flying is dangerous”, it is not inconceivable that such junk science could be used to pursue a political agenda to ban flying airplanes. The same could happen in other human activities: cat haters with a political agenda and political power could (ab)use examples of veterinarian research (Toxoplamosis) to prove that owning cats is health threatening to pregnant women and thus justify extensive public bans on having cats as pets. With sufficient money and power it is not difficult to (ab)use science to justify fear mongering policies and authoritarian bans on anything.
While challenging Public Health junk science cannot be done from within the Public Health academic environment, for the reasons you state, perhaps it can be done if pressed from the scientific environment but outside Public Health. In the specific case of e-cigs, the challenge can come from exposing the likes of Glantz in journals on Applied Statistics, or in journals dealing with Ethics. Perhaps I’m too naive or ignorant, but why not trying to produce a controversy in the Journal of Medical Ethics (http://jme.bmj.com/). Have you tried this?
If it serves you, you can use my own experience. Scientists (and I mean mainstream, not dissenters) are not aware of what is happening in Public Health. I attended a Cosmology congress last week. I had some informal chats with many colleagues on the issues of smoking, tobacco, marijuana. I was shocked to find out to what degree they are ignorant of basic facts on these substances, and to what degree they tend to uncritically believe the “authority” of Public Health. While some of my colleagues are very conformist and uncritical even in issues around the controversies in our field, a lot are inquisitive and skeptical and ready to criticize. A lot would oppose an “authority” in Cosmology that would be using flawed studies to force feed a politically motivated agenda. Perhaps you need to pass on the word of what is happening in Public Health to scientists in other fields.
Welcome, and thanks for the feedback. I will supplement this placeholder reply with a substantive reply to your thoughtful comments as soon as I can. Right now I am finishing up another post that happens to invoke a comparison to your field (I called it astrophysics — but maybe should have called it cosmology) I will boldly go with it ;-) but you can correct me if I got it wrong.
The distinction between astrophysics (the properties of objects within the universe) and cosmology (the properties of the universe itself) is something almost everyone gets wrong. So I wouldn’t worry about it too much.
So, stepping through your comments in order:
Just to clarify, I (and CASAA) support the substitution of all low-risk alternatives to smoking, not just e-cigarettes.
It is genuinely difficult for someone who does not delve in to believe that public health is as dishonest as it is. It has the trappings of being science, after all, so we do not realize how much of an outliar(!) it is compared to scientific fields. Much of it is the Big Lie problem: You expect advocates to lie a little bit, fudging the numbers and such, but “no one would make a claim that is *so* obviously and demonstrably false and so terribly harmful, would they? So there must be some truth to it.” It is the same tactic to claim that smokeless tobacco is deadly or to claim that invading Iraq is necessary and wise. A bunch of people who are experts are claiming all the evidence says otherwise, but the warmonger politicos (for the Tobacco War or the Iraq War) couldn’t possibly be lying *that* much, so there must be truth in what they say.
I have chronicled here before my first encounter with “public health”, when I was a grad student c1993 and got roped into writing a cost-benefit analysis of the health benefits of moderate alcohol consumption. When going through the research, I kept encountering authors who insisted that there is no such benefit, even though it was incredibly obvious from the research. Their alternative hypotheses (e.g., that teetotalers include a lot of people who do not drink because they are already sick) were tested and did not stand up, and yet they persisted. (Chris Snowdon has recently chronicled the reemergence of such claims, despite it being far clearer now that they are wrong, in his blog.) I simply could not figure it out, because it did not occur to me that these authors were “moralizers” who were wearing the disguise of being scientists to advance their personal political agenda.
I also noticed there was an effort to claim that the effects were specific to red wine, even though the evidence did not support that. I attributed this to an inappropriate fixation on the “French paradox” hypothesis in the face of evidence. That was a claim, based on the (erroneous) conclusion that the French had less CVD than would be predicted, and so maybe it is all that wine they drink, with its traces of micronutrients, that is protecting them. This was always wrong, the fault of another area of public health junk science, nutritional epidemiology, which had declared (incorrectly) that eating a lot of fat was bad for you. Thus the estimates for the CVD level the French “should” have was too high and there was no anomaly that needed to be explained. (The fact that they would call it a “paradox” when it was merely (supposedly) an outlier from predictions is rather telling at a more subtle level.)
Anyway, it later became clear to me that what they were doing is the same thing the U.S. tobacco controllers regarding the evidence about smokeless tobacco from Sweden in the 2000s. They claimed, based on nothing and counter to what evidence existed, “well, maybe that Swedish snuff is not so harmful, but the American products are.” In both cases, the game was to try to trick people into not using the popular products by saying it is only the relatively unpopular products (that are preferred by some connoisseurs) that are healthy. It was a second-best for them, but it worked. In any case, it was not an honest mistake, but a calculated political tactic, hidden behind dishonest scientific claims.
None of this is a mere matter of “not telling the whole truth”. It is Big Lie. Leading public health people do not care about telling the truth at all. They use the trappings of science merely as a way to find arguments for their political cause that some people might be tricked into believing. It is the same game as the “creation scientists”. Of course, as I noted, this does not describe everyone in the space. But there is spillover: The bad approaches to science that are accepted among the not-trying-to-lie segment of public health are what facilitate the liars, and the liars’ dependence on bad science results in them encouraging it be used in the field. (And, as I noted, this affects pro-ecig people who follow the public health script.) So, for example, I cannot recall anyone apparently trying to lie about H.pylori research for political reasons — it is hard to imagine what that would be. But I still had to write debunking papers when I worked on that because the poor quality of the scientific inquiry resulted in absurd claims that clearly contradicted the science.
…to be continued…
Public Health seem strangely familiar to me. ( suppose it might be confirmation bias ):
They seem very like many of the top dogs in post modern art academies ; Authoritative , not at all interested in ‘Art’ – in fact they have over the years redefined the subject to what suits- and above all, very happy being very authoritative in , syntax without semantics.
A sort of, under the stairs or looking-glass world, where they dress up and play act at ‘being’ science, in front of an audience that knows no better.
I understand your point on the “Big Lie” issue very well. Even if I knew before (because I know physics) that “Public Health” it lying when claiming that “no level of exposure to tobacco smoke is safe”, I myself also thought that “no one would make a claim that is *so* obviously and demonstrably false and so terribly harmful, would they? So there must be some truth to it.” But as you say, the Glantzes in “Public Health” are indeed making these demonstrable false claims without fearing any consequence. The public is largely unaware of the depth of this dishonesty and politics masqueraded as science, and thus is mistaken in giving them any “benefit of the doubt”, but is is very hard to confront this (at least in the USA) when the Glantzes enjoy such a broad institutional endorsement from the WHO down to the local medic around the corner.
Perhaps I need to explain why I got involved in this issue. I used to be a heavy smoker of cigarettes, but 20 years ago I switched to moderately smoking pipes, hooka and e-cigs and an occasional cigar, without inhaling. I live in Mexico and here, as in the rest of Latin America, smoking is not as stigmatized as in the USA or Canada. Our Federal Law on Tobacco is much milder than similar laws in the USA and does not support bans in large open spaces. However, times are changing, and hard line “Public Health” policies following the pattern of tobacco “de-normalization” are slowly being proposed in Mexico, as our local “Public Health” officials are trying to emulate their counterparts in the USA. Recently, one of these officials suggested in a radio interview an all campus smoking ban in a provincial public university, arguing the dangers of second hand smoke. While this type of bans will not be applied by any public university in the short term (though such bans exist in private universities), such bans may be applied in the future as “Public Health” keeps pressing the politicians (as it has happened in other countries as the heavily funded Glantzes keep pressing the institutions).
The possible nightmare of “Public Health” heavy handed policies slowly creeping into Mexico motivated me to search for information on ETS. I downloaded lots of material on epidemiological studies and found that the evidence of second hand smoking in open spaces is weak (to put it kindly). This evidence is even weak in indoor spaces, as is based on weak correlations shown by cherry picked studies, with the Glantzes systematically ignoring biassing factors and contrary results, such as the Enstrom-Kabat study. It is now evident to me that the goals of the “Public Health” bureaucracy have nothing to do with any reasonable (and humane) form of regulating tobacco or other substances (alcohol, marijuana) and to deal with obesity. I am now committed to prevent these fundamentalist moralizers to abuse science and to get their way into Mexico. As you say, exposing the scientific fraud of “Public Health” is not enough: political and social aspects have to be considered and an information campaign aimed at lay people is sorely needed. Perhaps the lay people will be more receptive here in Mexico, since there is here a lot of public support to oppose prohibitionist policies because of the devastating effects of the government’s “war on drugs” that produced at least 80 thousand dead and increase of criminality. So, the “Public Health” moralizers on every substance may get a bloody nose “south of the border”.
A quick response to this (I am still going to circle back to the original comment).
See this post about the Big Lie about “no safe level” — if you have not seen it, you will definitely like it: https://antithrlies.com/2015/12/23/utter-innumeracy-six-impossible-claims-about-tobacco-most-public-health-people-believe-before-breakfast/
Yes, I totally agree that it is hard to confront. But I also believe it can be done, eventually, with a concerted effort, and that fiddling around the edges (playing by their rules) will not accomplish anything.
The “public health” political strategy has long been to grab any “gain” (in their perverted view of the world) they can, lock it in, and move on. You are seeing that starting in Mexico. I have commented on that numerous times, though probably the best commentator on that particular point is Chris Snowdon. See also Dick Puddlecote.
And, yes, you are exactly right that the ETS evidence is weak. For those most heavily exposed to ETS — nonsmoking spouses of smokers, workers in particular places before the smoking bans were in effect — there is *maybe* enough evidence to say that there is a tiny detectable risk. Even that hovers at the edge of being detectable, as you note — plenty of studies fail to find anything, and it is compatible with the evidence to say that there is no risk. It is certainly plausible at those levels — a 2% dose of something we know causes substantial risks *probably* causes *some* risk. But a 0.1% dose is a different story.
“I am now committed to prevent these fundamentalist moralizers to abuse science and to get their way into Mexico.” Welcome aboard. I look forward to your new blog. :-) Or you can just do translations.
Seriously, though, tying this to the failed War on Drugs is an excellent angle. In the USA and UK that ought to offer some traction, because the odd politics are such that the very people who embrace the “public health” party line also are the more vocal supporters of an anti-Drug-War party line. Unfortunately, this has not gotten very far because, well, this is not exactly a crowd who thinks. In Mexico, however, with the widespread popular animosity toward the (our!) Drug War, it has the potential to get much broader traction. I would love to see that angle aggressively pushed.
…continuing the response to RS’s initial post…
Yes, the tobacco control industry has managed to make itself into a self-perpetuating bureaucracy, in all the worst senses of that concept. The turning point was when they conspired with the tobacco companies to create the “Master Settlement Agreement” that imposed an (arguably unconstitutional) national sales tax on smokers, a bit piece of which went directly to them. It was a win for everyone involved in the negotiations; notably, consumer interests were not represented by anyone, let alone the abstract interests of truth and good public policy. That and tons of other policies have created a perfect Iron Triangle (the polisci generalization of Eisenhower’s “military industrial complex”, a self-reenforcing alliance of a private special interest, captured government agencies, and influenced legislators).
Fortunately, it is not quite so easy to abuse science to pursue extremist political agendas in most areas. I am inclined to attribute this to the strong effects of culture. Indulge me a tangential analogy that intrigues me: The Westminster parliamentary style of government does not have the legal checks-and-balances of a U.S.-style system. While the U.S. system does allow runaway bad policies sometimes (when those Iron Triangles develop), it generally does a good job of preventing that (at the expense of gridlock, of course). But in a Westminster system, if the government in power and the “permanent government” (the career civil service that is integral to that system) agree that something, no matter how radical, be done, it can be done. Government efficiency has its upsides, of course, but it can get really ugly.
But in spite of the lamentations of some of my British blogosphere colleagues, the drift toward tyranny in the UK is relatively minimal (and a lot of what there is can be blamed on the EU). That contrasts with relatively young states that inherited the Westminster system — Australia and Canada — where lurches toward tyranny are distressingly common. The difference seems to me (and keep in mind that I am writing a blog comment here, not going so far as to put this in a paper) to be that England has the enormous ballast of the longest history of established cultural-political institutions in the world, and these provide the friction that the missing constitutional checks-and-balances would. (Less so Scotland and Wales, and notice that they have a rather greater propensity for dangerous radical policies.) Those very lamenting bloggers are part of that, anchored in strong culture far more effectively than any of their Anglophone colleagues elsewhere (including here).
Returning to the specific concern about other areas of science being abused, it is far less likely because of the honest and careful cultural institutions in those sciences. Perhaps ironically, those other sciences that are further from immediate real-world concerns, are populated by normal humans with average real-world concerns. As a result, it is difficult to imagine a “sciencey” campaign to ban cats would not be squashed by experts, due to both realistic science (because people doing veterinary and infectious disease research have a strong culture of trying to do good science) and normal human feelings (people in those fields are not out of touch with reality — they are quite fond of cats at roughly the same rate as the general population). Also, there is little chance for Iron Triangles — a few people could make a living campaigning for that (perhaps they already do), but not many.
…that seems like a good subtopic stopping point; I will return with one more reply to the rest of it…
” I look forward to your new blog. :-) Or you can just do translations.”
Yes, I am planing to start a blog, in Spanish (so I may ask you in the future permission to cite and translate stuff), but first I am surveying the potential blogosphere. I am now trying to contact people I know, political activists against drug prohibition, mathematical statisticians and open minded medics. So far I have seen (among my colleagues in physicists) that they are completely unaware of the abuse of science going on in Public Health, perhaps because we don’t have here known anti-smoking types like Glantz or Chapman. Not that dishonest scientists or medics or Public Health freaks are absent, but anti-smoking is not (yet) a big issue in Mexico. The big issue is prohibition of marijuana and hard drugs. I will definitely follow your advise and aggressively make the case against our local Tobacco Control in the framework of the animosity against prohibitionist policies that has caused so much harm here.
“But in spite of the lamentations of some of my British blogosphere colleagues, the drift toward tyranny in the UK is relatively minimal (and a lot of what there is can be blamed on the EU).”
When I got a load of how the EU deliberates “public health” policy, my immediate reaction was “Wow, this makes the FDA look wise and enlightened. And transparent.”
Yeeeah, don’t get tricked by the trappings. EU is just so ham-handed that they do not even create the illusion of rational analysis and good governance. FDA Tobacco creates the illusion, but their process is every bit as tyrannical and in violation of proper government behavior, and harmful to consumers.
…and the final of my three responses to RS’s original comment…
Regarding the point about rallying other scientists, particularly those adjacent to public health, to recognize public health is junk: Yes, I think that strategy is fairly promising, though it is not entirely clear how to implement it. I am not so into publishing in journals, but should probably consider it. It might make sense to get some more of this stuff out of the public health ghetto. It does seem increasingly farcical to watch the handful of public health insiders earnestly strive against the tide — comically pathetic (in the real sense of that word: it inspires pathos).
I am definitely open to brainstorming about tactics that go beyond “talk to real scientists about this stuff whenever you get a chance” — which I do too. I just have no idea what would “go viral” in that community. I could imagine a book like Innumeracy or On Bullshit that find its ways on to cross-disciplinary reading lists. Imagine. I have no idea how to craft it.
I think that one problem you would face when rallying other scientists is making a credible proof of the reversal of roles of the scientific hierarchy in Public Health. Normally the real science is done inside scientific institutions (not perfect, not utopian, but with relative honesty), with marginal scientist wielding little influence and crackpots heckling outside. Scientists watching Public Health from outside don’t know, and/or have no time to find out the technical details and to examine the issues at depth, so they trust that institutions and hierarchies in Public Health are roughly operating as their own honest scientific hierarchies and institutions. This makes it very hard to provide to them (from outside Public Health) convincing proof that in Public Health the roles are reversed: the crackpots (Glantz, Chapman, Repace, etc) not only are inside the institutions, but they run the show, while real science (not perfect, not utopian, but with relative honesty) is done by those in the margins and outside. Because of the instinctive trust in the way science institutions should operate, the Glantzes and Chapmans have the upper hand as top insiders in Public Health, as they can make an easy parallel between the outsiders criticising them and outsiders that honest scientists see in their own environment. In other words, the Glantzes can easily stick the labels of “crackpot” or “marginal” to their critics from outside, and the trick so far works, but not forever.
Likely, scientists in topics close to Public Health will not trust a radical critique that comes from those in the margins or outside Public Health. Editors in peer-reviewed journals or popular educated media receiving this critical material may contact the Glantzes or Chapmans just to “double check”, and the latter may wield sufficient influence to black publication. So, my gut feeling is to approach scientists that are somehow connected to the issues, but are sufficiently far from the controversies of Public Health and Medicine to be independent of the obstructive influence of Public Health top dogs. Good candidates may be mathematical and applied statisticians. The aim would be to show them the statistical junk produced by the Glantzes and to convince them to write critical articles, either to be submitted to their own peer reviewed journals, or to the popular educated press. Glantz and co. may sit on editorial boards of medical journals, but they have zero or much reduced influence in journals of statisticians. An article in the popular media, authored by top statisticians, denouncing specific examples of statistical trickery and manipulation in epidemiology would have more weight than a similar article authored by medical doctors or by known epidemiology critics. Such articles would not deal with issues of public health policies, or if smoking e-cigs is good or bad, since the authors would be mathematicians, not medics. Their credibility would not come from their medical knowledge, but from their expertise in statistics, which is far superior to the statistics expertise of epidemiologists. A critique by *REAL* experts in statistics would reveal that Public Health argumentation in (for example) e-cigs is based on junk statistics, and thus cannot be trusted. While this may not lead to blocking public policies that come from the statistic junk of epidemiology (something beyond the aim and scope of the articles), it may at least suggest that these policies should be questioned.
Critique of the statistics of epidemiology have been already made in the 1960’s. I forget the name of a brilliant British statistician who strongly criticised the poor statistical design of the Doll-White study. It did not make a significant impact, but these were other times. With today’s mass media, appetite for sensationalism, social networks and instant internet communication, things may develop differently.
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Yes, you are right, the distinction between astrophysics and cosmology is roughly a matter of scale. Cosmology is the study of our Universe as a physical system and thus can be conceived as the astrophysics of very large scale systems, or as is sometimes described as “extra-galactic” astrophysics, to distinguish it from “non-cosmological” astrophysics dealing with the solar system, stellar and galactic scales.
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Wonderfully written Carl! :)
One small point of disagreement/expansion: I believe you are wrong when you say, “Misinterpreting what studies actually show and doing inappropriate synthetic meta-analysis are indeed fairly standard practice in public health research.”
I think this is actually only a real problem in the particular, peculiar, and highly corrupt subset of PH research that concerns smoking (and vaping, by extension, since the ASDS sufferers have a hard time distinguishing the two)
It is **SO** extreme in the area of secondary (or tertiary, or quadrinary, or..) tobacco smoke exposure, that by this point I can be fairly confident that almost ANY study published in the area is either incompetent or corrupt and will have significant numbers of statements or assumptions that can easily be shown to be lies of one sort or another.
I don’t believe this is true of public health as a whole, but it is *outrageously* true in this particular little slime pit where Glantz et al spend their days swimming and sunning.
– MJM
You might be able to draw a distinction between fatally bad methodology and interpretation being intentional in anti-tobacco (and anti-whatever), and thus nearly always present, whereas in less political areas it merely stems from incompetence, and so i only common but not universal. I am not quite sure what to say about what appears in the pro-ecig literature, which is better than the anti stuff, but not really any better than public health as a whole. Anyway, it really is everywhere in “public health” — everywhere I have ever looked closely, anyway. For teaching examples of bad epidemiology, I always used to grab the latest population epi article from the NEJM — no matter what it was about, I could count on it having terrible flaws.
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