A give-and-take on censoring ecig research that gets almost everything wrong

by Carl V Phillips

I have watched with some amusement the swirl of attention around this op-ed (for that is what it is) by Jim McCambridge, in the journal Addiction, calling for further censorship of THR research, and this response to it in a blog post by Neil McKeganey and Christopher Russell. My amusement is first because it seems like this exchange feels like it was written 15 years ago and second because of the huge oversights by all involved.

It is hardly worth recounting the content of the McCambridge piece because anyone who follows these issues has read it all dozens of times before. He is calling for a ban on publishing of e-cigarette research that is funded by industry. (Publishing by whom? Great question. Read on.)  This, of course, is based entirely on hand-waving innuendo about misleading cigarette industry research from c.1970. He admits, in the most opaque way possible, that there is no evidence that this is still occurring. He fails to note that this is also true about the last four decades.

McCambridge extends this to full-on McCarthyism about anyone who has ever done research associated with industry. How much research would this have to be in order to disqualify? What type of relationship counts? He does not say, of course, because that would require trying to justify his position based on some stated goal, which he never attempts to do. He could not. Does the industry he is seeking to censor include just those e-cigarette manufacturers who existed as corporate entities in 1970, or does it also include the new wave of e-cigarette companies? He does not say, because that would require introducing actual substance to his diatribe. (It is largely moot right now, since the latter do not do or support much research, but that will presumably change.)

As much as I panned the facile and ham-handed discussion of conflict of interest by Marcus Munafo in the pages of Nicotine & Tobacco Research a few days ago, McCambridge’s drivel makes Munafo look almost scholarly by comparison. The Addiction piece has literally no analytic content; it is just a statement of personal pique peppered with some references that are used as in a middle school term paper, as pro forma decoration rather than analysis.

So that brings up the unseen elephant in the room: Why did Addiction editor Robert West decide to publish this boring and content-free statement of one extremist’s personal politics? The only apparent explanation is that it is a trial balloon, to see which way the wind blows on this before deciding whether Addiction will join in the attempted censorship. This is standard practice for political actors (and obviously this is all about politics; it has nothing to do with science), to have some supposedly respectable outsider endorse what they are considering doing, in order to see what the reaction is before they commit.

Now I am not entirely sure whose reaction West is interested in observing. It is not exactly a mystery that the “public health” people will come down in favor of trying to censor any research that is not sanctioned by Public Health Inc. It is equally clear that anyone who cares about science and real ethics will oppose it. I can only surmise that the target audience consists of the couple of hundred “public health” people who have embraced e-cigarettes (only as a tool to be imposed on smokers to get them to quit smoking, of course) but still cling to the illiberal and anti-scientific Tobacco Control Industry mindset.

It is amusing to note what no one in these discussions seems to notice: This type of censorship only hurts “public health” people. What happens if the public health journals censor industry research from their pages? It gets published in scientific journals instead. The work coming out of industry research shops is almost all straightforward real science, and legitimate journals that publish research of the particular type are not going to join in the censorship. A handful of them might succumb to some editor’s personal pique or outside political pressure, but there are plenty of other options. There are fewer, but still enough, options for the (relatively rare) pieces coming out of those shops that do not fit within a standard scientific discipline (e.g., big-picture analyses of harm reduction).

All moves like this “accomplish” are keeping the best science out of the pages of public health journals (for the major companies do almost all the good lab science in the field, and higher-quality epidemiology). This lowers the average quality of those journals, as is often noted. But it also keeps public health people, who are not exactly known for reading broadly, from learning what the industry has to say. Industry employees and outside researchers that are closely tied to industry do not blog. They do not comment on posts or articles, except for very technical points. They do not tack on unrelated editorial wanderings to their papers in scientific journals.

Does this mean that their big-picture analyses and political opinions never have any influence? Um, yeah.

What is truly hilarious is that the same “public health” people who scream about the enormous influence that industry has — thanks to their private and semi-private communications channels with the oligarchy — think that censoring them out of journal pages is a good move. If “public health” people understood any tactics other than using propaganda and brute force power via their control of government agencies, or even if they just understood the implications of their own rhetoric, they would be trying to sucker industry actors into publishing every study report, analysis, or commentary they wanted in public health journals. That way the “public health” people would actually get a good look at it, and be able to respond in a context where they have the upper hand (e.g., by soliciting real-time rebuttals or forcing authors to insert material into their papers). But because they are so far up their own…um, echo chamber, they think that it is a win to prevent this. They actually think their journals are just so important that putting such material on their own pages, instead of forcing it to be communicated out of their sight or control, would hurt their cause.

So if industry itself is not hurt by the censorship, who is hurt? It is the individual independent researchers who are targeted by the McCarthyist tactics. Researchers who are employed by industry or do most of their work on behalf of industry are untouched for the reasons noted above. The only ones hurt are those honest scientists wish to be part of the “public health” club — for whatever reason — but also want to take advantage of possible opportunities to get industry funding for their research. In this sense, the ad hominem attacks are a win for the “public health” extremists, in that they do keep some of their own people too scared to risk their academic and government dole by stepping out of line and doing unapproved research. But those who end up getting punished are still their own peeps.

(Notice, by the way, that this observation, combined with my assessment of who the trial balloon was targeted at, suggest that the balloon is going to crash.)

McKeganey and Russell are two of those targeted by the McCarthyist attack, as independent researchers who have taken industry funding. They make several good points including the very nice observation,

When it comes to assessing the health harm and public health benefits of e-cigarettes McCambridge must feel we are in a world of excess knowledge that he should so comprehensively discard research solely on the basis of the funding received.

This is a great line, though I cannot tell whether they really believe this was an oversight on McCambridge’s part, or whether it is the clever tactic of making a disingenuous statement you know your opponents dare not question. Of course, “public health” people like McCambridge do not consider minimizing the available knowledge to be a bug. To them it is a feature, though they cannot admit that. Their goals benefit from there being genuine uncertainty about e-cigarettes, and it certainly benefit from the predominant “research” on the topic being the junk-science that they produce. Excess knowledge is not on their side, and they know it.

Of course, this point is largely moot due to what I mentioned above: Keeping the good science out of Addiction and a few other journals is not going to stop it from being done. It will merely inconvenience public health people.

The amusing part about McKeganey and Russell is their suggestions that there is something even slightly new about this, with phrases including (emphasis added):

“the rise of academic McCarthyism”… “new McCarthyism” … “danger of creating an academic environment in which allegation or suspicion has supplanted proof when it comes to scientific misconduct” … “dangerous waters”

Um, yeah. Allow me to call attention to just a few of the papers I wrote or edited on this topic a decade ago. (In one of those papers, the author suggests that McCarthy is really not a strong enough metaphor, and that Lysenko/Stalin is more to the point.) There are, of course, many more such papers by many authors, responding to exactly this particular McCarthyism, dating back another decade before that. Or you can look at the archives of this blog, or of my previous blogs. Or those of dozens of others who have been writing on this topic.

McKeganey and Russell make the observation,

There is a real danger here of creating [sic] an academic environment in which allegation or suspicion has supplanted proof when it comes to scientific misconduct. The clearest example of this is contained within McCambridge’s own published commentary in which he acknowledges that he is not aware of evidence that the pharmaceutical industry has engaged in the same past misconduct as the tobacco industry. Yet, he says, he would not be surprised if this were the case, and he then goes on to offer a range of possible mechanisms though which the very thing he has acknowledged he has no proof is occurring may be taking place. Suspicion has assumed primacy over evidence.

I think it gives far too much credit to the perpetrators responsible for this (extant!) toxic environment to suggest it is about genuine suspicion. This seems to be a case of getting sucked into the extremists’ rhetoric and thereby endorsing it by implication. Just because someone can make up a hypothetical, it does not qualify as genuine suspicion. For every legend about events in the world, there is some nutcase who is “suspicious” that it is true. To treat this as anything other than pure bullying, motivated by the outcomes it produces rather than the rhetoric used to sell it, is to have already conceded most of the fight. (Oh, and anyone who genuinely wonders whether the pharmaceutical industry has gone to great, often nefarious, lengths to skew the literature in their favor is really far up his own echo chamber.)

What is missing from the McKeganey and Russell response is the most important point in all of this, that there is massive undeclared and unexamined — but incredibly obvious — conflict of interest present in non-industry research. “Public health” people produce boatloads of junk science that is designed specifically to further their special-interest politics. This blatant conflict of interest dwarfs any effects of industry funding. If you want to look for the “clearest example” of dishonesty and bad intentions “contained within McCambridge’s own published commentary”, it is not in the text, but in his own conflict of interest statement, in which he declares: “None.” Yes, what possible conflict of interest could there be in someone’s attempt to censor his political opponents and to make sure that his own faction and their funders have a monopoly on deciding what research is done?

[Update: An early reader suggested that I had not really made my case for the title of this post. I realized that I agree, that I had not clearly built up the thesis. So here is what I had in mind but never managed to say: There are legitimate concerns about industry-funded research, particularly it being used anti-competitively. For example, big companies with more resources can do research designed to suggest that their product might be a little bit less harmful than competing products — as with a closed-system e-cigarette with very limited ingredients versus less controlled systems — and the no one is in a position to respond effectively. This, unlike them producing falsified results, is a legitimate concern. But it is never mentioned by the would-be censors. The rebuttal post missed the biggest point, about COI among non-industry researchers, as I noted, and suggested this is some emerging problem rather than an ongoing extant problem. But my other concern was that it lent unwarranted legitimacy to the attacks, trying to debate the details and express concern about what it implied were unintended harms, rather than calling out the attacks for what they really are and recognizing that those harms are goals. These observations, plus the various elephants that no one seemed to even notice, are the basis for the title.]

Finally, it is worth noting that the single concrete example McCarthy… er, McCambridge mentions [I really did type that Freudian slip] is the Nutt et al. paper that consisted of made-up estimates of the harms from various tobacco products and associated non-tobacco products. This has become a favorite for the McCarthyists because some of the people involved with making up the numbers had received industry funding in the past and did not bother to mention it. As I have explained at length, the numbers from that paper come not from any scientific process, but from a bunch of people getting together and pulling them out of thin air. Many of the claims resulting from that “process” are utterly absurd on their face.

But the paper does serve one useful purpose: The obsession with the industry funding points out the utter scientific and intellectual vacuousness of public health. “Public health” people do not like the paper because it dares claim that there are lower-risk tobacco products (even though they should really love it because it grossly overstates the risks for those products, putting them at levels that actually support many anti-THR positions — as I said, they understand little about tactics). So they have been campaigning to discredit it. There are a host of grounds for criticizing that paper — indeed, more than there are for most anti-THR junk science papers — most notably that it is just a bunch of made-up numbers that should never be cited as evidence of anything. But this does not seem to bother the public health people, apparently because they simply do not recognize that making up numbers is problem. So instead their entire line of attack is ad hominem.

If you try to explain that — or any of the other oversights and absurdities noted above — to a thinking person who is not familiar with the behavior of “public health”, their first reaction is often that you must be joking. Discussions of scientific integrity in this field are self-parodies. At least that makes them, like the campaign for the Republican POTUS nomination, good for some amusement and interesting substantive analysis — so long as you can force yourself to view them from the outside and ignore the worldly impacts they have. However, the other thing these discussions have in common with that nomination race is that the substantive analysis plays no apparent role in the battle, and that perhaps the only viable tactic is ridicule.