Author Archives: Carl V Phillips

In search of an honest tobacco harm reduction (THR) skeptic

by Carl V Phillips

This is a serious question. I am genuinely trying to determine if anyone has an answer.

For many, if not most, polarized controversial political issues, it is possible to find decent human beings on both poles of the debate. I am talking about people who:

  • understand the fundamental facts of the matter and are not just dogmatically supporting a political position out of ignorance (a lie in itself, of course),
  • tell the truth, including:
    • acknowledging what is clearly correct among the arguments by the other side,
    • correcting themselves when they discover they have said something incorrect,
    • not acting as marketers under the guise of being analysts (i.e., grossly exaggerating the case for their position to sell it)
  • acknowledge and show proper respect for the gravity of what they are arguing, particularly the costs their position would impose on people.

In other words, there are people who are not overgrown children making adamant declarations about important matters they do not understand, who apparently legitimately believe their position is valid and thus that others might be persuaded to their position by the truth, and who seem to have a moral compass. Put another way, we are talking about people who do not appear — even to reasonable people who adamantly oppose their conclusions — to be evil, sociopathic, or a useful-idiot tool of those who are evil or sociopathic.

Theoretically, a non-sociopath can be an aggressive liar, genuinely feeling bad about the lies but having reached the studied conclusion that a greater good is served through those immoral acts. However, I would contend that in matters of political controversy (as opposed to, say, running a military campaign or trying to outmaneuver your market competitors), there is no legitimate role for lying. If you are trying to persuade the public of something and discover that you cannot do it by telling the truth, it is difficult to see how lying is ethically defensible. Thus there may be no such people, but if someone wants to try to make the case — that there are decent human beings who aggressively lie about THR but whose behavior is ethically defensible — I am listening.

I suspect we agree that there are decent people fitting the bulleted conditions on the different sides of the debates about abortion, climate change, redistributing wealth, animal rights, publishing pictures of Muhammad, and many others (assuming you do not feel so strongly about the issue that you cannot consider anyone who disagrees to be a decent person, but that is a different story — we are talking meta-characteristics of their position). There are also, of course, people who violate every one of the conditions in the above list on both sides of all those issues, but that does not change the fact that there are decent honest people making the arguments too.

Now consider an example that strikes me as similar to anti-THR: opposition to granting same-sex marriage rights. You could imagine someone making an honest argument along the following lines:

I realize that banning same-sex marriage causes some people to suffer material harm, as well as being treated like second-class citizens. Though I personally cannot empathize with wanting to do it myself, I recognize that many people do. I also realize there is no evidence of material harm to the rest of society from same-sex marriage (other than it making taxes and other finances more fair, and thus taking away some of the extra burden on gay people), no evidence that gay couples are worse parents, nor any other material motivation. However, I simply believe that homosexuality is per se wrong, and therefore I oppose any action by the state to normalize it.

A few minor word substitutions and you could get the argument of an honest ANTZ. The thing is, I do not recall ever seeing such arguments in either case. It seems like there must be someone out there in the wide world of anti-same-sex-marriage that actually owns up to this, though I am not sure because I have only cursory knowledge of the fight. By contrast, given my knowledge of the THR and anti-THR world, I think I would know if there was an honest, decent THR skeptic who admits the truths — that there is overwhelming evidence that low-risk tobacco products are indeed low risk; that THR has been shown to work; that many people like to use low-risk tobacco products; that various lies about risks and bad outcomes are, indeed, lies; that there is no material evidence of a downside — but who still expresses skepticism. I am not even talking about someone who admits the truth but is still is full-on anti. I cannot think of anyone who indicates even mild doubt about the wisdom of THR who does not also attempt to deny the truth.

Indeed, to relax the conditions one step further, perhaps there is someone who is a THR skeptic who disputes, based on some serious argument, some of what most of us think of as facts. I am not talking about just ignoring the facts or randomly asserting they are “not proven”, nor making patently dishonest junk “arguments”. I am talking something roughly analogous to disputing the worries about climate change, not by claiming there is some conspiracy to fake the warming data, but who rather, perhaps, offers a scientific argument as to why it might soon stabilize or why it would be easier to do something about it later rather than now. Is there anyone like that in tobacco control?

Again, this is a serious question. Is there anyone reading this whose self-perception is, “I am someone who openly acknowledges the facts about THR, even as I argue that actions should be taken that interfere with it”? Or is there anyone reading this who would say that about someone else.

A tangential follow-up question, then, for those who are not THR skeptics but self-identify as being in tobacco control: Given that the tobacco control establishment has evolved into being more anti-THR than anti-smoking over the last decade (and assuming you were not able to offer up a case that this was being done honestly), how can you stand to consider yourself a part of that?

Glantz attempt at dialogue makes clear the vacuousness of his arguments

by Carl V Phillips

The leading ANTZ strategy for creating the illusion that they have valid arguments, hiding the fact that they are a combination of liars and clueless, is to avoid dialogue. It is relatively easy to create the illusion of valid arguments that will trick the ignorant masses (and especially one’s own useful idiots) if you simply keep repeating your talking points and pretend that the rebuttals to them do not exist. The ANTZ make a practice of not showing up at any public discussion (except the fake public discussions where they control the entire agenda and prevent the airing of rebuttals) and pretending that the evidence that shows they are lying does not exist. The reasons for this are clear: If they try to engage in dialogue, it immediately becomes apparent that they do not have a leg to stand on. Continue reading

Science Lesson: on “anecdotes”

by Carl V Phillips

Following a twitter conversation between some vapers and some others who mistakenly think they understand science, I decided to write a quick lesson for those who might want more than a bumper-sticker about this. The issue at hand is whether you can learn anything about the world from individual testimonials about people’s experiences or other one-off “anecdotes”. The answer is obviously yes. It is safe to say that more than 99% of what each of us knows comes from such evidence. So why do so many people not understand this obvious fact, and habitually denigrate such evidence as “anecdotes”? It seems to be because they are stuck in a grade-school understanding of science.

I have written entire papers that are substantially about this point, but here is my quick explanation for how to better think about this. (Oh, and as an aside,  anyone who thinks that this exposition is more correct due to the fact that I have also published versions in journals knows even less about understanding scientific evidence, but that is another story that readers will know I cover elsewhere.) Continue reading

FDA thinks antifreeze is ok — for kids’ medicine (and other accidentally useful observations in the NYTimes)

by Carl V Phillips

The New York Times is a reliable mouthpiece for various powerful political factions but, frustratingly, is also a great source of information. As a result, we are forced to read it much the way that Soviet citizens learned to read Pravda — the information is there, but you have to learn how to read between the lines. A clever reader (h/t Gil Ross) spotted the NYT pointing out that FDA was blatantly hypocritical when they hyped the claim that “e-cigarettes contained antifreeze” during their attempt to ban them in 2009 (and — even worse — keep reporting that lie).

Background: In 2009, in an attempt to smear the e-cigarette companies that were suing them for illegally seizing products, FDA conducted studies of some of their liquids. They discovered a trivial contamination with diethylene glycol (DEG), in one unit, at a level that Burstyn has pointed out posed no concern. They tried to fool the public into believing this was a substantial hazard. Continue reading

Tobacco abstinence is not a safe alternative to harm reduction

by Carl V Phillips and Elaine Keller

In honor of the birthday of one of us (EK), we are using the great title that the other of us wishes he had thought to use for his 2009 paper. In acknowledgement of her birthday, Elaine posted this yesterday on the Facebook CASAA members group:

Today is my birthday. My birthday wish is that e-cigarettes had been invented in 1983 instead of 2003. I was reluctant to share with the world that I was diagnosed with lung cancer last summer. I was afraid that some tobacco control liars might use that information to falsely accuse e-cigarettes of causing cancer. But an important fact is that for ex-smokers, the excess risk for lung cancer doesn’t go away the day you quit. In fact, it hangs around for a good TWENTY YEARS after you quit smoking.

So if I had been able to quit smoking in 1989 instead of 2009, perhaps I would not have needed to have the lower left lobe of my lung removed in July, and to go through chemotherapy. I’m happy to share with you all that my follow-up CT scan on December 4, showed no evidence of cancer. So I am officially in remission. To those who want smokers to wait around for 10 or 20 years for scientific proof that e-cigarettes are 100% safe, I say this, smokers don’t have that luxury.

Dr. Carl Phillips, CASAA’s Chief Scientific Officer, brilliantly analyzed the difference between being able to quit smoking immediately via switching to a reduced risk alternative source of nicotine (Tobacco Harm Reduction – THR) and postponing quitting until ready to “quit completely” (e.g., not needing to earn a paycheck after reaching the age of retirement) in “Debunking the claim that abstinence is usually healthier for smokers than switching to a low-risk alternative, and other observations about anti-tobacco-harm-reduction arguments.”http://www.harmreductionjournal.com/content/6/1/29

Most lung cancers are not diagnosed until Stage 4, when survival rates are grim. I thank God, and credit e-cigarettes, for the fact that mine was caught at Stage 1.

Sure quitting tobacco products entirely was theoretically an option for every smoker in 1989, but how many did it? (Hint: not many.) E-cigarettes had already been manufactured starting in the 1960s (and even designed on paper in the 1930s, though we are aware of no evidence a device was ever constructed). Quitting tobacco products entirely was still an option in 1999, but how many did that? (Hint: more, but still not many.) That was about the time that a major tobacco company tried to bring a more modern e-cigarette to market, but, again, they were quashed by regulators. What would have happened if those options had not been banned? Some of the answer can be found in Elaine’s story and some in Carl’s New Year post here. Of course, low-risk tobacco products were on the market. By 1989 it was adequately clear that smokeless tobacco was low risk, and by 1999 there was no legitimate doubt. But that fact was hidden from smokers by a concerted disinformation campaign which was almost as effective at preventing harm reduction as  the repeated bans of e-cigarettes.

If smokers had been allowed access to e-cigarettes and knowledge of other low-risk alternatives decades ago, millions would have switched decades ago. It is not difficult to imagine that the majority of those now smoking would have quit via THR, or would have picked up a low-risk product instead. (It is particularly easy to imagine it when you observe that it actually occurred in Sweden.) The lowest risk alternative clearly was promoting THR in 1989, not pushing for total elimination of tobacco products.

Some of those behind the disinformation, bans, and attempted bans — both today and historically — are genuinely evil or at least sociopathic. They have a personal preference for a world that is free from all tobacco products (for some baffling reason that they never explain), and they lie and otherwise violate social norms, causing people to suffer and die, in pursuit of that goal. (Indeed, some of them clearly relish that suffering.) But they are a small minority of those responsible for this. They would not have the power without the much larger cadre of useful idiots. Most people who consider themselves to be “tobacco control” are not evil or sociopaths, but given the turn that the tobacco control industry has taken — in particular, that its defining characteristic today is being anti-harm-reduction — they have become the useful idiots serving the goals of the extremists. They typically actually believe that trying to dissuade people from THR is good for public health. Why? Because they believe that pursuing THR poses a higher risk to smokers than does pursuing complete cessation.

They are wrong. Badly wrong. This is obvious to anyone who actually thinks about this issue in even a slightly sophisticated manner.

Their naive notion seems to stem from the fact that, technically, from a purely medicinal standpoint, using a smoke-free tobacco product seems to pose some health risk (though we do not know that for sure) while abstinence poses none. Thus, they (mistakenly) conclude, THR must be the higher risk alternative. But this is only true if all else is equal — in particular if they would have both come to pass on the same day — and that is seldom the case. Someone who really would just quit on a given day in 1989 will have done so. Everyone else would have been safer had they switched, as emphasized by EK in her testimonial, as calculated in CVP’s cited paper, and as appears in the calculation for CVP’s New Year post.

In short, promoting abstinence is not a safe alternative to harm reduction.

Of course, anyone with an understanding of public health should know this already. Is demanding sexual abstinence a safe alternative to encouraging condom use? Is banning a popular drug a safe alternative to regulating it? Is mandating the use of an extremely awkward safety device, that technically offers slightly better protection to those using it than a pleasant alternative, a safer alternative? The empirical answer to the latter requires a bit of technical knowledge, but anyone familiar with occupational health or the use of safety gear more generally knows the answer: Offer only a highly unpleasant choice and people will just not comply, choosing the riskiest option of foregoing safety equipment entirely instead.

Sound familiar?

If non-sociopathic tobacco control people only understood the simplest 101-level lessons from their own field, public health, they would recognize this. But instead they are manipulated by the extremists into being useful idiots. They are tricked into not even thinking through what they are doing and saying.

One additional observation is necessary for fully understanding EK’s personal note and fully appreciating the preceding passages: Abstinence is a very unpleasant alternative for many. A few (like EK) can articulate this and openly explain that being able to function — to be happy, productive, employed — depends on continuing to consume nicotine. Given a choice of smoking, with all its costs and benefits, versus abstinence, smoking is better. Many other smokers basically get this, and do not seriously want to quit, even if they cannot quite articulate it. No observer has any excuse for not understanding this. It is simple social science or, for that matter, basic understanding of the behavior of sentient beings: Given only the two choices, if people choose smoking rather than abstinence, then they clearly like smoking (all costs considered) better than abstinence. Anyone who wants to dissuade people from smoking, then, who observes this — and who has even half a clue — will immediately figure out that he needs a third option.

And if he has a little human compassion, in addition to having a little clue, this will not just be because promoting THR lowers risk compared to promoting abstinence. It will be because THR gives smokers who benefit hugely from tobacco use (or just nicotine) a lot of benefit in addition to getting them off of smoking.

But even for those who do not care about people and only care about risks, the answer is the same. You have been duped by extremists who care neither about people nor even about people’s health, but are just bizarrely obsessed with the N. tabacum plant. Demanding the elimination of all tobacco product use is simply not the lowest risk alternative.

Smokers do not have the luxury of waiting for some perfect solution. Those who presume for themselves the right to control tobacco users do not have the luxury of pretending otherwise, pretending they are not killing people. Those who effectively prevented THR for decades are responsible for the lung cancers of Elaine Keller and tens of thousands of others.

Over 10,000 more Americans get to ring in 2015 thanks to e-cigarettes

by Carl V Phillips

This blog closed last year with a countdown of the worst liars of the year. This year, I decided to go for a more positive note.

We know that every time a smoker switches to e-cigarettes, there is a good chance she is saving herself from an eventual smoking-caused premature death. But this also means that, for someone who has quit smoking thanks to e-cigarettes, there is a chance she has already avoided premature death. Several months ago, a journalist posed this interesting questions to me: How many lives have already been saved thanks to e-cigarettes (h/t Maxim Lott). It is a very tough question, but I finally figured out how to estimate it based on the methodology I used in my 2009 paper, “Debunking the claim that abstinence is usually healthier for smokers than switching to a low-risk alternative, and other observations about anti-tobacco-harm-reduction arguments.” I have completed a working paper that calculates the estimate, which appears at EP-ology. Continue reading

What is peer review really? (part 7 – an amusing aside)

by Carl V Phillips

A couple of weeks ago, a funny story came out about a peer-reviewed journal accepting a “paper” which consists of nothing but the message (in the title, repeated in the text for pages, and in two figures), “Get me off your fucking mailing list”, laid out in the format of a research paper. The authors had created this to reply to the plethora of spam that scholars get, inviting them to submit papers, attend conferences, etc., and had been using it for a few years. So imagine their surprise when, after sending it in response to journal spam, they got the reply that it had been accepted for publication after it was favorably “peer-reviewed”. They merely needed to pay the $150 publication fee. (The rest of us were shocked that they apparently decided to not pay the fee and get the paper published. I mean, come on, how could you resist?) Continue reading

Burstyn comments at FDA workshop on ecig science

by Igor Burstyn

[Editor’s Note: As I mentioned previously, FDA refused CASAA’s application to have Igor appear on the agenda of the FDA workshop on e-cigarette chemistry and related science. After seeing who they did put on stage, it became doubly clear that they were intentionally avoiding Igor because he had the expertise and credibility to point out fundamental flaws in a solid majority of what was presented. Fortunately Greg Conley had three minutes on the agenda and gave it to Igor, so that he could present the following talk. It was not a lot of time, but it was enough for Igor to point out how absurd is most of what passes for science in this realm. His slides are here. I have inserted the slide advance marks in the text. –CVP]

[Slide 1] Good morning, folks. First, a small correction. Actually, my affiliations are on the slide now, not from the previous introduction.

[Slide 2] So what I’d like to talk to you about today very briefly is that there’s really not that much new under the Sun about e-cigarettes. I don’t come from the tobacco control world. I come from a very different area of academia and research. And I was surprised that so many things about electronic cigarettes were surprising to people. So that’s my story.

So we’re really not all that ignorant about toxicology of what comes out of electronic cigarettes. And I talk about it as somebody who’s trained in industrial hygiene, environmental health, who was taught to anticipate what would happen if my workplace had a source of environmental emission introduced to it that was very much like electronic cigarettes, and it was there, and it was exposing me. And I was trained through my undergraduate and my graduate training to recognize and deal with those situations and be able to make rational decisions about mitigating risks for myself, and my co-workers and my colleagues.

We have rich experimental experience from other areas of environmental and workplace emission controls and hazard assessments that are incredibly helpful and can be easily applied, and are portable to the world of electronic cigarettes and tobacco products. And there’s really no reason to assume this precautionary posture that really amounts to willful ignorance. We really know a lot more than we sometimes give ourselves credit for. And my claim to credibility, such as it is, is summarized in this paper, and if you’re really interested in what I have to say on this topic, it’s all published out there. You’re most welcome to contact me. I’m easily found.

[Slide 3] But this is my main point, which was made yesterday as well: The dose makes the poison. We have known that for a very, very long time, and it’s really not helpful for us to think otherwise because nothing really has changed in the truth of that statement since Paracelsus put it forward. And this is part of the story. [Slide 4] If we apply the standards that are admissible in workplaces to emissions from electronic cigarettes and look at about nine thousand chemical measurements that were available to me back last summer, we can see that across chemicals, we see individual exposures that are way below a threshold where we’d actually begin to worry about them. There’s really no reason to be concerned here. Most of them are in trace quantities. They’re present, but they’re not going to hurt you.

[Slide 5] And if you look at similar calculations based on emissions from vapers, you can reach the same conclusion. You can sit or stand near a vaper and experience emissions they generate, and you should not be worried or afraid for your life or health.

[Slide 6] So we do know a good deal about electronic cigarettes. If the word “cigarettes” was not in that title, we wouldn’t really be that worried about them because it’s just a name. And it’s not really appropriate to deal with these things as if we learned nothing since the 16th century. Scientists don’t try to avoid vials of chemicals; likewise, public should understand and treat chemicals with respect, but we should not be afraid of them.

Thank you very much for your attention.

[Slide 7 contains further observations that could not be fit in the limited time.]