Category Archives: Lies

Regular entries for this blog – bits of the catalog of lies.

Economic illiteracy about tobacco, from the antepode

by Carl V Phillips

The most fundamental lie of the tobacco control industry (TCI) is what I have dubbed the “demonic possession” theory of tobacco use. It is the myth that no one likes to use tobacco products.

It is obvious why they need this. If they admitted that people derived benefits from consuming tobacco, then they would have to balance the (supposed) benefits of their actions against the loss of benefits caused by the actions. More important, and the reason this myth is fundamental, is that if they admitted the truth they would have to admit to themselves that most of what they do inflicts harm — serious harm — on the hundreds of millions of people who they pretend they are trying to help. While many in the TCI are truly evil, and would not be bothered by this, many are not, and so need to preserve this fiction to be able to sleep at night. (And, no, “evil” is not hyperbole. It is clear that many people in tobacco control derive pleasure from inflicting pain on people who they consider to be The Other, exactly the same evil impulse that causes racism, homophobia, etc.) Continue reading

New study shows that if you have an MI, you should hope you use tobacco

by Carl V Phillips

A recent study by Arefalk et al., published in Circulation, was claimed by the authors, the AHA, and the corporate media to show that continuing snus use after an MI (heart attack) is harmful. In reality – if we are to just blindly interpret the study results, without context or thinking, as the authors imply we should – it shows that among people who have MIs, snus users and even smokers are better off than non-users.

To explain this, start with the letter to the editor Brad Rodu and I submitted to the journal (which, given the integrity typically displayed by health sector journals when it comes to admitting errors and allowing dialog, has a 4% chance of being published). It explains the basic problems and our methodology, but due to word limits does not present the full picture, which I continue below. (Note: Brad expects to post about this too, and I will update with a link when he does.  Update:  It is now live, here.)

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Letter by Rodu and Phillips Regarding Article, “Discontinuation of Smokeless Tobacco and Mortality Risk after Myocardial Infarction”

Arefalk et al. report mortality incidence rates (deaths per 1,000 person-years at risk, PYAR) following a myocardial infarction among Swedish tobacco users who, following the MI, continued to use snus (18.7), quit snus (9.7), continued to smoke (28.4) or quit smoking (13.5) (1). We point out several significant problems with this study.

From a methodological perspective, the authors’ inclusion of women in the estimates is a mistake. The number of women among snus users is so small that the gender control variable is extremely unstable. Any gain in power is more than offset by the resulting potential bias. Moreover, combining men and women smokers assumes that the effects of product use are the same for both, which is not justified. In this and similar studies, stratified analysis by gender is always the more informative approach.

The authors report that the mortality rate for the entire sample was 18.9, which appears to be incorrect. It is based on 812 deaths and 40,370 PYAR, which actually yields 20.1. Alternatively, one of the count numbers may be wrong; for example, the rate is 18.9 if the death count is 765. The error requires correction because it affects the article’s major conclusion about snus and smoking; the reported mortality rate for the entire sample (18.9) is similar to that for continuing snus users (18.7).

Arefalk et al. did not report the mortality rate among nonusers of tobacco, which comprise more than half of the sample. We estimated the nonusers’ rate after subtracting the deaths and PYAR for snus, cigarette, and dual users from the sample totals (our estimate of deaths and PYAR among 934 dual users assumed that they were proportional to the mean of those statistics for snus users and smokers).

The estimated mortality rate among nonusers is 21.4, based on 494 deaths and 20,031 PYAR. This is higher than the rate for continuing snus users (18.7), and far higher than that for snus quitters (9.7). In addition, it is higher than the rate for smoke-quitters (13.5). The only group that fared worse than non-users was continuing smokers (28.4). (If the death count was actually 765, the non-users disadvantage would be reduced but not eliminated.)

Thus, those who quit using tobacco products reduced their mortality risk by half compared to those who continued, but also compared to non-users. By the logic of the article’s conclusions, MI victims are better off if they use tobacco so that they can experience the benefits of quitting. The authors have the data to calculate the exact mortality rate for nonusers and adjust for age (which probably does explain part of the disadvantage among nonusers) and other factors. These additional results might explain how the reported harms from snus use can be reconciled with the apparent advantages of quitting.

1. Arefalk G, Hambraeus K, Lind L, Michaelsson K, Lindahl B, Sundström J. Discontinuation of smokeless tobacco and mortality risk after myocardial infarction. Circulation, published online June 23, 2014. DOI:10.1161/CIRCULATIONAHA.113.007252

Brad Rodu, DDS, Department of Medicine, School of Medicine, University of Louisville

Carl V. Phillips, PhD, Consumer Advocates for Smoke-free Alternatives Association

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The bottom line is that the authors tried to spin the results as suggesting that continuing snus use is bad for you after an MI. But those who did not quit snus after the MI had a lower death rate than people who did not use either snus or cigarettes at the time of their MI, and those who used snus but quit were far better off still. A simplistic interpretation of the data, then, is: “You had an MI. But the good news is that you use snus! If you now quit snus, your mortality risk compared to people who do not use snus – and thus do not have the opportunity to quit – is magically lowered by more than half. Moreover, even if you do not quit, your risk is still lower than that of non-users.” The authors really buried the lead on this one – or more accurately, did not report the lead at all.

Of course, I am not saying I believe that MI victims are genuinely better off if they use snus. But it is what these statistics suggest (and it is certainly a possibility). The authors carefully avoided reporting an obviously useful and important statistic, the mortality rate among non-users, because they presumably realized that it would call their anti-snus conclusions into question. And it does. Whatever is happening in this population, it clearly does not support the “snus is bad” message that the authors and other naive and politically-motivated commentators have presented.

There is a glaringly obvious explanation for why people who quit snus or smoking after an MI fare better than those who do not: Those who are generally healthy (except for the recent MI, of course) and expect to recover and live a long time are much more likely to take every possible precaution to minimize their risks. After being advised to give up snus, get proper physical therapy, and eat better, many of them will do it. Meanwhile, those who are sickly, have serious cancer, are depressed, etc. will have little incentive to make lifestyle sacrifices in an attempt to regain long-term health. There was no attempt to control for this obvious confounding in the study.

Of course, this would only explain the better outcomes of the quitters compared to those who continued tobacco product use, and does nothing to explain why all of them (except those who continued to smoke) fared better than the non-users. There are possible explanations for this in the form of statistical artifacts or real effects. But the key observation is that the data clearly do not support the main interpretation that the authors touted, that it is terribly bad for you to keep using snus after an MI.

Another important conclusion that should be drawn from this article is just how bad the peer review process is for medical journals. The out-and-out error we discovered in the reported numbers was not some obscure statistic buried in the depths of the paper, but was the key number reported in the first short paragraph of the results section. Brad immediately noticed that the calculation appeared to be wrong on his first read-through, and it took me fifteen seconds to provide the correct arithmetic while creating the spreadsheet that is the basis for our letter. Yet the vaunted “peer review process” let the error through. Those of us who are familiar with journal peer review understand that – contrary what most people seem to believe – the reviewers and editors cannot check anything that readers cannot check for themselves, because they have access to only the same paper the reader has, not the data or calculations. Thus it is, at best, a fairly weak check. But the failures here are a reminder that reviewers seldom even check what is in the paper.

Even without correcting that error or calculating the mortality rate for non-users, the (incorrect) reported number for the population as a whole can still be compared to rates for people who used snus or cigarettes at the time of their MI. This alone is enough to raise red flags about the analysis and conclusions, since it is still higher than the rates for smokers (averaging together those who quit and those who kept smoking) and for those who kept using snus, and far higher than the rates for those who stopped using either product.

Moreover, the obvious confounding described above is not something that only leading scientific experts understand, but is so well known that it even has a name in medical research: “confounding by indication”. It is a constant source of bias when an action (e.g., a particular medical treatment, or in this case, obeying the advice to quit tobacco) is associated with how healthy someone is. A new experimental surgical technique might have a higher death rate, not because it is worse than the conventional practice, but because it is only tried on people whose condition is particularly dire. Or to take an everyday example, someone slamming on their car brakes is much more likely to crash than someone not doing it; this is because the action indicates that there is a risk of imminent crash, not because it is harmful. But the naive logic from blindly looking at the data the way these authors did would be “never slam on your brakes – it will cause you to crash.” Anyone involved in medical research should understand this common problem, and yet the authors do not so much as acknowledge the possibility of such confounding, and the editors and reviewers let them get away with that.

In sum, the way these results were presented and interpreted is a simple classic piece of anti-tobacco propaganda. Researchers who were both skilled and honest would have tried to address the reasons that MI victims who quit using snus or cigarettes fare far better than those who did not use them in the first place, and even those who did not quit snus still did a bit better (after reporting this was the case instead of hiding it, of course). Researchers who were honest but not so skilled would have just reported that result. But the authors, and the journal editors and reviewers who enabled them, instead endeavored to hide that rather remarkable result and to lie that their results showed that snus was harmful.

[Update:  Brad recalled that Arefalk is a serial producer of anti-THR junk.  He posted about a previous claim here.]

More nonsense about gateway effects – this time from ecig supporters

by Carl V Phillips

It seems that most every researcher or pundit making claims about gateway effects — that e-cigarette use causes some people to then become smokers — has no clue about what evidence would support or contradict such a claim.  It is a truly amazing and sad commentary on what passes for scientific thinking in this realm.

I have already explained at length how Glantz et al.’s claims about having found evidence of a gateway effect are fatally flawed.  But they are actually one step better than two recent claims by e-cigarette supporters that there is no gateway effect.  Glantz basically made a single observation about a statistical correlation that you would, indeed, expect to see if the gateway claim were true.  But you would also expect to see that correlation if either of two other things were true, one of which (confounding by common cause) certainly is true and the other of which (people are employing THR) is far more plausible and better supported than the gateway claim.  Basically the logic was this:  “If it is Monday at noon, there should be light coming in my window. There is light coming in my window. Therefore it is Monday at noon.”  There are obviously many more states of the world where the observation is true and the conclusion is not, so this is terrible reasoning.  I remember learning that in grade school; apparently Glantz, the faculty at UCSF, and the editors and reviewers of the junk journals he writes for missed that day of class in third grade and never took any science courses in college.

But that is not the worst reasoning one could engage in.  At least observing the sun makes it a little more likely it is Monday at noon, since it allows you to rule out many times of the week, and therefore you have increased the probability that it is Monday at noon.  Of course, you have increased the probability that it is midafternoon on Wednesday just as much.  But the observations in this study, a survey of European e-cigarette users, do not even do that much.  That has not stopped e-cigarette touters from claiming that the study shows there is no gateway effect, a claim which has made the rounds in social media.

It is rather baffling.  The authors make no such suggestion in the article or their press release.  There is simply no support for the claim to be found there.  The interpretation seems to trace to this crap article in New Scientist, which makes the claim in the text, or this even worse one in International Business Times which put the claim in the headline.  Naturally, clueless people who know nothing about the topic believe whatever they read, but some people who are repeating this silly claim should know better.  (Here’s a useful little epistemic hint for future reference:  When a news story says a study was published in the non-existent Journal of Tobacco Studies, it is probably not a very good source of information.)

The “reasoning” seems to be that because only 1% of never-smokers in the survey had tried an e-cigarette, e-cigarettes must not be a gateway.  Huh?  By that logic, smoke-free tobacco products do not harm fetuses because less than 1% of pregnant women use them.  (Note: it remains unknown whether or not there is such harm.)  All the observation shows is that if there is a gateway effect, its possible absolute magnitude (so far) is capped by the fact that only a small portion of the at-risk[*] population has had the exposure.  It tells us nothing about whether there is any such effect.

[*Side note 1:  For those who may be confused due to the fact that this phrase is used incorrectly more often than correctly, "at risk" means "anyone who could become a case".  So "at risk of being a gateway case" means "not a smoker" (notice that this means that ex-smokers are at risk of becoming gateway cases, not just never smokers, so leaving them out of the "reasoning" was another error).  Thus, Glantz is at risk of becoming a gateway case, whereas someone who quit smoking using e-cigarettes is not.  The common misuse of the term is incorrectly substituting it for the intended claim that someone is at high risk of becoming a case.]

[Side note 2: I feel a personal need to point out that part of the touting of the study by pro-e-cigarette pundits is that it came out of Harvard.  I beg to differ. The authors all have some affiliation with Harvard School of Public Health, not the real Harvard.  The faculty at HSPH were serious researchers 20 years ago, and there are still a few good people from past eras (though not in the anti-tobacco and other nanny-state units), but is now it is pretty much just a school of public health, with all that implies.  Or as I put it previously,

The study, from a research group calling itself “Harvard School of Public Health”, was widely cited in the popular press.  (Note that while this organization does not seem to be related to the prestigious research institution called “Harvard University”, the allegations in the literature that it is actually a lobbying front group for shadowy government agencies and industry have not been proven, and so cannot be considered a reason to doubt their research.

Resuming….

The other common error about what constitutes evidence of no gateway, most recently committed by Siegel, is suggesting that declining smoking rates, in the context of increasing e-cigarette usage, must mean there is no gateway.  It is a fundamentally different error, though the implications are similar.  The error is a simple misunderstanding of magnitudes, statistics, and the passage of time. Even though e-cigarette use is increasing, its absolute level is still very small among those at risk of becoming gateway cases.  If every single at-risk e-cigarette user is a gateway case, the impact would not be visible in population smoking statistics.  The total number of at-risk e-cigarette users constitutes a smaller portion of the population than the statistical error in smoking prevalence surveys, to say nothing of what it would take to sort it out of the real changes in smoking rates over time.  Moreover, since “destined to start smoking due to her e-cigarette use” is not the same as “has started smoking”, the gateway cases would mostly not even be observable yet.

On top of that, e-cigarettes are causing some people to quit smoking.  So even if we had a perfect measure of smoking prevalence, and the only thing changing it over time was the effects of e-cigarettes, we would still see a decline in smoking rates even if there were a gateway effect (unless, of course, it were already so big in absolute magnitude that it exceeded the THR effect).  Thus, the “reasoning” here is an epic fail for at least three different reasons.

The reason that the implications of the two different errors described above are similar is that their proponents are really saying “the impact of the gateway effect is apparently small so far, so don’t worry about it.”  This is not a very effective argument.  There are very good reasons to believe there is not and never will be a gateway effect, or at least extremely little of it, but neither of the above are among them.  Effectively, those erroneous arguments invite the (valid) retort, “sure, we are not seeing it yet, but the way things are going, it will show up, and so we need to stop e-cigarettes before it does.”

The conclusion that there is no reason to expect a gateway effect is correct.  But making bad arguments in favor of a valid conclusion almost always sets up your opponent with a good argument in response, and that is certainly the case here. Moreover, if we are going to start trafficking in bad arguments, we are going to encourage and validate lying.  The other side will inevitably win the argument under those rules of engagement, because they are waaaay better at it.

Supposed THR supporter demonstrates he still thinks like an ANTZ

by Carl V Phillips

I consider Mike Siegel to be a friend and he does a lot of good work documenting lies by the ANTZ.  With that out of the way, I found his latest blog post to be a particularly disturbing disregard of science in favor of the ANTZ propaganda that he used to embrace.  In that brief post, he flat-out declares that the death from oral cancer of a prominent baseball player was caused by smokeless tobacco use and indicates his contempt for the best-proven method of tobacco harm reduction (which is, of course, replacement of smoking with smokeless tobacco).  He employs the ANTZ propaganda tactic of elevating unsupportable sensationalist specific claims over the evidence. Continue reading

Glantz takes a vacuous swing at Bates; Pruen eviscerates Glantz

by Carl V Phillips

I was not planning to comment on the recent mass-signed letter that was sent to the WHO, telling them how they should think about e-cigarettes.  But then Tom Pruen wrote this gem of an analysis responding to Glantz’s ignorant response to the letter, and I had to post simply to link to that.  It is an insightful and very informative analysis (obvious caveat: that is not an endorsement of every word of it). Continue reading

Clueless prohibitionists: the West was not wild (but is now, due to prohibitions)

by Carl V Phillips

Frequently the scientist in me is appalled by the drivel coming from “public health” regulators and “researchers” about tobacco products.  Every now and then, the more general scholar in me is equally appalled.

In the 2000s, a popular trope was to denigrate tobacco harm reduction with the non-analogy that switching to a low-risk alternative to cigarettes was “like jumping from a 10th story window rather than 20th”.  The exact floor counts varied, but heights were always chosen such that either fall was almost inevitably fatal, which not only overstated the near-zero risk from smokeless tobacco, but also overstated the risk from smoking.

My colleagues and I got so annoyed about this that we wrote this paper, in which we did a little research and concluded that a lifetime of smoking creates about the same probability of premature death as a (non-suicidal) jump from a fourth floor window or a bit lower (this ignores the fact that a death from the fall would be almost immediate, whereas the death from smoking would occur very late in life).  By contrast, the mortality risk from smokeless tobacco was in the neighborhood of the risk from a jump of less than two stories — there is a tiny possibility it will be fatal, but it is extremely unlikely.  We pointed out that many of us have intentionally taken such a jump. Continue reading

CDC goes full-Orwell in opposition to tobacco harm reduction

by Carl V Phillips

The CDC has been one of the most dedicated opponents of people avoiding the risks from cigarettes by using low-risk alternatives.  This dates back from before I started working in the area, long before e-cigarettes happened.  But it has usually been the same pathetic offhand lies you see everywhere, like those I documented from CDC Director Tom Frieden in the previous post.  But it has also become a fully Orwellian war on truth (or, as I just learned, perhaps Peleven-ian is the modern update of that, though I have not read him), an attempt to create an alternate reality that will trap the ignorant masses. Continue reading

CDC Director Frieden explains that he hates ecigs because he is clueless

by Carl V Phillips

I interrupt the analysis of the deeming regulation, because this article simply must be commented on.  CDC Director Tom Frieden “explains what he hates about electronic cigarettes” to the Los Angeles Times.  That is the actual headline — I paraphrased based on what he actually said. Continue reading