Why clinical trials are a bad study method for tobacco harm reduction

Following my previous post and my comments regarding a current ill-advised project proposal, I have been asked to further explain why randomized trials are not a useful method for studying THR. I did a far from complete job explaining that point in the previous post because the point was limited to a few paragraphs at the end of a discussion of the public health science mindset. So let me try to remedy that today. Continue reading

How the medicalized history of public health damaged its science too, particularly including understanding ecigs (fairly wonkish)

by Carl V Phillips

This week, in my major essay (and breezy follow-up), I argued that the dominance of hate-filled nanny-staters in public health now is actually a product of medic and technocrat influence more than the wingnuttery itself. The worst problem there has to do with inappropriate goals that stem from a medical worldview morphing into a pseudo-ethic. The seemingly inevitable chain of events created by that pseudo-ethic resulted in public health professionals hating the human beings who we think of as the public because we are a threat to what they think of as the public, which is just the collection of bodies we occupy.

But this is not the only damaging legacy in public health of the thoughtless application of medical thinking. The science itself has also suffered, most notably (though far from only) because of the fetishization of clinical experiments (aka RCTs: randomized controlled trials) and denial of research methods that are more appropriate for public health. This is something I have written and taught about extensively. I will attempt to summarize it in a couple of thousand words. Continue reading

Follow-up on how medics doomed public health – case studies

by Carl V Phillips

Yesterday I posted a long essay, a history-of-science analysis that wove in news events and personal flashbacks (hey, what author doesn’t want to be Kurt Vonnegut or Thomas Pynchon?), about why the public health profession ended up being the hate-filled anti-humanitarian institution that it is today. You will recall that it was ultimately the medics, not the temperance nuts, who were responsible for the downfall of public health. Today a case study, and a bit of a second, that provide some further illustration and some comic relief (there is no other way to play it — it is too absurdly horrifying to present as other than comedy). Continue reading

Dear Public Health: the public despises you, so you are probably doing it wrong

by Carl V Phillips

A collection of disjointed, though related, thoughts I have had for days, months, and years have coalesced together in a very interesting way. The thesis here is a theory I have evolved based on experience and focused thought over a couple of decades, not some flight-of-fancy. Still, I grant that this story is necessarily simplified and certainly there is room for debate. Also, as will quickly become apparent, this is not a typical post for this blog, but it is quite relevant.

The title of this post is something I paraphrase periodically in a tweet. But that phrasing is something I would have rejected a decade-and-a-half ago, when I first started working in THR. At that time, I repeatedly objected to the opponents of harm reduction being referred to as public health, which is of course the diametric opposite of what they were and are, assuming we think that public health is about improving people’s health.  Continue reading

CASAA comments on NIOSH proposed recommendations re workplace tobacco use

by Carl V Phillips

Recently the National Institute for Occupational Safety and Health issued a draft of proposed recommendations for employers and it was opened for comments. Their draft can be found here, though you really do not have to read it to make sense of our comment. Basically all you need to know is that they made exactly the same recommendations about smokeless tobacco use as they did about smoking (no amount of ventilation is sufficient for indoor use???). They made no explicit recommendations about e-cigarettes, but included innuendo about them.

As you may know, NIOSH is part of CDC, but they normally do not act like the CDC tobacco office that receives a lot of attention in this blog. They have a lot of genuinely good scientists there.

Our comment follows:

Continue reading

What is peer review really? (part 3)

by Carl V Phillips

After I was rudely interrupted by two of the most prolific weeks in anti-THR lies in recent memory, followed by a week of recovering from that, I am finally getting back to this series. You will recall that in Part 1 I reviewed the history of journal peer review, and pointed out why it is largely obsolete now, as well as why its current general failure in health science fields is inevitable. In Part 2, I started presenting a list of myths about peer review (in no particular order), with Myth 1: Peer reviewers have access to more information than any other reader of the paper. Continue reading

Number of lives saved must be adjusted for those who cannot be saved, etc. (wonkish)

 by Carl V Phillips

There is always some interest in quantifying how many people could be saved by THR, and it flared up this week thanks to estimates by Robert West (his paper; his press comments). As a result, Brad Rodu and I were discussing the challenge of correctly accounting for smokers who could not be saved by quitting (in any manner) because the disease by which smoking is going to kill them is already established. (Recall that CDC is apparently planning to try to trick people into believing that such diseases among vapers were caused by vaping itself, rather than because their learning about THR came a year or two too late — thanks in part to the CDC.)  Quitting is not the same as never having smoked, and THR switching is not the same as having always used the low-risk alternative. Continue reading

TrANTZlation of Goniewicz and Lee NTR abstract re “thirdhand vapor”

by Carl V Phillips

After an unrelenting two weeks of very important posts here on very important topics, it is time for some whimsy (whimsy with a serious scientific message, of course). What, some of you haven’t read all the other posts from the last two weeks? Well don’t waste your time on this! Click backwards and read them!

Goniewicz and Lee recently published a peer-reviewed (that is the first bit of whimsy) paper in Nicotine and Tobacco Research. Their abstract is here, and this is probably more amusing if you read that first, though basically every word of the original is still present in the following trANTZlation of it: Continue reading