posted by Carl V Phillips
This blog is only two weeks old but it is not too soon for an aside that addresses a critical tangential point, the accuracy and credibility of pro-THR claims.
Almost all anti-THR discourse is dominated by lies. It has to be, because the truth has such an obvious pro-THR bias. Most pro-THR claims are solidly based on evidence and honest communication of it, as well as established ethical norms and the very popular political view that people should have freedom to make their most intimate choices without interference by those in power. Thus it is not surprising that, with the exception of a few unscrupulous merchants and Chinese spammers writing about e-cigarettes (scourges which it is impossible to avoid or eliminate when there is free communication), pro-THR discussions are almost never anchored in misinterpretations of the evidence.
And there is the problem. The example to hand is the recent widely repeated claim that a study in Greece showed that “e-cigarettes do not damage the heart“. The study showed nothing remotely that general. It showed that under in particular circumstances, the brief use of an e-cigarette does not produce measurable acute (immediate) changes in a few particular biomarkers of cardiac functioning. Is this good news for e-cigarette users and THR? Of course. It is the best news that could come from that study, which was only looking at the immediate effect of one vaping session on the particular short-term biomarkers that were measured. But I trust that it is obvious why this is not sufficient to justify the headline that was repeated by many e-cigarette advocates. The study obviously could not address what matters for health outcomes, the long-term effects of long-term use (the natural interpretation of the headline of that press release). Moreover, it measured only a few of the many possible short-term effects. It is a result that should be added in to the body of technical knowledge that is useful for experts who are compiling all existing information into conclusions; it should not be interpreted as having clear practical implications and should not have been touted to the general public as saying there is no risk of damage.
Imagine that an anti-harm-reduction “researcher” did a lab study in which they asked a few smokers questions that reflect their desire to have a smoke later that day, asking before and after they used an e-cigarette, and found that the measured desire increased afterward. Headline: “E-cigarette use increases smoking”. Of course, the measure was very limited and artificial, and tells us very little about long-term effects. In that, it is very much like the e-cigarette cardiac study. In fairness to the latter, the cardiac study could have been legitimately reported in useful and accurate terms like, “certain cardiac functions that show acute negative effects with smoking do not show the same effects with e-cigarettes”, whereas the imaginary anti study has no apparent legitimate interpretation. But the accuracy of the more general declaration is similar in the two cases.
Of course, you do not have to imagine. Readers of this blog will undoubtedly have noticed that this heart study sounds remarkably like the lung effects study that we wrote about for the last three days, which was press released at about the same time. Both studies looked at short-term biomarkers of acute effect that could not possibly tell us anything about real health effects (unless the results were catastrophically bad, which we knew in advance that they would not be). Both studies could add a bit of useful technical information to what we know about e-cigarettes. Both were from Greece, though I think that is probably not relevant to anything. And, unfortunately, both were reported via press releases that absurdly overstated their implications.
There were important contrasts: The actual methods and useful results of the cardiac study were contained in the press release (to the extent possible in a few score of words), as opposed to the obviously misleading non-presentation of the science in the Christina Gratziou lung study. The cardiac study author’s stated conclusions in the text of the press release were quite modest (one might say even more timid than the facts support) about whether THR was a good idea, and did not lean too much toward claiming that his results were particularly important, whereas Gratziou was basically shouting “my results prove that you might as well smoke!” But still, the false claims in the headlines were remarkably similar, as was the willingness of news sources with the particular bias to uncritically repeat the claim in the headline.
Anti-THR activists cannot afford to not lie, because the truth is not on their side.
THR supporters cannot afford to make the mistake of blindly repeating overzealous pro-THR claims.
But, wait, a common response goes, you just pointed out that anti-THR people do exactly that, pretty much all the time. They do a lot worse too: full-on campaigns of lies and research misconduct. They lie constantly.
But that does not justify us doing it. In addition, and probably more important in the minds of most THR supporters, it does not make it tactically sensible. We have to police our own claims much more carefully, for the following reasons:
1. We do not want to be like them. Right? Nuff said.
1.5 And if we are like them then ,well, live by the favorable tiny little biomarker study of limited scientific value, die by the much larger number of unfavorable little biomarker studies of limited scientific value. If that cardiac study is evidence that e-cigarettes do not harm the heart, then the lung study is evidence that they do harm the lungs.
2. One false claim from our side — even if it is basically consistent with all the evidence (as is the claim that we do not think there is any major cardiac risk), and even if it is presented with the best of intentions, as an honest mistake rather than a crafted lie — will be used to excuse every single lie from the other side. We do not need to make false claims, but they do, so why give them the gift of being able to respond “well perhaps our claim of …, based on one finding from one study, overstates the case a bit; but the THR people claim that one little study of a few biomarkers showed that e-cigarettes pose absolutely no threat of cardiovascular disease, so they are really worse.” (Note, by the way, that this is true: claiming “no damage” based on any single study is more inaccurate than claiming “damage” based on a single study, because no little study can provide much evidence for the universal absence of a something, but it can show its existence.)
It does not matter if their claim in the “…” is more egregious. It does not matter that they have a legion of paid operatives who are intentionally trying to mislead, while we are running volunteer operations and trying to make the best sense we can of the science with limited resources, and so occasionally err by accident. And most of all, it does not matter that they tell a thousand lies that can fill in the “…”; every last one of those thousand will be declared to be justified by just a single example that can be presented on the other side.
3. It is not just the anti-THR people who will do this. There is a silly notion in the American press to seek what they call “balance” in anything they report, and this has spilled over into a lot of public Anglophone discourse (I cannot say for sure whether it is so common beyond that). A slight caricature of this is Krugman’s observation that if the mainstream press was running a story on the Earth’s shape, they would find one person who says it is flat and run the headline “Shape of the Earth: views differ”. Their silly urge to “balance” is even stronger when pointing out that someone is lying; no matter how blatant a lie is, the mainstream media’s reporting of this fact is almost always accompanied by a hunt for some error from “the other side” to “balance” the information. It just would not be [insert affected accent and fan self dramatically like a character from Gone With The Wind] proper to seem to be biased against a liar who represents an established and powerful institution, after all.
So, when we get mainstream discourse that points out that anti-THR claims are based on lies — which is what is something we really need to generate — it will most likely juxtapose that with pro-THR “lies”. If all they can find are a few shady merchants making absurd claims, it will not look so bad (so long as they do not lie and suggest that everyone on our side is making such statements). But “does not damage the heart”, widely reported by non-merchant THR supporters, is just the perfect balance to show that “both sides are making exaggerated claims.”
It may not be fair, but we have to deal with the way things are.
3.5 But it gets even worse and more unfair than that: The mainstream discourse is actually going to favor anti-THR lies over our pro-THR truth, since it almost always defers to lies from powerful institutions. So it will take a very long list of very obvious lies to hurt their credibility as much as one clear exaggeration hurts ours. The “public health” movement is a small-minority special interest group that has abandoned society’s norms of ethics and scientific conduct, but it is a rich and powerful special interest group and used to be respectable. The mainstream media, as well as most of the liberal-leaning new media and — most important — the average person on the street, still treat “public health” as if they are honest and public-spirited. The “public health” people know this, of course, which is why they do not hesitate to lie.
But more importantly for present purposes, it is also why they can get away with misleading fixation on unrepresentative individual actions of opponents that distract from the real truths of the matter (e.g., fixating on one unfortunately-phrased ad for smokeless tobacco from the 1970s as a reason for condemning all smokeless tobacco forever, or on the claims of a few fly-by-night e-cigarette merchants, or that whole “tobacco industry documents” obsession). The public is still ready to believe any bad thing that is claimed about THR products or those who support them (who will be labeled “the evil big tobacco industry”, of course). We cannot give them the openings.
Again, it is not “fair”, but the total dishonesty and unearned credibility of the Drug Warriors-types and other anti-harm-reduction activists in “public health” forces us to be even more scrupulously honest than might be needed otherwise.
4. If we start making every claim that seems to be pro-e-cigarette, treating anything that is pro as right and attacking everything that is perceived as anti as wrong, we will learn a lot less. Learning is good. Perhaps the marketers want everyone to believe that there is only good news, but those of us who care about more than pumping sales want to find the bad news when it exists. This is not just because of Point 1., and the potential loss of credibility if an overblown claim turns out to be wrong. It is also because consumers are better off if they know the risks, and only if we know about problems we can try to fix them. E-cigarette users should be the absolute last ones to want there to be claims of “no risk” when we do not actually know that.
This issue reminds me, to a very disturbing degree, of work I did in the 1990s, trying (unsuccessfully) to persuade vegetarian advocates to stick to the true and scientifically valid arguments that supported their position, rather than glomming onto every blatantly irrelevant or junk science claim that seems to point in the right direction. The bad information basically drove out the good (both the good information and most of the good people). The situations are quite different in many ways — e.g., there are relatively few non-experts writing books and junk science websites about THR (yet!), while such people dominated (and still dominate) the discourse about vegetarianism. But there are also some clear similarities.
There are honest and accurate pro-vegetarian arguments that would appeal to the substantial part of the population that is concerned about animals or the environment, and to a lesser extent their health, and yet vegetarianism was widely perceived mostly as a nutty cult. The true claims that might have persuaded people were (and still are) hopelessly lost amongst the easily-debunked false claims which were more prominent. So, almost two decades later and even as lots of people have stopped eating much meat, vegetarianism’s negative image has hardly changed. For example, it has been mentioned to me that my credibility in the work I do to promote animal well-being is enhanced by the fact that I am no longer vegetarian (I am pretty close, but not entirely). I believe that had influential pro-vegetarian advocates stopped acting like a bunch of unscrupulous marketers and doe-eyed cultists back then, things would look very different now.
THR is not nearly so vulnerable to being marginalized (a lot more people practice THR than practice vegetarianism in the West), but there is a powerful opposition that wants to marginalize it. If we do not police ourselves and discourage THR advocates from embracing any claim that seems to support the cause, we run the risk of become an insular fringe that opponents can just ridicule and thereby ignore. Quick: name an organization that advocates vegetarianism that you would turn to for credible information about the topic? I didn’t think many of you would have an answer, though if you have ever thought about the subject, you probably thought of several that you would not trust. There are some good resources out there, but you pretty much have to already be an expert to sort them out from the marketing and cultish propaganda. Do we want to risk THR and e-cigarette advocacy looking like that in a few years?