Tag Archives: CDC

FDA is complicit in CDC’s lies; grossly inappropriate behavior for a regulator

by Carl V Phillips

The neglected half of the story about CDC’s latest lies about e-cigarettes — and it is fully half of what is important, at least — is FDA’s complicity in it. As I recounted in the last two posts, and Brad Rodu expanded upon, the latest CDC claims about kids’ use of e-cigarettes are based on a shoddy and misleading study (presumably intentionally so). It is full of lies in itself, and those were then further exaggerated and made more inaccurate in CDC’s press release. It is certainly not acceptable that our government officials at CDC are acting as blatant propagandists for a special-interest position. It is probably illegal and is certainly unethical. But we have come to expect this from CDC — they have been one of the leading anti-THR liars for 15 years. It is far more troubling that the agency that is supposed to be the impartial regulator of such products, FDA, is complicit in the lies. Continue reading

CDC press release about e-cigarettes: blatant lying by government officials

by Carl V Phillips

Yesterday I peer reviewed the latest journal article about by CDC and FDA about kids’ use of e-cigarettes, pointing out the massive methodological flaws, inaccurate conclusions, Orwellian language, and overt political advocacy that it contained. I mentioned CDC’s associated press release, but did not go into details. But the press release is arguably a far greater crime (and that is not hyperbole — it is criminal for the US government to lie to the people), and calls for a post of its own. Continue reading

CDC refines their lies about kids and e-cigarettes

by Carl V Phillips

I will interrupt my series on the failures of peer review to look at a great example of the failures of peer review, a new broadside (I hesitate to call it a study) from the CDC that appears in Nicotine and Tobacco Research, an alarmist piece about kids’ reported use of e-cigarettes.  Here is the official abstract at the paywalled journal page.  And here is a bootleg copy of the full manuscript (the US government does not let you hide your work behind paywalls if it comes from taxpayer-funded grants, and so I am not going to let them do it when we are paying for it directly). Continue reading

Modest good news on smokeless tobacco use

by Carl V Phillips

I’m back.  I’ll start with something quick and easy and try to dive into the backlog of difficult topics shortly.

The CDC has belatedly reported some statistics on U.S. smokeless tobacco (ST) use from the 2000s.  Comparing surveys from 2005 and 2010, they found that ST use increased from 2.7% of the population to 3.0%.  For men, the figures were 4.9% and 5.6%, reflecting the fact that in this population, almost all ST users are men, and indeed that dominance increased over the study period.

This accounts for about 1/10th of the drop in smoking recorded by the same survey.  This is a rather more modest impact of THR then we usually estimate (some broader statistics suggest that replacement by ST accounts for about half of the smoking reduction through the 2000s).  But it is still a positive. 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

A paragraph-by-paragraph dissection of an unusually good article about e-cigarettes (part 2)

by Carl V Phillips

Continuing from yesterday’s post dissecting this NYT article by Sabrina Tavernise, we pick up with:

Pessimists like Dr. Glantz say that while e-cigarettes might be good in theory, they are bad in practice. The vast majority of people who smoke them now also smoke conventional cigarettes, he said, and there is little evidence that much switching is happening. E-cigarettes may even prolong the habit, he said, by offering a dose of nicotine at times when getting one from a traditional cigarette is inconvenient or illegal.

As noted previously, Glantz differs from some e-cigarette “pessimists” in his sociopathic willingness to repeat obvious lies.  Most notably, there is a huge amount of evidence about switching.  More subtly, there is no basis for claiming most people who vape are also still smoking.  We know that most smokers who have tried an e-cigarette are still smoking, contrary to the “they are a miracle” view, but we have relatively little information on how many e-cigarette users (by any normal interpretation of the term — i.e., not merely someone who has tried one or takes a puff on one periodically) still smoke.  The spotty evidence that exists suggests that most who have become regular e-cigarette users have become non-smokers or have moved far in that direction.

As a minor aside, it is worth noting that in some places, the verb “smoke” is used to refer to vaping an e-cigarette, but in the USA it tends to only show up when the author only did five minutes of research before claiming expertise on the topic (e.g., most local news reporters) or by someone who thinks that smoking is evil and wants to extend that to vaping.  Though it is not presented as a direct quotation, this paragraph appears reflect Glantz being in the latter category.

The last sentence is an out-and-out confession that tobacco control, and “public health” in general, is not about helping people, but about demanding obedience and intentionally hurting people if they are not obedient.  Basically it says, “we intentionally harm smokers, such as by limiting where they can smoke, for the purpose of lowering their quality of life so much that they are better off obeying our diktats.  E-cigarettes offer a way to relieve some of the imposed suffering, and we can’t have that.”  Of course, the same can be said about NRT, but is not.

That sentence, and the paragraph in general, illustrate a point about those who accept or even embrace e-cigarettes, but are still part of “public health” or the medical industry rather than really believing in the principles of harm reduction:  Glantz tells these lies because if they were true, his fellow “public health” people would conclude that e-cigarettes are bad.  But a real supporter of harm reduction — and indeed, any decent human being who actually cared about people — would still conclude e-cigarettes are good.  Even if the all lies were true, it would still be the case that some smokers are freely choosing to switch completely to e-cigarettes (good); some smokers, who now can choose to smoke, vape, neither, or both, find that “both” is the choice that is best for them (also good — those making that choice must like it better than just smoking); almost all of those choosing “both” are smoking less (good for their health); and the harm suffered by smokers from not being able to smoke in certain circumstances is also reduced (good, assuming you actually care about people).

Harm reduction inevitably increases total consumption; lower the cost of something and more people will consume it.  For THR, this primarily means that as low-risk tobacco products are developed and people understand them, there will be more total tobacco users.  Some people who would have been abstinent from all tobacco in a world without e-cigarettes — including some who would have never smoked at all — will decide to become vapers.  But in the weird world of tobacco politics, this has an unusual implication:  One of the harms suffered by smokers is having to go outside for a smoke, and smoke-free alternatives reduce that harm too.  The inevitable result of harm reduction, then, means that since smoke-free alternatives lower the cost of smoking a bit, they will cause some smoking that would not have otherwise occurred (albeit, probably very little).

In the “debates” that you see in the newspaper, almost everyone represented is of the opinion that this outcome is wholly bad, differing only in what they think (or pretend to think) about how this cost compares to the benefits.  The opinions that are allowed into the public debate cover the spectrum of views from A (abject hatred of all tobacco products and users, and a fantasy belief they can both be eliminated) through about P (reluctant acceptance that people will use tobacco and a belief that it is not too terrible, so long as it is low risk). Often there will be one line of praise from an enthusiastic user or shopkeeper who is at Z (though often only for e-cigarettes, and he is closer to A for other tobacco products).  Every so often there will be a technical acknowledgment of the benefits of nicotine.  But completely missing from the institutionally sanctioned “debate” is anyone who believes that something that makes people happier overall is good, even if it makes them less healthy compared to abstinence — which is to say, anyone who truly believes in the philosophy of harm reduction.

I will come back to this.

What is more, critics say, they make smoking look alluring again, with images on billboards and television ads for the first time in decades. Dr. Glantz says that only about half the people alive today have ever seen a broadcast ad for cigarettes. “I feel like I’ve gotten into a time machine and gone back to the 1980s,” he said.

I wonder if Glantz realizes that his recall of history that he lived through is as poor as his interpretation of study results?  No one has seen a television ad for cigarettes in the USA since the 1971, when they were banned (which means that well over half the population has not seen such an ad on domestic television). Perhaps Tavernise garbled his point and he was referring to cigarette billboards (though I do not recall seeing any of these for e-cigarettes), which did exist in the 1980s — but, um, also through the 1990s.  I suppose “senile” is a valid alternative hypothesis to “sociopath”.

Of course, that is not the main problem with the claim.  How can touting a smoke-free product that is all about anti-smoking make smoking look alluring? Those “critics” seem to never explain this, and the reporters — even when they are writing a basically solid story — do not bother to ask.

Researchers also worry that e-cigarettes could be a gateway to traditional cigarettes for young people. The devices are sold on the Internet. The liquids that make their vapor come in flavors like mango and watermelon. Celebrities smoke them: Julia Louis-Dreyfus and Leonardo DiCaprio puffed on them at the Golden Globe Awards.

I could have been charitable and skipped this paragraph, but I was so baffled about how it relates to the narrative, or even to itself from one sentence to the next, that I just had to comment.  It seems to be where some leftover sentences got dumped.

Of all the reasons that entertainers are terrible role-models, their choice to vape — or for that matter, to smoke or shoot heroin — is nowhere close to the top. Also, I would have emphasized Jenny McCarthy, who claims (contrary to reality, and at great expense to society) to have expertise on public health, rather than non-political entertainers who just happen to live on camera.  But since Tavernise did not actually go anywhere with this, it is hard to figure out what the point was supposed to be.

The first sentence is made substantive by the next paragraph:

A survey from the Centers for Disease Control and Prevention found that in 2012, about 10 percent of high school students said they had tried an e-cigarette, up from 5 percent in 2011. But 7 percent of those who had tried e-cigarettes said they had never smoked a traditional cigarette, prompting concern that e-cigarettes were, in fact, becoming a gateway.

As has been discussed extensively in this blog, these statistics have been widely misinterpreted, including by the CDC itself.  But this paragraph is worse than usual.  Notice the switching between percent of the entire population and percent of that percentage.  Most readers are going to interpret this as saying “10% had tried, and 7/10 of those had never smoked (i.e., 7% of the population had tried e-cigarettes and had never smoked)” when actually it says “a mere 7/100 of those who tried e-cigarettes had never smoked (i.e., 0.7% of the population).”  Moreover, not only is the gateway claim unsubstantiated, but is not supported by this observation at all:  Someone who has tried an e-cigarette and does not smoke is obviously not a gateway case.

“I think the precautionary principle — better safe than sorry — rules here,” said Dr. Thomas Frieden, director of the C.D.C.

That is not what the precautionary principle says.  That phrase is used incorrectly at a rate that may even exceed the misuse of “epicenter” or “socialist”.  While it is not well-defined, the actual precautionary principle basically says that we should not allow someone to inflict involuntary harms on others, particularly if the action is difficult to reverse, without first providing evidence that the harms are acceptable.  For example, the burden of proof should not be on those who fear that building massive “renewable” energy facilities causes harm, defaulting to allowing it them until someone proves it they are harmful, but rather on the builders to do the research in advance to show they are not too harmful, defaulting to forbidding it until that is established.  It is a reasonable standard for the environmental impact situations for which that principle was created.  It is not relevant to consumer products. The consumers are making a free choice that affects only themselves, and there is nothing irreversible about it.

This illustrates how “public health” treats people as adversaries rather than the basis of concern, and how the mainstream media never calls them on it.  A company that wants to site a noxious facility is in an adversarial relationship with people who might be hurt by it, and so there is a need for regulation about whether the action is allowed (as opposed to just quality control and truth in advertising rules, which are almost always appropriate) and the precautionary principle is arguably appropriate.  This does not describe choices about tobacco products (or soda, food, etc.), where the decision maker and the only “victim” of consequence are the same person.  This is perhaps the defining characteristic of the “public health” political faction, conflating individual choices with adversarial situations with imposed harms.  (Aside:  extremist “free market libertarians” make exactly the same mistake — conflating personal choices and actions that impose major external impacts — but conclude that because the former should be free, the latter should also.)

Focusing on the speaker rather than the message for a moment, here is where some knowledge about the history of THR would be useful.  The CDC and those who currently control it were blatant anti-THR liars long before e-cigarettes came along.  Everything they say about e-cigarettes needs to be filtered through that background knowledge.  Interestingly, that is not true of Glantz, who was largely silent about THR before e-cigarettes, even as he was authoring some of the most extreme anti-smoking lies.  This lends credence to the theory that he hates e-cigarettes because he genuinely believes they encourage or glamorize smoking, which he obsessively hates, or even that they just mimic it.  By contrast, Siegel was aggressively anti-THR before e-cigarettes, and that contradiction is more difficult to explain.

E-cigarette skeptics have also raised concerns about nicotine addiction. But many researchers say that the nicotine by itself is not a serious health hazard. Nicotine-replacement therapies like lozenges and patches have been used for years. Some even argue that nicotine is a lot like caffeine: an addictive substance that stimulates the mind.  “Nicotine may have some adverse health effects, but they are relatively minor,” said Dr. Neal L. Benowitz, a professor of medicine at the University of California, San Francisco, who has spent his career studying the pharmacology of nicotine.

Ok, fine.  But notice the non sequitur — another one that is common in the discussions and not just an artifact of Tavernise’s article.  The first sentence is about addiction, but the rest are about consumption, whether there is “addiction” or not.  It points out the fact that not only does “addiction” not have a real definition, but most of the time that it is used, it means nothing more than “engaging in a behavior that the speaker believes is immoral.”

Another ingredient, propylene glycol, the vapor that e-cigarettes emit — whose main alternative use is as fake smoke on concert and theater stages — is a lung irritant, and the effects of inhaling it over time are a concern, Dr. Benowitz said.

Um, sort of.  Its most common other use as an aerosol is fake smoke — it has a zillion non-aerosolized uses.  The aerosol is also used in some inhaled medicines.

Perhaps the reporter should have quoted someone with expertise on exposures other than nicotine regarding the non-nicotine aspects of the exposure.  It is true that the exposure is great enough and sufficiently novel that problems might be discovered, and it is worth watching for them.  But that conclusion, from someone who actually knows about exposures other than nicotine, is about keeping an eye on it, just in case, not the alarmist “are a concern” that feature story reporters prefer.

But Dr. Siegel and others contend that some public health experts, after a single-minded battle against smoking that has run for decades, are too inflexible about e-cigarettes. The strategy should be to reduce harm from conventional cigarettes, and e-cigarettes offer a way to do that, he said, much in the way that giving clean needles to intravenous drug users reduces their odds of getting infected with the virus that causes AIDS.

Therein lies a very interesting question.  Is THR really all that similar to injection drug use harm reduction?  And do the public health (to say nothing of the “public health”) people who support smoke-free alternatives really believe in the core values of harm reduction.  Yes and no.

The adoption of the phrase “harm reduction” in the tobacco context was a conscious reference to approaches like needle exchanges for IDU.  The comparison was certainly useful for getting the concept established, and I used it many times for a decade.  But with the term established (and with hopes of getting institutions that support IDU harm reduction to also support THR having proved a dismal failure in spite of focused efforts by me and others — another thing that is useful to know about THR), the analogy now seems to do more harm than good.

More on that in the next post.

One advantage of truth over lies: it seldom contradicts itself

by Carl V Phillips

As regular readers know, the tobacco control industry will say anything they can think of that might further their cause, regardless of whether it is true.  The downside of this — other than the fact that it means they fit the definitions of both “sociopath” and “evil” — is that lies frequently contradict each other.

There are a million examples of this, of course.  I find the most notable one to be the claim that there is a worrisome “gateway” effect from smoke-free products to smoking (which is not true) and yet there is a concerted effort to deny that smoke-free products are low risk compared to smoking (which would tend to create a gateway effect, since you might as well smoke if that is true).

A closely related problem is that sometimes the tobacco controllers want to report the truth, and the truth very frequently contradicts the sociopath lies.  A recent favorite lie that has been flogged by Stanton Glantz and used by others to attack e-cigarettes is the claim that they are often used merely to cut down on smoking, and cutting down does not reduce your risks.  More specifically, Glantz is claiming that the heart attack risk does not decrease and phrasing it to trick the reader/listener into believing that the claim is that risk does not decrease it all.  Even setting aside the fact that cutting down is a typical transition state on the way to stopping, this is simply not true.  Apparently the somewhat more honest tobacco controllers at the CDC did not get the memo that this is the lie of the month, because they just tweeted:

(‏@CDCTobaccoFree) No smoking is safe, but risk of heart disease & heart attack greatly increases w/number of cigarettes smoked.

For any readers who might be as innumerate as Glantz (though I cannot imagine there are any), “increases with the number of cigarettes” is exactly equivalent to “decreases when you cut down”.

By the way, for those interested in the truth, it is this:  The risk of cancer increases close to linearly with the number of cigarettes smoked (cut the number smoked by half and you cut the risk by half).  Cardiovascular risk, including heart attack, increases much more sharply with the number smoked and then gets flatter, which means that cutting from 20 to 10 does not cut this risk in half — not even close — but it does decrease it.  Other diseases seem to fall in between those functions.

We do not actually have very good data on smoking less than about 10 per day and almost nothing useful below 5, so it is hard to be sure.  But there are good reasons to believe that the cardiovascular risk from smoking just a handful per day could be in the neighborhood of half of that of smoking a pack a day.  (Strangely, this means that CDC was arguably overstating the benefits of cutting down without quitting.)

So there is a good reason to push on to zero after cutting down.  But it is obviously a lie to claim there are no benefits to cutting down.