Tag Archives: CDC

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.

CDC director misleads Medscape

by Elaine Keller

Centers for Disease Control and Prevention (CDC) Director Thomas R. Frieden, MD, MPH, sat down with Medscape during the recent National Health Research Forum in Washington, DC, to mislead the public about electronic cigarettes. http://www.medscape.com/viewarticle/811616  The following includes some of his comments and my corrections of the lies.

Medscape: There is a growing health concern about the electronic cigarette and how it is being marketed to consumers… What is the CDC doing to address this concern?

Dr. Frieden:  “What we are doing first is tracking…and we are seeing some very concerning trends.”

This is a misleading non sequitur and only the first half of the statement is true.  CDC has done no apparent research on marketing.  They are doing some tracking, but only about usage, not the reasons for usage.  And their data suggest nothing that is “very concerning”.

The CDC tracking he refers to seems to consist of their National Youth Tobacco Survey.  It asked youth whether they have ever tried an e-cigarette and whether they used an e-cigarette during the 30 days preceding the survey, even if only once. In addition, they asked youth whether they smoke conventional cigarettes. In order to make the numbers for trying e-cigarettes seem high, they intentionally avoided comparing them to the (much higher) numbers for youth smoking.  They also claimed there is a causal connection between e-cigarette experimentation and initiation of smoking, as well as claims that non-cigarette flavors are particularly appealing to youth, but they did not collect any data that addresses those claims at all — they just made them up.

Here is what the CDC is not reporting about e-cigarette use (some of which they do not know because they did not ask, and some of which they do know but avoided reporting):

  • How many students use e-cigarettes regularly or daily?
  • Among students who currently use e-cigarettes, how many are also smokers, or are former smokers who switched to e-cigarettes?
  • Among students who have ever tried e-cigarettes, how many prefer candy or fruit flavors, or even use them at all (let alone were attracted due to those flavors)?
  • How students are obtaining e-cigarettes?  Which merchants are refusing to sell to them and which are not?  Are the products they are using the ones that are actively advertised?

Dr. Frieden:  Use of e-cigarettes in youth doubled just in the past year…

Misleading! The only statistic that doubled was “ever use” which is really ever tried.  This category will inevitably increase for a novel product, even if there is no significant regular usage. If one student tries a puff, he is forever in that category, and if a second student tries a puff the next year, the statistic would double. This number grew from 3.3 percent in 2011 to 6.8 percent in 2012. However, the percent of youth in grades 6 through 12 who used an e-cigarette (even so much as one time) during the 30 days preceding the survey was only 2.1 percent.

Dr. Frieden:  “…and many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes.”

False. The CDC collected no data that would support this allegation.  Perhaps more important still, even if someone tried an e-cigarette and went on to smoke does not mean that the e-cigarette caused the smoking. Most people — quite possibly everyone — who follows that pattern would have started smoking anyway.  There is no reason to believe that e-cigarette use would make smoking more appealing, since we know that it generally makes smoking less appealing.  The whole reason e-cigarettes exist is to make smoking less appealing!

Assessing whether use of one product causes the use of another (rather than just precedes it) is quite difficult, which makes it easy for people like the CDC to lie for political reasons.  If it is true — if anyone is honestly interested in the answer, rather than just wanting to lie about it — we will know once e-cigarette use becomes so popular that we see an increase in smoking.  Past 30-day smoking rates have been steadily declining for youth between ages 12 and 17, dropping from 8.7 percent for males and 9.3 percent for females in 2009 to 6.3 and 6.8 percent, respectively, in 2012 (source).  Likewise, smoking initiation rates dropped from 6.2 percent for males and 6.3 percent for females in 2009 to 4.7 percent and 4.8 percent, respectively, by 2012.  If youth e-cigarette use is causing more smoking (rather than further reducing it, as it does with adults), this trend will reverse.  It seems impossible that this will happen.

Dr. Frieden: “Nicotine can be a very addictive drug, so we want to make sure that e-cigarettes don’t lead to another generation of kids becoming addicted.”

There is no basis for this claim.  There are strong arguments that nicotine (as opposed to cigarettes) is not addictive, and certainly no evidence to the contrary.  (See the previous post by CVP, for more on this topic.)

Though we do not know what he means by “addiction” we can guess at it and propose some real analysis that CDC seems oblivious to. They need to assess how many of the possible “addicts” (daily use might be a necessary condition for addiction, but it is not sufficient) were already regular smokers. Telling us that 9.3 percent of those who tried an e-cigarette (that may or may not have contained nicotine and perhaps tried only one time) were non-smokers provides no information at all about e-cigarette addiction. One way to get some notion of whether nicotine via e-cigarettes is addictive would be to track the number of never-smokers who became regular, daily users of e-cigarettes that contain nicotine. The CDC has not researched daily use or even whether the e-cigarettes being used by youth contain nicotine.

Dr. Frieden:  “In addition, if smokers want to quit, we know that there are FDA-approved medications that can double or triple their likelihood of succeeding.”

Been there, done that. The majority of adult smokers who turn to e-cigarettes have already tried FDA-approved medications more than once. One advantage of e-cigarettes is that the nicotine dose can be tailored to keep withdrawal symptoms under control.  Also, the only medicines that help more than a miniscule fraction of smokers (the case with NRTs) have major bad side effects.  I would be very interested in Frieden’s basis for claiming that these are better than e-cigarettes.

Dr. Frieden:  “Also, we need to make sure that people who have quit smoking don’t get hooked back on nicotine by starting up with e-cigarettes and then go on to smoking conventional cigarettes.”

Not likely. Many former smokers struggle with strong urges to smoke for years after quitting. Not having a satisfying substitute is the major risk for relapse. E-cigarettes with nicotine help prevent relapsing to conventional cigarettes. There are no reports of people who had quit smoking taking up e-cigarette use and then returning smoking conventional cigarettes.

It is bad enough that people who are paid anti-THR liars make claims like this.  But Frieden works for the U.S. government, and so has a legal obligation to tell the truth.  His moral obligation to tell the truth is also stronger since when he makes statements that contradict the facts, it will likely affect policy and thus hurt the public.

[For more on Frieden's lying, see also this post by Michael Siegel.]

CDC lies about kids using e-cigarettes

by Carl V Phillips

In a story that is practically a carbon copy of the lies from the Florida Department of Health that I discussed a few days ago, the CDC is lying to the public about statistics on school-aged e-cigarette use.  But this time, the lies are officially coming from our nation’s government, not some second-rate local department.  (Note, by calling them “second-rate” I am giving Florida the benefit of the doubt: in my experience, state health departments start at second-rate and go down from there.)

The CDC results were published in the agency’s newsletter/blog, Morbidity and Mortality Weekly Report and the lies were blasted out to the public via this press release.  Any American who is still shocked to find that their government is lying to them is an idiot (I doubt I will insult even a single one of my readers by saying that), and yet many reporters tend to blindly transcribe what CDC says rather than, say, bothering to read beyond the headline to see that it is clear based on only what CDC themselves reported in their press release that the claims are lies.

The headline of the press release manages to fit in one lie and two misleading claims, “E-cigarette use more than doubles among U.S. middle and high school students from 2011-2012″.  The biggest lie is that they report nothing about use.  All the reported statistics are about about trying the products, perhaps only once, which is obviously not the same thing (and CDC knows this).  Some statistics reported are for “ever having tried” and the others are “tried at least once in the last 30 days”.  They misidentify anyone who has tried in the last month as a current user, which is a rather blatant lie.  (Of course, some of those who tried recently may well actually be users, but there is nothing in the report that lets us conclude that even one single student is actually an e-cigarette user.)

The second sneaky lie was listing “middle school” ahead of “high school” even though the results for the former are trivial.  But it is scarier to imply that this is mostly about 12-year-olds and not 18-year-old high school students, isn’t it?

The third lie in the headline requires a bit of numeracy and data that is right there in the press release.  (This opens the question of whether our nation’s government’s top health officials are themselves innumerate.)  The number that more than doubled is for “ever tried”.  When your study population is 3/4 the same people from one observation to the next (as it the case with students who are in high school in 2012 compared to those in 2011), and the phenomenon you are studying is new enough that most of the trying is recent (as with e-cigarettes or whatever the latest offering McDonalds or Pepsico has added to their menu), then of course you are going to see a sharp increase in the number who have ever tried it.  It is almost impossible to see a decrease, and moreover, if the exact same number tried for the first time each year, that would come close to doubling the number who had ever tried.

You are with me there, right?  An 11th grader, in 2011, who tried an e-cigarette in 10th grade is still part of the “ever tried” group when he is in 12th grade in 2012.  If one of his classmates tried one for the first time in 11th grade, he joins his friend in the “ever tried” group in 2012.  Though the rate of trying was the same for this two-person population each year, the “ever tried” statistic DOUBLED!!!!  Scream it from the rooftops!

Did I mention that CDC are lying to people?

CDC apparently did not actually measure e-cigarette use.  They could have, of course.  Presumably they knew that the results would contradict the alarmist prohibitionist message they wanted to deliver, and so avoided the truth intentionally.  Actual use is clearly trivial.  If you actually wade though their breathless rhetoric to find information, you learn that 2.8% of high school students reporting trying an e-cigarette in the last month.  How many are actually using them?  If it is even as high as 1/10th of that, we are talking 0.3%.  But, hey, if you report something like that people will not be worried.  And worrying people is the goal.  So stick with “doubled!!!!!”.

Identifying the other important lies requires a bit of knowledge rather just the level of math that we can hope every subject of the studies learned many years ago.  (Am I being too optimistic about the quality of our schools?  Perhaps.  But that is off-topic.)  It turns out that almost all the e-cigarette triers had also tried cigarettes and indeed that almost 80% of them were “current smokers” (which, given CDC’s misuse of terms may be an overstatement of how much they actually smoke, though we do know that — unlike with e-cigarette trying (“hey, what is that? can I try a puff?”) — a large portion of those who puff a cigarette in a month are genuinely current smokers).  So this means that it is quite conceivable that most of those kids who tried an e-cigarette were pursuing THR!  That is, they consider themselves to be hooked on smoking and are seeking a low-risk alternative.  But we can’t have that, can we?

A comparatively minor point in the context of their more blatant lies, but still quite poisonous, is CDC converting their statistics (via the estimated size of the cohort they are studying) to “1.78 million” total students having tried e-cigarettes.  This level of precision implies that they have their result estimated so precisely that they know it to 1 part in 1000.  But their trying statistics, even if about as right as they could possibly be have precision in the range of maybe +/-20% at best.  (That is the best case scenario — when someone is lying about their statistics, always be concerned that they are lying about the data quality too.)  If they had said “almost 2 million” that would be reasonable, but even rounding to 1.8 million would imply more precision than they actually have, let alone 1.78.

Another comparatively minor but not trivial point is that quite a few high school students are of legal age to use tobacco products, and so it would be useful to break out the statistics for under-18 (which, of course, would be lower than those that include the 18- and even 19-year-olds).

It is also worth noting something that we know but apparently CDC does not:  Not all e-cigarettes even have nicotine in them.  How many of the kids tried e-cigarettes with nicotine?  No one knows.

Of course, the biggest lie is the “gateway” lie.  You know that when prohibitionists start making claims about a gateway that they have given up on pretending that a behavior is a problem in itself.  So they have to make up some reason for prohibiting it, so they claim that it leads to something that is a problem.  There is never any evidence to support those claims, about anything, as far as I have ever observed.  That is certainly the case here.  And yet the CDC makes claims that their data show that we should be worried about gateway effects even though there is no actual hint of that.

You can tell someone is starting with a conclusion and fishing for claims to support it when they contradict themselves over it within a few thousand words.  They claim both that the statistics showing almost all e-cigarette triers are smokers (or have tried cigarettes) suggests that there is a worry of a gateway and also that the statistics showing that a few (1/5th) of the (very few) younger kids who tried e-cigarettes had not tried cigarettes means that there might be a gateway.  So, guys, what would the evidence need to show to refute the claim there is a gateway?  The answer, of course, is that whatever the evidence shows, it supports the claim — this is religion, not science.

CDC on cigars – a great example of liar’s citations

posted by Carl V Phillips

I will come back to FDA in a few days, but we want to cover a few other things first.  One is to point out that the behavior of the FDA — in terms of both being anti-THR and junk science about tobacco/nicotine — does not represent either new or exceptional action by the US government.  The CASAA leadership just happened to be discussing this document from the US Centers for Disease Control and Prevention (CDC).  It is about cigars, which is related to THR, though not a core part of THR efforts.

There is good evidence that cigar smoking in traditional cigar style — puffing into the mouth with minimal inhalation into the lungs — is much less harmful than cigarette smoking.  Of course, the same method can be used with cigarettes too.  However, the interest in such substitution is limited and switching to smoke-free alternatives is far healthier, so there has been little interest in pursuing this.  (In addition, a lot of cigar consumption lately has been for products that are basically cigarettes and are smoked like cigarettes, as a way to avoid the punishing cigarette taxes.  That is understandable motivation, but it is not meaningful harm reduction.)

Still, that document says a lot about CDC’s approach to tobacco.  About half of the content is cited to three sources (links appear in the original if you really want to see them):

1. Campaign for Tobacco-Free Kids. The Rise of Cigars and Cigar-Smoking Harms . Washington: Campaign for Tobacco-Free Kids, 2009.

2. National Cancer Institute. Cigars: Health Effects and Trends. Smoking and Tobacco Control Monograph No. 9 . Smoking and Tobacco Control Monograph No. 9. Bethesda (MD): National Institutes of Health, National Cancer Institute, 1998.

3. American Cancer Society. Cigar Smoking . Atlanta: American Cancer Society, 2010.

This is a great example of lying with citations — putting in little footnotes that imply that the information presented is based on the best possible evidence, when actually the sources are rather useless.

You probably noticed that the first is to an anti-tobacco extremist organization, which, among other things, opposes harm reduction.  Moreover, it is not research by that organization, or even a review paper, but is just a two-page broadside.  The third reference is similar:  While ACS is thought of as a scientific organization, when it comes to this topic, they are also an extremist activist organization with little regard for honest science.  The cited webpages have a bit more content than the CTFK broadside, but not much, and do not even cite evidence for their claims.

So basically, we have an agency of the US government sourcing its scientific claims and consumer advice about a tobacco product to activist organizations whose mission is to say anything they can think of that is negative about tobacco products.  Their job description is to be biased, and that often means dishonest.  There is no possibility that CDC does not know this.  Could you imagine the State Department citing information in its travel advisories to the Middle East to anti-Islamic activists or the Department of Agriculture citing nutrition advice to anti-GMO activists?  This is similar in terms of credibility.

[You probably could, however, imagine agencies of the government deferring to other, more powerful, players for information in their areas of interest.  That observation -- and its relation to the present topic -- will be the subject of this week's Background post in a couple of days.]

At least source #2 is a real scientific review.  The problem is that it is from 1998 — very old history in a field like this.  But, funny thing: the CTFK document cites that 1998 report extensively.  So what CDC is really doing, by citing CTFK, is trying to hide the fact that all their information traces to 1998 by citing a more recent document that cites the original.  A common sneaky trick used in undergraduate term papers, brought to you by an authoritative voice of our government.

It gets worse.  The first statements that are cited to those three sources are:

A cigar is defined as a roll of tobacco wrapped in leaf tobacco or in a substance that contains tobacco….[1][2]

The three major types of cigars sold in the United States are large cigars, cigarillos, and little cigars.[1][2][3]

There is nothing wrong with the information, of course.  What is baffling is why CDC felt a need to provide a citation for it.  What is even more baffling is that citation #1 does not even provide a definition for cigar; citation #2 probably does, but I am not going to hunt for it.  Interesting, #3 does provide a clear definition — based on tax law — but is not even cited for the first sentence.  There is also clearly no need to cite that second sentence, but if you are going to, it should be to something relevant (like the official tax or regulatory definitions).  Here is a hint for those of you who want to cite a definition:  try a dictionary.

That is mostly just amusing, but it shows a general lack of seriousness.  More serious, and equally lacking in seriousness, are the series of health and other claims that are also cited to these three sources.  And lest you think I am cherry-picking, there are no other cited sources that provide any health information.  I am not going to go into detail about the claims because, for the reasons noted above, their role in THR is limited.  Suffice it to say that there is a lot of doubt now about the conventional wisdom about the risks that existed in 1998 (that probably sounds a bit familiar for those who know the science about smokeless tobacco).

So, basically, the official word of our government is: “(a) as far as we know, nothing has been learned since 1998; (b) just go read these activists’ position statements because we just defer to them anyway.”