Tag Archives: citations

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.”

The “do no harm” lie

posted by Carl V Phillips

To complete our series on the amazingly bad anti-THR position statement from the European Respiratory Society (presumably via Christina Gratziou), I will pick up the sentence I skipped in the previous post that pointed out their dishonest and otherwise abysmal use of source citations.

In general, ERS subscribes to the medical principle of primum non nocere and holds that Tobacco users “should not trade one carcinogenic product for another…”[6]

To finish up the theme from the previous post, let’s start with the citation, which is to the 2003 Congressional testimony of US Surgeon General Carmona about smokeless tobacco and THR.  As bad as the other six citations I discussed in the previous post were, this one packs in an unbelievable amount of fail:  They cited what is basically an opinion statement from 2003 — practically the dawn of history in THR terms — in a document about emerging products.  That particular statement is one of the most completely debunked anti-THR polemics in history, and made Carmona look like an idiot to anyone who understood the subject.  It was only about the smokeless tobacco products that existed in 2003, not the majority of the products discussed in the document.  The evidence then, as now, did not support the claim that popular smoke-free products were carcinogenic at a measurable level.

And finally, why would someone cite a source for a normative assertion (i.e., saying what they think should be the case) that is described in terms of “we hold that….”?  Their opinion is still just their asserted opinion (and is just as lies-based and harmful) in spite of someone having used the same phrase once, a long time ago.  Grade: F-minus-minus-minus.

But there is much more to this one horrible sentence (and I am not talking about the odd capital “T”):

That “primum non nocere” for those who do not speak pointless obnoxious pretensiousnessLatin, it means “first, do no harm”, a phrase that is somewhat mis-attributed to the Greek, Hippocrates.  The thing is, there is no such principle.

The words exist, of course, and they are even repeated frequently.  But they do not mean anything very useful, and cannot be the reason for a belief or claim.  The phrase is most often — perhaps even virtually always — used as a rationalization to dress up an existing opinion.  When you see these words used in anti-THR, you know you are dealing with someone with either limited understanding of what they are talking about, or who is a liar.

The simplest interpretation of that phrase is:  never do anything that might cause any harm.  But this effectively precludes all actions in health and medicine, and most any other action of any sort.  Any action stands a chance of doing harm.  Most medical procedures definitely do some harm, and all of them stand a chance of doing more harm than good in a particular case.

The usual response to anti-THR people invoking this non-principle is to point out that even as they oppose THR, they (usually) endorse anti-smoking pharmaceuticals, including those that sometimes cause people to become violent or suicidal — obviously causing harm.  But it is not necessary to get into such details to see that neither they nor anyone else actually believes that “never do anything that might cause harm” is good advice.  Cutting a hole in someone to remove a ruptured appendix does harm to the tissue on the way in, after all.

But, you say, we expect that the surgery will do more good than harm, so it is obviously a good idea.  Of course it is.  But it is doing some harm.  This observation suggests that we need to instead interpret the “principle” as something like: do not do anything that we expect will do more harm than good.  (In economist-speak — and this is really an economic statement — that reads: do not do anything with negative net expected value.)

That seems like good advice.  And it is.  It is such obviously good advice that it is not worth giving.  Of course we should not do things that we expect will do more harm than good.  If that is all the principle means, then the claim that it argues against THR is clearly wrong.  But even apart from that, this is clearly not what they are saying when they cite the “principle”, since making such a claim would require estimating the harm and good of an action and comparing them, and the ERS (and basically all anti-THR statements) fail to do that.

So can we find a definition of that phrase that is not utterly stupid advice (never do anything that might cause any harm) and is also not so obvious as to be unnecessary (do not do things that you predict will do more harm than good)?  It is typically interpreted to mean something like, “if you have no idea what might be helpful for someone, then do not just jump in and go mucking about, doing things that are just as likely to hurt as to help.”  But the key to this is being in a situation where you have no idea whether something will do good.  That contrasts with the situation surrounding THR, where we know that encouraging smokers to switch to low-risk alternative will do good.

In short, the ERS — and anyone making a similar claim — is just throwing out a fancy-sounding phrase that has nothing to do with the situation at hand.  They are lying when they suggest that there is a principle that supports their position. What they are doing is engaging in word games, suggesting that because there might be some harm, maybe, from encouraging THR, that doing so is precluded by the “principle”, whereas all other actions are allowable so long they are expected to do more good than harm.

(Note that when someone refers to the “precautionary principle” in the THR context, they are engaging in basically the same lie, though it is actually a bit worse.  I will come back to that when an example presents itself.  I am tagging with “precautionary” if you come across this post in the future and want to find that.)

I will conclude this series by noting the end of the ERS statement:

ERS…maintains that the best health advice to smokers is to quit smoking.

Oops, maybe I should not have been so hard on them.  Maybe they are pro-THR after all.

Lying via citations

posted by Carl V Phillips

When students are taught to write their first toy research paper, in grade 4 or so, they learn to find and cite sources for their claims.  The mere act of finding some source for a claim is a major intellectual development, moving for the first time beyond just writing what they believe.  But by the time they finish high school or at least university, those students learn that just because someone said something, even if the source seems to have credentials or the document appeared in some impressive forum, does not make it a legitimate source to cite (or, if they do not learn that, they should ask for their tuition to be refunded).  Moreover, the cited material needs to support the core claim that it is attached to not some non-core aside in the statement, or only some aspect of the claim, and it needs to be a genuine source of that information, not just someone making an unsubstantiated claim and writing it down.

Unfortunately, the corollary to that — that readers need to be wary of authors violating that rule — is not learned nearly as often.  Liars who make “sciencey” claims realize this and take advantage of it.  (Of course, I suspect some of them may not even know that blind use of citations is D-minus work in itself, but that just means they are both liars and know nothing about scientific inquiry.)  Indeed, some of them go even further and just tack on source citations that do not even seem to relate to the claim being made, figuring no one will notice.

Consider the ERS anti-THR position paper that I started discussing yesterday. The particular passages I quoted and responded to then:

The European Respiratory Society, ERS is opposed to the use of all tobacco and unapproved nicotine delivery products such as cigarettes, chewable tobacco, and emerging products that include electronic cigarettes (e-cigs), snus, dissolvable tobacco and waterpipes.

In response to the successful increase in tobacco-free policies, the tobacco industry has developed these new products, allowing consumers to obtain nicotine without the use of a cigarette.[1] In many cases, these new products are claimed and/or perceived to be ‘harm reducing’ or safe alternatives to conventional cigarettes; however, there is no reliable science to substantiate this claim.[2] Rather, available research suggests that these products pose a significant health risk to citizens, placing them at continued high risk for disease and negative health outcomes. [3,4]

Reference [1]  is to a paper in one of the anti-tobacco advocacy journals from 2007.  Even setting aside the lie about how the “tobacco industry developed” these “new” products (see previous post), how exactly would a paper from 2007 been able to report on the new dissolvables (some existed then, but did not even qualify as a niche product; they are overwhelmingly a product of the last few years) or even e-cigarettes (had started to become recognized by researchers then, but were barely on the scene).  But worse, the paper is a review of literature on perceptions, beliefs, and marketing, but the claim in the sentence is about the motive of the industry, something that the review could not have addressed.  Grade: F for utter lack of support for the claim in the source, and for citing a puff piece from 2007 (ancient history in THR terms) in a current position statement.

Reference [2] is an unsigned position paper of unknown provenance put out by a political organization (FCTC).  It should not be cited as scientific evidence for anything, in much the same way Wikipedia should not.  Either one can be used for a resource to find a real source of information, but if content cannot be traced back to a real source, then it has to be considered as being at the “I saw it on the internet somewhere” level.  Moreover, as far as I can tell, the document — as political as it is — never goes quite so far as to blatantly lie that there is no evidence that smoke-free alternatives are lower risk than smoking.  Grade: D for citing an unsigned political document, lowered to F for citing it inaccurately.

Reference [3] is one of the blurbs from FDA making absurd claims about e-cigarettes (look for the upcoming series on lies about THR by the US government).  Even if FDA were a reliable source on this topic, this is just a little statement directed at consumers, and so is similar to quoting a “public service” television advertisement or a pamphlet found in a medical office.  And guess what?  It still does not actually include any claims that “these products” cause substantial health risks — not even about e-cigarettes, let alone the other three smoke-free products among the list of “these” that are not even mentioned.  Thus, it most certainly does not contain claims that “research suggests” that this is true (and, of course, the blurb is certainly not research in itself, though perhaps someone like Christina Gratziou thinks it is).

The adjacent reference [4] is little better.  It is a lie-filled “advisory” from the Canadian government that is part of their rationalization for banning e-cigarettes.  And yet, again, even as laden with anti-THR lies as it is, it does not actually claim that there are substantial health risks or identify any research.  It is worth reiterating that neither of the cited sources addresses any product other than e-cigarettes at all, even though the sentence clearly refers to the entire list of products.  Grade:  I really wish there was something below F.  Oh, wait, there is: academic misconduct.

Next comes:

There is a growing concern about the potential health risks associated with e-cig usage and exposure. A recent sample of the product was found to contain carcinogens and toxic chemicals such as diethylene glycol, an ingredient used in antifreeze.[5]

That, of course, refers to the biggest anti-THR lie of recent times, in which the US FDA lied about unimportant contaminants they found in e-cigarettes.  Citing that thoroughly debunked propaganda is C-minus work in itself (only that high because there was at least something that might be called a study behind it).  But, wait.  The citation is to “Utah Tobacco Prevention And Control Program- position on E-Cigs”.  Yes, you should be laughing out loud by now — a supposedly learned European scientific society could not even manage to cite the original junk science, but instead cited a position paper from a little activist group in Utah.  Definitely lowers it to an F.

ERS fully endorses the Article 14 guidelines of the WHO Framework Convention on Tobacco Control[7] and therefore maintains that the best health advice to smokers is to quit smoking.

At least that bit is honest (the citation is to an FCTC document, of course).  The only honest statement in the entire broadside.  Translation:

We blindly follow what the FCTC says, and have neither opinion nor understanding of our own to offer on this topic.

I skipped [6] — that one gets a whole post of its own.

Last point (which you can skip if you are not particularly interested in the theory of citations):  It has long been clear to me that it is a very bad thing that public health adopted the endnote method of citation (in the original, those numerals are the standard superscript, by the way) used by natural sciences, rather than the embedded name and date format (e.g., “(Phillips et al., 2007)”) used in other social sciences.  First, it makes it very difficult to use the content footnotes that are needed in the more complicated social sciences, but not so much in simple natural science reporting.  More important, it tends to hide the information away from all but very attentive readers who jump to the end of the paper for every citation.  In decent natural science reports, this is probably not so necessary, but in social sciences it is quite often very crucial who said a particular thing and when.  Often any expert reading the paper would recognize that the particular source is biased or useless from the embedded citation, but might miss it in the endnote.  This, of course, does not fully explain why modern “public health” people lie so much and get away with it, but it does contribute.  I have a feeling that if the original editors in this field could see what they wrought, they would have chosen the social science style of citations.