Tag Archives: ERS

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.

ERS position statement – lies, but D-minus work even apart from that

posted by Carl V Phillips

I mentioned that the “European Respiratory Society statement on E-cigarettes and emerging products“, probably written or at least overseen by demonstrated anti-THR liar Christina Gratziou,  might be the stupidest anti-THR statement I have ever seen from a theoretically-respectable organization.  Apparently they are not actually respectable, as demonstrated by the statement looking like something you would expect from some sock-puppet group of high school kids.

It starts out,

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]

I could just write about the simple falsehoods — the claim that the tobacco industry developed the products and there is no reliable science — but this blog is going to get awfully boring if we just keep finding people making such false statements and repeating that they are false, over and over.  We will respond to claims like that when writing formal challenges like our formal complaint about Ellen Hahn, and will inevitably mention them periodically.  But we will try to minimize writing post after post about simple falsehoods in non-scientific statements.

In this case, beyond the blatant false statements there are three interesting and somewhat subtle lies in this position statement that I will cover in three posts.

The first can be found in the “and” toward the end of the last sentence.  There is almost nothing that can be said about this list as a collective entity (as in “these products” in the next sentence) that would be true.  Even setting aside the inclusion of cigarettes in that list, which I will be charitable and assume was a typo, what appears on this list of “new” alternatives to cigarettes with “significant health risks”, brought to you by “the tobacco industry”?

  • “Chewable tobacco” (normally called chewing tobacco), which is probably the original tobacco product, far older than cigarettes, and poses no health risks that are large enough to measure for the forms popular in North America and to a lesser extent, Europe.
  • E-cigarettes, a clearly low-risk alternative to smoking that is quite different from using whole tobacco in many ways, and was entirely an indy development until very recently.
  • Snus, the Swedish word for oral snuff, a product that like chewing tobacco is prehistoric, has been quite popular throughout the modern era (more now than before), and has also not been found to cause measurable levels of risk; alternatively, this word is commonly used in casual conversation to refer specifically to Swedish style snuff, in which case is it not prehistoric, but merely centuries old, with all of the other descriptions remaining the same.
  • “Dissolvable tobacco” (presumably referring to tobacco in a dissolvable substrate — the tobacco does not dissolve) which is a new innovation and is generally believed to pose close to the same very low risk as similar smokeless tobacco products, though there are some possible differences.
  • Waterpipes, another centuries-old traditional product, though one that is a form of smoking, and thus may pose risks that are similar to those from cigarettes (many estimates put the risk a bit lower, but the anti-tobacco industry has taken to saying it is 50 0r 200 times worse than cigarettes).

I trust it is fairly obvious that no statement that tries to generalize about that list, beyond simple statements like “these are all ways of using nicotine and tobacco that many people like”, is bound to be a fail.

But this is not an accidental fail.  It is a new version of the conjunction lie that my colleagues and I documented in what I believe is the first study of anti-THR lies.   The simplest version of this anti-THR lie is to refer to “tobacco” as if that plant name refers to an exposure — a single exposure, no less — and then start quoting statistics about the risks from smoking as if they are relevant to other forms of tobacco use.

The particular version of it that was popular c.2004 was the claim, “smoking and smokeless tobacco cause 75% of oral cancer.”    This was actually a bastardization of the more defensible “smoking, drinking alcohol, and smokeless tobacco cause 75% of oral cancer.”  This was based on a single study or one dataset that concluded that smoking and drinking (alone) were responsible for 75% of oral cancer.  So, add something else to that list that does not seem to cause oral cancer, and the estimate is still 75%.  As in “smoking, drinking, and listening to Mozart cause 75% of oral cancer.”

So, for any list that includes a form of smoking alongside a several smokeless alternatives with no proven risks, it is possible to say that “these” apparently cause various risks and have not been shown to be less harmful than smoking.  (This is even more obviously so if we leave cigarettes on the list rather than assuming it was a typo.)  Obviously any such claim is a lie, meant to trick the reader into believing that the claim is true for everything on the list, when it is actually true of only a small subset of the items on the list.

Those anti-THR liars think that they are just soooo clever.

As a final note, it is now generally accepted that papilloma virus causes a large fraction of oral cancers.  It was actually fairly clear that sexual transmission accounted for a lot of oral cancers back when the 75% claim was originally made, and that 75% was not even close to accurate.  That is now the conventional wisdom.  (I never got around to publish a paper that pointed this out — my bad.)  If anyone is aware of any case where the anti-THR or anti-smoking or anti-alcohol activists explicitly admitted they were wrong about their adamant declarations that “their” product caused most oral cancer, I would love to see it.  I have never seen any such admission of error in spite of this clear disproof of what was once one of their favorite claims.

…to be continued…

Christina Gratziou is a liar

posted by Carl V Phillips

Today I will start an analysis of the buzz-generating press release by Christina Gratziou (University of Athens) et al., based on their presentation at the recent European Respiratory Society (ERS) meetings.  Much has been written about this non-result that was blown up into the unsupported claim that e-cigarettes damage the lungs.  I call your attention in particular to a post by Katherine Devlin (ECITA) which does an excellent job of analyzing the situation, as well as presenting the analysis with verve that I cannot hope to improve on (see her letters to newspapers that naively reported on this, which are linked from the post, for more detail).

While it would be tempting to just yield this topic to Katherine (especially since she even used “lies” as the first word of her title), I think I have a few views on this that have not been covered and a few useful clarifications.  Also, I hope to make this blog a catalog of both anti-THR lies and issues related to anti-THR lying, and there are some points to be covered on that here.  With that, I start with the question of “why should the lay reader (or a reporter who does not understand the subject but wants to transcribe the press release) know that Gratziou is a liar?”

Start with the official abstract of her presentation:

Electronic-cigarette is marketed as potentially safer tobacco exposure product, but there are not enough data concerning its impact on the respiratory system. Therefore, we set out to investigate the acute effects of an e-cigarette on respiratory functions in healthy subjects and in smokers with and without chronic airway obstruction (COPD and asthma).

The basic statement is not too terrible.  To make it accurate would require only the minor change to saying e-cigarettes are a safer product.  Alternatively, to hedge and not make unnecessary claims in the introduction, that they are potentially safer or that they are widely believed to be safer.  Perhaps the poor wording just reflects the author not being a native English speaker; after all, “tobacco exposure product” is clearly garbled.

But, wait: “marketed”?  Why would a scientist care how they are marketed, even if she is inclined to mention how they are perceived. The only time anyone ever uses that nefarious-sounding word, marketed, is when they are actively setting out to dispute the marketing claim.  But someone doing vaguely-informative biomarker research should not be in the business of addressing such claims.  Someone writing a summary of all the knowledge on a topic can engage in such pursuits, but a single bit of lab research can only ever be about that single bit of lab research.

Now consider the press release (reporting on the exact same results covered in the abstract):

New research has shown that despite electronic cigarettes being marketed as a potentially safer alternative to normal cigarettes, they are still causing harm to the lungs.

This includes similar downplaying of the existing knowledge that they are safer.  But, wait: “despite”?  That word conveys the message that the belief is wrong because the research provides evidence of that fact.  But this is obviously a lie; even someone who somehow honestly believes that we lack sufficient evidence that e-cigarettes are less harmful than smoking, and whose caveats and other wording meant that she was just being a hyper-cautious about drawing any such conclusion, would know that finding one specific harm from e-cigarettes would not justify that “despite”.  Not unless the discovered harm were somehow worse than the combined harms from smoking, which this one obviously was not.  (Indeed, it was not apparently much of anything, but I will come back to that in a later post.)

But Gratziou is not hyper-cautious, nor a careful scientist.  Consider, for example, this interview she gave at the conference (h/t “elpatron83″ at ECF for the link)

We don’t suggest anybody to take and use e-cigarette as an alternative tool for smoking [broken English in the original — not a criticism, just trying to quote accurately]

(Aside:  Viewing the video, and even reading her text, one cannot help but be struck by her apparent glee when claiming that a tool that is helpful to so many people is bad for you.  She was not sad to be the bearer this unfortunate news; she reveled in it and clearly thought it was wonderful to report it.  Such glee — which can be observed in many anti-THR and anti-tobacco activists — is not the mark of a mere liar, but of something much much worse.)

The hyper-careful scientist possibility goes out the window as soon as she starts making unequivocal policy/behavior recommendations.  Even apart from the fact that she was telling people “you might as well smoke”, the fact that she was telling them what to do at all makes her an advocate.

There is nothing wrong with being an advocate, of course, nor with doing research when you are also an advocate.  But if you are actively supportive of a particular relevant viewpoint, you need to make that conflict of interest clear.  A researcher who gives no hint that she has that conflict of interest is implicitly communicating that she does not care which way her research comes out, which is clearly not the case here.

Moreover, if you are an advocate-researcher, then if your research tends to support your bias, you then need to be extra careful vigilant about presenting it in a way such that an honest expert reader of it would conclude, “I understand that the author preferred to get the answer that she got, but when looking at what she reported, unless she was simply lying about the data, she does indeed seem to have supported her conclusions.”

Gratziou failed both of these tests.  She covered up her conflict of interest, and she presented nothing but vague descriptions of the research and assertions about the results.

As a contrast, those of you familiar with the bits of my research whose results argue in favor of THR might have noticed that I make clear my views (stating them, that is; giving unintentional clues about bias via weasel words obviously does not count to one’s favor) and do everything I can to make sure that every bit of information that could possibly be reported is reported.  I have read plenty of whining about my research by people who wish it was not right, but I have never once read a challenge to my research by an anti-THR advocate or other ANTZ that identified any flaws in the research or reasoning, or that suggested there was something being hidden.  Ironically, I did publish a correction to one paper based on an error spotted by someone who is pro-THR; for most anti-THR papers, spotting such errors, which are clearly rife, would be impossible because the authors just make assertions rather than showing their work.

It is also interesting to consider the previous posts in this blog from the perspective of the obligations of the advocate-researcher:  Stephen Hecht has consistently covered up the fact that he is an anti-THR activist, and pretends to be doing unbiased research.  Ellen Hahn does not actually do research, so there is no mistaking that she is merely acting as an anti-THR activist — so by this one measure, she is the least dishonest of the individuals we have discussed.

Returning to Gratziou, she is Chair of the ERS Tobacco Control Committee, which is apparently responsible for the ERS’s aggressively anti-THR statement on e-cigarettes; undoubtedly she approved it and quite probably she authored it.  This moves her from advocate to activist.  (Incidentally, that statement might well be the dumbest, most uneducated position statement I have ever read from a theoretically-respectable organization — I am not counting the American Pediatric Association or ANTZ groups in that category, of course.  So it will be the topic of one or two future posts here.)

I will go on to analyze the science of her report — the few sentences worth of it that she actually reported — in the next couple of posts.  But today’s post should demonstrate how even someone who knows basically nothing about science (like, say, a typical health reporter for a newspaper), someone who cannot even figure out that the transitory effect that she measured cannot legitimately be called “harm to the lungs”, should know that she is a liar:  Her background statements made clear her activist agenda.  Yet she never admitted to being an activist, let alone made sure her claims were credible in spite of her bias.  Her grand sweeping conclusions about e-cigarettes could not possibly be supported by her research; even a health reporter should be able to figure out that unless she discovered an effect that might kill a third of all long-term users (which she obviously did not, nor did she even claim), then even if her results were completely definitive, she would not have support for her claim that you might as well smoke.  Yet she aggressively used weasel wording to imply that her little result contradicted the conventional wisdom.

Given the clear evidence that she is a liar and intent on presenting biased results without admitting her biases, her assertions should not be accepted (let alone published in newspapers), and the substance of her report (such as it is) should be analyzed with that in mind.  As I will do.

…to be continued….