Tag Archives: Glantz

Stanton Glantz hates smokers

by Elaine Keller (with contributions from other CASAA board members)

Stanton Glantz tries to project the image that he is anti-smoking, but his words and actions tell a different story: He hates smokers. Why else would he go to so much trouble to prevent them from escaping from the practice of inhaling smoke?

The word “smoking” specifically refers to the practice of inhaling smoke. Thus, to quit smoking means to stop inhaling smoke, not necessarily to become abstinent from nicotine or even from tobacco. The experiences of millions of former smokers who switched to e-cigarettes, smokeless tobacco, or some other non-smoked source of nicotine such as long-term use of NRTs serves as evidence that nicotine abstinence is not a requirement for the health improvements that come with smoking cessation.

One indication of the contempt Glantz feels toward smokers is his post about the thousands of letters that e-cigarette users submitted as comments in response to the FDA’s request “to obtain input on certain questions related to the implementation of section 918 of the FD&C Act (21 U.S.C. 387r), as amended by the Tobacco Control Act (Pub. L. 111-31).”

Lie #1: Glantz characterized the FDA’s Docket ID: FDA-2012-N-1148 as a request for comments on “treatments for nicotine dependence,” which implies that the topic is limited to products aimed at complete nicotine cessation. However, the request for comments was much broader. Specifically, the FDA was requesting comments in connection with a report Health and Human Services must submit to Congress, a report that will discuss three categories:  (A) total abstinence from tobacco use; (B) reductions in consumption of tobacco; and (C) reductions in the harm associated with continued tobacco use. “Also the report must include recommendations on how FDA should coordinate and facilitate the exchange of information on these `innovative products and treatments,” including providing a “fast track” method for approval.

Glantz either does not understand the purpose of e-cigarettes or he deviously pretends to misunderstand. E-cigarettes were not invented for the purpose of treating nicotine addiction. Their purpose is to serve as a replacement for smoking, supplying the nicotine without the damaging constituents in smoke. Eliminating the carbon monoxide and thousands of other products of combustion results in a reduction in the harm associated with continued nicotine use.

Consumers who obtain some of the nicotine they need from e-cigarettes as a result smoke fewer tobacco cigarettes, and many eventually stop inhaling smoke altogether. Smokers who completely switch to an e-cigarette have, in a literal sense, quit smoking. But Glantz chooses to misinterpret “quit smoking” to mean “quit nicotine.”

Lie #2: Next, Glantz complained that the individual testimonials submitted included claims of “therapeutic benefit.” Given the type of information the FDA specified in the Federal Register notice, the submissions were very appropriate: The consumers who commented discussed an innovative product and related how that product helped them to achieve total abstinence, reduced use, or reductions in harm. Some may have stopped all nicotine use, either by switching to an e-liquid containing zero nicotine, or by giving up the practice of vaping. But the abstinence or reduction being sought by e-cigarette consumers is from inhaling smoke, not necessarily from tobacco use or from nicotine. These reports can only be construed as health (not really therapeutic) claims because we already know that stopping smoking is healthy, but no testimonial is going to change the fact that we already knew that.

Lie #3: Glantz is either obfuscating or demonstrating that he failed to understand the basis for the ruling in the Smoking Everywhere, Inc. and Sottera, Inc. d/b/a NJOY court case: “The fact that the e-cigarette companies and their trade association have been encouraging their consumers to submit public comments to a docket about smoking cessation products can be read no other way than the e-cigarette companies and their trade association are promoting their products as having therapeutic benefit,” he declared.

We know Glantz read the emails that at least two e-cigarette companies were sending to their customers because he included copies of those emails in his comment to the FDA. Specifically, those emails asked customers to share their stories with the FDA if e-cigarettes had a made a positive difference or had a positive impact or on their lives. There is nothing in those emails that could be construed as a health claim or knowledge of the customer intending to use the product to treat a disease or condition. It is not illegal, unethical, or immoral for vendors to urge their customers to submit a comment describing how their product has changed the customer’s life. “Life” is not a disease. And there is no procedure code for “positive impact” or “positive difference.”

Moreover it is difficult to see how restrictions on claims that can be made in marketing a product could possibly be relevant to these submissions.  Is Glantz claiming that FDA experts and other government officials need to be protected from hearing consumers’ claims because it would somehow harm their delicate sensibilities or trick them into believing something?

By contrast, while it may not be illegal, it certainly is immoral and unethical to do what Glantz has done and bear false witness: to accuse a person or a company of an imaginary misdeed, and then urge the Federal authorities to punish the accused.

Lie #4: Glantz stated, “The e-cigarette companies cannot have it both ways.” He implied that vendors must choose between having their products regulated as tobacco products or as therapeutic drugs. Again, this is not what Judge Leon’s opinion indicates. The same product could be regulated in two ways. To claim that the product treats a disease or condition, the product would need to be approved by the FDA for that purpose and labeled accordingly. There is no reason why the same product could not continue to be sold, sans any health claims, as a tobacco product. Many products have multiple purposes.

Lie #5: As Carl Phillips discussed in a previous posts, Glantz falsely accused vendors of suborning claims of therapeutic benefit from their customers. As proof, he cited CASAA’s “What to Say” section in our Call to Action.
CASAA is not a vendor or a trade association. If Glantz cannot understand that, he needs to purchase a good dictionary and look up the definitions of the words in our full name. The Consumer Advocates for Smoke-free Alternatives Association represents (and is largely comprised of) people who consume smoke-free alternatives as a means of tobacco harm reduction (as well as those who might someday do so).

It is very much in keeping with CASAA’s mission to encourage consumers to advocate for their own health and well-being by letting the FDA know what types of products they tried and what types of products worked in helping them to achieve total abstinence, reductions in consumption, or reductions in harm associated with smoking. The U.S. Constitution protects their rights to express their experiences and opinions.

The sad thing is that the vendors have to carefully select their wording to avoid telling the truth—e-cigarettes do work, and work much more effectively for the purpose of refraining from smoking than approved treatments for nicotine addiction.

Even sadder is the fact that e-cigarette users, having finally found a way to stop smoking, are in danger of losing the very thing that made this possible. It seems that people like Glantz would prefer that former smokers who used e-cigarettes as their quitting method stop using them—even if that means taking up smoking again.

The problem with Glantz (and others like him) is not just that the claims are lies.  We can set aside his despicable tactics and think about his apparent despicable goals.  What purpose would be served by censoring success stories in any forum?  The publication of success stories serves to encourage smokers to try e-cigarettes, and some of those who try will quit smoking as a result.  There is no other apparent result.  People who do not use nicotine are not encouraged to start.  No one is encouraged to avoid any other method for quitting smoking.  The only possible explanation for Glantz hating this so much is that his real goal is not to reduce the number of people who smoke, but to make sure that smokers suffer.  He objects to harm reduction because it reduces the harm suffered by those who are the target of his hatred:  smokers and other nicotine users who will not obey his demands and just become abstinent.

Stanton Glantz hates America

by Carl V Phillips

I was going to end the series on Glantz with the three previous posts, but too many new observations keep popping up.  So, let’s make this a full-fledged Shark Week, or maybe that should be Sea Slug Week.

Glantz is clearly a terrible excuse for a researcher, unclear on basic bits of reality, and possibly also an aggressive intentional serial liar, but why?  Unlike a lot of anti-THR liars, he is apparently not getting rich from doing what he does.  At least one of his primary motivations — in common with a large portion of temperance activists, nanny statists, food police, and others who would discriminate in the name of some religion — seems to be seething hatred that is looking for a target and excuse.  In a follow-up post, Elaine Keller will discuss his apparent hatred of smokers.  Today is his hatred for what America stands for.

I realize that making the statement “that San Francisco radical hates America” does not put me in very good company.  Most of the people who utter such accusations are not patriots and do not really love America; they are crypto-fascist nationalists who are bothered that people are acting American — which is to say, are speaking freely and acting as citizens who understand they have a right and duty to question how things are currently done.  But that is quite the opposite of what I am doing.  Indeed, despite being a 1970s hippie throwback, I would argue that Glantz is actually an example of that same crypto-fascist mold.

Exhibit A is his war on Hollywood, demanding that free speech and artistic integrity be prohibited (in effect) in pursuit of his pet peeve, images of smoking.  Anyone who actually cared about America and what it stands for, and who thought about it a bit (or listened to others talking about it) would realize that this is a terrible policy.  Even if there were evidence that banning smoking imagery in movies would reduce smoking uptake (there is not) and even if he were truly devoted to going to great lengths to reduce smoking (which he is apparently really not, given that he would rather have people smoke than switch to e-cigarettes), if he actually cared about the American way of life, he would not propose this.  Actually banning smoking is far less un-American than restricting free speech/artistry/entertainment.  We ban heroin and slavery, but would never restrict their depiction.  The harm to our basic values, and the inevitable resulting spillover into other restrictions of free expression far exceed any possible benefit.

Exhibit B is his blog post that I mentioned yesterday, pointing out how he is so clueless that he claims that Consumer Advocates for Smoke-free Alternatives Association is an industry group.  He makes that claim in the context of demanding that the government censor the free speech of “the industry”.

Comments on our post have pointed out that his main substantive claim, that medical claims are being made by e-cigarette vendors and advocates, is absurd.  He is confusing expressions of consumer product appreciation with commercial claims about a medical drug/device.  “I would not have quit smoking without e-cigarettes” is only a medical claim if smoking were a disease.  Smoking causes disease, of course, but it is obviously a consumer behavior, not a disease.  Moreover, people — as opposed to corporations engaging in marketing — are free to make whatever claims they want.

By Glantz’s logic, a maker of whole grain bread would not be able to post a customer testimonial that said “my kids like it just as much as white bread and now it is all we buy.”  We know that e-cigarettes and whole grain bread are a lot healthier than cigarettes or white bread, but that is based on other common knowledge.  The mere fact of claiming that one product was an effective substitute for the other is not even a health claim, much less a medical claim.

This abuse of language is a standard ANTZ tactic, and can obviously cause a lot of trouble if it slips through without someone pointing out how stupid the claim is.

But what I personally find equally disturbing is that he is basically demanding that FDA act to censor the publication of people’s e-cigarette success stories.  Of course, that is never going to happen.  FDA obviously does not have that authority; the Constitution makes certain that no one in government has that authority, and certainly not a product regulatory agency.  But the fact that he demanded it makes clear that he would prefer to damage citizens’ rights to free speech, something that is arguably the most important tenet of the American way, in pursuit of his latest pet peeve.  This is the behavior of someone who hates America.

In addition, Glantz makes clear that he hates participatory democracy — government By The People.  Reading that post, you can just feel him seething about the fact that so many people presumed to submit comments to FDA, which he considers to be the private fiefdom of himself and his fellow extremists.  He wants stakeholder statements to be ignored and censored.  Indeed, he absolutely does not want the real stakeholders participating in government decisions.  In the case of THR product policy, the primary stakeholders are people who use or might someday use the products in question.  The secondary stakeholders are those who would make and sell such products.  Anyone else is a distant third. People like Glantz would exclude the real stakeholders despite themselves arguably having no standing in this matter at all.  He is, of course, free to shoot off his mouth (thanks to the rights that he would like to deny to others), but he is in no way a stakeholder.  Moreover, he is clearly not offering expert advice; you need only read this week’s posts to see that he is obviously not an expert.

Glantz’s tries to trick the reader into believing that his personal demands are something other than obvious violations of human rights and our laws.  To this end, he lies and claims that every effort to collect, to encourage the reporting of, or to publicize people’s stories of successful THR is not free citizen communication, but is commercial speech which can be regulated (to a limited extent).  That is, he is trying to claim (without actually saying so) that every consumer comment and every collection of testimonials is an act of marketing.

I have been a bit glib about his characterization of CASAA and the entire consumer testimonial process, but to get serious a minute:  It is impossible to believe that he is honestly mistaken about CASAA being an industry group.  He did not mention CASAA in his actual FDA filing, but only in this blog post.  It seems reasonably likely that he was motivated by a combination of being afraid to lie in federal testimony but wanting to lash out over the analyses of him that has appeared in the last few posts here.  (Of course he did not dare to actually respond to the content of the posts — he knew that he is on such weak ground and is so outmatched that trying to argue would make him look even worse.)  We intend to take some kind of action against him for this lie.

Obviously he is not going to succeed at mobilizing the government to inappropriately use its police powers based on his lies.  The government is not going to betray our fundamental way of life due to the demands of one self-centered, hateful, un-American little man.  Unfortunately, there is a risk that his cronies at the FDA Center for Tobacco Products might actually make moves in that direction before they are stopped by the courts.  We cannot ignore that possibility.  The price of freedom is eternal vigilance against those who would be tyrants.

It’s official — Glantz is clueless

No time for a real post today, but the discussion in the comments from the last one has more than a post’s worth of comments (and it is still going — I will respond more tomorrow).

But since the current thread has been asking the question about whether Stanton Glantz is clueless, a liar, or both, I will offer the latest piece of evidence that he is clearly clueless.  In his testimony for the recent FDA hearings, which he posted today, he included this gem when whining about the apparently thousands of testimonials from people who submitted their stories of successful THR:

Furthermore, many submitters appeared to be following specific instructions offered by the e-cigarette companies’ Consumer Advocates for Smoke-free Alternatives Association.

Yes, despite the fact that anyone with a modicum of knowledge about the world of THR and e-cigarettes knows we are a volunteer consumer organization, to say nothing of the clue offered by the words Consumer Advocates in our name, Glantz cannot figure out that we are not a vendor organization.  And, of course, the “specific instructions” were basically “if you are someone who succeeded with THR when all the ANTZ bludgeoning could not lead you to abstinence, let FDA know about it.”  Yeah, we sure can’t trust the actual stakeholders, the people who this really affects, to tell their stories, now can we?

Glantz’s tenuous grasp of science (cont)

by Carl V Phillips

[This is a continuation of yesterday's post on this topic and will probably not make much sense if you have not read that one.]

I will pick up the analysis with a thoughts that came up in the comments (h/t to the comment by “mav” in particular):  On the topic of whether Glantz is a liar, it is possible that he genuinely believes his absurd claims about how mere imagery of smoking is what causes people to benefit from nicotine/tobacco, and that he might have genuinely humanistic concern about the harm such images would cause.  (I.e., on that count, he is not the calculated corporate liar that dominates the tobacco control industry leadership.)  But then, it might also be that he is so worried about e-cigarettes creating such imagery (despite most of the decent e-cigarettes not looking much like cigarettes) that he is motivated to lie about e-cigarettes specifically.

There was also the observation that a single reported example of an exploding e-cigarette battery or contamination of the e-cigarette liquid is considered by the anti-harm-reduction activists to be true and worth repeatedly reporting.  So obviously they do understand the concept that a single observation is often adequate scientific evidence of a particular claim.  This argues in favor of the explanation that they are consciously lying when they deny the usefulness of personal success stories of how e-cigarettes caused someone to quit smoking.  If a personal testimonial of an exploding battery constitutes evidence, then countless testimonials about smoking cessation certainly do.

One of the reasons that both of these are so compelling is the plausibility of the claim.  Batteries (in all devices, whether they cost $5 or $200 million) do occasionally fail catastrophically, especially if someone uses the wrong kind.  Thus, it is not at all surprising that a few batteries have burned or exploded.  The e-cigarette is purpose-built for smoking cessation.   Thus, it is not at all surprising that e-cigarettes have caused lots of people to quit smoking.  There are many other examples of how to use prior knowledge in our scientific reasoning:  Since nicotine is derived from tobacco, we would expect to find a miniscule (inconsequential) trace of other molecules that occur in plants — e.g., TSNAs — in the nicotine that is used in NRTs or e-cigarettes, and indeed it has been found.  This contrasts with, say, a study of e-cigarette vapor that finds tobacco smoke combustion products that we do not expect to find; in that case, the explanation is probably sloppy lab procedure and equipment that was contaminated by previous analyses of smoke.

So for something that is easily predicted to be true, apart from the empirical evidence, we only need a little bit of empirical evidence to convince us that it is indeed true.  That evidence is valuable, though, no matter how strong the theory is.  So, recent efforts by smokeless tobacco manufacturers to bring new products to the American market have almost certainly caused some smokers to quit, but absent a bit of evidence to confirm success, it is not unreasonable to consider that conclusion less than definitive.  This relates back to the light switch point from the previous post:  We have strong reason to believe that the switch on the wall and not, say, the fact that it is 8:00 is what causes the lights to be on, so when our switch-flipping experiment seems to confirm that, we can be confident of the claim.

This does bring up the one bit of possible doubt about personal experiments:  What if someone is quite sure about a particular cause and effect, but they are wrong?  You only need to wander through the internet for a few minutes to find examples where this is pretty clearly the case.  But how could someone possibly be wrong about their smoking cessation?  Glantz tries to make up such a story by claiming “placebo effect”.

Glantz is in good company in clearly not understanding what this concept even means.  Most people who talk about placebo effects or placebo controls clearly do not understand what they are talking about.  So to explain…

The concept of a placebo, as part of a scientific inquiry, only makes sense with specific reference to context, and needs to be separate from similar but quite distinct effects.  When a placebo is referred to without a research context, it generally refers to an actual treatment method, in which someone is cured of a disease by intentionally tricking them into believing they are receiving a treatment with known benefits.  This is a good thing when it works, obviously.  To the extent that the word is interpreted this way, then for someone to quit smoking due to the placebo effects of e-cigarettes means that they quit smoking due to e-cigarettes.  Success!  (Michael Siegel wrote more about this observation yesterday.)

But that brings up the issue of what the word means in a research context, and that, rather than the intentional medical use of a placebo, is presumably what Glantz was referring to.  What would it mean for an e-cigarette to work as a placebo, rather than because… well, rather than what?  This points out that the concept of an experimental placebo has to refer to a specific characteristic of an intervention, and not the intervention in general.  Someone might wonder if the nicotine delivery from an e-cigarette really matters much, or whether the device and action itself is causing most of the effect — i.e., whether the nicotine content was merely a placebo.  In that case, the placebo control would consist of a nicotine-free e-cigarette that the subject did not know was nicotine-free.  The placebo would still be something real, as most placebos are, but not real in one specific sense.  But this would obviously not constitute a placebo if the question were “is the act of mimicking smoking useful for cessation?”  The concept of a placebo in research only makes sense when we consider the question that is being asked.

To further complicate it:  In clinical studies where some subjects are just given a sugar pill (Glantz’s example of what a placebo is), there is perhaps some placebo effect.  However, this is actually probably dwarfed by the “Hawthorne effect”, the tendency of people to behave differently just because they know they are being studied, regardless of whether anything is being done to them.  (Ironically, the Hawthorne experiment that it is named after probably actually demonstrated as much of a placebo effect as anything, but that is another story.  The concept is clearly right even though the name is wrong.)  When smoking cessation studies are performed, and it is found (as is pretty much always the case) that the NRT or other intervention had the same effect as a placebo, most of the effect is probably Hawthorne and not placebo.  That is, the cessation success rate is elevated for both groups not so much because of a placebo effect, but because people who are being studied are more likely to behave in different ways.

Indeed, I have long believed that the following intervention would have approximately the same success rate as NRT in clinical trials (or the placebos that have the same effect):  Have a reasonably attractive member of the opposite sex approach a smoker and say “I am from <organization> and we are very interested in finding out how many people are quitting smoking this year and how they are doing it.  Would you mind if I get contact information for you and check back in six months to see if you have quit?”  In both that scenario and in the real clinical studies, extra cessation (in excess of the population average rate) would mostly result from people who had been seriously thinking about quitting one of these days, and who — because they know that someone is watching them to see if it happens right now — go ahead and do it.  (We were actually considering doing that experiment when I was in Alberta, but did not manage to get it started.)

It should be obvious that both placebo and Hawthorne effects are much more likely when the outcome of interest is decision-based rather than biological.  That is, occasionally someone actually overcomes biological disease due to the power of belief, but it is much more likely for someone to choose an action because of their belief.  Indeed, people only take volitional action because of belief.  So talking generically of a placebo (rather than specifically, as with the nicotine-free e-cigarettes) when the outcome is behavioral actually makes no sense.  It seems likely that Glantz was confusing the Hawthorne effect, which occurs in study settings, with the placebo effect.  He was probably trying to suggest that since the placebo group in clinical trials quit at the same rate of those who received “FDA approved”-type interventions, that maybe that was also occurring with e-cigarettes.  But since he was talking about people making personal decisions in their normal lives and not in a study, there was probably almost no Hawthorne effect (there might have been a bit, if a friend who turned someone on to e-cigarettes was monitoring their success, but not much).

As I said, Glantz is in good company in not understanding this.  Well, I should say he is in a lot of company — the widespread failure to understand this among people who claim to be experts is not really forgivable.  When someone refers to a placebo effect, without actually identifying what specific aspect of an intervention is being replaced with a placebo, it is yet another example of someone understanding just enough about how to do science to create confusion rather than knowledge.