Tag Archives: Hecht

Gutka is not smokeless tobacco

by Carl V Phillips

There is a popular oral dip product in India called gutka.  It was recently banned, in one way or another, across much of India, though it appears that this has had relatively little impact (other than perhaps raising the price to the extremely poor people who are most of the users).  Gutka is more popular in that country than is smoking, and is used by an absolutely enormous number of people.

Gutka, and the somewhat similar paan that is popular in Pakistan, appears to pose a very serious risk for oral cancer and other oral diseases, and perhaps other serious diseases.  The health consequences appear comparable to those from smoking, and might even be worse — in particular because, unlike with smoking, many of the serious effects appear to occur before old age.  (The “appear” caveats I keep repeating reflect the fact that most of the epidemiology about these products is so utterly lousy that precision is impossible — we had better quality information about smoking half a century ago.  But there is enough information that it is difficult to doubt that there are serious and high risks.)

So, gutka and paan are, indeed, nasty.  But what they are not — contrary to the typical portrayal — is tobacco.  Gutka does contain tobacco, and paan sometimes does (but not always), but it is not the first ingredient and may not even be the second.  The first ingredient in gutka is areca nut (also known as betel nut), and other ingredients include catechu (a derivative of the acacia tree), various flavorings, and calcium hydroxide (aka slaked lime, or just lime).  The ingredients in the one packet of it that I have that lists the ingredients (most do not) are “betelnuts, tobacco, catechu, cardamom, lime, menthol, natural & artificial flavors”.

So this is tobacco only in the sense that a Big Mac, fries, and Coke is lean beef, potatoes, and water.  The latter are major components of those products, of course.  But if they were all that was consumed, while it would not exactly be healthy eating, but it would not be all that bad.  But a funny thing happens when you consider everything in the foods (various unhealthy fats, high glycemic carbohydrates, carcinogenic products from cooking, etc.) — the meal becomes rather unhealthy.  This is a nearly perfect analogy to the deadly implications of calling gutka “tobacco”.

Something in gutka is pretty clearly quite unhealthy.  Lime is a good candidate — it is quite caustic on your skin, as you might have experienced, and is even worse for your oral mucosa.  It has fairly obvious and rapid negative effects.  But it might be that holding areca nut or catechu in your mouth for a long time is quite harmful too.  The one thing that we can be pretty sure is not causing most of the harm is tobacco.  Why?  Because it is the one of the ingredients that has been extensively studied, as an oral dip exposure, and has been found to produce minimal risk.

To be precise and careful (quite unlike most of those who write about this topic), it is possible that the interaction of tobacco with the other ingredients causes more harm than the other ingredients would cause if the tobacco were absent.  It is also possible that because of the way this particular tobacco is processed, it causes harms that American and Swedish style smokeless tobacco do not.  (There is a plausible but unsubstantiated hypothesis that the much higher concentrations of nitrosamines in some non-Western and archaic products could make them much more hazardous, though there is no evidence that it would be anywhere close to as bad as gutka is.)  Thus, we cannot conclude that the role of the tobacco is benign, but it is clearly wrong to suggest it is the main source of the problem.

Who suggests that?  Pretty much everyone.  The impetus for me writing this post was running across this newspaper story about how the gutka ban is failing due to the black market, with a headline that refers to it as “chewing tobacco”.  But it is not just bad reporters and casual observers who make the mistake.  The packets of gutka I have all display the mandated statements “tobacco kills” and “tobacco causes cancer” and what I assume are their Hindi equivalents.  I do not know whether current products still have those statements (once you ban something, it is difficult to enforce labeling regulations, after all), but the point is that the government’s official statements describe the product as “tobacco”.  This is probably the fault of the World Health Organization, since India’s policy is pretty much “do whatever WHO tells us to do”, but I actually do not know the story.  (Anyone know?  Please let me know.)

But it gets even worse than that.  The anti-THR liars have made a concerted effort to trick Westerners into believing that the apparent harms from Indian “tobacco” are relevant to Western products.  The classic example of this IARC Monograph 89, from the International Agency for Research on Cancer — a unit of WHO that primary is known for its science-by-committee declarations, and is mistakenly seen to be an authoritative and apolitical research organization.  The authors of that document — including longtime professional anti-THR activists like Stephen Hecht (already represented in this blog), Scott Tomar (who got a passing mention but seems to have disappeared), and Deborah Winn (who will likely make an appearance) — tried to bury the fact in their 626 pages that their conclusion that smokeless “tobacco” causes cancer was basically based just on studies of gutka and paan along with a single old study of an archaic American product.

I realize that this post leaves the reader with many points of curiosity that call for more information.  I will try to circle back to these sometime.  But I will conclude by creating one more:

Why did I say it was deadly to refer to gutka as tobacco?  THR in the West is about replacing smoking with smoke-free alternatives.  But in South Asia, there is a lot of room for something else that could be called THR:  The replacement of gutka and paan with smokeless tobacco (snus).  Western-style smokeless tobacco could be made domestically (and thus be affordable, though perhaps more expensive than the current products — I am not sure) and it would presumably have about the same unmeasurably low risk as snus.  Given that the impact of the local dip products is similar to that from smoking, this has similar potential to Western THR.  But — as with Westerners who think that “tobacco” or nicotine is the problem rather than smoking — this is very unlikely to be pursued so long as everyone thinks that it is the tobacco that is the problem.

Policy recommendations as lies

posted by Carl V Phillips

Finishing up the series on Stephen Hecht’s latest alleged research, we focus on his policy recommendations.  How can someone’s recommendation be a lie, you might well ask.  When it is presented as if it follows from particular research, but it does not actually follow.

The juxtaposition of a scientific analysis and a policy recommendation clearly is meant to imply that the analysis is sufficient to justify the recommendation, and indeed that is often stated explicitly.  This is false even for honest recommendations in epidemiology research reports, and even more so for toxicology reports that are pretended to be epidemiology because a policy recommendation needs to be based on the full body of evidence about the effects of the exposure, as well as an analysis of the other costs and benefits of the policy.  Such information is not present in a report about one study’s results, and is seldom even asserted or referred to.

This means that most, indeed almost all, policy recommendations that appear in health science are lies, so there is nothing unusual about the THR context.  But such lies are less harmful in contexts where only scientists are reading the papers and decision-making filters through a reasonably expert process.  No one is going to react to some off-the-wall tacked-on recommendation about workplace safety or how best to deploy a screening test, and indeed, scientific readers typically just scan past those sentences like they would an ad.  But in contexts where people alter their behavior based on bad recommendations, and the science is really about politics, then such lies matter.

A recommendation might follow from the research if it is very modest and general (e.g., “this suggests we should reduce the exposure to the extent that it is easy” rather than “should be avoided completely [at all costs]” or “should be reduced to 10 ppb”) and appropriately contingent (“if the entire body of research on this topic comes to the same conclusion as this study”).  Those of you who ever look at these research reports will know that such modest phrasing is almost never used.  Instead, there is the bald lie, “these results show that we should….”

Hecht’s version of the bald lie in this case is:

“Obviously, we need to decrease the levels of this material in all smokeless tobacco products — or eliminate it altogether.”

Yeah, obviously.  The only thing that is obvious is that this conclusion does not follow from the observation that this chemical is bad for rats in large doses.  Sugar, therapeutic drugs, and cars also cause serious health problems in rats in large doses, so obviously we need to decrease them or eliminate them all together.  Since the relevant smokeless tobacco products do not actually cause measurable rates of cancer, the need to change them to reduce some apparently non-cancer-causing carcinogen seems rather less than obvious.

Hecht adds that removing (S)-NNN from these products is feasible. In fact, some products on store shelves today have reduced levels of the carcinogen.

Credit is due for these two sentences at least, a huge improvement over most “public health” activist science which does not even acknowledge that the feasibility of a recommendation matters.  Still, this is presented as an aside rather than a core part of the policy recommendation, and it is obviously not enough information (e.g., we do not know whether further reductions might be highly costly).

Still, if he were “these products are already very low risk, but all else equal, there might be some health benefit from reducing this chemical”, there is nothing wrong with that.  But rather than telling the truth about the low risk, he is instead communicating the lie “these products might be acceptable if changes were made, but they are horribly dangerous now.”  As for “all else equal”:

Hecht explained that the U.S. Food and Drug Administration has the authority to regulate tobacco products, but no regulations on the levels of specific carcinogens exist yet. “My suggestion is that levels of (S)-NNN in smokeless tobacco be decreased to below 10 parts per billion. That would make it more consistent with the levels of nitrosamines in food products,” he said. (S)-NNN also is in cigarettes and other smoked tobacco items, and he suggested that the substance be regulated in these products, as well.

Ah, there it is.  Someone not familiar with Hecht and his co-conspirators would have no idea of the subtext here, which just trying impose any rule they can rationalize on THR products (and on cigarettes).  There is absolutely nothing in his research that justifies this 10 ppb threshold, or any other specific threshold.  How could giving a megadose to rats possibly inform us about what the exact right level is?  But the goal here is just to require something that is difficult because it is difficult not because it is useful.  Then they can complain when it does not happen (“we think harm reduction is a fine idea in principle, but the products have not met the necessary conditions that we arbitrarily imposed”).  Better still (in their minds), complying might punish the consumers of the product by increasing its price or lowering its quality.

Hecht, of course, did not acknowledge his activist views in the press release — a lie of omission in itself.  A non-expert in the politics of the area would not recognize the mention of the FDA as being a statement about a particular anti-THR activist strategy, though its inclusion was obviously irrelevant to the reporting of the science.  It is a classic example of dog whistle politics, designed to signal his goal to his co-conspirators while hiding it from the vast majority of readers who would not approve of it.

A final aside on this thread:  Many people consider it acceptable to inflict pain and death on non-human animals in pursuit of knowledge that can improve the health and medical treatment of people.  There is a spectrum of a beliefs about the necessary balance of suffering to justify potential knowledge gain.  But only an extreme tail of that distribution — basically those who feel no compassion toward animals at all — would support Hecht inflicting suffering on animals in pursuit of a political hobby project which offers no conceivable benefit.  He is basically hurting animals to look for carcinogens which are not causing cancer.  A little education can save people from succumbing to his lies, but it cannot help the animals he tortures to produce his propaganda.

So, what is the point of Hecht’s latest press release?

posted by Carl V Phillips

I have been asked two very good questions about this topic:  (1) Is it really fair to treat Hecht as if his new claims reflect the same type of serial anti-THR lying found in Ellen Hahn?  (2) What exactly was the research that Hecht was touting in this press release?  The two questions are closely related, and one of them can be answered.

“This is the first example of a strong oral cavity carcinogen that’s in smokeless tobacco,” said Stephen Hecht, Ph.D., who led the study. “Our results are very important in regard to the growing use of smokeless tobacco in the world, especially among younger people who think it is a safer form of tobacco than cigarettes. We now have the identity of the only known strong oral carcinogen in these products.”

The answer to (1) is right there, in “…who think it is a safer form of tobacco than cigarettes.”  Out-of-control activists like Hahn might actually know very little about the relevant science they claim to be expert about, but Hecht has been at the center of anti-tobacco politics and research for many years.  There is no possibility he has failed to learn that smokeless tobacco is indisputably a safer form of tobacco than cigarettes.  Even in the unlikely event that he believes everything else he claims, the much lower risk of smokeless would still be obvious to him.  Perhaps his lies about the epidemiology, analyzed yesterday, could be seen as merely trying to puff up the perceived importance of his unimportant research rather than primarily being an active anti-THR effort.  But that “…who think…” lie is clear and obvious evidence of anti-THR activism disguised as science, which perfectly represents Hecht’s behavior over the years.

Notice also the “first” wording.  This is clearly meant to imply something like, “up until now, we were not really worried about smokeless tobacco causing oral cancer, but now we should look into it.”  The thing is, Hecht has been claiming that smokeless tobacco causes oral cancer for over a decade, claiming that the nitrosamines he has repeatedly reported on (particularly the chemicals known as NNN and NNK) were sufficient proof of that.  He has reported lab studies of basically the same thing, over and over and over again, and whatever the study result, his conclusions remained based on his politics.  His studies never changed the fact that the actual health science shows no measurable risk of cancer.  But that evidence never stopped Hecht from claiming that each of his non-new results provided new evidence that smokeless tobacco causes a high risk of cancer.

So what did he do this time?  It is very difficult to figure out because all we have is the press release.  Issuing a press release without making a working paper available is anti-scientific behavior in itself; even if everything presented were true, we are being asked to accept someone’s asserted conclusions without knowing their basis for those conclusions.  Some commentators focus on the lack of “peer review” in press releases, but this is really a red herring (peer review in health science is almost worthless — a topic for another day).  The real problem is the lack of information that would allow a reader to assess what was done and whether the methods and the conclusions seem reasonable.  All we actually know from the press release is that Hecht subjected rats to a mega-dose of a nitrosamine called (S)-NNN, presumably in a way that does not closely resemble smokeless tobacco use, though we do not know.  Some of the rats got cancer.

That is all we know.  We do not know what Hecht meant when he called this the first identification of a strong oral carcinogen in smokeless tobacco.  Is he admitting that his claims over the last decade about the other chemicals were lies?  Or are we supposed to conclude that “strong” has some subtle meaning, such that his previous claims were based on “non-strong” carcinogens and so he was not lying then about all of his claims then, but this is somehow different so he is not lying now about “first”?

Also we do not know how many trials Hecht ran, with how many different animals, with how many different chemicals administered in different doses and different ways, before he found a single result that made for good propaganda.  Actually, chances are we will never know that, even when this ends up in a journal.  When I said that toxicology was not inherently junk science, I glossed over the fact that this “hunt the carcinogen” branch of toxicology seems to have as its primary methodology, “keep doing ever-so-slightly different things until random error produces an outlier result for one trial, and then report on that result as if it were the only experiment that was done.”  That approach definitely qualifies as junk science.

The reader is not even told what (S)-NNN is, or how it differs from the NNN Hecht has been over-concluding about for years.  I could not easily find anything about it (e.g., it is not even clear whether this research represents Hecht discovering the chemical), though I am not a chemist so I might be missing something that the experts in that field could figure out.  But you know who are not experts in this entire area of chemistry?  Approximately everyone who reads the press release and the pseudo-news stories that resulted from it, who can thus be easily tricked by Hecht’s assertions.  All they came away “learning” were that Hecht and his ilk were not too worried about smokeless tobacco causing oral cancer last month, but based on this exciting new breakthrough, we should immediately take action.  More on that last aspect of the lies in the next post.

Stephen Hecht’s latest lies

posted by Carl V Phillips

Continuing with a debunking of the claims in this recent press release by University of Minnesota toxicologist Stephen Hecht, which was picked up by various non-expert health sites and news outlets.  Yesterday we pointed out how toxicology claims, in the context of anti-THR, turn out to be almost entirely lies, in part because they are used to make claims that contradict the epidemiology; epidemiology trumps toxicology in the same way that looking out the window to see if it is raining trumps looking at yesterday’s weather forecast for today.

Today we will address some of the background lies about epidemiology that Hecht included in this press release — claims that have nothing to do with this particular bit of research, but that he needs in order to fool people into believing the research matters.  [Note: some of the posts in this blog will be pretty self-contained, while others will appeal to extensive bodies of knowledge that cannot fit into one post.  This is an example of the latter.  More detail on the particular points will probably eventually be covered in this series, but in the meantime you can find more in more in-depth writing about THR by me, Brad Rodu, casaaa.org, and tobaccoharmreduction.org.]

Hecht:

smokeless tobacco is a known cause of oral cancer

The subtle little problem with that claim is that it is just not true, at least not in the current US context that is noted as the focus of concern in the press release.  The tiny subset of the epidemiology that Hecht and his co-conspirators like to cite to support this claim consists of one old study of archaic US products and various studies of Asian products, most of which are not even tobacco.  They then try to trick the reader into ignoring the many studies of the products that people actually use in the US and Scandinavia, which have shown that if there is any risk, it is too small to measure.

This is not to say that we know there is absolutely no risk, of course, but it is clear that the risk is very small and not even clearly established to be nonzero, whereas Hecht is communicating that it is large and clearly exists.

Evidence has been accumulating for years that people who use smokeless tobacco have an increased risk of cancer of the mouth, esophagus and pancreas.

This claim of an accumulation over time is more patently false than the claim that there is a risk.  The belief that smokeless tobacco causes oral cancer traces mostly to the one major study of a niche US product (almost never used and impossible to even find anymore) done in the 1970s, and to a lesser extent some low-quality, smaller studies from that era or earlier.  By the 1990s, those results had not been replicated and several major studies had instead found no risk from modern products; further research continued to support this new conclusion of no measurable risk after all.  That is apparently what passes for “has been accumulating for years” at the University of Minnesota.

As for pancreatic cancer, “accumulating for years” refers to two studies from the 2000s which claimed to find a risk, but which actually flatly contradict each other (i.e., if you choose to believe one of them is the right way to measure the effect, then the other agrees with the rest of the evidence, which suggests there is no measurable risk).  The accumulating evidence on esophageal cancer showed an amazingly consistent pattern of no risk, until recently when just a few studies suggested an association; the weight of the evidence clearly remains on the no measurable risk side.  (Also, most of the “evidence” that there is risk from smokeless tobacco from the 2000s came from a single research group that was clearly cooking their results; I suspect this blog will get to them eventually.)

That said, notice the subtle phrasing here:  “people who use…have an increased risk…”  Now this might just be accidental — Hecht seems to have no qualms about stating out-and-out falsehoods — but it might be another case of lying with a technically true statement.  It turns out that, in the US population, many smokeless tobacco users are former smokers and many are current smokers (who, thanks to people like Hecht, do not realize they would be much better off using the smokeless exclusively).  Smokers definitely have much higher risks of cancer of the mouth and esophagus (pancreas is a bit trickier).  Moreover, people who choose to use nicotine products have somewhat poorer health on average, apart from any effects of the behavior.

So, the statement as phrased is not actually claiming that smokeless tobacco causes these diseases, but rather it says that if you do not control for confounding then you will find an association.

Hecht had to present these lies, which have nothing to do with his research, in order to be able to sell his message that he had found a cause of cancer.  He would look really stupid if he said “Lookee everyone! I have found the reason why these products [which do not seem to cause a measurable risk of cancer] cause cancer!”  Better to be a liar than to look stupid, eh?

So how about both?

Toxicology, almost always a lie in the THR context

posted by Carl V Phillips

We now close the case on Ellen Hahn for a while, having pretty clearly debunked basically everything she says about e-cigarettes.  While she is probably the most prolific and dangerous anti-THR liar of the year, she will probably end up being a flash in the pan.  When I first started working on THR, the “Ellen Hahn” role was played by the University of Florida dentist, Scott Tomar.  Remember him?  I didn’t think so.

But there are others who have been using disinformation to dissuade people from THR for a decade and are still doing so.  One of them is University of Minnesota toxicologist, Stephen Hecht.  Unlike Hahn, he is a real researcher, but like Hahn, he is mostly just on a crusade against THR.  (Hahn is a researcher only if the sense that the Japanese commercial whaling fleet is really doing research, as they claim.  Both are cases of someone doing what they want, in violation of regulations, trying to excuse their behavior as “research” by keeping a record of what happens.)

Hecht’s latest lies about the risks from smokeless tobacco are found in this report, which I will directly address starting with my next post.  Today I will focus on a more general point about toxicology.

Toxicology can basically be thought of as trying to figure out whether particular chemical exposures will cause cancer, acute poisoning, or other bad effects, but without actually observing whether the exposure does cause cancer etc.  Instead of observing what we really want to know, it tries to predict it by looking at the effects of chemicals on cells, tissue, and non-human animals.   (Toxicology also helps us figure out why something is causing its effects and how to perhaps do something about that.)  If we have the information we really want — about what the exposure actually does to real people who are really exposed — then that is called epidemiology.

It should be obvious from this that if we have decent epidemiology about whether an exposure actually does cause a disease, then the toxicology that predicts whether the exposure causes the disease is no longer informative.  It is kind of like looking at last week’s weather forecast to determine whether it is raining right now, rather than looking out the window.

Obviously there is a lot of value in weather forecasting, and there is a lot of value in trying to figure out whether something will kill people without actually killing people to find out.  Both are imprecise, but neither one is inherently junk science so long as its limitations are duly acknowledged.  But almost any time toxicology is invoked in the THR context, it turns out to be junk science lies.

There are the Hahn-type lies (see the previous posts that are tagged with “chemicals“) in which she claims that any tiny trace of a sometimes-toxic chemical causes disease.  Presumably Hecht, as a toxicologist, would be among the first to label this junk science.  But then there are the Hecht lies, wherein he has spent a good part of his career claiming that we should believe speculative toxicological conclusions about smokeless tobacco causing cancer, despite having epidemiologic evidence that shows that such speculation is incorrect.