Tag Archives: innumeracy

Cheryl Healton lies (a lot!) to try to get NYC to restrict ecigs

by Carl V Phillips

This analysis, of this blog post, might seem a little more brutal than usual.  That is because the author, Cheryl Healton (the former head of the leading anti-tobacco organization, American Legacy Foundation — a fact that is omitted in the introduction of her in the blog in question — and now head of the public health program at NYC), knows the truth.  This is not a case of someone who is too innumerate to not know she is lying, or a useful idiot that is being used by the anti-tobacco extremists.  Healton is one of the puppet masters who manipulates her useful idiots (like New York Assemblywoman Linda Rosenthal), which she is doing in this post.  Notice in particular the many times that she lies by using literally true but highly misleading statements, the mark of someone who knows she is lying but wants to be able to pretend otherwise.

The post appears in the blog of the “NYC Coalition for a Smoke-Free City”, an obviously misnamed group since they are campaigning not against smoke, but against e-cigarette use.  The thesis is that NYC should go ahead with its proposal to prohibit e-cigarette use anywhere that smoking is prohibited.  It is remarkable how close Healton comes to lying in every single sentence.  The first few about the fact that NYC is about to act on this are true, but most everything that follows is a lie:

Who is the e-cigarette industry?  Increasingly the e-cigarette industry is owned by the tobacco industry, an industry that would not be permitted to exist were it invented tomorrow because it would violate the consumer protection laws of all states and virtually every country in the world.

As I have pointed out, this “would not be allowed to exist” claim is at best pure speculation, and probably wrong.  But apart from that, it refers to a product (cigarettes), not an industry.  If the industry came into being right now selling low-risk products like smokeless tobacco, e-cigarettes, and NRT (all of which are sold by “the tobacco industry”), it would be allowed to exist.  But, of course, this soup of words is not meant to analyze the actual claim, but to lie about e-cigarettes, suggesting they are some industry plot.  In case the innuendo is lost on the reader, she goes on to lie,

For this reason, a healthy degree of skepticism about the industry’s ultimate goal in buying up e-cigarette manufacturers and creating more “efficient” e-cigarettes should prevail as policy makers establish regulations governing them. It is quite possible that the net effect of e-cigarettes will be to induce greater youth initiation of smoking and reduce the adult cessation rate, but the jury is still out.

I cannot imagine that Healton is stupid enough to actually believe that.  It is impossible to come up with a story to explain why the existence of e-cigarettes (let alone the acquisition of a few companies that she led into that with) could cause smoking at all, let alone to cause a net increase in smoking initiation.  E-cigarettes, like any popular low-risk alternative, will replace smoking initiation, not cause it.

Both youth and adult smoking rates are at their lowest levels in decades, so much is a stake for the health of the public.

Setting aside the fact that the “so” is a non sequitur, is what she is saying is that having almost 20% of the population smoking is such a success that harm reduction should be avoided?  It appears so.

There is also much at stake for the tobacco industry as it seeks to apply its considerable marketing acumen and seemingly endless resources to maximize profit by increasing the number who start smoking by enticing youth worldwide to smoke and by trying to retain current smokers.

Complaining about “endless resources” is pretty funny coming from someone who is at the apex of the billions-per-year tobacco control industry.  But the real question is what this passage has to do with e-cigarettes at all, let alone restricting where you can use them.  It is typical tobacco control misdirection:  “Cigarette manufacturers profit from more people smoking and remaining smokers, and therefore we should restrict where people can use e-cigarettes.”  Huh??!

Who might be hurt by e-cigarettes?  The tobacco products the industry has historically manufactured and promoted as “reduced harm” are not benign products created to meet the broad range of consumer preferences in the United States, rather they are deadly products that when used as directed kill over 400,000 Americans each year and are predicted by the World Health Organization to kill a billion people worldwide this century, 10 fold more than they killed in the 20th century. To put the scope of the current tobacco-related epidemic in perspective, in a few years, global lung cancer deaths will surpass AIDS deaths as the steady march of tobacco industry marketing continues to engulf the world’s poorest nations.

Again, huh??!  Does anyone see any connection between that question and what follows?  (Yes, I realize that the reader might now be questioning my assertion that Healton is too smart to not know she is lying.)  Her allusion to historical products is the usual tobacco control canard about the introduction of “light” cigarettes four decades ago, products where there was no evidence to suggest they would be lower risk.  And yet they were actively endorsed by the public health community, not just the manufacturers.

However, a mistake by everyone a couple of generations ago about what might be lower risk tells us nothing about the present world of products that are known to be lower risk.  It is an utterly absurd and blatant lie to suggest otherwise.

None of what she says in this paragraph is true about the actual reduced harm products that have been introduced by the tobacco industry and by others.  Smokeless tobacco, e-cigarettes, and other low-risk products do not cause the harms she is citing; cigarettes do.  (Well, cigarettes cause and will cause a lot of harm, though not as much as she claims.  But that is another story).  She seems to be trying to invoke the conjunction lie, that cigarettes plus low-risk alternatives do that much harm (which implies the harm is shared, even though it is basically all caused by cigarettes), but she screws up doing even that.  She actually is claiming that the low-risk products alone cause all the harm from smoking.

Nicotine addiction is in and of itself a gateway to tobacco product use because once addicted many will broaden the products they use and included among these will be the most dangerous products like cigars, cigarettes and hookah.

It is true that people who like to use one tobacco/nicotine product often try other products.  But what she is trying to imply (carefully avoiding actually saying it) is that using e-cigarettes will cause people who would not have otherwise smoked to do so.  There is no reason to believe this would be the case, and certainly no evidence of it occurring.

And it is worth pausing to remember that the title of this post says that NYC should include e-cigarettes in its smoking place restrictions.  I have skipped a few sentences but have not left out anything that addresses that.  There has been nothing yet.  Even if the previous quote were not a lie, it would still only be an argument against letting kids use e-cigarettes, not about forbidding adults from using them at their desks or in bars.

Most tobacco-related deaths are the culmination of substantial suffering and societal cost from heart disease, emphysema or various cancers and are the direct result of nicotine addiction.  Moreover, nicotine addiction is considered by many scientists as the most intractable of all addictions as measured by the percent of ever users who become addicted and the percent who remain addicted until death. Half of lifelong smokers lose their lives to tobacco addiction and among these people nearly half die before retirement age.

A pretty good argument in favor of encouraging e-cigarette use.  The bit about “most intractable” is nonsense, of course.  The reason users have more incentive to quit, say, meth than to quit smoking is the high level of short-term damage it is doing them.  And the “half” is a made-up number that is higher than what the evidence suggests.  Most important is that claims about the “addictiveness” of smoking tells us little about e-cigarettes, given the evidence that e-cigarettes are much easier to quit.

And, once again, this has nothing to do with whether there should be a place ban on e-cigarettes.

E-cigarettes are a complex product and their availability and the regulatory framework for governing them may have different implications and considerations for youth non-smokers compared to adult smokers. E-cigarette policy could produce sharply differing results by population sub-group.  Data demonstrate that a significant swath of adolescents already are using e-cigarettes. Time will soon tell whether e-cigarettes function as one more point of entry to cigarette, cigar and hookah consumption among those using e-cigarettes initially. One thing is clear however, since cessation efforts have thus far not worked with teens, e-cigarettes will likely not do anything good for kids and may well entice many to start smoking in view of the broad array of sweet, candy flavors and slick e-cigarette marketing already blanketing the internet, mall kiosks, TV and radio, which have to date eluded regulation.

Blatant lies and clueless nonsense.  (Ok, I will admit I am starting to doubt my previous assertion that Healton really understands what she is saying.)  Skipping past the distractions that the first few sentences comprise, we have the lie that many adolescents are using e-cigarettes, a repeat of the lie that there is any reason they would cause smoking, the lie that because other cessation efforts do not work for kids that harm reduction will not work for them (it might be true, but probably is not, and it is nothing more than speculation asserted as fact), and of course the usual canard about marketing.  Once again, the biggest lie here is that this has anything to do with restricting where adults can use e-cigarettes, or anything else about adult use.

Whether e-cigarettes will offer an incremental boost to cessation rates nationally also remains to be seen.

No, it doesn’t.  Close to every e-cigarette user is either a former smoker or a current smoker who has replaced some smoking with e-cigarettes and could be persuaded to complete the transition.  Many of those who quit smoking report that they had not been able to succeed at cessation until they tried e-cigarettes, and only then did they quit.  Therefore e-cigarettes have increased cessation.  This is not really a difficult concept to understand.  (She goes on in that paragraph to lie about what the research shows, but I will stop at debunking her thesis claim.)

This is the epitome of the ANTZ tactic of declaring every negative they can concoct to be a real concern, even if there is zero evidence and even if the evidence clearly shows it is a non-issue, while denying every positive by pretending that the evidence does not exist.

We should also remain open to another highly plausible effect of e-cigarettes-that they will function in the same manner “light” cigarettes did when they were introduced in the 70′s, promoted by the tobacco industry as a step smokers could take to feel safer without actually quitting smoking. As many subsequent studies showed, in fact they were not safer and millions who would have quit had they not been introduced failed to do so costing innumerable lives.

And (setting aside the lies about “light” cigarettes themselves) there is that lie about the situations being similar again.  The obvious difference is that e-cigarette users are “actually quitting smoking”, unlike light cigarette users, and they are using a product that genuinely is low risk.  What does a public health failure of the 1970s have to do with e-cigarettes?  Absolutely nothing.  It is basically the same as saying leeches turned out to be harmful rather than helpful in treating infectious diseases, and therefore we should avoid antibiotics.

Do we really want everyone vaping where they once could smoke?  

Oh, look, she is finally addressing the question she claims to be addressing.

The proposed extension of the SFAA to e-cigarettes, which will be voted on tomorrow, also will reduce the “walking billboard” effect of thousands of New Yorkers once again lighting up in bars, subways, parks, office buildings and restaurants throughout the city. But banning e-cigarettes in some locations solely for this reason is un-American in a country that prides itself on maximizing the freedom of its adult citizens to choose to engage in a range of risky and frisky behaviors. 

Interesting.  It is not a very risky behavior, of course, but it is nice to see that New York is still part of America.

The “billboard” claim is utter nonsense, of course.  How is someone vaping in their office, rather than outside the front door, a billboard?  E-cigarettes could still be restricted on the subway and restaurants could make their own choices about what is best for their patrons and vibe.  The proposed ban would eliminate all discretion, reasonableness and common sense, going beyond a few specific restrictions that some might argue are reasonable and imposing rules that are clearly absurd and harmful.

Take a step back and see what she is doing with all of this.  She is appealing to people who are worried about kids using e-cigarettes and do not like people vaping on the subway, and trying to trick them into supporting a rule that bars cannot choose to allow their patrons to vape.  If she actually cared about kids and subways, she would propose something that affects kids (this rule would not) and would endorse a rule that just applies to the subways (which could probably be done by administrative fiat).  Notice she never once offers any reason why banning vaping in bars, private offices, and many outdoor spaces would do any good for anyone, and indeed tries to hide the fact that this regulation would impose such restrictions.  Classic tobacco control bait-and-switch.

It should be noted, however, that while we in general embrace this ethos, when it comes to public drinking we often do not. We do not embrace wandering down the street drinking a cocktail, hopping into the elevator rum and coke [sic] in hand or whipping out a flask of whiskey on a plane.

Ok, so no vaping on elevators and planes.  I suspect that even most dedicated vapers would not find those to be terribly unreasonable restrictions.  As for walking down that street, the street would be one of the few places vaping was still allowed under the restrictions.  The anti-THR people cannot even keep their own stories straight.

Do we know enough to allow vaping in public spaces?  So what are the real risks of public vaping? Is it as its promoters would like us to believe a benign, reduced harm practice that is at worst a passing fancy?

Um, no.  Its promoters think it is here to stay.  Also, the ban is mostly about private spaces, not public spaces.

Or is it a potentially toxic practice that places those in its immediate vicinity at risk. The answer is we do not completely know yet, although already studies have shown elevated nicotine levels among those exposed to secondhand vaping, and this in and of itself is ominous. Not definitively measured as yet among second hand vapers [sic] are the myriad other toxic substances which are contained in e-cigarettes. 

Cute, huh, that use of “completely” and “definitively”.  Of course we know, from ample evidence, with a very high degree of certainty that the risk to bystanders is zero or utterly trivial.   But we never know anything completely or definitively.  Someone can always use weasel words like that to intentionally trick the reader into thinking she made a statement about what we really know, rather than merely a statement about the fact that there is never proof or complete information in the real world.

And if anyone is aware of any study that shows elevated nicotine levels from people exposed to “secondhand vapor”, I would be quite interested in hearing about it.

Under these circumstances, the prudent course is to extend the SFAA to encompass e-cigarettes until, if ever, sufficient evidence exists demonstrating their safety.

Right.  And what might that be?  Oh, you say, no evidence would ever be sufficient for that.  Thought so.

And why exactly would this be prudent?  I do not think that word means what she thinks that word means.  Is it prudent to restrict a very personal freedom when there appears to be no reason to do so, just because such a reason might be found later?  (Sounds like an argument for banning, say, the building of mosques in America — there are many who would make the same “we just don’t know if this will hurt the children” arguments about that.)  Is it prudent to ensure that cigarettes remain as attractive as possible as compared to low-risk alternatives?

The only conceivable downside of not extending the SFAA to e-cigarette use is the loss of any incremental harm reduction for smokers associated with being permitted to smoke e-cigarettes in locations where smoking is now banned.

TrANTZlation:  The harm it would inflict on those not able to vape at their desk, in bars, etc. is of absolutely no consequence.  We are tobacco control.  We don’t actually care if tobacco users suffer.  In fact, we prefer it.

And, of course, making e-cigarette use less attractive creates the public health harm of encouraging smokers to keep smoking.

It is highly unlikely that such a benefit, if it in fact exists, would outweigh the harms to youth, to non-smokers exposed to vaping nicotine laden vapors and potentially other toxins, and to recovering smokers who now stay quit in part because smoking has become less ubiquitous than it was 50 years ago when the Surgeon General released the first report on Smoking and Health.

Huh?  It is highly unlikely?  Care to quantify?  I would love to hear about the harms to youth from people vaping at their desks.  What harms are caused by (barely) “nicotine laden vapors”?  What possible impact is there on “recovering smokers”?

Sadly e-cigarettes may lead to four negative outcomes: the initiation of more youth to nicotine dependence and subsequent conventional smoking; the use of e-cigarettes by current cigarette smokers who would otherwise have quit but instead use both conventional cigarettes and e-cigarettes in combination and therefore delay quitting or never quit and; the relapse to smoking by those who have already quit, first to smoking “benign” e-cigarettes and then to conventional cigarettes; and the exposure of people to e-cigarettes’ emissions unknown risks.

And how does all of this other than the last bit (a lie that has already been addressed) relate to the question at hand?

Who loses, if anyone, by extending the SFAA to e-cigarette use? Virtually no one loses. Vapers can still smoke everywhere current smokers now do. Let’s do what NYC has become known for and enact a policy that saves lives, not costs them.

Just in case the above trANTZlated passage was not clear enough, here she comes right out and says that the hardships suffered by vapers as a result of the rule do not matter.   Smoking place restrictions are designed to make smokers less happy — tobacco control advocates generally admit that these days — so obviously imposing the same restrictions on vapers will make them less happy too.  I wonder if it is a Freudian slip when she says that “vapers can still smoke” — because that is exactly what will happen:  Some would-be vapers, upon having to go out to the smoking areas anyway, will indeed smoke.  As a result, some of them will die from smoking and their blood will be on the hands of liars like Healton.

Glantz et al. lie and the NYTimes is gullible enough to believe it

by Carl V Phillips

In what Dick Puddlecote called “A New Low for Tobacco Control” (perhaps an overstatement given that is an incredibly high — or perhaps call it low — bar that is nearly impossible to achieve, but I see his point), Stanton Glantz and a few others told the New York Times that the reduction in the US smoking rate is due to such factors as removing smoking from movies and has nothing at all to do with THR.  Since the headline and the topic of the story were “Why Smoking Rates Are at New Lows”, you might expect that the reporter would have learned something and talked to people who do not lie about THR.  Of course, if you thought about it a little more, you would amend that to “the NYT reporter should have learned something about the topic and talked to real honest experts, but unsurprisingly, did not”.

The first thing to note is that about 90% of the time when news outlets with the biases of the Times (and by that I do not refer to usual erroneous claim that they are “liberal” in the political spectrum, but rather that the corporate media act as uncritical transcriptionists for what government and allied actors want the people to believe) report a reduction in smoking, they are just making a big deal about a statistical blip.  There are many surveys that estimate smoking prevalence, and so in most any quarter it is possible to report on the “exciting new reduction in smoking” based on one of them.  It is also possible to report quarterly on the “exciting new increase in smoking” when the statistical blips go upward — but, of course, no one does that.

That said, there is every reason to believe that there is real downward move in prevalence because of the growing popularity of e-cigarettes.  Since almost all e-cigarette use is as a substitute for smoking, it is not hard to do the math.  It is also worth noting that the very modest downward trend in smoking in the US for the decade or so before e-cigarettes started to become popular matched almost perfectly the increase in the use of smokeless tobacco (which remains more common than e-cigarette use).

In other words, it is very plausible to claim that basically all of the reduction in US smoking rates in this century is due to THR.  Certainly if those of us who support THR were as innumerate and unethical  as the tobacco control industry (TCI), we would be insisting that this was a definitive fact.  This would be too bold a claim, but it is actually much better supported than the usual TCI claims, including most everything that appears in this article.  As good scientists and ethical people, we can claim that THR might explain all of the reduction this century, and that it almost certainly did cause a large fraction of it.

With any legitimate conclusion based on statistics it helps to have a worldly story that is observable in the data, not just hand-waving stories about what a number represents (and only wild guesses about whether the data is accurate).  For the most recent figures (as opposed to the statistical errors that created trumped-up claims for the previous decade), there is a very good reason to believe the decrease is real because we can see exactly what is happening:  Many smokers are switching to e-cigarettes, and very rapidly.

So what do Glantz and the other “experts” that the NYT talked to attribute the decrease to?  Hand-waving stories, of course.

As proof that the NYT reporter, Sophie Egan, was just acting as an unquestioning transcriptionist, note the mention of the claim that “researchers” say that seeing smoking in movies is a major cause of smoking, and thus Glantz’s campaign to reduce such images somehow has something to do with the reduction.  Of course, it does not appear that anyone other than Glantz and his beholden useful idiots actually believes that, and even hard-core TCI people have pointed out that it is nutty.

On the reality-based side, higher taxes are identified as a barrier to smoking.  Of course, in some places they are also a barrier to THR, but I am sure nuances like that are well above the understanding of the author or interviewees.  Also, given that this is an article about a prevalence statistic, it would have been nice to see (but obviously way too much to expect, given the limited sophistication of those involved) some mention of the concern that use of the black market created by those taxes may increase measurement error on the surveys (i.e., it is plausible that people who buy contraband will wisely choose not to admit that when the government asks, though we do not know).

Someone other than Glantz reported the plausible claim that smoking place limitations result in the reduction in the number of cigarettes smoked by smokers.  The obvious point that this does not actually relate to the thesis of the article — about prevalence being down — seems to elude Egan.  But though a tangential point, it does seem to be real and the reduction is better for smokers’ health.  Funny, though, that there is no mention that Glantz is the one leading the charge to deny that reducing smoking is good for your health.  This does not mean that the restrictions are better for smokers’ overall welfare, in contrast with THR.  Of course, to Glantz, their suffering is a good thing, which in the article he notes with, “It also creates environments that make it easier for people to quit smoking.”  Yeah, that’s it – easier.  As in “the beatings will continue until morale improves, because beatings make it easier for you to decide you had better obey.”

But the most important lie in this article (again, reported by Egan in her role as an unthinking transcriptionist) can be found here:

“The fact that we’re below this theoretical sound barrier of 20 percent is important,” says Stanton A. Glantz, a professor of medicine at the University of California, San Francisco, and director of the university’s Center for Tobacco Control Research and Education. “This data shows that the whole premise that there is this hard-core group, where no matter what you do you can’t get them to quit, is just not true.”

That “20%” claim sounds rather like the observation I have been pushing for a decade.  But, if that is what Glantz is invoking, he (unsurprisingly) does not seem to understand it.  What I have been claiming (and what one of my colleagues wanted to label “Phillips’s Law”, but since I am really averse to naming transitory social science observations “laws”, I vetoed that) is that once smoking becomes popular in a population, it is nearly impossible to reduce it below 20% of the population except as a result of product substitution — i.e., THR.  That is, a huge body of data strongly suggests that roughly 20% of the population gets such great benefits from smoking that they will continue to choose to do it even though it is very expensive (in terms of both health and taxes) and highly vilified — unless they discover a substitute that allows them to keep most of the benefits without the health costs.  (Note that this observation refers to natural populations, and not highly unusual or self-selected subsets (e.g., Manhattan residents, university professors) or people whose liberties are seriously constrained (e.g., people living in psychiatric clinics, prisons, or submarines).)

[I should point out that I have no idea if this is what Glantz is actually referring to.  Perhaps the TCI people, in their secret cabals, have their own notion of a "barrier of 20%".  But if so, their version presumably does not recognize that THR (and only THR) offers that promise of blowing past the "barrier" -- perhaps they do not like that it does so without coercion.   If so, their version is simply wrong and has been clearly wrong ever since snus became dominant in Sweden.  TCI people like to pretend that Sweden does not exist, but I have been there so I am pretty sure it really does.]

So, when quoting my observation correctly, the US statistics tend to confirm it, not contradict it.  Smoking prevalence perhaps edged below 20% in the 2000s (depending on which statistics you believe — it might be considerably higher), but substitution of smokeless tobacco accounted for more than the gap between the prevalence rate and 20%.  And thanks to e-cigarettes, it might have dropped another percentage point since then.  The whole point of the 20% observation is not that it is impossible to torture a population into reducing tobacco use below 20% if you get draconian enough, but that it is easy to get well below 20% if THR becomes popular.

People like Glantz and the NYT editors are dead-enders, fiercely fighting an already-lost war against THR.  By fighting on, they continue to kill people (the war is metaphorical, but the killing is literal) even though there is clearly no chance they will achieve their dream of a tobacco-free world.  Indeed, there is no evidence that they have accomplished anything positive in the USA and similar populations for many years.  All of the gains they claim credit for seem to be best explained by the growing success of THR.

The “we do not know the population effects” myth

by Carl V Phillips

Some anti-THR activists are not willing to repeat the most blatant anti-THR lies, but they still need to concoct some reason for not supporting THR without admitting their true motives.  One tactic is to claim that even though it is clear that THR is beneficial[*] for individual smokers, it still might be harmful at “the population level”.  There is really no such thing “population level” health apart from individual health.  Health (unlike social phenomena such as social cohesion or inequality) exists only as an individual phenomenon, and what happens at the population level exists only as an emergent phenomenon of what happens to individuals (thus the advantage of using agent-based modeling to study THR, as I posted recently).

[*Actually, I am not sure that tobacco control industry people, even those who are not willing to blatantly lie, would use a proper term like "beneficial".  They tend to stick to weasel words like "a reduced risk alternative for those who cannot quit" while working hard to avoid any phrasing that admits that people must be choosing the option because it offers them the greatest welfare among the available alternatives.]

If we unpack the “population level” rhetoric a bit, it is clear that it is really just a way of obscuring the statement, “we are afraid that more people will use tobacco/nicotine when they find out they can do so with very little risk”.  This is undoubtedly true (that it will happen) — people are not morons, after all, despite what the ANTZ claim.  But is it really the case that we are unsure whether the average/aggregate population health effects will be positive or negative?  No.  It is obvious that the effects will be positive.

A good way to recognize someone who really thinks like a scientist and is seeking the truth, as opposed to someone who either does not understand how to do science or is intentionally trying to obscure the truth, is how he deals with orders-of-magnitude differences.  A scientist, as a matter of second nature, sets aside considerations that are too small to matter (after doing whatever it takes to ensure this is the case).  Typically some of these smaller considerations will be included in a scientific model because there is no reason to leave them out, but there will be no suggestion that they might substantially alter the main phenomenon of interest.

There is a classic illustrative joke.  A museum visitor asks a guard how old a particular fossil is.  The guard replies “two million and seven years”.  When asked by the baffled visitor how such precision is possible, the guard replies, “Well, when I started working here they told me it was two million years old, and that was seven years ago, so….”  We might hope that even a security guard, after hanging around researchers for seven years, would understand the concept of rounding error in this context.  But since it is pretty clear that most of the “scientists” who dominate public health and health reporters never seem to learn this grade-school-level science lesson, maybe this is too optimistic.

A scientist, when addressing the population average effects of promoting THR, would quickly recognize that what matters is how the THR effort affects the smoking rate.  Almost everything else is a rounding error.  Anyone who worries about finicky details — like exactly how many people will be using THR who would have otherwise been abstinent — is either (a) not actually concerned about health, and is using it to hide her real motives, or (b) is functionally innumerate.

Smokeless tobacco is about 99% (+/-1%) less harmful than smoking, and other smoke-free alternatives (e-cigarettes, pharma products) are similar (they might be a bit worse, but it would be shocking if any of them turned out to cause even 5% of the risk from smoking).  Thus, the number of people using THR rather than being abstinent that would be needed to make a dent in the net benefits from one person switching from smoking is quite large.  In fact, it is so large that the count of such people does not really even matter.  It is a rounding error.  Mis-estimating the reduction in smoking by 1% (which is pretty much inevitable) swamps the implications of that other estimate, so what really matters is improving the accuracy of the smoking reduction estimate.

Notice that I said this is almost the only thing that matters.  The only other number that has effects that are not swamped by uncertainty and rounding errors in the smoking rate (i.e., the only number that is worth not ignoring) is the impact of THR on causing some smokers to reduce but not eliminate their smoking.  Reducing smoking intensity reduces risk, though less than linearly (i.e., cutting down by half reduces your risk, but the reduction is by less than half).  So the number of smokers partially adopting THR, and how much they reduce their smoking, could have an effect worth measuring.

But notice that this points in the same direction as the main effect:  a reduction in smoking and thus a substantial reduction in average risk in the population.  The rate of use of THR alternatives is not even worth measuring when asking the question “are we sure the net effect is positive?”

The ANTZ rhetoric surrounding this issue often includes claims about how THR will cause some people to take up smoking, but there is no apparent way in which promoting something as a better alternative to smoking could lead to smoking.  The existence of smoke-free products might keep more people smoking — it tends to interfere with the efforts to torment smokers with place restrictions (prohibitions against smoking in certain places) because they can temporize with the smoke-free alternative.  Setting aside the unethical nature of such tactics, they undoubtedly work to some extent (they are akin to The Inquisition or criminalizing consensual sex — it is possible to torture or threaten someone enough that they will give up something that is very important to them).  But the actual promotion of THR, rather than just the existence of the products, has no such effect.  Besides, since no one has ever suggested banning all smoke-free nicotine products (including pharma products, which are often used to minimize the torment of place restrictions), it is difficult to believe that anyone is really motivated by this.

The context where this “population level” myth shows up most importantly is in US FDA policy, which will not allow a manufacturer to make claims about something being lower risk than smoking until the “population effect” is researched.  Thus, it is THR — not the product itself — that the “population level” myth is being used to interfere with.

With all that in mind, there is one apparent way in which education about THR could cause someone to smoke more than he otherwise would:  It could be that someone’s utility from abstinence would have been higher than that from smoking (so he would have quite entirely given only those options) but that the utility from reducing smoking to take advantage of some THR but then continuing to smoke is higher still.  Is that a plausible scenario, something other than an occasional curiosity?  Addressing that requires thinking about the utility function that measures the costs and benefits from smoking, something that the ANTZ and those dependent on their funding will probably never do (because they like to pretend there are no benefits).  I will let you know when I make some progress on the question.

Beware: e-cigarette vapor contains (gasp!) air.

posted by Carl V. Phillips

We continue Ellen Hahn week here at Anti-THR Lies (not to be confused with Discovery Channel’s Shark Week, since only one of them is about a single-minded evolutionary throwback whose actions are likely to kill hundreds of people every year if left unchecked).  We already addressed the rhetoric from her anti-e-cigarette poster, which is designed to trick people into being irrationally fearful about common chemicals.  This includes, specifically, the common (as in: found in pretty much everything in the biosphere) organic chemicals, acetone and xylene.  But how much of those chemicals is actually found in e-cigarette liquid or vapor?

The particular source that Hahn cites in her recent advocacy paper (which is the only reference in the poster and is consistent with other study results) found a concentration of less than 1/1000th of NIH’s recommended exposure limit for acetone in the air, close to 1/10,000th of the OSHA limit.  There are arguments that these limits are a bit too high, especially for some sensitive people, but not 1000 times too high.  Moreover, those US government specified limits are for someone’s average exposure throughout the day, so the exposure from vaping needs to be averaged across the entire day for comparison, making it far less than a one millionth of the exposure that is considered worrisome.   The ratios for xylene are a bit lower still.

In case Hahn simply does not understand what these numbers mean, the author of the study she cited (and thus what she implicitly claims is a sufficient source of information about this topic unambiguously concluded that these his results show there is no unexpected risk from this exposure.   So Hahn has no room to plead ignorance.

Perhaps the best way to illustrate that Hahn’s claim — that people should worry about e-cigarettes because of these two chemicals — is a blatant lie, however, is not a comparison to recommended maximum limits, but a comparison to air.  The concentrations of these chemicals in e-cigarette vapor — again, using those 2008 numbers — was only a few times higher than what is found in the outdoor air that most of us breathe.  A lot of what was measured was from the air, in other words, especially because the indoor air in a research facility might have concentrations many times as high as outdoor air.

Since these chemicals are at only slightly higher concentrations than the air, and since someone’s total volume of vapor intake is so small, when someone takes a pull on an e-cigarette and then tops it off with a full breath, most of the acetone and xylene in their airways is from the air, not the e-cigarette.  Someone who doubles their breathing rate for a minute or two, say by walking briskly or speaking, takes in more extra acetone and xylene than they would from a vaping session.

What is more, a more recent study found that the concentration of xylene the vapor was indistinguishable from that of the air.  That is, basically all of the measured xylene was contributed by the primary ingredient of vapor (air) rather than the additional contributions from the e-cigarette itself.

If Hahn was really worried about acetone exposure, she would be trying to shut down nail salons (where it often exceeds OSHA standards for the workers, and customers and innocent passers-by are exposed) not vaping.  But, of course, she does not really care.  She is just hunting for sciency-sounding anti-THR lies.

“There is no evidence….”

posted by Carl V Phillips (with contributions from CASAA Board)

A favorite anti-THR lie is to claim there is no evidence of something when there is actually a lot of very compelling evidence.  If pushed, such liars generally try to weasel out of their claim by saying “well, I meant no evidence of one particular type.”  Sometimes they will try to claim that only one particular type of evidence is informative (and they might even believe that — but that just means they have no business claiming to understand science, and so are lying about that).

For example: “we cannot be sure that smoking causes cancer because there are no randomized trials that show that.”  Yes, we are saying that the anti-THR liars of 2012 are borrowing the tactic used by cigarette companies in 1970.

The anti-THR liar who is currently at the top of the charts (though we predict she will be a one-hit-wonder) is the University of Kentucky’s Ellen J. Hahn, so we will feature her lies for a few days.  Some of them appear in this poster put out by her “Kentucky Center for Smoke-free Policy”.  (Contrary to its mission, this Center appears to be mostly focused on anti-THR, and so is effectively a pro-smoking organization.)

Hahn has produced and distributed this poster without admitting authorship (personally or in the name of her Center — notice that she made up a new name for her organization to try to hide the connection), making it pretty clear that she knows these lies are so bald-faced that even she does not want to be associated with them.  However, she did prominently post it at her Centers website, which makes the subterfuge rather obvious.

Today we will address just the “There’s no evidence of this.”  (We will not try to figure out why someone would use a contraction for “there is” in a written document.)  We will continue with the other lies from that poster tomorrow.

Anyone at all familiar with this topic knows that there is loads of evidence that e-cigarettes cause people to quit smoking.  There are hundreds of thousands of former smokers who now use e-cigarettes instead.  That alone would lead any honest person who understood scientific reasoning to conclude that they help some people quit.  There is simply no possible way that every one of those switchers, had they not discovered e-cigarettes, would have just quit smoking at the same time they switched; it would be utterly absurd to suggest that.  Moreover, there are countless testimonies from such people who declare that they are quite sure they would not have quit — already, and perhaps ever — had they not found e-cigarettes.

The presumed response to that (if anti-THR people ever dared stand up and try to defend their claims instead of hiding behind their propaganda posters and talking only to each other) would be, “but that information is not from organized scientific studies, and they are especially not from randomized trials, so it does not ‘count’!”  It is important that we do not let the pseudo-scientists that make such claims and thereby distract us from the scientific intuition that we all acquire as children.  We all know that most knowledge does not come from organized studies of the type that are used to, say, figure out whether one particular chemotherapy agent works better than another.  That type of study accounts for only a tiny fraction of all the scientific knowledge we have.  This is especially true for mass social phenomenon, like the decisions of free-living people to quit smoking, which are pretty much impossible to study in that way.

It turns out that even the “but there are no formal studies” claim is a factual falsehood in this case.  There are a few lab studies in which smokers were given e-cigarettes.  But we should not make the mistake — that the liars and innumerate non-scientists might make and then cause others to make — of thinking that these small, highly artificial observations are more informative than the observation of what people are actually doing.  It is reassuring that these studies come to the same conclusion we derive from observing the population.  But the best scientific evidence you can ever have that something happens in the real world is observation of it happening, hundreds of thousands of times, in the real world.