Tag Archives: policy recommendations

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.

The anti-THR preschool funding con (or, Wonkblog does not understand tobacco economics)

by Carl V Phillips

The Washington Post’s Wonkblog (often known as the blog of its first author, Ezra Klein) ran a series of posts yesterday about the proposed tax increase on cigarettes in Obama’s new budget, which would fund preschool education.  For people who are supposed to be carefully reasoning economists and Washington insiders, they sure missed some elephants in the room.

Sarah Kliff started it off with a too-trusting piece, in which she cites various claims about the enormous effect that the proposed 50 cent per pack national tax increase would have on smoking prevalence.  My personal favorite bit is when she cites a study from Tobacco Control that claimed to prove that heavy smokers are especially affected by prices.  Except the data did not support this claim.  That is standard practice for that “journal”, of course, and Kliff can be forgiven for not knowing that.  But someone writing for a blog that claims to be wonkish ought to at least be able to read the graph she reprinted, the one that divided smokers by intensity and showed that each group was reducing smoking, regardless of the price changes, and all by almost exactly the same rate, regardless of price change.  (The exception being the lightest smokers, who apparently smoked more when the price went up, but, hey, little problems with the theory like that are what cherrypicking is for.)

But naivety about the economics is not the real story.  Later that morning, Klien praised his favorite parts of the budget, leading with this one.  It is hard not to agree with his support for more funding for preschool education, but he also expressed support for the mechanism.  This was despite him quoting health policy commentator, Harold Pollack (Chicago prof, old friend of mine, and one of the most anti-smoking people you could ever quote who is actually smart and honest) lamenting that the tax punishes smokers rather than helping them.  Worse, Klein even cited fellow Wonkblogger, Brad Plummer, who posted a few minutes earlier a calculation showing the tax will not be enough if it causes smoking rates, and thus revenue, to drop.  Thus, it is a very bad way to fund a project.

Completely ignored in this is the reduction in smoking that is going to happen because of THR.  People who are not aware of e-cigarettes and the exploding popularity of these and other THR products are likely to get it badly wrong when they write about tobacco policy.  (In fairness, these are reporters, and part of the reason that they get it wrong is that the people they talk to who are making tobacco policy are clueless.)  The projections about the effects of taxes are based on data from before the coming THR explosion.  It is quite possible that they actually understate the effect of the price increase because more smokers will be aware of the good substitutes than before.  But whatever the interaction effect, the predictions are utter garbage because the tobacco/nicotine world of the next 10 years will not be anything that has ever been seen before.  THR is going to cause American smoking rates to drop substantially for the first time in almost a generation, regardless of prices.

Buried in all of this is the truly unforgivable failure to recognize the apparent hidden agenda.  The special interest groups that got this tax into Obama’s budget know very well, though they probably did not tell Obama’s people, that despite their best efforts THR is very likely to make a large dent in smoking rates.  As Plummer and Pollack suggested, a focused tax like this is a pretty good way to fund something that is tied to the quantity of sales (like anti-smoking efforts; even if you hate them, you can see the sense in funding them based on cigarette tax revenue, just like road repair being paid for with gasoline taxes), but it is a terrible way to fund something unrelated, like preschool.  When sales drop funding for some things should also drop, but obviously not for something completely unrelated.

Therein lies the apparent game.  If the anti-THR liar crowd can get the government to fund a popular program with dwindling cigarette taxes, then the next Congress and President will be left scrambling for funding.  They are naturally going to look to the increasingly popular e-cigarettes, smokeless tobacco, and other THR products.  Never mind that there is absolutely no justification for imposing a “sin tax” on these low-risk products, just like we would never impose such a taxes on similarly low-risk consumer goods like meat, bicycles, and leisure travel.  These “other tobacco products” will be in the same mental neighborhood as politicians get frustrated about cigarettes’ drop in popularity, the money will be needed, and so… “well geez, we had to start taxing them.”  The narrow special interests will prevail over consumer interests.  The ANTZ will get their anti-THR tax, and if they are really lucky they will succeed in keeping enough people smoking that they can stay in business.

Yes, I know.  Most anti-THR people seem to be about as clever as a bag of rocks.  But there are people hiding behind them who are running the multi-billion dollar tobacco control industry, and they are probably quite capable of figuring out this long con.  The only good news is that the Obama budget is generally perceived to be dead-on-arrival, so maybe this will just go away.  I hope so, because I have no optimism that anyone will try to block this provision because they recognize that its real goal is to pave the way for a high tax on nonsmokers.

Why most health policy recommendations are lies

by Carl V Phillips

I taught a class today to a group of public health students, with the theme that policy recommendations made based on an empirical study of a risk factor (e.g., an epidemiology study about the health effects of a behavior, or a study of the chemicals found in e-cigarette vapor) are never justified.  Or, in the terms of this blog, are lies (not in the sense that they do not reflect the authors recommendation, obviously, but the claim that the recommendation follows from the study is a lie).  There are five distinct reasons why making such recommendations are inappropriate.  That list is, I think, rather informative for disciplined thinking about promoting THR, so I thought I would share a summary of the basic points from the class with my rather larger audience here.

I started out by asking them if they had ever read a paper where the authors do a single study about a possible risk factor and then make broad policy pronouncements at the end.  I interrupted before they answered to assure them that I was joking – they are in public health, so of course they have read papers like that.

As motivating examples for the discussion, I had them read the post from a few days ago, about proposals to either ban cigarettes or drastically reduce the nicotine content, and read enough to know about plans to develop nicotine “vaccines” that would prevent someone from experiencing the effects of nicotine.  I also threw in Bloomberg’s soda ban (I love it when the lead headline in the New York Times is on-topic for the day’s class!).

The reasons why it is a lie to tack on policy recommendations to a risk-factor study:

0. The results of the study might not be right.

I did indeed start the counting at zero because this one is a bit different.  It is not about the wisdom of the policy, but about the study result itself.  A single study does not give us a definitive assessment that an exposure causes a particular outcome.  If it is the only such study that exists (which is rare — happens only once per exposure+disease, obviously) there is still whatever other knowledge we might have.  In theory a good paper could review the other evidence and draw conclusions about the totality of the evidence, but that is exceedingly rare (it usually requires a dedicated review paper to try to do that).  Thus, the implication of the particular study in isolation cannot even tell us too much about the risk, let alone how to respond.

Note that this applies to studies that suggest there is no risk.  Indeed, even more so.  The same possible errors that might cause a single study to exaggerate a risk could also cause it to miss a risk that really exists.  In addition, there are plenty of ways to do a study that will miss a phenomenon even if it exists.  Thus, pointing to a single study and claiming it is evidence that we do not need to act is an even greater mistake.  (Thus the reason that I and CASAA make it a point to avoid doing that.)

1. The proposed policy might not accomplish the goal.

It might be that an exposure is really causing a disease, but that a specific proposed intervention might not actually reduce the disease even though a naive knee-jerk impression say it might.  It might even be that no conceivable intervention could accomplish the goal, so even a general “something should be done to…” recommendation cannot be justified.

For example, Bloomberg has been furiously attacking the overturning of his soda ban by repeating observations about obesity being a problem.  But would banning 20 ounce Cokes do anything significant to reduce obesity?  The best guess is “no”, but more important, there is no reason to believe the answer is “yes”.  Governments like to engage in the “logic” of saying “there is a problem and something must be done; this is something; therefore this must be done.”

2. The intervention might create other harm (in the same realm where it is intended to do good — i.e., it might cause other health problems).

Bloomberg also moved to make food less flavorful (by reducing salt); this tends to make people want to eat more and thus become obese.  The proposal to reduce the nicotine in cigarettes would make them less appealing, no doubt, but it would also cause many people to smoke more of them.  The question of whether an intervention might cause other health problems is not answered by the study of a particular exposure+disease combination.

3. There will be costs to implement the policy; is it worth it?

The question of policy making becomes far more complicated still when we realize that most policy actions entail costs, often quite substantial.  No risk-factor study could possibly address this.  Assessing the costs and benefits of a policy generally requires more analysis than an entire risk factor study.

Why not just ban smoking?  If it worked, it would eliminate the health costs.  One reason is that the costs (causing people to lose the benefits of smoking and enforcement costs) would be enormous.  On a less dramatic level, even if Bloomberg’s plan would reduce obesity some, would that be enough to justify the various rather high costs?  It does not appear that anyone bothered to ask that question.

4. Is it ethical to do (even if it would work)?

This is, of course, the question that generates the most animated conversations.  I will not rehash the basic libertarian arguments here.  Nor will I attempt to delve into more subtle points.

But I will mention an observation I made to the students:  Some portion of the population would probably support giving their kid a vaccination that would prevent the child and the adult he will someday be from experiencing any benefits from nicotine.  Some portion of the population would argue that it should be mandatory (or close to), like the pertussis vaccine.  But probably roughly the same portion of the population would favor a hypothetical vaccine that would ensure that the kid is not gay or a similar magic bullet that would prevent him from ever embracing the teachings of the Koran.

The implication of that is that “public health” — the activist movement, as opposed to actual public health — is a special interest group filled with people who do not seem to realize that the interventions it demands are widely considered just as deplorable as anti-gay or anti-Islam interventions.  I took the opportunity to point out that any student who was planning to go into “public health” (as opposed to working in some more acceptable way to improve people’s health) should realize that they are on the wrong side of history.  While policy advocates in that area were once, legitimately, considered heroes, the generally celebratory reaction to Bloomberg’s plan being struck down by the court should give them pause.

[There are some concrete implications of this list for THR advocacy.  I will come back to that in a later post.]

Sometimes the anti-THR lie is just not mentioning THR

by Carl V Phillips

A recent highly touted op-ed in the NYT claimed to offer two ways to eliminate smoking in our society.  It was written by Richard A. Daynard, a law professor at Boston’s Northeastern University who is head of a “public health advocacy” institute.  If that bio leaves you expecting the content to be out of touch with science, ethics, human behavior, politics, and pretty much everything else someone needs to know to recommend policy, you will not be disappointed.

Daynard starts weak, by attributing a substantial amount of smoking reduction

to Dr. Koop’s antismoking crusade as surgeon general, from 1981 to 1989

In reality, of course, smoking steadily declined for over three decades, starting in the mid-1960s, due almost entirely to people’s decision to not smoke once they were educated about the risk (and such education was basically all anti-smoking consisted of during the most dramatic decline).  To the extent that any effort other than that basic education, which was universal by 1981, (and to a much smaller extent, price increases) had an impact beyond the trend caused by the education, it is really too small to estimate.  That does not stop Daynard from attributing the decline to every anti-smoking measure except the basic education and rational decisions by would-be smokers.

But this standard “public health” boilerplate was only window dressing.  He was clearly using Koop’s recent death as an excuse for publishing some pent-up madness he had sitting on his desk.  His real message was:

What we need is an all-out push to reduce smoking rates to well below 10 percent.

Notice the key noun in there: push.  This is not one of those pansy-ass academic lawyers like you might find across town among the Constitutional scholars at Harvard, who believes that Americans are a free people and who wants to help protect them from tyranny and abusive government.  Oh, no.  He believes that proper behavior of the rabble can only be achieved by government force.

One of his bright ideas is basically to just ban smoking (why did no one think of that before?):

no one born in or after 2000 can ever be sold cigarettes. Under such legislation…the vast majority of this cohort — the oldest are now 13 — would never begin smoking.

Of course.  Since everyone who starts smoking does so legally, dutifully waiting until they are 18 to light up, that should do it.  And since he tells us how this idea is supported by one guy in Singapore and political chatter in Tasmania, it must be a widely accepted good idea.

He does not actually argue that this would be wise.  He cannot.  Rather, his main basis for suggesting this is a claim that the FDA now has the authority to impose such a regulation.  Perhaps he does not realize that most governments have always had the authority to just ban smoking if they wanted to, for any age cohort.  I will not insult my readers by pointing out why not even Australia or Singapore has tried to exercise this authority.

At least the ban is just fantasy.  His other plan is potentially quite deadly:

The F.D.A. would be well within its authority to require nicotine content [of cigarettes] to be below addictive levels

This is nothing new, of course.  As Rodu recently noted, that idea traces to people who include the new head of FDA’s Center for Tobacco Products, and it was always a terrible idea.  Most people smoke primarily to get nicotine.  Reduce the nicotine and they will smoke more.

FDA arguably has the authority to do all kinds of things to lower the quality of cigarettes.  Most of them would cause people to smoke less (so long as you are not worried about pesky details like people’s freedom to choose and inalienable right to pursue happiness — since Daynard seems to like Singapore’s and Australia’s way of doing things, I assume he is fine with that).  But he managed to pick the one way to lower quality that will probably cause more smoking.

Of course he probably does not know enough to understand that.  Missing from this entire missive (not surprisingly, given it is written by someone with “public health institute” in his title), is scientific analysis and evidence.  He does use the word “evidence” twice, but it is not clear he knows what it means.  Regarding what would happen if some locality started imposing draconian restrictions on cigarettes unilaterally:

evidence suggests that border-crossing and smuggling would be minimal

And if you believe that….  Well, if you believe that, you are probably a victim of ANTZ lies and apparently not able to actually understand the evidence.  His other misuse of that word is rather more interesting:

if the F.D.A. insisted on the [reduction in nicotine], and cigarettes ceased to be addictive, ample evidence shows that most smokers would quit or switch to less toxic nicotine products.

Wrong again.  It is undoubtedly true that this change would drive some to quit and many to switch.  But this is based on general knowledge about people, and not what would normally be called “ample evidence”.  There is obviously an absence of what is normally called evidence when we are talking about what would happen following an extreme change that has never been tried before.

What is interesting, though is the acknowledgment of alternative products.  The alternative products that would fill the gap — if someone actually tried to implement this rule, and it actually succeeded rather than leading to a popular revolution — would probably be e-cigarettes and smokeless tobacco (assuming FDA did not try to ruin them first).  Some people who advocate THR favor efforts to push smokers into switching, while others believe they should be informed and encouraged, but left free to choose.

But Daynard says absolutely nothing more about the alternative products.  It seems rather unlikely that he actually understands THR, despite his claim of expertise about smoking cessation.  If he did, he would realize that the only evidence-based — and, indeed, proven — method for lowering smoking prevalence to that 10%, and the only conceivable way to do it without ruining a lot of people’s lives, is adoption of THR.  Instead, he proposes approaches that are based on wild speculation and that would seriously hurt a lot of people.  Despite his recognition of alternatives to smoking, his failure to even mention THR, along with the presentation of his radical alternatives to THR as if they were promising and practical, mean that his message is ultimately an anti-THR lie.

Kelvin Choi is a liar

by Carl V Phillips

A new ANTZ on the scene seems to be aspiring to be the new Ellen Hahn.  I supposed it is possible, given that he is at University of Minnesota that he aspires to the be the new Stephen Hecht, but that might be a stretch since Hecht seems to do somewhat useful bench science, and then just lies about the health and political implications.  Choi, by contrast, seems to be fully ensconced in the “public health” junk science paradigm.  Consider this recent abstract:

Objectives. We assessed the characteristics associated with the awareness, perceptions, and use of electronic nicotine delivery systems (e-cigarettes) among young adults. Methods. We collected data in 2010-2011 from a cohort of 2624 US Midwestern adults aged 20 to 28 years. We assessed awareness and use of e-cigarettes, perceptions of them as a smoking cessation aid, and beliefs about their harmfulness and addictiveness relative to cigarettes and estimated their associations with demographic characteristics, smoking status, and peer smoking. Results. Overall, 69.9% of respondents were aware of e-cigarettes, 7.0% had ever used e-cigarettes, and 1.2% had used e-cigarettes in the past 30 days. Men, current and former smokers, and participants who had at least 1 close friend who smoked were more likely to be aware of and to have used e-cigarettes. Among those who were aware of e-cigarettes, 44.5% agreed e-cigarettes can help people quit smoking, 52.8% agreed e-cigarettes are less harmful than cigarettes, and 26.3% agreed e-cigarettes are less addictive than cigarettes. Conclusions. Health communication interventions to provide correct information about e-cigarettes and regulation of e-cigarette marketing may be effective in reducing young adults’ experimentation with e-cigarettes. (Am J Public Health. Published online ahead of print January 17, 2013: e1-e6. doi:10.2105/AJPH.2012.300947).

Let’s set aside obvious problems, like the limited value for anything other than historical tracking of an awareness survey about e-cigarettes from 2010, or describing 20-something-year-olds as “experimenting”, as if they are children.  (Many of those crazy kids are also experimenting with buying houses, military service, and parenthood.)  Consider the core conclusion.  How can a simple cross-sectional survey of awareness and belief tell us anything about the effects of communication and regulatory interventions?  If you said, “I have no idea”, you nailed it.  It is a complete lie that the conclusion follows from the research.

And, of course, there is the little matter of which bits of information he wants to correct.  Does he want to help the 55.5% who do not realize that e-cigarettes help smokers quit?  Or is it the 47.2% who do not realize they are lower risk than smoking?  As you might guess, it is the ones who actually know the truth that he wants to “correct”.

(Note:  I trust my regular readers will recognize as subtle ridicule my use of three significant figures in reporting those numbers.  As anyone who understands sampling — and anyone familiar with my writing — knows that reporting that level of unwarranted precision is a bit of junk science in itself.)

There is some potential usefulness in the actual survey in terms of helping us learn about the rate of at which accurate knowledge of e-cigarettes and THR has spread.  However, what has no apparent usefulness are Choi’s thoughts and opinions, as evidenced by this interview.

I will skip past his first answer, a remarkably amateurish description of what e-cigarettes are, something that could be corrected by basically anyone who is familiar with the topic.  (But go ahead and read the whole interview if you are inclined to find unintentional comedy in ANTZ rantings — it is a good one for that.)  I skip that because it gets far worse:

There are a variety of reasons why e-cigarettes are unhealthy. First, they contain nicotine, which is a known addictive chemical. A recent study conducted by Vansickel and Eissenberg found that experienced e-cigarette users can obtain a significant amount of nicotine through e-cigarettes, which may be comparable to smoking cigarettes.

E-cigarettes deliver nicotine?  Who knew?  Glad we had that study (by the guy who originally claimed just the opposite and never admitted his error — but that is another story).  And the reason that they are unhealthy is that this chemical is addictive (whatever the heck that means), not because it is harmful.  Choi might want to ask for a tuition refund from whoever claims to have taught him about health.

Second, previous chemical analyses of the e-cigarette nicotine liquid found that some samples contain tobacco-specific cancer-causing agents and anti-freeze.

Yawn.  Yes, this PhD “researcher” cannot do any better than some random county public health nurse, citing the propaganda (rather than the actual scientific results) from the FDA.  Another tuition refund, please.  Oh, but wait.  Maybe that nurse could do better.  She probably would not claim that e-cigarettes actually “contain…anti-freeze” [sic], but merely “an ingredient found in antifreeze”.  The latter form of this is an example of lying with literal truths, of course, as previously discussed in this blog (did you know that breast milk contains an ingredient found in antifreeze?!! we should stop nursing babies immediately!).  Apparently Hahn Junior does not even realize that he is reciting propaganda meant to confuse people — he is among the genuinely confused.

Third, with the product being promoted as a cigarette alternative at places where smoking is not allowed, smokers may use these products to sustain their nicotine addiction, and may therefore be less likely to quit smoking

And another “problem” that is not an actual health risk from e-cigarettes.  That “where smoking is not allowed” pseudo-argument deserves a post or two of its own, which I will do that soon.  So today I will politely refrain from pointing out how utterly moronic it is.

And that is all he offers.  Not even a single claim of health risk.  Apparently he wants to keep people from “experimenting” with e-cigarettes because they… …um… cause no health risk at all.

Oh, but it gets dumber.  So much dumber.

I think the perception of e-cigarettes as cessation aids is of the greatest concern. First, this perception may drive young adults to use e-cigarettes when trying to quit smoking instead of proven-effective cessation treatments. To date, no studies have shown that e-cigarettes are more effective than proven-effective cessation treatments such as nicotine replacement therapy and counseling. Therefore, e-cigarettes may hinder young adult smokers from quitting smoking.

E-cigarettes are (correctly) perceived as being useful for quitting smoking?  Well, that is a dire concern indeed.  As for the claim they are not shown to be more effective than other methods that are “proven” to help a mid-single-digit percentage of smokers quit (to charitably take a best-case figure from the biased research on the topic), so what?  Even setting aside the fact that he is baldly lying about that — the evidence strongly supports the claim that e-cigarettes are more effective — how exactly do they prevent someone who wants to quit smoking from trying those other methods if the e-cigarettes do not work?

Anyone with a basic understanding about smokers and quitting — even at the casual layperson level of knowing actual humans who smoke or smoked — understands that most people who are interested in quitting try multiple methods.  How exactly can one method, even if he genuinely believes it is of no value at all, interfere with the others?  Does he really think that smokers are so dumb as to say “well, I wanted to quit and tried an e-cigarette, but it did not work for me, so I will just keep smoking because I have never heard of any other method I might try.”  Gee, if only there were some way to inform smokers that the powers-that-be think they should try NRT and counseling.  Someone should really get on that.

And if Choi really believes that introducing a new method of quitting will actually prevent the use of other options, does he rail against the introduction of new NRT products or counseling methods because they will keep people from trying the existing methods he thinks are actually “proven”?  I didn’t think so.

In short, either he has not even given enough thought to this topic to be considered even a generally aware layperson, and so is grossly lying about his expertise, or he is just making up lies because he wants a ride on the ANTZ gravy train.

Is there more?  Oh, yes, there is more.  It will have to wait until the next post.

There are no “neutral” views on THR (but there are clues about who is honest)

posted by Carl V Phillips

I run into quite a few people who want there to be some authoritative honest broker who can provide a “neutral” opinion about THR.  (Actually, we see this all the time regarding most controversial subjects, and it fails for basically the same reasons.  But I will stick to talking about THR and you can extrapolate to other topics.)  Everyone defers to authority or conventional wisdom for the overwhelming majority of what they do and think — that is the only practical way to exist.  But when there is political controversy and the issue is important to your own health (or public health, for those making public health pronouncements), it is time to stop deferring and recognize that there often (perhaps usually) are no neutrals.

This is clearly the case when it comes to THR.  While these observations are probably obvious to anyone who is invested in this topic, it might provide some useful information for those trying to begin to understand it.

A favorite target to defer to on matters of health (even by many non-Americans) is the US government.  Deferring to them in this cases consists of thinking: “They say e-cigarettes and smokeless tobacco are very very bad for you, so it must be true.  After all and they would not mislead me.”

Really?  Does anyone really believe that the government would not be biased or try to sell you on a particular belief system?  Almost no one would ever make such a claim, and yet many people act as if they believe it.

I hope it is obvious that our government is not an unbiased neutral broker of information when it comes to, say, the Department of Defense opining on the usefulness and ethics of assassination-by-drone-aircraft, or the Drug Enforcement Agency offering its assessment of the Drug War.  The retort I might expect to that is that, FDA and CDC are supposed to be looking out for our best interests, not pushing an agenda.  But I would expect that the people at DoD and DEA also think that they are looking out for our best interests.

The government, of course, is not a unitary actor, but consists of a lot of operations that each have their own mission.  When officials create a particular unit or a particular assignment, they have a goal in mind, and it is seldom to create a neutral arbiter.  But even when that is the goal, the well-known phenomenon of “agency capture” means that the people who join the agency or exert the most effort to influence it will be those who are highly focused on the issue, which is basically synonymous with “interested in a particular outcome”.

Most of the time, the capture is by an industry that stands to make or lose profit based on agency actions.  Sometimes not.  Theoretically, the government units that deal with tobacco could have been captured by the tobacco industry, but instead they were captured by the tobacco control industry.  Why that happened is no mystery, but it is sufficient to just observe that it happened.  So, there are revolving doors (people moving between the tobacco control industry and government agencies that support them) and iron triangles (a generalization of Eisenhower’s “military industrial complex” concept, which is basically the epitome of capture) everywhere you look.  No agency employee would dare contradict the government anti-THR lies, let alone say that perhaps people can rationally choose to use tobacco rather than not.

Trusting government agencies to be neutral — on most anything — is simply absurd.  It is generally safer to assume the opposite.  In this case, it is easy to see who controls the agencies.  But it should be equally clear that for an issue like this, these observations about government generalize to any supposedly neutral committee (made of people with an interest in the issue, chosen by someone who has an opinion) or organization (which generally exist to advocate a particular position).

Moreover, for the case of THR, being neutral makes about as much sense as being neutral about the shape of the Earth.  Someone who claims the Earth it is flat is an outlier who apparently is unfamiliar with evidence, or is just lying for some purpose.  But someone who “sees that both sides have merit” is also a nutcase (or worse, an irresponsible journalist trying to provide “balance”).  It would certainly be possible for someone to present the arguments from the flat-earther alongside the rest of the evidence.  But anyone who did not then arrive solidly at “spherical” should not be considered a trusted source of information.

People who learn and understand the truth about THR — and tell the truth about it — invariably come down on the pro-THR side, or at least admit that it offers clear benefits for public health, overall welfare, and individual rights.  The honest brokers might recognize nuances and caveats that are absent from extreme pro-THR positions, but frankly there are not very many people who exhibit extreme pro-THR positions.

It is theoretically possible for someone to take an honest neutral position on THR or even an honest anti-THR position, but I am aware of nobody who does.  It is possible to argue “there is overwhelming evidence that the risk from smoke-free tobacco/nicotine products is very low, and there is no reason to believe that encouraging their substitution for cigarettes will have negative effects on health, but I oppose [or, am on the fence about] providing accurate information and legal access to these products because….”  The “….” would have to be a statement like “I do not really care about health outcomes, but only care about hurting the tobacco industry” or “I am more worried about whether other people sully their bodies by using a drug then their happiness or health”.

You never hear such honestly, but it is theoretically possible.  The one version of the “….” that you almost see sometimes is “I care more about whether people are ‘addicted’ than the effects of that behavior”, but even this it is never stated so honestly, and is never coupled with the honest presentation of the health benefits.

The truth has an overwhelming pro-THR bias, and those who would attack THR implicitly acknowledge that fact by avoiding the truth.  Everyone who is anti-THR, or even claims to be neutral, whatever their real motivations might be, lies about the health science and bases their stated oppositions on those lies.  So they clearly fail the “honest broker” test.

But there is still a useful guide to finding the truth in this, but (like any other useful guide) it is not as simple as “just trust the government”:  When you observe:

  • everyone of any visibility on the anti side repeatedly makes claims that those on the pro side point out are lies, often based on easily verifiable information
  • those on the pro side consistently acknowledge and respond to the claims made by the antis
  • while those on the anti side never engage in dialog, not even so much as to dispute the substantive statements made on the pro side, but instead just keep repeating the zombie lies
  • some of those on the pro side try to police their side’s information, while those on the anti side virtually never criticize anyone on “their team”,
  • and those on the pro side can explain and document the motives of the antis to lie, while the antis can only resort to (unsubstantiated, and indeed easily refuted) sputtering protests about the other side consisting entirely of some secret industry cabal (for a non-existent THR industry, no less!),

well, then, I really think that it is not too difficult to figure out where to find the honesty.



Political philosophy is not a matter of personal opinion

posted by Carl V Phillips (with help from Julie Woessner)

I was not going to follow up on yesterday’s post about how normative statements can be lies, but Elaine Keller called my attention to this comment on the lies by Glantz that helped anchor that analysis.  It brought up a particular additional point on the subject that is worth making.

We see a lot of false statements about natural science because people do not understand the material.  [Note: natural science is basically the study of anything that would exist even if human society did not, and social science is the rest.]  But we see false statements about social science because of that but also, somewhat ironically, because people think they understand it better than they do because it does not use so many words they have never heard.  Moreover, discourse on both social science and political philosophy further suffers from sounding similar to topics where everyone is entitled to his or her own opinion (personal preferences and morality), which causes some people to make the mistake of thinking that their opinions are worth something even when the statement cannot be based on personal opinion.  Today’s example is a good illustration.

As I pointed out yesterday, Glantz wandered close to the neighborhood of avoiding his lie about what should be done (based on some accepted norm), replacing the lie with a true statement that he just has an extreme idiosyncratic view and his normative claim is based on that.  He did not get anywhere near close enough, but there was actually a hint there that he understood that he was basing his claim on a particular extremist viewpoint and not on anyone else’s measure of what constitutes the good.

Not so the anonymous commenter who, by comparison, managed to make Glantz’s grasp on reality look quite good.

We have every right to ban the unregulated use of any delivery method for a toxic recreational drug that has any potential to harm others whatsoever.

Yes, some idiot[*] really wrote that.  “We have every right to ban”.

[*Note: If you think I am being too hard on this guy, you can read the rest of the comment and see that I am not; I am just focused on one of several very stupid statements.  In fairness, this commentator, unlike Glantz, is not claiming to be an expert of any sort.  Still, anyone with grade-school level civics behind them should not have made the error in question.]

I will leave more in-depth analysis of such idiocy to those who write about liberty in the context of substance use.  (If you are interested in that topic but not sure who to read, start with Snowdon and branch out from there).  Suffice to say that a core part of post-Enlightenment Western political philosophy is about the rights of the individual to be free from tyranny and the very limited ways in which society should intervene in spite of those rights.  Notice that the word “rights” only shows up on one side of this equation, and it is not the nannying side championed by that writer.

Moreover, we can look at the specifics of the issue at hand.  Recall the context:  Glantz asserts that e-cigarettes should be banned anywhere that smoking is banned.  But there is no question that smoking bans are an extreme exception in the context of rights.  Smoking is one of the very few things that is not banned outright (like, say, punching someone in the face) but that private businesses (in many jurisdictions) cannot freely allow on their premises if they so choose, even if they make sure that everyone present is aware of that fact and even if all are required to explicitly declare they accept the situation before entering.  Indeed, most things that are banned outright are allowed under carefully constructed private agreements (you can enter into a contract to allow someone to punch you in the face, or hire someone whose job description includes allowing that to happen).  It is difficult to think of another example — outside of the rest of the Drug War and bans on sex work — where core freedoms are so thoroughly abrogated as with smoking bans.

But, of course, the likes of Glantz have been telling us for years that there is something unique about smoking.  There is a bit of merit to this.  For the many people who object to the smell of cigarette smoke, smoking is among the worst aesthetic insults someone nearby is likely to inflict, up there with talking loudly on the phone, blasting music, never bathing, or making racist/homophobic/anti-Islamic/etc. comments.  Private employers, hosts, etc. very often disallow all of these in the venues they control — as is their right as private actors — but are also free to allow them.  Indeed, some entities would have a hard time prohibiting the last on the list if they wanted to.  So smoking bans already defy normal notions of rights.

Then there is the health argument.  But there, the claims go, smoking is absolutely unique.  If you believe the common claims, it is several orders of magnitude worse than the next-worst thing that people inflict on their neighbors.  And even setting aside the exaggerations, it is still plausible to claim that it is an order of magnitude or two worse than any other common neighbor’s-health-affecting activity other than driving.

But even with all of that, the ethical case for taking away the rights of individual actors to decide whether to allow the exposure is very dicey.  It is quite controversial among the populace and even more so among people who seriously study such matters as rights.  Thus, it is obviously absurd to claim “every right” to ban something else that has a comparatively trivial impact.  There is no such right.  In fact, every notion of rights in our society cuts in the other direction.

This example illustrates that someone can be unambiguously lying when making claims in a non-scientific field.  It is possible to make a statement in political philosophy or some other area of ethics that is clearly false as a false scientific claim.  Someone saying “I personally think it is ok to….” is not a lie.  But misrepresenting the entire basis on which our society is built?  I would have to say that this is a rather worse lie (and a rather worse commentary on our educational system) than merely falsely claiming that something causes cancer.


background analysis, posted by Carl V Phillips

A couple of recent posts here have identified as a lie an author’s statement about what should be done.  This might seem a bit odd.  After all, it would seem that someone’s opinion about what ought to be done in the world cannot be wrong.  That is indeed true, so long as they make clear that they are basing their normative statement on their own opinion per se.  (Normative = philosophy or economics jargon for a “should” claim.)  A statement like, “I would prefer a world in which smokers do not have low-risk options, and therefore X should be done to interfere with adoption of THR,” cannot be a lie.

But when a normative statement is made based on some stated goal other than the whim of the author, then it can be false.  And if the author knows the claim is false — or claims to be sufficiently expert that he should know — then it is a lie.

If someone claims that an anti-THR action (product bans, message to smokers, etc.) is justified by public health concerns, they are lying.  (Alternatively, they are utterly clueless and are just some other liar’s useful idiots — but I will set them aside for this analysis and just focus on those who claim expertise.)  It is theoretically possible to concoct a scenario in which promoting THR could be bad for public health, and if someone actually does that, then they are not lying about the “should” (though they might be lying when they describe the scenario).  But lacking such a tortured scenario as part of the analysis, THR is so clearly pro-public-health that the “should” is a lie.

Similarly, if someone states “e-cigarettes contain chemical X and therefore should be avoided” or “…should be prohibited from public use”, it is a lie if the quantity of chemical X creates no known risk, or a risk down in the range of the thousands of exposures that are normally accepted.

Of course, most of the time someone makes a normative statement, they offer no explicit explanation for the normative standards (ethical rules) that they are using.  Typically, however, this can be inferred from context.  If the discussion surrounding the normative statement is about public health, we can infer that the normative claim is about what would be best for public health.  If it is about individual users’ health, that is the implied basis for judging what is best and thus the “should”.

Someone is free to explicitly state their normative standard is something other than what the reader would naturally infer.  But if that is what they are doing, they are obliged to be specific and argue that their normative claim is supported in spite of the lack of a normal public health argument.  In general, if someone is arguing based on a motive or ethic that is hidden, they need to make that explicit.

If that last sentence sounds familiar, it should.  It is really just another way of bringing up the issue of conflict of interest that was the subject of last week’s background post.  So, for example, when the American Lung Association advocates against THR (see previous post), they are lying to most readers, who reasonably assume they are taking a position that would tend to improve lung health, when in reality their position is bad for lung health.  It turns out that buried in their mission statement is an incongruous anti-t0bacco extremist (and thus anti-THR) position.  But unless they make clear they are acting based on that extremist mission, rather than a goal of promoting public health (let alone lung health) then they are lying.  Moreover, they should make clear that they are acting based on a clear conflict of interest: anti-tobacco extremism conflicts with the missions of lung health and public health in general.

An honest author is obliged to make clear their motive and its downsides and COIs.  The ALA cannot be honest unless they explicitly say “we oppose low-risk alternatives to smoking in spite of the fact that promoting such alternatives is good for lung health.”  Obviously they cannot fit this into everything they write on the subject, but because they do not make that clear in any of their writings — but instead pretend that being anti-THR is part of their lung health mission — then everything they write on the subject is a lie.

Compare:  No one who honestly writes about THR fails to acknowledge that even low-risk nicotine products probably pose some small risk of premature mortality compared to complete abstinence.  Sophisticated writers on the subject further acknowledge that more people will (quite rationally) use tobacco/nicotine when low-risk products are an option, rather than just cigarettes.  We then argue that THR is good for public health (among other things) in spite of those facts.

In addition, when someone presents a basis for making a normative claim that is likely to be controversial, they are obliged to make that clear rather than trying to hide it.  Consider the example from the previous post, where Standon Glantz called for vaping to be banned wherever smoking is banned.  He was clearly misrepresenting the science of the study he cited, and that was an indefensible lie.  But setting that aside, he also hinted at an ethic that could make his normative claim defensible: “No one should have to breathe these chemicals, whether they come out of a conventional or e-cigarette.”  Not “no one should have to breath these chemicals when produced by someone else”, but specifically if they come out of one of those products (which, I noted, are what he really cares about: products, not people).

So, he could have written:  “There is no reason to believe that environmental e-cigarette vapor causes any health problems.  But I believe that unlike a thousand other minor sources of air pollution that people inflict upon each other, which should not be banned when they are trivial and have no apparent health effect, any bit of air pollution from an e-cigarette should not be allowed.”  That would have been honest.  But it then would have been his obligation to convince people that this position is acceptable to take in a free society where most people do not share his personal pique.

Moreover, he would also be obliged to explain why this value of accomplishing this one goal — eliminating any bit of emission from this one particular source — outweighs the costs.  In particular, why is the supposed value of this goal sufficient to outweigh the public health costs of encouraging smokers to continue smoking.  In addition, he would need to argue that his personal goal justifies depriving people of private property rights and a host of other considerations.

Indeed, that last point brings up a further important consideration:  Not only is “getting rid of products that a few people find objectionable” not an accepted basis for normative judgment, but “improving public health” alone (absent a consideration of the myriad other preferences that people have) is not either.  More on that another day (or just read the tens of thousands of words that I and others write on that subject every year).  But even starting from the absurd normative position that public health trumps all other human preferences, anti-THR “should” statements are almost always lies.