Tag Archives: self policing

Number of lives saved must be adjusted for those who cannot be saved, etc. (wonkish)

 by Carl V Phillips

There is always some interest in quantifying how many people could be saved by THR, and it flared up this week thanks to estimates by Robert West (his paper; his press comments). As a result, Brad Rodu and I were discussing the challenge of correctly accounting for smokers who could not be saved by quitting (in any manner) because the disease by which smoking is going to kill them is already established. (Recall that CDC is apparently planning to try to trick people into believing that such diseases among vapers were caused by vaping itself, rather than because their learning about THR came a year or two too late — thanks in part to the CDC.)  Quitting is not the same as never having smoked, and THR switching is not the same as having always used the low-risk alternative. Continue reading

More nonsense about gateway effects – this time from ecig supporters

by Carl V Phillips

It seems that most every researcher or pundit making claims about gateway effects — that e-cigarette use causes some people to then become smokers — has no clue about what evidence would support or contradict such a claim.  It is a truly amazing and sad commentary on what passes for scientific thinking in this realm.

I have already explained at length how Glantz et al.’s claims about having found evidence of a gateway effect are fatally flawed.  But they are actually one step better than two recent claims by e-cigarette supporters that there is no gateway effect.  Glantz basically made a single observation about a statistical correlation that you would, indeed, expect to see if the gateway claim were true.  But you would also expect to see that correlation if either of two other things were true, one of which (confounding by common cause) certainly is true and the other of which (people are employing THR) is far more plausible and better supported than the gateway claim.  Basically the logic was this:  “If it is Monday at noon, there should be light coming in my window. There is light coming in my window. Therefore it is Monday at noon.”  There are obviously many more states of the world where the observation is true and the conclusion is not, so this is terrible reasoning.  I remember learning that in grade school; apparently Glantz, the faculty at UCSF, and the editors and reviewers of the junk journals he writes for missed that day of class in third grade and never took any science courses in college.

But that is not the worst reasoning one could engage in.  At least observing the sun makes it a little more likely it is Monday at noon, since it allows you to rule out many times of the week, and therefore you have increased the probability that it is Monday at noon.  Of course, you have increased the probability that it is midafternoon on Wednesday just as much.  But the observations in this study, a survey of European e-cigarette users, do not even do that much.  That has not stopped e-cigarette touters from claiming that the study shows there is no gateway effect, a claim which has made the rounds in social media.

It is rather baffling.  The authors make no such suggestion in the article or their press release.  There is simply no support for the claim to be found there.  The interpretation seems to trace to this crap article in New Scientist, which makes the claim in the text, or this even worse one in International Business Times which put the claim in the headline.  Naturally, clueless people who know nothing about the topic believe whatever they read, but some people who are repeating this silly claim should know better.  (Here’s a useful little epistemic hint for future reference:  When a news story says a study was published in the non-existent Journal of Tobacco Studies, it is probably not a very good source of information.)

The “reasoning” seems to be that because only 1% of never-smokers in the survey had tried an e-cigarette, e-cigarettes must not be a gateway.  Huh?  By that logic, smoke-free tobacco products do not harm fetuses because less than 1% of pregnant women use them.  (Note: it remains unknown whether or not there is such harm.)  All the observation shows is that if there is a gateway effect, its possible absolute magnitude (so far) is capped by the fact that only a small portion of the at-risk[*] population has had the exposure.  It tells us nothing about whether there is any such effect.

[*Side note 1:  For those who may be confused due to the fact that this phrase is used incorrectly more often than correctly, "at risk" means "anyone who could become a case".  So "at risk of being a gateway case" means "not a smoker" (notice that this means that ex-smokers are at risk of becoming gateway cases, not just never smokers, so leaving them out of the "reasoning" was another error).  Thus, Glantz is at risk of becoming a gateway case, whereas someone who quit smoking using e-cigarettes is not.  The common misuse of the term is incorrectly substituting it for the intended claim that someone is at high risk of becoming a case.]

[Side note 2: I feel a personal need to point out that part of the touting of the study by pro-e-cigarette pundits is that it came out of Harvard.  I beg to differ. The authors all have some affiliation with Harvard School of Public Health, not the real Harvard.  The faculty at HSPH were serious researchers 20 years ago, and there are still a few good people from past eras (though not in the anti-tobacco and other nanny-state units), but is now it is pretty much just a school of public health, with all that implies.  Or as I put it previously,

The study, from a research group calling itself “Harvard School of Public Health”, was widely cited in the popular press.  (Note that while this organization does not seem to be related to the prestigious research institution called “Harvard University”, the allegations in the literature that it is actually a lobbying front group for shadowy government agencies and industry have not been proven, and so cannot be considered a reason to doubt their research.

Resuming….

The other common error about what constitutes evidence of no gateway, most recently committed by Siegel, is suggesting that declining smoking rates, in the context of increasing e-cigarette usage, must mean there is no gateway.  It is a fundamentally different error, though the implications are similar.  The error is a simple misunderstanding of magnitudes, statistics, and the passage of time. Even though e-cigarette use is increasing, its absolute level is still very small among those at risk of becoming gateway cases.  If every single at-risk e-cigarette user is a gateway case, the impact would not be visible in population smoking statistics.  The total number of at-risk e-cigarette users constitutes a smaller portion of the population than the statistical error in smoking prevalence surveys, to say nothing of what it would take to sort it out of the real changes in smoking rates over time.  Moreover, since “destined to start smoking due to her e-cigarette use” is not the same as “has started smoking”, the gateway cases would mostly not even be observable yet.

On top of that, e-cigarettes are causing some people to quit smoking.  So even if we had a perfect measure of smoking prevalence, and the only thing changing it over time was the effects of e-cigarettes, we would still see a decline in smoking rates even if there were a gateway effect (unless, of course, it were already so big in absolute magnitude that it exceeded the THR effect).  Thus, the “reasoning” here is an epic fail for at least three different reasons.

The reason that the implications of the two different errors described above are similar is that their proponents are really saying “the impact of the gateway effect is apparently small so far, so don’t worry about it.”  This is not a very effective argument.  There are very good reasons to believe there is not and never will be a gateway effect, or at least extremely little of it, but neither of the above are among them.  Effectively, those erroneous arguments invite the (valid) retort, “sure, we are not seeing it yet, but the way things are going, it will show up, and so we need to stop e-cigarettes before it does.”

The conclusion that there is no reason to expect a gateway effect is correct.  But making bad arguments in favor of a valid conclusion almost always sets up your opponent with a good argument in response, and that is certainly the case here. Moreover, if we are going to start trafficking in bad arguments, we are going to encourage and validate lying.  The other side will inevitably win the argument under those rules of engagement, because they are waaaay better at it.

Supposed THR supporter demonstrates he still thinks like an ANTZ

by Carl V Phillips

I consider Mike Siegel to be a friend and he does a lot of good work documenting lies by the ANTZ.  With that out of the way, I found his latest blog post to be a particularly disturbing disregard of science in favor of the ANTZ propaganda that he used to embrace.  In that brief post, he flat-out declares that the death from oral cancer of a prominent baseball player was caused by smokeless tobacco use and indicates his contempt for the best-proven method of tobacco harm reduction (which is, of course, replacement of smoking with smokeless tobacco).  He employs the ANTZ propaganda tactic of elevating unsupportable sensationalist specific claims over the evidence. Continue reading

Please don’t cite the new Nutt et al. paper as evidence for tobacco harm reduction

by Carl V Phillips

Some of you may have seen this new paper by Nutt et al. that purports to show the comparative costs imposed by various tobacco products.  There might be some temptation to cite it as evidence of the benefits of switching from smoking to smoke-free alternatives.  But I urge you not to do that for the reasons explained below. Continue reading

Basic case for THR, A-; analysis/facts/science, D

by Carl V Phillips

I will have time to write some new analysis in a couple of days.  In the meantime, to keep things from getting too quiet, I will just copy and paste some observations I made in a Facebook conversation (at the Tobacco Harm Reduction page, a still somewhat active artifact from my old University of Alberta research group).

I really hate to have to rubbish (I am in England right now, so I have to talk like that) pro-THR missives, but it is important that our side try to do accurate work.  The anti-THR liars have wealth and power, while our main strengths are the truth and a mobilized population of product consumers and other supporters that know the truth.  We do not help ourselves by embracing bad analysis.  If we are sloppy, or just try to do what they do — created a politicized set of claims that is demonstrably wrong — then they have all the advantages.

The missive if in question, unfortunately, kind of reminded me of a thought I often have when I read instructions that accompany some Asian-manufactured product that are in completely garbled English:  “This company designed and produced a good product, and have an impressive production process, but then made their whole enterprise seem shoddy by not taking the time to get the instructions right.  There are like a billion people in the world who are fluent in English.  Could they not hire one of them to spend ten minutes rewriting this so that it was not such a mess?”

For the case in point, there are obviously not a billion, or even a thousand, people who thoroughly understand the science and other technical points about THR, but there are certainly enough that it is easy to find someone to provide an expert review.  There is no shame in someone who is skilled in product engineering and another language to draft an instruction document, with the inevitable grammar problems, and then ask for help to fix up the English so as to not detract from the value he has created.  It is the refusal to take that last step before going ahead and publishing that does the harm.

So, anyway…

facebook rstreet 1

facebook rstreet 2

As I said, I really hate this, but it needs to be done.  There are some powerful good messages about THR in this document.  There is some useful information.  But….

My first response was an indication of the fact that I was aware of the paper by really just wanted to ignore it and bury my head in the sand.  But that is just irresponsible, and I got called on it.  If we are going to police ourselves — and not just behave like the ANTZ, embracing any statement from “our team” without caring whether it is sound — it has to be done.

Just to save some of you the trouble of the obvious follow-up:  please do not ask me to itemize the errors and explain why they are wrong.  Regular readers should be able to figure out a lot of them anyway.  I will just offer the advice to not rely on this paper for information, and leave it at that.  Well one other thing:  I will also beg to any of you who are writing such things to circulate them for comments before publishing them.  There are experts who can help you get them right (or suggest that you just pare them down to your basic ideas and not try to delve into needless technical analysis).  I can assure you that I do that for anything I write on a similar scope.

Real public health research on e-cigarettes?

by Carl V Phillips

A funny thing appeared in the abstracts for the upcoming meeting of the Society for Research on Nicotine and Tobacco (SRNT).  Buried amidst the few dozen abstracts about e-cigarettes from the “public health” people is some actual public health research (i.e., research that could inform messages and regulation that would help people be healthier).

Most of the abstracts on e-cigarettes are just dumb make-work projects, presumably by people trying to justify their employment.  There are numerous surveys of attitudes, which mostly just reflect how the questions were asked and are changing by the month, and other variations on how to provide no useful information other than perhaps a historical record about the social dynamics of THR adoption (I will probably try to mine them for that).

Not surprisingly, many of the supposed social science projects violate the ethical norms of social science by using the concocted term “ENDS” rather than using the population’s preferred terminology for e-cigarettes.  This offers absolutely no scientific benefit (e.g., it does not more precisely define the behavior) and was clearly designed to be somewhat derogatory, but most of all it is designed to assert researcher primacy over a population’s own self-identity.  Some types of scientists can make up words when they are helpful, and political actors can have some fun with it when describing the powerful (e.g., “ANTZ”); people doing sociological research are ethically obliged to respect the populations they are studying.  Imagine researchers making up a patronizing name to refer to a self-identifying ethnic/cultural group; their writing would generate serious deserved backlash and be refused by any respectable journal or research organization.  This alone says a lot about these “researchers” and SRNT.

Most of the abstracts contain disinformation and, indeed, the one that I am highlighting has disinformation built into it (see below) despite its possible value.  It is by Alan L. Shihadeh and Thomas Eissenberg, who unlike their SRNT colleagues seem to be trying to do useful work and have some inkling of what useful science looks like.

(However, in spite of his increasingly valuable contributions, I believe the latter still owes the world an apology and/or retraction for his widely-cited publication that claimed that e-cigarettes do not deliver nicotine.  Politicians and activists make errors like that all the time and then pretend it never happened; scientists who make the mistake of epistemic immodesty need to rise to a higher ethical standard.  In science, the phrase “our one-off limited empirical study found something contrary to what all the previous evidence suggests” should always be followed by “so we probably did something wrong, so please ignore this result until we do additional research” rather than by “and therefore what everyone knew before was wrong” (or, better still, they should do the additional research to explain the discrepancy before publishing).  He does however get credit for trapping the ANTZ into starkly illustrating that science is just window-dressing to them and they do not really care what it shows:  When they were foolish enough to believe his claim, they condemned e-cigarettes as failures because they do not provide nicotine.  After it became clear that his claim was wrong, they condemned e-cigarettes because they effectively deliver evil evil nicotine.)

The abstract (or just skip down to my observations about it if you are in a hurry – there is really just one important point in it):

Background: “Electronic cigarettes” (ECIGs) heat a nicotine-containing solution to produce a vapor for inhalation. There is considerable variability in device characteristics and puff topography and each of these factors may be related to vapor toxicant content.

Method: We investigated the role of device voltage and puff duration on vapor toxicant content. We examined total particulate matter, nicotine, and volatile aldehyde emissions from 15 consecutive puffs of V4L™ ECIG cartridges (18 mg/ml nicotine) while varying device voltage (3.7 vs 5.2 volts) and machine-produced puff duration (1.8 vs 3.6 s). We used a puff velocity of 38.8 ml/s and 10 s interpuff interval (Goniewicz et al., 2012). In another study, we investigated a non-cartridge ECIG use method that involves dripping nicotine containing liquid directly onto a heating element and inhaling the resulting vapors. We measured aldehyde emissions from dripping 3 drops of e-liquid (16 microL, similar to the amount of e-liquid consumed in 15 e-cig puffs) onto a 300 C heater surface.

Results: The higher voltage tripled vapor nicotine content, and doubling puff duration doubled nicotine content. We also found that longer puffs resulted in greater cartridge temperatures, and that, for a given puff duration, higher puff velocities resulted in lower temperatures. Dripping liquid onto a heater surface produced more than 200 micrograms of formaldehyde, compared to 0.03 micrograms for 15 puffs of an ECIG cartridge (V4L™cartridge, topography of Goniewicz et al., 2012). We also measured 2-20 fold greater emissions of other aldehydes (9 species in total).

Conclusions: Overall, these results demonstrate that device characteristics (e.g., voltage), puff topography, and use behavior (i.e.,“dripping”) can influence vapor toxicant content. Indeed, these findings suggest that ECIG aficionados who take longer duration, slower puffs (Hua et al., 2011) are working to obtain higher nicotine doses and that those who drip liquid directlyon the heater (McQueen et al., 2011) risk significant exposure to formaldehyde that is a human carcinogen and is associated with COPD in conventional tobacco product users.

Most of the results fall into the “incredibly obvious” category:  Faster puffs result in lower temperatures (because more cool liquid moves across the atomizer, cooling it faster than it can heat).  Longer puffs extracted more nicotine, approximately proportional to the length of the puff (anyone surprised by that?).

It was interesting to see how much delivery (reported as nicotine quantities, but that is obviously just a measure of how much total liquid was aerosolized) increased with the increase in voltage.  This, of course, is not some universal finding for the ages, like something that might be discovered about the behavior of a molecule (though undoubtedly countless naive readers will interpret it as such).  Every result in this research depends heavily on the exact variables of the equipment and other methods they were using, and every device and every user is different.  But the authors get credit for actually varying a few of the variables a bit.  Reading most of the research on e-cigarettes would give the impression that there are no such variables, so actually the authors get a lot of credit for starting to correct that error.

The result that is potentially real health-affecting knowledge (unlike, as far as I can tell, every other bit of research on e-cigarettes in the SRNT abstracts) is the result of dripping e-cigarette liquid onto a heater at 300C.  This result is, unfortunately, also the germ of more disinformation because this is far hotter than what actually occurs (except, perhaps, with a seriously ill-advised novelty mod).  This presumably explains why the concentration of formaldehyde they found is enormously higher than that observed in analyses of real e-cigarette vapor.  Even if you preheat an atomizer to that temperature before dripping on it, it will rapidly cool toward an equilibrium temperature.  I am guessing that the “heater surface” they used was a piece of lab equipment that has a much larger mass than an atomizer filament, and thus maintained close to the original temperature rather than rapidly cooling when the first bit of liquid touched it.

We can safely assume that some people will spin this result as showing that e-cigarettes generate this quantity of formaldehyde, and thus the way the information was presented is a gift to the liars.  (Perhaps such an offering to the liars is the price of admission to SRNT.)  Still, this might offer a genuine contribution to health.  It does suggest that using very-high-temperature mods or a high preheating of the atomizer (by holding the switch on for too long before starting to draw) might increases vapors’ health risks.  Even if most of the liquid would not be heated to 300C, a bit of it might.  That is intuitive if you think about it:  higher peak temperature = more pyrolysis = more nasty chemicals.  But it is not clear there has been much thinking about it.

There should be more.  Good scientists who have more knowledge than I about the chemistry should really think this through — a little bit of theory and existing general knowledge would be worth for more than a series of one-off experiments on particular equipment.  If there is going to be any actual health-improving research about e-cigarettes, it obviously will not be the attempts to demonize them out of existence, but it also cannot be the attempts to claim everything about them is always just fine.  Real public health researchers do not behave like “public health” people who just look for an excuse to say “never do this, no matter how much you want to”; they figure out how to advise “if you are going to do this, you are better off doing it this way….”  This is, of course, the reasoning behind THR in the first place, and also describes what real health research about nicotine inhaler technologies should look like.  I suspect that most of this public health learning will have to wait until the tobacco companies report what they are doing, but it is good that at least one independent research team is headed in that direction.

Can we agree not to make obviously incredible claims?

by Carl V Phillips

Related to the claim in my recent post that THR advocates stick to solid science, and are properly skeptical and critical, while anti-THR is grounded entirely in unabashed lies, I really hope THR advocates do not start citing making strong claims based on this report that:

One third of smokers say, in a University of Canterbury (UC) survey, they would use a nicotine electronic cigarette to quit now, if it was available.

I will grant that it is delightful to see anti-smoking sponsored research that might actually give some insight into how to reduce smoking (though note that this was funded by Murray Laugesen’s shop, not the ANTZ).  And there are probably some useful insights to be gleaned from the actual study results.  But not from that press release.  1/3??!  E-cigarettes are legal and widely available in a lot of places that are not terribly unlike New Zealand, and the successful smoking cessation they have facilitated is impressive.  But nowhere close to 1/3 of smokers are using them to try to quit.

A realistic estimate for e-cigarette uptake can be found by simply looking at the USA or the UK.   Indeed, I suspect that most NZers who really want to use e-cigarettes, like Canadians who wish to avoid the ban there, can get them if they really want.  So asking about actual usage would probably provide a better realistic estimate than this cheap-talk hypothetical.

There are ways to honestly interpret the results, and these are still undoubtedly pro-THR.  And that survey result was what it was, of course.  But reporting it without the realistic context as if it were a simple picture of reality is not a good choice.  The ANTZ frequently make claims that are this discordant with observed reality based on a survey result.  We must not.

My Alberta shop did a survey years ago that asked smokers about “hypothetical” low-risk alternatives (that were really understated descriptions of existing low-risk alternatives) and a huge number of subjects (most of whom had never actually considered trying the alternatives) indicated that they would try them.  Needless to say, we did not assert the conclusions that widespread adoption would happen if there were a change in the availability of products.  Rather, we examined the implications of the difference between the responses and the observed reality.

Similarly, if you want to estimate how people will actually respond to prices, you need to do what economists and marketers do (look at how people actually respond to prices), not merely ask them a hypothetical question and conclude:

if cigarette prices doubled, two thirds of smokers would quit

Real prices have doubled several times historically.  They more than double as you move from some places to others.  None of those show a 2/3 reduction in smoking.

Finally, I hate to laugh at pro-THR messages, but I could not help it when I read:

Smokers sampled nicotine electronic cigarettes and liked them 83 percent as much as their own brand on average.

Granted this is not nearly as funny as Snowdon’s ROTFL-level extended discourse on a particularly stupid ANTZ’s claim about something being “100% easy”.  But it was still LOL-level for me.  What the hell is liking something 83% as much?  (And notice it is not merely 80% as much, but a full 83%!)  Presumably there was some arbitrary scale in the survey, and the e-cigarettes scored .83 the level that own-brand cigarettes did.  But there is no cardinal scale of liking (other than the economic approach of trying to measure willingness to pay, which seems to have been absent), so while an ordinal list of the ratings of multiple products could mean something, it is silly to make the claim that they did.

Please, people, do not go telling the FDA or your local politicians that 1/3 of smokers plan to switch to e-cigarettes and that they are 83% as good as smoking.  Our goal is to make it clear that we are the reality-based side of this debate.

More on a research agenda for e-cigarettes

posted by Carl V Phillips

I am going to keep brainstorming this (clearly related though somewhat tangential) subtopic that I started here, which has produced some useful feedback.

Based on numerous conversations I have had two different meetings since making that post, as well as the comments on that post, I think there is a need to dramatically increase the emphasis on the hardware specs and conditions, as compared to my original portrayal.  That is, I mentioned that we need to study the mapping from e-cigarette liquid chemistry to vapor chemistry as a function of the hardware used.  But I did not put enough emphasis on the latter bit.

While we are not going to be able to test every possible configuration, we should at least carefully examine the effects (on the liquid->vapor relationship) of different heat and power levels, as well as such things as what happens when the atomizer is heated dry.  We should also want to know what changes as components get old.  As noted in the previous comments, there are too many variables but if we can see what happens to a high-quality, pure, relatively typical liquid under varying circumstances, that would be useful.

The next step after that — dramatically more expensive and harder to do, but useful — is to look for human biomarker changes.  A bit of this had been done, but it is very limited.  It should also be tied back to the chemistry — given how much more expensive human subjects research is, it should always be combined with a chemical analysis of what is being vaped.  Perhaps we will have to wait until very large companies want to test their specific highly standardized products this way, perhaps to please regulators, but the results will also offer useful general knowledge.

Moving on from chemistry, I will branch the conversation into other areas of research.  We really need to collect the many personal testimonials about quitting smoking using e-cigarettes and analyze them.  In this case, by “we” I mean not a vague “the scientific community” or “humanity”, but CASAA in particular.  We have been planning to do that, and will start on that soon.

It would likewise be nice to have more of the data about how much product is actually being sold and how many people are consuming it.  This is not all that difficult to know, in theory, but there is remarkably little public information.

Finally, going beyond the relatively easy observations in the social science situation to actively create information, it would be valuable to understand more about users who fall in between trialers/beginners and the category I call “aficionados” (basically anyone who uses mods).  They are most of the users, almost certainly, and growing.  But are they really happy with the products they are using?  Are they at risk of relapse to cigarettes?  What would improve their vaping experience?  We have some good guesses about those, but learning more could improve THR efforts.

That is what I have for now.  I open the floor to comments, which are most welcome.