by Carl V Phillips
You have never heard of Chi Min Hai. He is not an ANTZ (though he became an instant ANTZ mascot), but either he or his institution (Brown University) is aggressively trying to spread anti-e-cigarette lies about his research. I do not know if Hai is culpable or just a naive dupe in this — that will be determined based on whether he steps up and points out his results are being over-interpreted.
Hai has done some toxicological research on why smoking causes atherosclerosis. This, unlike most research on smoking from “public health” people, was not useless. It is actually not well understood why smoking causes some particular cardiovascular diseases (CVD), and it might explain how to make smoking less harmful. What Hai discovered is that in his particular experiment (the details of which are not important), cigarette smoke, smoke without nicotine, and nicotine alone all caused vascular tissue damage.
Ok, fine. It might be generally true for this situation, might be lab error, might be idiosyncratic. It might be interesting for informing further science. What it most certainly is not, however, is any reason to believe that nicotine use, ex smoking, causes heart disease to any consequential degree. Yet this is exactly the message that Hai and Brown University are aggressively communicating to the press, trying to get into the news by claiming that his conference paper about a completely artificial experiment has real-world implications. And of course, the innumerate health press corp is buying the whole lie (example, Jen Christensen, CNN), and reporting that this is evidence that e-cigarettes cause heart disease.
I know that it has been aggressively touted because a week ago one reporter sent me a copy of the research to ask me about it, and told me it was being aggressively touted. Because he was sensible enough to not just copy-and-paste the press release, he was able to include my comment that this is nonsense. (He also asked me why the university would aggressively tout something that was nonsense. I pointed out that it happens all the time, and they just want to get their names in the paper, and do not care how.) Unfortunately, the reporter just quoted a soundbite assertion from me and did not explain to the reader (as I explained to him) why it was nonsense, which made what could have been a penetrating article into a fail, just a he-said-she-said.
That reporter did, however, provide evidence suggesting Chi-Ming Hai is indeed a liar and not a dupe, quoting him as saying,
In my opinion, if taking nicotine for a short time can lead to complete cessation of smoking, e-cigarette included, then it will be beneficial to take nicotine for a short time as a bridge to smoking cessation,” he added. “However, our data suggest that long-term consumption of nicotine by e-cigarette smoking is likely to increase the risk of developing atherosclerosis by stimulating invasion of vascular smooth muscle cells.
The reason that the claim is nonsense and thus this quote qualifies Hai as a liar is that we know that nicotine use does not cause a measurable risk for heart disease. We have extensive epidemiology about smokeless tobacco use that has failed to show measurable risk. Epidemiology (the evidence about what is happening with real people in the real world) trumps toxicology (the search, under artificial lab conditions, for phenomena that might — but usually do not — translate into the real world). Sometimes it is tempting to just say that all toxicologists are liars any time they make conclusions about real health outcomes, though this would be a bit too strong. But there is no question about this case, which is one of the classic toxicologist lies that goes something like this: “We have discovered why exposure E causes disease D, though we already know E apparently does not actually cause D. Therefore, this E causes this D.”
Granted, a small risk of CVD from nicotine would be completely buried in the confounding, so we cannot rule it out. Indeed that is the reason that the conventional wisdom is that smokeless tobacco and e-cigarettes are 99% less harmful than smoking. The reason for that remaining 1% is not because of any affirmative evidence of risk, but to be conservative about CVD risk from nicotine that may exist but is too low to measure. Thus, it would not be terrible to offer an interpretation of this toxicology data in terms like “while we know that nicotine without smoke causes very little risk of heart disease, this evidence suggests that it might not be zero.” Even that would be an over-interpretation of the toxicology; you can basically damage tissue in a lab with any chemical that is not completely inert if you want to. But at least it would not have been the full-on toxicology lie.
But Hai seals his liar status by not just making false epidemiologic claims based on what he could concoct in a lab, but by going so far as to make behavior/policy recommendations based on his incredibly tenuous results. (Until I reread that quote, I had a more equivocal title for this post, but that sealed it.) He further suggests his ANTZ-wannabe status by referring specifically to e-cigarettes. He clearly has little understanding of the real world he just threw his baseless opinions into — he apparently does not even know the epidemiology, let alone the politics. I will give him a few weeks to speak up against the (inevitable) misuse of his results in anti-THR propaganda to establish himself as an honest scientists and not an ANTZ or dishonest self-promoter. But I am not holding my breath, because I suspect the ANTZ are already writing him big checks from their copious warchests to pay him to go full-liar on this.
As for us, here is the soundbite we need to use in response to the inevitable deluge of lies from this: “That claim is based on only one very abstract lab work that probably does not relate to the real world. We have extensive evidence, from smokeless tobacco use, that nicotine without smoke causes no measurable risk for heart disease.”