Tag Archives: trANTZlator

TrANTZlation of Goniewicz and Lee NTR abstract re “thirdhand vapor”

by Carl V Phillips

After an unrelenting two weeks of very important posts here on very important topics, it is time for some whimsy (whimsy with a serious scientific message, of course). What, some of you haven’t read all the other posts from the last two weeks? Well don’t waste your time on this! Click backwards and read them!

Goniewicz and Lee recently published a peer-reviewed (that is the first bit of whimsy) paper in Nicotine and Tobacco Research. Their abstract is here, and this is probably more amusing if you read that first, though basically every word of the original is still present in the following trANTZlation of it: Continue reading

Economic illiteracy about tobacco, from the antepode

by Carl V Phillips

The most fundamental lie of the tobacco control industry (TCI) is what I have dubbed the “demonic possession” theory of tobacco use. It is the myth that no one likes to use tobacco products.

It is obvious why they need this. If they admitted that people derived benefits from consuming tobacco, then they would have to balance the (supposed) benefits of their actions against the loss of benefits caused by the actions. More important, and the reason this myth is fundamental, is that if they admitted the truth they would have to admit to themselves that most of what they do inflicts harm — serious harm — on the hundreds of millions of people who they pretend they are trying to help. While many in the TCI are truly evil, and would not be bothered by this, many are not, and so need to preserve this fiction to be able to sleep at night. (And, no, “evil” is not hyperbole. It is clear that many people in tobacco control derive pleasure from inflicting pain on people who they consider to be The Other, exactly the same evil impulse that causes racism, homophobia, etc.) Continue reading

New York Times goes “more at 11:00″ with story on ecigs and poisoning

by Carl V Phillips

Apparently the nation’s Paper of Record (*cough*) has decided that going tabloid is a better business model.  Or perhaps even better is to go full local-television-news, with its cut-ins during prime-time programming:  “Six common household items that are planning to kill you tomorrow. We’ll tell you which ones tonight at 11:00.”

The story is part of what they are now calling their series about e-cigarettes, which has seen about story per week for a month — see in particular my analysis of this one.  Hey, better late than never getting to one of the major stories of 2012.  Maybe it took until now for the powers that be to tell them how they were supposed to be spinning it.

The story by Matt Richtel has the tabloid headline “Selling a Poison by the Barrel: Liquid Nicotine for E-Cigarettes”.  The first sentence reads, “this article is intended to be a silly sensationalistic hatchet job, dictated to us by the tobacco control industry.” Continue reading

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.

“We were wrong about this” trANTZlates into “we were still right, just for another reason”

by Carl V Phillips

An aside that does not relate to THR, but provides a rare opportunity to observe how the ANTZ act when they have to admit one of their claims was wrong.  It is exceedingly rare because no matter how badly the ANTZ bungle their data or analysis, and no matter how clearly it is refuted, they never admit they made a mistake.  They are not, after all, real scientists; they are marketers who ape science to support their propaganda.  But in this case, a newspaper retracted the data so they had to respond.

A letter to a Japanese newspaper was supposedly from a six-year-old, telling the heartwarming story of talking a merchant into letting her buy cigarettes as a present for her grandfather, the only product that he really cared about.  This story sparked condemnation by the usual suspects about how screwed up Japanese society must be that a young child would be allowed to buy cigarettes for any reason, and that Something Needs To Be Done About It.

It became apparent that the letter was a hoax.  So the ANTZ naturally expressed relief that the world is not such a terrible place.

Ha! just kidding, of course.  What they actually did was publish a commentary in their pseudo-journal official party newsletter, Tobacco Control, that acknowledged the hoax but repeated the conclusion.  They interpreted the fact that the letter was considered a heartwarming story was evidence that Japanese society was screwed up and that Something Needs To Be Done About It.

Yes, life sure is easy in the ANTZ hill.  Not only do you take all the money you could ever want from smokers, providing job security as long as you dutifully recite the party doctrine, but no matter what the data shows, there is never a need to rewrite your conclusions.

Kelvin Choi is remarkably clueless (and a liar) – part 2/2

Yesterday I started dissecting the simplistic and false anti-e-cigarette claims being made by University of Minnesota researcher, and Ellen Hahn wannabe, Kelvin Choi.  This post picks up where that one left off.  To recount, Choi recently released a paper that contains some possibly useful historical data from a survey of knowledge and attitude about e-cigarettes.  But not content to do real science, he proceeded to tack on anti-e-cigarette lies and a conclusion that does not in any way follow from the research.  He then published an interview in which he bungles even the description of e-cigarettes and presents his reasons for worrying about the health effects, none of which actually involve any claim about any health effects.

I will note that the interview I am dissecting did not appear in some free weekly local paper or a radio news report.  It was published by the American Public Health Association (which runs the “journal” where Choi’s paper appeared), and was clearly crafted as a written document by that organization and Choi.  So we cannot attribute the gaffes to trying to dumb things down for a grade-school audience or misspeaking.

Continuing with examples of the lies that Choi and APHA chose to publish:

To date, e-cigarette marketing is not regulated.

Presumably he means in the United States (his apparent failure to recognize that regulations vary across jurisdictions is so minor among his errors that I only mention it because I need to clarify before continuing), in which case he is badly wrong.  Not only is e-cigarette marketing regulated by all basic federal and state rules about truth-in-advertising and such, but it is also severely restricted in terms of health claims.  Merchants cannot offer their customers any comparative risk or smoking cessation information, such as the obvious truths that switching to e-cigarettes is a good way to quit smoking for many people, or the health risk from e-cigarettes is trivial compared to that from smoking.  If this is Choi’s view of anarchy, I would hate to see what he considers to be regulation.

Advertisements for e-cigarettes appear on TV, magazines, the Internet and even in social media. Cigarette advertising has been known to have a strong influence on the perceptions and the use of cigarettes.

Ah, that explains it.  I believe he is mixing up the words “regulated” and “banned”, a common mistake when a native ANTZ speaker tries to communicate in English.

Therefore, it is similarly possible that e-cigarette advertising is one of the sources of influence on young adults’ views about e-cigarettes.

It is worth recalling that this interview was to tout a paper that reports results from a 2010-11 survey.  There was not exactly a lot of advertising of e-cigarettes back then.  This is the standard “public health” bait-and-switch:  do one simple and minor bit of research on a topic, with no policy analysis and no apparent understanding of the big picture, and then claim to be an authority on what policies should be implemented.

It appears that his complaint is that advertising — you know, that “unregulated” advertising which is prohibited from truthfully informing people about the smoking-cessation benefits or comparatively low risk of e-cigarettes — is contributing to people’s knowledge that e-cigarettes have low risk and are good for quitting smoking.  (Note that “knowledge” is the English word; to trANTZlate that into Choi’s ANTZ-speak, I believe their word for “knowledge” is “misinformation” when used in a context that means “knowledge that the ANTZ want to prevent people from learning”.)

I am sure the marketers will be glad to know that they are successfully communicating information that they are not allowed to communicate.  I suspect that during his continuing research on this topic, Choi will eventually learn about the restrictions on the advertising and then realize, like Stanton Glantz, that he needs to crusade for broader censorship of accurate information.

He concludes this thought with:

The challenge is whether we should swiftly regulate e-cigarette advertising before the issue gets out of hand.

Even trANTZlating “regulate” into “ban”, it is difficult to make any sense of this.  What issue?  What constitutes “out of hand”?  I am not even sure this qualifies as lying hype because although it tries to be hype, it is not at all clear what is being claimed.  So, moving on…

The second challenge lies in developing a better understanding of the effective communication channels to reach specific populations and how to best use these channels. For example, we know that a lot of young adults use Facebook, but we do not know how to effectively use Facebook to communicate the correct information about e-cigarettes to young adults. I think we still have a lot to learn in that regard.

Nice discovery about that Facebook thing.  Maybe he will write a paper about it before Facebook ceases being used by a lot of young adults — though I would not recommend holding your breath for that given that his claim to fame is his new paper about survey data from two years ago (ancient history in this fast-moving area, something he apparently does not understand).  But, of course, we again need the trANTZlator here to point out that when he suggests exploring ways to “communicate the correct information”, he really means to “get people to believe his lies”.

Because, after all, if he really wanted to use Facebook to communicate correct information, all he would need to do is point people to pages like CASAA, the We Are CASAA members page, ECCA UK, Vapers Network, the Tobacco Harm Reduction page created by my research group (which I believe is about as old as Facebook, though most of the traffic has shifted to those others over the last few years), or any of several other very active pages with a plethora of truth and where incorrect information is seldom posted without being corrected by someone.  His “we” may well be as clueless as he claims, but fortunately we are way ahead of them.

I wonder if this self-appointed e-cigarette “expert” has ever even seen those Facebook pages and our websites.  Probably not, or he would not have bungled so many simple points.  Still, maybe he is one of the rare ANTZ who actually reads outside of their echo chamber, and he will read this post and follow those links.  I look forward to seeing his comments there trying to provide us with “correct information”.  If you are reading this, Dr. Choi, please consider yourself encouraged to jump into the conversation — unlike your fellow ANTZ, we do not censor contributions from people who disagree with us.  Oh, but be warned, also unlike life inside your ANTZ echo chamber, when someone is lying, we call them on it.

TrANTZlating “no safe level”

posted by Carl V Phillips

I was asked by a CASAA member to turn the trANTZlator on the very confusing phrase, “there is no safe level of X”.  You have probably heard or read that phrase most often in the context of “there is no safe level of second-hand smoke.”  This is actually a pro-THR lie, as mentioned yesterday but the same phrasing is frequently used as an anti-THR lie in the context of the chemical exposures from THR products.

The reason this is a lie is that most anyone reading this phrase interprets it in the natural way:  no matter how low the quantity of the exposure is — and in particular, including whatever level of exposure is being discussed in the particular context — there are health effects that are significant enough to warrant being called “unsafe”.   But this is never what the phrase actually means.  It could be argued that the phrase is fine to use in a scientific context because readers there know what it really means.  But it clearly should never be used in popular communication where it will almost always be misinterpreted.

Those who use it in popular contexts either know that it is going to be misinterpreted (and thus are intentionally misleading people) or actually think that the sloppy technical phrase has its natural language meaning (in which case they have no business claiming they know what they are talking about).  Most readers of health science figure out the truism that quantities matter or “the dose makes the poison” — i.e., that trivial exposures do not matter in any practical sense.  The “no safe level” claim sends the message that this (true) belief is wrong, and it is difficult for the lay reader to have the confidence to reply, “I know that is never true.”

Most of the time, the claims “no safe level” is a sloppy shorthand (understood in the scientific context, but unknown to the broader audience that hears the phrase) for “no established safe level” or “no known safe level”, which in turn trANTZlates into “there is almost certainly a level of exposure that is perfectly safe, and it may well be that the levels being discussed in the particular context would be considered safe (in the common sense of the term), but the science has not been done.”  In other words, what is really a statement of ignorance is intentionally presented in a way that will be interpreted as a very strong affirmative claim.

Very occasionally the phrase actually does mean “we have tested exposures as small as we possibly could, and we still saw an effect” (example).  But even then it does not have the meaning that most people take from the phrase.  “As small as we could test” is still not “as small as could occur”, and “an effect” (e.g., at the molecular level) is not the same as “a measurable health effect” (i.e., real results on the actual health of people).  The former of these puts the lie to the literal interpretation of the statement, but it is the latter that really matters.  Any effects that are measured down to the lowest practical levels of exposure are not health effects, and only actual health effects can warrant use of the word “safe”.  Tiny measurable effects in vitro or even at the biomarker level do not necessarily imply actual health effects, and if they do, those health effects are almost certainly undetectable because they are tiny or extremely rare.

That leads to the ultimate problem with the phrase.  The natural interpretation of something being unsafe (which it must be, if there is “no safe”) includes the harm/risk having nontrivial magnitude.  What probably deserves to be called the #1 anti-THR lie is the statement “not a safe alternative to smoking”.  It literally means “there is some tiny tiny risk” or even “we are not sure it causes absolutely no risk whatsoever”, which is true for every exposure and thus technically true, but obviously misleading (i.e., the worst kind of lie).  When people read “not safe” or “no safe level” they do not interpret it as “some utterly trivial health risk that is so close to zero it does not matter”.

Indeed, there are a few exposures where any exposure actually does create a health risk because the risk is a constant role of the dice.  The simplest example is exposure to motorized transport:  Each second of exposure causes a tiny finite risk of injury from a collision.  The degree of safety is proportional to the quantity of the exposure, with any positive amount of exposure creating a positive amount of risk.  But if someone said “it is not safe to drive or walk to work”, it would be immediately clear that they were not using those words in the normal way (and so if they said the exact same thing in a context where people would believe them, it would be a lie).  If they said “there is no safe level of driving”, they would be effectively communicating that the phrase does not mean what people think it means.

As a slight aside, this reminds me of an ironic story that I recently heard (from a friend who contributes to this blog) about people who are so afraid of the “no safe level” of ETS will cross the street twice to avoid catching a whiff from a smoking area.  But we calculated that the risk from the average street crossing is three, maybe four, orders of magnitude higher than the risk from that ETS exposure — even if the effects of exposure are linear.  But furthermore, unlike the risk of accident from crossing the road which is pretty close to linear over the amount of exposure (crossing the road once is 1/1000th as risk as crossing 1000 times), chemical exposures like ETS tend to be far less than linear (that is, even if an exposure has risk X, an exposure that is 1/1000 as great has a risk much less than X/1000, and perhaps basically zero).  Of course, the total health damage done by the “no safe level” message in that case is pretty trivial compared to the damage done by using the phrase to discourage THR.

So what does “no safe level” mean?  Unfortunately, the trANTZlator can offer no consistent substitute.  The phrase is sloppy and can mean any of several things, ranging from “we are pretty sure there is a safe level but are not sure what it is” to “the risk is proportional to the exposure level and it never goes to zero, but it gets as small as you want, and well into the range that people would consider safe”  But it never means what most people think it means, that the quantities being discussed are known to cause health risk at a level that we should care about it (and moreover that any exposure causes such a level of risk).  After all, if the liars thought they could defend that claim, they would simply make that claim.

“Smoking” and “nicotine” are not synonyms

posted by Elaine Keller

The truthful statements in Justin Rohrlich’s story Smokeless Tobacco Advocate Rails Against ‘Frauds, Extremists, Liars’  were based on a two-hour-and-ten-minute phone interview with Smokefree Pennsylvania’s Bill Godshall. (How Rohrlich managed to gather so much information from Godshall in such a short phone call escapes me, but I digress.)

As a representative of one of the “Frauds, Extremists, Liars,” Danny McGoldrick, the Vice President of Research for the Campaign for Tobacco-Free Kids, was invited to comment, probably with the intention of bringing “balance” to the story.

To make any sense whatsoever of McGoldrick’s statements, you need the trANTZlator  that Carl recently introduced for the common Anti-Nicotine and Tobacco Zealot (ANTZ)  phrase, “smoking cessation.” Anyone who applies the common meanings of the words “smoking” and “cessation,” would think it is obvious that this phrase refers to the stopping (i.e. “cessation”) of the inhaling and exhaling of smoke.

*Gong* Wrong. When ANTZ people say “smoking cessation”, what they really mean is the act of stopping the use of any form of nicotine. Get it? Smoking = nicotine. Nicotine = smoking.

This is how Danny McGoldrick managed to testify at a legislative hearing on Tobacco Harm Reduction (THR) in Oklahoma with a straight face:

“…if the tobacco companies want to promote smokeless tobacco or anything else as a smoking cessation product, they can do this through the Food and Drug Administration like other cessation products by demonstrating with science that their products are a safe and effective way to quit smoking.”

“If the evidence is anywhere near what they claim, this should not present a problem for them,” he told the panel of lawmakers.

“There’s no evidence that people use smokeless tobacco to quit.”

There’s that bugaboo that Carl discussed in two previous posts: There is never no evidence (Part 1) and There is never no evidence (Part 2.) McGoldrick’s claim is nonsense from a scientific perspective.

If by “quit,” McGoldrick means “quit inhaling smoke,” it’s hard to believe that a man who holds the title of “Vice President of Research” was unable to track down any of the following articles, published in peer-reviewed scientific journals.

Effect of smokeless tobacco (snus) on smoking and public health in Sweden: “Snus availability in Sweden appears to have contributed to the unusually low rates of smoking among Swedish men by helping them transfer to a notably less harmful form of nicotine dependence.”

Is Swedish snus associated with smoking initiation or smoking cessation? “We investigated whether Swedish snus (snuff) use was associated with smoking cessation among males participating in a large population based twin study in Sweden. Snus use was associated with smoking cessation but not initiation.”

Randomized, placebo-controlled, double-blind trial of Swedish snus for smoking reduction and cessation: “Swedish snus could promote smoking cessation among smokers in Serbia, that is, in a cultural setting without traditional use of oral, smokeless tobacco.”

The association of snus and smoking behaviour: a cohort analysis of Swedish males in the 1990s: “We found clear associations between the two habits. For the younger cohort (age 16-44 years), snus use contributed to approximately six smoking quitters per smoking starter attributable to snus. For the older cohort (age 45-84) there were slightly more than two quitters per starter.”

These are far from the only published scientific evidence that snus can be used for smoking cessation. If what McGoldrick really meant was that it is unlikely or unknown whether snus can be used for nicotine cessation, that’s another story. But what he said was “smoking cessation.” So either he is lying about there not being any evidence, or he is extremely incompetent at his job.

Even respected government agencies are guilty of using “smoking” and “nicotine” interchangeably, and therefore misleading the public. All FDA-approved “smoking cessation” products are aimed at a goal of nicotine cessation. There are three problems with this approach: 1) It doesn’t work for over 90% of smokers that try to quit, 2) It isn’t necessary to become abstinent from nicotine to achieve smoking abstinence, and 3) Smokers who switch to a low-risk alternative enjoy the same health improvements as those that used nicotine abstinence to stop smoking.

There are many published scientific reports on the beneficial health effects of switching to smokeless tobacco.

Smokeless tobacco: a gateway to smoking or a way away from smoking: “Sweden has low rates of smoking and a lower rate of respiratory diseases and lung cancers by comparison to other developed countries.”

Health risks of smoking compared to Swedish snus: “Although few in number, these seven studies do provide quantitative evidence that, for certain health outcomes, the health risks associated with snus are lower than those associated with smoking. Specifically, this is true for lung cancer (based on one study), for oral cancer (based on one study), for gastric cancer (based on one study), for cardiovascular disease (based on three of four studies), and for all-cause mortality (based on one study).”

Lung cancer mortality: comparing Sweden with other countries in the European Union: “There were 172,000 lung cancer deaths among men in the EU in 2002. If all EU countries had the LCMR of men in Sweden, there would have been 92,000 (54%) fewer deaths.”

Summary of the epidemiological evidence relating snus to health: “After smoking adjustment, snus is unassociated with cancer of the oropharynx (meta-analysis RR 0.97, 95% CI 0.68-1.37), oesophagus (1.10, 0.92-1.33), stomach (0.98, 0.82-1.17), pancreas (1.20, 0.66-2.20), lung (0.71, 0.66-0.76) or other sites, or with heart disease (1.01, 0.91-1.12) or stroke (1.05, 0.95-1.15). No clear associations are evident in never smokers, any possible risk from snus being much less than from smoking. “Snuff-dipper’s lesion” does not predict oral cancer. Snus users have increased weight, but diabetes and chronic hypertension seem unaffected. Notwithstanding unconfirmed reports of associations with reduced birthweight, and some other conditions, the evidence provides scant support for any major adverse health effect of snus.”

Again, the above are just examples. Anyone can access PubMed’s search system and find many more studies.

Rohrlich’s story states, “Danny McGoldrick just can’t wrap his head around the idea of Big Tobacco’s collective conscience telling it to guide people to smokeless for their health.”

Actually, what McGoldrick can’t wrap his head around is the concept of how Tobacco Harm Reduction works. Or perhaps he just doesn’t want to.