Science Lesson: Conflating age with inevitable temporality (i.e., some things first occur in youth merely because youth comes first)

by Carl V Phillips

A random science lesson, because I have not written a good “the conventional wisdom — how everyone looks at this and thinks is self-evidently true — is not the only plausible explanation” lesson in a while (other than tweet storms), and just want to. I was triggered on the topic by some chatter I saw about a recent paper, though neither of those is particularly important (so no links).

Consider an example from another realm: A large portion of significant original contributions in theoretical mathematics are figured out, or at least the seeds are completed, when the author is under 25-years-old, or even under 20. The conventional wisdom is — or was (I have been out of that field for a long time) — that people’s sheer physical brainpower in this area declines with age, and that this is the only time someone has the ability to outperform all who have come before them. It is like being a professional athlete. You can be a perfectly solid athlete or science geek at 60 if you have the natural skills and keep at it, but to be among the absolute best — among the 0.001% who can be a performance-level jock or breakthrough mathematician — you have to have both the natural skills and be at your lifecycle physical peak.

But there is a plausible alternative theory that was pointedly ignored in that conventional wisdom: Generations of mathematicians have already worked out everything, within the bounds of what occurs to them to work on, that can be done by just plugging away at it. Therefore, new breakthroughs only come when someone is wired enough differently to see something beyond that, either in terms of recognizing something outside the existing bounds to pursue or some striking insight into a within-bounds problem. That is, they need to not just be solid in the skills of the field, but have one little cognitive quirk that no one else had. Either they have that when they are 16 or they don’t. If they do, they make their breakthrough early because they can. It is not about age — if one was somehow prevented from making the breakthrough for a couple of decades (but managed to keep up his skills in the field and was not scooped), he would have made it later.

Perhaps the relative contributions of those two factors has been largely resolved — as I said, I have been out of that area a long time. In contrast with the tobacco realm, most everyone who is aware of that debate is a smart clear thinker, so they may have long since worked out how much each of the stories explains the association of age and breakthroughs. But the point is that the naive explanation for something being associated with age — that it must have been entirely caused by age itself — was not so obviously correct as the conventional wisdom had it.

This is a metaphor, of course, for all the claims about tobacco use initiation, habituation, “addiction”, and such that are attributed to age because they are associated with age. This is a fail for exactly the reason found in the alternative theory of math prodigies: If something were able/likely to happen sometime in someone’s life, but not in most people’s, the fact that it happened early among the former (because it could) is not informative.

So we have the conventional wisdom that because smokers (etc.) mostly start fairly early in life, if you stop them from starting early, they never will. This is undoubtedly true to some extent. Everyone gets more set in their ways about what they do and do not do after adolescence. For smoking specifically, having adult-level judgment and a more forward-looking mindset makes it much less appealing (though this is not true for low-risk and potentially net beneficial smoke-free products). But it is obviously not nearly as true as is generally claimed. Someone who would have used a product at 16, but is somehow kept from doing so for two years does not magically revert to having the average lack of interest (which means being below the line for inclination to use the product) at 18. The same is true if you substitute age pairings 18…21 or even 16…40.

My goal here is to just immunize readers against the common naive error by planting the idea, so I am not going to delve deeply into the data. But just notice that transitioning to “smoker” status has gone down sharply among 14-year-olds in the US population, but not 18-year-olds. It is down overall, of course, but it is impossible to not notice that some of the “success” at earlier ages consists of delay rather than elimination. If the conventional wisdom were true, we should not have seen the sharp rise in the average age for that transition; the conventional wisdom says that the people who are pulling that average up do not exist.

The issue is clearer still for claims about early-initiating smokers (etc.) being more habituated (usually called “addicted” of course, but my readers will understand why that is bullshit rhetoric). If there is any variation within the population in terms of who is inclined to become strongly habituated — and obviously there is, due to both biological and social factors — then of course we see this. Those who are most inclined quickly become regular consumers upon first trialing at, say, 13. Those eventual-smokers (etc.) who ramp up more slowly were not so enamored, and so waited until it was easier to do. The former group are undoubtedly less likely to quit, have higher “dependence” scores, etc. The rhetoric attributes all of this obvious confounding to causation.

This does not means that there is no biological effect of early smoking (etc.) that causes greater inclination later in life, of course. But it does mean that the main body of evidence deployed in support of that claim is worthless. My readers presumably understand that the evidence deployed in support of “gateway” claims is bullshit because it merely observes the inevitable association across individuals choosing to use very similar products. Any association that is inevitable due to confounding cannot be said to be evidence of any causation without further serious analysis, analysis that tobacco control “researchers” never do. The present case is a bit more subtle than the gateway case, but it is exactly the same problem.

Similarly, these observations do not mean that somehow preventing an incidence of initiation at 16 is always just be a delay rather than permanent prevention. There is some probability of each. There is ample reason to believe that the probability of mere delay is fairly high. Yet the claims based on the observed association almost always bake-in the unstated and unexamined assumption that the probability of it being mere delay is approximately zero.

I did not become a regular drinker until my 30s, or a regular user of nicotine products and sometimes [redacted because we live in a fucked-up anti-liberty police state when it comes to stuff like this] until later still. But I trialed all of these before I was 20 and did a bit during my 20s. Those who want to say “it is all about ‘youth’ initiation!!!” will spin this into supporting their claims. Look closely at their claims and you will see that most of them would attribute my later behavior to those largely forgotten moments from adolescence. I can tell you there was no causal continuity between the trailing and later period of ongoing use, except via the confounding pathways. Granted I am a bit unusual — I have taken up quite a few things at time in my odd life that very few people ever do if they do not start at a much younger age: professional popular writing, various sports, farming, having babies. But the oddity there just illustrates the point that acting upon willingness or interest gets mistaken for causation, because willingness and interest are usually not kept latent for so long.

Consider one more metaphor that illustrates a different angle on this: adults who choose to visit Disney World (i.e., because they like to, not just because they are roped into taking their kids). There is undoubtedly a huge association between this and having visited as a child. Undoubtedly it is causal to some extent, but it would be obviously stupid to assume the association is all causal. Among those negative for both traits are those with a religious or semi-religious objection to visiting, those who disdained the idea as children (often due to their particular subculture think of it as belonging to Others), and those for whom making the trip is unaffordable. Those traits tend to be fairly persistent through the lifecycle, and this alone creates an association. Among those positive for both traits are those who just love stuff like that, and so pushed their parents to taken them and later choose to go again when they could. This increases the association with no causation in sight yet. Finally, among those positive for both are those who go back because they remember how much they enjoyed it as kids, the causal group. The “logic” of the tobacco control literature and rhetoric would be to claim that the association is caused entirely by the latter group.

I would assume that the marketing people at DisneyCorp — who are presumably much better at their jobs than most tobacco researchers and pundits are — have this all worked out and make extensive use of that knowledge. It would undoubtedly be possible to form honest estimates that separate the contributions of causation-by-age and mere temporality in the tobacco space also. But few in that space even recognize this is an issue, and most of them want to pretend it is not, and few of them have the skills to do the (actually pretty simple) analysis to try to sort it out.

It is one more persistent set of lies (partially intentional, partially due to Dunning-Kruger) to be aware of when analyzing tobacco control claims.

My recent contribution to Clive’s weekly reading list

by Carl V Phillips

As some of you know, Clive Bates puts out a weekly somewhat-annotated list of PubMed-indexed articles that are related to low-risk tobacco products and/or tobacco harm reduction (the search string for that appears at the end of what follow). It is a great resource; if you do not receive it, I am sure he would be glad to add you to the distribution list. As part of a planned projected that I have alluded to before, I am working on how to reinterpret this as an annotated weekly suggested reading (or knowing-about) list. To that end, this week I was a “guest editor” for Clive’s distribution list, and I thought I should share what I wrote here to broaden the audience. Yes, it is a little weird to publish a one-off “weekly reading” that is mostly based on an existing format that you might not be familiar with. But you should be able to get the idea. Hopefully I will be producing one every week before too long.

In the meantime, here is what I wrote that went out via Clive’s distribution lists. Sorry for the weird formatting — it is an artifact of the way the original PubMed search was formatted. Yes, I could have fixed the for aesthetics to re-optimize for this blog’s formatting, but since they do not hinder comprehension, I am not going to bother — sorry.


Greetings everyone. Carl V Phillips here, doing Clive’s list this week. I am trying out a new format for it, as follows: (1) They are not listed in the order that popped from the PubMed search string, but rather is in order of how worth reading they are. Obviously this is my own rough blend of various considerations, including importance of what is being addressed, value of what was produced, how potentially influential it is, and how much reader effort it takes to get value from it (note that I put relatively little weight on the latter). I have left the serial numbers from the search on the entries in case anyone wants to recreate the usual ordering. I add a full-text link if I think there is anyone other than specialists in the particular area would want to look at the full text. (2) I am not limiting this to PubMed-indexed papers. I am including popular press and policy statements (and would have included blogs but there were not any apparent candidates this week).

Continue reading

Weekly reading: ~20 Nov 2018

Something about this post (the title and thus the URL, I guess) made it so half my readers could not access it. So I replaced it with an exact duplicate here. I am leaving this here as a placeholder for those who do navigate to it, but deleting the duplicate content.

Peer review of: Linda Johnson et al. (Washington U med school), E-cigarette Usage Is Associated with Increased Past 12 Month Quit Attempts and Successful Smoking Cessation in Two U.S. Population-based Surveys, NTR 2018.

by Carl V Phillips

For an overview of this collection and an explanation of the format of this post, please see this brief footnote post.

The paper reviewed here is available at Sci-Hub. The paywalled link is here.

This collection will focus mainly on the misleading anti-THR papers produced by tobacco controllers. However, it is useful and important to provide reviews of potentially important paper that might be called pro-THR. This is one example of a paper that has gotten a lot of “ha, take that!”-toned traction.

If a “pro-THR” paper is tight, a review will provide a substantive endorsement, as positive reviews should do (but as the anonymous and secret — and presumptively poor-quality — journal reviews cannot do), as well as a signal boost. If a paper is useful but importantly flawed (as in the present case), the review can correct or identify the errors and focus attention on the defensible bits. And if the paper is fatally flawed, the review should point that out. Bad advice is still bad advice when it feels like it is “on your side”. Even when a paper basically only provides political ammunition and not advice, it is important to assess its accuracy. We are not tobacco controllers, after all, who just make up whatever claims seem to advance their political cause.

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Johnson et al. use historical nationally-representative U.S. tobacco use data (NHIS from 2006 to 2016 and CPS over most of that period), for 25- to 44-year-olds, looking at the rate of smoking quit attempts and the association between vaping status and quit attempts or successful smoking abstinence. The authors report an unconditional increase in the population for both quit attempts (measured as a the rate of past-year incidence among people who smoke) and medium-term smoking abstinence. They also report a positive association between vaping and smoking quit attempts and abstinence at the individual level. They interpret their results as running contrary to the recent spate of “vapers are less likely to quit” claims, stating “These trends are inconsistent with the hypothesis that e-cigarette use is delaying quit attempts and leading to decreased smoking cessation.”

This is an overstatement, but the results do run contrary to the “vaping is keeping smokers from quitting” trope that the authors position their paper as a response to. This research clearly moves our priors a bit in the direction of “yes, vaping encourages people to quit smoking, and helps them do so.” Our priors only move “a bit” because rational beliefs based on all available evidence tell us we should be very confident of that conclusion already. They should instead have said something like “even if you naively believe in those methods, for this data the result is different”, but such (appropriate) epistemic modesty is absent.

The paper is quite frustrating in that the authors seem to not recognize which of their statistics are actually most informative and persuasive, let alone take the deeper dive into specific implications that could have been done. The natural experiment interpretation of some of the results is more compelling than the behavioral-association-based analysis (see below). The authors overstate the value of their association statistics and effectively endorse the same flawed methods that are the source of the “vapers are less likely to quit” literature. Continue reading

Do vapers have an obligation?

by Carl V Phillips

I read an interesting brief thread just before taking my current yet-another break from Twitter (it is depressing, the world today; note that this means I will tweet that I have posted this, but may not look at my mentions). I am not linking or identifying the thread because the poster expressed a hint of doubt that s/he should really be quite so combative and emphatic about the point. But the emphatic nature of the tweets definitely had value because it got me thinking.

The upshot was, basically, “hey, you paid grandee types, please stop telling us, ordinary people who made a choice in our lives to quit smoking via vaping, that we have some obligation to get out there and spread the word, tell our stories, and push back against those other paid grandees who are attacking vaping.” It is a valid thought that is worth exploring.

Where might such an obligation come from?

There is the argument that we should all do something to try to make the world a better place, apart from our paid labor, and we should play to our comparative advantages there. That is, the admonishments can be read with the same tone as advice to vote or pick up litter: “Everyone do your part.” Then add the fact that vapers have an advantage in one particular area, offering help to smokers who might benefit from switching: “Anyone can pick up litter, but you are in a unique position to credibly tell the world ‘this works! try it!’.”

For some views of the social contract, this is enough to justify urging vapers to speak up. According to other views, of course, it is not. And for some vapers, it may not be their major comparative advantage (which might be creating public art or taking care of children), so this is relevant to some vapers, but not all. Universally-phrased admonitions imply that there are no such exceptions.

If that alone is not enough to create obligation (for either some or all success-story vapers), is there something more? Perhaps.

There is an argument that pay-it-forward situations create additional social obligation, beyond a generic “just do something to make the world better.” I could say that I and a few others worked hard for many years, at great personal sacrifice, to make your success story possible, and the least you could do is speak up to keep it going forward. But a legitimate retort to that is (a) “thank you, however I did not agree to repay, pay forward, or pay at all, so please do not suggest your largesse an obligation” and (b) “thank you, but today most people today who are telling me I should be out there doing stuff are profiting quite nicely from their work in this area, so it is not like I owe them anything.” (Yeah, I just suggested that the only legitimate responses include thanking the pioneers, even if it ends there — doing ethical philosophy does not remove all human desires :-).)

On the other hand, and I think this is in the spirit of the tweets that triggered this, there are a lot of things we could all be paying forward. We benefit from the efforts to defeat the Nazis, create the internet, eradicate smallpox, and ensure access to elementary education. But please do not tell me I should spend concerted time every day doing something for the next generation as a specific response to the advantage I got from each of those. (Note that I chose examples that someone profited from, quite a lot, but the people who really made sure it happened were doing it because it was social good.) What business does anyone have telling people which (supposed!) social obligation they should be proactively paying forward?

In some sense, telling someone that their vaping success is a defining element of their niche in society is just a variation on the tobacco control obsession mentality. It is a Most Important Thing In The World for a few people, but not for most people. For someone who fought or fights this war, just like someone who carried a rifle in a Good War (setting aside the question of whether anyone under the age of 90 qualifies as having done so), it is personally defining. So it is easy to think it is more socially defining — or personally defining for those affected — than it really is.

That’s all. No conclusions or policy recommendations. Just some thoughts about something that deserves some thoughts.

An overlooked lesson from Glantz harassment and fraud cases: tobacco is way out of FDA’s skill-set

by Carl V Phillips

I have written repeatedly about how FDA is totally outside their comfort zone and skill-set in dealing with tobacco products. The most obvious example might be them trying to deal with data from e-cigarette manufacturers, which caused their computer systems to melt down multiple times. I would guess it is a bigger database than every other database they have, combined, and is still growing. Similarly, their comically quaint attitude toward illicit markets, apparently genuinely thinking that the huge illicit market they would create by banning e-cigarettes or most e-liquid flavors, or removing the nicotine from cigarettes, will be as easy to handle as the tiny markets they deal with (not really very effectively) in counterfeit drugs and raw cheese. But the Glantz affair (see this post and what it links back to) brings up a more subtle problem.

FDA is used to dealing with criminals in the iron triangle they share with pharma and other big businesses. But it is the genteel world of halls-of-power crime.  People in that world clean up their own messes, cover up, and pay hush money and fines when necessary, and always create plausible deniability. But the tobacco portfolio puts FDA in bed with tobacco control, who are more like the Sopranos: They also get away with what they are doing, but not because create an image of respectability that deflects allegations. Their behavior is obvious for all to see, but they use intimidation, omerta, and corruption of those who should be policing to let them to get away with it.

This is not FDA’s preferred kind of crime. It puts them in a position for which they are not prepared.

A new BuzzFeed article by Stephanie M. Lee claims that FDA has no policy in place for dealing with sexual harassment charges against extramural researchers. Since this is a direct quote from an FDA spox, I suspect it is probably accurate, even though so much of the rest of Lee’s article is naive or out-and-out wrong.

(My personal favorite is when she credits Retraction Watch with breaking the story of the Glantz settlement in an article that came out… a mere week after I published my much deeper and more accurate analysis of the settlement. And I read at least three other stories about it in between those. My seven-year-old also sometimes does that too — thinking that whoever he first heard about something from is the one who discovered it — so I guess he is ready to write for BuzzFeed. I am still ok giving her a link, though, because she gets legacy credit for originally publicizing the story last year.)

More interesting is Lee’s naivety that probably generalizes to other observers, that FDA’s lack of a policy should be seen as nothing deeper than an outgrowth of NIH’s less-than-muscular response to situations like this. A key bit of background here (which Lee and most others may not realize) is that because doing grants is outside of FDA’s comfort zone, they were officially outsourced to NIH and thus are subject to NIH rules. NIH recently put a stronger policy in place and put out an article that at least says all the right stuff about #MeToo. It is not difficult to connect the dots here: It would not be surprising if UCSF raced to get this case against Glantz settled without an admission of guilt because of NIH’s new positions. (As I noted in my analysis of the settlement, the plaintiff got rolled into agreeing to get almost nothing, perhaps because her lawyer decided she would not be convincing on the stand.) The alleged acts of sexual harassment are actually a minor part of what Glantz is accused of in that and another suit, but they are what pop press readers understand.

But today’s point is how FDA itself has no institutional capacity for dealing with such matters. NIH is not exactly good at dealing with these issues, but at least they have experience creating subsidiary shops at universities and thus with all the potential complications this creates. It seems safe to assume that there is plenty of harassment in the companies FDA works for …er, regulates, to say nothing of scientific fraud, but they cover their own messes and FDA can pretend it does not exist. They cannot ignore what happens in their subsidiary shops, and have no idea how to deal with it.

Lacking institutional capacity, and given that the Commissioner is a stuffed shirt, FDA’s response to this matter will probably default to the Center for Tobacco Products leadership. That is, it will default to career tobacco controllers. Chances are they will do what they usually do about fraud and other misdeeds: pretend they do not exist. Oh, but oops, tobacco controllers are also out of their element here too: Normally nobody looks closely at their misdeeds and they can bedazzle the press with faux-science. But a government-funded sexual harasser (to look at this case with the inaccurate simplicity of the pop press) gets traction.

It could be hard for both FDA and tobacco controllers to ignore if it is a recurring tangent in everything anyone writes about FDA for a while. They will have no clue how to deal with it. It will be amusing to watch.

Peer review of: Michal Stoklosa (American Cancer Society), No surge in illicit cigarettes after implementation of menthol ban in Nova Scotia, Tobacco Control 2018

For an explanation of what this post is, please see this brief footnote post.

The paper reviewed here is available, open access, here.


 

It is vaguely embarrassing to write a review of this piece, which is effectively a bad local newspaper story, dressed up as if it were scientific research (though not nearly as embarrassing as being the the journal that published it). However, it is worth a few minutes because it will inevitably be used in the absurd-but-persistent propaganda efforts to claim that bans — in particular, flavor bans — do not create alternative supply chains. The open access status of the article, unlike most articles at the journal, is a bit of a giveaway about its purpose.

On the upside, it is a good quick teaching example about the standard public health research practice of ignoring competing hypotheses and explanations. There are three layers of that in this case. Continue reading

Peer review of: Dunbar et al. (Rand Corp), Disentangling Within- and Between-Person Effects of Shared Risk Factors on E-cigarette and Cigarette Use Trajectories From Late Adolescence to Young Adulthood, Nicotine & Tobacco Research, 2018

by Carl V Phillips

For an explanation of what this post is, please see this brief footnote post.

The paper reviewed here is available at Sci-Hub. The paywalled link is here.

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The typical “gateway” paper consists of observing the exposure of whether subjects (typically teenagers) have, at baseline, engaged in a particular behavior (vaping, in this case), and then observing the association with an outcome behavior (in this case, smoking). There is also an even worse collection of papers that do not even assess the order of events and simply look at whether prevalent ever-exposed status is associated with prevalent smoking. All of these suffer from the obvious fatal problem that a positive association is inevitable because inclination to ever vape is associated with inclination to ever smoke. In a counterfactual world in which vapor products did not exist, someone who vaped in the real world would be more likely to smoke than average, and this would obviously not be caused by (nonexistent) vaping. In short, since a positive association is inevitable, regardless of whether the hypothesis “vaping causes smoking” is true, observing a positive association obviously tells us nothing about about the hypothesis.

The present paper attempts to improve upon the standard worthless analysis. This is a commendable goal, and there is information value in what was done (unlike most gateway papers). However, the contributed information is very modest and does not actually support the authors’ conclusions. In particular, they claim that their results support the gateway hypothesis, and that they do so in ways that the usual longitudinal studies do not. This is simply false. Continue reading