posted by Carl V Phillips
This blog is only two weeks old but it is not too soon for an aside that addresses a critical tangential point, the accuracy and credibility of pro-THR claims.
Almost all anti-THR discourse is dominated by lies. It has to be, because the truth has such an obvious pro-THR bias. Most pro-THR claims are solidly based on evidence and honest communication of it, as well as established ethical norms and the very popular political view that people should have freedom to make their most intimate choices without interference by those in power. Thus it is not surprising that, with the exception of a few unscrupulous merchants and Chinese spammers writing about e-cigarettes (scourges which it is impossible to avoid or eliminate when there is free communication), pro-THR discussions are almost never anchored in misinterpretations of the evidence.
Almost never.
And there is the problem. The example to hand is the recent widely repeated claim that a study in Greece showed that “e-cigarettes do not damage the heart“. The study showed nothing remotely that general. It showed that under in particular circumstances, the brief use of an e-cigarette does not produce measurable acute (immediate) changes in a few particular biomarkers of cardiac functioning. Is this good news for e-cigarette users and THR? Of course. It is the best news that could come from that study, which was only looking at the immediate effect of one vaping session on the particular short-term biomarkers that were measured. But I trust that it is obvious why this is not sufficient to justify the headline that was repeated by many e-cigarette advocates. The study obviously could not address what matters for health outcomes, the long-term effects of long-term use (the natural interpretation of the headline of that press release). Moreover, it measured only a few of the many possible short-term effects. It is a result that should be added in to the body of technical knowledge that is useful for experts who are compiling all existing information into conclusions; it should not be interpreted as having clear practical implications and should not have been touted to the general public as saying there is no risk of damage.
Imagine that an anti-harm-reduction “researcher” did a lab study in which they asked a few smokers questions that reflect their desire to have a smoke later that day, asking before and after they used an e-cigarette, and found that the measured desire increased afterward. Headline: “E-cigarette use increases smoking”. Of course, the measure was very limited and artificial, and tells us very little about long-term effects. In that, it is very much like the e-cigarette cardiac study. In fairness to the latter, the cardiac study could have been legitimately reported in useful and accurate terms like, “certain cardiac functions that show acute negative effects with smoking do not show the same effects with e-cigarettes”, whereas the imaginary anti study has no apparent legitimate interpretation. But the accuracy of the more general declaration is similar in the two cases.
Of course, you do not have to imagine. Readers of this blog will undoubtedly have noticed that this heart study sounds remarkably like the lung effects study that we wrote about for the last three days, which was press released at about the same time. Both studies looked at short-term biomarkers of acute effect that could not possibly tell us anything about real health effects (unless the results were catastrophically bad, which we knew in advance that they would not be). Both studies could add a bit of useful technical information to what we know about e-cigarettes. Both were from Greece, though I think that is probably not relevant to anything. And, unfortunately, both were reported via press releases that absurdly overstated their implications.
There were important contrasts: The actual methods and useful results of the cardiac study were contained in the press release (to the extent possible in a few score of words), as opposed to the obviously misleading non-presentation of the science in the Christina Gratziou lung study. The cardiac study author’s stated conclusions in the text of the press release were quite modest (one might say even more timid than the facts support) about whether THR was a good idea, and did not lean too much toward claiming that his results were particularly important, whereas Gratziou was basically shouting “my results prove that you might as well smoke!” But still, the false claims in the headlines were remarkably similar, as was the willingness of news sources with the particular bias to uncritically repeat the claim in the headline.
Anti-THR activists cannot afford to not lie, because the truth is not on their side.
THR supporters cannot afford to make the mistake of blindly repeating overzealous pro-THR claims.
But, wait, a common response goes, you just pointed out that anti-THR people do exactly that, pretty much all the time. They do a lot worse too: full-on campaigns of lies and research misconduct. They lie constantly.
But that does not justify us doing it. In addition, and probably more important in the minds of most THR supporters, it does not make it tactically sensible. We have to police our own claims much more carefully, for the following reasons:
1. We do not want to be like them. Right? Nuff said.
1.5 And if we are like them then ,well, live by the favorable tiny little biomarker study of limited scientific value, die by the much larger number of unfavorable little biomarker studies of limited scientific value. If that cardiac study is evidence that e-cigarettes do not harm the heart, then the lung study is evidence that they do harm the lungs.
2. One false claim from our side — even if it is basically consistent with all the evidence (as is the claim that we do not think there is any major cardiac risk), and even if it is presented with the best of intentions, as an honest mistake rather than a crafted lie — will be used to excuse every single lie from the other side. We do not need to make false claims, but they do, so why give them the gift of being able to respond “well perhaps our claim of …, based on one finding from one study, overstates the case a bit; but the THR people claim that one little study of a few biomarkers showed that e-cigarettes pose absolutely no threat of cardiovascular disease, so they are really worse.” (Note, by the way, that this is true: claiming “no damage” based on any single study is more inaccurate than claiming “damage” based on a single study, because no little study can provide much evidence for the universal absence of a something, but it can show its existence.)
It does not matter if their claim in the “…” is more egregious. It does not matter that they have a legion of paid operatives who are intentionally trying to mislead, while we are running volunteer operations and trying to make the best sense we can of the science with limited resources, and so occasionally err by accident. And most of all, it does not matter that they tell a thousand lies that can fill in the “…”; every last one of those thousand will be declared to be justified by just a single example that can be presented on the other side.
3. It is not just the anti-THR people who will do this. There is a silly notion in the American press to seek what they call “balance” in anything they report, and this has spilled over into a lot of public Anglophone discourse (I cannot say for sure whether it is so common beyond that). A slight caricature of this is Krugman’s observation that if the mainstream press was running a story on the Earth’s shape, they would find one person who says it is flat and run the headline “Shape of the Earth: views differ”. Their silly urge to “balance” is even stronger when pointing out that someone is lying; no matter how blatant a lie is, the mainstream media’s reporting of this fact is almost always accompanied by a hunt for some error from “the other side” to “balance” the information. It just would not be [insert affected accent and fan self dramatically like a character from Gone With The Wind] proper to seem to be biased against a liar who represents an established and powerful institution, after all.
So, when we get mainstream discourse that points out that anti-THR claims are based on lies — which is what is something we really need to generate — it will most likely juxtapose that with pro-THR “lies”. If all they can find are a few shady merchants making absurd claims, it will not look so bad (so long as they do not lie and suggest that everyone on our side is making such statements). But “does not damage the heart”, widely reported by non-merchant THR supporters, is just the perfect balance to show that “both sides are making exaggerated claims.”
It may not be fair, but we have to deal with the way things are.
3.5 But it gets even worse and more unfair than that: The mainstream discourse is actually going to favor anti-THR lies over our pro-THR truth, since it almost always defers to lies from powerful institutions. So it will take a very long list of very obvious lies to hurt their credibility as much as one clear exaggeration hurts ours. The “public health” movement is a small-minority special interest group that has abandoned society’s norms of ethics and scientific conduct, but it is a rich and powerful special interest group and used to be respectable. The mainstream media, as well as most of the liberal-leaning new media and — most important — the average person on the street, still treat “public health” as if they are honest and public-spirited. The “public health” people know this, of course, which is why they do not hesitate to lie.
But more importantly for present purposes, it is also why they can get away with misleading fixation on unrepresentative individual actions of opponents that distract from the real truths of the matter (e.g., fixating on one unfortunately-phrased ad for smokeless tobacco from the 1970s as a reason for condemning all smokeless tobacco forever, or on the claims of a few fly-by-night e-cigarette merchants, or that whole “tobacco industry documents” obsession). The public is still ready to believe any bad thing that is claimed about THR products or those who support them (who will be labeled “the evil big tobacco industry”, of course). We cannot give them the openings.
Again, it is not “fair”, but the total dishonesty and unearned credibility of the Drug Warriors-types and other anti-harm-reduction activists in “public health” forces us to be even more scrupulously honest than might be needed otherwise.
4. If we start making every claim that seems to be pro-e-cigarette, treating anything that is pro as right and attacking everything that is perceived as anti as wrong, we will learn a lot less. Learning is good. Perhaps the marketers want everyone to believe that there is only good news, but those of us who care about more than pumping sales want to find the bad news when it exists. This is not just because of Point 1., and the potential loss of credibility if an overblown claim turns out to be wrong. It is also because consumers are better off if they know the risks, and only if we know about problems we can try to fix them. E-cigarette users should be the absolute last ones to want there to be claims of “no risk” when we do not actually know that.
This issue reminds me, to a very disturbing degree, of work I did in the 1990s, trying (unsuccessfully) to persuade vegetarian advocates to stick to the true and scientifically valid arguments that supported their position, rather than glomming onto every blatantly irrelevant or junk science claim that seems to point in the right direction. The bad information basically drove out the good (both the good information and most of the good people). The situations are quite different in many ways — e.g., there are relatively few non-experts writing books and junk science websites about THR (yet!), while such people dominated (and still dominate) the discourse about vegetarianism. But there are also some clear similarities.
There are honest and accurate pro-vegetarian arguments that would appeal to the substantial part of the population that is concerned about animals or the environment, and to a lesser extent their health, and yet vegetarianism was widely perceived mostly as a nutty cult. The true claims that might have persuaded people were (and still are) hopelessly lost amongst the easily-debunked false claims which were more prominent. So, almost two decades later and even as lots of people have stopped eating much meat, vegetarianism’s negative image has hardly changed. For example, it has been mentioned to me that my credibility in the work I do to promote animal well-being is enhanced by the fact that I am no longer vegetarian (I am pretty close, but not entirely). I believe that had influential pro-vegetarian advocates stopped acting like a bunch of unscrupulous marketers and doe-eyed cultists back then, things would look very different now.
THR is not nearly so vulnerable to being marginalized (a lot more people practice THR than practice vegetarianism in the West), but there is a powerful opposition that wants to marginalize it. If we do not police ourselves and discourage THR advocates from embracing any claim that seems to support the cause, we run the risk of become an insular fringe that opponents can just ridicule and thereby ignore. Quick: name an organization that advocates vegetarianism that you would turn to for credible information about the topic? I didn’t think many of you would have an answer, though if you have ever thought about the subject, you probably thought of several that you would not trust. There are some good resources out there, but you pretty much have to already be an expert to sort them out from the marketing and cultish propaganda. Do we want to risk THR and e-cigarette advocacy looking like that in a few years?
Tobacco harm reduction, anti-THR lies, and related topics 
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One of the core concepts of being credible is beautifully outlined here. This is a must read for anyone who is citing research and making claims of any kind based on studies done to date and in the future. Well timed and with the important message; do not make claims that are not directly written in a peer reviewed article or presented poster. Quote directly from the author, do not infer or extrapolate meaning that is not directly referenced to a valid source. In science may be, might be, could be, appears to be and such statements are mere speculations. These are the stuff hypotheses are made of and not the facts that arise from the results of the studies and experiments that test these hypotheses.
Personal stories are opinions and valid only as testimonials. They may be 100% truthful, yet they in themselves are not science.
In my opinion, this does not mean that we do not share experiences and our own subjective results. These are important to catalogue and have available for others to see, examine and critique. They are useful in letters and in responses to bans or exclusions as a personal experience for a non-scientific community.
To err may be human, retraction is honorable and the desire to advance the cause admirable. As the blog states, it takes but one false claim and one misrepresentation of fact to ruin credibility. Quote and reference exactly as the study concludes, leave the speculation to those who are doing the science and have the means to formulate experiments and conduct sound trials.
The problem is that in our area, the peer reviewed scientists are spouting as much anti propaganda as anyone else, so that is not really a good dividing point. Too many make conclusions which are in direct contrast to or in spite of the results (ie. conclusions stated by the authors are not supported by their own evidence.) Also, the “peer reviewed” system is quite biased and studies opposing the approved rhetoric/political position are either ignored or buried completely. They may never even get the chance to be reviewed, if they are even allowed to happen in the first place. So, that means that we, as the public, are often kept in the dark as to the existence of opposing study results and cannot trust that peer reviewed studies are “the whole story.” In reality, we can give very little weight to just one study on its own, as each must be looked at as a part of a whole with all other studies – especially studies which seek to duplicate and confirm the results of earlier, smaller studies. There are entirely too many studies out there that are cited in later research on other effects that have actually never been duplicated in larger studies (for example, citing the results of the one and only study ever done on the air resistance in vapers as a basis of fact/evidence for whatever you are researching.)
Also, stories/testimonials/opinions are useful if they are used in the right way. In fact we will want to start a process of formally collecting them for scientific purposes. They are actually an important part of the scientific process – considering a lot of what we know is only found out after releasing a product to the greater numbers available in the public. The key is that one individual story should never be mistaken for the best knowledge on a subject, but lots of stories from lots of people tell us a lot. They tell us why people choose to vape and about how they tried to quit smoking before doing so. They tell us that they like to vape and it is causing no apparent health problems. This is not quite as good as a systematic study that captures the same information and more, but it is very useful. The testimonials and real-life personal experiences of 100,000 users could tell us a lot more than a controlled study of 40 vapers that were chosen fit within a narrow criteria. (Look what happened when they excluded a certain group from Chantix studies and how the reports from personal experiences, once it was released to the public, changed everything.)
It is not enough to avoid wrong-doing, we must also avoid all appearance of wrong-doing.
I think you are confusing things – The title the press uses, how the press represents the abstracts and presentations and what the studies actually say – there is no control of what the press chooses as the headlines and what the study says – the title of the study is “Acute effects of using an electronic nicotine-delivery device (e-cigarette) on myocardial function: comparison with the effects of regular cigarettes”
We are not the press and not accountable to the press; We are accountable to what we write on forums and blogs. Venders are accountable to their claims. That is the issues. THR must speak truth as truth. Speculation must be stated as speculation.
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While it would be nice if everything said and written by every tobacco harm reduction advocate was true, it is impossible to control the statements of millions of individuals.
As one who has spent most of the past decade educating the public health community, the news media, elected officials, smokers and smokefree tobacco product consumers about tobacco harm reduction products, research and policies, I’ve become increasingly frustrated with the rampant and growing ignorance about tobacco harm reduction (due to the explosive growth of THR).
The overwhelming majority of vapers don’t even know (or care) that Obama appointees at DHHS have conspired to lie and scare the public about e-cigarettes, and to ban the sale and usage of e-cigarettes since 2009.
Anyone who says that e-cigarettes are “safe” should be
I would love to learn how Bill would finish that sentence. :-)
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I am really surprised that a title in a press release could lead to marginalization of electronic cigarettes. Whether we like it or not, electronic cigarettes are already marginalized. Just look at the news, what kind of information is provided to the public and how this information is presented. Just look at how the majority of public health authorities and even scientific organizations react towards electronic cigarettes. How many e-cigarette users have heard from people that they use a cancer-causing product? There is nothing more they can do to marginalize the product. It is already marginilized. Period.
Yes, i did not choose the title of the press release, nor any of the other co-researchers chose it. However, when they changed the title, we approved it. Why? The reason is so obvious, it should not need any explanation. Spreading bad or catastrophic news about something is really easy. The public gets easily convinced when they see something negative, when they hear catastrophic claims. They can unconsciously believe everything they hear, just because bad news pass easily and gets installed into their brains. On the contrary, saying something positive is almost never accepted in this way. You may need to speak for a long time, present too many arguments, and still many will be unconvinced.
Our study was not funded by anyone. We paid even for the device and the liquids we used. None of the researchers was user of electronic cigarettes when we started the study. None has any financial interest or holds stocks in any company in e-cigarette industry. Thus, none wanted to spread false claims about our study or about e-cigarettes in general. Our study was the first-ever evaluating acute effects of e-cigarette use on cardiac function. It is not the end of research, just the beginning. Yes, one study is nothing; but it is more and better than no studies. False claims are already spread worldwide by opponents. To the point that it could be easily characterized as propaganda against e-cigarettes. This misinformation has reached to a point that e-cigarette is already a marginalized product. We do not regret for accepting the press release title, because it would be the only way for people to get informed about something that is opposite to what they are used to hear. We never tried to overestimate the results of our study, we never claimed that this study made the difference in the matter. But, asking for long-term studies is the main argument of e-cigarette opponents. And they keep asking for such studies because they know that they cannot be done now!!! E-cigarettes use has spread since 2009, and users are mostly in their 30s and 40s. At least this is the experience we have in Greece. It is impossible under these circumstances to perform long-term studies or ask for long-term effects estimations. This is completely uinrealistic, but it is used as an argument to undermine all studies performed now (that are mostly short-term).
Realistically speaking, you cannot fight iron with cotton. People should be informed. Even if e-cigarettes are found to produce adverse effects, people are entitled to know it. However, one-sided information with intense exaggeration about catastrophioc effects of e-cigarettes is certainly not proper, unbiased information….
I do not think that anyone has suggested that you were improperly motivated. Obviously we (CASAA and others) agree that anti-THR discourse is full of over-hyped results and other lies — that is kind of the point of this blog, after all. Also, I do not believe I have seen anyone suggest that your study was not of value for what it was, and expert opinions are that it constitutes information that will be part of a growing body of knowledge in eventually figuring out the health effects of e-cigarettes.
Unfortunately, thousands of vapers and others mistakenly think that it showed that there is no risk of heart disease from vaping, and this perception was clearly caused by the lead of the press release and the uncritical repeating of that by bloggers and other news sources. This is a bad thing in itself.
As for fighting hype with hype, I urge you to read the post. I understand the urge to do it. It seems unfair that we have to be more honest and disciplined than the anti-THR liars. But hype is a near-certain loser for our side. It is a mistake to think that your press release could not lead to any more reputational problems for e-cigarettes. Before it, no one could truthfully claim that anyone other shady merchants were making unsubstantiated health claims. But now there is the risk that they will say, “you accuse us of hyping study results that provide only a little bit of evidence of risk, but pro-e-cigarette researchers hype results as showing there is *no* risk, which is even more of an overstatement.” It does not matter that you are honest researchers and did a much better job of reporting your actual results than they do. The headline was damaging. They can take that headline and run with it, which they could not do before, and they have a lot more assets to run with than we do.
This was a bad thing for the cause of THR. It will be much worse if it keeps happening. Indeed, probably the surest way for THR advocacy to fail is to start acting like the anti-THR liars. They have the money, the power, and (for the moment) command badly misplaced trust of the press and most of the public. Our main advantage and only hope of dealing with their wealth and power is that the truth is on our side and they depend on lies. We cannot afford to blur that distinction and lose our one clear advantage.
My experience with the media is that without producing an impressive title there will be no publicity. That is probably why ESC decided to change the title, and we agreed on it. All facts point to this: our study was presented in a press conference held by ESC and in a lecture during the congress. However, it received almost the same publicity with a simple poster that was presented in ERS congress (and i still have not seen the abstract of this). If another title was chosen it would probably be buried by the media.
Electronic cigarette supporters are already overwhelmed by opponents. And this will continue unless we get access to the media. Unfortunately this is not science, but still it is a necessary step…
You seem to be missing the point, so I am afraid I have to be a little more direct: You may have been thinking you were doing something good, but you were not. You *aided* those opponents. You also misled e-cigarette supporters about what we know about health effects. There was nothing good about getting the “no harm to heart” story into the press. You hurt the cause. I am not quite sure what you think was beneficial about what you did.
Frankly, it is not clear to me why you think a research report like this should be featured in the popular press. Do you think it was a good idea that the press picked up the Gratziou study (a similarly-scaled short-term biomarker study that came at about the same time and claimed to show “harm” to the lungs)? The reporting of both of them was equally misleading. It is difficult to imagine that the press could accurately convey the modest implications of a study like this — or that they would want to. Not all science is telegenic.
Just because someone wants publicity does not mean that a research result can be effectively publicized. In this case, the publicity was harmful for the cause of e-cigarettes and THR. But even apart from that, if it is necessary to misrepresent the science in order to get it in the newspaper, then the ends do not justify the means. Misrepresenting the science cannot be justified. Sometimes you cannot get what you want; that does not make it ok to use all means necessary to get it.
Perhaps we have different opinion, or we talk about a different matter. In fact, my report and the press release content were very cautiously written, perhaps they were even more balanced than they should be. The title was not my choice but was approved by authors. Science is not for the newspapers. We as scientists do not need publicity, but electronic cigarettes certainly need some positive publicity. If someone wants to be properly informed, he will read the whole press release, the abstract and the manuscript when it gets published. However, he could not have any access to them if the matter was not followed by the media. The title was just the “passport” so that, finally, a positive study about electronic cigarettes comes to the surface. Has anyone in the e-cigarette community heard about the study recently publiced about the short-term effects of e-cigarette use on complete blood count (Flouris et al, Food Chem Toxicol. 2012;50:3600-3603)? Probably none knows it, however, i am sure that if e-cigarette had any adverse effect it would be headline news.
My cousin quit smoking by using electronic cigarettes for 3 months. When he heard a famous greek respiratory physician talking about the possible carcinogenic effects of e-cigarettes on TV, he immediately turned back to tobacco cigarettes!! That is why electronic cigarettes do not need only pure scientific data but some positive publicity too.
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Hmm…I suppose it all depends whether your moral position is based on ‘consequentialism’ or a kind of Kantian imperative that requires telling the truth, no matter the cost. Would you lie to save a life? No? What if the life in question was your child’s? Would you exaggerate or misrepresent to save a life? What about two lives? What about millions? Or is science something so holy, so sacred, that it should never be misrepresented, regardless of the benefits that might be procured by so doing?
I could go on, but you get the picture. Personally, I side with science, good science, science that tells the truth. Ultimately if our Pro THR position is to prevail, it’s arguments must come from solid, unassailable foundations, and not be infected with any taint of misrepresentation or exaggeration. We’ll leave those tactics to the anti THR liars. I don’t want to deify science here – science has always made mistakes, some egregious, but it’s the best tool we have – probably. Logic is our other big weapon – the simple message is this – however bad vaping might be, it cannot be as bad as smoking tobacco. This is not of course water-tight deductive reasoning, but it is at least an inference to the best explanation.
So let us keep going, with logic, with science and with truth. Surely these are better weapons in the fight than the misrepresentation, exaggeration and blatant lies that are the weapons of choice of the anti THR lobby…
I actually don’t think the answer depends on which (of the normally defended) moral codes you consider. I took the practical strategic view (which is consequentialist), but it is not clear to me that any alternative would lead to a different conclusion. (Indeed, if I were aware of such, I would have noted that — unlike the ANTZ, I am thorough and honest.) An act-based imperative is an additional argument that leads to the same conclusion.
As for the last bit, I was responding to those who take the opposition position: because they are doing it we should and/or must do it also. I agree with you, obviously, that we have better options available, and it could be effective (subtle but maybe meaningful in the long run) if we show that their entire collection of tactics is unnecessary when arguing for the science.