The value of individual testimonials and more on negative evidence

by Carl V Phillips

Continuing from my post earlier today (basically “class notes” for an interview I am doing later), which is part of the current series on how to best communicate the truths about THR.

Point 2:  What evidence can we cite to argue that e-cigarettes are useful for smoking cessation?

The good news is that we have great affirmative evidence about this rather than having to infer from negative evidence (as was the case with Point 1, how we can be confident of the low risk).  The bad news is that it is still necessary to discuss real scientific reasoning rather than just doing something easy like pointing to a simplified artificial study.

I already addressed this point in a recent series about an anti-THR liar who wants to censor the strong evidence we have (for obvious reasons).  Rather than report the details again, I refer you to these two posts.  But I will summarize here:  We have a huge collection of individual reports of how switching to e-cigarettes facilitated people’s smoking cessation after their failed attempts to quit in every other way imaginable (except switching to smokeless tobacco, it turns out –that was seldom attempted).  These are the best evidence possible that e-cigarettes cause smoking cessation for some people who would not have otherwise quit (at least not any time soon, which is critical).

By contrast, the typical statistical study that collects various data on a lot of people — but not their valuable individual narratives — could never provide such useful information.  We would have to infer from limited data whether someone seems like they are the type who would have quite without the aid of e-cigarettes, rather than having their own testimony on this point.  “Public health” researchers might prefer that study because it is the type of work they are paid to do, but a scientist would recognize that the quality of the information is markedly inferior.

There is a somewhat legitimate criticism of the testimonial evidence:  It is difficult to assess how often e-cigarettes cause smoking cessation.  That is mostly true, though notice that the premise of the criticism is that it e-cigarettes cause cessation sometimes — a concession already!  But we do have evidence that there is a lot of success because there are so many reports.  Moreover, almost every vaper you meet will report that they cannot imagine they would have quit smoking anytime soon without e-cigarettes.  There are only a few who report something along the lines of “I would have been happy quitting entirely, but I am happier using e-cigarettes” (note that this is not a bad thing either — it means that e-cigarettes made them happier than abstinence — but the “public health” people are likely to treat it as a bad thing, so we need to save that observation for people who genuinely care about people’s welfare).  Thus, the evidence shows that the vast majority of people who switched from smoking to vaping only quit smoking because of the e-cigarettes.

We can endeavor to predict what portion of smokers will quit due to e-cigarettes as a function of knowledge, social forces, etc., and I am working on exactly this in my current research.  But we will not know for sure until we can look back on the history.  But the good news is that the accuracy of this prediction does not affect the argument that keeping e-cigarettes available is a good idea:  The option of switching to e-cigarettes does not crowd out any other cessation options.  If they will not work for a particular smoker but something else will, that something else will still be there.  Quitting smoking is what matters, and everything else is a rounding error.  The risks from the alternatives to smoking (various THR products and abstinence) are approximately the same, so there is no harm in offering a method even if it works for only a few people (so long as the method itself is not harmful, like Chantix or waterboarding, and trying e-cigarettes is obviously not).

Point 3 (after 1, evidence about the low risk, and 2, effectiveness) was a collection of minor points.  The most common is the classic “gateway” propaganda about youth use that will lead to smoking.  For those who do not know, the concept of the gateway was made up, based on no real evidence, by drug-war types to concoct an excuse for treating cannabis as if it were as harmful as “hard drugs”.  When cannabis is smoked, it is probably as harmful as any other smoking, but still obviously nothing compared to other strictly prohibited drugs.  So they needed to make up a reason to treat it the same.  There are several good reasons for dismissing the gateway claim about e-cigarettes.

First, if there are any youth who would never have smoked but choose to use an e-cigarette, it must be because they know it is low risk and they avoided smoking because it was high risk.  The same is true for the few older people (mostly ex-smokers) who were not already smokers when they started using e-cigarettes.  It would obviously be absurd to think that someone who avoided smoking and started using the low-risk product only because it was low risk would somehow forget that motivation and start smoking.

Second, there is no evidence of youth uptake despite the growing popularity of e-cigarettes.  Again, we have to reason from the lack of evidence because there is not much useful affirmative evidence of a lack of uptake.  A few studies, including one out this week, looked for youth uptake and found almost none.  What use there is among young people is actually for the same reasons adults use e-cigarettes — because they smoked and liked smoking, but wanted to avoid the negative health effects.  E-cigarettes just do not have the same appeal to a new user that smoking does.  But, third, to the extent that e-cigarette use does crowd out smoking among young people, this is obviously a good thing.  Harm reduction is not just for middle-aged people, after all.

Probably next on the list of topics that get argued is the “it looks like smoking” claim.  This seems to be another point (along with “people should be allowed to choose what makes them happier even if it is slightly unhealthy”) where we need to try to pry open the gap between normal thinking people from the “public health” industry.  The response needs to be: “Why is that a bad thing?  After all, the purpose of fighting smoking is to eliminate the health effects of smoking, not the appearance of smoking, right?”  It is true that vaping has much of the look and feel of smoking — that is part of what makes it useful.  The ANTZ hate it because of that, and there is nothing that can be done about that.  But normal people might be tricked by the ANTZ into believing that the appearance could be seen as an endorsement of smoking.  But, once again, there is no evidence to support this claim.  It is rather more plausible, once everyone who gets out much is aware of e-cigarettes and recognizes them (a point we may have reached already in many populations and certainly will reach soon), that every sighting of an e-cigarette will be an overt reminder that someone has decided to not smoke.

I will continue with some other points (and comments for which ways to go with this are welcome), but that is all I have time for today.  I will conclude with the key observation on that “prying normal people away from the ANTZ” point:

When presented with the choice of (i) letting smokers, if they wish to do so, continue to enjoy the benefits of smoking in a form that does not substantially harm themselves or anyone else, versus (ii) forcing all smokers to suffer a great deal in order to get rid of the harm, normal people would obviously support allowing the former.  ANTZ would demand the latter.  If you can get someone to stop and think through their answer to that choice, setting aside all the fiddly details, you can then point out to them that the anti-THR people simply want those who like nicotine/tobacco to suffer the costs of abstinence rather than enjoy the benefits with very little cost.  Since the ANTZ know that normal people would not support that, they are trying to trick everyone into believing that this is not really what they are demanding.  Even setting aside the public health (not to be confused with the “public health” industry) point that many will not obey them, and will continue to smoke, their best case view of forcing universal abstinence even though THR is an option, is not one that normal caring people would embrace if they understood the options.