Monthly Archives: June 2013

Sunday Science Lesson: “carcinogen” is not a useful category

by Carl V Phillips

I was recently asked by a correspondent if we could perhaps make the case that being in the same room as aerosolized cooking oil is more carcinogenic than being exposed to what might be called second-hand vapor.  The context was dealing with the dumb (really really dumb) law in California that requires every venue to post a sign that says, in effect, that being in this facility results in exposure to known carcinogens, and how that whole  California-style “known carcinogens” concept means that e-cigarettes are getting identified as such.

Of course, technically the California law does not require that the sign be posted in every venue, but merely those that have chemical carcinogens floating around in them.  But since this condition is met everywhere that contains, say, furniture or walls, effectively the rule requires posting the sign everywhere.  There is far more that is stupid about this law than I will cover here (e.g., a warning that appears everywhere has zero information content).  I will focus on its very premise: the concept of something dichotomously being either a carcinogen or not.

The only real dichotomy is between exposures that we have evidence that pretty clearly demonstrates that they cause cancer (under particular circumstances, for particular people, in particular doses, and with some possibly very small probability — i.e., the evidence pretty much never suggests that they always create a risk, let alone one that is large enough to matter) and exposures that probably cause cancer (with all those caveats) but the evidence does not exist yet. It is a safe assumption that under the right circumstances, any exposure experienced by a body can cause cancer.

Some of you might notice that this construction sounds disturbingly like the attitude of “public health” people (and sometimes even real public health people) that is epitomized in such statements as “this study failed to demonstrate that the exposure creates any important risks, so more research will have to be done to show that is true.”  But there is a fundamental difference here:  The “public health” people are looking for an excuse to take some action that they have a political/religious desire to take.  The implications of my point are the opposite, that the differences between the many exposures where it is surmised that their is some tiny risk are about the same as all those exposures where no one has chosen to surmise this yet, and in all such cases, almost any proposed actions or restrictions are inappropriate.

Notice that the latter statement applies to only those “known carcinogen” exposures where the guess is that there is some tiny risk of cancer, not exposures that cause important risks.  Just because there is no bright-line dichotomy does not mean that the world does not divide, and some exposures matter, of course.

Most carcinogen exposures — either the “known” ones or the billions of others — cause such a trivial risk that (a) they do not matter and (b) it is only possible to make wild guesses (often dressed up to look like science, but still just wild guesses) about the magnitude of the risk.  If an exposure does not cause a large enough risk, there is no way to detect it, let alone measure it.  It is difficult to imagine ever being able to detect a risk that causes 1  in 100,000 exposed people to get a cancer, even if that cancer were extremely rare and a lot of people were exposed.

You might argue that I should not have even go down to that order of magnitude to make the point, and that the same thing can be said about 1 in 10,000.  In reality, measuring risks in the 1 in 1000 range is beyond practical capabilities.  E.g., while there is no clear evidence that smokeless tobacco causes any risk for oral cancer, it is plausible that there is a relative risk in the order of 1.1 or perhaps even 1.3; these figures would put the risk in that 1 in 1000 range, but despite the exposure and outcome being easy to detect, the outcome being rare, and the great interest by ANTZ in the topic, it is not possible to conclude whether the risk is 1 in 1000 or zero or somewhere in between.  Similarly, any risks from second-hand smoke are down in this barely detectable range.

To the extent that quantification even exists, most of the wild guesses (that get called calculations or extrapolations) about the vast majority of “known carcinogen” exposures put the risks in the order of 1 in a million or 1 in a billion.  To put that in perspective, the risk of dying from driving 1 km is about 1 in a billion.  Yes, you read that right — the lifetime of exposure to some of these “known carcinogenic exposures” that the California-types want you to worry about cause about the same risk of getting a cancer (not even necessarily a bad cancer) as the risk of dying from driving a few blocks.

So with that in mind, there are a couple of key lessons here.

First, the one in the title: Since basically anything is a carcinogen under the right circumstances, merely calling something a carcinogen is uninformative, and quite often is fear-mongering disinformation.  Of course, most of us use the word, but usually we mean something like “carcinogenic, under the relevant circumstances, to a degree that matters or is at least measurable”, and that is how most people interpret it.  Thus, when it is used to describe something that poses a risk that is trivial or speculative, it is terribly misleading.

Second, my last disjunction is a bit misleading because the trivial and the speculative are mostly the same category.  That is, when something is guessed to produce a very small risk, it is never known for sure that this risk exists at all.

Third, given that, it should be clear that it is impossible to compare risks down in that trivial range.  Is the risk from an exposure 1 in a billion, or 1 in a million, or 1 in 10,000 (or zero)?  We will probably never know.  Thus, there is simply no basis for concluding that one exposure that is down in this range is a worse than another.  Of course, all differences among miniscule risks are themselves miniscule, so it does not matter anyway.  Anyone making such comparative claims — unless accompanied by a lot of caveats — is lying.  And, unfortunately, that would include us if we started trying to make such comparisons.

Irrational fear of and despite toward “carcinogens” is the biochemistry equivalent of racism or homophobia.  They are all driven by tendencies toward tribalism (an unconscious desire to find someone to hate) and fear (at the unconscious animal level) that are part of what we inherited from our ancestors.  There is a bit of value in responding to any of these with facts, of course — but the simplest facts (those people are mostly exactly like you; trivial carcinogenic risks are everywhere) probably matter just as much as any details.  There may be a role for the scientific details in, say, court proceedings.  But for changing the general prejudices, even we scientists have to concede that a real solution comes most from in the subconscious release of irrational hatreds and fears that comes from familiarity.

Advertisements

Glantz et al. lie and the NYTimes is gullible enough to believe it

by Carl V Phillips

In what Dick Puddlecote called “A New Low for Tobacco Control” (perhaps an overstatement given that is an incredibly high — or perhaps call it low — bar that is nearly impossible to achieve, but I see his point), Stanton Glantz and a few others told the New York Times that the reduction in the US smoking rate is due to such factors as removing smoking from movies and has nothing at all to do with THR.  Since the headline and the topic of the story were “Why Smoking Rates Are at New Lows”, you might expect that the reporter would have learned something and talked to people who do not lie about THR.  Of course, if you thought about it a little more, you would amend that to “the NYT reporter should have learned something about the topic and talked to real honest experts, but unsurprisingly, did not”.

The first thing to note is that about 90% of the time when news outlets with the biases of the Times (and by that I do not refer to usual erroneous claim that they are “liberal” in the political spectrum, but rather that the corporate media act as uncritical transcriptionists for what government and allied actors want the people to believe) report a reduction in smoking, they are just making a big deal about a statistical blip.  There are many surveys that estimate smoking prevalence, and so in most any quarter it is possible to report on the “exciting new reduction in smoking” based on one of them.  It is also possible to report quarterly on the “exciting new increase in smoking” when the statistical blips go upward — but, of course, no one does that.

That said, there is every reason to believe that there is real downward move in prevalence because of the growing popularity of e-cigarettes.  Since almost all e-cigarette use is as a substitute for smoking, it is not hard to do the math.  It is also worth noting that the very modest downward trend in smoking in the US for the decade or so before e-cigarettes started to become popular matched almost perfectly the increase in the use of smokeless tobacco (which remains more common than e-cigarette use).

In other words, it is very plausible to claim that basically all of the reduction in US smoking rates in this century is due to THR.  Certainly if those of us who support THR were as innumerate and unethical  as the tobacco control industry (TCI), we would be insisting that this was a definitive fact.  This would be too bold a claim, but it is actually much better supported than the usual TCI claims, including most everything that appears in this article.  As good scientists and ethical people, we can claim that THR might explain all of the reduction this century, and that it almost certainly did cause a large fraction of it.

With any legitimate conclusion based on statistics it helps to have a worldly story that is observable in the data, not just hand-waving stories about what a number represents (and only wild guesses about whether the data is accurate).  For the most recent figures (as opposed to the statistical errors that created trumped-up claims for the previous decade), there is a very good reason to believe the decrease is real because we can see exactly what is happening:  Many smokers are switching to e-cigarettes, and very rapidly.

So what do Glantz and the other “experts” that the NYT talked to attribute the decrease to?  Hand-waving stories, of course.

As proof that the NYT reporter, Sophie Egan, was just acting as an unquestioning transcriptionist, note the mention of the claim that “researchers” say that seeing smoking in movies is a major cause of smoking, and thus Glantz’s campaign to reduce such images somehow has something to do with the reduction.  Of course, it does not appear that anyone other than Glantz and his beholden useful idiots actually believes that, and even hard-core TCI people have pointed out that it is nutty.

On the reality-based side, higher taxes are identified as a barrier to smoking.  Of course, in some places they are also a barrier to THR, but I am sure nuances like that are well above the understanding of the author or interviewees.  Also, given that this is an article about a prevalence statistic, it would have been nice to see (but obviously way too much to expect, given the limited sophistication of those involved) some mention of the concern that use of the black market created by those taxes may increase measurement error on the surveys (i.e., it is plausible that people who buy contraband will wisely choose not to admit that when the government asks, though we do not know).

Someone other than Glantz reported the plausible claim that smoking place limitations result in the reduction in the number of cigarettes smoked by smokers.  The obvious point that this does not actually relate to the thesis of the article — about prevalence being down — seems to elude Egan.  But though a tangential point, it does seem to be real and the reduction is better for smokers’ health.  Funny, though, that there is no mention that Glantz is the one leading the charge to deny that reducing smoking is good for your health.  This does not mean that the restrictions are better for smokers’ overall welfare, in contrast with THR.  Of course, to Glantz, their suffering is a good thing, which in the article he notes with, “It also creates environments that make it easier for people to quit smoking.”  Yeah, that’s it — easier.  As in “the beatings will continue until morale improves, because beatings make it easier for you to decide you had better obey.”

But the most important lie in this article (again, reported by Egan in her role as an unthinking transcriptionist) can be found here:

“The fact that we’re below this theoretical sound barrier of 20 percent is important,” says Stanton A. Glantz, a professor of medicine at the University of California, San Francisco, and director of the university’s Center for Tobacco Control Research and Education. “This data shows that the whole premise that there is this hard-core group, where no matter what you do you can’t get them to quit, is just not true.”

That “20%” claim sounds rather like the observation I have been pushing for a decade.  But, if that is what Glantz is invoking, he (unsurprisingly) does not seem to understand it.  What I have been claiming (and what one of my colleagues wanted to label “Phillips’s Law”, but since I am really averse to naming transitory social science observations “laws”, I vetoed that) is that once smoking becomes popular in a population, it is nearly impossible to reduce it below 20% of the population except as a result of product substitution — i.e., THR.  That is, a huge body of data strongly suggests that roughly 20% of the population gets such great benefits from smoking that they will continue to choose to do it even though it is very expensive (in terms of both health and taxes) and highly vilified — unless they discover a substitute that allows them to keep most of the benefits without the health costs.  (Note that this observation refers to natural populations, and not highly unusual or self-selected subsets (e.g., Manhattan residents, university professors) or people whose liberties are seriously constrained (e.g., people living in psychiatric clinics, prisons, or submarines).)

[I should point out that I have no idea if this is what Glantz is actually referring to.  Perhaps the TCI people, in their secret cabals, have their own notion of a “barrier of 20%”.  But if so, their version presumably does not recognize that THR (and only THR) offers that promise of blowing past the “barrier” — perhaps they do not like that it does so without coercion.   If so, their version is simply wrong and has been clearly wrong ever since snus became dominant in Sweden.  TCI people like to pretend that Sweden does not exist, but I have been there so I am pretty sure it really does.]

So, when quoting my observation correctly, the US statistics tend to confirm it, not contradict it.  Smoking prevalence perhaps edged below 20% in the 2000s (depending on which statistics you believe — it might be considerably higher), but substitution of smokeless tobacco accounted for more than the gap between the prevalence rate and 20%.  And thanks to e-cigarettes, it might have dropped another percentage point since then.  The whole point of the 20% observation is not that it is impossible to torture a population into reducing tobacco use below 20% if you get draconian enough, but that it is easy to get well below 20% if THR becomes popular.

People like Glantz and the NYT editors are dead-enders, fiercely fighting an already-lost war against THR.  By fighting on, they continue to kill people (the war is metaphorical, but the killing is literal) even though there is clearly no chance they will achieve their dream of a tobacco-free world.  Indeed, there is no evidence that they have accomplished anything positive in the USA and similar populations for many years.  All of the gains they claim credit for seem to be best explained by the growing success of THR.

CVP take on NICE Guidance

I finished writing up my views of the implications of the new UK National Institute for Health Care Excellence’s Guidance on one aspect of tobacco harm reduction.  They are in a fairly long post at EP-ology.

As a brief summary, there has been a lot of concern expressed about that Guidance because it is solely focused on “licensed” products (i.e., NRTs) as substitutes for smoking.  However, I am much more positive about it.  It does actively call for clinicians and information providers to advise smokers to switch or cut down using a low-risk substitute, even if the specific statements are only about a narrow and ineffective set of products.  This is positive in itself.  Moreover, there is almost no hint of negativeness about other THR products.  Thus, any educated and open-eyed reader (or those of us who wish to cite the Guidance as endorsement of our positions) can easily extrapolate the implications — everything they say about the benefits of THR using “licensed” products applies equally to other roughly-equally-low-risk products.

In addition, while the Guidance does not explicitly acknowledge the benefits of tobacco use, it does repeatedly cite what people want to do as a reason for this approach.  This is perhaps a bit subtle, but it is a radical position, recognizing that people get benefits from smoking that are, at least partially, replaced by substitute products, and that these consumption choices are something people want or might want, not merely diseases to be cured.

My new overview of THR

by Carl V Phillips

Every couple of years I write a short overview of tobacco harm reduction.  The latest (shorter than most — some would call that a good thing, but not me), by Phillips and Rodu, Tobacco harm reduction: opportunity and opposition, has just been published in a special issue of Drugs and Alcohol Today in a special issue on THR.

I have been told that the issue is supposed to be open access, but it is not yet anyway.  So you can read my final version of the paper (same text as far as I know) here.

Also in that issue is an interesting study by researchers at British American Tobacco about how general practitioner medics have little idea that THR is even possible, as well as a lot of other interesting stuff I have not been able to read yet (I will comment on the others if I get a chance).

CASAColumbia are liars

by Carl V Phillips

Normally we would not bother to respond to a letter to the editor that responded to a fairly typical news story about e-cigarettes.  No, it is not that the name is bugging us (they were probably CASA before we were CASAA, after all).  Rather, this seems to forebode the possible entry of a new tobacco control industry group into active campaigning against THR.

The group in question is The National Center on Addiction and Substance Abuse at Columbia University.  They justify their existence based on the following claim:

Today approximately 16% of the U.S. population age 12 and over meet clinical diagnostic criteria for addiction to nicotine, alcohol or other drugs and another 32% currently use one or more of these addictive substances in ways that threaten health and safety.  Together, addiction and risky substance use affect a staggering 48 percent of the nation—nearly every other American —and constitute the largest preventable and most costly public health problem we face.

Those are some remarkably precise statistics they are throwing around there, especially considering that they do not (anywhere I can find, and I looked) explain what “addiction” even means.  Or “risky” (anything that entails any risk? I believe that encompasses everything).  Or how “abuse” differs from “use” (usually it is implicitly defined as “any use that I personally do not approve of”, and it appears that they follow that standard).

Nor do they explain what constitutes the clinical diagnostic criteria for addiction to nicotine.  There are no such accepted criteria, though of course various people have thrown out quasi-definitions (never real definitions to my knowledge — they are always mere “I know it when I see it” checklists).  So what did they do, add up everyone who seems to qualify for one of those definitions?  By that standard, 100% of all people are idiots (just add up everyone who qualifies under someone’s statement of a sufficient condition for being an idiot).

It is not as if there is disagreement about their basic premise.  Most tobacco use (except in Sweden) is quite bad for the user.  Much of the use of alcohol and other mind-altering drugs is bad for the user and also creates serious problems for the rest of society.  But never trust those who try to dress up their political activism in these areas with junk scientific claims, and that seem unaware that many people like to use these drugs (or tries to hide that fact behind weasel words like “addiction”).  For when as someone goes down that path, you can bet that their targets include the rational and beneficial use of drugs by thoughtful adults.

To wit, the attack on e-cigarettes in that letter to the editor, signed by Jeffrey B. Lane, chairman of the board of CASAColumbia, which states:

E-cigarettes are a very effective delivery system for the addictive drug nicotine. Nicotine is particularly dangerous for our children, since early use increases the risk of addiction involving both nicotine and other drugs.

Not off to a good start there.  It is difficult to justify the “very effective” claim given how much less effective existing e-cigarettes are at delivering nicotine than is smoking.  But, moving on from the random silly statement to the lies, what do we know about children using nicotine?  Nothing.  We know a fair amount about children smoking, but there is basically no data about children who use just nicotine.  There is a bit of information about children who use smokeless tobacco, which is closer to “nicotine” than to smoking in most ways.  But do we know that any of these “increases the risk of addiction”?  No.

This is basically the classic “gateway” claim used by drug-warrior types.  Even setting aside the lack of definition of “addiction” all we really know is that an inclination to use the products in childhood is associated with use as adults.  But does the use really increase the risk of “addiction”, or is this just the obvious point that “deciding to do something is an indication that you like to do it, and therefore someone who makes that choice at a young age is more likely to do so later, as compared to someone who displays a lack of interest from the start”?  That is, is early use causing later use, or just predicting it?  We do not know because the “research” on the topic generally fails to distinguish these (largely by design, I would venture).

Flavorings like chocolate, cherry and peach are clearly not aimed at the typical middle-aged consumer seeking to quit an addiction involving tobacco, and these products have not been proved to be effective in accomplishing that goal.

I trust I really do not have to explain why this is a complete lie.  I should note that it quite probably the case that Jeffery B. Lane is so clueless about this topic that he actually believes this is true, and that so the lie is claiming expertise.  It does pretty much put CASAColumbia squarely in the mainstream of anti-harm-reduction activists, and their willingness to say anything — without regard to whether they know it to be true — to further their pet cause.

It appears that CASAColumbia is really more anti-corporate than they are pro-health, as is often the case for “public health” types.

With its enthusiastic endorsement of e-cigarettes, the tobacco industry is once again marketing the disease of addiction to this most vulnerable customer base. As the old saying goes, “The best way to get a lifetime user is to start him early.”

More than one in seven Americans already have the disease of addiction. Are we prepared to knowingly stand by and allow Big Tobacco to increase that number in the name of profit yet again?

So the “tobacco industry” is marketing the products to children?  Well, e-cigarettes sellers (whether they are part of what is normally known as the tobacco industry or not) are allowed to advertise their products, so you can look at the advertising and see that it is clearly targeted at existing smokers.  The ability to advertise contrasts with cigarettes that so many children start using, that somehow are still attractive in spite of the ban on using effective marketing methods.  So if the goal is to sell e-cigarettes to kids, rather than selling them cigarettes, no one is doing a very good job of it.  You might think that experts on tobacco use would realize all this.  (And you would be right — experts do realize this.)

As for that “old saying”, I have never heard it before.  I googled it and the only hit for any similar sentence was this letter to the editor.  Of course, if you are making up statistics, why not make up old sayings too?

But the real telling bit is in that last sentence — that evil profit.  Because we certainly do not want big, effective, efficient corporations providing people with something that they want and that reduces their health risks.  Oh, no.  Improving people’s health has to be left to little, ineffective, inefficient activist groups, and as for making people happier — well no one should be doing that.

It was always clear that the entry of major corporations into the e-cigarette market (whether tobacco companies or otherwise), though extremely promising for public health, was going to mobilize out the anti-corporate types in opposition to THR.  (E.g., that seems to be the explanation for Glantz who had not previously attacked THR.)  Fortunately, this probably does not matter much.  But it is worth noting that when they jump in, they always seem to lead with lies.

Coffee, not cigarettes

Outsource to myself:  I just posted my analysis of why I think it is time to start pushing the message that tobacco harm reduction is not just about harm reduction.  I posted at EP-ology rather than here to make clear that I was speaking for myself, not on behalf of CASAA.  But I think that anyone who reads this blog will want to read it.

(The title here refers to the observation that low-risk tobacco products are a consumer choice that is basically equivalent to drinking coffee, and very different from smoking cigarettes.)

CASAA’s take on the recent move by MHRA

For those who read this blog but not the main CASAA blog, you might be interested in our assessment of the UK MHRA’s move to require that e-cigarettes be approved as medicines.  You may find our analysis of what regulation by MHRA would look like to be somewhat more optimistic than what you might have read elsewhere.  However, we are rather more concerned than some other commentators about its implications for the EU.

Stanton Glantz – liar or innumerate? New evidence says: both!

by Carl V. Phillips

I am working on a couple of things that will lead to some original research appearing here.  In the meantime, I will contribute to some ongoing discussions.

As my readers will know, I have had a long-time hobby project of trying to figure out to what extent that anti-tobacco extremist Stanton Glantz, a professor at UCSF (I assume he teaches innumeracy), is just utterly clueless about what he claims expertise in, or whether he is intentionally lying.  You can search the archives and see that I have come to lean toward “intentionally dishonest” quite often, but he still offers enough detail about some of his claims that suggest he just does not understand simple scientific points.

Readers of this blog will know there are many of each kind of liar.  My casual empiricism suggests that most institutions identified as anti-THR liars intentionally lie while most single individuals who are identified simply do not know what they are talking about (in which case their intentional lie is to claim expertise that they do not have and to try to inappropriately influence others’ beliefs).  On the other hand, when individual anti-THR liars are at respectable universities, the trend shifts to them apparently knowing that they are lying.  Of course, the anti-smoking operation at UCSF resembles a respectable university only in the sense that it takes place indoors.  Bottom line:  No clues about Glantz from general principles.

To find further evidence, consider a story that has been covered in two posts by Michael Siegel, about Glantz’s interpretation of a recent research paper.  The paper reported on a study of smokers who called “quit lines”, and was a basic overview of who they were, with a bit of semi-useful follow-up data.  Like any such study, it is not very informative about anything, but not useless, and the authors seemed to understand this.  The paper emphasized e-cigarettes, and the study asked why those who tried them did so (mostly to try to quit, of course).  One of the observations in it was that those callers who had tried e-cigarettes in the past were a bit less likely to quit during a period after calling the quit line than those who had not.  (Surprise! People who tried a very effective method for quitting but still kept smoking were the type of people who would not then quit a short time later.)

To be clear, the authors did not suggest any causal claims about this.  Several commentators criticized the study authors for doing biased anti-e-cigarette research and drawing inappropriate conclusions.  But if you read the paper, they really did not (the introduction about e-cigarettes was rather naive, but that is just a throw-away).  Moreover, when they blogged about it, they actively disputed the inappropriate interpretation (subtext: they smacked Glantz down rather thoroughly), rather than employing the “public health” tactic of embellishing headline-generating claims that were not even in the paper.  All in all, very respectable and honest work by the original authors.

Glantz, in what appeared to be a demonstration of his lack of knowledge of even elementary-level epidemiology, interpreted the study as evidence that e-cigarettes do not help smokers quit.  He seemed genuinely unaware of what the study actually showed, even though any second-semester student should have been able to figure it out.  There are some very basic epidemiologic concepts (selection bias, immortal person-time, unhealthy survivor effect) that anyone with a basic understanding of the science would see make it impossible to draw the conclusions that he did.

Basically, any smoker who “survived” the use of e-cigarettes and remained a smoker (i.e., trying e-cigarettes did not take them out of the study population) is necessarily someone for whom e-cigarettes are not an easy path to quitting.  The mere fact that they were able to be studied meant that they are not among those who e-cigarettes were a good way to quit.  Obviously this shows that e-cigarettes do not work for everyone (no shock there) but tells us nothing about how often they do work.  Moreover, the fact that they tried e-cigarettes and also called a quit line suggests that they are looking for a personally acceptable way out of smoking and not finding it.  Studying such a population can be interesting for some purposes, but obviously not for purposes of drawing conclusions about smokers in general.

The study authors understood this and presented it (though, I would argue, not as clearly as they could have).  Expert readers noticed it without needing that clarification.   Glantz, however, seemed genuinely oblivious, so score a point for the “innumerate” theory.

However, the plot thickens.  Because this is a rare case where someone spouting a very specific anti-THR lie is actively shot down by the very people he claims to be citing, any further repetition of the lie is a clear indication of intentional dishonesty.  As Siegel noted, it had been clearly pointed out to Glantz by himself and the study authors (and this was such a one-person issue that there is no possible way he did not receive multiple copies of each of these), and yet he persisted in making the exact claims, in particular in a radio interview.  Score a decisive point for the “intentional liar” theory.

So the answer seems to be both.  That is, Glantz seemed to have genuinely made the elementary error in his initial analysis, and seemed to believe what he was saying.  And yet after he was definitively corrected, he kept saying it.  So:  Innumerate about the field he works in and actively dishonest in his public statements.  He certainly chose his career path wisely, finding one of the few jobs for which those are considered beneficial traits.