Monthly Archives: August 2013

The Florida Department of Health are liars (and innumerate)

by Carl V Phillips

Perhaps as a tribute to our nation’s great accredited schools of public health, the Florida Department of Health recently blasted the world with junk science claims based on incorrect research methods and basic innumeracy.  What they were trying to do was issue dire warnings about children using e-cigarettes, but mostly I think they succeeded in issuing a different warning to parents:  Do not let your children study public health!

The Florida exaggerations are already being used in anti-e-cigarette propaganda.  For example, they appear in the actual language of the bill to effectively ban e-cigarette sales in NYC (it would ban flavors, which are obviously rather critical to the product.)  (See this recounting of the language.)  The claim was that 40% more high school students tried e-cigarettes in 2012 than the year before, which is not actually what the data shows.  According to the Florida DoH Fact (sic — and LOL) Sheet about this (not dated, but clearly from earlier this month since that was when it was press-released), their surveys found that 6.0% of such students had tried an e-cigarette in their 2011 survey and 8.4% in 2012, which they described as a “40.0%” increase.  Numerate readers will immediately notice that (a) the uncertainty in the survey means that there is absolutely no way they can make a claim with three significant figures and (b) the third digit is undoubtedly wrong, and probably the second too, since they apparent rounded the other results to two sig figs and then did the calculation.  (Credit to the above news story for correctly rounding this to 40%.)  So, basically, public health people lack grade 7 level math/science training.

Rather worse in their reporting is describing this ever use statistics as “prevalence of this behavior”, meaning they did not understand the one semester of epidemiology they took in public health school either.  The word “prevalence” is inappropriate, and thus misleading, when describing an “ever” statistics.  Since “ever” ratchets (once you are in that category, you can’t go back), it is basically inevitable that there will be an increase in a population that is 3/4 the same people from one year to the next.  This misreporting may partially explain why the equally innumerate people in the NYC Health Department misinterpreted the result (lied) by saying the number who tried e-cigarettes that year had increased by 40%.  And, of course, if they had emphasized the more useful number, that 8% of high school students reported ever having tried an e-cigarettes, even just one puff, the number would not have been impressive at all.

The statistics are not legitimately reported even if we believe the point estimates are exactly right.  After we consider random sampling error (not reported), response bias (clearly a problem, but completely ignored), and measurement error (I know that I always gave random data when asked to do some intrusive survey like this when I was in school) the results are pretty meaningless.  The only reason that we should believe the trend at all (that there has been an increase) is that it is pretty much inevitable, not because if their data.  Needless to say, given these basic errors in reporting, we should doubt the accuracy of their numbers also.

But even if we start with their basic numbers and ignore their errors and sensationalism, what can we make of it?  How many of those who tried e-cigarettes were regular smokers?  Quite possibly all of them, since the rate of current smoking is higher than the number who have merely tried an e-cigarette, but we will never know because they suppressed that information (which they apparently do have).  How many of them had tried at least one puff of a cigarette?  I would guess approximately all.  How many of them are of legal age to use tobacco products, as many high school students are?  Again, they intentionally hid all that information.  It is difficult to see such obvious omissions as mere incompetence — they are clearly intended to mislead readers.

Similarly, they lied about current use.  They did this mainly by referring to “tried at least one puff in the last 30 days” as “current use”.  Moreover, their numbers for recent trying (which is what this really is, not “use”) are very low —  half or less the figures for “ever tried”.  So, of course, the propagandists did not mention them, hoping that sloppy readers would mistake “ever tried” for “uses”.

It is interesting to note that as a portion of those who had ever tried, those who had taken one puff within 30 days dropped substantially from 2011 to 2012.  Since many of those who have only tried e-cigarettes on a few occasions must have done so within any given month, this shows that a rather small fraction of those who have tried an e-cigarette did it very often after that (let alone qualified as genuine “current users”).  This is especially true for the 1.8% of middle school students who had tried in the last month (compared to 3.9% who had ever tried), since they would have had relatively few total months in their history that they might have tried them.  Nevertheless this was breathlessly reported as having “increased by 20.0%” (emphasis and that same sig fig error in the original), and it is that statistics that has been repeated in subsequent propaganda, rather than the low absolute numbers.

What can we make of this?  Well, we know what the ANTZ want to make of it, as quoted in the press release (attributed to the American Cancer Society):

We do know that e-cigarettes can lead to nicotine addiction, especially in young people who may be experimenting with them, and may lead kids to try other tobacco products, many of which are known to cause life-threatening diseases.

Of course, we most certainly do not know that e-cigarettes can lead to addiction.  There is not the slightest piece of evidence to support that claim.  Notice that the Florida data itself shows that most of those who try e-cigarettes have not tried one in the last month — if this is addiction, then that ANTZ word has become even more meaningless than it was before.  Nor is there any evidence that e-cigarettes cause anyone to use other tobacco products.  And, of course, only cigarettes and their minor variations (not “many” products) are known to cause life-threatening diseases (though it was amusing to see the implicit claim in that that e-cigarettes do not cause such diseases).

Honest people looking at this data can conclude almost nothing meaningful, other than that e-cigarettes exist.  Is it possible that all the students who are using e-cigarettes are current or former regular smokers using them for THR?  Yes — it is consistent with what was reported that every last one of them is.  Could experimentation with e-cigarettes be causing other net reductions in risks in this population?  Yes — those who are experimenting are the ones who are most likely experimenting with other drugs or behaviors that can do a lot of harm.  If using an e-cigarette is displacing underage drinking, it is contributing even more to harm reduction than it does when it displaces smoking.

E-cigarettes are used by people almost exclusively to replace a much more harmful behavior.  Students are people.  Why then, exactly, is the assumption that when they are using them, there is net harm?  Of all the drugs or other youthful dalliances that kids might be engaging in, it is difficult to imagine one that is less harmful than e-cigarettes (or smokeless tobacco), except maybe coffee, and even then it is not clear which is less harmful.

Lies and conflict of interest

by Carl V Phillips

Chris Snowdon understands what constitutes true conflict of interest, and provides us with two critical observations about it relating to THR.  I point out that he understands it because most people who invoke the concept, especially those who make it a centerpiece of their rhetoric, clearly do not have a clue about what it means.

Conflict of interest occurs, to put it clearly enough that even those who harp on the concept might understand, when there is an interest someone is supposed to be serving (perhaps due to their job description, but possibly just because of how they are representing themselves), but there is something about that individual that might cause them to favor some other interest that is conflict with the one they are supposed to be serving.  Notice that this is not remotely similar to the usual naive misunderstanding of the concept, that COI exists if and only if someone has received funding from industry.  Indeed, notice the funding is not only not sufficient for COI to exist, but it is not necessary.

For example, when Stanton Glantz humorously tried to take on Igor Burstyn’s science, he had a severe conflict of interest:  He was pretending to offer a scientific analysis, and thus was obliged to fulfill the interest of being an honest scientific analyst, but because Glantz is really motivated entirely by personal politics when he is pretending to be a scientist, there is a conflict of interest.  By contrast, if Glantz has published his screed and had made clear his real goal — “here are some talking points that those of you who wish to deny what this study demonstrated can use” — then there would have been no COI.  This is because his personal politics would be perfectly aligned with the interest he claimed to be serving, so there could be no conflict.  Whether some interest creates a conflict obviously depends on what interest you are claiming to serve.  That should seem rather obvious, but again is apparently completely over the head of almost everyone who presumes to make a big deal about COI.

In this brief but completely damning post, which he quite rightly describes as the “conflict of interest of the week”, Snowdon reports on a director at a smoking cessation clinic complaining about the success of e-cigarettes in taking away his clients.  The director includes an attack on vaping as part of that.  So, what interest is a government-funded smoking cessation employee suppose to be pursuing?  Smoking cessation, of course.  If he is objecting to successful smoking cessation it must be because he is more interested in serving some other interest, say, keeping his job.

In this much longer post, Snowdon explores how COI seems to being the defining factor in government decision-making about e-cigarettes.  The interest of a government official is supposed to be the interests of her constituents or the people.  Snowdon recounts a recent story that, by itself, is the typical naive COI story:  The expert panel that advised the UK MHRA on e-cigarettes included people who had gotten grants and contracts from pharma companies.  Left by itself, that is a major *yawn* — everyone with any skills in health research has gotten grants/contracts from pharma companies.  But treating that as if it were somehow noteworthy in isolation is exactly what most commentators did.  Would the influence from such funding alone cause someone to lie?  Doubtful.

But contrast, Snowdon goes on to put this in the context of the outright bribery that seems to dominate EU parliament votes related to tobacco and THR.  Of course, the EU is pretty much purpose-built for COI.  The representatives are so incredibly far from their constituents, and barely monitored by them or the press, and live in a disconnected world that is all about power and connections and prestige (and thus the handing out of material benefits).  Europe still loves monarchy (though if you have real monarchy there is no COI because there is no obligation to the people — l’etat c’est moi).

Snowdon leaves it to us to connect the dots, but I think he is pointing out that perhaps we should be rather more wary about observations that might suggest there might be a hidden COI (even though they do not themselves represent a real COI) among decision makers.  A history of a few grants and contracts means nothing, unless it is a corner of a serious COI scandal.  It is as if we were considering tobacco industry behavior and we were still living in 1975 (which, apparently, most of tobacco control thinks is the case) and there were subtle hints of tobacco company influence over decision makers.  That would be in the context of definitive evidence of improper influence elsewhere, and would suggest extra scrutiny.  Except in this century, of course, it is everyone other than the tobacco industry that seems to warrant the extra scrutiny.

Finally, it is worth noting that while the prospects of personal financial gain might explain the behavior of the MEPs, I actually think it is way down the list of important COIs that caused people to lie about e-cigarettes in the other cases.  Tobacco control and smoking cessation people are probably much more conflicted by the desire to personally be responsible for health benefits, a self-centered but not precisely selfish motive.  That is, they are desperately afraid that the goal will be achieved in spite of them rather than instead of them.  This interest conflict severely with the goal itself when the world moves on and the goal is better served by what others are doing.

Blogiversary

by Carl V Phillips

It is one year today that we started this blog.  The mandatory basic stats for such a post:

  • 159 posts
  • Just under 90K page views
  • 985 comments

I was really hoping for 100K views, but disappointment is my penance posting almost nothing for two months of that.  Besides, I will just assume that the difference was covered by those reading on feeds or reblogs, or those reading more than one post when visiting the homepage. :-)

I do notice that some of the oldest posts, some of which are quite significant, accumulated less than 200 views.  I will try to do some archive revisits.

More important than the basic stats is that I think we have put the fear of Truth into quite a few people by calling them out on their lies.  Several of them got very quiet.  This blog is just one little corner of that effort, of course, but the combination of effective archiving and search (unlike chat networks), credibility, and being willing to directly confront the lies (unlike most other credible blogs) give it a unique niche.  And, yes, I have kind drifted away from focusing on the Lies, and I should probably make an effort to start back on them.  The archive project will help with that.

And who knows, maybe there will be fewer lies during the next year.

(kidding)

Does anyone really believe in freedom? (other than us, of course)

by Carl V Phillips

Bear with me.  This ends up on-topic.

Today I experienced the remarkable coincidence of having twitter arguments (which I never ever do, because trying to converse on twitter is stupid[*]) with two professional colleagues, who are also friends,  They would generally be regarded as pretty much, respectively, left-wing and right-wing by many observers, and both (I would venture to say) see themselves as staunch defenders of the rights and freedoms of individuals.  Both conversations consisted of me challenging them over statements that struck me as harmfully anti-freedom.

[*To avoid any risk of unintentional offense, I will explicitly point out that this parenthetical is self-referentially ironic, self-deprecating, and obviously false.  A gentleman never offends someone unintentionally.]

From the left came an attack on the U.S. government trade negotiators, who are objecting to proposed special tariffs on cigarette imports (probably all tobacco products, actually) by countries in a free-trade zone.  Just to clarify, free trade would still allow them to impose sales taxes and other restrictions on tobacco sales, as is common — they would just not be allowed to favor domestic products over imports by adding a special tax on the imports.  My friend is an expert economist and acknowledged the great value of free trade, but argued that for these particular products, the health concerns outweigh the value of freedom.

My point (to the extent that I could make it using 20 word bursts) was basically: Who gets to decide what is the one exception to a useful principle of freedom, that one thing that is unlike any other?  (This is rather similar to the classic political science question, Who guards the guardians?)  One minority, which happens to hold a lot of sway over several governments right now, believes that tobacco (notice I did not say “cigarettes”) is the one item that rises to that level of exceptionalism.  Other minorities, some of which hold sway over some governments, are quite certain that the “so bad that it constitutes the unique exception” category is books, or “blasphemous” artwork, or Hollywood movies, or any recreational drug no matter how benign.  Still other minorities (mostly without much sway in the world) would make exceptions to free trade (in support of their personal political goals) for certain foods, coffee, children’s cartoons and toys, petroleum from Canada, etc.

My point was not that there is a slippery slope (though that may be true also), but rather is why should anyone get to decide that their favorite cause, no matter how good a case they think there is for it, constitutes the exception to a valuable general freedom (which in this case, the commentator agreed is valuable), especially when many people disagree with their view?  The answer is, of course, that despite the timeless insights of Madison, Jefferson, and many others, it is difficult for anyone to accept the value of a principle or process (be it freedom or anything else), no matter how important it is, when it conflicts with their gut view about what people ought to be doing.

There is also the problem that many people subconsciously think their political faction will remain in power or soon be in power and stay there, so there is no worry about the harm that would be caused by someone else imposing their “bad” views about what exceptions should be made.

I had a friend (much older than I, obviously) who had been personally attacked and seriously harmed by the Joseph McCarthy witch-hunts by the U.S. government.  And yet he was the staunchest paleo-liberal believer that government was the solution to most every problem.  Continuing the irony, his academic and political career was devoted to fighting for particular freedoms in the education system, but he was very much on the losing side when I knew him.  His preferred version of the system had been completely crushed by actions of the Bush administration and many states.  And yet he remained opposed to, say, free-choice in education that would allow some enlightened people to pursue his vision, because he was subconsciously certain that his side would ascend to power and be able to impose the choice throughout the system.

Coming from the political right today on twitter was an endorsement and continued defenses of this horrible editorial at a magazine/website that is a flagship for the self-proclaimed “libertarian” movement.  The commentary criticized — indeed, aggressively ridiculed — prisoner Chelsea Manning (nee Private Bradley Manning, US Army, the Wikileaks leaker) for declaring her new name and gender identity today.  Setting aside the author’s glaring ignorance of the difference between gender and sex (you think he might have bothered to learn that before opining on the issue), why would a supposed defender of liberty attack someone for exercising this most intimate of personal freedoms?

Seriously — if they were looking for a way to support the widespread stereotype that people who adopt the political identity “libertarian” are mostly just extremists of a different sort who merely pretend they are all about liberty, then they could not have done much better.  Keep in mind that the author and my friend were not criticizing, say, an illiberal government dictate that the press must refer to someone with her preferred gender pronoun even if their stylebook calls for basing that on sex rather than gender.  They were attacking her for declaring her new gender and politely requesting that others respect it.

Why would libertarian commentators proactively tout this message that serves no apparent purpose other than announcing, “just as you might have suspected, we really only believe in the liberties that we personally (or our rich patrons) want to exercise — beyond that, we have the same illiberal ‘moral’ preferences as anyone else”?  The answer is, of course, in my phrasing of the question.  Very few people, left or right, no matter how dedicated to individual rights and freedoms they geninely believe themselves to be, can overcome their personal moral/emotional/subconscious disgust, disdain, or mere patronizing looking-down-upon about the choices that some other people want to make.

And that brings me back to on-topic, as promised.  I have often said that the choice of what to smoke/chew/vape/inject/snort/etc. is the most intimate personal choice after the choice of who to sleep with.  (I think I may need to put the choice of gender up above it now too, though that is a comparatively rare consideration.)  But there is a remarkable tendency of people who engage in one of those behaviors that is under attack from a special-interest minority (say, vaping) to join in the disdain for people who engage in another one of those behaviors that is under attack from a special-interest minority (say, smoking).  I notice that the vaper-vs-smoker bickering seems to have flared up again on twitter (I need to get out more, don’t I?).

Most notoriously, the International Harm Reduction Association (now known as HRI) aggressively rejected the adoption of tobacco harm reduction as part of their goal because, well, defending the rights of junkies is important, but tobacco use is just Irredeemably Bad.  In an interesting contrast, the pro-cannabis activists seemed to have played an important role, alongside CASAA and others, in finally defeating the proposed California restrictions on e-cigarettes this week.  Unfortunately, this may not represent a move toward “we drug users are all in this together, so let’s make common cause”, but rather was because they wanted to protect the availability of hardware that is similar to e-cigarettes for their drug of choice.  Once their political position is more secure, I am not sure we can expect their help again.

As one comment on the anti-Manning editorial noted, that commentary represented an attitude that is born of privilege.  If someone is quite sure they will never have need to exercise a particular freedom, it is easy to forget all those nice words about individual freedom and react only with personal policy preferences or disgust.  Someone who would never consider smoking (or smoking again) finds it all too easy to attack cigarettes, smoking, and smokers and not notice the similarity of that to attacks on their belief in the sacred right to vaping, or smoking weed, or being GLBT.

You see my point, so I will be brief in my conclusions:  My dear fellow THR advocates and practitioners, you have seen and felt the threat to freedom from the anti-THR special interests.  Realize that you cannot credibly argue for your favored personal freedom while attacking someone who is exercising another  very personal freedom.  Try to persuade smokers to adopt THR while still respecting them as allies even if they are not persuaded.  And perhaps even think a little bit about non-tobacco freedoms and seek common cause with their defenders.

There is no proof (except when the authors wants there to be)

by Carl V Phillips

I finally have a few free minutes while others tinker with the document I have been working on, so I thought I would comment on something that struck me about a post from Chris Snowdon this morning.

In the post, Snowdon rightly ridicules the UK National Health Service for bragging about their programs to assist smokers who want to quit, which he points out reached very few people, with minimal success, and at rather great expense.  I found myself taking the thoughts one step further, and questioning whether even the claimed modest NHS accomplishments really occurred.

What struck me is that the anti-tobacco cadre who claim that this (and other similar smoking cessation programs) are a success is the same crowd that will deny clear evidence of THR success, based on such claims as “correlation is not causation; we do not know anything until we have randomized trials”.  As in, there is no proof that Sweden’s low smoking rate is due to substitution of snus, or that reductions in cigarettes sales that match increases in e-cigarette sales mean that e-cigarettes are replacing smoking.

In this particular case, there is apparently not even a correlation.  The NHS provided a service, and a tiny number of people who availed themselves of it quit smoking.  Did the success rate go up with intensity of effort?  It does not sound like it.  Did those in the system quit with a greater success rate than similar people not in the system?  Perhaps, but quite probably not — but NHS does not seem to have even tried to figure that out before declaring victory.

Of course, these tactics — believing anything that tends to support one’s position and denying everything that does not using made-up-on-the-spot rules about what evidence “counts” — are common across all dishonest activists.  The same tactics are used by those who wish to deny the health risks from cigarettes.  Hardly a day passes when I do not see these tactics used by spokespeople for some industry (including, I should note, the e-cigarette industry though, to my recollection, never in modern times by the major tobacco companies).

Here is the flyover takeaway message from this:  There is no proof in empirical science (i.e., there is no proof in the real world, only in constructed systems like mathematics).  We sometimes use the word to mean “overwhelming evidence”, of course.  But anyone who tries to make an argument about what is true in the world that hinges on the concept of proof either does not understand what they are talking about or are trying to mislead you.

Almost any data allows us to make some inferences about cause and effect.  But no data ever proves it.  Moreover, there are no simple recipes — analysis is required.  Some data are easier to interpret better than others, but data is not the same as knowledge.

When someone claims causation merely because the data shows one event followed another (as with the NHS), that is clearly not adequate analysis.  But at the same time, when someone just cries “correlation is not causation!!!” with no further analysis to explain why the particular correlation is apparently not causal, that is arguably even worse.  Don’t trust anyone who makes a habit of doing either one of these.  Anyone who does has demonstrated to you that they are not seeking to discover the truth, let alone to tell you the truth.

ANTZ engineer their next anti-ecig lie: They facilitate smoking cannabis

by Carl V Phillips

I am back from the recent FDA TPSAC hearings (my live blog/commentary is not too far down the CASAA Members Facebook page for those interested).  During the public comments period (in which only special-interests, not the public, were represented this time — CASAA decided to sit this one out), the ANTZ groups (Legacy, CTFK) kept making vague references to the risks that consumers would tamper with “MRTPs”.

(For those who do not know, “MRTP”=”modified risk tobacco products”, which were the main focus of these hearings, is FDA-speak for anything that is lower risk than a standard cigarette.  It is a very misleading collection, since it includes everything from minor modifications of cigarettes that might or might not reduce risks by 10% to smokeless tobacco which is definitively demonstrated to be about 99% less risky.  It is also a dumb term since many of these products are not “modified” — they are what they have always been — they are just different.  Finally, the word “modified” could refer to either increases or decreases, so what they really mean is lower.  I am tempted to say that the government is a clear and present threat to effective communication, but they are hardly the only one so that would be a bit glib.)

My reaction to these references to tampering were WTF are they talking about?  These are consumer products, designed to be used in the quantity and with the particular behavior preferred by the consumer.  “Tamper” is a meaningless concept in that concept.

What was immediately apparent, though, is that whatever they meant, it was the next orchestrated campaign of anti-THR lies.  As I noted in the previous post, the anti-THR extremists and other ANTZ maintain semi-secret channels of communication in which they engineer talking points that can then simultaneously be stated by the various paid activists and their useful idiots at the same time, as if it were something people were really thinking.  It is the same thing political parties do (and entirely different from what honest and truth-seeking organizations and associations do).  Sometimes these talking points are so utterly inane, like the one I discuss next, that you would think that the press etc. would figure out that they are engineered lies.  (Who remembers the classic when they got their useful idiots to recite “Camel Snus packages look like cellphones (i.e., they are rectangular with rounded corners), which appeal to chiiiildren”?)

As soon as I had a chance to think about it for a few minutes, I realized that my CASAA colleagues had already picked up on some of the chatter and identified one of the meanings of these bizarre claims:  The ANTZ plan to claim that e-cigarettes should be restricted because the devices can be used for vaporizing certain cannabis products.  The reason this is a lie is not because there is not a developing technology for vaporizing a cannabis wax in devices that are quite similar to e-cigarettes — such technology is developing.  The lie is that this has any bearing whatsoever on the regulation of e-cigarettes.

First, vaping a wax requires a different atomizer and not just any cartridge/tank.  (The batteries can be the same, of course.  Batteries are batteries.)  Thus, it is not like someone can just put the wax in an e-cigarette that is designed to vape an aqueous liquid.  They need new hardware.  This contrasts with combustible tobacco products which are easily used to smoke cannabis leaf (sprinkle or roll some in, set it on fire).

Second, the liars are going to try to imply that the supply of cannabis vaping equipment can be eliminated if e-cigarettes are banned.  But see the first point: different equipment is needed, and so they are not diverting that from e-cigarettes.  But maybe we could stop cannabis users from getting, say, eGo batteries, if the e-cigarettes supply chains are banned.  Um, people, they manage to get cannabis.  Do you think that the supply chain that provides this can perhaps expand to include the hardware too?  Do you think maybe it already has?  I am sure that the ANTZ puppet masters are smart enough to know this, and thus know this new campaign is a lie, though their useful idiots include a lot of idiots (in the basic sense of the term) who can be tricked into believing that somehow the chiiiildren would not be using weed because were it not for e-cigarettes.  As I said: idiots.

One additional point:  Vaping cannabis is almost certainly less harmful than smoking it or than the devices that are normally called vaporizers in that world.  (The latter are called “heat-not-burn” when used for tobacco, and the guess is that they are perhaps about half as harmful as smoking, maybe somewhat less, but that still makes real vaping a lot less risky.)  If the ANTZ do not abandon this talking point quickly, as they usually do with their dumb claim of the month, but stick with it, we could use it to drive a wedge between them and the real public health people who support harm reduction for illicit drugs.

Thinking about this further, I realized there was a second implication to these bizarre pronouncements about the risks of tampering, this one more of a hand-tipping about a future threat, rather than a lie per se.  The statements by the ANTZ at the hearing yesterday included references to altering delivered doses.  But, of course, using your snus or modding your e-cigarette to get the dose you want is just part of using it — as I said, the notion of tampering simply makes no sense.  So, what would make that bizarre claim make sense?  If the ANTZ managed to persuade the government to impose restrictions on the physical properties of low-risk products (most likely e-cigarettes, not smokeless tobacco, for obvious reasons) such that they could not be used the way consumers wanted to use them.

So the ANTZ are tipping us off that a core part of their plan, given that they have failed in their attempt to ban e-cigarettes, is to cripple them.  Banning flavors (such that “tampering” consists of adding flavor) is an obvious example, though it does not relate to the point that they hinted at, restricting dosage.  But there are others the come to mind:  Forcing a shut-off of the device after a certain number of puffs over a certain period.  Restricting battery options or tank sizes.  And, of course, limiting nicotine strength.

So do not be surprised when these attacks on THR start flying from every direction.  You are warned.  Now make sure that we push back against the engineered “tampering” campaign any time these attacks pop up, rather than treating these as random stupid comments that will just disappear on their own.

Glantz vs. Burstyn – hardly a fair fight

by Carl V Phillips

Ok, I am giving in to all the lobbying I have gotten to respond to Stanton Glantz’s inane attack on the Burstyn study.  I will call it my Sunday Science Lesson for the week.

I am not going to bother to submit at Glantz’s page because though Glantz makes is page look like a blog, it really isn’t — he censors out any comments he does not like.  (That, of course, is not true here — he or anyone who agrees with him is free to respond in the comments without fear of censorship.)  Indeed, at the time of this writing the only comment allowed, despite several readers of this blog reporting that they wrote comments, was one by a clueless supporter of Glantz who clearly did not even read the paper (I am not addressing that, but it is addressed by Konstantinos Farsalinos here).

[UPDATE: Not too long after this post was published, several comments submitted on Glantz’s post that had already been posted in comments in this blog but had not been left unapproved by him for days were allowed to post.  Funny that.]

I am pretty sure that Prof Burstyn is not going to be interested[*] in wandering over to see the ramblings of Glantz and other anti-scientific extremists, so this will also serve the purpose of letting him know what was claimed.

[*The passage from Alice’s Adventures in Wonderland comes to mind:

“But I don’t want to go among mad people,” Alice remarked.  “Oh you can’t help that,” said the Cat. “We’re all mad here. I’m mad. You’re mad.” “How do you know I am mad?” said Alice. “You must be,” said the Cat, “or you wouldn’t have come here.”  ]

My first observation is that Glantz’s attack serves as  a testimonial that he recognizes that Burstyn’s paper is important and a threat to anti-scientific lies about e-cigarettes.  Glantz responded about four hours after the paper became available — not really enough time to seriously read a new paper, let alone think through how to comment on it.  This was a clear example of panic.  The panic was not about the study being used in advocacy or showing up in newspapers — that will happen slowly, over the course of months or years, so there would be no need to hurry.

No, it was quite clear that he was panicked about the ANTZ’s useful idiots hearing about it and possibly learning something their puppet masters did not want them to know.  I am talking about the people working in county public health departments, GP medics, etc., who genuinely care about health and thus would support THR if they knew the facts, but whose misplaced trust has made them victims of the anti-THR liars like Glantz.  If they heard about this before they could be pre-propoagandized, they might learn something.  So Glantz’s junk response was rushed out through the (not-entirely-secret) secret communication channels that are used to keep the useful idiots in line.

(For those who do not know, the ANTZ mostly communicate through these secret channels, in contrast with the behavior of truth-seeking or public-interested advocates, who communicate openly.  They do this because (a) they know that if the made their claims in the light of day, their lies would be ripped to shreds and their useful idiots might rebel and (b) like most political (i.e., not truth-seeking) groups, they like to create the illusion of a consensus by instructing hundreds of seemingly unrelated people to “spontaneously” make the same observations to the press, hiding the fact that this is really just a few thousand people trying to look like they are a broad political movement.)

So, I award one point to Burstyn for Glantz’s panicked reaction.

Skipping first to the end, and Glantz’s only substantive claim in his attack:

The analysis also ignores the high levels of ulttrafine particles e-cigs generate that can trigger inflammatory processes and trigger heart attacks and respiratory problems.

This is actually LOL funny if you are enough of a geek.  Those two links (in the original, of course) are to fairly arcane statistical analyses of epidemiologic data, so they cannot actually tell us anything about mechanisms (like inflammatory processes), only observable population outcomes.  However, if Glantz were not so averse to using honest science, he actually could have actually supported this claim using relevant evidence about the tissue effects that has been done by tobacco companies (example).  But his citations and all the research that actually supports his claims are about the effect of combustion products.

The lung and heart problems result from solid particles, whereas e-cigarettes produce liquid particles (aka aerosol or droplets) which have entirely different properties.  Some types of small solid particles can lodge deep in the lungs, creating problems over time, or travel into the bloodstream, maintaining their form, and do damage elsewhere.  Small liquid particles do exactly the same things as larger ones in the lungs — they transfer the liquid through the lung (there is nothing to lodge), which is then diluted into the blood (there are no longer any particles).  Indeed, it appears that small droplets are probably better because devices that apparently deliver smaller droplets (e.g., using bigger batteries) seem to be preferred by consumers (though I would expect that in Glantz’s anti-humanitarian view, “preferred by consumers” is a bad thing).

Glantz presumably knows that e-cigarettes produce liquid particles, since it is right there in Burstyn’s paper, as well as being common knowledge about e-cigarettes.  Moreover, Burstyn points out that chemistry studies that have been used to suggest there are inorganic solids in the vapor are misleading, since they do not assess what molecular form the metals were in; he points out that they were most likely dissolved salts (i.e., part of the liquid).  Thus, apparently Glantz’s problem (this is the LOL part if you are geeky enough) is that he does not understand the difference between liquids and solids.  This perhaps explains why he had to leave mechanical engineering (where not knowing the difference between liquids and solids can be rather disastrous) and go into anti-tobacco extremist activism (where it is not such a problem to not know… well, anything).

So, clear point to Burstyn there.

Circling back to his less substantive points, he leads with standard ANTZ drivel:

This paper uses  the same approach to risk assessment that I remember from risk assessments done of secondhand smoke years ago by tobacco industry apologists that concluded that secondhand tobacco smoke could not produce any adverse health effects.

What same approach to risk assessment?  Reviewing studies?  Calculating exposure levels?  Putting exposure levels in a useful perspective?  Basing conclusions on data rather than political goals?  Writing in English?

Of course this paper uses the same approach to risk assessment as other approaches to risk assessment.  Someone with a great deal of experience at doing such research (Burstyn) is going to use the accepted methods (though since he is one of the great epidemiologic thinkers of his generation, I am confident that he used the best of these, and did not blindly follow what is typical).  Someone who does not actually read much (Glantz) is going to notice that these look a lot like the only other risk assessments he has ever looked at.

Notice that Glantz’s statement is designed to make his typical sloppy reader believe that he said “there are elements of this analysis that are similar to Evil Evil Tobacco Company analyses of ETS and different from what is normally done in the analyses that are used to make exposure policy.”  But he does not say that, does he?  (The above quote is everything he says.)  He could have given even a single example of how Burstyn’s analysis had something in common with the studies he denigrates (though notice he does not actually find fault with them) and that differs from those used to make thousands of regulatory decisions about airborne exposures, but he did not.  Presumably he had nothing in mind beyond misleading innuendo.

This is such a stupid claim by Glantz that perhaps it would be too generous to award Burstyn a point for it, but Glantz definitely gets a -1 penalty for it.

Glantz follows that with:

The first problem with this study is that it compares levels of various toxins in e-cigs with threshold limit values (TLVs) which have been published by the American Council of Government Industrial Hygienists using that are generally viewed as not health protective.  In addition, as noted in the report, TLVs are for occupational exposures.  Occupational exposures are generally much higher than levels considered acceptable for ambient or population-level exposures. Occupational exposures also do not consider exposure to sensitive subgroups, such as people with medical conditions, children and infants, who might be exposed to secondhand ecigarette emissions.  Finally, even when setting allowable occupational exposures, regulatory agencies like OSHA often establish tighter standards than TLVs, and often those tighter levels have been criticized as not being health protective.

His basis for that claim about “not health protective”?  Burstyn explained and defended the choice of the TLVs; Glantz tries to trick his readers into believing that Burstyn just made a random choice without justification. Burstyn points out that occupational standards are actually rather conservative (i.e., highly protective) when we are talking about an intentionally-chosen exposure.  We all engage in countless activities that expose us to hazards that, if they were an involuntary hazard that was being forced upon workers in order to be able to keep their jobs, would not be allowed, or at least there would be mandatory mitigation measures imposed.

Glantz’s only basis for this attack appears to be quotes from Wikipedia — I did not notice before that this is what he links to (another LOL moment!).  The rest of that sentence is a close paraphrase of a sentence in the Wikipedia entry (and both the entry and Glantz assert the claim without support).  So Glantz is relying on an unsupported statement by an anonymous author (which might even be himself) of a single line of a general-knowledge encyclopedia.  (For those who may not know, Wikipedia is an excellent source for countless areas of inquiry, but every scientific expert knows that it fails miserably — for fairly obvious reasons — when dealing with controversies in science or science-based policy.)

But setting that aside, let us assume that Glantz genuinely believes there are better standards to compare an exposure to.  Fine.  That almost starts to look like a comment by someone who is actually seeking the truth.  Indeed, in private comments, several reviewers of the paper who are actual peer reviewers (i.e., expert enough to provide useful comments) have suggested that the next version make comparisons to some other standards too, which would show that the conclusions do not depend on the choice of standards (so long as Burstyn avoids absurd standards like an EPA standard for formaldehyde that apparently makes being in the same room as yourself an unacceptable hazard).

But Glantz’s statement only almost looks like that of someone interested in the truth.  Someone who was minimally attempting to seek the truth would have suggested a specific alternative comparison.  He makes a vague allusion to OSHA standards (again, apparently quoting from Wikipedia), but does not actually say “I think this would be better”.  Someone who was both seeking the truth and expert, and trying to be useful, would go so far as to pick one of those alternative standards and compare it to Burstyn’s numbers (a fairly simple exercise).  Even someone lacking the numeracy to be able to do that, but who was interested in the truth, could say something like “if he were to compare the levels to Standard X and still find that they were non-problematic, then I would believe him.”  But of course Glantz did not do any of that, because he already guesses that the answer will not support him, so he does not want to commit to ever believing any science.  He already plans to come up with some other rationalization for ignoring the truth when this one is shown to be wrong.

Notice also that he brings in the chiiiildren.  He implies that Burstyn’s analysis was about ambient and population exposures.  Is he lying to his useful idiots or just incapable of understanding the paper?  We cannot be sure.  But those of us who did understand the paper know that the numbers analyzed are for the exposure to the vaper herself, and that any second-hand exposure is noted to be orders of magnitude smaller still.  That is, the second-hand exposure is not merely well below the TLVs; it is orders of magnitude lower than the numbers that are already well below the TLVs.  Burstyn never tries to compare the exposure of bystanders to TLVs or any other standard because he reports that those exposures are so unimaginably low that it makes no sense.

Burstyn does not make the point that someone who has a medical condition that contraindicates e-cigarette use should not use them, but he does point out that it is a voluntary exposure and the rest obviously goes without saying.  And, of course, Glantz does not identify what conditions he might be talking about, he just vaguely waves his hands because he does not want to get pinned down so that he cannot change his story later.  (I will believe that he actually cares about second-hand exposure — rather than just using it as a rationalization for fighting THR — the day he recommends that smokeless tobacco should be endorsed over e-cigarette use, or even just over smoking.)

So, one point to Burstyn for explaining why occupational standards are actually conservative, a clear victory over Glantz just lifting some vague and unsubstantiated claims from Wikipedia.  One point to Burstyn for pointing out that the second-hand exposures are orders of magnitude less than the vapers’ exposures, a clear victory over Glantz trying to pretend this is not the case.  Because I cannot find anything else that could possibly earn Glantz a point, I am going to take pity and give him one for the very charitable interpretation of this passage as saying “you should probably include comparisons to other published exposure limits in order to make the accuracy of your conclusions more clear.”  However, I am going to penalize him a point for relying on Wikipedia for claims about a scientific controversy, just as I would penalize any undergraduate, let alone graduate student.

Finally, Glantz ends his missive with a random ad hominem attack on me.  This is especially pathetic because, obviously, I am not even an author of the study.  He attacks Burstyn because he mentions me in the acknowledgments.  It is like second-hand ad hominem (1000 times less harmful than the already inconsequential implications of an ad hominem attack).   The content of the attack is basically, “Phillips does not share my irrational hatred of tobacco products and tobacco companies.”  I will take that as a complement.  This is especially the case because I have repeatedly pointed out (and endorsed others pointing this out too; no links because there are too many to track down), based on actual analysis, not ad hominems, how Glantz is both scientifically clueless and dishonest.  And yet the best he can come up with about me, after all that, is that I do not share his irrational hatreds.

Another -1 for Glantz for exposing us to second-hand ad hominem, and even though I am not actually in the match, I am going to award myself a point for the fact that he cannot come up with even a single criticism of my analyses.

So the final score:  Burstyn gets a hat trick plus one, and Glantz nets negative one, which puts him behind me, even though I was not even on the pitch.  Come to think of it, it also puts him behind the 7 billion other people who have not entered the conversation at all.

A really good day for THR (navel gazing)

by Carl V. Phillips

I am assuming that there is no one reading this who did not already see yesterday’s post, so I will not even include a link.  The release of Igor Burstyn’s paper was huge for THR, making clear that the apparent risk from vaping is not only lower than the anti-THR liars are trying to portray it, but probably even lower than those of us who are interested in the truth and familiar with the science thought.

On the same day, we won a victory in the fight against inappropriate e-cigarette bans and learned of an amazing success story about THR in a clinical setting (I am seeking permission to report that story here).  Small scale in comparison to the study, I realize, but it makes for a good day.  And at the even smaller scale and purely personal level, first thing yesterday, before writing the blog post and the release of the study, I did what turned out to be great interview on talk radio.

It all added up to me thinking, “this is one of the best days in the history of THR”.  Not top five, but I found I had a hard time pushing it out of the top ten.  As you might expect, that got me thinking about what other days should appear on such a list.

The top few on the list definitely include the release of the seminal Rodu and Cole paper (Nature, 1994) that was the first major science and ethical statement in favor of THR, and when Judge Leon prevented the US FDA from banning e-cigarettes here in 2009.  I am also inclined (though obviously biased) to include up there the appearance of TobaccoHarmReduction.org, published by my research shop at University of Alberta in 2006 and updated for a few years after that; we got more press about that in Canada than “World No Tobacco Day” (the day we chose to release it) did, and the website is the source of a huge amount of the current popular wisdom about THR, even among many people who got here later and have never heard of it.  (Like the 1994 paper, it is still out there but quite dated now, and yet still is often read — though I would recommend against citing it for any purposes other than historical analysis.)  I am also inclined (and obviously biased) to include the creation of CASAA near the top.

At that point, I decided to crowdsource it.  Any thoughts from biases other than my own?  What are the best moments?  It definitely does not have to be an identifiable day, but I am looking for the relatively concrete and not just general phenomena (i.e., the gradual appearance of e-cigarettes on the market does not count, nor the gradual success of THR in Sweden).

It would be great to include the introduction of specific THR products into particular markets, which does tend to involve a clear moment in time, but sadly most of those efforts flopped (maybe Camel Snus?).  One or more of the moves by big companies into e-cigarettes might prove important, but it is hard to tell now, and for similar reasons hard to be sure something like the founding of NJOY should make the list; in such cases, it is tough to say that something really made the world different, rather than merely being a matter of who edged out competitors that would have been almost exactly the same.

No political victory compares to 2009, but what are the candidates for the list? Defeating the proposed New York ban?  The original MHRA decision to allow THR to be an “indication” for use of a product would surly be high on the list, but for what has come later that seems to make that part of a larger picture that does more harm than good — so include it?  The granting to Sweden of an exception to the anti-health EU snus ban comes to mind, but since Sweden would presumably not have joined the EU without it, it does not seem to count.

What other research publications?  It is really hard to identify many individual publications that had much of an impact.  Rodu’s book from the 1990s or others by him?  There are a few candidates about smokeless tobacco.  The nascent research on e-cigarettes does not seem to offer candidates — there are good and useful studies, but no game changers other than yesterday’s.  I am partial to a few of my other publications, but I can’t say they made much of a splash at the time; my 2006 calculation about comparative risks is quoted constantly without people knowing they are doing so (“99% less harmful”), but it is hard to identify any “moment” for that one

Prominent policy opinion statements?  The first Royal College of Physicians report on the topic is a clear candidate.  (But please do not suggestion Clearing the Smoke — bleah!)  Was there an identifiable moment for Bates launching his backing of THR (I honestly forget — getting old)?  I can’t think of any clear “moment” for Godshall or Stimson, but maybe there was one.  (All three of you read this, so I demand answers!! ;-)  IHRA embraced THR for about five minutes, but we subsequently lost that fight, so no credit there.

So that is my brainstorm.  Should be enough to get some thoughts flowing.  Your turn.