Monthly Archives: January 2014

ASH UK lies to censor criticism: bogus legal claim against critic

by Carl V Phillips

As you know if you read this post from a few days ago, @TobaccoTacticss is one of the most spot-on critics of the lies and other evils of the tobacco control industry.  The anonymous author is also clearly strong supporter of THR.  Thus, it is in the interests of all of us who dare criticize that rich, powerful, and genuinely evil industry to publicize the fact that ASH UK is attempting to censor that feed.  (I.e., please publicize this, write your own blog about it, etc. to whatever extent possible.)

[UPDATE: This is being done.  Enjoy in particular this tweet and the blog it links to.]

@TobaccoTacticss received the a notice from Twitter that several posts had been removed based on this complaint:

== Reported Twitter account: @TobaccoTacticss

== Description of original work: Several copyrighted photographs taken from our flickr account.

== Description of infringement: – Copyrighted image modified to misrepresent our views.
https://twitter.com/TobaccoTacticss/status/420866659708985344
(original image: http://www.flickr.com/photos/ashuk/8740223787/)
– Fake newspaper article including one of our copyrighted images (also infringing the Telegraph’s rights): https://twitter.com/TobaccoTacticss/status/421670854020190209
– Fake book cover including one of our copyrighted images (also infringing Penguin’s rights):
https://twitter.com/TobaccoTacticss/status/420849895096864768
– use of copyrighted image without authorisation
https://twitter.com/TobaccoTacticss/status/420675013914533888

== Reported Tweet URL: https://twitter.com/TobaccoTacticss/status/420866659708985344

== Where does this Tweet link to?: n/a

== Where does this Tweet link to?: I have confirmed that the infringing material is available for download at the linked site as of the submission of this notice.

——-

== 512(f) Acknowledgment: I understand that under 17 U.S.C. § 512(f), I may be liable for any damages, including costs and attorneys’ fees, if I knowingly materially misrepresent that reported material or activity is infringing.

== Good Faith Belief: I have good faith belief that use of the material in the manner complained of is not authorized by the copyright owner, its agent, or the law.

== Authority to Act: The information in this notification is accurate, and I state under penalty of perjury that I am authorized to act on behalf of the copyright owner.

== Signature: Nicolas Chinardet

Note that the links all seem to still work at the time of this writing, though the images have been removed from the tweets.

Let’s hope that the liability statement there gets put into practice.  As you may know, both the UK and the USA (the relevant jurisdiction is probably California, where Twitter is based) have clear exceptions to copyright restrictions that say that copyrighted material can be displayed (within broad bounds) for purposes of parody or critical analysis, both of which @TobaccoTacticss is clearly engaged in.  Thus this complaint is blatantly contrary to the laws to which ASH is appealing.

But more important, think about the ramifications of this:  The tobacco control industry is so desperately worried about anyone criticizing what they are saying that they will take (illegal) legal action to try to stop it.  They realize they are incapable of defending their claims on the merits.  They do not engage in any public debate with their critics (they will talk to a few pet “critics” in stage-managed settings, but pretend that their real critics do not even exist). Censorship is the tactic of someone who has only power, not truth, on their side.

Since we truth-seeking writers really despise censorship on principal — even apart from liking the content of what was censored — here is my contribution to Streisand Effecting this material.  Please join me in that.

As of right now, three of the perfectly legal parody images can be found at http://imgur.com/a/7RTIH, and the original for the fourth deleted image is at http://www.flickr.com/photos/ashuk/11338567545/sizes/l/ but since that might change too, here they are (and the author of the parodies has declared them to be in the public domain, so do not hesitate to copy and repost):

GdVdaWX

kw2pMHY

RJHEckx

XRa1A0L

11338567545_0e9837335a_b

Since wealth and power often triumphs over truth and the rule of law, it seems quite possible that @TobaccoTacticss will be shut down in the near future.  If so, I will be sure to point everyone to wherever it is resurrected.

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Letter re fatal flaws in Schober et al. paper on environmental vapor

by Carl V Phillips

Below is a letter to the editor and Igor Burstyn and I will be submitting to the journal that published this article — “Use of electronic cigarettes (e-cigarettes) impairs indoor air quality and increases FeNO levels of e-cigarette consumers” by Schober W, Szendrei K, Matzen W, Osiander-Fuchs H, Heitmann D, Schettgen T, Jörres RA, Fromme H — which made alarmist claims about the content of exhaled e-cigarette vapor and the biological effect on users.  It is wrong on almost every count, with the conclusions not supported by the data and various other problems.

This might come as a shock to all of you who believe in the perfection of the academic journal system, but journals are often not so good about publishing letters that point out that articles they published are fatally flawed (in spite of that wonderful institution of peer review!).  So this might be the only place it is published.  Please point to it any time someone inaccurately suggests the claims made by those authors actually reflect their results.

Note in particular the analysis of “particulate matter”, which is a good general response to any of the anti-THR liars who traffic in alarmist rhetoric about particles, either out of scientific illiteracy or actual malice.  [Update: Thanks to a useful observation by McFadden in the Comments, we have updated this discussion.  The new bit is underlined (which is obviously just to illustrate the update here and will not be included in the submitted version).]

——

The recently published article by Schober et al. [1] about environmental air pollution from e-cigarette use suggests lab error, misunderstanding of the measured results, and unacknowledged political bias on the part of the authors.  The authors should be commended for analyzing the e-cigarette liquid as part of this study of the aerosol, which has been noted as a serious omission in past research [2].  The outcome measurements, however, are suspect, and the conclusions even more so.

The methodology is poorly described:  The authors seem unaware of the fact that vaping behavior strongly influences the environmental release of the aerosol from e-cigarettes, and failed to either control or report relevant details about subjects’ behavior.  Experienced users can maximize efficiency and almost eliminate environmental release, whereas new users (or experienced users who are intentionally producing visible clouds at the cost of inefficient consumption) can release a large portion of the aerosol into the environment.  The authors fail to report the efficiency of the behavior, though we know they recruited inexperienced users (smokers who were only briefly instructed on how to use e-cigarettes).  The environmental measures were higher when the users were using nicotine-free e-cigarettes (Table 2), which demonstrates the behavioral effects: without nicotine, the users have no reason to puff in a way that efficiently absorbs the aerosol.

The authors emphasize the increase in PAHs in their test chamber, but correct use of e-cigarettes does not produce PAHs.  This suggests either the inexperienced users were overheating their devices, the devices were faulty, the PAHs were outgassing from the users (who were smokers), or lab error.  In past studies, high PAH values have been attributed to lab error, probably cross-contamination with cigarette smoke, which was seen as calling all the study results into question [2,3].  But even if the results were not lab error, they do not appear problematic:  The authors show no increase in the most carcinogenic PAH tested (benzo[a]pyrene) and all other reported “increases” were within experimental error reported by the authors.

Results about metals that are presented without attempting to determine the parent molecule are misleading, evoking thoughts of dangerous molecules, but probably actually representing common harmless ones [2].  The presences of sodium almost certainly represents trivial quantities of NaCl.  The authors emphasize aluminum, but that seems also likely to be in the form of biologically unimportant salts.

Results about FeNO exhalation (Figure 1) are intriguing but simply confirm that there is no evidence that there is a biological effect: In half of the subjects there is a weak effect (those with high baseline of FeNO) and there is no effect in subjects with low baseline FeNO.  It is likely that if the data were represented as percent change of baseline, there would be no systematic increase. This suggests there is nothing more than experimental noise that the authors interpreted as meaningful.  Further investigations of biomarkers in exhaled air, if done on a large scale and under representative vaping practices, could prove informative about early effects of vaping on health.  The present results can only be viewed as reassuring, in contrast with how they were spun.

The authors found (Figure 2) that subjects’ urinary nicotine concentration increased after using nicotine-free e-cigarettes, which they attribute to the subjects smoking, contrary to the stated methodology.  Whatever the explanation, it indicates a serious error in the methodology which was inadequately investigated.

The biggest problem, suggesting both a lack of understanding and possible political bias, is repeatedly referring to the aerosol droplets as “particulates” and suggesting they behave similarly to solid particles.  While droplets are particulates in the broadest sense of the term, in the context of environmental pollution that term generally refers to fine solid particles that can lodge in or be absorbed through the lungs intact.  A liquid, of course, just dilutes into the bloodstream or other bodily liquids, regardless of particle size and deposition location.  Thus, the extensive discussion of particulate size, let alone the explicit claims about health implications, is highly misleading.  Indeed, the results they found are not all that different from the “particulate” exposure when someone takes a cold shower in terms of both “particle” size and concentrations [4], which illustrates the need to characterize the tiny bits of matter that disperse light, not merely determine that they exist.  The device the authors used to detect “particles” does not distinguish between droplets and solid particles; to assess any health-relevant particles the authors should have used gravimetric techniques that determine the mass of solid particles emitted into the air.  As such, the authors’ work suffers from inadequate testing of their major conclusion and confirmation bias: they assumed health-relevant particles would be present in the aerosol, performed a test that was incapable of ruling that out, and then interpreted their results as confirmation.

The authors demonstrate a further political bias – not disclosed in their conflict of interest statement – by (1) cherry-picking the existing biomarker literature, (2) making unsubstantiated claims about motives for using e-cigarettes, (3) including an irrelevant (and inaccurate) discourse about the effects of nicotine, (4) suggesting that the policy-relevant comparison is between a straw man, “emissions free,” and any emissions whatsoever, and (5) recommending restrictions on e-cigarettes.  They fail to assess the implications of their results for bystanders, the crux of their political claims, which would show how trivial the impact would be even assuming their results were valid.  It is, of course, impossible to make a legitimate policy recommendation without analyzing all the impacts of the proposed policy; context-free results from a single study are clearly not sufficient.  Various regulations may or may not be warranted, but that cannot be determined based on the mere observation that e-cigarettes are not “emissions free.”  The inclusion of such recommendations in a research report suggests that the authors were just doing the science as an excuse for expressing their political beliefs.

Carl V Phillips, PhD, Scientific Director, Consumer Advocates for Smoke-free Alternatives Association (CASAA), USA

Igor Burstyn, PhD, Associate Professor, School of Public Health, Drexel University, USA

1. Schober W, Szendrei K, Matzen W, Osiander-Fuchs H, Heitmann D, Schettgen t, Jörres RA, Fromme H. Use of electronic cigarettes (e-cigarettes) impairs indoor air quality and increases FeNO levels of e-cigarette consumers. International Journal of Hygiene and Environmental Health, 2013 (online publication ahead of print).

2. Burstyn I. Peering through the mist: systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks. BMC Public Health 2014, 14:18.

3. McAuley TR, Hopke PK, Zhao J, Babaian S: Comparison of the effects of e-cigarette vapor and cigarette smoke on indoor air quality. Inhalation Toxicology, 2012, 24:850–857.

4. Zhou Y, Benson JM, Irvin C, Irshad H, Chen YS. Particle size distribution and inhalation dose of shower water under selected operating conditions. Inhalation Toxicology 2007, 19(4):333-342.

Jane Brody turns up the NYT’s lies about THR, e-cigarettes, etc.

by Carl V Phillips

The New York Times has some good health science reporters, but their best known health writer, Jane Brody, has been a reliable embarrassment for that newspaper for decades (and it takes a lot to embarrass the newspaper that led the drumbeat to start the disastrous war with Iraq, repeating and even embellished the claims about WMDs).  It might not be fair to blame the newspaper itself for one writer who seems to have managed to learn nothing of the science she has written about forever, but for the fact that the paper has been editorializing against THR also.  So blame for the lies should go to both the author and the editors.

The first of her two-part series on tobacco product use is no worse than typical Brody standards.  It focuses on the 50th anniversary of the 1964 Surgeon General report on smoking, and the burst of associated activity.  It is typical naive transcription of the standard claims, many of which are exaggerations of the risks from smoking or are otherwise not quite right, but are mostly not too harmful.  It is specifically remarkable that someone who is supposedly an expert would declare that her husband’s cancer death — 15 years after he quit smoking — was definitely caused by smoking.  (Yes, it is certainly quite possible it was caused by the smoking, but that long after cessation, there is a good chance it was not, as anyone who understood the science would know.)

It is tiresome to read the naive and self-serving claims of the tobacco control industry repeated once again (hey, we can’t expect a reporter to bother to check whether there is any real basis for what she is being told, can we? reporters are far too busy to do that).  But most of them do relatively little damage to the world.  That is, until they spill over into denigrating proven-effective smoking cessation methods in favor of the self-serving failed approaches of the TCI, which is where Brody goes in her second post.

She claims:

[CDC Director] Frieden and public health specialists everywhere are seeking better ways to help the 44 million Americans who still smoke to quit and to keep young people from getting hooked on cigarettes.

And she might actually be naive enough to believe that claim.  As I said, she is known for having a remarkably poor understanding of what she presumes to write about.

The reality, of course, is that “public health” people are the active opponents of the better ways that are emerging.  The only proven method of substantially further reducing smoking is THR.  But instead of embracing it, “public health” continues to come up with even more absurd and socially burdensome interventions that accomplish approximately nothing.

Brody’s litany of claims about the wonderful effectiveness of the ruling class’s anti-smoking methods is so antiquated it appears to be a joke.  She spends a quarter of the post on WHO’s 2008 pabulum regulatory guidelines and even mentions, as if were news, a year-old proposed tax increase.  Strangely, she apparently did not read her own first post, which laments how all interventions to date have proven inadequate.  Logical consistency has no place in tobacco control or, apparently, NYT reporting.

Before getting to the part that matters most, it is worth calling out this:

“A higher cigarette tax is not a regressive tax, because it would help poor people even more than the well-to-do,” Dr. Frieden noted.

Frieden and Brody should both take a minute and look up what “regressive tax” means.  But even aside from this being a bald lie,  just pause and think about the mindset behind it.  The ruling class has decided that imposing a huge punishment on poor people helps them.  After all, if the savages are not beaten, they will continue to sin.  The only thing missing is “qu’ils mangent de la brioche.”

Brody’s actively damaging lies start after that, as she concludes her discussion of how not enough has been done to reduce smoking with an attack on the one recent innovation that has dramatically increased cessation:

Electronic cigarettes are being promoted by some as a way to resist the real thing. E-cigarettes, invented in 2003 by a Chinese pharmacist, contain liquid nicotine that is heated to produce a vapor, not smoke. More than 200 brands are now on the market; they combine nicotine with flavorings like chocolate and tobacco.

Setting aside the first common misconception (e-cigarettes were invented at least as long ago as the 1960s and the current form was invented by an American in the 1990s), how clueless do you have to be to say they contain “liquid nicotine” (rather than a very diluted nicotine solution) and that there are only 200 brands?  Ok, so far it is just illiterate, but not harmful.

But their contents are not regulated, and their long-term safety has not been established. In one study, 30 percent were found to produce known carcinogens.

Not regulated — just like the vast majority of the (largely useless) cessation methods she recommends in her post.  Not established — as opposed to the wonderful long-term safety of the approach her husband used, which was to repeatedly fail in his attempts to quit smoking until (according to her) smoking finally killed him.  Seriously, is she even reading her own prose?  And don’t even get me started on the NYT’s supposed expert health reporter falling for the “produce known carcinogens” silliness (hey guess what, Jane, 100% of humans tested produce known carcinogens).

Dr. Frieden said that while e-cigarettes “have the potential to help some people quit,” the method would backfire “if it gets kids to start smoking, gets smokers who would have quit to continue to smoke, gets ex-smokers to go back to smoking, or re-glamorizes smoking.”

Yes, and it would also backfire if it caused a resurgence of smallpox, triggered a nuclear war, or was a prelude to an invasion by space aliens (as I have speculated it might be — have you seen some of those mods?).  Too bad we do not have an institution in society whose job it is to ask questions of government flacks, like “so, is there any reason to believe that is a real risk?”

Nearly two million children in American middle and high schools have already used e-cigarettes, Dr. Frieden said.

And, of course, that was a lie.  But, hey, it is not up to the transcriptionist to check the accuracy of what she is writing.

In an editorial in the Canadian Medical Association Journal last year, Dr. Matthew B. Stanbrook, an assistant professor of medicine at the University of Toronto, suggested that fruit-flavored e-cigarettes and endorsements by movie stars could lure teens who would not otherwise smoke into acquiring a nicotine habit.

Well then, a random medic speculated about this.  And demonstrated his expertise by being able to write it down.  Must be true.

A survey in 2011 of 75,643 South Korean youths…

A minor aside, but anyone who does not even know how to round numbers to leave out irrelevant detail should not be reporting about science.  Nor should anyone innumerate enough to quote Stanton Glantz as if he had even half a clue about science.

…in grades 7 through 12 by researchers at the University of California, San Francisco, revealed that four of five e-cigarette users also smoked tobacco. It could happen here: Stanton A. Glantz, the study’s senior author and a professor of medicine at the university, described e-cigarettes as “a new route to nicotine addiction for kids.”

That is the note she ends on:  most teens who even tried e-cigarettes were already smokers, and therefore we better put a stop to it.

Ms. Brody, I suggest you go back and read your own posts, and then ask yourself:  Who is it that is dooming millions of people to keep smoking, as your husband did?  Could it perhaps be those who are lying about the benefits of switching to a low-risk alternative, a group that now includes you?

This is what local public health looks like, Iowa edition

by Carl V Phillips

Granted, the position statement on dissolvable tobacco products by the Iowa Counties Public Health Association matters very little to the world (though at CASAA we do like to highlight absurdities from Iowa, the new home of one of our directors).  But it tells us a lot about how phenomenally clueless “public health” people on the ground are. They should really stick with practical matters they understand, like restaurant inspections — and you do not want to think too hard about the implications if their understanding of how to do restaurant inspections is as poor as their understanding of tobacco.

Keep in mind that this statement was published this month (h/t Jan Johnson for reporting it), not two years ago.

Background: In response to increasing restrictions on the use of cigarettes and other products limited by the implementation of smoke-free air acts in multiple states, the tobacco industry has produced and begun to distribute new dissolvable products including Orbs, Strips, and Sticks, and Ariva and Stonewall tablets. Flavored tobacco products are considered the potential third wave of tobacco addiction.

Notice that they lead with the top-down “it is all about us” presumption that I analyzed in detail recently.  They then go on to mention five products.  The first three, from RJR, have been dismal failures (which is 1/3 a shame:  the Strips and Orbs are as unappealing as NRT, but the Sticks were a good product, and smokers who tried them often found them a very good substitute; I have suggested to RJR, only half-joking, that they re-launch the Sticks as “battery-free eco-friendly e-cigarettes” or something).  The other two lozenge products, from Star Scientific — very much not part of “the tobacco industry” — have been off the market for more than a year.

I have no idea what the “third wave of tobacco addiction” even means.  Despite their passive voice assertion, I have never heard that phrase before.  But I suspect it is not compatible with “all of these products sunk beneath the waves because they never caught on with consumers.”

I could probably just stop there and observe just how amazingly clueless the anti-harm-reduction industry’s local useful idiots are.  But a bit more…

Concerns regarding the potential health impacts of these products include the following.  These products are not FDA-approved cessation products. They do not help people end their addiction to nicotine.

Um, how is either one of those a health impact?  And, actually, they kind of are/were FDA approved, in the sense that FDA has jurisdiction over them but has not quashed them.  They may or may not help people end their “addiction” — given their minimal sales, it is hard to argue that there is evidence that they do, but clearly there is no evidence that they do not, as is asserted.

Dissolvable tobacco contains higher levels of nicotine than cigarettes. The typical cigarette will give the smoker a dose of between 1 and 2 milligrams of nicotine over the time it takes to smoke the cigarette (10 min or so). These products are designed to dissolve in the mouth in 3 (strips) to 10 (tablets) minutes but they can also easily be chewed or swallowed whole. Arriva delivers about a 1.5 mg dose, Stonewall delivers about 4mg.

Seriously, these are the people who presume to be offering advice to others. Swallow nicotine and very little of it gets absorbed.  The numbers for those (non-existent) products are — or, rather, were —  the nicotine content of the objects, not how much gets absorbed.  They cannot even get the time periods right (e.g., the strips dissolve in less than a minute and so give a bit of a kick, though not nearly as much as a couple of puffs on a cigarette; the lozenges, if you can stand them, last a lot longer than a cigarette).  Do you think anyone involved with this report even talked to someone who had used one of these products?

These products are intentionally marketed in colorful packages, sweet flavors, and convenient sizes that are very attractive to youth and are very easy to hide. Kids can use them at school, at home–anywhere. Their discreet form, candy-like appearance, and added flavorings may make them very attractive to children, and increase the risk of unintentional ingestion of toxic levels of nicotine. Further, access to these products may increase youth initiation and addiction to tobacco products.

Yes, that has always seemed like a concern ANTZ should have about NRT (except for that “toxic” bit — you would have to consume more product than you could shove into your mouth to get to toxic levels).  Oh, wait, you say, they were not talking about NRT?  No, they must have been, because those dissolvables had about the least appealing packaging I have ever seen, whereas NRT is pretty much packaged to look like candy.  (Btw, if you have never read the “study” at that link, you really should — I think it is the funniest thing I have ever written.)

Of course, what is most clueless about this whole 2014 position statement is that they obsess about products that were removed from the market in 2012 and yet fail to mention that the currently most interesting existing product in this whole NRT/dissolvable tobacco sector (they are basically the same niche) is RJR’s Zonnic.  They are strangely silent about the evils of the tobacco industry selling an NRT product.  It makes the tortured distinction between NRT and dissolvables a little too obvious.

Dissenters argue that tobacco products already cannot be legally sold to anyone under the age of 18; however, these products are being aggressively marketed to youth via social media channels. Youth will access these products in many ways, including from legal purchasers, just as they have done with other illicit products in the past.

Once you stop laughing (remember, this was published this month), consider that this is something we do not make a big enough deal about:  These same people who predict that e-cigarettes, etc., are going to have some horrible impact also claimed the same thing about dissolvables, which basically no one consumed.  I suspect there are more kids using meth in Iowa than ever used dissolvables.  We need to point out that they use the same dire language about everything, regardless of being proven wrong in the past.

Policy Recommendations:  To prevent tobacco-related disease and death, ICPHA recommends three measures designed to control the sale and distribution of these products within Iowa based on ordinances that were recommended by the Linn County Board of Health to the Linn County Board of Supervisors:

Read:  The biggest clueless obsessives in the word, re this issue, live here in Iowa. Thus we should defer to them.

Prohibit the sale of Dissolvable Tobacco Products;
Prohibit the sale of Buy One Get One Free Tobacco Product Offers; and Prohibit the Distribution of Smokeless Tobacco Samples at Qualified Adult-Only Facilities.

Did you catch their analysis of the dangers of BOGO and ST samples in their claims?  Neither did I.  (I left out a bit because it is tiresome to respond to the same lies all the time, but nothing about those.)  This is what public health looks like:  Write the conclusions based on whatever personal bias you happen to have; write some words above them; don’t worry if the latter have nothing to do with the former.

Oh, in case you wanted to weigh in on this:

Comments are closed.

Wouldn’t want to risk someone pointing out how clueless they are, would they?

Nicorette ad celebrates the glamour of smoking; tobacco control mysteriously silent

by Carl V Phillips

Another in the series of examples of what we can learn if we just look carefully at what “they” are saying.  It is not quite as smack-to-the-head revealing as yesterday’s, and it is not nearly as important as the one before that, which I think is critical for anyone who is serious about advocacy (and not just wanting to engage in feel-good chatter) to understand.  H/t to @MattGluggles for tweeting a video of a Nicorette video advertisement that adulterates various old movies to show the actors sucking on the Nicorette inhaler instead of the cigarettes they were actually smoking.  I have seen it before, though I cannot say for sure whether it was on television.

Without getting into the general crime of advertisers (as well as Disney, Broadway, etc.) trying to misappropriate every great work of art in the human domain, in order to dumb it down and profit from it, we can observe that this is a blatant attempt to celebrate and then borrow the glamour of smoking to sell NRT.  This contrasts with most e-cigarette marketing, that tends to denigrate smoking, or at least apologize for it (“no foul odor”, “does not affect those around you”, etc.).  But I have not heard a peep of complaint about this ad from the usual suspects who complain that e-cigarette marketing somehow glamorizes or “renormalizes” smoking.  I would be surprised if there has been any such peep.

The reality is, of course, that advertisements for a substitute for cigarettes — NRT or e-cigarettes — sends an anti- not pro-smoking message.  The magnitude of any impact is probably pretty minor, but the sign is obviously negative.  Still, if someone believes that the generally information-heavy e-cigarette ads that do not even evoke smoking are pro-smoking, a flashy NRT ad that shows smoking actors using a similar-appearing substitute must be more so.

The anti-THR liars will seek refuge in some silly claim about NRT being government approved.  The response is: “what does that have to do with the glamorizing imagery?”  Just think about just how stupid their claim is.  How can the fact that it is “approved” (which is to say, declared officially by governments to be an effective smoking cessation method — never mind the inaccuracy) have any relevance whatsoever to the question at hand.  If you stab someone in the eye with a Nicorette inhaler in a bar fight, you are not going to be able to defend yourself in court by saying that it is a government approved cessation device.  The approval has nothing to do with either weaponization or glamorization.

This is one for the top file, to always pull out when responding to silly claims that e-cigarette use celebrates and glamorizes smoking.

“We just don’t know” is a bit old, isn’t it?

by Carl V Phillips

A quick post to recognize a brilliant tweet by @TobaccoTacticss.  For those who do not follow that feed (and you should! — consider this a #FF), it was launched as a parody of a website published by the University of Bath (your tax pounds at work, dear UK readers) that consists of libel and ad hominem attacks about people who disagree with the tobacco control industry.  For the uninitiated, that page is referred to as “the wiki” in the feed.  (In a bit of self-parody, the Bath people tried to censor the feed, tricking Twitter into forcing the anonymous author to change the feed’s name a few times, but never slowing him/her down. Apparently they finally acquired the good sense to give up.)  The feed has expanded to being what is perhaps the best running commentary on the sheer idiocy of the tobacco control industry.

But the feed is not just entertaining.  The author provides some stunning insights, subtly presented.  Here is one that made me wonder why the biting simple observation had never occurred to me before:

The link in the tweet is to a 2008 BBC article in which anti-THR activists (the WHO and ASH, specifically) complained that we just do not know enough about e-cigarettes yet to be comfortable with them.  And they were right — back then.  Yes, there were those who were already jumping on the bandwagon, but it is fair to say that the cautious tobacco control people, not the bandwagon, had it right at the time.

But, as noted (presumably to help out the anti-THR people who are notoriously bad with numbers), that was five and half years ago.  Those of us in the reality-based community now know a lot about e-cigarettes and it is basically all reassuring.  The constant repetition of c.2008 ignorance — “we just don’t know” — is no longer caution, it is a lie.

Well, let me temper that:  An anti-THR activist who says “I just don’t know” is probably telling the truth, the same way most of us would be telling the truth if we said “I just don’t know how the CERN Supercollider works.”  Of course, we would have the good sense and honesty not to pretend to offer engineering advice about particle accelerators, given that ignorance.

But here is the key observation:  The tobacco control industry recognized that e-cigarettes were an important phenomenon a very long time ago.  That industry has orders of magnitude more money for research than every independent researcher working on the topic combined.  And yet they have failed to generate any useful knowledge on the topic, or even — according to their own frequent admission — acquire the knowledge that the rest of us have generated.  Their ignorance tells us nothing about e-cigarettes, of course, but it might be the clearest evidence (amongst a crowded field) that the entire tobacco control industry is just wasting society’s resources.

NEJM: insight into the narrowness of public health views about THR

by Carl V Phillips

A commentary about e-cigarettes in the New England Journal of Medicine by three professors from the Columbia School of Public Health is remarkably educational.  This is not because of the content, which is all well known to anyone who follows and understands THR or e-cigarettes.  But by not spouting the usual tired, lying dogma, and presenting an intelligent view, the authors unintentionally give us a window into the genuine naivety of the public health community.

The magazine article (yes, magazine — any publication that has a sidebar with an interview of a politico, advertisements, etc. is a magazine, not a journal), entitled The Renormalization of Smoking? E-Cigarettes and the Tobacco “Endgame” by Amy L. Fairchild, Ronald Bayer, and James Colgrove is not anti-THR or anti-ecig.  It is not lies.  It borders on being pro-THR.  Thus, it is genuinely interesting.  After starting with some of the usual boilerplate about e-cigarettes, the authors write:

But e-cigarettes are the subject of a public health dispute that has become more furious as their popularity has increased. Whereas some experts welcome the e-cigarette as a pathway to the reduction or cessation of tobacco use, opponents characterize it as a dangerous product that could undermine efforts to denormalize smoking.

Perhaps it was a Freudian slip, but maybe it was intentional:  Notice that those on the side of THR are experts, while those on the other side are merely opponents.  I like that.

They then discuss several local place bans (with information that was already out-of-date at the time of publication — score one for blogs over magazines) as a lead-in to:

This debate occurs as tobacco-control advocates have begun examining policy options for a tobacco “endgame” — the implementation of radical strategies for eliminating tobacco use globally.

I am not sure whether this is naive, pandering, or foreshadowing.  I will circle back to it.

Marketing campaigns for e-cigarettes threaten to reverse the successful, decades-long public health campaign to denormalize smoking. The chief advertising officer of one e-cigarette company has spoken explicitly about the “renormalization” of smoking in the form of “vaping” — the popular name for e-cigarette use.

This is where the authors start illustrating how out-of-touch the public health establishment is with the real world.  When “public health” people (the scare quotes referring to those who embrace the term, but are really concerned about controlling people, not their well-being) lie about THR, as is typical, it is difficult to disentangle knowing falsehood from ignorance and innumeracy. These authors are being honest, and are smart, literate, and numerate people, so that means we can separate out the effects of buying into their lying colleagues’ propaganda and the resulting naivety it creates.  Do they really believe that an e-cigarette company would want to renormalize smoking?

Vaping does, of course, normalize tobacco use while further helping to denormalize smoking.  The anti-tobacco extremists object to this because (a) it tends to denormalize smoking without demonizing tobacco users, which is what they really are seeking to do, cloaking it in the nicer-sounding word, and (b) they do not really care about the impacts of smoking, but about eliminating what they consider to be an immoral choice of behaviors.  Real public health people — perhaps because they share the top-down control culture of  that field and of the ruling class in general — get taken in by their lies, and believe that the modern tobacco control industry is really about public health.

Even Big Tobacco dared not utter such words as the image of smoking was transformed over the decades.

“Big Tobacco” was fine with the status quo.  Companies lost some business to competitor products, and they lost some business to the demonization campaign.  It was just another competitor.  Occasionally companies find that the best advertising strategy is to go head-to-head with a competitor, but usually they do not.  Usually, simply trying to better sell one’s own product without reference to the competition is the best strategy.  The view from “public health” (and public health) is so self-centered that there is little recognition that others do not see the world in the same way that they do.  In particular, they genuinely do not realize that their warfare mentality is not shared by those they have declared war on.  Anti-tobacco extremists are obsessed with tobacco companies, and apparently have no idea that tobacco companies do not reciprocate, and merely consider the extremists to be just another part of the market environment.

As information about the hazards of sidestream smoke was publicized in the 1980s and 1990s, the imperative to protect “innocent bystanders” moved to the center of tobacco-control efforts, and public smoking bans pushed smokers into the shadows. The once-widespread habit didn’t simply become denormalized or marginalized; it became highly stigmatized. The pervasive became perverse.

Notice the passive voice here.  There seems to be no recognition that this was an orchestrated campaign by the extremist group to intentionally stigmatize smokers (not smoking, smokers).  It was successful.  The will of most smokers to defend their choice to smoke was broken by it (a simple fact, not a judgment about whether this was good or bad).  The misplaced emphasis on the industry and advertising means that the people who are taken in by the tobacco control propaganda do not recognize the significance of this:  Smokers have been mostly broken, like many downtrodden minorities (religious, racial, etc.) are so often by those in power; vapers are not.

The authors discuss some examples of e-cigarette advertising and go on to observe:

The tobacco-control community has responded to these messages with alarm. In 2009, the World Health Organization warned that e-cigarettes threatened bans on public smoking, which have been key to tobacco control. Similar concerns were raised by anti-tobacco activist Stanton Glantz and his colleagues: “Given the substantial research demonstrating the effect of viewing smoking in the movies on adolescent smoking initiation, the addictive nature of nicotine and the lack of regulatory assurance of their quality or safety, it is important to keep ENDS [electronic nicotine-delivery systems], and other similar products, from being sensationalized through the use of celebrity promotion or product placement in movies or other entertainment media.”

Naive or pandering?  These authors are not clueless like Glantz.  Surely they must realize that this “research” is pure junk and the claim that a large fraction of all smoking initiation is caused by portrayals in movies and such, as Glantz claims, is obviously batshit crazy.  Even more troublesome is the willingness to uncritically repeat the absurd claims about threatening bans on public smoking.  How, exactly, does replacing smoking threaten bans on smoking?

The authors then repeat the misleading claims about the CDC data about children using e-cigarettes, which have already been covered here at length.   They continue the naive/pandering repetition of obviously false claims by serial liars (which I will not bother to address yet again), but their lead-in to that is very interesting:

Invoking images of terrorism, two tobacco-control advocates claim that “smoking bans and clean air advocacy are being hijacked….

This is amazingly insightful, but unfortunately they do not follow through.  Terrorism, as the word is commonly used these days, refers to violence inflicted by zealots on innocent people who are just trying to live their lives. The most obvious extension of this theme is to observe that such “terrorist” actions in this world are largely perpetrated by the tobacco control activists. More subtly, this further illustrates the ruling-class view from public health, that consumers are mere targets in the war they have declared, not stakeholders and certainly not intelligent adults making decisions for themselves.

Also note the failure to analyze the anti-tobacco extremists’ rhetoric and note even its most obvious dishonesty:  If “clean air advocacy” is threatened by people choosing to not smoke, then it is really not about clean air, is it?  (Note that the same people also condemn smokeless tobacco using the same language, so there is no defense for them to be found in exaggerated claims about the environmental impacts of vaping.)

The most vocal supporters of e-cigarettes, other than those with commercial interests in them, have been public health professionals who’ve embraced the strategy of harm reduction — an approach to risky behavior that prioritizes minimizing damage rather than eliminating the behavior.

This, I think, is the key observation about the ruling-class mentality.  Yes, I am happy to take credit for the handful of us public health (without the scare quotes) professionals who did research on smokeless tobacco and tobacco harm reduction long before e-cigarettes happened.  Without that work, it is difficult to believe that e-cigarettes would have succeeded.  But we are hardly the most vocal supporters, and neither is industry.

Building on the foundations we built for THR, e-cigarette users themselves (who, interestingly, are largely unaware they are standing on a platform built by public health professionals) have become the most vocal supporters.  The top-down obsession of the public health community, and the notion that some ruling class — either industry or people like them — controls this conversation, is fascinating.

People who only read journals and magazines — who are out of touch with the popular culture and mass communication channels — end up looking like the older generation that has no idea who their kids’ favorite pop idol du jour is.  Of course, that is just fine for the case of the pop idols.  It is not, however, acceptable for those who presume to analyze the world of tobacco product use, let alone to dictate policy.

Although the evidence is limited and contested, some studies suggest that the majority of e-cigarette users treat them as cessation aides and report that they’ve been key to quitting smoking. For example, in one study, e-cigarettes compare favorably to nicotine-replacement therapies in terms of the likelihood of having returned to smoking 6 months after a cessation attempt.

This is a great example of why that naivety is a fatal problem.  There is exactly one useful “study” of e-cigarettes out in the world, and it is the world — a world that most in ivory towers seem unaware of.  Clinical studies like the one they cite can be a little bit interesting, but they are ultimately almost useless for figuring out what will really happen in a case like this — let alone what is actually happening!  Tobacco control extremists take advantage of the fetishization of clinical trials (which is to say, conferring on the object itself magical powers that cause the tool or symbol to displace the actual goal or reality) to attack anything that is not medicalized or top-down.  Real public health people are tricked into this because they often do not realize that social science (which they should be doing) is not medicine.

We do not do clinical trials to figure out, say, the effect of unemployment insurance on the labor market.  It should be obvious that while you could concoct such a trial (and people do), that such an artificial study of the non-representative individuals who volunteer to participate is far less informative about the world than watching real-world natural experiments.  The results from the real-world natural experiment about e-cigarettes are most definitely not limited.

Given the near unanimity of the public health community in pressing for harm reduction for injection-drug users in the face of relentless political opposition, some harm-reduction advocates find it stunning that their allies in that struggle have embraced an abstinence-only position on smoking…

Yup.

…These advocates claim that a strategy of reducing, though not eliminating, risk is a moral imperative, given the certainty of harm associated with continued tobacco smoking.

Yes, but not quite.  The harm reduction philosophy is not just about finding a substitute for the failure of the abstinence-only approach.  Harm reduction is about letting people choose to do what makes their lives better, trying to make it less harmful to do it.  The better analogy is not IDU, but sexual behavior, and the comparison to IDU is inherently (and often intentionally) inflammatory, invoking a behavior that is often terribly destructive and legitimately dissuaded.  Sexual behavior harm reduction is about making an unhealthy but also highly-beneficial behavior less risky (obviously sex is more beneficial to most people than is nicotine, but the basic characteristics are similar, and quite different from IDU). In both cases, encouraging harm reduction rather than demanding abstinence is only condemned by a special-interest group of “moralizers” who, due to some quirk of their wiring or unfortunate upbringing, deeply resent that other people out there are enjoying something they find objectionable.

The debate’s stakes are heightened by the current discussion of the tobacco endgame, which aims to eliminate smoking or reduce it to very low levels. Most endgame strategists have advanced prohibitionist policies, from complete bans on traditional cigarettes, to regulatory strategies that would reduce and eventually eliminate nicotine, to efforts to manipulate pH levels in tobacco to make inhaling unpleasant.

Take a careful look at the language here, and in the foreshadowing above.  The phrase “tobacco endgame” is juxtaposed with “eliminate smoking”.  I suspect that these authors really believe that eliminating smoking is the goal.  They just do not realize that most of those who talk of an “endgame” really want to eliminate tobacco use, not merely the high-risk version.  Indeed, many of them are more worried about THR than they are about smoking because they realize that low-risk tobacco product users — as opposed to smokers — have little reason to become abstinent, and thus probably will not do so.  Also note the charitable use of the word “strategy”.  As Ken Warner (who is featured in their next paragraph) implicitly conceded, with unintentionally ironic phrasing, the mentioned tactics hold little promise of success.  A goal is not a strategy.

As for the stakes being heightened — um, no.  Just because a few hundred thousand people in the world are into this “endgame” does not substantially change the stakes.  The stakes for tobacco harm reduction are whether hundreds of millions of people are happy (part of which is being healthy).  The opinions of a few extremists matter only to those extremists and those who are sucked into their ruling-class mentality.

From the glowing tip to the smokelike vapor, e-cigarettes seek to mimic the personal experience and public performance of smoking. But ironically, the attraction of the device is predicated on the continued stigmatization of tobacco cigarettes.

The authors go on to conclude with some pro-THR observations, but I will end my analysis here in order to emphasize my response to this, which is: Nononononono.

It is true that the adoption of (all) THR products is encouraged by the stigmatization of smoking and smokers (to emphasize once again: it is the people who are stigmatized, not the products).  But “predicated”??  Tobacco users, contrary to the views of tobacco control, are not morons or automatons who depend on the ruling class to manipulate them into better behavior.  This may come as a shock, but they are thinking people who care about their overall well-being (which includes health) and thus many (not all) of them are interested in choosing a low-risk alternative if they find one of sufficiently high quality.  And, contrary to the view of the ruling class, “quality” will be defined by those individuals.

In their conclusion, the authors suggest that opposition to THR is “dangerously close to dogmatism” (emphasis added — probably not meant to be funny, but it made me laugh out loud).  What is actually dangerously close to dogmatism (which is to say, trapped in their thinking by some of the views of the still-embraced dogmatic extremists) is the top-down ivory tower view of THR.  It might be that more genuine public health people can play a positive role in the THR revolution.  But they are unlikely to do so until they recognize the dogmatism that prevents them from understanding what is really happening.

TVECA letter ups the controversy for THR-vs-THR

by Carl V Phillips

My post about damaging battles among supposed THR advocates, and its unplanned follow-up, were among the least read posts on this blog lately.  I think this is sad and, frankly, a little embarrassing for our community.  Sure, I read the news as much for entertainment as enlightenment as much as the next guy.  But the sharp contrast is troubling, between the few hits on those posts that include actionable thoughts about what those on our side need to do differently, compared to posts about silly liars that are, for knowledgeable readers, frankly just entertainment (they serve a critical practical purpose as a reference to direct honest undecided or not-fully-informed people to, of course).

I have a feeling that this third entry in the unintentional series will change that (though I wish that were motivated by genuine reflection rather than the hatred that is brewing over this one).

[UPDATE: The response to yesterday’s post about NCI’s “tell your quit smoking story” page has included over one hundred tweets and retweets (counting just those that linked to the page or were sent to me, as of 11:30 am Eastern Time today), as well as FOIA filings and proposals to create a competing site.  That is great, but you know what:  It just doesn’t matter much!  It might prove embarrassing enough to NCI that they have to just take down that page (which is what they will do).  It will provide a footnote we can maybe mention in some contexts.  But it is not like that page was really hurting THR.  What I am talking about in this series is hurting THR.]

Today, TVECA, one of the U.S. e-cigarette industry groups, along with European partners, sent a letter to members of the European Parliament supporting the EU’s latest proposed regulation of e-cigarettes.  This was quickly followed by some prominent calls to boycott TVECA members and other companies who supported this move, because it is generally agreed among knowledgeable THR and vapors advocates that the current proposal is a very bad thing.  Clive Bates reprinted the letter and excoriated TVECA (within hours of it being submitted) here, and also reprinted his observations that presented the consumer position.  He points out the contempt and scorn TVECA et al. direct toward the real consumer advocates and their lobbying efforts.

(Note that CASAA does not consider itself expert enough on the EU law and process to become directly involved in this fight, thus the somewhat neutral language of this post.  We are expert on the U.S. law and process, and do not want to play the half-informed dilettante pundit game, as people do when they try to opine about everything in the field.  Personally I trust Clive as the leading expert and best advocate on EU regulation.)

By all appearances, this is a classic case of industry supporting a regulation that gives them a competitive advantage (it hurts the competition more than it hurts them), and while they pretend it represents concern about the consumers, it clearly hurts consumers.  That lack of concern about the consumers also translates into: they do not really care about THR; this is all just making money to them.  It looks no different from NRT merchants wanting to eliminate other low-risk tobacco products, big e-cigarette companies (mostly, but not entirely, the cigarette companies) favoring stringent regulations that only they can meet, or Kind Consumer lying about current-tech e-cigarettes.

I trust this will be properly disillusioning for some of you.  There are genuinely caring people in companies in all of these sectors, and thus units of companies of all sizes and business models that are genuinely pro-THR.  Because of this, sometimes the entire company is genuinely pro-consumer and pro-THR.  But  it is the nature of business (and government) that sociopaths — those who are naturally born and those who evolve those traits through seeing what is successful in business — tend to rise to the top.

The post is summed up best in the comments:

Q: Are they nuts?

CB: The short answer is ‘yes’.  It’s hard to see the public affairs logic of such a crude intervention. … It takes an especially divisive talent to do it as badly as TVECA, and they have yet to explain why they think their companies will benefit from agreement to all the things they list in their letter.

So they might be shooting themselves in the foot too, because they do not understand what they are saying (see above points about dilettantes).  But it seems pretty clear that while they might have accidentally hit their own foot, the fact that the consumers took a direct hit from this was no accident.

On a brighter note from Europe, comes this story about how one smokeless tobacco manufacturer released a product that avoids the ban on snus.  It has long been the case that some Danish manufacturers produced smokeless tobacco products designed for dipping (which is banned) but were able to sell them because they declared them to be for chewing (which is not).  The recent move takes this one step further, creating a minor variant on standard pouched snus and marketing it as pouched chew (yeah, right!).

Now that is the right way to deal with bad laws:  Figure out how to let people reclaim their liberty in spite of the law.  Those who favor tightening laws for their company’s — or their personal favorite products — advantage, please take note.