by Carl V Phillips
This recent paper in Addiction by Hitchman, McNeill, and Brose, is a commentary calling for an “accurate and evidence-based debate” about e-cigarettes. I will admit that my favorite part of it is this reference:
Anti-THR lies and related topics [internet] 2014. Available at: https://antithrlies.com/2014/03/07/stanton-glantz-is-such-a-liar-that-even-the-acs-balks/ (accessed 11 March 2014) (Archived at http://www.webcitation.org/6OJPSzZLh on 24 March 2014).
I find it quite an entertaining citation, and for that I want to offer an apology to the authors. That post was properly cited because it was (in my possibly biased opinion) the best debunking of the spurious gateway claims that was published at the time of their writing. However, citing the title I published the analysis under must have given the authors pause. Fortunately they went ahead and did it anyway.
Not that the title is incorrect — it clearly was accurate. But this blog contains several different types of posts, and I try to reflect the type in the tone of the title. That post was one of more serious types, a deeper analysis that was basically a quick-and-dirty research paper, and I should have given it a fitting title. But when I first started writing it, I was heading somewhere else, and I failed to change the title to better reflect the ultimate content before posting. For that I apologize to Hitchman et al.
To remedy this, I have posted a working paper version at EP-ology. It is a more complete version of the analysis for those who read the first and want more. And it gives future authors something more complete and formal to cite. Comments on it are welcome.
Continuing with the Hitchman paper, after the section on the gateway hypothesis note that the gateway claims are not supported (citing the above), they suggest:
We think a useful research exercise would be to explore the ‘gateway’ hypothesis in more detail—what evidence would be needed before the ‘gateway’ hypothesis could be demonstrated to be accurate? Can we set a standard to which all academics would agree?
Great idea. I have mostly finished that paper (though I have no delusions about all academics agreeing about anything). This time I will release it under a suitable title, I promise.
The authors point out the flaws in current research practice that result from e-cigarettes being very heterogeneous, including their form factor, what they deliver, and how they are sold. They could have added “in their quality control” to that list. The authors soft-pedal the implications of research for this, but basically it boils down to: most generalizations are wrong. This is a good point.
I recall presenting at the European SRNT meeting in 2011 regarding a research agenda on e-cigarettes. My message (which I have been repeating for three years now) focused on explaining why detailed research on particular product or what happens to be the product-mix at a particular point in time was pointless. Chances are that by the time someone finished such a paper, the products they studied would no longer exist. Overview and less-detailed information is useful and more generalizable, but the super-specific analyses that are typical in the field are a waste of time, at best. They are potentially quite misleading for the reasons that Hitchman et al. mention, among others. After the talks in that session — and the other two presenters basically agreed with me, though had different main points — there was an extensive discussion among the room full of researchers who were just discovering e-cigarettes. Several of these comments consisted of someone proposing some ridiculously detailed analysis of a product or the current mix of products. I resisted the urge to scream: “weren’t you even listening?!!”
The problem is that e-cigarettes were dropped into a research community that is full of people who only have one hammer and so use it to hit whatever interesting topic comes along (which is not at all unusual in academia), and who had been studying a single consumer product and behavior that had not substantially changed for decades, and thus could almost be treated as having the properties of a physical constant (which is rather unusual). Their methods were poorly suited for studying e-cigarettes; this could be remedied but has not been (e.g., the continuing failure to figure out how to create a machine vaping regimen; the focus on chemistry that is relevant for cigarettes, but not e-cigarettes). But worse, their mindset was not suitable, and this probably cannot be remedied for most of them.
Hitchman et al. also adamantly argue that e-cigarettes are not tobacco products. My readers will know that I disagree. They assert:
Whether this is due to lack of knowledge, carelessness or attempts to associate e-cigarettes with the immense harm caused by tobacco, classifying e-cigarettes as tobacco is inaccurate and unacceptable.
It is not due to any of these. It is a legitimate categorization. The immense harm is caused by smoking. Other tobacco products — whether smokeless tobacco or e-cigarettes — do not create this harm. If the categorization tobacco products should not include e-cigarettes for the stated reasons, then it should not contain smokeless tobacco either, which seems like rather a strange claim to make.
We do not believe that NRT products are referred to as tobacco products, so why are researchers inaccurately classifying e-cigarettes in this way?
Um, actually I do refer to NRT products as tobacco products. They are low-quality tobacco products, but tobacco products just the same. What makes them such is their niche in society and behavior, not their regulation or manufacturing provenance. Most NRT products sold are used like e-cigarettes, cigarettes, smokeless tobacco, and other tobacco products — as a way of self-administering nicotine (and other chemicals), in a causal way, while going about one’s life.
Trains, ferries, and ride-share vans are all public transport, even though they are quite different physically, regulated differently (with some overlap, of course), and differ enormously in how hazardous they are. Similarly, broccoli, Big Macs, beans, and fugu sushi are all food products. There are useful subcategories within these collectives, of course. But the overarching category is also useful. If a natural-language term evolves to replace tobacco products as the overarching term, that is fine. But in the meantime, the accepted collective term is what it is.
The problem is not that these products have similarities that create a collective identity (in addition to their specific detailed identities). The problem is the tobacco control industry mentality that says “if it is a tobacco product, then we must treat it like we treat cigarettes” (even setting aside the issue of whether it is appropriate to treat cigarettes that way). But trying to socially engineer via vocabulary is a completely hopeless way to address that problem. (There is a reason we refer to ANTZ and not ATZ). Attempting to shield e-cigarettes behind terminology will not work and has many downsides. The viable response for those who object to e-cigarettes being treated “like tobacco products” is to push back against the much broader problems of how tobacco products are simplistically and inappropriately treated.