Supposed THR supporter demonstrates he still thinks like an ANTZ

by Carl V Phillips

I consider Mike Siegel to be a friend and he does a lot of good work documenting lies by the ANTZ.  With that out of the way, I found his latest blog post to be a particularly disturbing disregard of science in favor of the ANTZ propaganda that he used to embrace.  In that brief post, he flat-out declares that the death from oral cancer of a prominent baseball player was caused by smokeless tobacco use and indicates his contempt for the best-proven method of tobacco harm reduction (which is, of course, replacement of smoking with smokeless tobacco).  He employs the ANTZ propaganda tactic of elevating unsupportable sensationalist specific claims over the evidence.

First and foremost, of course, is the fact that there is not scientific support for the claim that smokeless tobacco (ST) causes oral cancer.  If Siegel wants to make a post arguing against this scientifically, he is welcome to.  But what he did was instead pure ANTZ propaganda sensationalism — not only failing to argue the general case, but also making a specific claim that is even less supportable.

Even apart from the lack of support for a population-level causation claim, he made the never-defensible claim that a particular case of cancer can be attributed to a specific cause with certainty.  To explain why that is so clearly wrong, imagine that ST actually does raise the risk of oral cancer by a factor of 1.5.  There is not affirmative support this claim, but a risk of that magnitude is at the edge of the limits of detection, making it a worst-plausible-case estimate — it cannot be ruled out based on the limited and imperfect data we have.  Hypothesizing that risk, there is still a 2/3 chance that for a particular person who used ST and got the disease, the disease was not caused by the exposure.  Consider even an absurd and easily ruled-out scenario, that ST increases oral cancer risk by a factor of 10.  Even then, there is a 10% chance that an exposed individual with the disease did not get it because of the exposure.  In the latter hypothetical causation is more likely than not, of course, but even then it is not certain, as Siegel declared it to be.

On top of that, it appears from the news stories (and thus this might be wrong) that the cancer in question was salivary gland.  Most research that tries to find a link between surface oral exposures (alcohol, tobacco products) and oral cancer leaves out salivary gland cancer because there is no reason to believe that glandular cancer is caused by chemical impacts on the epithelial cells.  Thus, even to the extent that there are claims that ST causes oral cavity cancer, these claims do not extend to the salivary glands.  [Update: More on this specific point from Brad Rodu from two years ago.]

Of course, this will not stop all the talk about banning ST use among ball players.  (Do not expect any talk about trying to restrict the real cause of elevated oral cancer among players: the fact that they also tend to be “players”, and oral cancer is caused by sexually-transmitted HPV.)  But this does not excuse someone who is trying to position himself as a scientific analyst.

Siegel declares:

Many tobacco control advocates have asked me why, as a harm reduction supporter, I am always talking about the use of electronic cigarettes to help people quit smoking, rather than the use of smokeless tobacco products.

For these reasons, I believe that electronic cigarettes are a much more viable option as a harm reduction approach for smoking cessation.

I am not buying it.  Siegel makes no secret of his ANTZ-level hatred for tobacco companies, and has engaged in the politics of personal destruction aimed at those who try to productively engage with the industry.  Anti-THR, even when it is only partially anti, is generally not motivated by health concerns.  Even if there is nonzero risk from ST, it is trivial compared to that from smoking.  And yet Siegel was anti-ST even when ST was the only THR option out there.  No, this appears to be about personal politics and pique.  One has to wonder how this will play out in his psyche as the traditional tobacco companies expand their dominance of the e-cigarette market.

Moreover, his expressed certainty that e-cigarettes are much lower risk than ST is fundamentally naive.  Siegel may not agree with my assessment — that current-tech e-cigarettes are almost certainly higher risk than ST — but there is little doubt that some health risk from e-cigarettes will eventually be established.  Siegel is implicitly arguing that until then, we should be making decisions about e-cigarettes based on our ignorance about their risks — standard ANTZ playbook, albeit the opposite conclusion.  How will Siegel respond to the inevitable discovery of an apparent risk from e-cigarettes, one that is of similar magnitude as the supposed small risk from ST he believes exists (oral cancer is fairly rare, so a few tens of percent increase in risk is quite small in absolute terms)?  Will he declare e-cigarettes to not be “viable” either?  When the first story comes out claiming that the death of a particular vaper was definitely caused by e-cigarettes, will he declare his support for that absurd conclusion too?

I think the answer is no, and hopefully that will reflect not a political doubling-down, but that his time embracing e-cigarettes has taught him that harm reduction is about, well, reducing harm while giving people honest information to make informed choices about what they prefer in life, even if that involves risks that are not reduced quite as much as they might be.  It will be better still if he figures out that such considerations extend beyond his personally favorite option.


9 responses to “Supposed THR supporter demonstrates he still thinks like an ANTZ

  1. Well written, and strongly agreed. While e-cigs are likely to have a near-zero risk profile, there’s no *TOTALLY CERTAIN* way of knowing until we have fifty years or so of use by a data pool of tens or hundreds of thousands AND are certain (which we can never be) that we’ve accounted for all confounders.

    Statistically, in terms of someone (like a chew-using ballplayer or a heavily ETS-exposed spouse) who ends up suffering from a cancer or heart condition, *even if* you fully accept whatever possibly-bogus stats are out there floating around, *all* that you could say is that “According to the research, there seems to be an X% chance they got this because of (chew or ETS).” Thus, while the EPA figures might indicate that forty years of day-long exposure to ETS at 1940s-80s smoking workingplaces produce a lung cancer in one out of every thousand folks so exposed for those forty years, the reverse side of that an individual who DOES get lung cancer after such exposure really only has, by their statistics, about one chance in five (19%) of it having been caused by that exposure.

    Carl, your reference to an earlier blog you did on this subject regarding Dr. Siegel (the politics of personal destruction link above) is worth reading for anyone (like me! LOL) who missed it, and it might also be worthwhile for your readers to read my own recent unanswered challenge to Dr. Siegel on his blog: (No way of direct linking to the comment, but it’s about the fifth most recent from the top: 13 days ago at the moment)

    (Click the “See More” button that appears under the third paragraph.)

    While I admire Dr. Siegel’s dedication to publishing pretty much everything on topic except outright obscenities, he disappoints me greatly when he ignores direct challenges.

    – MJM

  2. “It will be better still if he figures out that such considerations extend beyond his personally favorite option.”

    What an understatement. Thanks Carl.

  3. …and good lord…what a misleading “headline”…

  4. Whims, not consistent principle, seems to be an epidemic among those in this field.

  5. As an ST user I have a very hard time calling Siegel a friend. For me he is in the same league as Glantz and all the other anti-THR thugs.

    I have no faith that Mike will ever support all aspects of THR. In his heart he is really trying to salvage the credibility of tobacco control. Good luck with that one:

  6. “..current-tech e-cigarettes are almost certainly higher risk than ST ”

    Interesting…..Why do you think that is?

    • Carl V Phillips

      I have written about this at some length. To summarize: The only serious honest guess about nontrivial risk from ST is the cardiovascular effects of nicotine. That is basically where all of the remaining 1% in “99% less hazardous” comes from. So anything delivering nicotine shares that risk. That leaves only a miniscule — and possibly non-existent — space for any nicotine product to get in below ST. (And if the CV risks are not real, then they are all better than 99% and there is still little space.) With that little space, and given any possibility of risk, it is almost certain to not sneak into that space. E-cigarettes have a lot of unknowns, and the current technology (other than the super-clean closed systems from the major tobacco companies) produce measurable quantities hazardous chemicals and they are delivered to the lungs. Any time you involve the lungs in something, bad surprises are possible.

      So I am not saying that there is some surprise risk lurking, and I certainly have no guess about what it might be. But given that we know most everything we can about ST, given that small space, and given the unknowns about ecigs, there is pretty much no place to go other than worse — almost certainly by only a tiny bit, of course.

      • Thanks for putting things into perspective (again). I sure wish that we could get Dr. Siegel to respond to your comments here. I tried to leave a comment on his blog last night in response to his anti-smokeless rant, but my comment (after spending a significant amount of time working on it) was “eaten” by mysterious internet goblins..or my computer….who knows…:)

        “,,and the current technology (other than the super-clean closed systems from the major tobacco companies) produce measurable quantities hazardous chemicals..”

        What makes for a super-clean closed system?

        • Carl V Phillips

          High-tech systems can guard against overheating or heating an almost-dry atomizer. That is probably the biggest single factor. But also, they can test their exact liquid, including their flavorings, with the exact hardware it will be used with. The liquid and the hardware are pretty close to exactly the same every time. Once the variables of open systems are introduced there can be unplanned outcomes, and those are almost always negative. Still, even the cleanest system still involves the lungs. But I should reiterate that there is no affirmative reason to believe any of these risks are great enough to alter anyone’s behavior. But they go to the point that it is unlikely ecigs squeak in below ST in risk.

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