by Carl V Phillips
Yesterday I peer reviewed the latest journal article about by CDC and FDA about kids’ use of e-cigarettes, pointing out the massive methodological flaws, inaccurate conclusions, Orwellian language, and overt political advocacy that it contained. I mentioned CDC’s associated press release, but did not go into details. But the press release is arguably a far greater crime (and that is not hyperbole — it is criminal for the US government to lie to the people), and calls for a post of its own.
First and foremost, the mere act of the government putting out any press release based on that article is sketchy. Even setting aside that the original article was junk science as written and obvious political propaganda in itself — pretending for the moment it was done as honest science — it is still a problem. The study is based on really sketchy data and poorly chosen questions (more on that later) which could provide only a very rough cut at the questions of interest. Doing the research is fine (again, pretending it was done honestly) and potentially useful. But not useful at the level of informing the public. The best possible version of that paper would not qualify as legitimately newsworthy. Add to that the imprimatur that comes from the government putting out the statement, and the act is inherently inappropriate government behavior.
That would be the story if the research were honest and the press release were an accurate representation of it. But it is worse than that. Oh so much worse.
Yesterday I mentioned the problem with the title of the press release itself. To reprise:
“More than a quarter-million youth who had never smoked a cigarette used e-cigarettes in 2013”
Um, no. Did you not read your own methods section. The results showed that in 2013, this many kids had ever tried an e-cigarette, not that they tried (let alone used) e-cigarettes in 2013. I never realized that you had to be an expert in epidemiology or econometrics (which these people clearly are not) to understand the concept of “ever”.
But that is not even the worst sentence in the press release. That dishonor goes to this one, noted by Allison Taylor in the comments on yesterday’s post. Quoting her comment:
This is an exact quote from the CDC’s press release, “Among non-smoking youth who had ever used e-cigarettes, 43.9 percent said they intended to smoke conventional cigarettes within the next year, compared with 21.5 percent of those who had never used e-cigarettes.”
No matter the reasoning they employed for counting an answer of “probably not” as intending to smoke (which is already highly problematic, as you pointed out), it is an outright lie to characterize these youth as “saying they intend to smoke”.
Yes, that. It is worth adding that if we just look at CDC’s claim for kids who have never smoked a single puff and never vaped a single puff, they are saying that 21.5% intend to smoke in the next year. Seriously? This is our government saying this. If that were true, and only a quarter of those who intended to smoke actually carried through each year, about half the population would be smoking. (I guess the good news is that they are sure it is exactly 21.5% and not a full 22%.)
Less important, but just as dishonest, is the description of the study population as “non-smoking” rather than never-smoking.
The biggest running lie is the same one that CDC has been using since they first started lying about e-cigarettes last year: that ever have taken one puff constitutes “using”. They get a lot of mileage out of that.
“We are very concerned about nicotine use among our youth, regardless of whether it comes from conventional cigarettes, e-cigarettes or other tobacco products. Not only is nicotine highly addictive, it can harm adolescent brain development.” said Tim McAfee, M.D., M.P.H., Director of CDC’s Office on Smoking and Health.
Funny how the FDA has declared that nicotine itself, in the form of NRT (many of which are much more similar to e-cigarettes than is smoking), is not addictive. Or that the only evidence ever cited to show that nicotine is addictive (whatever that means – it is not a scientific term) is about smoking, not nicotine, as is evidenced by the next paragraph:
Nicotine is highly addictive. About three out of every four teen smokers become adult smokers, even if they intend to quit in a few years.
The claims about brain development are equally junk, though rather more complicated — certainly nothing that should be declared as fact. And yet:
There is evidence that nicotine’s adverse effects on adolescent brain development could result in lasting deficits in cognitive function.
There is also evidence that nicotine improves brain functioning and easily as much reason to believe the net effects are positive as negative. Caution in the face of such uncertainty is fine. Blatant lying by the government that the question is settled is not.
“The increasing number of young people who use e-cigarettes should be a concern for parents and the public health community, especially since youth e-cigarette users were nearly twice as likely to have intentions to smoke conventional cigarettes compared with youth who had never tried e-cigarettes.” said Rebecca Bunnell, Sc.D., M.Ed., Associate Director for Science in CDC’s Office on Smoking and Health and the lead [liar] of the study.
(Sorry, I could not resist the minor edit. This is just too appalling.)
As noted yesterday: these “intentions” could consist of realistically answering “probably not” rather than the obviously unrealistic “definitely not” to one of two questions; the difference is easily explained by obvious confounding which the authors not only did not try to deal with, but pretended did not exist; the total numbers we are talking about are less than 1% of the never-smoking population; and the “increase” is actually just an artifact of what they are measuring (when you are measuring “ever tried” it is obviously going to increase because it cumulates).
So, yeah, this should be a really top concern for parents of teenagers. I assume that Ms. Bunnell does not know any parents of teenagers.
The press release concludes with a long paragraph about how terrible smoking is, including:
unless the smoking rate is rapidly reduced, 5.6 million American children alive today – about one in every 13—will die prematurely from a smoking-related disease.
Funny how the press release did not mention that most e-cigarette trialing (and presumably actual use) found in the surveys was among smokers, and thus was probably serving exactly this purpose, helping reduce smoking.
We have come to expect junk science in “public health” and tobacco journals, and even though most of that is indirectly paid for with our taxes, this blatant propagandizing from the government itself is so clearly worse. We have gone from the annoying background hum of Tobacco War-mongers to having an iron triangle of government agencies, corporate interests, and members of congress, along with their pet press and academic cheerleading loons, that is conspiring to lie us into war. I cannot believe how much this reminds me of 2003, and while this is not likely to create anarchy and The Islamic State, the death toll from this war on THR could still be just as great. (The good news is that unlike with Iraq, the lead NYT writer on the topic has started to quietly correct the government’s errors in some of her stories, rather than just playing transcriptionist, though has not actually gone so far as to call them out like she should.)
Finally, to quote (with permission) Clive Bates from an email discussion about this:
[The article and associated material] raises the question of accountability more generally… Who is responsible for this?
- The authors for doing such poor work?
- CDC/FDA for having a propagandist approach to research and their own mandate?
- Weak government or Congressional oversight of the activities of these agencies?
- The SRNT journal Nicotine & Tobacco Research editorial board for publishing it?
- The peer reviewers who presumably waved through this paper not noticing or caring about its serious weaknesses?
- The peer review process which allows reviewers to comment anonymously and unaccountably and is open to multiple abuses (too many to go into here)?
- The media for uncritically reporting it and not creating ‘back pressure’ for rigour
- The lack of timely and effective options for academic criticism – [CVP’s] critique was published on a blog, but where else could it go and who should do it?
- The intellectual climate in ‘tobacco control’ academia that cheers this work on or allows this to persist relatively unchallenged (note: the editor of another journal was enthusiastically tweeting about it)?
- The confusion at the boundary between academia and activism and the mistaken idea that research must contribute to a public health cause?
- The role of funders (agencies in this case) with declared or undeclared policy agendas, but not normally regarded as creating a conflicting interest?
Yes, them. All of them. Except I do not regret publishing my analysis in this blog. This and a few other blogs are the leading reliable sources for scientific information about THR. They are years ahead of what appears in journals, and always will be. The problem is not with the medium, but with the fact that people in this field (in contrast with many others) have not figured that out yet and continue to fetishize the failed academic journal system.