by Carl V Phillips
The title refers to a classic joke about economists, describing a common practice in the field: Something is observed in the real world — say, the collapse of the Greek economy, insurance prices dropping under the ACA, or people lining up to buy new iPhones in spite of already owning perfectly good old iPhones — and the theoretical economists scramble to figure out if their models can show that it can really happen. In fairness, that way of thinking is not as absurd as it sounds. Developing a theory to explain an observation is good science, so long as it is being done to try to improve our models and thus better understand reality and perhaps make better predictions. Obviously, the ability or inability to work out the model does not change what has happened in reality.
Note that the term “model” is generally misused in the tobacco research arena, so this observation might require some clarification. Most of what gets misidentified as “models” in tobacco research are actually just big deterministic calculations, something along the lines of “if this many people start smoking each year, this many quit, this many switch to e-cigarettes, etc., then the total number of smokers in 2020 will be….” A proper model, however, is a simplified representation of a part of reality that can tell us new things about the real world. Most scientific theories fit this description. So do most experiments, such as clinical trials. If you build a miniature of an airplane you have a model; you can put it in a wind tunnel and learn things about how the real airplane will fly. But if you just posit how fast an airplane goes, in order to “model” how long it will take to get somewhere, that is merely a calculation.
So coming up with a model of why some smokers switch to e-cigarettes and others do not is interesting (at least I think so), and if it is correct it can help us predict the future and better understand the details of what we have observed. It could also help us target research to answer open questions. For example, a model of people’s motives and choices could highlight that we are not really sure of, say, which features of an e-cigarette seem to be better at motivating complete smoking cessation.
A model/theory obviously cannot tell us whether what we observed actually occurred. It would be fairly silly to say “my model of the economy says that recent government actions would create high inflation, and therefore we have high inflation — never mind that reality shows otherwise.” Ok, people actually do say that, but it is obviously silly. Fortunately using data to prove (or improve) theories is what is normally done in science, even though politics sometimes drives people to go in the wrong direction, to act as if observed reality is subordinate to theoretical results. Sadly, when it comes to academic research on e-cigarette use, the wrong direction is the norm.
I did a radio interview this morning that was motivated by this study, a clinical trial where some smokers were assigned to substitute e-cigarettes, whose authors described the results to the press (e.g., here) in terms of e-cigarettes reducing the “craving” to smoke. Um, yeah. Can you imagine someone describing having a meal of fish as reducing the craving to then eat some beef, or describing owning a Samsung Galaxy as reducing the craving to buy an iPhone? E-cigarette users also did not have the elevated carbon monoxide levels of smokers (shocking!). Slightly more interesting, the study found that a lot of those assigned to substitute e-cigarettes remained abstinent from smoking through the follow-up period. I told the radio producer that I would be happy to talk about the study, though frankly it is a bit silly, so it might be better to just talk about the reality (and to their credit, they went that direction instead).
Why “slightly” and “silly”? Because ultimately studies like this are just a more subtle version of the economist joke. If e-cigarettes were a new invention and we wanted to predict what would happen if they were offered to smokers in advance of introducing them to the real world, such results would be interesting. They would help predict something we do not already know. But since we already know how e-cigarettes have been received in the real world, doing such a test simply shows that what happened in reality can be replicated in a theory (that is, in a model, the artificial simplification of reality created to do the study).
What is worse, the entire discussion of the topic tends to favor theory over reality, and most people do not seem bothered by that. This is a serious problem that interferes with having a reality-based discussion. Those who advocate for e-cigarettes and THR should not be treating these models as if they are more informative than reality (“see, this study proves that e-cigarettes really do work, like we have been saying”). Down that path lies the inevitability that some models will produce results contrary to reality, and accepting those also as more informative than reality.
But there is a potentially bigger problem, the waste of the potential to learn something. We know that a lot of real-world smokers will switch to e-cigarettes if given ample encouragement. We are even starting to have a pretty good estimate of how many. But we know woefully little about many important questions, such as how to identify optimal candidates for switching or exactly what variables in the experience change the probability of switching. We waste the opportunity to answer these questions every time someone implements a model (study) that is designed so that it can do nothing other than roughly replicate what we have already seen the real-world version of. It is the difference between a useful experiment and a mere demonstration. Yet if the models are treated as useful even when this is all they do, chances are it is going to keep happening.
The economist joke is not really fair because those building the theory to explain the reality are generally doing so in a way that can provide information about reality that we do not already have. They are asking “why?” or “exactly what is happening?”, not “did this really occur?” Economists seldom actually think the models answer the latter question, as the joke implies. Moreover, such efforts are a pretty cheap way to pursue further knowledge. It would seem that the real joke lies elsewhere, and it is not really so funny.
Tobacco harm reduction, anti-THR lies, and related topics 
“insurance prices dropping under the ACA”
Hardly dropping, my quote is for higher price under ACA with higher deductible and lots of items not covered under the ACA policy that were under my regular old fashioned healthcare policy I am still grandfathered into for a while longer, but not forever. Not everyone is seeing “prices dropping” with Affordable-Care-Act/Obamacare plans. That is just propaganda saying it in the media, for benefit of pushing the ruling class agenda.
As with basically all the examples here, researchers tend to look at the average effects (e.g., I am sure someone in Greece is financially better off than a six years ago, but on average the economy has crashed). Sometimes it is interesting to study the heterogeneity and sometimes that is not what is of interest for a particular question. As I argued, the heterogeneity is what is interesting about ecig switching because we already know that it works for 10% of the population or more. This contrasts with getting the big picture about Greece or the ACA on average.
The impression I got is that these seemingly-silly studies are trying to say “It works in anecdote, let’s see if it works when non-bloggers try it.” That is a useful experiment for us. At least the first 3 times it is done and published. After that, yeah, let’s look at HOW to make it work better. But for now, we know it works better if the ANTZ don’t get it outlawed and slandered, therefore proving it also works when honest, credentialed, researchers are watching is useful. Am I missing something here?
That would be important if we were almost in the hypothetical world I mentioned, of not having yet introduced the products into the wild. If there were just a few first-mover aficionados who had switched, something like this could show that a lot of switching is possible even though had not been seen yet. But once some populations have seen millions of people adopting ecigs, it is too late to need to show that.
Honest credentialed researchers can also do research about the real world rather than artificial poor substitutes for it. Indeed, some of us prefer it.
This fact would be hilarious if it wasn’t so common. I am, along with many others, a person who smoked so much for so long that I don’t know if making the switch will help much other than my pocket. But I learnt, read many studies, picked out the good from the bad (maybe with the advantage of a science background) and now know who is doing real research and who is making the facts fit the poor theories that don’t exist in the real world. For this myself and my compatriots, many who have finally found a way out of smoking by switching, are insulted in public and on social media by Tobacco Control people who obviously believe that because they have the unfortunate name of electronic cigarettes they must be similar and at least as dangerous. I have been called astroturf, accused of being paid by tobacco companies, as has everybody else who dares to suggest that they appear to be safer (not 100% safe) than smoking. I see governments rushing to ban these devices, ignoring all real world evidence and all research that disagrees with their views.
Probably most who made the switch are unaware that the devices that saved them from smoking will soon be either banned or rendered useless, with reasons given that might be possible theories if there was little or no real-world experience, but are proved wrong by the fact that they have been in use in the West since 2008, have advanced technically to a point where they are a real substitute for smoking and the only evidence of harm are a few fires caused by faulty chargers and ex-smokers becoming smokers again because of the fear and media scaremongering generated.
Soon we in the EU will have to choose between returning to smoking or buying from criminals in a black market because of a new EU law that has designed an impossible electronic cigarette. There will be children choking on tiny bottles, large quantities of harmful waste, accidents caused by people throwing small metal tubes on roads, causing tyres to be ripped, and that is if we are lucky. The advances that allow vapers to use less nicotine of lower strength will have gone because, as shown by the Dutch pre-TPD legislation, because of fear and maybes that have not been born out by the real world, devices that were in use five years ago will be all that are permitted. As we see new developments if more efficient and safer delivery systems every three months or so, that will be impossible because all new devices must have near-medical approval six months before being placed on the market.
There is a great fear that this way out of smoking is in fact a way in, so because vapour from a box ‘looks like smoking’ the tobacco companies that the lawmakers are told have found a new way to recruit smokers now that smoking is denormalised and no sane person would ever touch a cigarette, these evil companies have found a new device that will even encourage very young children to use them because they have pleasant flavours. That any flavour but possibly tobacco or menthol would cause non-smokers to yearn to smoke.
Personally I know of people who have returned to dual use because they fear that when they have to choose between smoked tobacco and the risk of very noxious substances sold by criminals they will find smoking tobacco disgusting because of the feared ‘candy flavours designed to appeal to children.
Governments and many in Public Health regard the use of nicotine to be far worse than the use of pharmaceutical nicotine products intended for smoking cessation although these products are authorised for long-term use as a substitute. In spite of the fact that, apart from the few European countries where snus is legal, smoking rates have remained the same since 2006. It is true that less cigarettes are sold now, and less NRT products, but that will change if the electronic cigarette ceases to be the cheap, easily obtained product that exists now, with varieties to suit almost any individual.
All these new laws to prevent the use of vaporised nicotine instead of smoked tobacco exist because of making real life fit theories and ignoring good research.
I fear that they will cause many deaths that are now avoidable. Those who are long-term smokers, have tried every approved method of stopping many times and failed, will not do what was stated by the Chief Adviser on Health in England and ‘grow a backbone and just quit’
Here’s another classic joke about the difference between theoretically and realistically:
Boy: “Dad, what’s the difference between theoretically and realistically?”
Dad: “Go and ask your mother if she’ll sleep with the milkman for $2 million”
The boy goes and asks his mother and returns to his father.
Dad: “Well?”
Boy: “She said of course she would.”
Dad: “Now go and ask your sister if she’ll sleep with the postman for $1 million”
Again the boy goes off and asks his sister if she would sleep with the postman for $1 million and returns to his father with the answer that she indeed would.
Dad: “See, here’s the difference. Theoretically we’re sitting on $3 million but realistically we’re just living with two sluts!”
Pingback: Crippling Control | Norbert Zillatron
Thank you! I wholeheartedly agree.
Inspired by your posts on RCTs I sketched some thoughs on the possible pitfalls from a vapers point of view: http://nzillatron.wordpress.com/2014/11/01/crippling-control/
I also have some remarks on this study there.
Keep in mind (referring to what you posted) that models like clinical trials can err in either direction, for obvious reasons. You note the pitfall of testing a weak regimen (not enough variety, etc.) and thereby underestimating the effectiveness. But there are various other possible errors, including selection of a non-representative sample of smokers (those who are more interested than average in switching). This seems to be the case here. We are starting to see where switching levels off in England, and it is at a fall lower portion of the population than switched in this study. There could easily have been a disproportionate number of Category 1 and maybe even Category 4 smokers in the study population. (That will mean nothing to you. Explanation is in the new paper I will be releasing — should be this weekend.)
The bottom line is that models are often highly imperfect measures of reality.