by Carl V Phillips
If you read the title of the paper (peer-reviewed journal article!), “Nicotine and the Developing Human, A Neglected Element in the Electronic Cigarette Debate” by Lucinda J. England, Rebecca E. Bunnell, Terry F. Pechacek, Van T. Tong, MPH, and Tim A. McAfee (all employees of the U.S. CDC), you might think it was a study of the effects of nicotine. But upon reading the abstract and noticing that it merely has some vague hand-waving about that, and is mostly about “needed” policy interventions, you would probably think it is instead a policy analysis. But it is neither. It is a case study of how “public health” people do not think that conclusions and policy recommendations need to be based on any analysis whatsoever.
The body of the paper itself starts with the expected wandering, useless, and misleading discourse on e-cigarettes (wasting about a quarter of the total length). It then has brief sections that address nicotine and pregnancy/fetuses, children, and adolescents. Given that nicotine use is increasingly separated from smoking, these are useful topics to carefully analyze to determine the real level of concern (which falls somewhere above zero for the case of pregnancy, but far below panic). But these authors are not up to that task. Those sections read like a college-level term paper on the topic, consisting of a list of conclusions from other papers (with particular reliance on assertions from a Surgeon General report on smoking, rather than original sources), without any quantification (literally none), or analysis. The sources are presumably cherrypicked too, given the biases and approach to science of these authors, but I am not inclined to delve into that.
So we still await some real analysis of those topics.
But these authors are not inclined to wait for science. Oh no. Their conclusions recommend five interventions regarding e-cigarettes. With the exception of the recommendation for child-resistant packaging — a proven-useful intervention that is straightforward to implement and poses no substantial costs, and thus the mere fact that there are any accidental exposures is sufficient to recommend it — the recommendations do not in any way follow from any analysis. It is standard ANTZ practice to do a throwaway research study as an excuse for writing an unrelated editorial about how the authors would like the world to be. But these authors did not even do the research study. Moreover, they made specific recommendations that call for analysis, rather than just opining that they personally think the world would be better off without e-cigarettes.
Consider their first recommendation, “strong prohibitions on marketing that result [sic*] in youth uptake”. Does marketing that results in youth uptake even exist? Which particular marketing is it? They do not analyze these questions, let alone establish that it exists. If it does exist, would these unspecified “strong prohibitions” actually change that fact? Obviously they have no idea, since they do not even establish what the target is or suggest what a prohibition would look like. How much would this cost in terms of real resources and political capital? What would be the consequences in terms of causing fewer smokers to switch (including smokers who are “youth”)? Do the benefits justify the costs? They address none of this. Answering the last question requires quantification, which is completely absent.
[*Petty aside: The typo is kind of amusing. If you read the sentence without mentally correcting it, it actually says they recommend taking action that (itself) will cause youth uptake.]
These are the policy analysis questions that need to be asked about any proposed policy action. The same questions need to be applied to the recommendations about health warnings, protection from “secondhand” exposure (which, of course, is ANTZ-speak for banning use in adults’ private spaces while doing nothing to change it in the domestic settings where it might actually affect children), and even youth access laws.
Such analysis is always(!) absent from ANTZ policy recommendations. The reasons for this are two-fold: “Public health” people, in general, are clueless about policy analysis and dangerously narrow-minded, and genuinely think “I have identified an exposure that might have some negative effect” is sufficient for “and therefore we should implement whatever half-assed policies I can think of, which kind of sound like they might reduce the exposure, without consideration of anything else in the world.” But this becomes even worse in the case of anti-tobacco recommendations because they consider the costs to be benefits too. Indeed they sometimes even admit this, though they usually try to hide it. “So the policy will just make tobacco users suffer and impose resource costs on them and industry without contributing anything toward the ostensible goals? Great!”
Circling back to the “analysis” in the paper, I was particularly amused by the extensive discourse on “tobacco company” efforts to convince women that e-cigarettes are safe during pregnancy (efforts that, needless to say, do not exist). They assert that these (non-existent) efforts could convince women that smoking in pregnancy must be fine. Huh? That was almost 10% of the total text of the paper! I was less amused by the fact that the effects of nicotine in pregnancy is a genuinely important topic for us to try to understand, in order to make valid health recommendations, but someone reading this paper would learn nothing.
The section on children is half about e-cigarettes “renormalizing” smoking (because it is “indistinguishable from smoking”!). The bit that is actually about nicotine exposure via environmental deposition says that “the health effects of nicotine in this age group are uncertain”, though this does not stop them from recommending aggressive policy action. The section about adolescents starts with the usual CDC lies about widespread “use” of e-cigarettes, and ends with the usual gateway myths, both of which I have extensively discussed previously. In between, for a few words, it touches on the brain porn analyses of the effects of nicotine. Again, I am not amused because if there is real reason for concern, it would be useful to know. But we are not going to learn anything from tracts like this (or people like these).
Finally, it is always worth noting how ANTZ authors consistently lie about their conflicts of interest. The authors declare that they have no financial conflicts of interest other than one pharma grant that actually seems to create absolutely no hint of COI in the present context. They seem strangely ignorant of the fact that their jobs and salaries depend on toeing the CDC party line of producing anti-ecig propaganda and actively pursuing aggressive policy interventions. Needless to say, this is about the most extreme COI that someone could have.
(h/t Clive Bates)
But this applies to all so-called ‘public health’ research that focuses on everyday substances, whether tobacco, alcohol, sugar….
And it was tobacco research that started it.
Basically true, yes, though to put a finer point on it: Pretty much all of public health research (without the scare quotes — I am included the relatively non political stuff) suffers from the basic phenomenon I note. Someone finds some possible tiny risk (in one dataset) from, say, a particular type of cleaning product, and does the same thing, calling for policy interventions without reference to costs, effectiveness, etc. They probably do not actually think that the costs are benefits, they just don’t understand that they exist. The anti-alcohol extremists also believe that most of the costs are benefits; they do not all seem to want drinkers to suffer (as the ANTZ clearly want tobacco users to suffer), but they certainly consider imposing higher financial costs to be a benefit. The anti-sugar people are just loopy, so it is hard to tell what they really want.
Research on the effects of smoking did indeed launch much of epidemiologic research. And the lavish funding for anti-tobacco has certainly created the groundwork for other extremism. But it cannot be said to have created these “public health” attitudes, which predate anti-tobacco.
NRT has been around for quite a long time- in australia it is something like 25 years(or more).
.I would guess that there must be by now a significant number of women who switched to NRT because they were pregnant? have there not been any studies of the actual children of such women?
As far as I know, there are no such studies, just as there are no studies of long-term users of NRT. The reason for that is fairly clear: The manufacturers want to maintain the fiction that NRT is used to quit smoking, even though far more of it is sold to continuing smokers for temporary use when in smoke-free places, and to people who are using it long-term as a THR products. Similarly, they do not want anyone to know how many pregnant women are using the product (which is warned against on the U.S. labeling and presumably elsewhere), let alone risk collecting evidence that their fetuses are being harmed as a result. Thus, the manufacturers — those who fund most research on any product — are not going to support such research, and they will use their influence to prevent governments and major health charities from funding it either. Perhaps a major tobacco company would fund such research, but it is hard to imagine anyone else doing it.
Carl, from my reading of anti literature of very late (e.g. their WHO conference at the moment) I come away with a very strong feeling that they have brainstormed for a particular renewed push in their blueprint: “It’s the tobacco industry we’re after.” I believe the motive is to “prove” — in a “doth protest too much” sort of way — that it’s not the smokers/vapers who are their target. “Tobacco industry” is their scripted sound bite now.
It was your “I was particularly amused by the extensive discourse on ‘tobacco company’ efforts…” that elicited my comment about my observation.
They certainly do that, trying to create the fiction that their policies that are designed to harm consumers (and there is no other way to describe taxes, place bans, etc.) is really harming the industry (which it does not actually do — except for things like trying to ban ecigs, which of course would harm that industry). I am not sure I have noticed any change in this, though. Their rhetoric has always tried to create this misleading impression, presumably mostly aimed at their useful idiots who actually believe it.
Its pretty easy to see why so many of them go this route its not new at all
Epidemiologists Vote to Keep Doing Junk Science
Epidemiology Monitor (October 1997)
An estimated 300 attendees a recent meeting of the American College of
Epidemiology voted approximately 2 to 1 to keep doing junk science!
Specifically, the attending epidemiologists voted against a motion
proposed in an Oxford-style debate that “risk factor” epidemiology is
placing the field of epidemiology at risk of losing its credibility.
Risk factor epidemiology focuses on specific cause-and-effect
relationships–like heavy coffee drinking increases heart attack risk. A
different approach to epidemiology might take a broader
perspective–placing heart attack risk in the context of more than just
one risk factor, including social factors.
Risk factor epidemiology is nothing more than a perpetual junk science machine.
But as NIEHS epidemiologist Marilyn Tseng said “It’s hard to be an
epidemiologist and vote that what most of us are doing is actually harmful
But who really cares about what they’re doing to epidemiology. I thought
it was public health that mattered!
we have seen the “SELECTIVE” blindness disease that
Scientist have practiced over the past ten years. Seems the only color they
see is GREEN BACKS, it’s a very infectious disease that has spread through
the Scientific community with the same speed that any infectious disease
would spread. And has affected the T(thinking) Cells as well as sight.
Seems their eyes see only what their paid to see. To be honest, I feel
after the Agent Orange Ranch Hand Study, and the Sl-utz and Nutz Implant
Study, they have cast a dark shadow over their profession of being anything
other than traveling professional witnesses for corporate hire with a lack
of moral concern to their obligation of science and truth.
The true “Risk Factor” is a question of ; will they ever be able to earn
back the respect of their profession as an Oath to Science, instead of
corporate paid witnesses with selective vision?
Oh, if this seems way harsh, it’s nothing compared to the damage of peoples
lives that selective blindness has caused!
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