by Carl V Phillips
I was recently compiling a collection of journal articles related to THR for a study of peer review. (More on that before too long.) One thing that I was struck by was how many articles about assisted smoking cessation did not make the cut to be in our collection because there is no mention of THR. I guess it comes as no surprise when you think about it. But the sheer volume comes as a rather stark illustration for those of us whose reading is concentrated on articles that do focus on THR and THR products.
Yes, we know there is a new journal article published about tobacco approximately every ten minutes. And we also know that 99% of them are junk science, thinly veiled commentaries, or otherwise utter wastes of time, and so ignore them. But when forced to thumb through them, you notice a few things. In particular, I noticed how rare any mention of THR was, even in articles that cried out for it. This cannot be an accident.
THR is currently the most common method for successful assisted quitting in some of the populations that are most often studied. THR has long been well established as a particularly successful method of assisted quitting — one might say an outlier compared to other methods. With the explosion of interest in e-cigarettes, it has become quite common to try. And yet it is almost never mentioned, even in articles that are about assisted quitting methods.
I would not necessarily call foul on the failure to mention THR in articles about the biological effects of smoking. (Yes, people are still wasting their time and our money on more studies to show that smoking is bad for you. I suspect they will not stop until they “show” that smoking causes more than 100% of all deaths.) However, they do invariably waste words on observations about how many people smoke, how many are predicted to keep smoking, what various political actors say about it, and such. And so it is notable that they do not mention THR in these tangents. Of course far better still would be to eliminate the tangents, as I always point out should be done when I review a paper. A report that smoking causes 23.627% of traumatic brain injuries should only tell us what the study did and “showed”; it should not include a the authors’ version of a anti-smoking pamphlet. But once that is there, the omission of THR is a further problem.
But there is absolutely no excuse for failure to mention THR in the far larger collection of articles that are about smoking behavior. This is particularly true for the seemingly countless studies of smoking cessation assistance in populations like the USA, UK, France, and many other places, where it is a blatant omission of one of the most salient aspects of the topic.
As an aside, it is astonishing in itself that there are just so many such papers. It would be a full-time job to read them all. And that would be a really unproductive job, even by public health standards: It seems like these studies are an exercise in that wag definition of insanity, repeating the same actions over and over again and expecting different outcomes. Seriously, what level of narrow-mindedness or not really caring whether you succeed would lead people to keep pursuing such a legacy of failure?
The exception about even mentioning THR products can be found in reports of studies in Sweden, where the authors cannot really help but mention snus use. Of course, most of those authors are among the “public health” activists who do not really care about science, research ethics, or health, let alone people’s welfare, and so they inappropriately denigrate the use of snus. The rare mentions of e-cigarettes are consistently worse still. The “public health” people like to point out that switching to a THR product is “unapproved” (unapproved by who and for what? and more to the point, why does that matter at all for anything?) and “unproven”. The latter is, of course, out-and-out false. There is overwhelming evidence that THR has reduced smoking more than all those “approved” methods and is a more effective intervention for smokers — at least it is outside the hands of ivory tower researchers who do not know how to market it and apparently do not know how to do the simple science necessary to show how effective it is.
But therein lies the real issue here, a conspiracy of circularity. So long as these anti-tobacco extremist authors do not mention THR in their papers, and so long as they get away with their tacit fiction that any evidence in the world that does not appear in one of their papers does not exist, they can keep saying there is no evidence. Ninety nine percent of smokers in the USA could switch to low-risk alternatives, but so long as they never acknowledged that fact in their papers, it would be unproven in their little echo chamber. Indeed, they would probably keep hunting down the last holdouts to do more of their silly studies about whether changing a font or adding a phone app makes their near-useless interventions 0.1% more effective.
Oh, and as for journal peer review, the reviewers are invariably part of the same conspiracy. I did not actually look through the journal reviews of papers that talked about assisted cessation without mentioning THR (perhaps a project for another day — anyone interested?) but I figure it is a safe bet that the reviewers did not suggest it ought to be mentioned. Obviously they did not suggest it be reported about honestly.
[Update: This post was not amusing enough. But I ran across this cartoon, so now it is. I realize this fits better in one of my posts specifically about the folly of using RCTs to study THR, but it works here too.