by Carl V Phillips
I have watched with dismay as the relationship with science in the e-cigarette advocacy world has continued to descend toward that found in tobacco control: embracing anything that supports ones political beliefs and rejecting anything that does not, regardless of the validity or scientific defensibility of the claims. While we are still a ways from parity — and it is certainly the case that pro-ecig misinformation tends to move the debate closer to reality even though it is wrong (because the anti-ecig misinformation is so widely believed) — it is hard to not extrapolate the trend. And even if it stops here rather than continuing downhill, we are not in a good place.
I am not talking so much about the chatter among the enthusiastic consumer community. It is inevitable that this is full of cheerleading and echo-chambers, and thus it is inevitable that a lot of misinformation is touted. The same is true for pretty much any issue of politics or lifestyle. It would be better if that were not the case, and one of the several purposes of this blog (along with others) is to try to reduce that tendency a bit. But this tendency to interpret scientific claims based primarily on the political implications of the conclusions is also common among ostensible experts. Going down that path is exactly how the movement that began with legitimate research and education about the harms from smoking turned into the fanatical and lie-based tobacco control industry we see now.
Consider the major anti-ecig broadside of the week, the claim that a new study shows a gateway effect from vaping to smoking among teenagers. This has been widely decried in pro-ecig circles. But just two days ago, those circles — in some cases, the exact same people — were touting the claim that another study had demonstrated there was no gateway effect. The thing is, the former claim is actually more legitimate than the latter.
They are both wrong. This would be obvious if we had a methodological analysis that points out what evidence would actually inform either of those claims. Oh, wait, we do have that. And it covers the fatal flaws in each. Yet I never saw it invoked in any of the commentary of these claims (though obviously I do not read everything). And, no, this is not about me wanting the citation — it would have been fine if someone offered such analysis by either borrowing my thoughts without attribution or re-deriving the points, but no one did.
Monday’s claim about there being no gateway effect was just dead wrong. There is literally nothing in the reported research that supports that claim. This is quite obvious on its face, but it also happens that I addressed the very fallacies employed in making the claim in my methodology paper. The short version is: The claim is based on two observations, that there are few teenage e-cigarette users who are even at risk of being gateway cases (i.e., they were not smokers in the first place) and that smoking rates are not going up. But the first of these obviously does not show there is no gateway effect, only that it has not had a chance to affect many people (yet). And this itself is the reason why the second is fallacious: even if, say, a quarter of the vapers in that at-risk group became gateway cases, it would be too few to show up in the smoking statistics.
By contrast, today’s claim is actually grounded in evidence that could be interpreted as supporting a gateway claim. Such a conclusion is still wrong, but it takes a bit of serious analysis to see why. The research found that teenagers who were exclusive e-cigarette users were more likely to later become smokers than teenagers who used no tobacco products. The pro-ecig commentators who dismissed the claim argued that this association could easily be explained by confounding: that the teenagers who chose to adopt e-cigarette use were more likely than average to become smokers for reasons that were not caused by their vaping. But the authors of the study, quite expectedly, preempted that simplistic response, pointing out that they controlled for some variables to try to correct for such confounding.
It turns out that “we controlled for that” is usually a bullshit claim in epidemiology; the standard statistical practice is inadequate. But simply crying “that association could have been caused by residual confounding!” is epistemic nihilism — you can always say that and thus use it as an excuse for refusing to accept a result you find objectionable. Thus, everyone is wrong at the simplistic level this conversation took place. Fortunately, we do not have to stop at the simplistic level. There are ways of assessing whether the “we controlled for that” claim is at all convincing — I cover them in my paper so will not repeat them here — and it turns out that the claim is very much not convincing in this case.
It is not that pro-ecig commentators were wrong in arguing the authors of that paper failed to rule out the obvious confounding as an explanation for the association. That statement is right. But it is not right because residual confounding is always possible and therefore you are free to ignore any study result you do not like. Such nihilism is exactly the behavior we observe from tobacco controllers when they want to dismiss a study result they do not like.
If this were explained by a culture of great scientific skepticism, it would be different. But pro-ecig advocates have also adopted the tobacco controllers’ habit of declaring that any study result that kinda sorta hints at support for their preferred hypothesis is sufficient for declaring it to be true. The pattern is that study results can be dismissed with hand-waving complaints about the methods being imperfect (as methods always are), unless the authors stated the right conclusion, in which case the methodology was just fine. Sound familiar?
There are various aphorisms along the lines of “choose your enemies carefully because you will eventually end up acting like them.” Frankly I find this fairly silly as a general statement. It is obviously not true that everyone ends up acting like their enemies, and when they do it is likely to be for organic reasons that have nothing to do with what the enemies did (e.g., soldiers do not commit war crimes because their enemy have done so, but because they are all put in similar horrific circumstances that bring out the worst devils of human nature). But it actually does seems to be causal in the present case.
Non-scientists in the e-cigarettes space are exposed to “science” mostly by reading tobacco control junk science and similar bad “public health” research. While they might reject the conclusions, their understanding of how scientific conclusions should be reached is poisoned. More important, many of the ostensible experts who are pro-ecig are tobacco controllers. They may be schismatic regarding the political party line on this one point, but their training and experience are still based in junk science. They simply were not taught any better in school, did not learn by example because they did not read outside their field, and never suffered any penalty for doing junk work because there was no critical review. And all this remains true after they went pro-ecig.
This brings us to the other big e-cigarette news of the week, today’s report published by Public Health England, which is being touted as The Best Thing Ever by many e-cigarette proponents. Really? My reading finds this a not-very-veiled stalking horse for medicalizing THR, which has always been a goal of tobacco controllers (and the authors very much tobacco controllers, despite being schismatics). In addition, the content makes a good argument for discouraging or even forbidding e-cigarette use as a reasonable lifestyle choice, relegating to merely being a lesser evil than smoking. This is tangential to the point of the present post (see my next post, which I had been working on for most of two weeks when this came along, for more on this point), but some specifics are exactly on point.
In particular, the report is presented under the headline, “E-cigarettes around 95% less harmful than tobacco estimates landmark review”. Just skip over the overblown self-assessment of this made-for-government-palatability review, whose main messages were already obvious to anyone who had been paying attention, to the number: 95%?? Where did that come from? Well it turns out that it was just made up from whole cloth, tracing to an exercise in making up numbers which is often mis-described as a study. (I excoriated that silly exercise here.) Yet the number is declared not merely to be a fact, but to be exactly right (there is no hint of an uncertainty interval around it).
The magnitude is absurd. If vaping really were really 5% as harmful as smoking, it would be the most harmful lifestyle choice almost any nonsmoker ever made, short of bundling all of “not eating optimally” into a single choice. It would be more harmful/risky than all of someone’s transport and travel, or being substantially overweight, or eating tons of sugar, or eating lots of fried foods, or dabbling with drug use, or most levels of heavy drinking, and so on. If I believed vaping really was that harmful, I would be encouraging vapers to quit, so long as the alternative was not returning to smoking or being very unhappy. If drinking coffee were 5% as harmful as smoking, I would certainly give it up, as much as I like it.
For vaping to be 5% as harmful as smoking, there would have to be particular diseases that produced that much harm. There is no such thing as “just harm”, without a specific disease pathway. But no one has made any plausible suggestions about what diseases those are, presumably because they would clearly be absurd. Still, supposed expert commentators made this claim and others seem unbothered by it. I am not sure whether to say this scientific failure should be attributed to pro-ecig advocates (who have gushed about the report and the original paper) or tobacco controllers (who are the ones who ultimately benefit from such a claim being accepted). I suppose it is not necessary to sort that out, because my point is that those groups demonstrate similar willingness to accept absurd scientific-sounding claims.
I have observed some pushback against this claim from the pro-ecig side, trying to rewrite it to say that 5% is the maximum possible level of risk. But this is not true either. The reasonable point estimate is a small fraction of that 5%, but we still cannot rule out that the risk is greater than 5%. It is unlikely, based on the knowledge we have, that inhaling the chemicals in e-cigarette vapor for a decade or two is all that harmful, but it is certainly not impossible, given that we have never observed these exposure levels before. Again, we are growing a culture of just making up and uncritically accepting scientific claims that quite easy to debunk.
It seems rather unlikely that this will work out well. When people look in at a squabble where both sides are, um, stretching the truth, those who are 90% honest do not actually look a lot different from those who are 40% honest.
It does not have to go this way. I noted that because the anti-ecig junk claims are so widely believed, it turns out that pro-ecig junk claims tend to push the messaging closer to the truth. But the fully accurate and defensible claims are also quite sufficient to do that. It is really not all that hard to get the science right. The obstacle is not a lack of ability to do so, but a distressing lack of an ethic that getting it right is the right and proper thing to do — ultimately better for the consumers whose welfare this is supposed to be about — and a lack of concern that flouting getting it right is ultimately toxic.
Tobacco harm reduction, anti-THR lies, and related topics 
Descending toward Tobacco Control level? You mean, “Bringing a baby into a room where someone earlier used an e-cig will make them healthier.” and “E-cigs are the most beneficial drug on the planet, more helpful to humanity than smallpox vaccine, insulin, and antibiotics combined! And thirdhand E-Cigs are even BETTER!”
That’s actually about what they’d need to do, although I understand what you’re saying and agree with it.
The E-Cig folks need to be VERY careful NOT to tell the lies of the Antismokers and Antivapers in reverse. Study the history of the fight against the Antismokers and learn from it so you can avoid falling into the same traps and so you’ll know the weaknesses of your enemy. Their MAIN weakness has always been their lies. There’s no need to fight about claims that are acutually questionable for the most part if you’re talking to, or for the benefit of, the general public: concentrate on their most egregious and most easily exposed lies. Once you’ve shown people convincing evidence that they DO lie, and that they’ve been doing it for years on end as a pure matter of course, they’ll be more open to questioning whether ANYTHING they hear from that crowd is true.
And that can only benefit them (the general passers-by, the public) as well as us (Smokers and Vapers).
– MJM
You are comparing not to the Very Serious People in tobacco control, who are my basis of comparison, but to the fringe loonies. There will always be those in every cause. And, yes, you can find random proponents making more or less the claims that you joke about re ecigs. That fits into my “chatter will be chatter” aside. I would like to educate such people, but I am not too worried they exist.
I agree that lies are a great point of attack (obviously — see title of blog). So far, I think the grandees of the pro-ecig movement have not believed that such attacks are needed, which may be why they do not worry about creating a vulnerability to them. They tend to act as if they are playing a fair game of tug-of-war and think they just need to pull harder. Maybe they are right, now that they have captured the UK government.
Heh, Carl, I wasn’t proposing those statements as actually being said by *anyone* on the e-cig side: not even the loonies! I meant it as a comparison to the outlandish statements made as standard material by mainstream Antismokers. Winnickoff scared the public in 2009 with the idea that radioactive thirdhand smoke was poisoning children as if they were KGB agents being hunted down by counterspies. And the “Smoking is the most-addictive/deadliest drug etc” claim has been around since at least the 80s.
Both of those smoking statements have become quite mainstream despite their misleading characteristics and they’re paralleled almost to the letter by the opposite sort of e-cig statments I proposed that actually, to the best of my knowledge, have never ever been made even by the most extreme Vapers.
My point was that it’s the exaggerations and the lies that are the greatest weakness of the antismoking movement. The antivaping movement has its own examples of which you’ve documented a good number over the years. And what I always remind smoking activists of, I’d also like to remind vaping activists of: Do *NOT* supply the enemy with ammunition to use against us: make sure your claims are solid and can be backed up, and then you can always use the springboard of the Antis’ lies to lay out your own truths as comparisons.
That’s how the “hearts and minds” of people in general can be won out there — although it’s hard when your opponent’s money-microphone is literally on the order of 500,000 times as large as yours.
I want to agree with this, but it’s difficult to. Let’s list some known things:
1. Whether the 95% figure is correct or incorrect, it’s certainly true that e-cigarettes are much, much safer than cigarettes.
2. The best case scenario we can imagine in terms of reducing tobacco harms involves e-cigarettes and other low risk sources nicotine being available, inexpensive, effective and pleasurable.
3. Those who are attempting to regulate e-cigarettes and low-risk nicotine sources want them to be unavailable, expensive, ineffective and boring. They have stated as much in their official published plans.
4. E-Cigarettes are much less harmful than tobacco whether or not the science that allows them to be on the market is correct or incorrect. There is no plausible situation in which their harm begins to outweigh their benefit because of the kind of inaccurate report we see here, so long as the report allows them to stay on the market unscathed.
5. The opponents of THR are willing to use this type of junk science without a second thought.
6. Using this kind of junk science is extremely effective for them and has had absolutely no downsides. They have an very good chance of destroying the industry after having done so despite the “good” science being overwhelmingly against them in reality.
7. This particular report is the largest single piece of good press we’ve ever had.
Our opponents are willing to use this kind of junk data and do, and that using it has had absolutely no downsides for them but rather has allowed them to beat us down at every single turn despite the good science and best logic being entirely inconsistent with their stance. ‘
If they win, hundreds of thousands of smokers die who did not have to. If we win using this kind of junk science, they live. They live exactly as much as if we had won not using it, and far more than if we had lost because we took a moral stance and lost.
You speak of “accurate and defensible” claims, but we have bushels of those and they’ve been consistently ignored by the media, who finds them boring and will not print them. I’m not saying you are wrong on the science, but in a strategic sense it seems absolutely silly to allow smokers to die rather than to use convenient tools dropped in our lap. I fail to understand why I’d want to let them die to preserve pride in my own discernment.
I will distill what you said down to: “We should just go ahead and lie because our cause is right and telling the truth hasn’t been completely successful.” I have seen that before in other areas of advocacy. In fact, I have seen it in every area of advocacy I have ever delved into. It never works out well.
It is premised on us being right. Obviously we think we are right (no one thinks otherwise or they would change their mind). But someone thinks otherwise. A good test is if they have to lie to sell their story and we can tell the truth, then we are indeed right. If we have to lie, then perhaps we are wrong. Maybe not about the big picture, but about a particular point. If we have to lie about evidence about the gateway effect, then maybe there is a gateway effect. If so, are we still willing to defend our position in spite of there being a gateway effect? Or are we only willing to defend it if we trick ourselves and others into believing there is not?
That is the ethical side. The tactical side is equally compelling even if you are merely acting like a mercenary re the ethics.
If the truth is not getting any traction, why would you expect any little lies to change that? But if you move into big lies, they become easy targets for discrediting the whole movement. The response to that I have heard a million time is “but they do it!” But ours, like many advocacy movements, is a case asymmetric warfare. Those who control the media and most of the popular opinion can get away with lying. It can still be used against them: their experience of being able to get away with any lie they can concoct (because no one was responding) is a point of weakness that can be exploited. But mostly they can get away with it. They can base their whole argument on the claim that children are using them for a year (…this is a hypothetical story, of course…) and then, when definitive data comes out that children are not using them, change to a different argument and forget the previous claim, and they will get away with it. Try to pull the same stunt from our side and it will set us back enormously.
The real world is always difficult for a scientist, because nobody needs or wants truth. It has no real use in politics, which is where health issues are whether we like it or not. So, the other side’s lies are countered by our lies, and a fair balance is achieved. It’s got nothing to do with facts, but it is about reality – and reality is all about who owns the revenue streams. Science is pretty much irrelevant at that point.
Some of us didn’t get involved with all the hoo-hah this week because, as you say, it’s all about junk in both directions; and ulterior motives for what looks useful on the surface; and agenda-based moves that only look beneficial if you don’t look too hard. Anyone who took the time to weigh up exactly why things happened as they did can smell something fishy. But it’s all grist to the mill and we surely need a lot more junk on our side to balance out the billion tons of it over on their side. Nutt and his junk will help to even out the million greater sins on the other side; a million-to-one sin ratio isn’t too bad. And it does look as if our well-targeted junk is more effective than their scattergun junk – this week anyway.
Evidence? Who cares about that in the tobacco-health wars? That’s just the worst of a bad joke.
That is a common attitude. I would be interested in learning of a single example where it seems to have paid off for those battling in an analogous situation (grassroots movement, fight against dominant popular perception, David-v-Goliath struggle). Lashing out is not a tactic. “Fairness” is not a tactical concern. I can point out quite a few cases where that attitude caused a movement to wander off into the weeds (e.g., most any “healthy eating” movement that actually was backed by real science, but ended up looking no different from the nutcases).
Yeah, I was just being a bit cynical, probably. Anyway, this week we scored a big win with ‘our’ junk. A win is a win, after all. Too bad it wasn’t down to anything honest or factual or morally defensible. Luckily there is no need for real scientists (or anyone with any principles) to get involved with slinging this kind of dirt around, both ways, so let’s just stand back and watch the fun. War is dirty and we’re wading in it now.
In any case it won’t have any effect on the TPD imposition here, that is bombproof because it’s about the money and no one with any power goes against that. The biggest value in the PHE announcement is probably to THR advocates in the USA. Funny the way these things go.
That is indeed funny, and I think you are probably right. In addition to the TPD issue, the rather nasty subtext will be lost — that is, the Old Europe government tendency to shift something from being forbidden (at least almost) to being mandatory (or at least government provided), without a stop in the middle at free to choose. That is so foreign here that no harm will come of it. So what will be left if the one sentence version that the UK government has endorsed e-cigarettes.
“If a claim is dubious or unsupported, then the opposite, competing claim automatically becomes true.”
Every area of human discourse would benefit greatly if people would just stop thinking this.
Again Carl you have proven yourself worthy of being heard globally. I know I have certain qualities to perpetuate your analysis, but unfortunately find it difficult to express it the way you and only you can. Admired and appreciative of your complete and honest philosophies backed up by the history of the past 30 years of Tobacco Control and its misinformation which sadly continues. What todo, what to do?
When you consider the made up smoking risks that blame smoking for everything under the sun I don’t think 5% of actual risk would be that much. A 95% decrease in all cancers, all lung disease, most heart disease (have to leave room to blame sugar there) is huge. I think the 95% is setting ecigs up for the bigger fall since all the things they blame on smoking are not caused by smoking alone. If 95% of all diseases and time off work don’t disappear after 50 years of ecigs they are deemed a failure. Of course most time off work is mandated by law and not at the employee’s discretion so that won’t change by 95%.
I agree with Chris Price. This is a political war rather than a scientific one and the unfortunate fact is that it must be fought that way. I think that Carl’s position – which amounts to taking the high road – supposes that there is or ever will be a high road to take. That is, that we can all sit and wait while someone, somewhere produces Carl’s vision of the immaculate science (re: your linked paper) that will be convincing to all. Not only is this unlikely to be produced, given the particular interests (funding, etc..) involved, but I would suggest that there simply can never be such a perfect behavioral health study that it erases all doubts. It is not possible.
You can call this “epistemic nihilism” — but I call it the nature of the beast. The methods we have produce imperfect results. There is always room for error and criticism of research or a body of research, and thus, no one will ever hold “the truth”. Waiting for the incontrovertible truth to emerge is a losing game.
Ya feel me?
Is my position ethical? I don’t know. I know that my freedom (and that of many others) to make certain lifestyle decisions has continued to erode over my adult life. And I believe that what is ethical has to be evaluated in terms of regaining that freedom.
It took me a long time to come to this position. I used to be a believer in science. I used to believe that science could sort things out. I used to believe that “researchers” were mostly ethical. I simply don’t believe those things anymore.
It’s funny Carl, when I read your blog, I get the impression that you feel that you can educate folks to understand things the way you do. Like, if they really understood the stats, and how they could be improved, things would get better. But sometimes it seems like the readers you are trying to educate are worlds ahead of you in seeing the real world. They’ve been there, done that, and moved on.
As for – “I would be interested in learning of a single example where it seems to have paid off for those battling in an analogous situation (grassroots movement, fight against dominant popular perception, David-v-Goliath struggle). ”
If I understand your question correctly — Those who promoted ETS as a health hazard (at least I imagine they saw themselves that way in the beginning).
Yes, that is probably analogous. And the thing is that they tried to do good science. Yes, there were clowns like Glantz kicking around back then, but they were not taken seriously. You can trace that cause’s descent into nonsense over time as they gained influence. Coincidence? I don’t think so. If you already control the popular discourse, you can start to get away with that; before then, you will get slammed for it. Exactly my point.
“Yes, there were clowns like Glantz kicking around back then, but they were not taken seriously. You can trace that cause’s descent into nonsense over time as they gained influence. Coincidence? I don’t think so.”
No, not coincidence, but my own close observation of the movement since the mid 1970s has led me to conclude that there were two HUGE “luck breaks” for the antismoking movement that gave them the foothold that eventually produced the game-changing EPA Report of the early 90s.
The first break came when Banzhaf swung the court decision granting an immense amount of free air-time to Antismokers in the late 1960s for antismoking messages. Those messages were VERY powerful for their time — so powerful that the tobacco companies decided not to really fight the campaign muzzling their commercial speech on the airwaves. Unfortunately for Big Tobacco, the move not only served to de-legitimize their product, but after the fact it left the Antismokers *still* holding a significant fragment of free air time advertising in a field with no opposition at all!
The second came when Glantz et al got Proposition 88(???) passed in California in 1988 (???) dedicating 25 cents per pack (or some significant portion of it) to antismoking efforts. Up until that point the Antis were basically in the same boat as most social reformers before them: a small band of struggling idealists with a huge personnel turnover and very few long-term dedicated actors. That initial tax raised the general US “Antismoking Budge” from what was likely a figure in the tens of thousands of dollars to a figure likely in the tens of millions of dollars: a thousandfold increase practically overnight. Suddenly there was a FLOOD of cash out there to attract all sorts of charlatans willing to make antismoking efforts their life careers while paying off fancy mortgages.
Those two events set the stage for the EPA Report, and then the EPA Report set the stage for the widespread bans of the 90s and the ultimate victory, the MSA Settlement that moved the tens of millions of annual antismoking dollars high up into the hundreds of millions of antismoking dollars.
I’ve sometimes joked (semi-seriously) that if I and my fellow bicycle activists had been given that sort of bankroll back in the 70s and 80s to brainwash people with, we’d all be riding around in bicycle-driven rickshaws today.
– MJM
Oh! a second answer to your question would be Global Warming Activists. Whether you believe such a thing exists or not (that’s irrelevant) – the amount of poor quality science cited in its support is astounding. I’d say that has paid off.
No, that does not fit. Even if we accept your claim that this cause was advanced by poor science (because that — not merely that some people who supported the cause made poor science claims — would be needed to defend doing it by analogy), that cause is advanced mainly by scientists and the governments they directly influence, with the popular action being a mostly a sideshow where it did not matter what was being claimed and only other members of the sideshow would care about it.
Hi Carl – I think the 95% claim is best understood as a risk communication designed to better align risk perceptions with reality. Quantification was used because that has more impact, and therefore more people will have better aligned risk perceptions as a result. It is a way of saying “a lot less risky, but you can’t be sure they are entirely safe”. It is grounded in a cautious view of toxic exposure (Burstyn etc not just the Nutt synthesis) but it would have been difficult for this public body to say 99% less or 100% safe with confidence – I’d see the 5% residual risk as a ‘safety cushion’. This claim should be seen as competing with hundreds of other risk-related claims that mostly deliberately mislead or, though well meaning, understate the risk differentials in THR – and I include in that the MRTP claim for snus, which does not convey the magnitude of the risk reduction and so is in the category ‘true but incomplete and misleading’. Even so, I am supporting the MRTP claim as being much better than the FDA default. So in a world of imperfect claims and incomplete caveats, we should give kudos to claims that shift perceptions closer to reality, have impact and provide a better basis for informed choice.
There is a risk that the claim is wrong – as you say, most likely that the claim is over cautious and that the implied residual risk it is too high, but it is also possible that some unknown unknown will render it too low – though I doubt that for a range of reasons. The usual way public bodies approach this risk of being wrong is to say nothing, to fudge and hedge, or to allow smokers to form their own perceptions from the maelstrom of ill-informed and malicious comment that circulates in this field. The result as we know is that consumers greatly overstate the risks of these products – many believing there is no difference in risk between cigarettes and e-cigarettes, and few appreciating the magnitude of the risk reduction. This caution *transfers* misperception risk from the public body to the consumer and is basically irresponsible. In the case of CDC and California Health Dept, it is worse than irresponsible – as they are purposefully trying to exaggerate the risk. In comparison, PHE is being responsible and proactive in making this claim.
So it is imperfect, not exactly how I would have phrased it (I prefer at least 95% lower as an expert judgement – a formulation previously used by these academics) – but it is an expert judgement presented by the CDC-equivalent here. It should help to do the right thing, which is contribute to consumers making better informed reality-based choices – which is what PHE is trying to do, but CDC isn’t. If CDC had made this claim, would you not welcome the attempt to get in the right ball-park on risk communication?
Your points about medicalisation are absolutely right – and in the UK the public sector has a bias towards discussing the things the public sector does. But it was not their intention to get into a debate about prescribing (providing free) e-cigarettes – it emerged from left field under questioning from journalists in their press conference… as you know, stories can take on a life of their own, and in the UK we are obsessed with the National Health Service and the public sector as the answer to all ills.
Clive, Thanks for the response. I agree with most everything you said. Everything, that is, except for the implicit conclusion of, “and therefore what they did was a reasonable way to address these points.” There is a whole lot of room to communicate the message you are describing without saying “the current best estimate” and “current expert estimate” is 95%, let alone say it so many times. If they really hold the beliefs you are attributing to them, this would be an intentional falsehood, made in needlessly strong terms.
It would be possible to make a nonspecific claim that suggested this magnitude without stating a number. It would be possible to state the numbers or some numbers vaguely, without implying precision and leaving the careful reader able to see that you are not really endorsing the number. Hell, it would possible to just put “95%” there without surrounding it by word that make it sound like it is base on something. But they took none of those options. And this is the big headline from the report (the authors and publishers made it the big headline). Despite some very good and sophisticated bits elsewhere (and serious kudos for the use of appropriate vocabulary — do you think we had some influence there??), it is hard to not see that as anchoring this clearly in the tradition of the last 20 years of tobacco control science, where authors believe they can get away with saying anything they want. (Note that this is not the only example: Much of the discussion about effectiveness for smoking cessation is nonsense.)
I have pointed out that 5% as bad as smoking is still a terrible risk. One correspondent ran with that and suggested this means they intentionally picked a number that was low enough that it encouraged switching, but still high enough that vaping is a terribly unhealthy thing to do, and thus worthy of being the target of the next round of tobacco control efforts. (That seems plausible, though I would have picked 90% if I were playing that game.) Whether that is true or not, it is no different from what you are proposing they did, which is make up a number and declare it to be scientific fact for purposes of social engineering. That is not appropriate behavior, whether their goal is to encourage switching, to discourage continuing ecig use, or whatever.
Also, I am not sure how you can say they attribute this number to anything other than Nutt’s junk science. That is the only thing they cite, other than some commentary by West that was even further removed from actual analysis. This is how the tobacco control echo chamber works. Someone makes up a claim. Others repeat it as if it were something other that just made up. And a “fact” is born. I have watched it happen, over and over again, for a couple of decades. And so have you. It is not ok to defend this approach on the basis of the ends justifying the means in this case. Mostly that method gets used by radical political factions to create misperception (the best example in the USA right now is the belief by those in one echo chamber of the claim that the Affordable Care Act did not succeed, is over budget, has driven up healthcare costs, when in reality the opposite of each of these is clearly true — this game threatens the public’s health far more often than it stands to benefit it).
You and I both have seen enough to also predict that we are well on our way to most people repeating this “5% as bad as smoking” claim still a decade from now. You release the kraken now and it will still be around when you really wish it wasn’t anymore.
My point is, and always has been, that the good parts of the goals you voice can easily be accomplished without saying things that are patently false. The ease with which supposed scientists in this realm slip into saying something patently false (needlessly false!) is disturbing. The ease with which others defend them for doing so is equally disturbing. This is an enormous outlier compared to every other science-dense policy arena I have ever observed. In most of those there are, of course, a few ostensibly respectable commentators making radical claims. But if you look closer at most such discussions, they are actually hacks that only laypeople think are experts, and the real experts making such claims are subject to critical review by their colleagues.
As for the medical side, it was not like the reporters were pulling this from nowhere. It is addressed in very first substantive chapter of the report.
I should add that I am saying this all from the perspective of believing that something as bad as 5% is not altogether implausible. That contrasts with your position, Clive, that it is an upper bound, which would mean it is not plausible. Of course, 5% being plausible does not make it a good point estimate. It certainly does not justify lying by suggesting that it is a scientific estimate.
The other thought that occurred to me is that the defenses of lying to counter the other side’s lies have a remarkable resemblance to bad ideas about gun violence that are always present in the USA and is flaring up particularly right now. The narrative goes, “the bad guys have guns and kill a lot of Americans, so we need the good guys to have more guns to counter that.” It is easy to understand the urge: people who feel fearful and powerless seek to make themselves feel empowered; people who think it is unfair that others get away with something want to do it themselves. The problem is that all the evidence shows that putting more guns in the hands of the good guys just further increases gun violence by turning domestic situations or bouts of depression into additional fatalities, and basically never stops bad guys from shooting anyone. Meanwhile, it further entrenches the culture of having lots of guns around, which perpetuates the problem via that pathway. As a good English Gentleman, you should definitely not be endorsing the deficiencies of American culture :-).
Clive, Carl thank you both
Interestingly while abortion has been freely available in NSW for about 35 years that is not because of a change to the letter of the law rather it is because of a courts interpretation of the law . And everybody is quite happy to leave it at that
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As soon as I saw that “95% safer”, I thought, “OK – almost 100%”. I think that is how the vast majority of the public would think. I base that upon my own perception of risk. Every time I board an aircraft, I am aware that the most dangerous part of the flight is take-off. Other than the possibility of a mid-air collision, there is no danger whatsoever during the flight. Landing? Nowhere near as dangerous as take-off. So, if you said that the danger during take-off was 5%, most people would not think that 5% was very, very high! I know that that idea is stupid, since it would suggest that 5 out of every 100 take-offs end in disaster, but I’d bet a pound to a penny that the general public would not be able to ‘read’ the implications.
I understand Clive B’s reasoning – better to issue a public health statement which is easily understood, and which delivers the message of ‘much less danger’ than to bother about whether the reduction of danger is 98.2% or 97.8%.
However, there seems to me to be another consideration.
It would be possible to claim that ecigs are 99.99….% safer than tobacco cigs, based upon toxicology. But epidemiology cannot produce such certainty. There is this “95% Confidence Interval/level” bla bla in the studies. Thus, it is quite understandable that PH England would not wish to claim results of studies as reasonably certain beyond the lowest level of the ‘Confidence Interval’ – 95%.
Or is that far too clever – or far too stupid?
The PHE report is not a change of sides, it is a change of position of one group on the ‘other side’.
now we have two different camps within tobacco control bidding for control of the industry. So I need to ask, as they offer no significant harm to the user, or bystanders. They contain no tobacco And they are used as a consumer product, why do we assume TOBACCO control have any right To proffer bids. Ecigs are being accepted as a harm reduction product, which is hard to argue against. Having said that, lots of things are used in harm reduction, condoms for instance. But harm reduction is NOT how most people use them. We have not chosen to hand control of condoms to any public health group simply because they claim it. Most people try ecigs because they are smokers who have had enough of smoking and want to try an alternative. To the users ecigs are neither medical nor quit tool. Ecigs are clearly a consumer choice, one that has no impact on anyone, lending no one any rights to take over to save us from……well thats what they can’t quite define, they just KNOW they need control.
It is simplistic to say that there are two factions. It is more nuanced than that. But, yes, there are a minority of card-carrying tobacco controllers — those that have managed to stay part of that club and gravy train — who are pro-ecig but not actually pro-THR. In fact, many of the darlings of the ecig consumer chatter fit that description. No one has chosen to assign power to any faction, of course. This type of power is seized, not granted.
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Note: worth reading.