New FDA-funded @SDSU research establishes that public health researchers are remarkably dim

by Carl V Phillips

I was not going to post today, but there is so much hilarious chatter about this new press release from San Diego State University, and their FDA-funded “research” on e-cigarettes that I could not resist. This simplistic research about web searches related to e-cigarettes deserves a paragraph-by-paragraph dissection.

Oh, and of course there is a new journal paper that goes with it. But, seriously, who cares? Academic “public health” practice has descended to the point that a journal paper is just an excuse to write an even more misleading press release. It is time to stop pretending otherwise and just peer-review the press release. I am sure if I dissected the paper itself I could identify numerous problems that are not evident from just the press release — that seems to always be the case — but, again, who cares? It is not as if anyone in public health pays any attention to the quality of the science. When the paper is cited, those citing it will effectively just be citing the press release.

It is worth starting with the last bit, to see who shares the “credit” here:

The study was funded by 5R01CA169189-02, RCA173299A, and T32CA009492 from the National Cancer Institute and U.S. Food and Drug Administration Center for Tobacco Products. The content is solely the responsibility of the authors and does not represent the official views of the funders. The funders had no role in the design, conduct, or interpretation of the study nor the preparation, review, or approval of the manuscript. Additional collaborators on this study included: Benjamin Althouse of the Santa Fe Institute; Jon-Patrick Allem of the University of Southern California; Eric C. Leas of the University of California, San Diego; and Mark Dredze of Johns Hopkins University.

About San Diego State University: San Diego State University is a major public research institution that provides transformative experiences, both inside and outside of the classroom…blah, blah, blah….

Ok, on to the silliness, which begins with:

The Oxford Dictionaries selected “vape”–as in, to smoke from an electronic cigarette–as word of the year in 2014. It turns out that Internet users’ search behavior tells a similar story.

Between 2009 and 2015, the number of people in the United States seeking information online about vaping rose dramatically, according to a recent study co-led by San Diego State University Internet health expert John W. Ayers and University of North Carolina tobacco control expert Rebecca S. Williams as a part of the Internet Tobacco Vendors Study.

Yes, that really is the start of the press release. Normally cutesy hooks like this are not worth thinking about, but this is ostensibly a scientific press release, so let’s think like scientists for a moment. What could “tells a similar story” possibly mean? What story? The reader is presented with no story that offers any similarity to anything, let alone to search histories.

If the reader has the knowledge to fill in what the first sentence represents, then this becomes even sillier. The “word of the year” is not a measure of prevalence, or the first derivative of prevalence, of a word’s use. Those play some role, obviously, but the choice is ultimately a decision about what word seems to be a good representative of the changing zeitgeist, as evidenced by the many nominees and winners that are not particularly common. You would think that most scholars already know this, and those who did not know would invest the three minutes’ of research it would take to discover it before invoking the inaccurate analogy. But we are talking about public health activists, not scholars.

Oh, and of course, “to smoke from an electronic cigarette” would be a fairly stupid thing to do. Of course, don’t blame the linguistically careful folks at Oxford Dictionaries for that error; their definition makes clear they know that there is no smoke involved. That error is the fault of the team of crack team of FDA-funded researchers.

Moving on with the study results, we learn the shocking news that searches for a product category increase dramatically when it becomes fairly popular, as compared to when it was barely known. In other news, searches for “greek yogurt”, “is Pluto a planet”, and “Bernie Sanders” increased dramatically between 2009 and 2015.

E-cigarettes and other hand-held vaporizers began appearing on American shelves in the mid-2000s. Since then, they’ve quickly risen in popularity while regulators have been slow to adapt smoking legislation to account for these devices.

It is not clear which “other hand-held vaporizers” are not e-cigarettes, but never mind that. Also, we will just gloss over the odd use of either “mid-” or “shelves” (it should either say “began appearing via internet sales” or “late-2000s”; but, hey, it is just so much to ask to get simple background facts right). Focus instead on the last bit, in which these people who are supposedly issuing a press release about research lead off with an unsupported normative claim (that regulators should adapt smoking legislation to “account for” [sic] e-cigarettes). Notice that they slip this in as if it goes without saying, when it is actually a far more significant claim than anything in the research results they actually report. That, of course, is SOP in “public health”, where research is done primarily as an excuse to express unsupported political opinions.

“Big Tobacco has largely taken over the e-cigarette industry. Alongside unchecked marketing and advertising, e-cigarettes have exploded online,” Ayers said.

So in public health land, “largely taken over” means having less than half the market share (which is itself divided amongst several competing companies), and “unchecked” means “subject to the countless restrictions on all marketing communication, as well as specific restrictions such as not being able to tell the truth about the health risks.” Um, yeah. So that would mean that Apple has largely taken over the smartphone industry, and is free to lie to consumers about their products with impunity.

Internet users’ search history bears this out.

Wait, what? (Note that I am not skipping any text.) How can any data about search history “bear out” any of the claims in the previous sentence? The closest it could come to any of them would be that an increase in searches would probably be associated with that “exploded online” thing, though the latter seems to be a claim about the supply of information while the searches reflect demand for information.

Ayers, Williams, and a team of colleagues from across the country examined search history from Google Trends, which includes statistics on what specific words people searched for, the search term’s popularity relative to all other concurrent searches in a specified time, date and geographic location. From this data, the researchers can find patterns that point to Internet searchers’ apparent preferences and attitudes.

Ok, that is a nice high-school science project or term-paper-level exercise. One can learn something from that. Let’s see if they did….

When they looked at searches related to e-cigarettes starting in 2009, they found a sharply rising trend through 2015 with no end in sight.

I am not sure if that is LOL funny for everyone reading it, or if it is just me. I actually had to pause for a couple of minutes before resuming. As already noted, obviously there is going to be a sharply rising trend from 2009. But it is the “no end in sight” that really got me, at several levels. Why would anyone in their right mind even think to mention that? Internet use is increasing and e-cigarettes are increasing in popularity; what possible end are they even talking about?

Moreover, at a deeper scientific level, we are talking about a social phenomenon that could end, and quite abruptly, whatever the historical trend is. This is not like claiming there is no end in sight for the warming of the planet, which could be based on what we know about atmospheric chemistry, which is not affected by social proclivities that can change abruptly. Social trends can change abruptly. I am sure that the data for searches of “Bernie Sanders” follows a very similar trend to searches for e-cigarettes, but any real social scientist can foresee an end to that trend.

For example, in 2014 there were about 8.5 million e-cigarette-related Google searches. For 2015, their model forecasts an increase in these searchers of about 62-percent. Looking at geographic data, they found that e-cigarette searches have diffused across the nation, suggesting that e-cigarettes have become a widespread cultural phenomenon in every U.S. state. Over the same time period, searches for e-cigarettes far outpaced other “smoking alternatives” such as snus (smokeless tobacco) or nicotine gum or patches.

I am not sure what that first sentence means, but it obviously does not mean what it says. I would guess that readers of this blog alone conducted most of 8.5 million “e-cigarette-related” Google searches in 2014. Obviously researchers can choose to study whatever specific phenomena they want to, narrowing what they are counting up, but they need to say what they are doing. The fact that someone would put out an obviously incorrect number like this and that the press would dutifully report it without thinking it through speaks volumes about what a joke public health discourse has become.

The results about states is equally useful information. I mean, who would have guessed that the primitive tribes of Tennessee and the transcendent life forms in Oregon would have similar internet search behavior to the rest of the country? It is not surprising that the searches exceeded those for other low-risk alternatives (though I have no idea what their scare quotes are supposed to mean — presumably it is innuendo that alternatives to smoking are not really alternatives to smoking). Though I have to wonder if their methodology missed most of the searches for smokeless tobacco, which probably used established brand names rather than the word “snus”.

The researchers published their findings today in the American Journal of Preventive Medicine. (Note: this URL will be active after the embargo lifts)

Oh, look, I don’t have to wonder. I could go read the paper and learn their exact methodology. Just kidding. I have little doubt that I would still not know, given the poor quality of methods reporting in public health research. (Also I would have to go search for it, since the aforementioned URL does not actually exist on that page — the smallest of the many errors that appear.) Since there is really no chance that anything useful will come of that effort, I am skipping it. Anyone who actually bothers to read the paper can use the comments to backfill anything good I might have missed.

What most concerns the researchers, though, is that when people search for e-cigarette information, they’re using search terms like: “best e-cig,” “buy vapes” or “shop vaping.”

Why should anyone care about what most concerns these researchers? They should not. Being able to run simple statistics on Google searches implies absolutely no moral authority to opine about, let alone ability to analyze, what is better for society. (Incidentally, what would most concern me would be if the phrases “buy vapes” or “shop vaping” were more common than grammatically sensible phrases. I assume they actually were not, and that they were intentionally cherrypicked to try to ridicule consumers.)

In any case, in what world would it be at all concerning that most of the searches for a consumer product would be a combination of seeking review information (as “best e-cig” is presumably intended to do) and purchase options? It would certainly not surprise anyone.

“One of the most surprising findings of this study was that searches for where to buy e-cigarettes outpaced searches about health concerns or smoking cessation,” Williams said.

I stand corrected. Let me amend that to, “It certainly would not surprise anyone with a clue about how the world works.”

“Despite what the media and e-cigarette industry might have you believe, there is little research evidence to support the notion that e-cigarettes are safe or an effective tool to help smokers quit. Given that, we think it’s revealing that there were fewer searches about safety and cessation topics than about shopping.” In fact, she said, searches for e-cigarette safety concerns represented less than 1 percent of e-cigarette searches, and this number has declined over the past two years.

Um… what?

Set aside all the usual lies that are embedded in that, about what the evidence shows, the “safe” wordplay, misrepresentation of the predominant message in the media, and misrepresenting what is permitted in marketing. Just skip to the specific claim here, that he seems to think that those phenomena (even if they actually were true) would cause people to do more searches for background information than for product reviews and purchases. Seriously?

Even for a product where most of the background information you would find from a random search was not utter bullshit, as it is in this case, consumers are still going to mostly search regarding purchase plans. People who are seriously interested in that other information develop networks of trusted sources; they would get nowhere doing random searches. Anyone who is shopping for e-cigarettes has already acquired the information that e-cigarettes are worth shopping for, presumably knowing that they are a low-risk alternative to smoking. Why, exactly, would he want to search for that?

Frankly, I would be extremely disturbed to learn that many short-phrase searches about e-cigarettes were seeking scientific information. That would truly be a tragic commentary on people’s understanding of how to learn anything about controversial issues via the internet.

If these “researchers” actually had any expertise in the research they were conducting — which is to say, about consumer online search behavior, not about tobacco politics — we might have gotten some useful information. For example, how do these statistics (which are inevitably very weak, depending on their choices of phrases and how they were coded) compare to those for other products? What is the quality of information that someone would get were she to pursue such a blind search for information? This speaks to a common problem in “public health”, where research follows political interests rather than scientific skills. There is absolutely no reason why someone doing this particular research would need to know anything about e-cigarettes, other than some basic vocabulary. They should, however, know something about real-world consumer behavior.

A linguistic trend also emerged from the study. The term “vaping” has quickly overtaken “e-cigarettes” as the preferred nomenclature in the United States. That’s important for health officials and researchers to recognize, the team noted. Surveillance of smoking trends is done primarily through surveys and questionnaires, and knowing which terms people use can affect the accuracy of this data.

Wow, that is almost useful information. Of course most of us already knew that. We also know that “vaping” is an act whereas “e-cigarettes” are a product, and so they are not really commensurate, which is a rather important distinction for doing those surveys and questionnaires. (“Hey, guys, according to this new study, we should stop asking ‘have you used an e-cigarette’ and start asking ‘have you used a vaping’.”) Those of us who know how to do surveys, of course, already make a point to define what we are talking about, including offering the multiple popular terms if that is an issue.

Also, one of the major weapons anti-smoking advocacy groups have is counter-advertising. In the Internet age, advertisers look for specific keywords to target their advertisements. Knowing that more people use the term “vaping” than “e-cig” helps them be more targeted and effective, Ayers said.

So “counter-advertising” in the interests of “anti-smoking” should make sure to intercept all those searches for “vaping” in order to make sure the anti-vaping propaganda reaches its target audience of people who want to avoid smoking. Yup, they pretty much earned their FDA money with that one.

“Labels do matter,” Ayers said. “When you call it ‘vaping,’ you’re using a brand new word that doesn’t have the same historical baggage as ‘smoking’ or ‘cigarette.’ They’ve relabeled it. Health campaigns need to recognize this so they can keep up.”

“They’ve relabeled it”? Who is this “they”? Oh yeah, I remember, it is the Oxford Dictionary people. The bastards.

Of course what “health campaigns” really need to do to keep up is to learn something about health. They are not going to achieve that by doing random internet searches, by the way. Nor by reading press releases or papers by the tobacco control industry’s pet academics.

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20 responses to “New FDA-funded @SDSU research establishes that public health researchers are remarkably dim

  1. Another outstanding break down Carl. I had a few LOL moments myself.
    Thanks again for all your efforts.

  2. No comment of the use of the phrase “Big Tobacco”? ;)

    • Carl V Phillips

      Aside from it being a silly phrase, it actually does have a pretty clear meaning here — they clearly were trying to say “the collection of the major traditional tobacco companies and their subsidiaries.” So I was able to just comment on the inaccuracy of the content.

      When the phrase itself is actively harmful to honest communication is when it is used to imply that a bunch of competing companies are some monolithic unitary actor. And, of course, when it is used to refer to actions of consumers or smaller companies, it is an out-and-out lie.

      • “they clearly were trying to say “the collection of the major traditional tobacco companies and their subsidiaries.””

        No. Seriously – no! They were clearly trying to /imply/ that it’s just people from tobacco industries.

        But when they say “Big Tobacco” they mean *anyone* who doesn’t see the world as they do.

        Including private individuals who aren’t associated with tobacco companies.

        For example this bit of character assassination: http://tobaccotactics.org/index.php/Dick_Puddlecote. Whether the misunderstanding there is deliberate or not, it’s not clear – it hasn’t changed in a couple of years.

        (I get my own mention as being part of Big Tobacco on there.)

        ‘Big Pharma’, ‘Big Temperance.’ and ‘Big Puritanicals’ never seem to get a mention in their press releases.

        • Carl V Phillips

          I totally agree with you that the use of that term usually denotes an evil and utterly clueless mindset. I was just pointing out that in this very narrow use of the term, it could pretty solidly be interpreted as being a specific concrete claim, which I then pointed out was false. (Also, I take some pride in the fact that my page at that slander site was, the last time someone told me the states, by far the most popular page there :-)

  3. Carl, I’m not sure if the deceit implicit in this ” report ” is the result of calculation or deliberate intention to mislead. I think, from the casual way it runs through the article, it’s a result of ignorance and assumption.
    Who ever commissioned this or comes across it by being on a mailing list of funders should question if their ( our?) money is being well spent.

  4. It makes me sick to see my tax dollars used for this crap. How can we find out the cost of producing this particular piece of garbage?

    • Carl V Phillips

      It is probably not formally broken out anywhere (though I guess it might be). Taking a guess based on the scope, number of extraneous participants, and the general inefficiency of these people, I would guess in the neighborhood of $50-75,000.

      • Do you mean “fifty dollars” or “fifty thousand dollars”? It’s an afternoon on Google, for crying out loud.

        • Carl V Phillips

          As I said, the core of it — everything of value — would make a pretty good term paper. More than one afternoon, but only a few person-days. But the combination of the inefficiency of the people, the inefficiency of the process, and all the pointless details probably ended up consuming many person-months.

    • No worries — it won’t be much. I don’t know all the details of who got money from whom for what, but it doesn’t look to me that this “study” has cost much public money, most likely none at all. The relevant question is: Has any public money been spent that would not have been spent if the study had not been conducted? It doesn’t look like that, so it is probably the wrong example to bang on about the waste of tax dollars.
      The authors didn’t seem to hire anyone to carry out work for this project, didn’t buy or rent equipment for it, didn’t travel anywhere for field work. They are (I guess) salaried academics who are paid anyway, so the marginal costs to the taxpayer from this study is very close to zero.
      They didn’t waste resources of their universities either (which may or may not be publicly funded). This kind of study is still something that you can do on your own without asking for anyone’s permission. You do your searches, write up the paper, submit it to a journal. You don’t need to go through a million committees, so no admin costs involved.
      They only wasted their own time, but no taxpayer money. The harm from this study comes from the disinformation and the waste of other people’s time, but not from public funds being used for nonsense.

      • Carl V Phillips

        The study was all funded by public money and, as I said, there is little doubt they burned through quite a lot of it for this. Their “own time” is taxpayer funded (their salaries and whatnot are pay for by these grants). Though many people do not realize that, that is how public health works, so this assessment is not right. They are not salaried academics in the way you are thinking — they are best thought of as consultants who need to generate money from clients to pay their salaries. So it is proper to think of this as being a waste of the client’s (the US government) money.

        I suppose you could base some of what you said on an sunk cost analysis: Once these grants were given to this group, it was wasted public money because they did not have the skills+honesty to do anything useful for the world. Whether they did this or some equally bad project does not change their total drain on the coffers. You could take that back further and say that because these grants were only ever going to go to such people, as soon as the grant programs were created the public money was wasted. However, under that way of looking at it, you would also have to say that say, a city inspector who spends workday napping in his car is not wasting public money, since he would have collected his salary for the day anyway. This is not what we usually mean when using such words.

        • I made that point over at Clive’s — in absence of monetary expenses the only cost incurred by the public are the authors’ opportunity costs. But we wouldn’t seriously expect any quality research from them, would we?
          In your example, the cost inflicted by the lazy inspector is the foregone benefit from the inspector’s supposed work, or the actual cost of hiring an extra inspector to make up for the loss. For a single day this would be hard to quantify, but not conceptually impossible and definitely real.
          The concept of sunk costs doesn’t really apply. Sunk costs are costs that have been incurred in the past and are irreversible. They should not affect decisions concerning the future, but they can be relevant when evaluating the past. In this case we are evaluating whether this particular study has wasted public money. The relevant costs are the marginal costs, i.e. comparing the state of the public finances in worlds with and without this study. Both worlds contain Ayers and Williams sitting on their positions and being paid, so these costs cancel out, but that doesn’t make them sunk costs in the usual sense. They just happen to be irrelevant for the evaluation exercise we attempt, since they are present in both worlds.
          It is very different if we ask the question “Was it worth keeping Ayers and Williams on their positions and paying them?” In this case we need to compare the worlds with and without Ayers and Williams on their positions, so whatever is paid for their salaries becomes part of the marginal costs. [I have checked: Ayers gives SDSU as his affiliation, but he is not listed as a faculty member, but as “adjunct faculty”, Williams is a “research associate”, which suggests that their salaries are funded from external grants. It doesn’t matter for the evaluation of this individual study, but it does matter in other contexts]
          The tricky bit about economic costs (as opposed to accounting where you just apply a set of rules) is that they are specific to the decision you have to make or the project you want to evaluate. An item may be sunk cost in one context but not in the other. Opportunity costs are even harder. You have to know what your opportunities are, i.e. the actions that you did not take because you committed your resources to the action you took. If Ayers and Williams hadn’t spent their time on Google, what brilliant stuff would they have produced instead? Nobody knows. But in order to drain the public coffers with this study, we would have to assume that they would have produced something genuinely beneficial. Since they are incompetent they wouldn’t know how, and since they are dishonest they wouldn’t want to.
          The reason why I’m a bit pedantic about these things is that I see so much abuse of economics in public health. Take the notorious claim that smoking costs the healthcare systems x billion dollars a year. By deliberately getting the relevant costs and benefits wrong, they make the public believe falsehoods. We should not be tempted to make cheap points in the same way.
          Don’t get me wrong – I am totally convinced that the grants Ayers and Williams hold are a complete waste of money, that most of the funding for public health should be scrapped, and that public funding bodies deliberately channel public money to junk science. It’s just that this study, bad as it is, is no proof of that.

        • Carl V Phillips

          This is getting awfully far afield, but I will make one more reply, because I think you may not be aware of a critical fact, and I perhaps did not state it clearly enough before: Most everyone in “public health” academia, and quite a fit near that cesspool, receive compensation in a manner that is similar to a hair stylist rather than an engineer or even a lawyer. That is, they may be technically (for accounting purposes) paid by the house, but actually they are paid by the individual clients and are actually kicking some of it back to the house for the “privilege” of being there. No mental gymnastics is necessary: There is simply no question that they are doing contract work, paid for by the grant funder (i.e., the taxpayer, in this case). It is reasonable to think of many cases as a law firm lawyer, who is on salary from the firm but will be fired if he does not adequately cover that salary (and the vig) with billed hours; that is not quite so clear, but the upshot is the same.

          Also, I think you are misunderstanding something about the concept of sunk costs. You actually are arguing that the money (which is what this thread was originally about) is a sunk cost when you conceptualize the cost of lousy research in terms of opportunity cost. For the cost to be measured purely as opportunity, you are treating the wage as sunk — fixed no matter what work is done. It is always fuzzy and a matter of context to apply sunk cost thinking when speaking of salaries. Even if someone would be fired or suspended in a month if they stopped working, you could still say that the coming month’s salary is already sunk. From that, it is a short step to saying all wages (as opposed to performance-based contracts) are always sunk before they are paid or the work is done, and productivity merely competes with other uses of time (your sunk-cost-based view) or is traded for future wages via building reputation for being worth the sunk wage. So whether it is sunk or not depends on the point from which you based the analysis. I was suggesting it is not altogether unreasonable to think of the creation of the grant program in the first place as the step at which the costs were sunk: At that point you can either think of the cost of incompetent researchers being opportunity cost from not funding good researchers, or you can think that anyone in this space is going to produce junk, so it was more like the authorization of a welfare payment.

          However, that is not the normal reasonable way to think of wages, which is to simplify the steps about reputation and the money passing through the hair salon’s books before returning to the worker, and whatever. Rather, it is normal, easy, and economically legitimate to just think of the cost of a project as being the its accounting costs, which in this case is the salaries and, as I said, undoubtedly in excess of $50K.

  5. What I found really annoying as I read the press release was the implication/suggestion that people should be googling ‘health affects’ etc; that people should have, as their primary motive, a wish to know how harmful or harmless ecigs might be.
    That ideological premise is very prevalent amongst “public health” people. The possibility that ecigs might actually be an enjoyable way to reduce or stop smoking never seems to enter their minds.
    I watched this video earlier:

    An ’eminent professor’ advocates ecigs.
    Even he had no interest in enjoyment, but simply looked at ecigs as being just another ‘nicotine delivery system’. He wants flavours such as bubble gum banned so that ‘young people’ don’t find them enjoyable and become addicted to nicotine. I do find such statements to be rather infantile. Do ‘young people’ take up smoking because tobacco smoke tastes like bubble gum (which it doesn’t, of course)? In fact, it is worth asking if bubble gum flavour is of any interest to young people in their mid to late teens. I suppose some smokers still enjoy bubble gum and some don’t, and that some teenagers enjoy it and some don’t.
    Smoking is enjoyable, whether because of the flavour or because of the effect of the nicotine. Any substitute needs to be at least as enjoyable if it is to succeed; better still, it should be more enjoyable.

    • Carl V Phillips

      I agree that their assumption that people should — or would want to — search for their propaganda is pretty silly. I did not go into that, but it was a major theme of Clive Bates’s post on this which also was published today on his blog.

      I looked as some of that video that is making the rounds (I RTed it myself) — touted as being such a great thing — and I have to agree with the “friends like these” sentiment about it. The ultimate problem is that “public health” people work under the assumption that the only good in the world is longevity. This produces unethical demands, of course, but it becomes absolutely absurd when they assume people act accordingly and then try to reconcile the assumption with reality.

  6. At least the search trends for “tobacco control” and “public health” move in the right direction…

  7. Talk about stupidity. I had quite a few LOL moments reading this one. :-)

    Carl, as always, you hit the core problems with the content of the paper. What is missed is the stupidity of actually publishing this publicly. I mean, seriously, if you’re going to do some SEO optimization you don’t telegraph what you’re up to ahead of time.

    Knowing what they are expecting to target, and likelihood they will use paid SEO placement, we can monitor the BS, and rest assured that serious consumers actually bypass the paid placement stuff, while those who sell product in volumes high enough will out-compete for the paid placement space, forcing further expenditure (and likely much consternation about the results) to push their ‘product’.

    It’s actually laughable, except these folks actually are serious ‘experts’. As Bugs Bunny would say: “What a bunch of maroons.”

  8. How about a study on the attitude of public health workers towards smokers? That has to be terrible. May be we have been dehumanized. We are written off as worthless for any other purpose except a source of revenue and when we escape the beneficiaries are infuriated. I’ve read so many news stories relating to ecigs. The most obvious common theme is NOBODY cares about the health of smokers. Given that why do they suddenly care so much when we switch to vaping? Follow the money.

    There needs to be some macro economic modeling of what would happen across the economy if cigarette revenues decline very rapidly. A lot of money will start flowing in new directions. There will be lots of interesting secondary consequences. Who will be the winners and losers? Since they get most of the money the most interesting question will be how government spending might change. The biggest complainers about ecigs are local governments, medical research and public education. Are they also the ones whose funding would be the hardest hit? What ever happened to conflict of interest?

    • Carl V Phillips

      It is definitely true that “public health” people express open hostility toward smokers, even as they pretend they are motivated by helping them. This is both obvious and widely documented, though I do not think it has been done systematically. That would be pretty interesting, though I am not sure what would be the right data to analyze (tweets, maybe?).

      As for why they object to THR, see this series: https://antithrlies.com/2015/07/21/why-is-there-anti-thr-1/. It picks up on some of the themes you mention, though the nuances are often more subtle.

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