by Carl V Phillips
In the previous post, I commented upon the most recent in the endless series of analysis-free and truth-free McCarthyist demands from “public health” to censor industry-funded research (as well as upon what I felt was an inadequate retort to it). I quipped on Twitter that every time I read one of those pieces, I feel like I am reading @DPRK_News. If you are not familiar, that is a great parody feed that satirizes what official communications from North Korea might say about domestic and foreign events. The parody is grounded in filtering events through over-the-top premises about the depravity of the West and the success of the North Korean government. It is not exactly a mystery why the political statements of core “public health” people resemble what we might expect to hear from a cult of personality that keeps its subjects completely cut off from reality, bragging about its performance (which is, of course, mind-boggling disastrous), while making up crazy stories about the rest of the world.
The @DPRK_News comedy includes treating one-off problems from the news of the day as being representative of all life in Western societies. “Public health” treats transgressions by cigarette companies that occurred two generations ago, by no one who is still active today, as if they have a bearing on the quality of current research. What makes @DPRK_News particularly funny, more so than if similar jokes came from a mock Mother Jones or Rush Limbaugh feed, is the contrast between the supposed Western problem and the reality of North Korea, which is worse by most any measure (except perhaps when the topic is gun violence in the USA, in which case the faux-Koreans are kind of right). The parallel with the accusations from “public health” should be clear: A huge portion of “public health” research is utter junk science, blatantly tortured to serve their special-interest political goals, while research done by the tobacco companies is honest and consistently high quality, and has been for a few decades.
Now you might think, “tobacco companies certainly have political goals too, so don’t they choose their scientific work to further those goals.” Well, yes and no. Of course they are researching products in their space, along with associated behaviors and health effects, with an expectation that it will help them be more successful in the future — help the individual company, that is, not the mythical unitary “the tobacco industry” the public health people seem to think exists. It is not as if tobacco companies are altruistically trying to figure out how to stop Zika (though we would be better off if scientists of their caliber were, rather than leaving that to WHO and CDC). So, yes, their research is their own interest. That, of course, does not mean that it is not also in the public interest, which it is.
On the other hand, their science is all about details, and is seldom overlayed with anything attempt to support their big-picture political preferences. The do almost no public research to debunk the junk science that is used to attack them, and that is the biggest threat to their business model. Any of the majors could turn out hundreds of papers a year debunking just the bright-line wrong bits of public health’s “science”. If they turned into the public-spirited actors that “public health” people always whine they should be — instead of just conservatively pursuing narrow product science — they would be doing just that. They would be sticking out their neck to debunk the politicized epidemiology that keeps magically elevating the harms attributed to smoking (thereby helping save epidemiology from “public health”), the patently absurd claims that smoking imposes net negative externality costs (helping save health economics), the “miracle” claims about plain packaging and such, the boatloads of junk science about “second-hand” smoke (thereby protecting the interests of their customers), this misleading reports about e-cigarette uptake (defending harm reduction), the claims that smokeless tobacco is measurably harmful (ditto), and so on.
Such debunking would be straightforward, not requiring them to go out on any scientific limbs, but it would be going way out on a political limb. They are far too conservative to do that. They have been beaten into timidity, and have good reasons to continue to be timid. I state this as a simple descriptive fact, not a normative judgment about their strategy, reasonableness, or ethics.
They used to do such debunking work, but most of them abandoned that responsibility (ok, I am going to go a bit normative) fifteen to twenty years ago. Presumably not coincidentally, it was after that disciplining force was removed that public health went totally off the rails, not even trying to do valid science anymore. Occasionally a major tobacco company will commission a public independent report targeting some particular bit of junk science that is deployed against them, but this still tends to be very focused scientific analysis of specific points, without pushing any big-picture political goals.
In all sectors, most big legacy companies are fairly conservative in their public statements, which includes public research. They are in equilibrium niches where they have a lot to lose and little to gain from poking their heads up too far. The management came into their jobs when the company was already in a stable state, and are answerable to diverse shareholders, so their job is to be conservative. But this is only part of the story with the tobacco industry. Other big companies that are heavily impacted by government policy openly do some big-picture research and fund various think tanks to go out on political limbs for them. But the tobacco industry is under such intense scrutiny that they do not dare attempt even that. They will not even make clearly truthful and legal claims about their products without expressed permission.
For example, in 2002 U.S. Smokeless Tobacco Company (then an independent company that was not in the cigarette business, subsequently acquired by Altria) was pushing the boundaries about as far as industry dared, trying to make the case for THR. (Starting at about that time, they funded some of my research, and funded that of a few other independent researchers who were trying to do the same.) They petitioned the Federal Trade Commission, which regulates advertising, for an advisory opinion on whether they could include science-based tobacco harm reduction (they used that phrase) messages in their advertising. Keep in mind this was before the Tobacco Control Act explicitly forbade communicating such accurate information. FTC responded that they would not issue such an advisory opinion, but would only rule on the legality of extant advertisements. Lacking explicit permission, USSTC basically abandoned the plan.
They were never (to my knowledge) advised by FTC they should not do it, but given their natural tendency to be extremely careful/timid (choose which you prefer), they were not willing to take a risk. Indeed, calling it a risk understates the certainty of the pushback they would face for daring to tell the truth. Some zealous state attorney general would undoubtedly try to prosecute them for it, even if the advertising were perfectly legal and accurate and FTC did not object to it. Rhode Island prosecuted USSTC when an employee, in a press interview, stated that it was not scientifically established that smokeless tobacco causes oral cancer (which was understated in its accuracy). Certainly the anti-health “public health” people would attack them for it, as Campaign for Tobacco Free Kids did attacked them even asking FTC for a ruling.
Perhaps if USSTC had just gone for it, they would have prevented countless smoking-caused deaths and become the biggest tobacco company in the country rather than a division of their larger competitor. More likely they would have gotten limited traction and have been savaged for their troubles. Not exactly a gamble that corporate managers like to take. So it is easy to see why major tobacco companies stick to just reporting results of set-piece studies and rarely try to interpret the evidence publicly.
Of course the gamble looks very different for e-cigarette companies. The status quo for them is unstable and failure to “go for it” creates an existential threat to them. It is often claimed that the great innovation in e-cigarettes in the 2000s was a technological invention, but this is an error that invites misunderstanding of the current situation. Major tobacco companies could have brought to market a product that we would recognize as an e-cigarette in the 1990s, perhaps even the 1980s. Technology for nicotine vapor products of one sort or another dates back for decades before that. Yes, battery miniaturization was better in the 2000s, but little else was new on the tech side. The innovation, as it were, in the 2000s was social not technological: A bunch of suppliers just ignored the government until they built something worth fighting for.
The U.S. FDA had made it clear to the tobacco industry that they would consider any such product an unapproved medical drug delivery system (and presumably others countries’ regulators had also made that clear or at least would act the same, but the public record is better in the USA). The companies seemed to have believed that they could probably successfully fight such a ruling, but why would they want to risk it? The market potential for one of these low-risk alternatives was unknown, but the fights and attacks they would suffer for introducing it were easily predictable. As stable profitable companies, they had more to lose than to gain. This was not true of the e-cigarette upstarts.
It would probably be giving those upstarts too much credit to suggest they did the calculation. Most were probably oblivious to the fact that they were flouting the stated position of regulators. It also appears to have been a stroke of luck, rather than planning, that the industry grew up under the radar of those who would have strangled it in its crib (as would have happened if the always-monitored major companies had created the market). But they became established, and having done so they could fight and the upsides of doing so obviously outweighed the downsides.
This is a digression from the point about research itself, but it ties back in. A remarkable amount of the current “debate” about censoring industry research focuses on whether ecig-only companies and researchers they fund should be exempt from the censorship. (Note to those advocating this position because they think it serves their own special interest: “they came first for the Communists, but I…”.) But these companies are the ones with everything to lose if they do not employ every means available, and relatively little to lose by making bold public statements, and this includes shading the science in their own favor. I trust it is obvious that I am not saying that those companies’ research or researchers they fund — or, for that matter, anything else they want to communicate that not false — should be censored, or that there is anything nefarious about it. The point is that the major tobacco companies are the ones who have to be the most careful actors in sight.
Consider the example of the Schiffman et al. survey of responses to flavor descriptors that NJOY commissioned. I pointed out its limitations and how it was over-interpreted here, and discussed tobacco control’s crusade against it here. In short, the actual research did not (could not) offer nearly the reassurance about e-cigarette flavors not attracting underage use that was claimed by the authors and others. I find it difficult to imagine that a major tobacco company would have written or commissioned such a report. The study was a standard ad hoc “health promotion” type study, a convenient vague measure of some psycho-social phenomenon that is properly interpreted very modestly. It was not the solid scientific application of established research methods that the majors restrict themselves to.
That is not a criticism. We cannot restrict ourselves to studying only things that are easy to study using extremely established methods. We want to know other things. I trust industry to do a better job of seeking these complicated truths than “public health” people. The point is that the major tobacco companies would be extremely reluctant to do any such research, let alone make bold claims about its implications. Doing anything with such data requires making a big-picture assessment of what the results mean, rather than just reporting lab values and letting them speak for themselves. The majors would get brutalized for publishing such a thing. If you were doing to do an ad hominem ranking of the probability that a research study conclusion is overstated or out-and-out wrong, it would be: major tobacco company at the low end (they wouldn’t dare); e-cigarette company or advocates in between (they have truth on their side and are truth-seeking, but have less to lose and more to gain from pushing beyond what is really solid, and are unlikely to get called out for it); and “public health” people worst by far (their discipline is inherently dishonest, so they have absolutely nothing to lose from lying, and they know the truth is not on their side).
The accusations about industry sponsored research, as with what the government of North Korea tells its citizens, have nothing to do with anyone’s actual conduct. In both cases the actors are trying to distract from their own faction’s reprehensible conduct by inaccurately accusing their enemy of exactly what they do themselves. The claims are comedy fodder because they are such a perfect reversal. Tobacco controllers, who lie constantly, attack the integrity of those who are so timid they consistently understate the truth. I find it impossible to believe that anyone authoring those claims, assuming he is not utterly deranged, actually believes what he is saying. Yes, their useful idiots, like many citizens of North Korea, believe it; that is the whole point. Usually people who are tricking their minions know the truth and know exactly what they are doing.
It would be great if someone could maintain a parody tobacco control feed in the style of @DPRK_News (hint, hint). @TobaccoTacticss, my friend, if you are reading this, I miss you.