by Roberto A Sussman
[Editor’s Note: This post is the third here on the recent Tobacco Control editorial. The first two, by me, are here and here. This guest post was inspired by a comment Dr. Sussman left on one of the previous posts. His outsider perspective, from physics, offers insight that may not be apparent to those of us mired in social science and health debates, and he provides a deeper dive into the stated policies of the “journal” than anyone else has done. –CVP]
In a recent statement of editorial policy the editors of the journal Tobacco Control declared that the journal’s “Rapid Response” section will be henceforth the only legitimate space to express a scientific critique of articles published by the journal. In particular, the editors singled out (unnamed) internet bloggers as illegitimate critics.
This editorial policy reads as an unnecessarily harsh and defensive reaction, as scientific debate in all fields has never been narrowly confined to peer-reviewed journals, and more so in the current age of broad internet usage and social media. Moderated internet sites (such as the Los Alamos National Laboratory LANL arXiv site) have become a regular and very handy communication channel in physical and mathematical sciences and are fully as serious as journals; researchers can upload material not yet published in a journal (under review), or not intended to be published in a journal, to induce an open discussion of fresh (even controversial or unorthodox) ideas without the constraints of the formal review process. Blogs and Facebook pages exist in all disciplines that serve as useful complementary spaces where research issues can be discussed either informally, or with varying degrees of rigor, mostly involving scientists and graduate students, but also educated non-scientists that may be interested. Besides all these points, publication in peer-reviewed journals is not a guarantee of solid or good quality research, as many peer-reviewed articles in “official” journals report false, methodologically inconsistent, or dishonest results.
However, some forms of “unofficial” critique are neither valuable nor useful. Scientists make an effort to avoid and exclude cranks and crackpots voicing (mostly in social media) all sorts of critical opinions on various scientific topics (especially politically controversial ones). Typically, these characters cleverly juggle (out of context) technical terminology to produce theoretical constructions that may fool lay persons, but are easily seen as incoherent nonsense by any professional researcher (or even a competent undergraduate student). As a common feature they deflect criticism by invoking conspiracies directed by some “scientific establishment” bent on silencing them. As a professional scientist (specialized in theoretical astrophysics and cosmology), I can recall very frustrating experiences involving encounters with this type of non-scientific critics. I have also engaged creationists and “UFO-logists” in front of non-scientific audiences, and have learned the hard way that debating scientific issues requires proper rules of engagement and proper spaces (which does not exclude blogs). Without the appropriate environment and moderation, scientific arguments (even if expressed in non-technical manner) cannot compete with “punchlines” or quick soundbites and analogies.
Medical sciences are not immune to science trolling, as can be witnessed by the efforts of groups like ACSH (American Council of Science and Health) to expose all sorts of doubtful health claims promoted by fad peddlers and cranks writing in social media. This type of science trolling about medical issues has more direct and significant social impact and consequences than in physics. Statements promoting well-being, or warning against terrible ills that would follow automatically from some diet or substance consumption or from adopting a new habit, have an immediate practical impact for those accepting them as true or plausible. We have fallacies potentially producing immediate behavior patterns. By contrast, a cranky statement from physics trolling, such as “a black hole emerging from the Large Hadron Collider (LHC) may cause a great planetary catastrophe”, sounds distant and abstract even to those understanding or believing it. After all, whether one believes it or not, there is no practical course of action to prevent the whole earth from being carved out by a massive black hole, but for those believing that diet X cures cancer, adopting and promoting this diet is concrete and doable. The apparent fallaciousness of such a claim (i.e. diet X does not appear to cure cancer) can only be verified by looking at data-based statistics after decades of observation. It is very unlikely that the lay public will follow up the long-term epidemiological studies. As a consequence, large sections of the public may keep believing fallacious health claims (especially if propagated by wide media coverage) and those propagating it are very likely able to get away with it (especially if well connected politically). On the other hand, cranky predictions from physics trolling tend to be rapidly disproven and forgotten: no planetary catastrophe happened when the LHC started functioning.
While the disinformation propagated by science trolling and the peskiness of some social media crackpots are very disturbing, these phenomena can not serve as reasons to decree a strict enclosure of all scientific discourse and debate within the walls of academic journals. Even if we assume that the editors of Tobacco Control (and other scientists) could be legitimately annoyed by cranky “outsider” critics writing in social media and blogs, their editorial is an evident over-reaction. Normally, scientific journal editors would not bother expressing a forceful editorial policy based on declaring war on this type of science trolling. The latter is simply and unceremoniously filtered out of the scientific debate without constraining the discussion and critique to strict officialdom.
The key issue is to understand what lies behind this overreaction is to ask: Are the bloggers that annoy the Tobacco Control editors part of the legion of social medial cranks that pester scientists in various disciplines? To answer this question we need to examine the material posted by these bloggers. If this material is worthless inconsistent nonsense disguised as technical criticism, then the Tobacco Control editors may have a point (even if they exaggerate). But if this material is valuable and methodologically sound criticism, then the defensive reaction from the editors would likely follow from their inability to disprove them within the rules of scientific debate. To address these questions we also need to understand the specifics of the Tobacco Control journal and the research it publishes, as well as the motivations and backgrounds of the critical bloggers and the material they post.
To the external eye, Tobacco Control looks like an ordinary scientific journal: it has an editorial board of professors; its contributors are PhD’s and other credentialed researchers working (mostly) in academic or government environments, receiving public and industry (pharmaceutical) grants; it undertakes a formal peer-reviewing process; it includes a rapid comments section; etc. This looks like any journal in other disciplines.
However, this resemblance is a deceptive illusion based on common external markings and trappings. Tobacco Control is not a proper scientific research journal that serves a real academic community. It is a journal for a loose alliance of academics and regulators (mostly, physicians, lawyers and other non-scientists) whose main task is to advocate and promote a specific tobacco regulation policy with the aim of eradicating tobacco and nicotine usage.
The advancement of the policy strategy is paramount for the journal and is not open to debate, with the “science” part and related technical aspects in the research it publishes being strictly confined to tactical issues subservient to their potential utility in this advocacy. This characterization requires no secret knowledge. A glance at the recommendations to prospective authors of articles to be published by the journal clearly and openly states its research orientation and strict priority:
The principal concern of Tobacco Control is to provide a forum for research, analysis, commentary, and debate on policies, programmes, and strategies that are likely to further the objectives of a comprehensive tobacco control policy. In papers submitted for review the introduction should indicate why the research reported or issues discussed are important in terms of controlling tobacco use, and the discussion section should include an analysis of how the research reported contributes to tobacco control objectives.
In fact, prospective authors are explicitly discouraged from submitting articles which may contain potentially valuable scientific material but have no direct effect on the advancement of the core policy strategy. From their list of papers they are not interested in:
Papers that show the authors have never opened Tobacco Control and do not understand its primary focus on tobacco control rather than on tobacco and its use and health consequences. We are interested in such papers, but only if their authors address the implications of their findings for tobacco control.
While it may be argued that most research is (or could be) connected to some type of social activism that could have some public policy implications or to other type of social or political “extra-science” concerns, no journal I know of in other disciplines (not even in the politically contentious climate change issue) functions with such a strict focus and dependency on advocacy and a specific political agenda. This renders Tobacco Control primarily an activist broadside that acts as a travesty of a science journal.
To illustrate how the science part of Tobacco Control is just skin coverage to a particular advocacy position, we need to examine what lies beneath this skin. I elaborate below on this issue.
Practically all the published articles in Tobacco Control present research that fully complies and completely agrees with the elements that justify the regulatory agenda that defines the journal. This lack of disagreement on core technical issues signals a sort of inbuilt monolithic alignment that one expects to find among echo chambers of political activists or dogmatic sects, but is quite suspicious and uncommon in all fields of science where dissent on core issues occurs and is voiced (of course, I do not mean crackpot dissent, but dissent within the rules and bounds of scientific activity).
Perhaps editors or contributors of Tobacco Control might argue that this unanimity is justified because the “hard science” behind their strategic policy “has been settled”, and thus disputing the policy would imply a “flat earth attitude” based on questioning well established rock solid scientific research. However, this is a clear fallacy: there is no factual basis in the assumption that health science has fully resolved all tobacco related issues and thus has become cast in stone. There is strong evidence (epidemiological and physiological) on high health risks and hazards from primary cigarette smoking, but many open problems still remain to be researched, and evidence is weak or even contradictory (i.e. science is far from “settled”) on other related issues, such as health risks from environmental tobacco smoke (ETS) or from other tobacco and nicotine delivery products (smokeless tobacco or electronic cigarettes). These issues, especially harm from ETS exposure, remain controversial, and thus must be open to debate. A rigid set of policy recommendations on these issues has questionable scientific basis. The unanimity on core issues proclaimed by the Tobacco Control journal bears much more resemblance to “toeing the party line” in a political or ideological agenda than endorsing science.
Another issue that reveals the skin depth of the scientific part of Tobacco Control is the technical sloppiness (and in some case outright methodologically fatal flaws) of many articles published in the journal. Some might think that it is necessary to be a trained health professional to properly appreciate and evaluate the technical aspects of medical research on tobacco that could justify a regulatory policy. This is not so. While expert analysis of clinical issues and diagnosis and treatment might require medical or health science training, most articles published in Tobacco Control rely on results of epidemiological research that can be well understood (at a core level) by any professional possessing a decent training in statistics and some knowledge of social science methodology. Also, professionals with a decent knowledge of the physics and chemistry of gases and aerosols can similarly evaluate issues related to putative harms from ETS and e-cigarette vapor.
There are many examples of methodologically deficient articles published by Tobacco Control. In particular, I cite two studies published recently that contain fatal flaws: (i) a 2016 study claiming to have detected a 11% decrease in heart attacks in Sao Paulo, Brazil, immediately after the enactment of a city-wide smoking ban on bars and restaurants and (ii) a study claiming that usage of e-cigarettes is a “gateway” to smoking among high school students in the USA. In both cases the data was handled very sloppily and the results blatantly contradict available evidence. Nevertheless, they got published, which implies that either: (a) the editors and peer reviewers were utterly incompetent, or (b) that technical quality and methodological consistency are secondary concerns when the prospective articles are deemed by the editors to provide a significant contribution to the journal’s main concern: the regulatory agenda. In fact, (a) and (b) above are not necessarily mutually exclusive.
Articles dealing with tobacco/nicotine issues with similar themes and fatal methodological flaws have appeared in other journals. The Sao Paulo study is a sort of sequel to the famous “Helena miracle” study published in the BMJ flagship journal (same publisher as Tobacco Control), which has been widely criticised and debunked (example), whereas the study on teenage vaping fits the pattern of another study published in Lancet Respiratory Medicine, which was also heavily criticised (example). Both of these studies are co-authored by known anti-tobacco activist and prolific contributor to research on ETS and tobacco issues in medical journals, Prof Stanton Glantz (the Truth Initiative Distinguished Professor at The Center for Tobacco Control Research and Education at UCSF). These patterns clearly illustrate the fact that the advancement of the regulatory policy as a paramount concern that even supersedes quality control in methodological consistency, is not confined to the Tobacco Control journal, but extends to the whole cabal formed by the vast majority of public health researchers publishing in journals articles that deal with tobacco issues that may have implications in regulation policies.
It can be argued that technical flaws, such as sloppiness in handling data and statistical hodgepodge to obtain outcomes favouring funders’ preferred conclusions, are not confined to Tobacco Control and similar journals involved in researching tobacco/nicotine issues, but are common drawbacks in other disciplines as well (especially in various branches of health sciences). However, the credibility of scientific research is undermined even more when, besides these drawbacks, journals (such as Tobacco Control) themselves gauge and evaluate research results by their utility for advocating a specific regulatory policy. Since the latter is endorsed and implemented globally at the highest bureaucratic and government levels, authors of such flawed studies are basically free from scrutiny and are thus more than willing to publish any research that favours their advocacy even if it contains extremely misleading and false results.
Articles that exhibit this type of scandalous level of faulty methodology would never be published in my research area. This does not imply that erroneous or false (or even fraudulent) results are never published by physics journals. But once proven wrong or debunked, the authors and journals acknowledge the faults. Two years ago data the BICEPS2 observations seemed to have found a weak signal providing indirect evidence of tensor modes associated to gravitational waves that could have been produced during cosmic inflation. If verified, this signal would have been the first empiric proof of the inflationary hypothesis and a strong indication for the existence of gravitational waves (thus further corroborating General Relativity theory). However, it turned out that the handling of the BICEPS2 data had been sloppy, that the data was corrupted by Milky Way dust, whose noise completely buried the detected weak signal. In contrast with medical journals refusing to withdraw health claims on tobacco/nicotine related issues that were later debunked, the BICEPS2 claim was immediately withdrawn by all involved researchers and journals.
Now, what about the bloggers that the editors of Tobacco Control wish to excommunicate? Are they science trolls? The social media blogs that criticize articles appearing in the Tobacco Control journal (and similar journals) are quite diverse, with perhaps their single common feature being their opposition to the type of tobacco and e-cigarette regulation that is aggressively advocated by these journals.
Some of the blogs represent the vaping community and some claim to speak for smokers and vapers. Others are more broadly libertarian. Some of them argue the case for the tobacco harm reduction (THR) approach, even intensively promoting vaping or smokeless tobacco as a substitute for cigarette smoking, while others adopt a pragmatic approach that supports THR without campaigning against combustible tobacco. Some of these blogs are scholarly defenders of science. Some are not scholarly, but aim to provide a voice for a community of smokers, smokeless tobacco users, and vapers that actually enjoy using the products and feel personally affected by the social stigma produced by the intrusive bans that follow from the policy recommendations.
These bloggers, as well as most readers commenting on their posts, may be critical but are not on denial of the health risks from smoking, particularly cigarette smoking. As far as I can tell, very few of the bloggers and readers advocate the return to the old days when smoking was almost unregulated and allowed everywhere. Instead, all bloggers and readers express a generalised desire for a more humane regulation of tobacco smoking (and now of vaping), with the right of nonsmokers to smoke-free environments being respected, but also demanding that smokers (and vapers) must be able to enjoy public indoor spaces where they can smoke/vape without being shamed and vilified by “denormalization” policies. Bloggers and readers comment how such policies are promoted by a global conjunction of increasingly authoritarian public health lobbies and charities, whose aims are perceived to lie far from a genuine public health concern, and are more about the preservation of their bureaucratic power (the “gravy train”), with many of them having intimate financial ties with the pharmaceutical industry.
Some of the blogs are quite scholarly (some are run by experienced scientists) and do provide, together with useful verifiable information, a solid reasoned criticism of the loose methodology prevalent in the research published in Tobacco Control and other health journals. In fact, all the methodological flaws I mentioned before, the faulty meta-analysis — the statistic hodgepodge, the “Helena miracle” claims, the mishandling of the data, the simplistic “addiction” theory, the dismissal of previous results not aligning with the agenda — have been extensively and rigorously discussed in the pages of these scholarly blogs. While most blogs (even the scholarly ones) tend to avoid the dry cauterised style full of technical terms found in published journals, favoring a more colloquial, but well-articulated style amenable for an open and broad audience, a lot of the material appearing in the scholarly blogs could easily meet (after some editing and style changes) the methodological standard of quality that merits publication in a scientific journal.
These scholarly bloggers actually provide a very fresh and healthy counterbalance to the “official” tobacco/nicotine research published in academic research, which is excessively constrained by global public health politics and by the vested interests of the pharmaceutical industry. In particular, they promote varied proposals of a new regulatory paradigm based on THR to replace the policies trying to enforce the “abstinence only” approach. While the bloggers are certainly not beyond criticism (and some may tend to become too self-centered and too defensive), they are absolutely not (not even remotely) comparable to crackpots or science trolls. In fact, these bloggers provide the necessary and refreshing debate and exchange of ideas that could prevent the science on tobacco/nicotine issues from becoming practically indistinguishable from quasi-religious dogma.
Controversy on core issues and the challenging of dominant paradigms occur naturally in every scientific discipline: there is no reason why this should not occur in public health science. In fact, part of the community of public health scientists has resonated with the criticism expressed by the scholarly bloggers, agreeing (with various degrees of consistency and conviction) with them on various proposals for shifting regulatory policies towards a THR approach. To claim (as a lot of official tobacco scientists do) that all this wide spectrum of voices criticising the dominant politics are mere fronts of the maligned tobacco industry is a ridiculous libel that can easily be disproved.
It is clear beyond doubt that the harsh defensive reaction of the editors of the Tobacco Control journal stems from their inability to acknowledge serious technical errors that the bloggers they would like to excommunicate have spotted. These editors are exploiting the fact that, externally, their niche (a journal whose editors and contributors are credentialed academics) resembles the niche of other scientific journals, while the bloggers (even if posting valuable material) are outside these “official” channels. The hope of the Tobacco Control editors is to secure, by association, the professional authority of journals in other sciences and that this will help them to deflect the bloggers’ criticism.
The tactic of the editors of the Tobacco Control journal is then evident: to identify all their critics, but especially those writing in scholarly blogs, with the social media crackpots that besiege scientists in other disciplines. Their editorial is an attempt to utilize their external resemblance to a real research journal, serving real academic communities, for this purpose. Their target audiences are: first, the media, the politicians and the medical community who can implement the policies they advocate; second, the public health authorities and other academic communities (which would identify with them because of the superficial resemblance); and third, the lay people, who are completely unaware of the inner workings of scientific activity and simply assume that somebody like Prof Stanton Glantz, a co-author of the fraudulent “Helena miracle” (to use a well-known example), is as good a scientist as any other.
It goes without saying that the dominant majority of public health researchers involved in tobacco/nicotine research are acting with gross dishonesty when they paint themselves as bona fide scientists besieged by social media cranks or “Big Tobacco” front. Neither Prof Glantz nor any other prominent individual in this cabal has ever disavowed the most extreme pieces of tobacco junk science published in journals — for example, the claim that minutes of outdoor exposure to ETS produce coronary disease, or the existence of “third hand smoke” (health harms somehow resulting from tobacco smoke residue in rugs and walls where someone smoked). The claims from such pieces of published third-rate junk science are at the same level of science trolling as the writings of cranks in social media. There is little difference between the “third hand smoke” claim, which treats tobacco smoke as a sort of quasi-magical substance that is lethal even in extremely minute dosage, and quasi-witchcraft statements by a social media freak naturist sect announcing that wearing a pyramidal magnetic amulet around the neck protects from cancer. Yet the naturist sects do not claim patronage from science, whereas this type of officially published ultra-junk science does. For this reason, the latter is much more harmful socially than the former.
The identification of Tobacco Control critics with crackpots besieging scientists may backfire, as it can easily be shown to be false simply by reading through the pages of the scholarly blogs and comparing with the pages of the journal that they criticize. Not even the non-scholarly blogs and their readers can be tagged as trolls, as (in general) they avoid the extreme abuse seen among social media trolls. In fact, anybody having tried to debate extreme or neurotic anti-smokers (whether laypersons or physicians) rapidly discovers that expressing any doubt or nuance on the usual soundbites, such as “second hand smoking kills” or “you have no right to force your filthy habit on me”, or various forms of “protect the children” demagogy, is met by ad hominem, angry denials and abusive language. A large minority of anti-smokers in all walks of life are very prejudiced individuals whose attitudes to smokers are no different from attitudes of racists and homophobes towards their hate targets. In fact, anonymous anti-smokers in social media exhibit all the unpleasant features of internet trolls and crackpots: dogmatic belief in possessing absolute truths together with invoking conspiracies (the tobacco industry luring “kids” to become nicotine addicts). Unfortunately, some academics that publish on tobacco issues in official journals espouse the same type of cranky troll-level ideas, just expressed in polite technical terms.
Evidently, the editors of the Tobacco Control journal are trying to mobilise the medical-political bureaucracy and charities that share their anti-tobacco/anti-nicotine advocacy. The aim attached to their recent editorial is to pin all its critics (especially scholarly blogs) with the crackpot label, as the old “tobacco industry mole” label is no longer credible. They may succeed, but nevertheless, the label is deceptive. Sooner or later most people will realise it and admit that “the king is naked”.