Category Archives: truths

discussions of how to best present the truth

Can smoking protect you against COVID-19?

by Carl V Phillips

Many of you will have already seen or heard about a paper by Farsalinos et al., in which they review some case series data from China and observe that for hospitalized COVID-19 patients, the recorded smoking prevalence is far lower than would be expected given the population prevalence. The US CDC also released data a couple of days ago that shows the same pattern. If the data is representative and accurate (but note that there are compelling reasons to question whether either of those is true), this strongly suggests that smoking is hugely protective against COVID-19 inflection and/or the resulting disease progressing to the point that hospitalization is required.

We are not talking at the level of “well I guess smokers get a bit of compensation this year for all the health costs of smoking.” This is at the level of “everyone should take up smoking for a few months until the pandemic abates.” The protective effect implied by the data is absolutely huge. Continue reading

New Glover-Phillips paper: “Potential effects of using non-combustible tobacco and nicotine products during pregnancy: a systematic review”

by Carl V Phillips

This new paper, by Marewa Glover and me, is just out in Harm Reduction Journal. In it, we review the available epidemiology evidence about the effects of nicotine-sans-smoke (NRT, snus, vape) on pregnancy outcomes. It was a bit of a challenge to get it published because we wrote the paper we needed to, rather than a “typical review”. As you might know, the journal publication process is rather …well, let’s just say conservative.

(I should note that we finalized the review before this new contribution to the literature by Igor Burstyn et. co., “Smoking and use of electronic cigarettes (vaping) in relation to preterm birth and small-for-gestational-age in a 2016 U.S. national sample” (note that this link bypasses the paywall, but does not seem to work in all browser configurations). Igor’s paper is higher quality than anything we reviewed.)

A typical review of epidemiology looks at the results that are reported in journal articles and then just naively believes them, suggesting that What We Know consists of a vague summary of whatever results the previous authors chose to publish. Or even worse — so much much worse — suggesting that a calculated average of those results is the best estimate. That is never a legitimate assessment of existing knowledge, and less so in our case. Continue reading

“Dependence” and the danger of adopting the language of your oppressors

by Carl V Phillips

Vaping, smoking, and other tobacco product use are routinely described as “addictive”. As I have pointed out repeatedly, this is a very misleading characterization. (You might recall my major essay – years in the making – on this topic from earlier this year. If you missed it and are reading this, you will definitely want to go read it.) The two sentence summary of the headline point is: All ‘official’ definitions of “addiction” hinge on the behavior being highly disruptive to someone’s functioning – work, social, etc. But tobacco product use has no such effects, at least not for more than a minuscule fraction of consumers.

So the fallback position, in the event that someone recognizes the problem with that word, is to say that tobacco product use produces dependence. But this is barely more accurate and is equally misleading. For those who use these products or advocate for their acceptance, to use of either of these words is to make the rhetorically and psychologically dangerous mistake of adopting the language of one’s oppressors. Continue reading

Essay on bans by Marewa Glover

by Carl V Phillips

I wanted to call attention to a new essay about bans by Marewa Glover, probably the most thoughtful and clear-reasoning person who still self-identifies as a tobacco controller. The piece is entitled “Do We Really Need Another Law? The cost to New Zealand of banning smoking in cars,” which describes its titular focus and the motivating policy proposal. But it is more a wide-ranging examination various implications of bans and tobacco control more generally. It is a long read at 16K words (which she calls a book, even though I would call it two long blog posts :-), but easy going and worth the time.

You can find it at her institute’s website, here. (Needless to say, by recommending it I am not endorsing every word of it. I have some disagreements.) Continue reading

Tobacco Wars collateral damage: feature, not bug

by Carl V Phillips

A single-observation post, inspired by the great consternation I am seeing this week about proposed FDA retail restrictions on vapes, ostensibly for the purpose of reducing vaping by minors. There are quite a few reasons this is a terrible policy (see coverage by Clive Bates here), but the theme of the typical criticism is that it will hurt legal “proper” vape consumers (primarily by denying them flavors they like or convenient purchase venues) more than it will “help” teenagers (by denying them something they want to do). The criticism is presented as if this supposedly odd perverse effect might persuade tobacco controllers to change the policy.

Here’s the thing: Hurting people who continue to use a tobacco product is considered a feature, not a bug. Despite the endless chatter about trivial policies, there is basically only one category of tobacco control policies that matter (by any measure), other than the bans that exist for some products in some places: the high punitive taxes on cigarettes and other products. These policies is lauded by many of the same people who condemn blunt-instrument anti-teen-vaping policies. Yet they are almost exactly the same from an ethical perspective. Continue reading

What is a lie?, revisited.

by Carl V Phillips

As regular readers know, I have written a fair bit about the nature of lies. I make a serious study of it as part of the mission of this blog and my larger approach to the politics of harm reduction and real public health. I do this with as much scientific rigor as is possible for such a question. Recently a confluence of events — the ongoing attempts of the press to deal with Trump’s claims, dealing with my ex’s lawyer, and most importantly the “vaping causes seizures” controversy — reminded me that I have not updated my thinking on this for a while. So here goes. Continue reading

New statistics about vape risk misperception (and a subtle extra-bad implication)

by Carl V Phillips

A new paper in JAMA Network Open by Jidong Huang et al. from Georgia State University provides some new statistics about just how effective the war on vaping is, in terms of the average American’s perceptions of risk. Despite working for one of FDA’s pet research shops, the authors make clear their opinion that it is bad that so many people think that vaping is as harmful as smoking or worse. Continue reading

Even Norwegians do not understand how low-risk snus is

by Carl V Phillips

In honor of my launching my Patreon account a few hours ago…

[Inevitable plug: If you like my work and consider it valuable, please consider becoming a patron. There will also be some premium content for donors. Check it out here.]

…I thought I would write about one of the rare good and useful bits of new research in this space. It is “Relative Risk Perceptions between Snus and Cigarettes in a Snus-Prevalent Society—An Observational Study over a 16 Year Period” by Karl Erik Lund and Tord Finne Vedoy, available open-access (kudos!) here. In it they discover that despite Norwegian population becoming one of the small number of THR success stories, perceptions about the risk from snus (the leading low-risk substitute for smoking there) are still way off.

(This is a workaday research review. If you want something deep and epic, please check out the previous post. If you want something incendiary, please stay tuned [or scroll down to the Update].)

Continue reading