Category Archives: truths

discussions of how to best present the truth

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].)

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Smoking is not addictive

by Carl V Phillips

Now that I have your attention, this long essay is my response to the frequent requests to summarize my analyses of the concept of addiction, particularly how it relates to tobacco product use. I should note that the headline is based on the most commonly-accepted definition of “addictive”. I will work my way through that to other senses of the word under which smoking might be considered addictive. Continue reading

Tobacco control ratf**king

by Carl V Phillips

Sorry for the silence, though it may get worse. As some of you know, I lost my funding to keep working on THR issues, and I expect I have to fully move on to other work. But I thought I would pop in with some insight from the old guard. After that, I have an epic post that is almost finished (years in the making). These will be good notes to go out on.

For those not familiar, “ratfucking” is a term from the Nixon era that refers to political dirty tricks. The word has had a major resurgence in the age of Roger Stone, Stephen Miller, et al. [Fun fact: I was not sure of the spelling of Miller’s name, so I typed a search for “Trump advisor smug weasel” and his name appeared as the second entry after an article about presidential advisors in general.] The nuance of the word typically refers to sowing false information or allegations to harass and damage the opposition. The acts are usually barely legal (except perhaps insofar as they constitute a criminal conspiracy) or at least are impossible to prosecute, but they are a clear violation of norms of social behavior and other rules of conduct.

In the political arena, ratfucking includes such things as push-polls, doctored photographs, engaging in public bad acts while pretending to be a member of the opposition, and other methods of trying to exacerbate problems that are blamed on the opposition. As practiced by tobacco controllers, ratfucking includes, well, such things as push-polls, doctored photographs, engaging in public bad acts while pretending to be a member of the opposition, and other methods of trying to exacerbate problems that are blamed on the opposition. Continue reading

My recent contribution to Clive’s weekly reading list

by Carl V Phillips

As some of you know, Clive Bates puts out a weekly somewhat-annotated list of PubMed-indexed articles that are related to low-risk tobacco products and/or tobacco harm reduction (the search string for that appears at the end of what follow). It is a great resource; if you do not receive it, I am sure he would be glad to add you to the distribution list. As part of a planned projected that I have alluded to before, I am working on how to reinterpret this as an annotated weekly suggested reading (or knowing-about) list. To that end, this week I was a “guest editor” for Clive’s distribution list, and I thought I should share what I wrote here to broaden the audience. Yes, it is a little weird to publish a one-off “weekly reading” that is mostly based on an existing format that you might not be familiar with. But you should be able to get the idea. Hopefully I will be producing one every week before too long.

In the meantime, here is what I wrote that went out via Clive’s distribution lists. Sorry for the weird formatting — it is an artifact of the way the original PubMed search was formatted. Yes, I could have fixed the for aesthetics to re-optimize for this blog’s formatting, but since they do not hinder comprehension, I am not going to bother — sorry.

Greetings everyone. Carl V Phillips here, doing Clive’s list this week. I am trying out a new format for it, as follows: (1) They are not listed in the order that popped from the PubMed search string, but rather is in order of how worth reading they are. Obviously this is my own rough blend of various considerations, including importance of what is being addressed, value of what was produced, how potentially influential it is, and how much reader effort it takes to get value from it (note that I put relatively little weight on the latter). I have left the serial numbers from the search on the entries in case anyone wants to recreate the usual ordering. I add a full-text link if I think there is anyone other than specialists in the particular area would want to look at the full text. (2) I am not limiting this to PubMed-indexed papers. I am including popular press and policy statements (and would have included blogs but there were not any apparent candidates this week).

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Weekly reading: ~20 Nov 2018

Something about this post (the title and thus the URL, I guess) made it so half my readers could not access it. So I replaced it with an exact duplicate here. I am leaving this here as a placeholder for those who do navigate to it, but deleting the duplicate content.

Peer review of: Linda Johnson et al. (Washington U med school), E-cigarette Usage Is Associated with Increased Past 12 Month Quit Attempts and Successful Smoking Cessation in Two U.S. Population-based Surveys, NTR 2018.

by Carl V Phillips

For an overview of this collection and an explanation of the format of this post, please see this brief footnote post.

The paper reviewed here is available at Sci-Hub. The paywalled link is here.

This collection will focus mainly on the misleading anti-THR papers produced by tobacco controllers. However, it is useful and important to provide reviews of potentially important paper that might be called pro-THR. This is one example of a paper that has gotten a lot of “ha, take that!”-toned traction.

If a “pro-THR” paper is tight, a review will provide a substantive endorsement, as positive reviews should do (but as the anonymous and secret — and presumptively poor-quality — journal reviews cannot do), as well as a signal boost. If a paper is useful but importantly flawed (as in the present case), the review can correct or identify the errors and focus attention on the defensible bits. And if the paper is fatally flawed, the review should point that out. Bad advice is still bad advice when it feels like it is “on your side”. Even when a paper basically only provides political ammunition and not advice, it is important to assess its accuracy. We are not tobacco controllers, after all, who just make up whatever claims seem to advance their political cause.


Johnson et al. use historical nationally-representative U.S. tobacco use data (NHIS from 2006 to 2016 and CPS over most of that period), for 25- to 44-year-olds, looking at the rate of smoking quit attempts and the association between vaping status and quit attempts or successful smoking abstinence. The authors report an unconditional increase in the population for both quit attempts (measured as a the rate of past-year incidence among people who smoke) and medium-term smoking abstinence. They also report a positive association between vaping and smoking quit attempts and abstinence at the individual level. They interpret their results as running contrary to the recent spate of “vapers are less likely to quit” claims, stating “These trends are inconsistent with the hypothesis that e-cigarette use is delaying quit attempts and leading to decreased smoking cessation.”

This is an overstatement, but the results do run contrary to the “vaping is keeping smokers from quitting” trope that the authors position their paper as a response to. This research clearly moves our priors a bit in the direction of “yes, vaping encourages people to quit smoking, and helps them do so.” Our priors only move “a bit” because rational beliefs based on all available evidence tell us we should be very confident of that conclusion already. They should instead have said something like “even if you naively believe in those methods, for this data the result is different”, but such (appropriate) epistemic modesty is absent.

The paper is quite frustrating in that the authors seem to not recognize which of their statistics are actually most informative and persuasive, let alone take the deeper dive into specific implications that could have been done. The natural experiment interpretation of some of the results is more compelling than the behavioral-association-based analysis (see below). The authors overstate the value of their association statistics and effectively endorse the same flawed methods that are the source of the “vapers are less likely to quit” literature. Continue reading

Glantz settles academic fraud and sexual harassment lawsuit

by Carl V Phillips

As my regular readers — or anyone who appreciates some really awesome schadenfreude — will know, two lawsuits were filed by female students against UCSF anti-tobacco nutcase and faux-scientist Stanton Glantz (technically they were postdoctoral fellows, but there is no relevant difference here between a graduate student and a postdoc). They were billed as sexual harassment suits, though the real payloads were about other abuses by Glantz. I covered it at The Daily Vaper, here, here, and here, and did a video interview about what I wrote here.

Mine account for approximately half the newspaper articles written about the story. That pattern does not quite constitute a coverup, but it is pretty close. Compare the number of stories about any similar accusations a professor who is not a pet of the US government and a favorite of institutions with political influence over the mainstream press. (Sexual harassment suits are a topic that, for obvious reasons, you cannot count on the right-wing press to pick up on, even if suits them politically.)

As I noted in my previous coverage, the most striking aspect of the story is that not a single person in tobacco control expressed so much as a lame “troubling if true” comment. At the same time, not one expressed doubt about the allegations and tried to defend Glantz. Presumably they did not actually doubt that the claims were true, but just did not care.

Also as I noted in my previous coverage, the salacious #MeToo allegations in the complaints are not really the biggest allegations. The sexual (and racial) harassment allegations in the lawsuits were pretty weak. They consisted of rude and boorish behavior by Glantz, and do not paint a picture of a sustained environment of this. Even that much is grossly inappropriate for any employer, let alone an academic mentor, of course. But we are not talking “high-ranking Republican official”-level behavior; more like Al Franken behavior. (In keeping with my running observations about the parallels between the GOP/Trump and tobacco control, it is worth noting that Franken’s party forced him to resign over one boorish incident from his past, while tobacco controllers’ ignoring of the Glantz allegations parallels the GOP practice of ignoring credible criminal-level allegations against Trump and other officials.) Of course, it is possible that the lawsuit filings do not fully capture just how pervasive and oppressive the behavior was, though it seems extremely unlikely there were worse specific acts that were not mentioned.

If the plaintiffs could not produce much more about that than the filings included, it seemed really unlikely they could get it to stick. But this is not true for the less salacious allegations that most observers overlook. The first lawsuit, by Eunice Neeley, said that Glantz stole credit for a paper she wrote and even submitted it to a journal under his name. This is extremely serious bright-line academic fraud, and very easy to prove. The second lawsuit included a claim about Glantz defrauding the U.S. government in order to get funding. This was presented less clearly, but seems like it is probably also bright-line and easy to prove. Of course, if the U.S. government cared about Glantz committing fraud, they would not be happy about his “research” in the first place. (Narrator: “They are actually quite delighted with his fraudulent research.”)

It was recently noticed (not actually announced) that UCSF and Glantz settled the Neeley lawsuit a few weeks ago. UCSF has posted the settlement agreement (h/t @jkelovuori). It is not clear whether they posted it because of transparency requirements or if they agreed to do it as part of the settlement. It could be they think it makes them look a lot better than a pending lawsuit, which is arguably true.

The settlement included UCSF paying Neeley (which really means mostly or entirely her attorney) $150,000. This is about what it would have cost the defendants to go to court and win, let alone risk losing. As is usually the case, the settlement document includes the defendants’ denials of all the allegations. The pro forma denial and the limited dollars do mean that the settlement document makes UCSF look pretty good. Neeley’s lawyer may have decided that the case was unwinnable. The part that was bright-line misconduct is something (real) scholars would care deeply about, but a court probably would not. Or perhaps she was just looking to collect her pay and move on, and so convinced Neeley that it was unwinnable. Neeley seems pretty adamant in her feelings (read on), so it does not seem like she lost interest in pursuing it.

The only thing she got from the settlement, other than whatever loose change her lawyer did not keep, was the right to the one paper Glantz stole from her and an agreement that Glantz would not touch it again. There is little doubt she could have gotten that without a lawsuit, given how obvious Glantz’s academic fraud was. Indeed, even that concession came with enough administrative strings attached that she probably could have done better just by relying on the court of academic public opinion. (Interestingly missing is mention of any other work by Neeley, even though her complaint claimed that this was not the only work of hers that Glantz was trying to steal.) One might conclude this was the one thing Neeley wanted, a matter of credit and honor. Some of her past statements support that honorable interpretation. But she has made clear that this is not the case (read on).

It is impossible to feel sorry for Neeley. She is a tobacco controller of the worst sort (read on). She went to work for a known sociopathic fraudster who has no respect for science and scholarship. Even if he has never committed any actionable sexual abuse, it is well-established that he is an abuser. We might be able to say “just a kid, could not recognize that” about Neeley regarding the latter. But she took the job after getting a doctorate (*smirk/snort*) in public health, and so has no excuse for not understanding the former.

Absent from the settlement was a gag clause (you have to spend a lot more than 150K to buy a woman’s silence — just ask any number of right-wing “family values” types). So a few weeks ago, Neeley joined Twitter to post her allegations about Glantz in random responses to tweets by his funders and others. No link, unfortunately, because literally minutes before I was about to publish this she deleted her account. So now I am even more annoyed at her, for making me re-edit.

Her tweets made it clear she was adamantly committed to the belief that Glantz is an ongoing threat to young women, and that she wants to warn and inform about that. If Glantz and UCSF really believed their denials, they would already be threatening to sue her for libel (and, I suppose, that may have been what just happened).

I am not sure whether Neeley uses other platforms. Her tweets never linked to any essay-length statement, which you think she would have written. Her tweets did not link to any other social media. Perhaps it exists — she was amazingly bad at Twitter for a millennial, so maybe it did not occur to her to mention it. I offered her some advice about some easy ways to do better in her mission, but she seems to have ignored that.

I did not mention in that advice that she came across as a raving loon in most of her tweet replies. If that represents her demeanor and level of focus in person (I have no idea whether it does), her attorney definitely would not have wanted to put her on the stand. I am obviously not saying that presenting that way invalidates a #MeToo complaint (as a certain disgusting ilk do), let alone that the mere act of accusing a powerful man of sexual harassment makes someone sound like she is raving (again, as that ilk do). I am specifically saying that most of her tweets were not what anyone would take seriously. They make her allegations seems less plausible. Thus my advice to her.

But it gets worse (or better, depending on how you choose to relate to this story). Greg Conley noticed that one of Neeley’s tweets claimed that a UCSF investigation confirmed her allegations. (That thread is now missing her tweets, of course, but he was responding to one that said what I just paraphrased.) Conley naturally asked if there was a copy of that report available. You might think that someone who was intent on making her case, and interested in being at least a little bit credible, would have an easy answer to that. Presumably it would be “Unfortunately I don’t have a written report and none is public. I am aware of their findings because….” (you have to assume, as bad as she is at this, she would have linked to it if she could have). But no. Here is her (now deleted) reply:

I do not support vaping, Mr. Conley I know who you are. But, I brought this up because I want to protect individuals working with Stan.

I laugh every time I read that (and not about the typo since I average about .5 typos per tweet, though that did bring to mind HRH Conley the First writing “Counterblaste to Tobacco Control”). “I know who you are” is presented as if it is some kind of accusation. Um, someone working in that area better know who he is. She better know who I am too, though I did not get the courtesy of an “I know who you are.”

(*author pauses to laugh some more, and ponders himself writing Counterblaste to Tobacco Control*)

Anyway, Conley responded sensibly and politely that differences about other politics should not interfere with the shared concern about Glantz hurting his students. In another thread, he offered some other advice, pointed out to her that I was the only reporter who had followed the story, and noted that zero tobacco controllers follow her on Twitter because they want to suppress this. As of today, she had 17 followers; 14 were anti-TC people of various stripes and the other 3 were bots. She did not respond to him.

I chimed in with this observation:

“I am terribly worried about other women, but not enough that I will talk to someone who supports harm reduction” is quite the remarkable position. Says a lot about the brainwashing that led to the omertà silence.

It is truly remarkable. Neither of us explicitly pointed out to her the common practice of narrow alliances, or merely taking advantages of resources when you can. The government that paid for her education is responsible for killing a million people in a war of aggression recent enough for her to remember it. Few of us refuse government services as a result. However much someone might quite reasonably despise the cops, they tend to call on them to perform the legitimate part of their job when needed. I heartily welcome Neeley’s exposure of one tiny corner of one individual’s deplorable behavior, even though I think her political views are also deplorable. Someone should probably point this out to her rather than thinking it is so obvious it goes without saying. Tobacco control lives so far up their own asses that they may be the only people who do not get this.

She is obviously adamant and genuine about her concern, but is such a tobacco controller at heart that she will not actually do anything useful. She is effectively silencing herself (and not just be deleting her useless tweets). She plays at getting the word out, but does not actually want to get the word out because it might interfere with tobacco control’s efforts to ruin people’s lives. She somehow thinks that harm reduction supporters getting the word out will benefit harm reduction, but that her getting the same word out (which is really beyond her ability) would not. But how does that even work? (A doctorate in public health does not exactly teach scientific or logical thinking.)

So she attacks the only useful potential allies she has in the world, now that her lawyer took the money and skated.

Oh, and a few last bits of bathos. Her response to me:

I am for harm reduction because I do not want anyone to use any nicotine-containing product. I am well aware of the harms of nicotine and that is why I have advised the FDA to lower the nicotine in all nicotine containing products.

I am pretty sure that, despite being a supposed scholar and researcher in the field, she genuinely does not understand that her described position is roughly the diametric opposite of harm reduction. This is what I meant by “a tobacco controller of the worst sort”.

And another random other tweet by her:

For all you vapers and tobacco companies, I am strongly anti-tobacco and anti-vaping. I am only complaining about @ProfGlantz because of his decades of sexual harassment. So if you are pro-nicotine, I would not follow me because I advise the FDA to protect public health.

I guess she only liked her bot followers.

Since her deleting her account ruined the ending I had written, I will instead go all-in with the bathos and treat you to a couple of pictures Greg Conley sent me while preparing this. Trigger warning: Once you see these, you cannot unsee them. (Yeah, I know, you saw the pictures before you read this paragraph. I did not mean it.)

bHTquwzJWait, where is his right hand?

OAocjo3MYes, that really is a screenshot of his phone wallpaper.






Public health publishing is fundamentally unserious: evidence from a single measure of area

by Carl V Phillips

Sometimes an error matters because of its effects. Sometime it matters because what it says about its causes.

I was late to this nice piece by Roberto Sussman (a guest post at Brad Rodu’s blog) that takes down a recent silly paper out of University of California about environmental deposition on surfaces resulting from vaping exhalate. They do not actually call it “third-hand vapor”, though they all but do so, explicitly likening it to the myths (which they endorse, of course) about “third-hand smoke”. For the analysis of the science, please read Roberto’s piece, because here I am just focusing on a single gaffe and its implications.

As background, note that this that this came from the supposedly respectable tobacco controllers at UC, including Benowitz and Talbot, not the utter loons in Glantz’s shop. It was published not in some random online journal, but in the supposedly respectable flagship journal of the tobacco control movement, BMJ’s Tobacco Control.

Reading Sussman’s piece, I came across this, which he quoted from the original paper:

After 35 days in the field site, a cotton towel collected 4.571 micrograms of nicotine. If a toddler mouthed on 0.3 m2[squared meters] or about 1 squared feet of cotton fabric from suite #1, they [sic] would be exposed to 81.26 m[micrograms] of nicotine”. 

Sussman’s post is analytic, but it was written as an essay and so I was reading it fairly casually. That is, I was not trying to actively check each bit of the math as I read it, as I would when reading a research report. But even a quick glance across that passage was enough for me to trip up and notice the error. A square meter is about ten square feet, and thus 0.3 m^2  is about 3 square feet. Sussman, who was reading the original paper carefully for purposes of criticizing it, of course also caught this error and noted it in his next paragraph.

In theory this affects the thesis of the paper, which is based on the premise of a toddler sucking out all the nicotine that has accumulated in a towel that has sat untouched in a vape shop for a month. (Yes, believe it or not, that is really the premise of the analysis.) So the error means that the magical vacuuming toddler is given credit for extracting 3 ft^2 worth of accumulation by sucking the heck out of a mere 1 ft^2 of fabric.

However, this is not one of those convenient errors that creates artifactual results that matter First, every bit of this scenario is obvious nonsense, as Sussman explains, and every step grossly exaggerates the real-world exposures. And, second, even with all that, the tripled quantity is still trivial. So it is not like was the common type of “error” from tobacco control research, one done intentionally to get the result the authors want. It merely changes the result from “a silly premise that despite its huge overstatement still only yields a trivial exposure” to “a silly premise that yields an exposure that is three times as high, but is still trivial.” It is obvious that the conclusions of the paper (“environmental hazard” — i.e., landlords should be pressured to not host vape shops) were in no way influenced by the results.

In addition, it is a pretty stupid intentional “error” to make. It is a bright-line error, which appears right there in the text, as if someone had written 2+2=5. The typical tobacco controller “errors” consist of such tricks as conveniently not mentioning that a crucial variable makes the entire result go away (which only very careful readers catch), or fishing for a model that produces the most politically favorable result and pretending it was the only version of the model ever run (which is easy to detect, but impossible to prove).

No, it is clear that this was a mere goof. Someone who is not so good with numbers was thinking “a meter is about three feet, so it must be that a m^2 is about three ft^2”. Oops.

But here’s the thing: Whoever was doing the calculations for the paper made that goof, but more significantly did not catch it on further passes through the material. In other words, no one ever thought carefully about the calculations. Then someone transferred the calculation notes into text of the paper without noticing the error at that point. The other authors of the paper (there were four total) reviewed the calculation and the paper without ever engaging their brains enough to notice the error, and let it go out the door. Or perhaps they never even reviewed the calculations they were signing-off on, and perhaps not even the paper.

Keep in mind that perhaps you, dear reader, might not notice this error on a quick read. Perhaps you did not even know that a m^2 is about 10 ft^2. But anyone who does science, and is burdened with the hassle of dealing with stupid non-SI American units of measure, knows stuff like this intuitively. As I said, I noticed it without even thinking about it, just like you would notice a misspelling even though you are not actively looking for mispelings as you read. Sussman noticed it, and he is a scientist who probably never sees mention of non-SI units in his work, and who lives in a normal country that uses SI units (i.e., “the metric system”) in everyday communication. It is apparent that none of the authors of the paper ever read it as carefully as he did.

The American authors, who need to be literate in translating from American units to scientific units, should have noticed it. It is a safe bet that if prompted, “there is an error in that sentence,” they would figure it out in a few seconds. So the point here is not that they do not know the units or how to do arithmetic, but that they did not pay enough attention to their own calculations to notice the simple error. They never really cared about the calculations, as evidenced by the conclusions that are not actually supported by the results.

They were not the only ones. The reviewers and editor(s) at BMJ Tobacco Control also did not read the paper carefully enough to catch the error. As I have noted at length on this page, journal peer-review in public health is approximately useless. A generalist copy editor would probably have caught it, but presumably BMJ TC does not employ one despite being hugely profitable.

This also means that no one other than the aforementioned seven or eight individuals read the paper carefully. Indeed, it is quite possible that no one else read the paper at all before it appeared in the journal. From the perspective of serious science, is actually the biggest problem in public health research evident here: not circulating a paper for comments before etching it in stone, but rather creating a “peer-reviewed journal article” out of what is effectively a superficially polished first-draft of a scientific analysis. Anyone who actually wants to get something right makes sure a lot of people read it critically before they commit to it.

Many errors in public health articles are a bit complicated, and pretty clearly happen because the authors and reviewers do not know enough science to know they were errors. Many others are pretty clearly intentional on the part of the authors, and signed off on by reviewers because they are incompetent, inattentive, and/or complicit in wanting to disseminate the disinformation. But a stupid error like this illustrates something different: Public health authors and journals are simply not even trying to do legitimate analysis.