Analysis of the new ASH ecig survey

by Carl V Phillips

One of the nice things about having a scholarly blog is being able to write what are basically extended footnotes for papers. Writing anything other than simple lab reports in the health sciences is extremely difficult for real scholars because of the length constraints: pressure to keep papers too short to do serious analysis and the lack of footnotes. These result from a combination of atavism (to fit more papers into 20th century paper journals), a warped sense of how science works (hint: pronouncements from authority), and a fear that if people knew that actual thoughtful analysis was an option the whole enterprise of churning out thought-free claims would collapse. Since I need to reference the ASH results for a forthcoming paper, and because someone asked me about them, here is my assessment. Continue reading

Ecig deeming regulation — nothing new to see here

by Carl V Phillips

A topic came up that made me really want to suspend my blog hiatus. The deeming regulation, the most chatter-inducing event in the history of THR, was not that topic. But I figured if I simply posted on another topic right now I would get asked why. I started to write this as a prologue to the other post, but that was distracting, so here it is. Continue reading

“I vape and I am eligible to vote, but seldom do it” is probably a better slogan

by Carl V Phillips

There has a lot of discussion about tactics in the comments of my recent posts, including the common error that there is a tension between tactical thinking and scientific analysis (see the my last paragraph from the previous post). So this post is entirely about tactics — from a scientific perspective.

In the USA, presidential elections get people briefly interested in the politics that shapes their lives. In the UK, the Brexit vote has momentous implications. In both of these, there are memes floating around about how voters who are motivated to protect their right to vape could sway elections. But could they really? Continue reading

Six bad arguments against criticism of misleading pro-THR claims

by Carl V Phillips

The title is a reference to this post by Lee Johnson, in which he did something that I often do (though seldom in list form): He pointed out a handful of arguments that are often made in vaping advocacy but that should be avoided because they are misleading or out-and-out factual errors. He dared suggest that even if you believe in a particular conclusion, not every claim that ostensibly supports your position is right. For his trouble, Johnson received (a little) well-deserved praise and (a lot of) very predictable attacks. What struck me — and strikes me every time I am the target of those attacks, but it was more clear from the outside — is that the criticism of him was just as patently invalid as the fallacious claims that he was debunking.

That particular kerfuffle has already faded away, thanks to the news-cycle proclivities common in this space (another problem in itself, though largely unrelated), but this is a recurring theme, so is worth some reflection. Following Johnson, I present the common arguments in six points. Continue reading

Economic innumeracy in public health, with an emphasis on tobacco harm reduction

by Carl V Phillips

I recently had the opportunity to give a talk at what was basically the wake for the end of the quarter-century run of the wonderful Robert Wood Johnson Foundation Scholars in Health Policy Research program at the University of Michigan. I chose to put together some themes from my work as a tribute to one of the goals of that program, bringing the thinking of serious social scientists into health policy arenas where it is desperately lacking. Alas, most of my fellow alumni focus on engineering a better medical system or medical financing, with few choosing to try to deal with public health (let alone “public health”). Medical practice is obviously extremely important, but not so desperately in need of imported thinkers. Well, at least you have me.

I got some great feedback on this talk making that alone well worth my effort. (Thanks to all my colleagues. And it was great seeing you. We’ll be in touch.) But I wanted to also share what I created more broadly here. The following are my slides from the talk, with some text to explain what is not fully contained in the slides, along with a bit of extra material that was not in the talk. Continue reading

Smoking is normal, and acknowledging that is part of proper tobacco harm reduction

by Carl V Phillips

Audrey Silk, via her CLASH organization in New York, recently launched a “Smoking is Normal” campaign (CLASH Facebook page, campaign Facebook page, press release). All the talk we hear about e-cigarettes “renormalizing” smoking is premised on a claim that something that about a fifth of the U.S. population does (and a larger portion in most rich countries) is not normal. In terms of prevalence, it is much more normal than being gay or being an American muslim. But think of the outcry — from very people who tend to be anti-smoker — that results when someone so much as points out those statistics, let alone suggests anything is abnormal about being in one of these minorities. Smoking is more normal than marrying outside one’s race or even marrying someone whose height percentile differs markedly from one’s own.

Of course, “denormalization” rhetoric is not an empirical claim about prevalence. It is a political tactic, an attempt to denigrate some people as being abnormal, in a sense that means abhorrent or deviant. In that sense, it is every bit as anti-THR as the most visited topic of this blog, attempts to convince people that a low-risk alternative to smoking is more harmful than it really is. No one who supports “denormalization” of smokers can be said to genuinely support tobacco harm reduction. Continue reading

An excellent indictment of public health paternalism

by Carl V Phillips

This is mostly an outsource: Go read this truly excellent case against paternalism by a professor of public health at Boston University with the unfortunate name, Leonard Glantz. I do not recall reading any analysis of this caliber by a public health professor since…, well since I was a public health professor (and I cannot claim I wrote anything quite so good on this particular topic back then). It deserves the highest praise: I wish I had written that.  Continue reading

An old letter to the editor about Glantz’s ad hominems

by Carl V Phillips

I am going through some of my old files of unpublished (or, more often, only obscurely published) material, and though I would post some of it. While I suspect you will find this a poor substitute for my usual posts, I hope there is some interest (and implicit lessons for those who think any of this is new), and posting a few of these will keep this blog going for a few weeks.

This one, from 2009, was written as a letter to the editor (rejected by the journal — surprise!) by my team at the University of Alberta School of Public Health. It was about this rant, “Tobacco Industry Efforts to Undermine Policy-Relevant Research” by Stanton Glantz and one of his deluded minions, Anne Landman, published in the American Journal of Public Health (non-paywalled version if for some unfathomable reason you actually want to read it). The authorship of our letter was Catherine M Nissen, Karyn K Heavner, me, and Lisa Cockburn. 

The letter read:

——–

Landman and Glantz’s paper in the January 2009 issue of AJPH is a litany of ad hominem attacks on those who have been critical of Glantz’s work, with no actual defense of that work. This paper seems to be based on the assumption that a researcher’s criticism should be dismissed if it is possible to identify funding that might have motivated the criticism. However, for this to be true it must be that: (1) there is such funding, (2) there is reason to believe the funding motivated the criticism, and (3) the criticism does not stand on its own merit. The authors devote a full 10 pages to (1), but largely ignore the key logical connection, (2). This is critical because if we step back and look at the motives of funders (rather than just using funding as an excuse for ignoring our opponents), we see that researchers tend to get funding from parties that are interested in their research, even if the researcher did not seek funding from that party (Marlow, 2008).

Most important, the authors completely ignore (3). Biased motives (whether related to funding or not) can certainly make us nervous that authors have cited references selectively, or in an epidemiology study have chopped away years of data to exaggerate an estimated association, or have otherwise hidden something. [Note: In case it is not obvious, these are subtle references to Glantz’s own methods.] But a transparent valid critique is obviously not impeached by claims of bias. The article’s only defense against the allegation that Glantz’s reporting “was uncritical, unsupportable and unbalanced” is to point to supposed “conflicts of interest” of the critics. If Glantz had an argument for why his estimates are superior to the many competing estimates or why the critiques were wrong, this would seem a convenient forum for this defense, but no such argument appears. Rather, throughout this paper it seems the reader is expected to assume that Glantz’s research is infallible, and that any critiques are unfounded. This is never the case with any research conducted, and surely the authors must be aware that any published work is open to criticism.

Indeed, presumably there are those who disagree with Glantz’s estimates who conform to his personal opinions about who a researcher should be taking funding from, and yet we see no response to them. For example, even official statistics that accept the orthodoxy about second hand smoke include a wide range of estimates (e.g., the California Environmental Protection Agency (2005) estimated it causes 22,700-69,600 cardiac deaths per year), and much of the range implies Glantz’s estimates are wrong. But in a classic example of “a-cell epidemiology” [Note: This is a metaphoric reference to the 2×2 table of exposure status vs. disease status; the cell counting individuals with the exposure and the disease is usually labeled “a”.], Glantz has collected exposed cases to report, but tells us nothing of his critics who are not conveniently vulnerable to ad hominem attacks.

It is quite remarkable that given world history, and not least the recent years in the U.S., people seem willing to accept government as unbiased and its claims as infallible. Governments are often guilty of manipulating research (Kempner, 2008). A search of the Computer Retrieval of Information on Scientific Projects database (http://report.nih.gov/crisp/CRISPQuery.aspx) on the National Institute of Health’s website found that one of the aims of the NCI grant that funded Landman and Glantz’s research (specified in their acknowledgement statement) is to “Continue to describe and assess the tobacco industry’s evolving strategies to influence the conduct, interpretation, and dissemination of science and how the industry has used these strategies to oppose tobacco control policies.” Cleary this grant governs not only the topic but also the conclusions of the research, a priori concluding that the tobacco industry continues to manipulate research, and motivating the researcher to write papers that support this. Surely it is difficult to imagine a clearer conflict of interest than, “I took funding that required me to try to reach a particular conclusion.”

The comment “[t]hese efforts can influence the policymaking process by silencing voices critical of tobacco industry interests and discouraging other scientists from doing research that may expose them to industry attacks” is clearly ironic. It seems to describe exactly what the authors are attempting to do to Glantz’s critics, discredit and silence them, to say nothing of Glantz’s concerted campaign to destroy the career of one researcher whose major study produced a result Glantz did not like (Enstrom, 2007; Phillips, 2008). If Glantz were really interested in improving science and public health, rather than defending what he considers to be his personal turf, he would spend his time explaining why his numbers are better. Instead, he spends his time outlining (and then not even responding to) the history of critiques of his work, offering only his personal opinions about the affiliations of his critics in his defense.

References

1. Landman, A., and Glantz, Stanton A. Tobacco Industry Efforts to Undermine Policy-Relevant Research. American Journal of Public Health. January 2009; 99(1):1-14.

2. Marlow, ML. Honestly, Who Else Would Fund Such Research? Reflections of a Non-Smoking Scholar. Econ Journal Watch. 2008 May; 5(2):240-268.

3. California Environmental Protection Agency. Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant. Executive Summary. June 2005.

4. Kempner, J. The Chilling Effect: How Do Researchers React to Controversy? PLoS Medicine 2008; 5(11):e222.

5. Enstrom, JE. Defending legitimate epidemiologic research: combating Lysenko pseudoscience. Epidemiologic Perspectives & Innovations 2007, 4:11.

6. Phillips, CV. Commentary: Lack of scientific influences on epidemiology. International Journal of Epidemiology. 2008 Feb;37(1):59-64; discussion 65-8.

7. Libin, K. Whither the campus radical? Academic Freedom. National Post. October 1, 2007.

——–

Our conflict of interest statement submitted with this was — as has long been my practice — an actual recounting of our COIs, unlike anything Glantz or anyone in tobacco control would ever write. It read:

The authors have experienced a history of attacks by those, like Glantz, who wish to silence heterodox voices in the area of tobacco research; our attackers have included people inside the academy (particularly the administration of the University of Alberta School of Public Health (National Post, 2007)), though not Glantz or his immediate colleagues as far as we know. The authors are advocates of enlightened policies toward tobacco and nicotine use, and of improving the conduct of epidemiology, which place us in political opposition to Glantz and his colleagues. The authors conduct research on tobacco harm reduction and receive support in the form of a grant to the University of Alberta from U.S. Smokeless Tobacco Company; our research would not be possible if Glantz et al. succeeded in their efforts to intimidate researchers and universities into enforcing their monopoly on funding. Unlike the grant that supported Glantz’s research, our grant places no restrictions on the use of the funds, and certainly does not pre-ordain our conclusions. The grantor is unaware of this letter, and thus had no input or influence on it. Dr. Phillips has consulted for U.S. Smokeless Tobacco Company in the context of product liability litigation and is a member of British American Tobacco’s External Scientific Panel.