Tag Archives: 95%

Index of my Daily Vaper articles (2)

by Carl V Phillips

In my last post, I noted that most of my writing is currently at The Daily Vaper. I also promised that I would keep an index of those publications here for those who following this and not those, highlighting the ones that fans of this blog might be particularly interested in. This also provides an option for commenting on them, which DV does not have, and a chance for me to add a bit more about some of them.

Here is my belated second entry in the series. I will try to do this more frequently so the list is not so long (sorry — maybe keep this tab open and take a few days to get to all of them you want to see).

In rough descending order of what I think regular readers of this blog would find most interesting (I expect you will want to read at least the first seven):

1. I wrote a science lesson about anchoring bias and why it means that we should really stop describing the risks from low-risk tobacco products in relation to smoking (e.g., “99% less harmful”). I have hinted at some of this here, but I have never really nailed it before. This is new analysis. Anyone interested in my evolving thinking about accurate messaging — based on more years of experience and thought than anyone else involved in this realm — should definitely read this.

2. I reported on a court ruling that is fairly obscure, but truly delightful: The usual gang of anti-tobacco groups petitioned to be co-defendants, alongside FDA, in a suit against FDA by cigar manufacturers over aspects of the deeming regulation. The judge denied it. Why should we care? Because the ruling basically said that they are not stakeholders. For those of us constantly frustrated by the bullshit suggestion that they are (let alone that the primary stakeholders, tobacco product consumers, are not), this is just too good. Unfortunately I suspect I am the only one who will try to make anything of this. I strongly encourage those of you who are involved in advocacy (and especially those involved in lawsuits) to run with it. It really is a huge potential lever.

3. This piece is about the unethical scientific practices of tobacco controllers, specifically their flouting of human subjects protection rules. These are bright-line violations of codified rules, unlike the usual unethical behavior of tobacco control which is evil but not unlawful. I mention a couple of the reports about that which I have written here along with some new material. I suggest that perhaps a blanket boycott campaign would make sense. If I have time, I will write a piece about that specifically for this blog.

4. My personal favorite is this one, where I catch FDA chief Scott Gottlieb, in congressional testimony, offering basically the NIDA definition of “addiction”, a definition that clearly excludes tobacco products (including cigarettes). As my readers know, I have made a study of what people mean when they say “addiction”, and how there is apparently no viable definition that anyone wants to defend that actually includes tobacco/nicotine. In this case, Gottlieb was stuck because he had to talk about opioid addiction, and so was forced effectively undercut all the CTP rhetoric on the subject. Well, undercut it if anyone decides to challenge them based on this, which probably will not happen. The industry is not exactly known for being that clever.

(Foreshadowing note: I actually think I have figured out how to characterize what people mean when they say smoking etc. are addictive. One of these days I hope to write a major piece on this.)

5. In what could basically be an uncharacteristically terse version of a post here, I wrote about a recent “what parents need to know” statement about vaping in JAMA Pediatrics. It was all the terrible you might expect. I shredded it. If your appreciation for shredding exceeds your inclination to be annoyed by the terrible, you should find it a satisfying little read.

6. I reported how, after Senator Chuck Schumer launched an amazingly stupid attack on vaping in a press conference, Gottlieb practically fellated him on Twitter. (No, I did not put it quite that way.) This suggests that despite all the overly-optimistic talk of regime change at FDA, nothing has really changed in terms of who they consider their political patrons. (*cough* *told you so* *cough*)

5. My most recent piece was about the FDA’s Orwellian-named “Real Cost” campaign. I noted that they are about to aim this anti-scientific propaganda campaign, currently focused on smokeless tobacco and smoking, at vaping. I recount some of the campaign’s content and assess what they will do regarding vaping. I will write more about this shortly.

6. I did some original data analysis in this article, based on a recent CDC report of vaping rates across demographics and occupations. The authors could not see past the raw vaping rates. This is merely an uninteresting echo of the smoking rates; whoever smokes most is going to vape most. I looked at the ratio of vapers to smokers, which is actually useful. I found that across almost every group, the ratio is very close to the overall average. This effectively shows that the rate of switching from smoking to vaping is about the same across the different groups. The one big exception was African-Americans, where the ratio is much lower. That is, few smokers in that population are switching to vaping. I suppose this is worth a journal article, but I do not have time. (Free easy publication for any student or academic who wants to take the lead and write that with me! Seriously, let me know if you are interested.)

7. In this brief piece, I review the results of a recent paper that shows the anti-vaping bias in mainstream media reporting. It just confirms what we all know, but does a nice job of it. Most notably, it observes that anti-vaping statements tend to be attributed to people with supposedly expert credentials (though obviously they are really either clueless or liars), while the truth is attributed to advocates who the average reader will (mistakenly) consider less credible.

8. Here I analyzed a research paper out of FDA which is part of their assessment of how MRTP labeling might affect consumers. Unsurprisingly, it seems designed to make the case that allowing manufactures should not be allowed to tell the truth about their products. The study was bad, and they clearly intend to spin it worse.

9. I reported on FDA’s release of “adverse event” type records that they collect for tobacco products, which are really mostly about vapor products. I noted it is pretty much meaningless, but that it might be used in anti-vaping advocacy. I indicated my suspicion that FDA released it for just that purpose, not because of some belief it should be available because it is genuinely informative (it is not).

10. In this science lesson, I summarized my analysis that shows that the optimal tax rate for low-risk tobacco products is zero if the goal is to promote population health, or any other defensible stated goal. Not “lower than the tax on cigarettes” or “proportional to the risk”, but zero. My readers will already be familiar with these arguments, though if you are looking for a short summary, this is it.

11. I tried to assess the recent FDA “guidance” about the ban on free samples of vapor products (e.g., sampling e-liquid flavors), now that they are deemed as tobacco products, with all the rules that apply to them. I say “tried” because the guidance sort of says that it does not apply to adults-only venues (e.g., most vape shops). But how exactly this will play out — i.e., will flavor sampling be banned? — is not clear.

12. I analyzed a recent survey by BAT about beliefs about the risks from vaping. It is pretty straightforward “latest study” reporting, though I got some additional data from the researchers that allowed me to offer a better assessment than those who were just working from the press release. The main takeaway is that even in the UK, a ridiculously large portion of the population does not understand that vaping is much less harmful than smoking.

13. I introduced readers to the CASAA Testimonials collection that I created in 2013. Long-time readers of this blog will be familiar with it. I plan to publish more little articles that are excerpts from that collection.

14. Finally, I reported on the fight over vapor product taxes in Pennsylvania. The upshot is that tax structure, not just tax rates, matter a lot. A rather more interesting aspect of that story — and of another story that got spiked — does not appear there. I hope to get time to report it here sometime (ooh, more foreshadowing).

(Damn, that is a lot of material. Comments welcome. I suggest using the serial numbers if you are commenting on one in particular.)

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Time to stop measuring risk as “fraction of risk from smoking”?

by Carl V Phillips

I ran across a tweet touting a press release out of the Global Forum on Nicotine (GFN) meeting (a networking meeting, mostly of e-cigarette boosters) that made the claim that snus is 95% less harmful than smoking. This was variously described as being based on “new data”, “new data analysis” and “the latest evidence”, but with no further explanation of where the number came from. Since the presenter was Peter Lee, those of us who know who’s who can surmise that it is a statistical summary of existing published studies, because that is what Peter does. There is nothing necessarily wrong with that (though for reasons I will explain in an upcoming post, it is potentially suspect in this context). but it is certainly not new data or the latest evidence.

Oh, and it is clearly wrong. Continue reading

What conflict of interest accusations really mean (with a tie to The Times’s attack on GTNF participants)

by Carl V Phillips

Public health activists are extremely fond of using ad hominem attacks to avoid admitting they have no substantive defense against their critics. They are not alone, of course, with many supporters of other indefensible causes doing the same — e.g., anti-agritech activists, “alternative” energy advocates, alt-right adolescents on Twitter, etc. These attacks most often take the form of claiming “conflict of interest”. Endless ink has been spilled on the fact that resorting to an ad hominem attack is practically an admission that one’s opponent is right. But there is far too little discussion about the actual substantive content of the COI. Basically, what is dressed up as genteel productive discussion is actually a bald accusation that someone is lying, and moreover usually that they are only choosing to lie because of some (often trivial) transfer of funds. Continue reading

Extraordinary claims

by Carl V Phillips

Fairly often (e.g., in the previous post) I make reference to the concept that extraordinary claims require extraordinary evidence. That is, if something seems extremely unlikely based on a great deal of accumulated knowledge or an understanding about how the world works, and you wish to claim it is true, you really need to have done some tight work. It is a good principle in science. Research does not produce scientific knowledge without adherence to principles like this (note that there are no “rules” in science, so we have to make do with evolved principles).

Today I am thinking of that in terms of a new study that was reported in this BBC story, “E-cigarettes ‘help more smokers quit'” (quotes from there). Continue reading

Saying e-cigarettes are “95% less harmful” is a very bad idea (part 143 of 10,000)

by Carl V Phillips

Because trying to have a discussion on Twitter is not a clever thing to do, and I like to stop doing unclever things when I catch myself at it, here is a Q-and-A format (most of the Qs are not really questions, but I will just call them that). If you have a Q or an A that is missing, leave it in the comments and I will update the post.

My tweet that started my ill-advised foray in trying to discuss via twitter:

Your periodic reminder: if vaping is really 95% less harmful than smoking, as many vehemently claim, then it is really quite bad for you.

Background: This specific point estimate (synonymous with “5% as bad for you as smoking”) has rapidly evolved into “fact” (in the political sense of that term). It is repeated in a large fraction of popular press reports and widely used in arguments, snipes, and broadsides from vaping advocates. It seems to have emerged from nowhere when the Public Health England report asserted the figure. That traced to what was actually a huge misinterpretation of what was only a made-up number, from one junk-science journal article. When called on this, the PHE authors denied that was the source of the number, though they did not offer an alternative basis for the number and they did cite that paper originally, so the protest was not exactly convincing. I have documented all of that on this page in detail.

If the figure were true, it would put vaping very high up the list of “something a lot of people choose to do that is bad for their health”. That is particularly true if you accept tobacco control’s inflated claims about the effects of smoking (which most of those making the present claim endorse), but still true if you base it on an honest estimate of the risks from smoking. Vaping would be worse than eating a pretty bad diet rather than an ideal diet. It would be worse than never getting any health screening test. It would be many multiples of the risk from smokeless tobacco. It would be worse (for the individual) than forgoing most vaccines. In other words, if someone has the “public health” mindset that it is ethical and socially acceptable to dictate people’s health affecting choices, this figure puts vaping near the top of the list of activities that warrant action (i.e., aggressive denigration, misinformation campaigns, bans — you know the drill).

Is this an accident? Perhaps, but that is far from obvious to me. Notice that the 95% claim was made up and touted by pro-ecig tobacco controllers. For them it is the perfect sweet spot, which makes it seems like less of an accident: It is low enough to clearly justify their efforts to promote vaping as a “cure” for smoking. But it is plenty high enough to justify trying to prevent vaping or to promote vaping cessation for anyone who does not “need” it to avoid smoking. It offers a very nice political compromise with their colleagues and funders who they are answerable to (the offer has been rebuffed so far, but sits there as a way to get to yes): Stop screwing up our attempts to, um, persuade smokers to switch to vaping, and we will back your position that vaping should be avoided by anyone who is not using it to quit smoking; in a few years, after vaping-assisted smoking cessation has pretty much played out, we will be on the same side again.

But whether or not that suspicion is valid, the point estimate of 5% the risk from smoking is way higher than what the science supports.

Question: That is why we say “at least 95% less harmful”.

Answer: First, that is mostly not true. Most statements I have seen do not include “at least”. Second, saying that does not matter. Basically everyone who gives me crap about arguing for scientific honesty justifies their behavior based on needing to say what is effective, regardless of what is true. Setting aside the ethics and long-term tactical implications of saying whatever seems to be most effective, if that is your position, you need to learn something about how people respond to particular statements. In particular, when people see “at least 95%”, most of them just think and remember “95%”.

Third, such a statement is clearly scientific nonsense. Whatever the best point estimate is, there is no “at least”. This is fundamentally true for all science. Such a statement is tantamount to saying there is no evidence that could appear tomorrow that would push the estimate beyond the stated bound, which is the mindset of religion, not science. But in this case, it is not even a matter of fundamentals. We do not have any epidemiologic evidence that would let us rule out risks greater than that. There is a reasonable chance that we will never have such evidence.

Question: But the more recent Royal College of Physicians report has all that covered. They make various versions of the statement:

Although it is not possible to estimate the long-term health risks associated with e-cigarettes precisely, the available data suggest that they are unlikely to exceed 5% of those associated with smoked tobacco products, and may well be substantially lower than this figure.

Answer: See above — this still anchors the claim at 5%.  That “may well be” is a rather weaker statement than the “at least” (though it is, of course, a legitimate scientific statement, as opposed to “at least”). Indeed, it is an extremely weak and misleading way of saying “it would be extremely surprising if it were as high as 5%”, which is a valid claim. The implicit claim is still that 5% is the right point estimate. It goes without saying that in cases where we do not have a lot of really solid evidence, the true value may well be lower, even by a lot. But a point estimate also means that the true value may well be higher.

Now that the claims include more words than will fit on a bumper sticker, we can drill down a bit more to what is being claimed. The RCP authors, to their credit, note that there are minimal short-term health effects (which contrasts with smoking). So what risks are they actually claiming? There must be some scalar that the ratio claim applies to. In the above executive summary material they refer to “health risks”; in the body of the report they instead say “harm”. So are they saying that e-cigarettes cause 5% the risk of stroke, 5% the risk of lung cancer, 5% the risk of aortic rupture, etc.? Seems unlikely. When they add “harm” are they also claiming 5% of the accelerated tissue aging, etc.? Seems even less likely.

So it becomes apparent that even those touted as the “more scientific” contributors to the 5%-er madness are not actually making meaningful statements.

Question: But we need to be able to say something to counter the nonsense claims that all tobacco products are equally harmful and such.

Answer: Why not use the truth?

Question: The truth??

Answer: Ok, fair enough. Why not use the best evidence-based estimate of the real point estimate, for an actual well-defined scalar, like the chance it will kill the consumer (i.e., substantially hasten his death) or, roughly equivalently, the chance it will cause life-threatening disease.

Question: But you just said there is no such evidence for e-cigarettes.

Answer: No, I said we do not have epidemiology about long-term effects. That does not mean we do not have any evidence.

Question: Go on.

Answer: Thank you. As I have explained at length, repeatedly, for a decade now, the solid evidence we have about the long-term effects of nicotine consumption is based on ample evidence about smokeless tobacco. The evidence-based point estimate of the risk of it causing a consumer’s death was about 1% of that from smoking. In retrospect, that decade-old calculation seems a bit pessimistic, but it remains basically solid. E-cigarettes might cause a bit more risk — lung involvement and various novel exposures create that possibility. (There is no conceivable way e-cigarettes could be lower risk, controlling for dosage, because basically all of that point estimate is about the nicotine.) But the existing short-term evidence about vaping gives us confidence that a lot of possible effects are below the limits of detection and our knowledge of the chemistry and occupational epidemiology give us decent confidence that the long-term risks are pretty minimal.

In short, there is a very solid basis for a point estimate of 99% less harmful.

It kind of seems like win-win-win (for everyone other than the tobacco controllers, that is). There is a vanishingly small chance this figure is further from the truth than the 95% claim. It is actually based on evidence, rather than being a number someone pulled out of the air and others just repeated because tobacco control politics frowns upon bringing up points of scientific disagreement. Oh, and in case it is not obvious, 1% is less than 5%.

Question: But 1% is not much different from 5%.

Answer: Oh, but it is. It is enough different that it brings it down into the range of countless everyday hazards, rather than keeping it up in the list of top hazardous consumer choices. It is not all that difficult to justify(*) prohibitionist “regulation” of something that is 5% as harmful as smoking. If you drop to 1%, that would mean justifying heavy-handed regulation of almost every consumer choice.

(*This assumes, of course, that someone thinks it is ever ethically acceptable to use police powers and disinformation to manipulate people’s choices “for their own good”. I expect most readers of this blog, along with a mostly silent majority of everyone else, disagree. That is a far better argument, by the way, one that actually defends the hill you really want to defend: “I don’t care if it is 1%, 5%, or 50% as harmful as smoking. You have no right to tell me I cannot make that choice.” But that is a different dialogue.)

Oh, but you are right about one thing. “99% less” and “95% less” are close enough at a gut level that you are not going to lose anyone by claiming the figure that is better rather than the one that is wrong at every level. There is virtually no one out there who would accept “95%” upon hearing it, but who would be thinking “you know, if they had claimed 99% I would have said ‘no way, can’t be true, so must really be just as bad as smoking’ but since they said 95%, I will just accept that as true.” So the common protest, “the important thing is to move people away from believing the risk is the same as smoking!”, is not an argument for making the bad claim. The better claim does that equally as well.

Question: I was just about to bring up that “the important thing is…” point.

Answer: A good socratic dialogician always knows out all the likely comments before starting.

Question: But we still have to concede that it is harmful, right?

Answer: The actual scientific answer is that this is far from obvious. Recall that the 1% figure was based on the chance of the exposure causing substantially hastened death. It does not account for the other side of the ledger, causing a substantially delayed death (aka “preventing” a death). The net effect could well be zero or less (i.e., a net protective effect). Smoking and smokeless tobacco use protect against several nasty diseases. There is a good case to be made that smokeless tobacco is good for your health, on net. It is too close to be sure, given the limits of the science, but a net of zero is a pretty good point estimate. The case is a bit harder to make for e-cigarettes (some of the benefits might be from other chemicals; e-cigarettes have the additional possible risks), but hardly heroic. So it is far from clear that the net health effect of vaping is negative.

Question: But that is going to be much harder to sell to people than the “9x% less” claims.

Answer: Granted. Depending on your audience, you probably do not want to try to make that case (though you might want to keep it in your back pocket if they prove open to reason). People categorize exposures naively — “good”, “bad” — and so convincing them that it may well be good is a huge step. But they also homogenize small probabilities, such that 1/20, 1/100, and 1/10^12 are all about the same to them so, again, there is no reason to concede the 1/20.

Question: So what you are really saying is that we are being suckered into repeating a claim that is based on nothing, and that primarily serves the agenda of one clique of tobacco controllers? And while their agenda is somewhat more aligned with both science and the freedom I deserve than other tobacco controllers, it is still an agenda, and one that is ultimately a threat to science and the freedom I deserve? And that the truth is far better, in every way, including supporting my goals, than this claim? And while politically we may choose to ally with people who are not really on our side, it does not mean that we have to bite at every piece of tempting bait they dangle in front of us? Are you saying we can do better than this?

Answer: Yes. Thank you. It is as if you read my mind. Or perhaps you just read what I have actually written. In any case, you avoided surrendering to the common base urge of, “I heard this claim and uncritically accepted it, and I even repeated it, and now because I am subconsciously unwilling to ever accept that I was wrong in a belief, no matter how it was created, I am going to fight tooth-and-nail against anyone who points out it is wrong, baseless, and ultimately harmful to my cause.”

Question: Do you think your analysis and calling attention to this is going to make any difference?

Answer: Nope. I have long-since gotten used to my role as Cassandra.