Tag Archives: big picture

In the debate about vaping, asking the wrong “right questions”

by Carl V Phillips

Making the rounds today is this post at The Guardian entitled, “In the polarising debate about vaping, we’ve forgotten to ask the right questions”, by Alex Wodak. You can read a quick Wodak biosketch, about his history as an Australian drug policy reformer of a certain stripe, at the Guardian or on Twitter. I find this piece quite interesting, both because of the good things that is says and in how and why it fails to fulfill its stated mission. It is much better than most of the ostensible “big picture overview” analyses in the blogosphere or academic press, which are not even worth reading. But I think what is most interesting is that the laudable sentiment starkly emphasizes where the common laudable sentiments come up short.

Recently I noted that the “debates” about e-cigarettes within the “public health” community may be perceived by those involved to be (on a scale of 1 to 10) the 9s squaring off against the 1s, 2s, and 3s, but on the scale of how people in the real world think, the they are merely those sitting at 2, maybe sometimes 3, versus those sitting at 1.  Continue reading

Ecig proponents need to learn lessons from other activists

by Carl V Phillips

Several recent conversations in the comments here, on other CASAA media, and elsewhere reminded me of the unfortunate fact that many pro-ecig activists have (a) little awareness of the history of fights about THR related to smokeless tobacco, (b) a hostile attitude toward pursuing their natural common cause with smokers’ rights advocates and those who oppose anti-smoking junk science for other reasons, and (c) a failure to understand that social cause activism is a well-worn path, and the habit of trying to reinvent it without seeking outside wisdom is a recipe for defeat. Point (a) largely represents simple lack of information (though this translates into unforgivable ignorance on the part of those who presume to be organizers and opinion leaders), which I am trying to address in my “Why is there anti-THR?” series. No such explanation is available for the latter two, which seems mostly driven by a lack of appreciation for what constitutes useful tactics.

One of the aforementioned conversations began when a vaper activist prominently repeated anti-smoking junk claims, specifically the claimed number of deaths from smoking and the trope that smokers cost the rest of society money. (I have covered these in depth elsewhere. The very short version is: 1. The death claims are basically made-up numbers, cooked up by anti-tobacco activists using secret methods and secret data, in blatant contravention of the principles of proper science; thus they are almost certainly biased upwards even if they are roughly accurate. I started a series that goes into greater depth on such estimates. 2. Smokers clearly save the rest of society money; claims to the contrary are utter junk. See this comment thread for more on the latter, and also an example of the problem I am addressing here.) It is easy to understand the urge to repeat these claims. But it is almost as easy to see why this is a very bad tactic.

It is very difficult to credibly argue, “we should trust whatever CDC et al. claim about smoking, but what the same people say about e-cigarettes is a bunch of blatant lies.” This lack of coherence probably does not matter much for social media sloganeering. But then again, nothing matters much there because most such material is just preaching to the choir. It can be valuable catharsis and cheerleading, but it is not advocacy action. As soon as you start trying to build a coherent case, such as writing testimony or an advocacy article, the self-contradiction becomes apparent.

Every endorsement of an ANTZ claim increases their credibility across the board. Cite them as definitive authorities on one point, and it is difficult to suggest that they are completely wrong about a similar claim about another product. This would create a dilemma if they really were providing good and useful scientific information about smoking while lying about THR products, but they are not. Their claims about smoking are as full of lies and junk science as their claims about THR products.

So, you ask, what if you want to say that smoking is really bad for you and kills hundreds of thousands of Americans every year? Just say it — everyone knows this and so you do not have to cite anyone. (Or better still, just don’t say it — again, because everyone knows it.) What if you want to give death statistics to three significant figures, or even two? Don’t do it! Such claims of precision are patently absurd on their face (even done honestly, the calculations are necessarily far too rough and assumption-laden to be so precise), and those claims are the product of professional anti-tobacco liars.

From a tactical perspective, never forget that these people are the poster children for the aphorism “give them an inch….” Perhaps you personally support smoking place bans because you would like to reduce how often you have to smell smoke (I trust you understand that it has no material health impact for you). So be it. But don’t think for a minute that such bans are good for vaping; once they are in place, the proposal to extend them to vaping will follow immediately. The core strategy of tobacco control is to seize whatever advantage they can, whenever they can, and then use that as a launching point for grabbing more. This includes getting one dubious claim established as “fact” and then building more such “facts”. They have to be fought in depth because — as everyone who has fought them before can tell you — their ambition knows no bounds. To torture the ground-war metaphor, you personally may think there is a natural line of defense (e.g., between products that contain bits of shredded tobacco leaf versus high-tech tobacco products that do not, or between high-risk versus low-risk products) where they would consider stopping their advance, but they do not.

Repeat their claims exaggerating the health effects of “second-hand smoke” and you strengthen their efforts to forbid even the lesser impacts of  “second-hand vapor”; you have endorsed their junk science, as well as their intentionally inflammatory term for environmental tobacco smoke or environmental vapor. Endorse the patently false claims about smoking costing society money, and you invite punitive taxes on e-cigarettes (because then it must be true of vaping also, so it is just a matter of negotiating the price). Suggest that smoking is never a legitimate choice but just a horrible “addiction”, and it helps them make the exact same point about vaping.

This is not to say we should never attempt to use ANTZ lies against them. That is always a good tactic (and fun!). But it needs to be done without endorsing the lies. The best way is often an “if you really believe that, then why…?” construction. E.g., “if you are really so concerned about environmental exposure, why are you not encouraging all tobacco users to switch to smokeless tobacco which has no environmental impact?” or “if you are so worried about the impoverishing effects of buying cigarettes, why do you charge smokers $7 a pack in taxes?” This challenges their inconsistencies without needing to endorse either of their claims. Indeed, it is nice little hobby to adopt to follow a few ANTZ organizations or individuals on social media and point out such contradictions whenever the opportunity presents. (The “if you smell something, say something” principle.)

But if you adopt their language, then you are playing their game. Adopt their “facts” and you are paving the way for the next “fact”, which you may not like. Endorse one of their efforts to impose restrictions and they will grab that and move on to demanding the next restriction, which you might not like. This is obviously not to suggest just being contrary. Sometimes they are right about something. But usually they are right for the wrong reason, if you see what I mean. So make sure to endorse the fact or policy without endorsing their path to it.

But all this is only half the problem. In fact, it is less than half the problem. The bigger issue is letting the other side trick you (perhaps unintentionally) into fighting the wrong battle.

I was impressed by the usefulness of Katha Pollitt’s observations in a recent a NYT op-ed about tactics in abortion rights advocacy. Whether you share her goals there or not, there is much to be learned from her tactical assessment. There are similarities with the fight and tobacco product users’ rights. Indeed, the fights are extremely similar in lots of ways, with the notable contrast being that those who would restrict abortion rights often articulate well-defined moral positions (based on the rights of other parties or theistic rules) that are shared by many, while “public health” is based on vague moralistic premises about proper behavior that involve no other parties and no religious doctrine. The “public health” moral position is never actually articulated because proponents realize that few people would support them if they were honest about their motives. (Needless to say, this observation is true whether or not you agree with the anti-abortion moral principles, and does not imply that everyone taking that political position articulates a defensible moral position. Also, I trust I do not have to mention that I am not inviting debate about claims or policies related to abortion; comments that go in that direction will not be posted.)

Pollitt writes:

To deflect immediate attacks, we fall in with messaging that unconsciously encodes the vision of the other side. Abortion opponents say women seek abortions in haste and confusion. Pro-choicers reply: Abortion is the most difficult, agonizing decision a woman ever makes. Opponents say: Women have abortions because they have irresponsible sex. We say: rape, incest, fatal fetal abnormalities, life-risking pregnancies.

These responses aren’t false exactly. Some women are genuinely ambivalent; some pregnancies are particularly dangerous. But they leave out a large majority of women seeking abortions, who had sex willingly, made a decision to end the pregnancy and faced no special threatening medical conditions.

We need to say that women have sex, have abortions, are at peace with the decision and move on with their lives. We need to say that is their right, and, moreover, it’s good for everyone that they have this right: The whole society benefits when motherhood is voluntary. When we gloss over these truths we unintentionally promote the very stigma we’re trying to combat. What, you didn’t agonize? You forgot your pill? You just didn’t want to have a baby now? You should be ashamed of yourself.

Some of her other material is equally interesting, particularly the discussion that follows about mobilizing those who she feels should actively support her position but do not. But I will stick with this passage.

To paraphrase her argument, if proponents of her view lean too heavily on arguing that abortion is a remedy for the effects of rape or a dangerous pregnancy, then they are failing to actually fight for the right to choose to have an abortion. You could imagine that if that position won the debate, then abortion would be permitted but always subject to some adjudicator deciding that the circumstances of the pregnancy were repugnant or dangerous enough. This would be considered an almost total loss for many of those who lean on the arguments Pollitt cites.

It turns out that opponents are unlikely to take advantage of that opening because many of them still find that outcome unacceptable, but the same is not true for the analogous situation for e-cigarettes. Tobacco controllers will grab anything they can. If e-cigarette proponents lean too heavily on e-cigarettes being a cure for the evils of smoking, it sets us up for a similar near-total-loss “victory”.

E-cigarettes do reduce smoking, of course. But if their use is defended almost exclusively on the basis of them being a “cure” for smoking, then their opponents can argue — and do — that their quality should be lowered or price increased so that they are just attractive enough to be acceptable to smokers but not really all that appealing. Opponents further toy with such ideas as making e-cigarettes available only by prescription, letting people who are quitting smoking use them but no one else. It does not take a lot of knowledge about tobacco control’s history to know that the next step there is to attempt to sanction such vaping for only a few months. After all, we also claim (truthfully) that many vapers who thought they would never be able to quit smoking find that they can take or leave vaping and that they would never consider going back to smoking. If this is just about providing a cure for smoking, the obvious ANTZ response to these observations is, “great! now we should go ahead and make them quit vaping too.”

What happens after a clinical trial (RCT) of usage behavior comes out that “proves” that cigalikes are just as good for smoking cessation as open systems, or that particular liquid flavors do nothing to benefit smoking cessation? (You may think that these claims are not true and therefore such a result will never occur. But the typical RCTs produce pretty much random results when the goal is to understand real-world behavior, and so it is inevitable that such a result will come out of some of them.) There is no doubt the ANTZ will then argue that open systems and those flavors should be banned. After all, this is just about smoking cessation, right? And that will just be the start. When they make some progress on one of those points, they will move on to further erode product quality.

Similarly, leaning on the “this is needed for stopping smoking” arguments facilitates the ANTZ claim that e-cigarettes are not needed because everyone should just use the “proven” “approved” methods to quit, and anti-smoking measures will soon force everyone to quit regardless. Of course, a valid response to any of these “science-based” claims is that they are wrong: RCTs in this area are junk science; those other cessation approaches do not actually work very well; total smoking in the world continues to increase. But even though these are obvious to anyone with expertise in the area, this is a layer of fight that is often lost. If the argument instead focuses on the real harm reduction philosophy — smokers’ right to choose to switch if that is what they prefer — then it is not necessary to struggle to convince everyone that the “proven” cessation methods are not promising.

The point here, in case it is not obvious, is that the choice to use e-cigarettes serves multiple purposes. Smoking cessation is one of them. But using the products also provide benefits, which is why people choose to keep using them. The real goal is protecting the right to choose to vape, and to be able to do so using one’s preferred products, without punitive taxes or unreasonable restrictions. This does not mean abandoning the smoking cessation and public health arguments, obviously. They are valid, important, and very useful, particularly when responding directly to health-based claims. But if they are emphasized to the point of not even mentioning that people just like to vape — and that letting people do what they want, in the way they want, when it does not harm anyone is a good thing, and there is no conceivable basis for denying them this choice — then the opponents have successfully seized control of the debate. It is being conducted on their terms with their messaging. If the battle is fought there, they stand a very good chance of success.

I wrote the above during the course of the last few weeks. Then events provided me with a perfect ending. Yesterday’s Public Health England report, which was very positive about the value of e-cigarettes in smoking cessation and which disputed some of the worse anti-ecig junk science, was touted by many e-cigarette advocates as The Best Thing Ever. But was it? It has obvious benefits, of course, merely by being a government report that has something positive to say about e-cigarettes. It also has junk science claims. What it does not have is any recognition of the concept of consumer choice, nor any discussion of consumer welfare, let alone of joie de vivre.

It is a document written by tobacco controllers, albeit ones who happen to think that switching to e-cigarettes should be encouraged as a method of smoking cessation, and it treats e-cigarettes as the equivalent of that agonizing choice that is necessary to save the mother’s life. Much of the discussion about the report has focused on the possibility of medicalizing e-cigarettes. It has been suggested to me that the report’s headline claim, that vaping is 95% less harmful than smoking (a made-up number that was reported as if it were science-based), was intentionally chosen to be able to claim that switching is clearly better than continuing to smoke, but still poses such a high risk that no one should do it (or be allowed to do it) unless they absolutely have to.

A standard response to these observations is that the authors took it as far as they could go, given that they could not overly offend or indict tobacco controllers, especially those at Public Health England who could have spiked the report. But how, exactly, is that reassuring? The inevitable answer is that it is a step the right direction. But does that step really suggest a trend, or is this “as far as they could go” really “as far as they will go”? It is just far enough to give tobacco controllers a nice place retrench, albeit with a definite retreat from utterly vilifying e-cigarettes and convincing people they are as harmful as smoking.

The report fits perfectly into tobacco control’s history of attempting to undermine real harm reduction by co-opting it to be just about curing smoking in people for whom all else fails. There is no choice or freedom; tobacco control is about grandees deciding what people should be doing, and the new report does not depart from that. There is no empowerment or discussion of preferences except as methods of manipulation; the report reads like a study in how to best care for livestock. There is no suggestion that someone might be better off vaping rather than quitting all tobacco products entirely; indeed, it says just the opposite.

The useful-idiot-level tobacco controllers have been decrying this report since it came out, but I suspect their puppet masters are not all that concerned. After all, the EU Tobacco Products Directive, with its anti-ecig provisions, will soon come into force, so the practical implications for the UK are limited to encouraging the use of e-cigarettes in medical or government smoking cessation interventions. (It has been suggested that this report will probably have the most value for American advocates; we are fighting a hodgepodge of local attacks and can offer this as political cover for politicians who oppose the attacks.) Even if the content of this report were undisputed, it would not stop vaping opponents from continuing to push for restrictions, product quality reduction, medicalization, and sending the message that e-cigarettes are bad except in the immediate context of smoking cessation.

They’ll take it.

It is, after all, the rough equivalent of that hypothetical pyrrhic victory of allowing abortions whenever those in power can be persuaded that the need is sufficient in a particular case.

Then they will keep pushing.

Pro-ecig scientific claims are descending toward tobacco control quality

by Carl V Phillips

I have watched with dismay as the relationship with science in the e-cigarette advocacy world has continued to descend toward that found in tobacco control: embracing anything that supports ones political beliefs and rejecting anything that does not, regardless of the validity or scientific defensibility of the claims. While we are still a ways from parity — and it is certainly the case that pro-ecig misinformation tends to move the debate closer to reality even though it is wrong (because the anti-ecig misinformation is so widely believed) — it is hard to not extrapolate the trend. And even if it stops here rather than continuing downhill, we are not in a good place. Continue reading

On the complete absence of ethical etc. thinking in tobacco control (in the context of denicotinized cigarettes)

by Carl V Phillips

In a discussion group of scientists, policy-influencers, and other players in the world of THR (mostly e-cigarette) policy that I am a part of, there was a long discussion of mandatory “denicotinization” of cigarettes. As the discussion progressed, I ended up contributing an overview analysis of the whole matter that I think warrants a wider airing here. What appears below is the post I made there, though to protect the confidentiality of other contributors I referenced in the original I have deidentified them (following the Chatham House rule) and replaced their names with letters (W,X,Y); I am posting a note to the discussion group that those who want to claim credit for their contributions or to continue the debate here should jump in.

For those who may not know, the idea of forcing manufacturers to lower the nicotine content of cigarettes to make them less “addictive” has been kicking around from before the time there was much serious discussion about THR. The proponents of this arranged to have written into the Tobacco Control Act the provision that FDA can impose such mandatory reductions or ceilings, with the only limit being they cannot mandate complete removal of nicotine (which is really a meaningless caveat, since there is no practical difference between that and mandating a ceiling of a miniscule quantity nicotine — hey, it is not zero!). Continue reading