Tag Archives: demonic possession

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

Utter innumeracy: six impossible claims about tobacco most “public health” people believe before breakfast

by Carl V Phillips

As anyone with a modest understanding of the science knows, tobacco controllers and other “public health” people make countless statements that are utterly false. The tobacco control industry depends on making claims that flatly contradict what the science shows. But there is a special class of claims that are not wrong just because they contradict particular empirical evidence; rather, everyone should know they are wrong based merely on understanding some basics of how the world works. Many such claims are constantly repeated as if they were self-evidently true even though they are actually self-evidently false. I was having trouble defining the category until I recalled the quote from Alice in Wonderland alluded to in the title. Continue reading

Sunday Science Lesson: So how would you estimate how many deaths are caused by smoking?

by Carl V Phillips

This continues from last week’s post. In that post, I pointed out what a death caused by smoking even means. (Recall: It technically means a death hastened by even one second. This means that basically every death in an ever smoker could be included, though this is clearly not how people interpret the figures and even those who are trying to exaggerate the number do not actually game it this way. Still, it is not clear what the claims do mean.) I then explored what data you would ask for if you could have any data you wanted to answer the question, a critically important thought experiment in epidemiology that is almost never done. (Recall: You would want to run an alternative history of the world where no one smoked but all else was the same, and compare the death counts.) Today I am going to move from that into what we can actually do with the data we can get, and why it fails to do a very good job answering the question. Continue reading

Economic illiteracy about tobacco, from the antepode

by Carl V Phillips

The most fundamental lie of the tobacco control industry (TCI) is what I have dubbed the “demonic possession” theory of tobacco use. It is the myth that no one likes to use tobacco products.

It is obvious why they need this. If they admitted that people derived benefits from consuming tobacco, then they would have to balance the (supposed) benefits of their actions against the loss of benefits caused by the actions. More important, and the reason this myth is fundamental, is that if they admitted the truth they would have to admit to themselves that most of what they do inflicts harm — serious harm — on the hundreds of millions of people who they pretend they are trying to help. While many in the TCI are truly evil, and would not be bothered by this, many are not, and so need to preserve this fiction to be able to sleep at night. (And, no, “evil” is not hyperbole. It is clear that many people in tobacco control derive pleasure from inflicting pain on people who they consider to be The Other, exactly the same evil impulse that causes racism, homophobia, etc.) Continue reading

CVS and cigarettes, an embarrassing Rorschach test

by Carl V Phillips

Presumably anyone who reads in this area is already aware that the CVS drug store chain announced that they will stop selling cigarettes and other tobacco products.  The practical consequences of this are almost nil, but the response to it are rather educational.  It is a veritable Rorschach test (though not exactly the same, since no one seems to have said “it looks like a butterfly” or likened the announcement to some bit of the female anatomy).

The immediate practical consequences of the move are:  (a) CVS will lose $2 billion/year in revenue, by their own estimate; (b) some smokers will have to make an extra stop if they want to buy both toothpaste and cigarettes; (c) C-stores and other competitors will thus gain about $2 billion/year in revenue; (d) some C-store may also increase their profit margin on cigarettes because they no longer have to price-compete with a nearby CVS.  It is probably also the case that: (e) tobacco companies will increase their profits a bit because CVS’s size allowed it to negotiate better wholesale prices for cigarettes than their average competitor.

Of course, none of those could possibly be the motive for the decision.  To the extent that I have seen cogent explanations of the motives, it appears to have happened because CVS’s biggest cash cow and growth area is not retail, but providing insurance-like services to big companies.  Apparently their clients and potential clients (presumably strong-armed by the tobacco control industry) pressured CVS into making the move.  Assuming this is true, it was a symbolic gesture in which they decided to take something away from their peon retail customers in order to please (not even materially benefit) their big corporate customers who offer much bigger margins.

Of course, that is not how they spun it to the public.  It very convenient when you can spin a sacrifice you are forced to make (in order to get some benefit) as a good thing in itself rather than a price paid.  So, of course, CVS claimed exactly that in their (transparently false) public statements — it was a principled decision because they did not feel that people should be buying cigarettes the same place they are buying medicines.

The most obvious hypocrisy in that spin has been pointed out by pretty much every commentator on the topic, even those that know little about tobacco:  CVS sells — right up front in their most prominent displays — unhealthy snack foods, “energy drinks”, candy, and so on, so this is clearly not about removing products because they are unhealthy.  A more sophisticated take on the hypocrisy comes from the observation that they are removing not just cigarettes, but smokeless tobacco.  If this were really about health, they would have kept the latter and steered would-be cigarette purchasers to this low-risk alternative.

What is most interesting, however, is how the tobacco control industry went gaga over this move that had only symbolic consequences.  The Robert Wood Johnson Foundation added it to their animated timeline of the most important moments in the history of tobacco control (and apparently did so within minutes of CVS’s announcement — not that this proves that the surprise announcement was actually an orchestrated conspiracy or anything).  Then @RWJF_PubHealth tweeted about this addition approximate once per hour, and even paid to promote the tweets (must be nice to be able to pay to get people to look whenever you update your website).

The Rorschach test tells us the tobacco control industry is so starved for anything they can call a victory that they celebrate this useless gesture.  They are beside themselves with delight that smokers who are shopping at CVS will now have to go cleeear to the nearest C-store to buy cigarettes. To the present generation of tobacco controllers, this is all they can add to the list that includes such genuinely important moments as the 1964 Surgeon General report, the groundbreaking epidemiology on smoking from the 1950s, and….  Well, actually those are really the only things that ought to appear on a story of the great moments in anti-smoking.

Of course, that RWJF timeline is not actually about successes of tobacco control (i.e., events that reduced smoking), but successes of the the tobacco control industry (i.e., events that demonstrated and/or increased their power and wealth, or inflicted punishment on tobacco users for their sins, even though almost all were inconsequential in terms of reducing smoking).  In that sense, I suppose, this was a victory for them.

While desperation for something to claim as a victory, along with boasting about their ability to exercise power, probably explain most of the TCI reaction, to some extent it is genuine innumeracy (albeit intentionally-cultivated — i.e., lie-based — innumeracy).  Notice that the above list of consequences of CVS’s move did not include “there will be less smoking”.  This is because of the obvious fact that one fewer retailer of cigarettes has absolutely no effect on the demand for cigarettes, and it is the demand that matters.  Or, as I tweeted about it, “#CVSQuits selling cigarettes. Tobacco controllers demonstrate their continued failure to understand supply is not demand by celebrating.”

Part of the core myth of tobacco control is that there is no demand for tobacco, and that the reason people consume it basically demonic possession.  So, the “reasoning” goes, since demand is not causing consumption — contrary to what anyone with a modicum of knowledge about economics or human beings would conclude — then it must be supply.  Ergo, eliminate some of the supply and you eliminate some of the consumption.

But it is not just the TCI who saw what they wanted to in CVS’s move.  NJOY and other e-cigarette companies, as well as many vapers, celebrated this as a victory for e-cigarettes.  Huh?  There are some reports that CVS specifically promised they would also not sell e-cigarettes after the removal date, though there are also contrary reports on this point.  But either way, the fact that they are removing low-risk tobacco products along with cigarettes does not exactly suggest that they will be restocking the back wall with a different low-risk tobacco product.  Moreover, it is not as if the TCI bullies who leveraged this move in the first place are going to let up on e-cigarettes, and so CVS will probably be pressured into not selling them either.  E-cigarette merchants and cheerleaders need to figure out that each restriction on cigarettes should be interpreted not as “more for us”, but as “you’re next”.

Indeed, the backlash resulting from a (very hypothetical) principled stand by CVS — were they to insist that e-cigarettes are pro-health and therefore they are going to sell them — would probably be increased as a result of them already caving on cigarettes.  Once you cave to someone’s political pressure — giving up billions in revenue to get some goodwill — they own you.  The revenue is gone, but they can still take away the good will that justified the loss, and so they have even more power over you than they did before.

So while it is possible that CVS will be stocking e-cigarettes instead, it seems ridiculously optimistic to assume they will, or even to conclude that it is more likely to happen given the removal of cigarettes than would be the case had they kept them.  And this is to say nothing of the fact that it is better to have e-cigarettes displayed next to where people are buying their cigarettes so they might spontaneously choose to try the former.  Bottom line:  What some elements of the e-cigarette community saw in the inkblot also suggests they suffer from some of the same problematic thinking as the TCI — not nearly as badly, for sure, but remarkably similar.

The final category of reaction I will note is that of every single smoker who was quoted in the mandatory “we asked this random shopper” section of news reports about the move.  Unsurprisingly, the reaction was basically, “Really? Oh well, I guess I will have to buy my cigarettes somewhere else.”  There were barely even any hints of annoyance.  You could almost hear the subtext: “My dry cleaner does not sell cigarettes. My bank does not sell them, nor does McDonalds.  Now my usual drug store won’t either.  But so what?  It is not like I can’t go to a gas station / 7-11 / other drug store / etc.”  In this population — the people who know best, after all — it never even crossed their mind that change in one source of supply would have any effect on demand.

draft Regulatory Science White Paper #2: The “gateway effect”

by Carl V Phillips

You will recall that a month ago, we posted our first draft white paper, on e-cigarette use by children.  We received, in various forms, the very useful suggest that our original title for the series (position papers or position statements) was misleading and did not do them justice.  Thus, we have renamed the series “Regulatory Science” and just call them white papers.

The term “regulatory science” is a thing right now, and is the language being used by the FDA and others.  It is not clear exactly what it means (and, indeed, it is my personal feeling that almost anytime someone precedes “science” with an adjective like that — pretty much any adjective that does not demarcate a specific area of science like “biological” — the adjective might as well be “junk”). We have chosen to interpret the term as something like: “scientific analysis that is specifically geared toward translating the scientific knowledge base into decision-relevant information”.   That is basically what I taught as a professor, and that turns out to be almost completely absent (perhaps completely now that I am retired from academia ;-) from public health sciences programs.

Anyway, the first white paper has now been reviewed — by you and recruited peer reviewers — and will be finalized and posted soon.  The second and third are done.  The second follows this paragraph.  As before, we are interested in any comments from anyone — peer review type comments especially, but we will certainly consider anything else that might strike you also.  CASAA members are invited to weigh in on the “our position” bit, since you are part of “our” (want to comment on that and are not a member? join – it’s free!).

Consumer Advocates for Smoke-free Alternatives Association

DRAFT Regulatory Science Series #2:  The “gateway effect”

draft – not yet peer reviewed

 Soundbite version

Those who oppose the promotion of tobacco harm reduction frequently claim that low-risk tobacco products will cause people to start smoking, the so-called “gateway effect.”  This claim has been heavily employed in anti-e-cigarette disinformation campaigns.  However, there is absolutely no evidence that such causation occurs.  Data that is cited in support of gateway claims about smokeless tobacco merely demonstrates the obvious point: people who use one tobacco product are more likely to use other tobacco products than those who avoid tobacco entirely.  Moreover, a moment’s thought reveals that such an effect is unlikely:  Why would someone who chose abstinence over smoking, upon discovering that they prefer a third alternative to either of those, be caused to make a change to their least-preferred option, smoking?  Asking that question, rather than making affirmative arguments, is probably the best response to anyone who is claiming that there is a gateway effect.

 Finally, even if someone speculates that there are some gateway cases, these are still clearly dwarfed by the number of would-be smokers who choose a low-risk alternative instead.  Thus the low-risk products still provide large net population health benefits.


A typical fallback position for those who want to condemn a drug or behavior, but cannot credibly argue that it is harmful in itself, is to claim that it is a “gateway” to genuinely harmful behaviors.  In the case of tobacco harm reduction (THR) products, the claim is that they cause some people to smoke.  In the early 2000s, anti-THR activists frequently claimed that smokeless tobacco (ST) was a gateway to smoking, though they seem to have largely dropped the argument because it proved much more effective to just mislead people into believing that ST causes substantial risk in itself.  But the rhetoric has recently been revived as an attack on e-cigarettes because attempts to convince the public they are high-risk are falling flat.

A simple analysis reveals that the gateway claim is fatally flawed.  It must be realized that the gateway claim is that the THR product is causing smoking – that is, smoking would not have occurred if the other product did not exist or were not tried by the user.  Mere precedence – e.g., someone puffing an e-cigarette before they ever tried a cigarette and later becoming a smoker – does not suggest there is causation; the smoking habit probably would have happened had the other product not existed.  When the gateway claim is used in anti-THR rhetoric, there is (presumably intentional) conflation of causation and mere precedence, but the implication is always about causation, and thus “gateway” should be interpreted in terms of causation.

While it is theoretically possible for low-risk tobacco product use to cause smoking, there is no empirical evidence that it ever occurs, and indeed anyone who thinks through the scientific analysis will realize that it is vanishingly unlikely.

Empirical evidence

Simply put, there is no empirical evidence of a gateway from low-risk products to smoking.  What was cited as a evidence of this for ST merely showed that people who were inclined to use tobacco liked to use tobacco.  That is, the conclusions were based entirely on the (clearly true and unsurprising) observation that people who used one tobacco product were more likely to become users of another tobacco product than were lifelong never-users (example).  So, in particular, users of ST were more likely to become smokers than were never-users of tobacco.  But this told us nothing about whether they would have been smokers had they never used ST.

In theory, evidence like this could show whether there is a gateway effect by controlling for propensity to smoke.  That is, if many former ST users became smokers even though they were not the type of people who normally become smokers, this would suggest a gateway effect (and if it did not occur, it would be empirical evidence that there was no such measurable effect).  None of the researchers or activists making gateway claims seemed to have even seriously attempted this, nor even to have understood that it was necessary.  One response reanalyzed the data from one of the naive pro-gateway claims that merely observed that those who used one tobacco product were more likely to use another; using with controls for propensity, it showed that most of the claimed association disappeared.  Another study used propensity based matching and did not detect a causal relationship between ST use and later smoking.  However, it is difficult to imagine creating a sufficiently accurate “propensity to smoke” score that could detect the signal amidst the noise of the obvious correlation between liking one tobacco product and liking the other, and the modeling would offer the analyst so many degrees of freedom that it would be easy to bias the results for political purposes.  Thus, there is basically no possibility that this line of research can distinguish between zero gateway effect and a small gateway effect, though it can clearly rule out a large effect.

(Aside: The mere fact that switching from ST to smoking was about as common as the other way around in historical U.S. data is disturbing from a public health perspective, even though it does not support the gateway claim.  This pattern is easily explained by the fact that most Americans were (and largely still are) victims of the anti-THR disinformation campaign that convinced them that smokeless is just as high risk as smoking, so they might as well smoke.  The good news is that willingness to switch products means that THR is likely once someone fully understands and internalizes the truth.)

There have been several studies that provide affirmative observations that are generally contrary to gateway claims about ST.  They found that few cases of ST use were even candidates for the gateway claim, that people who initiated tobacco use with ST were less likely to smoke than those who initiated with cigarettes, and that in Sweden (a population where ST use is common) there was far more switching from smoking to ST than the other way around.

The evidence from Sweden shows that if there is a gateway effect, it is utterly dwarfed by the THR effect (that is, even if the gateway affects a few people, far more would-be smokers choose ST, so the net effects are overwhelmingly positive).  Sweden has a high and long-standing use of THR products (in particular, snus) and has by far the lowest smoking prevalence of any country where smoking was ever popular.  Moreover, the comparison of men (whose use of snus is more prevalent and occurred earlier in time) and women shows an inverse association: male smoking rates dropped markedly as they took up snus while female smoking rates only followed the steady downward trend observed elsewhere (see, e.g., reference).  If snus were causing many users to smoke, this would not be the case.  (No analogous observation is possible about e-cigarettes because they are not sufficiently popular in any population that a gateway effect would impact population statistics.)

Neither the above-cited studies, nor the Swedish data, nor any conceivable data can rule out that there are some gateway cases.  A few cases would simply not be detectable, and thus cannot be ruled out.  But they do show that there are either few or none.

In the current discussion of e-cigarettes, there are not even any observations about people trying e-cigarettes first and becoming smokers, let alone support for the claim that it is a gateway.  The claims about e-cigarettes are just made up from whole cloth (example).

There are no apparent studies of possible gateway effects at the individual level (for example, testimonials of smokers who report that they eschewed smoking until they became a user of a low-risk alternative and then found themselves drawn to smoking).

Scientific analysis

The empirical evidence fails to demonstrate any gateway effect and shows that it is small if it exists.  The argument that it is non-existent, or close do that, can be found in the logic.  It is absurd to even think that low-risk tobacco/nicotine products would cause smoking.  Consider the combination of traits and choices that would have to be true of someone for someone to be a “gateway” case:

1) He would not smoke if not exposed to the low-risk alternative (otherwise smoking would have occurred anyway, so the other exposure is not causing it).  That is, abstinence is preferred to smoking, perhaps because of the health risks or perhaps just a lack of taste for tobacco use.

2) He chooses to use the low-risk product.  That is, the low-risk product is preferred to abstinence, so he has a preference for tobacco use so long as the risk is low.

3) Having adopted the low-risk product, he then prefers smoking and switches to it.

 A moment’s thought reveals how absurd that combination is.  The low-risk product is preferred to abstinence which is preferred to smoking.  But using the low-risk product does not cause the user to decide he does not like it (and go back to abstinence) or to become a dedicated user of that product.  For some mysterious reason, it somehow causes him to switch to his least-preferred alternative.  Why would this be?  His preference pattern probably reflects the fact that he is concerned about the health effects, even though he likes to use tobacco/nicotine (though it might just be that he just does not like smoke).  Why, exactly, would using the low-risk product cause him to forget about this?

The reason the absurdity of the claim is not immediately obvious to all observers is that tobacco control has convinced many people of their “demonic possession” theory of tobacco use.  That is, contrary to ample evidence, and in contrast with all other consumer choices, they imply that people do not choose to use tobacco or choose among tobacco products because of preferences.  It just sort of happens.  Since people’s actions, according to this story, have nothing to do with preferences or volitions, they must be controlled by demons.  Since demons can behave in completely arbitrary ways, any behavior pattern is thus possible, even when it is clearly absurd if based on an analysis of preferences.

Of course, it might be that someone could craft a non-absurd story of how the gateway works.  But to our knowledge, none of those who assert there is such an effect have ever done so.  We suspect such a story would involve an appeal to a some concept of addiction, but invoking that concept would not explain why an increasing desire for the low-risk product would result in it having less appeal than the previously dispreferred product; some plausible reason for that would be necessary.

The failure of THR opponents to try to produce a mechanism for the gateway effect may be because one part of any plausible explanation does not work in their favor.  When people do not know that smoke-free products pose orders-of-magnitude lower risk than smoking, the barrier for switching in the unhealthy direction is much lower. The aforementioned studies about ST use and smoking in the USA, a population that mistakenly believed the two products posed similar risks, show a similar pattern of switching in both directions.  While it is still the case that most or even all would have still smoked in the absence of ST, some of the switching in the unhealthful direction might have been causal.  Ignorance of the comparative risk alone still does not explain why someone who would have never smoked would be caused to smoke, but it frees that story from one enormous hurdle:  The user is still switching to what was once his least-preferred option, but he does not know that this entails an enormous increase in health risks because he has been tricked into believing that, from the health perspective, he might as well smoke.

In short, if there are gateway cases, much of the explanation for them is the mistaken belief that the low-risk alternative is actually high risk.  The fact that the same activists who purport to worry about a gateway effect also spread such disinformation suggests that they are not genuinely worried about the gateway effect.  It is also worth noting that the claims refer only to non-pharmaceutical tobacco/nicotine products, though it is equally plausible (which is to say, equally implausible) that nicotine gums, lozenges, and patches could be a gateway to smoking.  Yet those who claim to fear the gateway effect usually support aggressive touting of these products.

It follows from this that accurate communication about low-risk alternatives cannot create a gateway effect.  Even if availability of those product could create some gateway effect (contrary to both the empirical evidence and logic that suggests otherwise), accurate communication about the risks would tend to reduce this.  Thus, it is nonsense to even suggest that informing people about the low risk of available products could cause a gateway effect.

Our position

If anyone who would not have otherwise smoked is caused to smoke, that is unfortunate.  If THR were causing this to happen to a substantial degree, it might be a cause for concern even though the net population effects would still be beneficial.  Ethically, it is debatable whether population benefits always trump uncompensated individual costs.  But given that it is difficult to imagine why it would happen at all, and there is nothing to suggest it is happening to a measurable degree, this abstract debate is moot.

It is clear from their other behaviors that those who make claims about a gateway effect are not genuinely concerned, but are merely following a pattern of making every anti-THR claim they can think of.  Their willingness to mislead about comparative risks, and to express no concern about NRT availability and marketing, make clear that they do not really believe what they are saying.

If there is any gateway effect, the best way to reduce it is to clearly communicate to low-risk product users how much higher risk smoking is.  There is no plausible way such communication could increase the effect.

Based on everything we know, this is simply a non-issue.  Unless those who claim to worry about it are able to produce some argument or evidence, rather than just making vague assertions, there is nothing more that can be said about it.

Smoking initiation getting older, what does it mean?

by Carl V Phillips

This is a bit tangential at the start, but it is a good science lesson and you will see how it relates to THR, particularly the common claim that there is no value in THR because everyone is just going to stop using tobacco soon.

I was monitoring the tweets from today’s tobacco control industry’s (TCI) meeting to celebrate the 50th anniversary of the U.S. Surgeon General’s report on smoking (you can find the tweets at #SGR50 if you are interested — you will need to scroll down to today to find the comments on the meeting because there will be a lot going on at that tag over the next week).  There was a lot to despise about it.  Primarily it consisted of a bunch of people who were not even born yet (and a few who were children) trying to take credit for the historical anti-smoking measure that mattered far more than any other: telling people about how risky it is.  This seems to be an attempt to distract people from the fact that what they are doing now is basically useless — except when it is harmful, as when they try to prevent THR.

Apparently several of the speakers took this celebration of a report on smoking as an excuse to attack low-risk alternatives.  A few others, notably Matt Myers of CTFK and the president of the American Academy of Pediatrics (AAP), made the claim that a large majority of smokers start as kids.  The thing is, smoking initiation in the U.S. is now almost exactly half adults and half children, as shown here.

It is not clear whether they are simply illiterate, not understanding verb tense (a large majority of current smokers started as kids, but that appears to no longer be true of those who start).  More likely they are innumerate (that would fit their historical bad science, certainly) and do not understand the basic epidemiologic concept of age/period/cohort.  It is actually quite simple, though it confuses a lot of people who have never had it explained to them when they try to understand events that are happening over time.  A cohort is a group of people born within a particular period (for simplicity, just call it a year); period refers to calendar time; age is obvious.

It turns out that if you fix two of those, it determines the third.  For example, if you want to look at people born in (cohort) 1970 when they are (age) 44, that would mean you are looking at (period) 2014.  (Yes, I know — more precisely you are looking at part of 2014 and part of 2015 for each individual, but we tend to ignore that for convenience.)  Most important, for understanding these things, is that if you are looking at a particular age range (say 12- to 17-year-olds) over changing time (as is done when we chart how many children are starting smoking each year, as in the above link), then you are talking about a series of different cohorts.  That is, it is about different (though in this case, overlapping) groups of people.

To make this more concrete, most current smokers are members of cohorts that started smoking during periods where smoking initiation was at younger ages.  But the current cohorts are not doing this, and therefore in the future more smokers will have started at later ages.  If one does not understand the concept of cohort (as is apparently the case for those speaking today), it might be difficult to understand this.

This also lets us better understand the significance of the fact that smoking initiation is shifting to older ages.  As the tobacco controllers like to brag when they are touting their accomplishments (and like to hide when they are demanding more funding), smoking initiation among children is definitely trending down.  In particular, the TCI uses this observation to claim that THR is not useful because smoking is disappearing (never mind those who are already smoking — they can just die from it).  But initiation among the population as a whole is almost keeping pace with population growth.  With an understanding of cohorts (and being able to not conflate them with periods), it is relatively easy to hypothesize an explanation for this.

Hypothesis: Aggressive anti-tobacco (not just anti-smoking) propagandizing of children is causing them to avoid it until they reach an age where they throw off the manipulations of their younger self.  At that point, however, the portion of the population inclined to try or use cigarettes or other tobacco products is barely changed.  That is, pushing initiation to a later age does not substantially change the behavior of the cohort in the long run.

To better understand this, consider two other behaviors:  If children are effectively discouraged from engaging in the risky activity that is American football, they will never play it; basically no one takes up football as an adult. But if children are effectively discouraged from engaging in the risky activity that is sex, the percentage of the population that will eventually become sexually active is barely changed.  These represent the polar cases of whether stopping early initiation stops initiation entirely, or whether it basically does not reduce eventual initiation within the cohort at all.

The TCI wants us to believe (and themselves desperately want to believe) that tobacco use is more like football — that anyone who avoids starting it as a child will never start.  But the data is suggesting it is more like sex — where the inclination is not substantially changed by delay.  That is, a relatively constant portion of each cohort that is interested (obviously, a much smaller portion for tobacco than for sex).

If the above hypothesis is correct, we would expect that causing a decrease in children initiating would cause an increase in young adults initiating a few years later.  This generally fits the data — not perfectly, but better than does tobacco control’s hypothesis that if you stop a would-be child initiation, that person will therefore never start.  (To maintain that fiction, they try to maintain the fiction that most initiation occurs in childhood, despite the very simple data that shows otherwise.)  There will be a reduction in the number of smokers in this scenario (due to the lower rate in the cohorts who are currently children), but not the cohort effect that tobacco control claims:  There will be about the same number of 24-year-old smokers each year in the future as there are now.

If the hypothesis is basically correct, there will presumably still not be perfect substitution.  The trend will be at least a little bit of the football effect, with some who avoid starting as children losing all interest before become adults. So the current tactics for blocking childhood initiation will reduce total smoking in the cohort, but it appears that it will not be very much.

Getting this right has obvious implications for THR.  First, it shows that while the 1964 Surgeon General report and related education efforts mattered a lot in lowering the inclination to smoke, the near-plateau that has been reached in initiation is not actually changing.  This is contrary to what one might naively conclude from the data on current children that ignores the rest of the cohort’s lifecycle.  Thus, THR remains the only proven method for getting smoking rates to drop much below 20% of the population.  Second, it is further evidence against the TCI’s demonic possession theory of why people smoke.  It shows that people use tobacco because they like it.  Just as delaying sexual behavior initiation does not cause people to not like sex, delaying tobacco initiation does not substantially change the number of people who like tobacco.  Thus having low-risk tobacco products will make a lot of people happier, even apart from making them less likely to smoke.

New York Health Commissioner Nirav R. Shah lies about e-cigarettes

by Carl V Phillips

In a letter to the New York Times, probably fueled by anger that that newspaper did not toe the “public health” party line per usual, the Health Commissioner of the state of New York tries to criticize Joe Nocera’s wonderful pro-ecig NYT op-ed.  Having no valid complaints available, he naturally adopts the usual anti-THR tactic, lying.  He starts with,

Nocera…implies that the science related to e-cigarettes is being ignored by the public health community. It is not.

But what he then goes on to present is the little corner of the science that supports an anti-ecig position — a corner that is mostly filled with the worst junk in the field.  I suppose he might argue what he said is technically right, since the “public health” community merely ignores almost all the science, including in particular the most useful science.

Early studies of the value of e-cigarettes as a smoking-cessation device have found that they are no more effective than nicotine replacement therapies approved by the Food and Drug Administration.

Here he is employing the standard liar tactic of pretending that some fairly useless research is what we should focus on, rather than the overwhelming evidence from other sources that shows that e-cigarettes work.  Moreover he lies about even that:  there was only one such study (not plural) and it did show that e-cigarettes did better than the NRT.  Of course, they did not do nearly as much better as they do in real life, but that was because the study was pretty much useless:  poor-quality e-cigarettes, given to people who do not necessarily want them in an artificial situation are not terribly effective.

No expert real scientist puts much stock in that study.  The real science can be found in the evidence about how many people have switched, which Shah pretends does not exist.  At least he implicitly admits that NRTs are not effective.

We also know that the smoke that comes off an e-cigarette is not just “vapor,” a term probably promoted by the industry to make it sound innocuous.

The funny thing is that he is technically correct, though he probably is too innumerate to know it:  The “vapor” is, of course, mostly aerosol, with very little actual vapor.  I cannot fathom what he could possibly mean by the “just”, though — no one claims that because it is vapor (or aerosol) it poses no substantial health risk.  That would be stupid.  And I mean “public health”-level stupid.  There are obviously a lot of vapors and aerosols in the world that are very harmful.  Indeed, the word “vapor” has, in the history of public health, generally been associated with source of harm.

The real argument is, of course, that we know what the exposure actually is (consumers care about the actual chemicals, unlike “public health” that is satisfied to just assign labels).  Based on that we know that the risk is very low.  Shah lies by setting up a straw man.

I like that “probably” in there.  It is like he was saying “I would like to lie and claim that the term is a product of industry action and not popular culture, but even among the anti-THR liars I cannot find any assertion on which to base that lie, so I pretend to be honest by hedging.”

There has been an increase in use of e-cigarettes coincident with the aggressive marketing of the product. But there has been no concomitant increase in the incidence of smoking-cessation coincident with the use of e-cigarettes.

Notice the cute trick of implying (but without actually saying) that e-cigarette use is caused by marketing and not by, say, the fact that people really like them and find them to be a great way to quit smoking.  Gotta get that “demonic possession” theory of tobacco use in there.  And, of course, as anyone who knows about tobacco use knows (i.e., apparently not Shah), smoking cessation has increased at a rate that is remarkably similar to the uptake of e-cigarettes.  (Of course that does not prove causation, though there is no doubt that the “public health” types would insist that it was causation if it went in their favor to do so.)

Much remains unknown. How will smokers and former smokers use e-cigarettes: to reduce tobacco use or to maintain nicotine addiction by smoking e-cigarettes where they would normally have to abstain?

There is no doubt that many are using e-cigarettes to quit — it is a lie to say that is unknown.  It is also known that some are using them primarily because they are not so restricted.  Um, so?  It is still making them better off, without hurting their health, so what’s the problem?  Of course, he is implicitly admitting that in the mind of “public health”, making smokers happier is the problem because the purpose of place restrictions is to torture smokers into quitting.  But if you are going to restrict e-cigarettes because they can be used for this, you obviously need to restrict NRT also, since more of it is sold for this purpose than to quit smoking.  (And, of course, if we avoid bone-headed anti-harm-reduction efforts by “public health”, smokers who are using low-risk products some of the time are excellent candidates for completing the transition.)

Does the doubling of e-cigarette use by youth in the last year portend an increase in tobacco use that will reverse the significant reductions in cigarette use since 2000?

The “doubling of use” claim is a well-documented lie, of course.  But even if it were not, it obviously would do nothing to cause cigarette use.  It would tend to increase the reduction.  Of course, pretending not to be lying, Shah did not actually assert the claim that he is carefully implying.  He phrased it as a question, a classic liar tactic.

Most would agree that there is no public health value in youth nicotine addiction and that regulation by the F.D.A. as a tobacco product is necessary.

Wow, you could use that as a dictionary example of “straw man”.

The lack of science on critical questions should be cause for close regulation of e-cigarettes until these questions are better answered, rather than careless optimism with the lives of our youth.

Oooh, if we do not ban these it will kill the chiiiiildren!  Except that they are close to harmless and substitute for far more hazardous behaviors even among chiiiildren.  We have enough science to know without a doubt that there is no dire hazard here that calls for precipitous action.  Yes, some science would be helpful in making regulations.  Isn’t that what the “public health” types always crow about: science-based regulation.  So why is it they are always asking for regulation that is explicitly based on a lack of science (or more precisely, in pretending that there is a lack of science)?