Tag Archives: economics

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

Toward beneficial and practical standards for e-cigarettes

by Carl V Phillips

At the GTNF2015 conference I was on a panel discussing e-cigarette standards. The standards being discussed include manufacturing practices (e.g., clean rooms, hardware materials), specific technologies (e.g., whether a heating coil is capable of overheating, safe batteries), and ingredients (e.g., the perennial debates about whether some flavoring agents pose too much of a hazard). I decided to take the approach of addressing what the proper role for standards is, from a political economy perspective. What follows is the talk I gave (not word-for-word, and with a few additions to make it a document better suited for reading, taking advantage of the lack of time limit here). I follow that with some additional thoughts I voiced during the course of the Q&A and discussion. Continue reading

Public health (heart) lung cancer

by Carl V Phillips

Tobacco control and “public health” have the same attitude toward lung cancer as homophobes do toward AIDS. In both cases, they are motivated by “moral” objections to particular behaviors and are desperately frustrated that people fail to just stop doing what they personally consider sinful/disgusting/unappealing (those are fairly interchangeable concepts for this sort of person). Thus many of them are happy that there is a disease that disproportionately punishes the sinners. Of course gay bashers (as well as also those who object to all sexual promiscuity and the relatively smaller group who hate injection drug users) do not pretend to care about the physical health of the targets of their opprobrium, so they are merely vile; “public health” people are also hypocrites.

About ten years ago, I coined the term “anti-tobacco extremists” to refer to those who take the most extreme view of tobacco use. This was an attempt to push back against anti-THR activists being inaccurately referred to as public health, given that they actively seek to harm the public’s health. I have since given up on that, and recognize that “public health” is an unsalvageable rubric, which should just be relegated to being a pejorative. But the extremist concept remains useful. The test for anti-tobacco extremism is the answer to the following question: If you could magically change the world so that either (a) there was no use of tobacco products or (b) people could continue to enjoy using tobacco but there was a cheap magic pill that they could take to eliminate any excess disease risk it caused, which would you choose? Anyone who would choose (a) over (b) takes anti-tobacco to its logical extreme, making clear that they object to the behavior, not its effects. Continue reading

Tobacco abstinence is not a safe alternative to harm reduction

by Carl V Phillips and Elaine Keller

In honor of the birthday of one of us (EK), we are using the great title that the other of us wishes he had thought to use for his 2009 paper. In acknowledgement of her birthday, Elaine posted this yesterday on the Facebook CASAA members group:

Today is my birthday. My birthday wish is that e-cigarettes had been invented in 1983 instead of 2003. I was reluctant to share with the world that I was diagnosed with lung cancer last summer. I was afraid that some tobacco control liars might use that information to falsely accuse e-cigarettes of causing cancer. But an important fact is that for ex-smokers, the excess risk for lung cancer doesn’t go away the day you quit. In fact, it hangs around for a good TWENTY YEARS after you quit smoking.

So if I had been able to quit smoking in 1989 instead of 2009, perhaps I would not have needed to have the lower left lobe of my lung removed in July, and to go through chemotherapy. I’m happy to share with you all that my follow-up CT scan on December 4, showed no evidence of cancer. So I am officially in remission. To those who want smokers to wait around for 10 or 20 years for scientific proof that e-cigarettes are 100% safe, I say this, smokers don’t have that luxury.

Dr. Carl Phillips, CASAA’s Chief Scientific Officer, brilliantly analyzed the difference between being able to quit smoking immediately via switching to a reduced risk alternative source of nicotine (Tobacco Harm Reduction – THR) and postponing quitting until ready to “quit completely” (e.g., not needing to earn a paycheck after reaching the age of retirement) in “Debunking the claim that abstinence is usually healthier for smokers than switching to a low-risk alternative, and other observations about anti-tobacco-harm-reduction arguments.”http://www.harmreductionjournal.com/content/6/1/29

Most lung cancers are not diagnosed until Stage 4, when survival rates are grim. I thank God, and credit e-cigarettes, for the fact that mine was caught at Stage 1.

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

Predicting the black market in e-cigarettes

by Carl V Phillips

The anti-tobacco movement is fundamentally dishonest and unethical, and it is also led by minimally-skilled people who isolate themselves in an echo chamber that avoids scientific review.  As a result, it is frequently difficult to determine whether one of their false scientific claims is an intentional lie or blatant ignorance.  Most of their epidemiologic claims seem to fall into the former category.  But most of their economics-related lies seem to stem from an utter failure to understand even first-semester level economics.  Snowdon and I (mostly at EP-ology including a few days ago, but also on the present blog) have documented this extensively.

One of their fundamental failures in this area is the apparent belief that — contrary to all we know from the results of the Drug War, to say nothing of all other observations of supply and demand — that bans will eliminate supply even when there is huge demand.  One critical appearance of this ignorance relates to the current U.S. FDA draft regulation of e-cigarettes.  FDA has clearly made no attempt to consider what the real — as opposed to fantasy idealized — results of their proposed e-cigarette ban would be.  It is not difficult to understand that there will be a continuing market in e-cigarettes — mostly not actually “black” despite the shorthand in the title. Continue reading

Demonization of tobacco users (or, just because it is a puff piece does not mean I cannot analyze it)

by Carl V Phillips

Vapers are delightedly tweeting this bit of satire from The Daily Mash, entitled,”Put cancer in e-cigarettes, say non-smokers.”  The conceit is that THR causes non-smokers to lose their feeling of superiority, forcing them to frequent crack houses to recapture that old feeling (a gateway theory?).  I saw it tweeted as “anti-smokers” rather than “non-smokers”, but this actually missed the point:  The characters in the story are not anti-smoking; they like smoking and its ill-effects due to the schadenfreude.

This contrasts with professional anti-smokers — or more accurately, the tobacco control industry, anti-tobacco extremists, or ANTZ — who also favor keeping tobacco use harmful, but for somewhat different reasons.  As noted from the start in this blog, anti-THR has several motives, all of them perverse, and none of them having to do with health even though the anti-THR liars cloak themselves with the title “public health”.

The anti-THR activists consider tobacco use to be some kind of moral failing or otherwise just want to eliminate it, and thus prefer to keep it as harmful as possible.  For the less-bright majority of that crowd, this is for motives as base as those in the Daily Mash story:  They are annoyed that tobacco users will not obey, and want them to suffer for their temerity.  But the smarter tobacco controllers, those who talk about “endgame” or “tobacco-free by 2030”, know that low-risk alternatives guarantee that they will fail:  So long as tobacco use is highly harmful (i.e., smoking), everyone has a good reason to quit.  While it is unlikely they will all do so, there is a chance.  But low-risk tobacco products have benefits that greatly exceed their costs, and so people do not have an incentive to quit, and sensible politicians have no reason to support measures to discourage use.  Moreover, the realization that tobacco use is becoming low-risk will inevitably cause a backlash against the entire anti-tobacco industry and their lavish use of our tax money.

But unlike the characters in the Daily Mash story, the tobacco control industry cannot ever admit their motives.  Even if they preferred telling the truth over lying (though there is no evidence that suggests this is the case), they would have to lie about this one.  The mere admission of their real motives would derail the entire enterprise.  Of course, the cannot make e-cigarettes more hazardous than they are, like the characters in the story wish, but they can try to trick people into believing that e-cigarettes and smokeless tobacco are high-risk, and thus encourage them to smoke instead.  As long as most tobacco users are smoking, the tobacco control industry can continue to profit and dream.

In a less puffy piece that also pursued the theme of people feeling superior to smokers, the New Republic called for an end to campaigns to stigmatize smokers.  It likened the stigmatization of smokers to the stigmatization of people with HIV/AIDS.  This is a valid moral equivalence.  In both cases, it is about a behavior that someone is choosing to engage in, which happens to be something that a tiny minority violently objects to as immoral.  In both cases, that tiny minority uses the health risk (and the grossly exaggerated tiny spillover risk to others) as a convenient tool for making it appear that their motives are something other than hatred.  This allows them to enlist the support of others who vaguely disapprove of the behavior, but not so much that they would deny others their free choice based on that disapproval, let alone would intentionally inflict punishment on the “sinners”.  The article seals the comparison by looking at the stigmatization of lung cancer victims.

The article fails to note that the portion of lung cancer is caused by smoking is smaller than the portion of HIV infection that is caused by various demonized behaviors.  Nor does it point out that anti-smokers are exactly the same violent and hate-fueled people as gay bashers — which of those two a particular person turned out to be is just an accident of what subculture he grew up in.

Unfortunately, some of the analysis is the article is not so good.  It suggests that tobacco control efforts have played a large role in reducing smoking, when actually almost all the credit goes to simple knowledge and rational consumer choice.  It also conflates genuine effects of smoker demonization with statistics like “Most non-smokers would be reluctant to date someone who smokes (72%).”  There are perfectly legitimate reasons for making that personal choice that do not imply a dislike of smokers, let alone a desire to inflict psychological violence on them or schadenfreude.

The hook for the New Republic story, and a companion piece, was the CVS move to stop selling cigarettes.  The quotes about that in the articles, and to a lesser extent the articles themselves, show more of the naivety about it explored in my previous post.  It is amusing that those praising the move simultaneously describe it as “courageous” and “principled” and also claim it will be good for business (or naively believed that because CVS stock price upticked, it proves it was good for business).  I suppose it is not too shocking that those innumerate people cannot figure out the laughable contradiction there.

Of course, that does not explain why removing a product from the shelves — with a predicted substantial loss in revenue — is good for business.  As I noted before, it appears that the answer is that it gets them more corporate customers for their much-higher-margin medical service businesses.  But why? Basically because the business leaders have been strong-armed by the tobacco control industry (particularly including its units in government) into pushing their medical service suppliers to not sell cigarettes.

This creates an amusing contradiction for the doctrinaire free-marketeers, some of whom praised the CVS decision as a free choice of a business in the market.  When market decisions are caused by tax-fueled campaigns to force companies to change their behavior, what exactly does “free market” mean? Also, how perfect is the market if the CVS customers who are companies make decisions based on non-market influences that would not affect individuals (there cannot be 1000 people in the country who avoid buying from CVS when they offered the best value, just because they sell cigarettes)?

But while the free-market extremists get a lot of things wrong, the core points about markets are right.  In particular, the more merchants stop selling cigarettes, the greater the profits for those who still do (volume will clearly increase, and per-unit profit will also inch up due to the reduced competition). Thus, however much political pressure there is to make the “free” decision to stop selling cigarettes, there will be an equilibrium when that is not enough to offset the available profits and cause more merchants to exit the market.  My suspicion is that the “endgame” types have no idea that this is the case.

Finally, for those who have been missing my writing about THR for the last week and a half, it is because you are not reading EP-ology, where I posted two pieces on the topic (as well as other interesting stuff).