Tag Archives: “no evidence”

Jane Brody turns up the NYT’s lies about THR, e-cigarettes, etc.

by Carl V Phillips

The New York Times has some good health science reporters, but their best known health writer, Jane Brody, has been a reliable embarrassment for that newspaper for decades (and it takes a lot to embarrass the newspaper that led the drumbeat to start the disastrous war with Iraq, repeating and even embellished the claims about WMDs).  It might not be fair to blame the newspaper itself for one writer who seems to have managed to learn nothing of the science she has written about forever, but for the fact that the paper has been editorializing against THR also.  So blame for the lies should go to both the author and the editors.

The first of her two-part series on tobacco product use is no worse than typical Brody standards.  It focuses on the 50th anniversary of the 1964 Surgeon General report on smoking, and the burst of associated activity.  It is typical naive transcription of the standard claims, many of which are exaggerations of the risks from smoking or are otherwise not quite right, but are mostly not too harmful.  It is specifically remarkable that someone who is supposedly an expert would declare that her husband’s cancer death — 15 years after he quit smoking — was definitely caused by smoking.  (Yes, it is certainly quite possible it was caused by the smoking, but that long after cessation, there is a good chance it was not, as anyone who understood the science would know.)

It is tiresome to read the naive and self-serving claims of the tobacco control industry repeated once again (hey, we can’t expect a reporter to bother to check whether there is any real basis for what she is being told, can we? reporters are far too busy to do that).  But most of them do relatively little damage to the world.  That is, until they spill over into denigrating proven-effective smoking cessation methods in favor of the self-serving failed approaches of the TCI, which is where Brody goes in her second post.

She claims:

[CDC Director] Frieden and public health specialists everywhere are seeking better ways to help the 44 million Americans who still smoke to quit and to keep young people from getting hooked on cigarettes.

And she might actually be naive enough to believe that claim.  As I said, she is known for having a remarkably poor understanding of what she presumes to write about.

The reality, of course, is that “public health” people are the active opponents of the better ways that are emerging.  The only proven method of substantially further reducing smoking is THR.  But instead of embracing it, “public health” continues to come up with even more absurd and socially burdensome interventions that accomplish approximately nothing.

Brody’s litany of claims about the wonderful effectiveness of the ruling class’s anti-smoking methods is so antiquated it appears to be a joke.  She spends a quarter of the post on WHO’s 2008 pabulum regulatory guidelines and even mentions, as if were news, a year-old proposed tax increase.  Strangely, she apparently did not read her own first post, which laments how all interventions to date have proven inadequate.  Logical consistency has no place in tobacco control or, apparently, NYT reporting.

Before getting to the part that matters most, it is worth calling out this:

“A higher cigarette tax is not a regressive tax, because it would help poor people even more than the well-to-do,” Dr. Frieden noted.

Frieden and Brody should both take a minute and look up what “regressive tax” means.  But even aside from this being a bald lie,  just pause and think about the mindset behind it.  The ruling class has decided that imposing a huge punishment on poor people helps them.  After all, if the savages are not beaten, they will continue to sin.  The only thing missing is “qu’ils mangent de la brioche.”

Brody’s actively damaging lies start after that, as she concludes her discussion of how not enough has been done to reduce smoking with an attack on the one recent innovation that has dramatically increased cessation:

Electronic cigarettes are being promoted by some as a way to resist the real thing. E-cigarettes, invented in 2003 by a Chinese pharmacist, contain liquid nicotine that is heated to produce a vapor, not smoke. More than 200 brands are now on the market; they combine nicotine with flavorings like chocolate and tobacco.

Setting aside the first common misconception (e-cigarettes were invented at least as long ago as the 1960s and the current form was invented by an American in the 1990s), how clueless do you have to be to say they contain “liquid nicotine” (rather than a very diluted nicotine solution) and that there are only 200 brands?  Ok, so far it is just illiterate, but not harmful.

But their contents are not regulated, and their long-term safety has not been established. In one study, 30 percent were found to produce known carcinogens.

Not regulated — just like the vast majority of the (largely useless) cessation methods she recommends in her post.  Not established — as opposed to the wonderful long-term safety of the approach her husband used, which was to repeatedly fail in his attempts to quit smoking until (according to her) smoking finally killed him.  Seriously, is she even reading her own prose?  And don’t even get me started on the NYT’s supposed expert health reporter falling for the “produce known carcinogens” silliness (hey guess what, Jane, 100% of humans tested produce known carcinogens).

Dr. Frieden said that while e-cigarettes “have the potential to help some people quit,” the method would backfire “if it gets kids to start smoking, gets smokers who would have quit to continue to smoke, gets ex-smokers to go back to smoking, or re-glamorizes smoking.”

Yes, and it would also backfire if it caused a resurgence of smallpox, triggered a nuclear war, or was a prelude to an invasion by space aliens (as I have speculated it might be — have you seen some of those mods?).  Too bad we do not have an institution in society whose job it is to ask questions of government flacks, like “so, is there any reason to believe that is a real risk?”

Nearly two million children in American middle and high schools have already used e-cigarettes, Dr. Frieden said.

And, of course, that was a lie.  But, hey, it is not up to the transcriptionist to check the accuracy of what she is writing.

In an editorial in the Canadian Medical Association Journal last year, Dr. Matthew B. Stanbrook, an assistant professor of medicine at the University of Toronto, suggested that fruit-flavored e-cigarettes and endorsements by movie stars could lure teens who would not otherwise smoke into acquiring a nicotine habit.

Well then, a random medic speculated about this.  And demonstrated his expertise by being able to write it down.  Must be true.

A survey in 2011 of 75,643 South Korean youths…

A minor aside, but anyone who does not even know how to round numbers to leave out irrelevant detail should not be reporting about science.  Nor should anyone innumerate enough to quote Stanton Glantz as if he had even half a clue about science.

…in grades 7 through 12 by researchers at the University of California, San Francisco, revealed that four of five e-cigarette users also smoked tobacco. It could happen here: Stanton A. Glantz, the study’s senior author and a professor of medicine at the university, described e-cigarettes as “a new route to nicotine addiction for kids.”

That is the note she ends on:  most teens who even tried e-cigarettes were already smokers, and therefore we better put a stop to it.

Ms. Brody, I suggest you go back and read your own posts, and then ask yourself:  Who is it that is dooming millions of people to keep smoking, as your husband did?  Could it perhaps be those who are lying about the benefits of switching to a low-risk alternative, a group that now includes you?

Cheryl Healton lies (a lot!) to try to get NYC to restrict ecigs

by Carl V Phillips

This analysis, of this blog post, might seem a little more brutal than usual.  That is because the author, Cheryl Healton (the former head of the leading anti-tobacco organization, American Legacy Foundation — a fact that is omitted in the introduction of her in the blog in question — and now head of the public health program at NYC), knows the truth.  This is not a case of someone who is too innumerate to not know she is lying, or a useful idiot that is being used by the anti-tobacco extremists.  Healton is one of the puppet masters who manipulates her useful idiots (like New York Assemblywoman Linda Rosenthal), which she is doing in this post.  Notice in particular the many times that she lies by using literally true but highly misleading statements, the mark of someone who knows she is lying but wants to be able to pretend otherwise.

The post appears in the blog of the “NYC Coalition for a Smoke-Free City”, an obviously misnamed group since they are campaigning not against smoke, but against e-cigarette use.  The thesis is that NYC should go ahead with its proposal to prohibit e-cigarette use anywhere that smoking is prohibited.  It is remarkable how close Healton comes to lying in every single sentence.  The first few about the fact that NYC is about to act on this are true, but most everything that follows is a lie:

Who is the e-cigarette industry?  Increasingly the e-cigarette industry is owned by the tobacco industry, an industry that would not be permitted to exist were it invented tomorrow because it would violate the consumer protection laws of all states and virtually every country in the world.

As I have pointed out, this “would not be allowed to exist” claim is at best pure speculation, and probably wrong.  But apart from that, it refers to a product (cigarettes), not an industry.  If the industry came into being right now selling low-risk products like smokeless tobacco, e-cigarettes, and NRT (all of which are sold by “the tobacco industry”), it would be allowed to exist.  But, of course, this soup of words is not meant to analyze the actual claim, but to lie about e-cigarettes, suggesting they are some industry plot.  In case the innuendo is lost on the reader, she goes on to lie,

For this reason, a healthy degree of skepticism about the industry’s ultimate goal in buying up e-cigarette manufacturers and creating more “efficient” e-cigarettes should prevail as policy makers establish regulations governing them. It is quite possible that the net effect of e-cigarettes will be to induce greater youth initiation of smoking and reduce the adult cessation rate, but the jury is still out.

I cannot imagine that Healton is stupid enough to actually believe that.  It is impossible to come up with a story to explain why the existence of e-cigarettes (let alone the acquisition of a few companies that she led into that with) could cause smoking at all, let alone to cause a net increase in smoking initiation.  E-cigarettes, like any popular low-risk alternative, will replace smoking initiation, not cause it.

Both youth and adult smoking rates are at their lowest levels in decades, so much is a stake for the health of the public.

Setting aside the fact that the “so” is a non sequitur, is what she is saying is that having almost 20% of the population smoking is such a success that harm reduction should be avoided?  It appears so.

There is also much at stake for the tobacco industry as it seeks to apply its considerable marketing acumen and seemingly endless resources to maximize profit by increasing the number who start smoking by enticing youth worldwide to smoke and by trying to retain current smokers.

Complaining about “endless resources” is pretty funny coming from someone who is at the apex of the billions-per-year tobacco control industry.  But the real question is what this passage has to do with e-cigarettes at all, let alone restricting where you can use them.  It is typical tobacco control misdirection:  “Cigarette manufacturers profit from more people smoking and remaining smokers, and therefore we should restrict where people can use e-cigarettes.”  Huh??!

Who might be hurt by e-cigarettes?  The tobacco products the industry has historically manufactured and promoted as “reduced harm” are not benign products created to meet the broad range of consumer preferences in the United States, rather they are deadly products that when used as directed kill over 400,000 Americans each year and are predicted by the World Health Organization to kill a billion people worldwide this century, 10 fold more than they killed in the 20th century. To put the scope of the current tobacco-related epidemic in perspective, in a few years, global lung cancer deaths will surpass AIDS deaths as the steady march of tobacco industry marketing continues to engulf the world’s poorest nations.

Again, huh??!  Does anyone see any connection between that question and what follows?  (Yes, I realize that the reader might now be questioning my assertion that Healton is too smart to not know she is lying.)  Her allusion to historical products is the usual tobacco control canard about the introduction of “light” cigarettes four decades ago, products where there was no evidence to suggest they would be lower risk.  And yet they were actively endorsed by the public health community, not just the manufacturers.

However, a mistake by everyone a couple of generations ago about what might be lower risk tells us nothing about the present world of products that are known to be lower risk.  It is an utterly absurd and blatant lie to suggest otherwise.

None of what she says in this paragraph is true about the actual reduced harm products that have been introduced by the tobacco industry and by others.  Smokeless tobacco, e-cigarettes, and other low-risk products do not cause the harms she is citing; cigarettes do.  (Well, cigarettes cause and will cause a lot of harm, though not as much as she claims.  But that is another story).  She seems to be trying to invoke the conjunction lie, that cigarettes plus low-risk alternatives do that much harm (which implies the harm is shared, even though it is basically all caused by cigarettes), but she screws up doing even that.  She actually is claiming that the low-risk products alone cause all the harm from smoking.

Nicotine addiction is in and of itself a gateway to tobacco product use because once addicted many will broaden the products they use and included among these will be the most dangerous products like cigars, cigarettes and hookah.

It is true that people who like to use one tobacco/nicotine product often try other products.  But what she is trying to imply (carefully avoiding actually saying it) is that using e-cigarettes will cause people who would not have otherwise smoked to do so.  There is no reason to believe this would be the case, and certainly no evidence of it occurring.

And it is worth pausing to remember that the title of this post says that NYC should include e-cigarettes in its smoking place restrictions.  I have skipped a few sentences but have not left out anything that addresses that.  There has been nothing yet.  Even if the previous quote were not a lie, it would still only be an argument against letting kids use e-cigarettes, not about forbidding adults from using them at their desks or in bars.

Most tobacco-related deaths are the culmination of substantial suffering and societal cost from heart disease, emphysema or various cancers and are the direct result of nicotine addiction.  Moreover, nicotine addiction is considered by many scientists as the most intractable of all addictions as measured by the percent of ever users who become addicted and the percent who remain addicted until death. Half of lifelong smokers lose their lives to tobacco addiction and among these people nearly half die before retirement age.

A pretty good argument in favor of encouraging e-cigarette use.  The bit about “most intractable” is nonsense, of course.  The reason users have more incentive to quit, say, meth than to quit smoking is the high level of short-term damage it is doing them.  And the “half” is a made-up number that is higher than what the evidence suggests.  Most important is that claims about the “addictiveness” of smoking tells us little about e-cigarettes, given the evidence that e-cigarettes are much easier to quit.

And, once again, this has nothing to do with whether there should be a place ban on e-cigarettes.

E-cigarettes are a complex product and their availability and the regulatory framework for governing them may have different implications and considerations for youth non-smokers compared to adult smokers. E-cigarette policy could produce sharply differing results by population sub-group.  Data demonstrate that a significant swath of adolescents already are using e-cigarettes. Time will soon tell whether e-cigarettes function as one more point of entry to cigarette, cigar and hookah consumption among those using e-cigarettes initially. One thing is clear however, since cessation efforts have thus far not worked with teens, e-cigarettes will likely not do anything good for kids and may well entice many to start smoking in view of the broad array of sweet, candy flavors and slick e-cigarette marketing already blanketing the internet, mall kiosks, TV and radio, which have to date eluded regulation.

Blatant lies and clueless nonsense.  (Ok, I will admit I am starting to doubt my previous assertion that Healton really understands what she is saying.)  Skipping past the distractions that the first few sentences comprise, we have the lie that many adolescents are using e-cigarettes, a repeat of the lie that there is any reason they would cause smoking, the lie that because other cessation efforts do not work for kids that harm reduction will not work for them (it might be true, but probably is not, and it is nothing more than speculation asserted as fact), and of course the usual canard about marketing.  Once again, the biggest lie here is that this has anything to do with restricting where adults can use e-cigarettes, or anything else about adult use.

Whether e-cigarettes will offer an incremental boost to cessation rates nationally also remains to be seen.

No, it doesn’t.  Close to every e-cigarette user is either a former smoker or a current smoker who has replaced some smoking with e-cigarettes and could be persuaded to complete the transition.  Many of those who quit smoking report that they had not been able to succeed at cessation until they tried e-cigarettes, and only then did they quit.  Therefore e-cigarettes have increased cessation.  This is not really a difficult concept to understand.  (She goes on in that paragraph to lie about what the research shows, but I will stop at debunking her thesis claim.)

This is the epitome of the ANTZ tactic of declaring every negative they can concoct to be a real concern, even if there is zero evidence and even if the evidence clearly shows it is a non-issue, while denying every positive by pretending that the evidence does not exist.

We should also remain open to another highly plausible effect of e-cigarettes-that they will function in the same manner “light” cigarettes did when they were introduced in the 70′s, promoted by the tobacco industry as a step smokers could take to feel safer without actually quitting smoking. As many subsequent studies showed, in fact they were not safer and millions who would have quit had they not been introduced failed to do so costing innumerable lives.

And (setting aside the lies about “light” cigarettes themselves) there is that lie about the situations being similar again.  The obvious difference is that e-cigarette users are “actually quitting smoking”, unlike light cigarette users, and they are using a product that genuinely is low risk.  What does a public health failure of the 1970s have to do with e-cigarettes?  Absolutely nothing.  It is basically the same as saying leeches turned out to be harmful rather than helpful in treating infectious diseases, and therefore we should avoid antibiotics.

Do we really want everyone vaping where they once could smoke?  

Oh, look, she is finally addressing the question she claims to be addressing.

The proposed extension of the SFAA to e-cigarettes, which will be voted on tomorrow, also will reduce the “walking billboard” effect of thousands of New Yorkers once again lighting up in bars, subways, parks, office buildings and restaurants throughout the city. But banning e-cigarettes in some locations solely for this reason is un-American in a country that prides itself on maximizing the freedom of its adult citizens to choose to engage in a range of risky and frisky behaviors. 

Interesting.  It is not a very risky behavior, of course, but it is nice to see that New York is still part of America.

The “billboard” claim is utter nonsense, of course.  How is someone vaping in their office, rather than outside the front door, a billboard?  E-cigarettes could still be restricted on the subway and restaurants could make their own choices about what is best for their patrons and vibe.  The proposed ban would eliminate all discretion, reasonableness and common sense, going beyond a few specific restrictions that some might argue are reasonable and imposing rules that are clearly absurd and harmful.

Take a step back and see what she is doing with all of this.  She is appealing to people who are worried about kids using e-cigarettes and do not like people vaping on the subway, and trying to trick them into supporting a rule that bars cannot choose to allow their patrons to vape.  If she actually cared about kids and subways, she would propose something that affects kids (this rule would not) and would endorse a rule that just applies to the subways (which could probably be done by administrative fiat).  Notice she never once offers any reason why banning vaping in bars, private offices, and many outdoor spaces would do any good for anyone, and indeed tries to hide the fact that this regulation would impose such restrictions.  Classic tobacco control bait-and-switch.

It should be noted, however, that while we in general embrace this ethos, when it comes to public drinking we often do not. We do not embrace wandering down the street drinking a cocktail, hopping into the elevator rum and coke [sic] in hand or whipping out a flask of whiskey on a plane.

Ok, so no vaping on elevators and planes.  I suspect that even most dedicated vapers would not find those to be terribly unreasonable restrictions.  As for walking down that street, the street would be one of the few places vaping was still allowed under the restrictions.  The anti-THR people cannot even keep their own stories straight.

Do we know enough to allow vaping in public spaces?  So what are the real risks of public vaping? Is it as its promoters would like us to believe a benign, reduced harm practice that is at worst a passing fancy?

Um, no.  Its promoters think it is here to stay.  Also, the ban is mostly about private spaces, not public spaces.

Or is it a potentially toxic practice that places those in its immediate vicinity at risk. The answer is we do not completely know yet, although already studies have shown elevated nicotine levels among those exposed to secondhand vaping, and this in and of itself is ominous. Not definitively measured as yet among second hand vapers [sic] are the myriad other toxic substances which are contained in e-cigarettes. 

Cute, huh, that use of “completely” and “definitively”.  Of course we know, from ample evidence, with a very high degree of certainty that the risk to bystanders is zero or utterly trivial.   But we never know anything completely or definitively.  Someone can always use weasel words like that to intentionally trick the reader into thinking she made a statement about what we really know, rather than merely a statement about the fact that there is never proof or complete information in the real world.

And if anyone is aware of any study that shows elevated nicotine levels from people exposed to “secondhand vapor”, I would be quite interested in hearing about it.

Under these circumstances, the prudent course is to extend the SFAA to encompass e-cigarettes until, if ever, sufficient evidence exists demonstrating their safety.

Right.  And what might that be?  Oh, you say, no evidence would ever be sufficient for that.  Thought so.

And why exactly would this be prudent?  I do not think that word means what she thinks that word means.  Is it prudent to restrict a very personal freedom when there appears to be no reason to do so, just because such a reason might be found later?  (Sounds like an argument for banning, say, the building of mosques in America — there are many who would make the same “we just don’t know if this will hurt the children” arguments about that.)  Is it prudent to ensure that cigarettes remain as attractive as possible as compared to low-risk alternatives?

The only conceivable downside of not extending the SFAA to e-cigarette use is the loss of any incremental harm reduction for smokers associated with being permitted to smoke e-cigarettes in locations where smoking is now banned.

TrANTZlation:  The harm it would inflict on those not able to vape at their desk, in bars, etc. is of absolutely no consequence.  We are tobacco control.  We don’t actually care if tobacco users suffer.  In fact, we prefer it.

And, of course, making e-cigarette use less attractive creates the public health harm of encouraging smokers to keep smoking.

It is highly unlikely that such a benefit, if it in fact exists, would outweigh the harms to youth, to non-smokers exposed to vaping nicotine laden vapors and potentially other toxins, and to recovering smokers who now stay quit in part because smoking has become less ubiquitous than it was 50 years ago when the Surgeon General released the first report on Smoking and Health.

Huh?  It is highly unlikely?  Care to quantify?  I would love to hear about the harms to youth from people vaping at their desks.  What harms are caused by (barely) “nicotine laden vapors”?  What possible impact is there on “recovering smokers”?

Sadly e-cigarettes may lead to four negative outcomes: the initiation of more youth to nicotine dependence and subsequent conventional smoking; the use of e-cigarettes by current cigarette smokers who would otherwise have quit but instead use both conventional cigarettes and e-cigarettes in combination and therefore delay quitting or never quit and; the relapse to smoking by those who have already quit, first to smoking “benign” e-cigarettes and then to conventional cigarettes; and the exposure of people to e-cigarettes’ emissions unknown risks.

And how does all of this other than the last bit (a lie that has already been addressed) relate to the question at hand?

Who loses, if anyone, by extending the SFAA to e-cigarette use? Virtually no one loses. Vapers can still smoke everywhere current smokers now do. Let’s do what NYC has become known for and enact a policy that saves lives, not costs them.

Just in case the above trANTZlated passage was not clear enough, here she comes right out and says that the hardships suffered by vapers as a result of the rule do not matter.   Smoking place restrictions are designed to make smokers less happy — tobacco control advocates generally admit that these days — so obviously imposing the same restrictions on vapers will make them less happy too.  I wonder if it is a Freudian slip when she says that “vapers can still smoke” — because that is exactly what will happen:  Some would-be vapers, upon having to go out to the smoking areas anyway, will indeed smoke.  As a result, some of them will die from smoking and their blood will be on the hands of liars like Healton.

Et tu, Ken Warner? (and some musings about “endgame”)

by Carl V Phillips

The tobacco control industry’s house organ pseudo-journal, Tobacco Control, just released a special issue about what they call the “endgame”, which is their code word for the elimination of all of tobacco/nicotine use.

It is kind of a funny choice of words, since the word derives from the phase of a chess match where there are few pieces left on the board and a decent player can analyze every possible set of moves with greater certainty than earlier in the game.   This is rather unlike the situation with tobacco/nicotine today where there are more options, more companies, more tobacco control activists, more real public health and consumer advocates (those of us supporting harm reduction and such), and — most notably — more smokers than there have been ever before, and where there is far less certainty about what will happen next.  Most of those who use the term seem to be looking for a something more like the military concept of “mop up”, where victory is assured but some final actions are required.

On the other hand, the more I think about it, the clearer it becomes that they accidentally got something right in this case:  When a chess match between serious players has an endgame (rather than one player resigning), it means that a balance still exists and the outcome is yet to be determined.  If someone’s victory is already assured, there will be no endgame.  Moreover, the endgame is (roughly) defined as the time when the removal of other pieces makes the pawns particularly important and the kings become active fighters rather than just hiding from the action.  This seems like a pretty good metaphor for the rise of grassroots activism against the power brokers and for the emergence of active involvement of the primary stakeholders, the consumers.  The more I think about it, the more I really like that.  Bring on the endgame!

Anyway, I am not sure I have the stomach to read through most of the articles in that issue, though there is probably a month’s worth of the typical tired anti-THR lies to be found in them.  I will count on some of you to highlight any high points (which probably really means low points).  But I did read the short introduction by Kenneth E Warner, the Michigan professor who organized the conference that led to this collection of papers, and his anti-THR lies probably pretty much sum up what else is to be found there.

Ken is a smart and generally honest researcher, and was one of my mentors during my postdoc about 17 years ago.  For quite a while in the 2000s, some of us working on THR thought that he was the most likely candidate among the card-carrying respected insiders of tobacco control to seriously embrace harm reduction and say “be damned” to the ANTZ special interests.  I also remember that for a few years, he repeated something I told him during my postdoc:  I had thought about doing more work on smoking-related policy and science, but with people like him already in the space, there seemed like there was not much more to contribute that would be useful.  When I said that, I was half right:  Brad Rodu had already released his groundbreaking work on THR, though most of us in public health did not have the slightest idea about it, which made clear that there was a lot of new, interesting, innovative, and helpful work to be done.  However, I was right in my assessment that every other avenue of legitimate science about smoking was pretty much done by then; there has been approximately zero legitimate analysis any consequence since that time.

Alas, Warner never came out in favor of harm reduction, which brings us back to his recent paper, which asserts:

The continuing scourge of tobacco-produced disease is unlikely to yield to today’s evidence-based interventions. Several public health visionaries have introduced tobacco endgame proposals with the goal of substantially reducing, and perhaps entirely eliminating, the toll of tobacco.

He uses the anti-THR lie that “tobacco”, rather than smoking, is a major cause of disease.  More importantly, he implicitly claims (several times) that THR is not evidenced-based, one of the two or three biggest anti-THR lies.  The reality, of course, is that the evidence does not support the claim that current tobacco control tactics — more aggressive use of drugs, manipulation of packaging, and various other restrictions — do much more than torture smokers.  The evidence is pretty sketchy about whether further education (in already educated populations) makes any difference or what the effects of even higher taxes and similar quasi-bans will do (there cannot be much evidence about something that has never been tried, after all).  But, but contrast, the evidence that THR can reduce smoking and thus disease is overwhelming, at both the individual and population levels.

As for that last quoted sentence, the terms “visionary” and “public health” give far too much credit for the authors of the other papers in the issue and what appear — based on a quick review — to be the same tired old useless welfare-lowering and/or prohibitionist policies.  Even the paper by Lynn Kozlowski, long the tobacco control industry’s pet harm reduction advocate (i.e., the guy they brought in for their staged “debates” about harm reduction rather than dare hear from those of us who were the real advocates for THR), barely mentions harm reduction and does not acknowledge its potential.

Interestingly, Warner fails entirely to even mention THR, let alone point out that it is the most important phenomenon in the area today, something that he surely realizes.  Perhaps he did not want to risk offending his friends and patrons by even acknowledging it (very much like the last time I ran into him, at a Society for Research on Nicotine and Tobacco conference nine or ten years ago — after I had become a visible proponent of THR but before the U.S. SRNT stopped allowing us proponents to present — where he literally distanced himself from me, practically running away to avoid being seen talking to me).  Yet at the same time, he acknowledges that “something new, bold and fundamentally different from the tried-and-true” is needed.  Funny that.

Fortunately, as with actual endgames, one player does not get to just decide how it will play out.  And unlike with the opening in chess, where following memorized long-established sequences is the norm, or the middle game where most players make use of general heuristics about what positions are better, in the endgame the exact ramifications of each move are thought out precisely.  It is pretty clear that the ANTZ have little idea how to play in that world.

Kelvin Choi is a liar

by Carl V Phillips

A new ANTZ on the scene seems to be aspiring to be the new Ellen Hahn.  I supposed it is possible, given that he is at University of Minnesota that he aspires to the be the new Stephen Hecht, but that might be a stretch since Hecht seems to do somewhat useful bench science, and then just lies about the health and political implications.  Choi, by contrast, seems to be fully ensconced in the “public health” junk science paradigm.  Consider this recent abstract:

Objectives. We assessed the characteristics associated with the awareness, perceptions, and use of electronic nicotine delivery systems (e-cigarettes) among young adults. Methods. We collected data in 2010-2011 from a cohort of 2624 US Midwestern adults aged 20 to 28 years. We assessed awareness and use of e-cigarettes, perceptions of them as a smoking cessation aid, and beliefs about their harmfulness and addictiveness relative to cigarettes and estimated their associations with demographic characteristics, smoking status, and peer smoking. Results. Overall, 69.9% of respondents were aware of e-cigarettes, 7.0% had ever used e-cigarettes, and 1.2% had used e-cigarettes in the past 30 days. Men, current and former smokers, and participants who had at least 1 close friend who smoked were more likely to be aware of and to have used e-cigarettes. Among those who were aware of e-cigarettes, 44.5% agreed e-cigarettes can help people quit smoking, 52.8% agreed e-cigarettes are less harmful than cigarettes, and 26.3% agreed e-cigarettes are less addictive than cigarettes. Conclusions. Health communication interventions to provide correct information about e-cigarettes and regulation of e-cigarette marketing may be effective in reducing young adults’ experimentation with e-cigarettes. (Am J Public Health. Published online ahead of print January 17, 2013: e1-e6. doi:10.2105/AJPH.2012.300947).

Let’s set aside obvious problems, like the limited value for anything other than historical tracking of an awareness survey about e-cigarettes from 2010, or describing 20-something-year-olds as “experimenting”, as if they are children.  (Many of those crazy kids are also experimenting with buying houses, military service, and parenthood.)  Consider the core conclusion.  How can a simple cross-sectional survey of awareness and belief tell us anything about the effects of communication and regulatory interventions?  If you said, “I have no idea”, you nailed it.  It is a complete lie that the conclusion follows from the research.

And, of course, there is the little matter of which bits of information he wants to correct.  Does he want to help the 55.5% who do not realize that e-cigarettes help smokers quit?  Or is it the 47.2% who do not realize they are lower risk than smoking?  As you might guess, it is the ones who actually know the truth that he wants to “correct”.

(Note:  I trust my regular readers will recognize as subtle ridicule my use of three significant figures in reporting those numbers.  As anyone who understands sampling — and anyone familiar with my writing — knows that reporting that level of unwarranted precision is a bit of junk science in itself.)

There is some potential usefulness in the actual survey in terms of helping us learn about the rate of at which accurate knowledge of e-cigarettes and THR has spread.  However, what has no apparent usefulness are Choi’s thoughts and opinions, as evidenced by this interview.

I will skip past his first answer, a remarkably amateurish description of what e-cigarettes are, something that could be corrected by basically anyone who is familiar with the topic.  (But go ahead and read the whole interview if you are inclined to find unintentional comedy in ANTZ rantings — it is a good one for that.)  I skip that because it gets far worse:

There are a variety of reasons why e-cigarettes are unhealthy. First, they contain nicotine, which is a known addictive chemical. A recent study conducted by Vansickel and Eissenberg found that experienced e-cigarette users can obtain a significant amount of nicotine through e-cigarettes, which may be comparable to smoking cigarettes.

E-cigarettes deliver nicotine?  Who knew?  Glad we had that study (by the guy who originally claimed just the opposite and never admitted his error — but that is another story).  And the reason that they are unhealthy is that this chemical is addictive (whatever the heck that means), not because it is harmful.  Choi might want to ask for a tuition refund from whoever claims to have taught him about health.

Second, previous chemical analyses of the e-cigarette nicotine liquid found that some samples contain tobacco-specific cancer-causing agents and anti-freeze.

Yawn.  Yes, this PhD “researcher” cannot do any better than some random county public health nurse, citing the propaganda (rather than the actual scientific results) from the FDA.  Another tuition refund, please.  Oh, but wait.  Maybe that nurse could do better.  She probably would not claim that e-cigarettes actually “contain…anti-freeze” [sic], but merely “an ingredient found in antifreeze”.  The latter form of this is an example of lying with literal truths, of course, as previously discussed in this blog (did you know that breast milk contains an ingredient found in antifreeze?!! we should stop nursing babies immediately!).  Apparently Hahn Junior does not even realize that he is reciting propaganda meant to confuse people — he is among the genuinely confused.

Third, with the product being promoted as a cigarette alternative at places where smoking is not allowed, smokers may use these products to sustain their nicotine addiction, and may therefore be less likely to quit smoking

And another “problem” that is not an actual health risk from e-cigarettes.  That “where smoking is not allowed” pseudo-argument deserves a post or two of its own, which I will do that soon.  So today I will politely refrain from pointing out how utterly moronic it is.

And that is all he offers.  Not even a single claim of health risk.  Apparently he wants to keep people from “experimenting” with e-cigarettes because they… …um… cause no health risk at all.

Oh, but it gets dumber.  So much dumber.

I think the perception of e-cigarettes as cessation aids is of the greatest concern. First, this perception may drive young adults to use e-cigarettes when trying to quit smoking instead of proven-effective cessation treatments. To date, no studies have shown that e-cigarettes are more effective than proven-effective cessation treatments such as nicotine replacement therapy and counseling. Therefore, e-cigarettes may hinder young adult smokers from quitting smoking.

E-cigarettes are (correctly) perceived as being useful for quitting smoking?  Well, that is a dire concern indeed.  As for the claim they are not shown to be more effective than other methods that are “proven” to help a mid-single-digit percentage of smokers quit (to charitably take a best-case figure from the biased research on the topic), so what?  Even setting aside the fact that he is baldly lying about that — the evidence strongly supports the claim that e-cigarettes are more effective — how exactly do they prevent someone who wants to quit smoking from trying those other methods if the e-cigarettes do not work?

Anyone with a basic understanding about smokers and quitting — even at the casual layperson level of knowing actual humans who smoke or smoked — understands that most people who are interested in quitting try multiple methods.  How exactly can one method, even if he genuinely believes it is of no value at all, interfere with the others?  Does he really think that smokers are so dumb as to say “well, I wanted to quit and tried an e-cigarette, but it did not work for me, so I will just keep smoking because I have never heard of any other method I might try.”  Gee, if only there were some way to inform smokers that the powers-that-be think they should try NRT and counseling.  Someone should really get on that.

And if Choi really believes that introducing a new method of quitting will actually prevent the use of other options, does he rail against the introduction of new NRT products or counseling methods because they will keep people from trying the existing methods he thinks are actually “proven”?  I didn’t think so.

In short, either he has not even given enough thought to this topic to be considered even a generally aware layperson, and so is grossly lying about his expertise, or he is just making up lies because he wants a ride on the ANTZ gravy train.

Is there more?  Oh, yes, there is more.  It will have to wait until the next post.

Don’t Be Fooled by the Canadian Lung Association

By Elaine Keller, with input from CASAA Board

[Note: Carl will resume his series about useful truths next week.  We have a few lies we want to cover first.]

Good health advice is any instruction or set of instructions that, when followed, results in health improvement or the avoidance of illness or injury. Bad health advice, when followed, results in illness or injury that would have been avoided by not following the advice. The public expects organizations that position themselves as leaders in fighting disease to provide good health advice that is based on accurate information.

“Don’t be fooled by e-cigarettes,” states a press release from the Canadian Lung Association (CLA). “These electronic devices could be potentially harmful to lung health” and that smokers should “avoid” them. Is it good health advice to discourage smokers from using an effective method for quitting? Clearly not, since there is overwhelming scientific evidence that smoking is harmful, not just to lung health, but in many ways. They are trying to discourage quitting by any smoker who is not willing and able to do it their way.

If they truly were concerned about lung health, they would have pointed out that there is no doubt that vaping is better for lung health than smoking. Then they would have discussed any actual concrete concerns about vaping and lung health. Instead, they just presented several irrelevant details intended to distract the reader from the truth. It might have been defensible advocacy for the lung association to say something like, “If you have quit smoking using e-cigarettes, that is some progress, but now you need to quit the e-cigarettes.”

But that is not what they did. For example, two paragraphs of the CLA press release are devoted to conjecture that the products might appeal to children. There is no evidence of this, but more important, how does this support what they are supposedly claiming, that there is a health risk? They clearly did not believe they could support their claim about health risk. And for good reason, when you consider the available evidence about e-cigarette effects on lung health.

First, consider what consumers who switched from smoking to an e-cigarette say about their lung health. For example, a University of Geneva researcher wrote, “Respondents reported more positive than negative effects with e-cigarettes: many reported positive effects on the respiratory system (breathing better, coughing less), which were probably associated with stopping smoking.”

Second, what do other sources say? In 2009, the U.S. Food and Drug Administration (FDA) invited consumers to use the agency’s Adverse Event Reporting System (AERS) to report problems experienced with using e-cigarettes. Results were reported in a letter to the editor of Nicotine and Tobacco Research. There had been 1 AE reported in 2008. There were 10 AE reports in 2009, 16 in 2010, 11 in 2011, and 9 in the first quarter of 2012. The types of problems reported are very similar to those reported with pharmaceutical products such as nicotine gum or lozenges, for example, headache, sore throat, abdominal pain, coughing, etc. The author commented, “Of note, there is not necessarily a causal relationship between AEs reported and e-cigarette use, as some AEs could be related to pre-existing conditions or due to other causes not reported.”

The author also mentioned that the number of people reporting ever an using e-cigarette more than quadrupled between 2009 and 2010. If there were any serious health risks posed by e-cigarettes, we would expect the number of AE reports to quadruple as well, but the number of reports dropped in 2011.

Third, the clinical trials that have been completed and that are in progress would be stopped if serious adverse events, such as lung health impairment, occurred. To date, no clinical trial of e-cigarettes has been stopped due to adverse events.

Under the heading, “E-cigarettes are not proven safe,” pediatrician Dr. Theo Moraes, a medical spokesperson for the CLA is quoted, “People who use e-cigarettes inhale unknown, unregulated and potentially harmful substances into their lungs.” Is this statement accurate? No, it’s a lie. It is a lie simply  because we have a quite a good accounting of what is in e-cigarette vapor. Additionally, its implication is a lie. As Dr. Phillips pointed out in an earlier post, before the first study of e-cigarette chemistry was ever done, we were 99% sure that cigarette smoke was many times more hazardous than vapor. People who smoke inhale thousands of chemicals from combustion, many of which are quite hard on the lungs (to say nothing of other parts of the body). Those chemicals are basically absent from vapor.

The substances in e-cigarette liquid are well known, and all ingredients are government-approved for human use (though not specifically in the form of e-cigarettes, of course). They include USP grade propylene glycol and/or vegetable glycerin, water, approved food flavorings, and (optionally) pharmaceutical-grade nicotine. Numerous toxicology studies have been conducted on the liquids and on the vapor, and none have found quantities of any chemical that are believed to be substantially hazardous.

The infamous FDA initial lab test is mentioned in the CLA press release, without pointing out that the “detectable levels of carcinogens” match the levels in FDA-approved nicotine patches. The “carcinogens”, tobacco-specific nitrosamines (TSNAs), are present at similar trace levels in any product that contains nicotine because nicotine is extracted from tobacco. The “toxic chemicals” turned out to be a non-harmful quantity of one chemical in one sample. Also not mentioned is the fact that the only two brands tested were the two companies that were in the process of suing the FDA, which is a red flag for bias.

Bottom line: Dr. Moraes is either deliberately misleading the public or is woefully uninformed about the contents and nature of e-cigarettes. He certainly does not understand the purpose of the products. “There are many nicotine replacement therapies approved by Health Canada to help someone quit smoking; the e-cigarette is not one of them,” he stated.

The nicotine replacement therapies (NRTs) approved by Health Canada are not aimed at helping people to quit smoking. They are aimed at treating “nicotine addiction”. They provide a reduced quantity of nicotine on a temporary basis, which is then further reduced and ultimately discontinued. E-cigarettes are not intended to treat nicotine addiction. They are used as a replacement for smoking that doesn’t require nicotine cessation.

Which works better? The vast majority of smokers who try to quit by cold turkey or using recommended medical interventions resume smoking. The published research probably overstates how often these “approved” therapies work, and even it agrees that they are nearly useless. As one example:  “Approximately 75% to 80% of smokers who attempt to quit relapse before achieving 6 months of abstinence. Of the remainder, relapses may occur years after a smoker initially quits.”  Consider what passes for “success” for NRT, such as a study comparing 6-month abstinence rates of those using NRTs versus those not using NRTs. In the first phase of the study, rates were 9.4% in the NRT group versus 3.5%. In the second phase, the rates were 6.9% in the NRT group compared with 4.3% in the non-NRT group. The authors stated, “NRT use was associated with improved chances of long‐term abstinence when controlling for nicotine dependence.” Both of these studies, as well as numerous others and simple common knowledge, also tell us that there are some smokers who are much less inclined to become abstinent from nicotine.

The critical difference between the “approved” approaches and typical e-cigarette use is that e-cigarettes do not involve becoming abstinent from nicotine. Once e-cigarette users have replaced all of their smoked cigarettes with e-cigarette use, they have stopped smoking. Because they are not required to become abstinent from nicotine, those who are more dependent or who simply are less inclined to give up the beneficial effects of nicotine, can continue to experience those benefits without destroying their health by smoking.  We do not know what portion of all smokers who seriously try to switch to e-cigarettes succeed at it, but we do have good evidence that the rate is pretty good — certainly better than quit rates using “approved” methods — and that lots of people who would not have quit smoking using those other methods have quit by using e-cigarettes.

To summarize the evidence, e-cigarettes: (i) have not been shown to harm users, based on either actual outcomes or what we can predict from the chemistry; (ii) appear to be much more effective at smoking cessation than “approved” methods, even for those who would consider quitting nicotine entirely, and (iii) are clearly more effective for those who want to quit smoking but do not want to quit nicotine.

In the final analysis, the CLA, like the American Lung Association, is a liar. The CLA says “don’t be fooled,” but the evidence says that the CLA is the one trying to fool the public. If the CLA were truly concerned about lung health, it would be doing everything possible to help smokers stop smoking as quickly as possible. If they genuinely believed that e-cigarettes left some tiny fraction of the lung risk for those who quit smoking, then they would try to address that. Instead, the CLA is actively discouraging smoking cessation by misinforming Canadian citizens about the speculative risks of using e-cigarettes and overstated claims about everyone can easily just quit nicotine entirely.

If you smoke, or care about someone who does, don’t be fooled by the CLA or ALA.  (And definitely make sure that you and people you know avoid supporting them financially.)

Glantz’s tenuous grasp of science (cont)

by Carl V Phillips

[This is a continuation of yesterday’s post on this topic and will probably not make much sense if you have not read that one.]

I will pick up the analysis with a thoughts that came up in the comments (h/t to the comment by “mav” in particular):  On the topic of whether Glantz is a liar, it is possible that he genuinely believes his absurd claims about how mere imagery of smoking is what causes people to benefit from nicotine/tobacco, and that he might have genuinely humanistic concern about the harm such images would cause.  (I.e., on that count, he is not the calculated corporate liar that dominates the tobacco control industry leadership.)  But then, it might also be that he is so worried about e-cigarettes creating such imagery (despite most of the decent e-cigarettes not looking much like cigarettes) that he is motivated to lie about e-cigarettes specifically.

There was also the observation that a single reported example of an exploding e-cigarette battery or contamination of the e-cigarette liquid is considered by the anti-harm-reduction activists to be true and worth repeatedly reporting.  So obviously they do understand the concept that a single observation is often adequate scientific evidence of a particular claim.  This argues in favor of the explanation that they are consciously lying when they deny the usefulness of personal success stories of how e-cigarettes caused someone to quit smoking.  If a personal testimonial of an exploding battery constitutes evidence, then countless testimonials about smoking cessation certainly do.

One of the reasons that both of these are so compelling is the plausibility of the claim.  Batteries (in all devices, whether they cost $5 or $200 million) do occasionally fail catastrophically, especially if someone uses the wrong kind.  Thus, it is not at all surprising that a few batteries have burned or exploded.  The e-cigarette is purpose-built for smoking cessation.   Thus, it is not at all surprising that e-cigarettes have caused lots of people to quit smoking.  There are many other examples of how to use prior knowledge in our scientific reasoning:  Since nicotine is derived from tobacco, we would expect to find a miniscule (inconsequential) trace of other molecules that occur in plants — e.g., TSNAs — in the nicotine that is used in NRTs or e-cigarettes, and indeed it has been found.  This contrasts with, say, a study of e-cigarette vapor that finds tobacco smoke combustion products that we do not expect to find; in that case, the explanation is probably sloppy lab procedure and equipment that was contaminated by previous analyses of smoke.

So for something that is easily predicted to be true, apart from the empirical evidence, we only need a little bit of empirical evidence to convince us that it is indeed true.  That evidence is valuable, though, no matter how strong the theory is.  So, recent efforts by smokeless tobacco manufacturers to bring new products to the American market have almost certainly caused some smokers to quit, but absent a bit of evidence to confirm success, it is not unreasonable to consider that conclusion less than definitive.  This relates back to the light switch point from the previous post:  We have strong reason to believe that the switch on the wall and not, say, the fact that it is 8:00 is what causes the lights to be on, so when our switch-flipping experiment seems to confirm that, we can be confident of the claim.

This does bring up the one bit of possible doubt about personal experiments:  What if someone is quite sure about a particular cause and effect, but they are wrong?  You only need to wander through the internet for a few minutes to find examples where this is pretty clearly the case.  But how could someone possibly be wrong about their smoking cessation?  Glantz tries to make up such a story by claiming “placebo effect”.

Glantz is in good company in clearly not understanding what this concept even means.  Most people who talk about placebo effects or placebo controls clearly do not understand what they are talking about.  So to explain…

The concept of a placebo, as part of a scientific inquiry, only makes sense with specific reference to context, and needs to be separate from similar but quite distinct effects.  When a placebo is referred to without a research context, it generally refers to an actual treatment method, in which someone is cured of a disease by intentionally tricking them into believing they are receiving a treatment with known benefits.  This is a good thing when it works, obviously.  To the extent that the word is interpreted this way, then for someone to quit smoking due to the placebo effects of e-cigarettes means that they quit smoking due to e-cigarettes.  Success!  (Michael Siegel wrote more about this observation yesterday.)

But that brings up the issue of what the word means in a research context, and that, rather than the intentional medical use of a placebo, is presumably what Glantz was referring to.  What would it mean for an e-cigarette to work as a placebo, rather than because… well, rather than what?  This points out that the concept of an experimental placebo has to refer to a specific characteristic of an intervention, and not the intervention in general.  Someone might wonder if the nicotine delivery from an e-cigarette really matters much, or whether the device and action itself is causing most of the effect — i.e., whether the nicotine content was merely a placebo.  In that case, the placebo control would consist of a nicotine-free e-cigarette that the subject did not know was nicotine-free.  The placebo would still be something real, as most placebos are, but not real in one specific sense.  But this would obviously not constitute a placebo if the question were “is the act of mimicking smoking useful for cessation?”  The concept of a placebo in research only makes sense when we consider the question that is being asked.

To further complicate it:  In clinical studies where some subjects are just given a sugar pill (Glantz’s example of what a placebo is), there is perhaps some placebo effect.  However, this is actually probably dwarfed by the “Hawthorne effect”, the tendency of people to behave differently just because they know they are being studied, regardless of whether anything is being done to them.  (Ironically, the Hawthorne experiment that it is named after probably actually demonstrated as much of a placebo effect as anything, but that is another story.  The concept is clearly right even though the name is wrong.)  When smoking cessation studies are performed, and it is found (as is pretty much always the case) that the NRT or other intervention had the same effect as a placebo, most of the effect is probably Hawthorne and not placebo.  That is, the cessation success rate is elevated for both groups not so much because of a placebo effect, but because people who are being studied are more likely to behave in different ways.

Indeed, I have long believed that the following intervention would have approximately the same success rate as NRT in clinical trials (or the placebos that have the same effect):  Have a reasonably attractive member of the opposite sex approach a smoker and say “I am from <organization> and we are very interested in finding out how many people are quitting smoking this year and how they are doing it.  Would you mind if I get contact information for you and check back in six months to see if you have quit?”  In both that scenario and in the real clinical studies, extra cessation (in excess of the population average rate) would mostly result from people who had been seriously thinking about quitting one of these days, and who — because they know that someone is watching them to see if it happens right now — go ahead and do it.  (We were actually considering doing that experiment when I was in Alberta, but did not manage to get it started.)

It should be obvious that both placebo and Hawthorne effects are much more likely when the outcome of interest is decision-based rather than biological.  That is, occasionally someone actually overcomes biological disease due to the power of belief, but it is much more likely for someone to choose an action because of their belief.  Indeed, people only take volitional action because of belief.  So talking generically of a placebo (rather than specifically, as with the nicotine-free e-cigarettes) when the outcome is behavioral actually makes no sense.  It seems likely that Glantz was confusing the Hawthorne effect, which occurs in study settings, with the placebo effect.  He was probably trying to suggest that since the placebo group in clinical trials quit at the same rate of those who received “FDA approved”-type interventions, that maybe that was also occurring with e-cigarettes.  But since he was talking about people making personal decisions in their normal lives and not in a study, there was probably almost no Hawthorne effect (there might have been a bit, if a friend who turned someone on to e-cigarettes was monitoring their success, but not much).

As I said, Glantz is in good company in not understanding this.  Well, I should say he is in a lot of company — the widespread failure to understand this among people who claim to be experts is not really forgivable.  When someone refers to a placebo effect, without actually identifying what specific aspect of an intervention is being replaced with a placebo, it is yet another example of someone understanding just enough about how to do science to create confusion rather than knowledge.

Is Stanton Glantz unable to figure out light switches?

by Carl V Phillips

Apologies for my ongoing fascination with Stanton Glantz.  As regular readers know, I have made a minor hobby of trying to figure out what really makes him tick, and that I sometimes hesitate to call him a liar because he seems to believe some or all of the crazy things that he claims.  I have called him out as a liar because at the very least he lies when he claims to understand what constitutes good and honest science.  Indeed, it seems impossible that he does not know he is lying with statistics in his claims about ETS.  But he might not be the calculated and knowing liar that many others are.  For example, he seems to really believe his claims that smoking in movies causes most smoking initiation; and why would someone flog such an embarrassingly nutty claim and go to war against free artistic expression except out of genuine belief?  In general, he may not even know enough to know that he does not understand science.  But he is aggressive and somewhat influential, and that makes him fair game, so….

My latest fascination is with this little post by him, which was basically just housekeeping.  The purpose of it was apparently just to explain why he deletes comments on his blog about e-cigarette success stories.  I suspect he has been deluged with those since he started becoming aggressively anti-e-cigarette.  (This is relatively new.  Previously he focused on anti-smoking.  It is not entirely clear why he has adopted this issue.)  The mere fact he posted that is interesting, and he gets props for it in my mind.  He did not do what most corporate tobacco control industry actors routinely do, which is to just censor comments without admitting they are doing so, with no attempt to justify their actions.  Instead, Glantz basically acknowledged that he was receiving such testimonials and felt that he owed people an explanation for why he would not post them. This also contrasts starkly with the behavior of someone Glantz is often inappropriately lumped in with, the self-important pre-adolescent bully boy Simon Chapman, who has a history of aggressively ridiculing people’s personal testimonials and taking joy making fun of difficulties people have suffered.  Glantz seems to be genuinely interested in being a decent person, however misguided we might think his goals.

Frankly, I have to sympathize with Glantz on this — I would not want the comments section of one of my blogs flooded with 1000 word essays that I did not consider to be informative.  Ah, but there is the problem.  Glantz’s claim that these posts are not informative brings us to his profound lack of understanding of the science he claims expertise in.  The post in question was just over 200 words, most of which were just his unsupported personal opinions about e-cigarette regulation.  The entire content that is fascinating me is:

There is a long and well-developed literature about the placebo effect where people think a treatment worked when, in fact, it was no better than a sugar pill.  Personal testimonials about the benefits of e-cigarettes do not constitute scientific evidence that they are effective ways to quit smoking. If and when there are high quality longitudinal studies showing that e-cigarettes as actually used actually help people quit smoking conventional cigarettes, I will modify my opinions on e-cigarettes as cessation aids. As of now, the reality is that such studies simply do not exist.

Let’s think about the “do not constitute scientific evidence” and “longitudinal studies” bits.  What exactly does he think a longitudinal study would show better than the testimonials?  Such a study would consist of gathering a group of current smokers and following them over time to see what they did.  Assuming these were Americans or others with similar economic and social circumstances and access to THR products, it is safe to predict that the result would be many still smoking, many becoming tobacco/nicotine abstinent, probably many switching to e-cigarettes, a fair number switching to smokeless tobacco, and a fair number switching to other nicotine products.  So assuming many switched to e-cigarettes, would that constitute particularly good evidence that e-cigarettes are an effective way to quit smoking?  Not really.

It would be possible that those who switched to e-cigarettes would have become abstinent (or would have switched to another low-risk alternative) had e-cigarettes not been available, and so e-cigarettes caused no smoking cessation.  That would be an absurd story, knowing what we know, of course.  But if we pretend, as Glantz apparently would like us to, that the study alone provides the useful evidence and nothing else does, then we would not be able to rule that out.

Why do we know that is absurd?  Because of the countless testimonials by people who tried to become abstinent before they tried e-cigarettes and did not, but that quit smoking using e-cigarettes, and moreover are delighted to be using them instead of smoking.  Those testimonials are the real scientific evidence, not the vague statistics that Glantz proposes collecting.  Any real scientist would recognize this.  It turns out that the statistics he wants to collect offer us little or no information about what we want to know — what switchers would have done without e-cigarettes.  It is that kind of information that is not scientifically useful.  The testimonials, on the other hand, are a rich source of scientific information about smokers who did not quit (they would probably say “could not quit”) until they found e-cigarettes.  These testimonials represent useful scientific experiments.

This leads to that light switch remark in the title:  I wonder what Glantz does when he walks into a new classroom [does he even teach? not sure. a scary thought for another day] and notices it is dark and not getting any lighter?  Most of us would flip the switch on the wall, and if the lights came on at that moment we would conclude that that switch causes the lights to come on and be comfortable with that knowledge and take advantage of it.  Glantz apparently would stand in the dark until someone conducted a longitudinal study, observing a group of rooms and what happened to the lights.  But after doing that study, he would still have a problem, since the data collection would inevitably not be sufficient to discriminate between whether the switches made the lights go on, or the presence of people, or certain hours of the day.  If forced to rely on that results of that study, he would still not know if that switch caused light.

Non-scientists who are being trained to appreciate the simplest forms of scientific reasoning without really learning how to think scientifically (a characterization which applies most public health and medical students) are taught that particular formal study types give us more information than do collections of less organized observations.  But real scientists learn to recognize when the simplistic rules of thumb are misleading.  We figure out that sometimes a collection of one-off experiments is worth far more than a formal study. Flipping a switch, or collecting a few hundred personal testimonials, is sometimes better evidence about what we want to know than any other practical study could be.

[This post is already running long, and I will probably come back to this theme later.  But for those who are interested right now, I wrote a paper whose major theme is further exposition of this point for a different but remarkably related topic, which you can find here.]

I will give Glantz some more credit here, though.  It is true that it is difficult to assess exactly how often something happens based on personal testimonials alone.  Unfortunately, his longitudinal study would not provide very useful information about that either, since it would be for a particular population at a particular time, and would be almost impossible to extrapolate to anyone else given how rapidly circumstances are changing with respect to e-cigarettes.  He also gets credit for not calling for clinical trials.  Again, people who half understand science think that clinical trials are always useful, or even always best.  But while they are great for studying people’s biology under fairly simple circumstances (e.g., for assessing most disease treatment options), they are generally quite poor for studying anything else, like behavior.  Something like smoking cessation involves the effects of countless complicated real-world factors that are absent from an artificial clinical setting.  (Of course, it is possible that Glantz’s real motive is that a longitudinal study would take much longer than clinical trials, and he just wants to stall.  If that turns out to be the case, I will take back several of the things I have given him credit for.)

Having spent >1000 words dissecting his 100 words, I have still not gotten to his equally fascinating lack of understanding about the placebo effect.  But discussing that will take another 1000 words, so I will leave it for tomorrow.

US Department of Health and Human Services are liars (and kinda stoopid)

by Carl V Phillips

I hope my readers in the US had a good holiday, those in the UK are recovering from being intensively aware of alcohol during #alcoholaware2012, and everyone else was productive for the last few days.  In honor of the US holiday, I present another little chapter on the past and current champion anti-THR liar on the planet, the US government.

The Department of Health and Human Services (HHS), at apparently the central-administration level (no operating division is mentioned), recently released this document that trashes e-cigarettes, and so joints its FDA, CDC, and NIH operating divisions in the anti-THR lies business.  There is really not much here that is not already pushed by the departments, but for completeness, a few words about this additional abuse of our tax dollars being used to keep people smoking.

The short document contains the usual lies that these products appeal to children (despite the lack of evidence about that, and the clear evidence that they appeal less than does smoking) and that they lead to smoking (despite the fact that this is utterly ludicrous).  Interestingly, they felt constrained enough by the evidence to not make risk claims, but instead use this to sneak in a reference that gives the casual reader the impression that they are making risk claims:

Using e-cigarettes may lead kids to try other tobacco products—including conventional cigarettes—which are known to cause disease and lead to premature death.

Yes, that’s right:  Because the product they replace is known to cause disease, e-cigarettes are bad.

They also tell us that in addition to sometimes looking like cigarettes and cigars, e-cigarettes sometimes look like pens.  While I am sure that there is some product on the market that does look like a pen, I have never seen one that could be mistaken for a pen from five feet away.  I think all they are suggesting is that they are often roughly cylindrical objects that fit in your hand, in which case they apparently also look like… well, you get the idea.

But these pale compared to the lead-off moronic lie, one I have previously covered before in other forms:

Because clinical studies about the safety of e-cigarettes have not been submitted to the U.S. Food and Drug Administration (FDA), you have no way of knowing:

  • If they are safe
  • Which chemicals they contain
  • How much nicotine you are inhaling

Seriously?  How can someone believe such a thing and still understand how to dress himself in the morning?  Did you know that since clinical studies about taking a stroll in the park (or reading this blog!)  have never been submitted to FDA, you have no way to know if it is safe?  Did you know that since clinical studies of foods have never been submitted to the FDA, you have no way of knowing what chemicals they contain and how much?  It turns out that no one in the world knows anything until something is submitted to FDA.  That is going to seriously slow down science.

(Ironically, no one has submitted studies of any type to anyone that suggest e-cigarettes appeal to children or lead to smoking.  But they have no hesitation to make those claims.)

I am sure what they must have been trying to say is that you have no way of knowing unless you have a bit of common sense and knowledge about how the world works, and know how to read.  So if you are an infant or just arrived from another planet, you definitely have no way of knowing, and therefore should probably not be vaping.

But it gets worse than that if you think about it a moment.  How, exactly, would a submission of a clinical trial of safety tell you what chemicals they contain?  And how would it tell you how much nicotine you are getting?  (I would recommend looking at chemistry studies and statements by reputable manufacturers to assess the former, and assessing your own reaction for the latter.)

I realize that people at HHS central administration are politicos and lawyers, not scientists, but geez.  Can our science education really be failing so badly that not one of what was probably a couple of dozen people who reviewed the document noticed how absurd this was?

Less absurd, but similarly wrong, is the closer:

Although e-cigarettes may be marketed as a tool to help smokers quit, they have not been submitted for FDA evaluation or approval and there is no evidence to support those claims.

The first bit is not true, except to the extent that marketers are violating US law.  The latter bit is, of course, another version of the “I am going to pretend the evidence I do not like does not exist” lie.  That statement is followed with:

There are, however, a number of FDA-approved quit-aids available to smokers, including: Nicotine gum, Nicotine skin patches, Nicotine lozenges, Nicotine oral inhaled products, Nicotine nasal spray, Zyban, Chantix

To their credit, they did not lie about this.  Those products do indeed exist and they are FDA-approved.  They never actually claimed those products work, that using them is a good idea, or that people are better off using them rather than pursuing THR.