Tag Archives: Siegel

Next round of gateway claims

Posted on 12 June 2016 by | 15 comments

by Carl V Phillips

Tomorrow a new paper about the supposed gateway effect from e-cigarettes will come out of “embargo”. Over the last few days, Clive Bates and Michael Siegel have published pre-rebuttals of it (Clive basically declared as much on Twitter. Mike did not, but the timing seems like more than coincidence.) Sometime I will analyze the paper based on the framework I developed for assessing whether evidence actually supports a gateway claim (which the authors of the paper ignored). For now it is interesting to go meta. Continue reading →

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Supposed THR supporter demonstrates he still thinks like an ANTZ

Posted on 16 June 2014 by | 9 comments

by Carl V Phillips

I consider Mike Siegel to be a friend and he does a lot of good work documenting lies by the ANTZ.  With that out of the way, I found his latest blog post to be a particularly disturbing disregard of science in favor of the ANTZ propaganda that he used to embrace.  In that brief post, he flat-out declares that the death from oral cancer of a prominent baseball player was caused by smokeless tobacco use and indicates his contempt for the best-proven method of tobacco harm reduction (which is, of course, replacement of smoking with smokeless tobacco).  He employs the ANTZ propaganda tactic of elevating unsupportable sensationalist specific claims over the evidence. Continue reading →

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A paragraph-by-paragraph dissection of an unusually good article about e-cigarettes (part 3 of 3))

Posted on 25 February 2014 by | 3 comments

by Carl V Phillips

Finishing up the series that starts here, I pick up the discussion of how providing clean needles for injection drug users is a poor analogy for tobacco harm reduction.  I used it myself for a long time, but now I tend to avoid it.

First, the reduction in harm is not nearly as impressive.  Switching to smoke-free alternatives lowers the risk from smoking — which THR’s most vocal opponents insist is the absolute worst health scourge in the world — to very close to zero.  Clean needles do a lot to reduce risks that dwarf those of that “worst” scourge, but that alone leaves IDU quite dangerous.  The fact that Philip Seymour Hoffman was (presumably) using clean needles obviously was not enough.  There are more serious harm reduction strategies for IDU, that include safe injection sites, or distribution of rescue drugs combined with avoiding using heroin without someone else there to administer them.  But even in the best case, the residual risk dwarfs that of using smoking-free tobacco products (and indeed, by any reasonable measure, still exceeds that from smoking).  Thus, the analogy sells THR short.

But more important, it implicitly buys into the “everyone should quit, but [shake head, let out a sigh] if they will not, we should make it less harmful” mentality.  That is sometimes described as the philosophy of harm reduction, but this characterization is incorrect.  As I noted previously, the public debate – as exemplified by articles like the one under discussion – covers the range of opinions from A-through-P, with P being merely accepting that statement in quotation marks.  Injection drug use is, in the opinion of almost everyone (almost – keep reading) something everyone should be pushed to quit.

But if we continue a few letters beyond P, we find a recognition that THR is more like harm reduction for sexual behavior, particularly encouraging condom use.  No one in their right mind claims that “everyone should quit having sex, but if they will not….”  (I have to specify “in their right mind” because some public health advocates actively suggest abstinence is the best choice in anti-HIV education campaigns.)  Like tobacco use, sex has great benefits (for many people) and potentially great health costs that can be largely eliminated.  Yes, there are people who believe that sex is usually immoral and so pushing for abstinence, the lowest risk option, is reasonable.  But not nearly as many who have the same deranged notions about tobacco.  For both behaviors it is clear that if you get the risks low enough, abstinence not only harms happiness, but harms health also.

It is worth continuing the digression one step further, to consider the views of those who are the most genuine supporters of harm reduction for illicit drug use and sex work, rather than just using it as a rhetorical point and a way to claim broadmindedness.  They are far past P on the spectrum, and generally do not condemn the high-risk version of the behaviors even as they promote harm reduction.  They also support decriminalization of the behaviors, in sharp contrast with the P-level advocates for e-cigarettes who actively advocate further creeping criminalization of smoking.  Harm reduction is not just about health risk, but about defending people’s rights to not be punished or demeaned for their choices (whether they be high- or low-risk).  The traditional harm reduction community also includes, within the core leadership of the movement, many people who engage in those behaviors, or once did and still strongly identify with them.  By contrast, the influential people and ostensible experts who appear in the public THR debate, as exemplified by the article being discussed, include almost no one who uses tobacco products.  The exceptions tend to be when someone from CASAA (whose policies embrace the true harm reduction philosophy) or from the e-cigarette industry is allowed to have a voice.  This would not happen if the discussion were really about harm reduction.

Solid evidence about e-cigarettes is limited. A clinical trial in New Zealand, which many researchers regard as the most reliable study to date, found that after six months about 7 percent of people given e-cigarettes had quit smoking, a slightly better rate than those with patches.  “The findings were intriguing but nothing to write home about yet,” said Thomas J. Glynn, a researcher at the American Cancer Society.

The first sentence of that is so vague that it is meaningless.  The rest clarifies what it – naively – means:  We do not have useful tightly regimented experiments about smoking cessation using e-cigarettes.  That is true.  And it will always be true.  The conditions “tightly regimented experiments” and “useful” are mutually exclusive in this context.  The success of an “in the wild” harm reduction method, something that requires no formal intervention, and indeed is probably hindered by a regimented intervention, cannot be measured that way. Anyone who thinks that trial (rather than the real world) is the most reliable study to date clearly knows so little about scientific inquiry that they do not deserve to be called “researcher” (let alone “expert”).

We measure the effectiveness of seat belts in reducing harm not by putting people in seat belt clinical trials, but by observing what portion of the population use them (and crossing that with data about how much lower their risks are).  That “nothing to write home about” quip is a gross understatement.  If it were true that e-cigarettes have barely more impact on smoking than NRT, they would be a dismal failure.  But obviously they perform far better than NRT, and thus that study primarily serves to demonstrate the irrelevance of studies like that for understanding what really matters.

In Britain, where the regulatory process is more developed than in the United States, researchers say that smoking trends are heading in the right direction.

More developed?  Yes, the UK has an “indication” for THR in their medicines regulation system, which could allow for an e-cigarette to be approved as a medicine.  But none have been, and it is not clear when one will be (and it will likely be no more than one or two for a very long time).  At the same time, the national regulators arbitrarily issued a threat to ban all non-medicalized e-cigarettes in the near future, which will probably not be implemented but will be fought over.  Of course, that will become moot if Brussels overrides them and issues rules that cripple or effectively ban e-cigarettes, which is a distinct possibility despite the proponents of that action offering no cogent arguments in its favor.  If that is what “more developed” regulation looks like, we are better off taking our chances with anarchy.

“Motivation to quit is up, success of quit attempts are up, and prevalence is coming down faster than it has for the last six or seven years,” said Robert West, director of tobacco studies at University College London. It is impossible to know whether e-cigarettes drove the changes, he said, but “we can certainly say they are not undermining quitting.”

I have nothing to add to that, other than it is so nice to see real scientific reasoning in a discussion about e-cigarettes.  One wonders whether West went so far as to suggest that, though there cannot be certainty, there is decent support for the hypothesis that e-cigarettes did indeed contribute to the trend.  Such knowledge would have ruined the suspenseful movie script narrative of the article, so he might have said it and it was intentionally omitted.

The scientific uncertainties have intensified the public health fight, with each side seizing on scraps of new data to bolster its position. One recent study in Germany on secondhand vapor from e-cigarettes prompted Dr. Glantz to write on his blog, “More evidence that e-cigs cause substantial air pollution.” Dr. Siegel highlighted the same study, concluding that it showed “no evidence of a significant public health hazard.”

The first sentence of this is the leading reason why I credit Tavernise with writing a genuinely good article.  Though buried, this is really the most important thesis of the entire piece, and it takes an insightful neutral party to say it because partisans are too busy seizing scraps.

The insight is further buried by being tacked onto a paragraph about dueling interpretations of a study, neither of which actually looked at the real science.  The scientific reality is that the study was fatally flawed, and should be mainly interpreted as worthless.  This further bolsters Tavernise’s observation about “scraps of new data”, though the reader would never know just how how  paltry those scraps are because the he-said-she-said approach omits any scientific analysis.

That Big Tobacco is now selling e-cigarettes has contributed to skepticism among experts and advocates.  …blah blah blah…
“Part of the furniture for us is that the tobacco industry is evil and everything they do has to be opposed,” said John Britton, a professor of epidemiology at the University of Nottingham in England, and the director for the U.K. Center for Tobacco and Alcohol Studies. “But one doesn’t want that to get in the way of public health.”

Usually the seemingly-mandatory references to evil big tobacco in a story about THR is a tangential throwaway.  In this case, something very insightful comes out of it:  “Part of the furniture.”  It is just there.  It is there because someone put it there a very, very long time ago (we are talking about English university furniture, after all) for purposes that have nothing to do with present reality.  No one thinks about whether it ought to be there.  No one considers moving it.  It just has to be – tradition and all that, mate.

Carefully devised federal regulations might channel the marketing might of major tobacco companies into e-cigarettes, cannibalizing sales of traditional cigarettes, Dr. Abrams of the Schroeder Institute said. “We need a jujitsu move to take their own weight and use it against them,” he said.

Back to the furniture themes about how “public health” has to exert control over the dumb animals (us), and how everything good comes results from commands from the top, not from free choice.  Still, I have to think that Abrams is clever enough to know that large successful corporations are not large and successful because they are stupid enough to let their strength be used against them.

Perhaps what he really meant is leveraging their inclination to promote their low-risk products at the expense of cigarettes (not at the expense of themselves).  That makes a lot of sense.  One could go further and speak of assisting their organic efforts to promote the alternatives.  This is certainly part of the most effective road toward greater THR.  But many anti-industry activists (not so much “advocates” and definitely not “experts”) have hardened their violently anti-THR positions (“skepticism” grossly understates it) because of this.  The A-through-P debate has thus become even more impoverished because the only acceptable opinions about the role of “Big Tobacco” are the ones embedded in the furniture.

And finally:

“If we make it too hard for this experiment to continue, we’ve wasted an opportunity that could eventually save millions of lives,” Dr. Siegel said.

Dr. Glantz disagreed.

“I frankly think the fault line will be gone in another year,” he said. “The evidence will show their true colors.”

Siegel is obviously correct.  Glantz scores about 1/4 correct:  The evidence will show more-and-more over time, of course, as he says.  But he is wrong in believing that very much new will be learned this year.  His innuendo that the new evidence that will somehow be contrary to all the evidence so far is about as anti-scientific as you can get (call it faith-based Bayesianism: having such a strong prior belief that, no matter what the evidence says, your posterior believe is still that all future evidence will show you are right).  Perhaps “genuinely delusional” needs to be added to the list of hypotheses, alongside “sociopath” and “senile”.  But most wrong of all, as he would know if he could correctly analyze even himself, is the notion that the fault line will not be gone.  He and his tiny cabal of extremists will say the same thing in February 2015 (and 2016, and 2017…) as they are saying now, no matter what happens in between.

And, unfortunately, the press will still be reporting their rants as if they represent an expert view.  Even in the surprisingly good articles.

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A paragraph-by-paragraph dissection of an unusually good article about e-cigarettes (part 2)

Posted on 24 February 2014 by | 9 comments

by Carl V Phillips

Continuing from yesterday’s post dissecting this NYT article by Sabrina Tavernise, we pick up with:

Pessimists like Dr. Glantz say that while e-cigarettes might be good in theory, they are bad in practice. The vast majority of people who smoke them now also smoke conventional cigarettes, he said, and there is little evidence that much switching is happening. E-cigarettes may even prolong the habit, he said, by offering a dose of nicotine at times when getting one from a traditional cigarette is inconvenient or illegal.

As noted previously, Glantz differs from some e-cigarette “pessimists” in his sociopathic willingness to repeat obvious lies.  Most notably, there is a huge amount of evidence about switching.  More subtly, there is no basis for claiming most people who vape are also still smoking.  We know that most smokers who have tried an e-cigarette are still smoking, contrary to the “they are a miracle” view, but we have relatively little information on how many e-cigarette users (by any normal interpretation of the term — i.e., not merely someone who has tried one or takes a puff on one periodically) still smoke.  The spotty evidence that exists suggests that most who have become regular e-cigarette users have become non-smokers or have moved far in that direction.

As a minor aside, it is worth noting that in some places, the verb “smoke” is used to refer to vaping an e-cigarette, but in the USA it tends to only show up when the author only did five minutes of research before claiming expertise on the topic (e.g., most local news reporters) or by someone who thinks that smoking is evil and wants to extend that to vaping.  Though it is not presented as a direct quotation, this paragraph appears reflect Glantz being in the latter category.

The last sentence is an out-and-out confession that tobacco control, and “public health” in general, is not about helping people, but about demanding obedience and intentionally hurting people if they are not obedient.  Basically it says, “we intentionally harm smokers, such as by limiting where they can smoke, for the purpose of lowering their quality of life so much that they are better off obeying our diktats.  E-cigarettes offer a way to relieve some of the imposed suffering, and we can’t have that.”  Of course, the same can be said about NRT, but is not.

That sentence, and the paragraph in general, illustrate a point about those who accept or even embrace e-cigarettes, but are still part of “public health” or the medical industry rather than really believing in the principles of harm reduction:  Glantz tells these lies because if they were true, his fellow “public health” people would conclude that e-cigarettes are bad.  But a real supporter of harm reduction — and indeed, any decent human being who actually cared about people — would still conclude e-cigarettes are good.  Even if the all lies were true, it would still be the case that some smokers are freely choosing to switch completely to e-cigarettes (good); some smokers, who now can choose to smoke, vape, neither, or both, find that “both” is the choice that is best for them (also good — those making that choice must like it better than just smoking); almost all of those choosing “both” are smoking less (good for their health); and the harm suffered by smokers from not being able to smoke in certain circumstances is also reduced (good, assuming you actually care about people).

Harm reduction inevitably increases total consumption; lower the cost of something and more people will consume it.  For THR, this primarily means that as low-risk tobacco products are developed and people understand them, there will be more total tobacco users.  Some people who would have been abstinent from all tobacco in a world without e-cigarettes — including some who would have never smoked at all — will decide to become vapers.  But in the weird world of tobacco politics, this has an unusual implication:  One of the harms suffered by smokers is having to go outside for a smoke, and smoke-free alternatives reduce that harm too.  The inevitable result of harm reduction, then, means that since smoke-free alternatives lower the cost of smoking a bit, they will cause some smoking that would not have otherwise occurred (albeit, probably very little).

In the “debates” that you see in the newspaper, almost everyone represented is of the opinion that this outcome is wholly bad, differing only in what they think (or pretend to think) about how this cost compares to the benefits.  The opinions that are allowed into the public debate cover the spectrum of views from A (abject hatred of all tobacco products and users, and a fantasy belief they can both be eliminated) through about P (reluctant acceptance that people will use tobacco and a belief that it is not too terrible, so long as it is low risk). Often there will be one line of praise from an enthusiastic user or shopkeeper who is at Z (though often only for e-cigarettes, and he is closer to A for other tobacco products).  Every so often there will be a technical acknowledgment of the benefits of nicotine.  But completely missing from the institutionally sanctioned “debate” is anyone who believes that something that makes people happier overall is good, even if it makes them less healthy compared to abstinence — which is to say, anyone who truly believes in the philosophy of harm reduction.

I will come back to this.

What is more, critics say, they make smoking look alluring again, with images on billboards and television ads for the first time in decades. Dr. Glantz says that only about half the people alive today have ever seen a broadcast ad for cigarettes. “I feel like I’ve gotten into a time machine and gone back to the 1980s,” he said.

I wonder if Glantz realizes that his recall of history that he lived through is as poor as his interpretation of study results?  No one has seen a television ad for cigarettes in the USA since the 1971, when they were banned (which means that well over half the population has not seen such an ad on domestic television). Perhaps Tavernise garbled his point and he was referring to cigarette billboards (though I do not recall seeing any of these for e-cigarettes), which did exist in the 1980s — but, um, also through the 1990s.  I suppose “senile” is a valid alternative hypothesis to “sociopath”.

Of course, that is not the main problem with the claim.  How can touting a smoke-free product that is all about anti-smoking make smoking look alluring? Those “critics” seem to never explain this, and the reporters — even when they are writing a basically solid story — do not bother to ask.

Researchers also worry that e-cigarettes could be a gateway to traditional cigarettes for young people. The devices are sold on the Internet. The liquids that make their vapor come in flavors like mango and watermelon. Celebrities smoke them: Julia Louis-Dreyfus and Leonardo DiCaprio puffed on them at the Golden Globe Awards.

I could have been charitable and skipped this paragraph, but I was so baffled about how it relates to the narrative, or even to itself from one sentence to the next, that I just had to comment.  It seems to be where some leftover sentences got dumped.

Of all the reasons that entertainers are terrible role-models, their choice to vape — or for that matter, to smoke or shoot heroin — is nowhere close to the top. Also, I would have emphasized Jenny McCarthy, who claims (contrary to reality, and at great expense to society) to have expertise on public health, rather than non-political entertainers who just happen to live on camera.  But since Tavernise did not actually go anywhere with this, it is hard to figure out what the point was supposed to be.

The first sentence is made substantive by the next paragraph:

A survey from the Centers for Disease Control and Prevention found that in 2012, about 10 percent of high school students said they had tried an e-cigarette, up from 5 percent in 2011. But 7 percent of those who had tried e-cigarettes said they had never smoked a traditional cigarette, prompting concern that e-cigarettes were, in fact, becoming a gateway.

As has been discussed extensively in this blog, these statistics have been widely misinterpreted, including by the CDC itself.  But this paragraph is worse than usual.  Notice the switching between percent of the entire population and percent of that percentage.  Most readers are going to interpret this as saying “10% had tried, and 7/10 of those had never smoked (i.e., 7% of the population had tried e-cigarettes and had never smoked)” when actually it says “a mere 7/100 of those who tried e-cigarettes had never smoked (i.e., 0.7% of the population).”  Moreover, not only is the gateway claim unsubstantiated, but is not supported by this observation at all:  Someone who has tried an e-cigarette and does not smoke is obviously not a gateway case.

“I think the precautionary principle — better safe than sorry — rules here,” said Dr. Thomas Frieden, director of the C.D.C.

That is not what the precautionary principle says.  That phrase is used incorrectly at a rate that may even exceed the misuse of “epicenter” or “socialist”.  While it is not well-defined, the actual precautionary principle basically says that we should not allow someone to inflict involuntary harms on others, particularly if the action is difficult to reverse, without first providing evidence that the harms are acceptable.  For example, the burden of proof should not be on those who fear that building massive “renewable” energy facilities causes harm, defaulting to allowing it them until someone proves it they are harmful, but rather on the builders to do the research in advance to show they are not too harmful, defaulting to forbidding it until that is established.  It is a reasonable standard for the environmental impact situations for which that principle was created.  It is not relevant to consumer products. The consumers are making a free choice that affects only themselves, and there is nothing irreversible about it.

This illustrates how “public health” treats people as adversaries rather than the basis of concern, and how the mainstream media never calls them on it.  A company that wants to site a noxious facility is in an adversarial relationship with people who might be hurt by it, and so there is a need for regulation about whether the action is allowed (as opposed to just quality control and truth in advertising rules, which are almost always appropriate) and the precautionary principle is arguably appropriate.  This does not describe choices about tobacco products (or soda, food, etc.), where the decision maker and the only “victim” of consequence are the same person.  This is perhaps the defining characteristic of the “public health” political faction, conflating individual choices with adversarial situations with imposed harms.  (Aside:  extremist “free market libertarians” make exactly the same mistake — conflating personal choices and actions that impose major external impacts — but conclude that because the former should be free, the latter should also.)

Focusing on the speaker rather than the message for a moment, here is where some knowledge about the history of THR would be useful.  The CDC and those who currently control it were blatant anti-THR liars long before e-cigarettes came along.  Everything they say about e-cigarettes needs to be filtered through that background knowledge.  Interestingly, that is not true of Glantz, who was largely silent about THR before e-cigarettes, even as he was authoring some of the most extreme anti-smoking lies.  This lends credence to the theory that he hates e-cigarettes because he genuinely believes they encourage or glamorize smoking, which he obsessively hates, or even that they just mimic it.  By contrast, Siegel was aggressively anti-THR before e-cigarettes, and that contradiction is more difficult to explain.

E-cigarette skeptics have also raised concerns about nicotine addiction. But many researchers say that the nicotine by itself is not a serious health hazard. Nicotine-replacement therapies like lozenges and patches have been used for years. Some even argue that nicotine is a lot like caffeine: an addictive substance that stimulates the mind.  “Nicotine may have some adverse health effects, but they are relatively minor,” said Dr. Neal L. Benowitz, a professor of medicine at the University of California, San Francisco, who has spent his career studying the pharmacology of nicotine.

Ok, fine.  But notice the non sequitur — another one that is common in the discussions and not just an artifact of Tavernise’s article.  The first sentence is about addiction, but the rest are about consumption, whether there is “addiction” or not.  It points out the fact that not only does “addiction” not have a real definition, but most of the time that it is used, it means nothing more than “engaging in a behavior that the speaker believes is immoral.”

Another ingredient, propylene glycol, the vapor that e-cigarettes emit — whose main alternative use is as fake smoke on concert and theater stages — is a lung irritant, and the effects of inhaling it over time are a concern, Dr. Benowitz said.

Um, sort of.  Its most common other use as an aerosol is fake smoke — it has a zillion non-aerosolized uses.  The aerosol is also used in some inhaled medicines.

Perhaps the reporter should have quoted someone with expertise on exposures other than nicotine regarding the non-nicotine aspects of the exposure.  It is true that the exposure is great enough and sufficiently novel that problems might be discovered, and it is worth watching for them.  But that conclusion, from someone who actually knows about exposures other than nicotine, is about keeping an eye on it, just in case, not the alarmist “are a concern” that feature story reporters prefer.

But Dr. Siegel and others contend that some public health experts, after a single-minded battle against smoking that has run for decades, are too inflexible about e-cigarettes. The strategy should be to reduce harm from conventional cigarettes, and e-cigarettes offer a way to do that, he said, much in the way that giving clean needles to intravenous drug users reduces their odds of getting infected with the virus that causes AIDS.

Therein lies a very interesting question.  Is THR really all that similar to injection drug use harm reduction?  And do the public health (to say nothing of the “public health”) people who support smoke-free alternatives really believe in the core values of harm reduction.  Yes and no.

The adoption of the phrase “harm reduction” in the tobacco context was a conscious reference to approaches like needle exchanges for IDU.  The comparison was certainly useful for getting the concept established, and I used it many times for a decade.  But with the term established (and with hopes of getting institutions that support IDU harm reduction to also support THR having proved a dismal failure in spite of focused efforts by me and others — another thing that is useful to know about THR), the analogy now seems to do more harm than good.

More on that in the next post.

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A paragraph-by-paragraph dissection of an unusually good article about e-cigarettes (part 1)

Posted on 23 February 2014 by | 9 comments

by Carl V Phillips

Most of what gets published in newspapers about tobacco products is complete garbage, written by someone whose research and critical thinking abilities seem to be at about the level of a middle-school report.  Thus, this article about e-cigarettes in the New York Times by Sabrina Tavernise was extremely refreshing.  By virtue of that, it is a great opportunity to explore some of the common misconceptions, oversimplifications, and narrow thinking that appear in the intelligent discussion of the topic.  Dissecting the usual drivel gets pretty useless after a while, but this is different.

After introducing Stanton Glantz and his protegé and reluctant antagonist, Michael Siegel, the Tavernise continues:

These experts represent the two camps now at war over the public health implications of e-cigarettes. The devices, intended to feed nicotine addiction without the toxic tar of conventional cigarettes, have divided a normally sedate public health community that had long been united in the fight against smoking and Big Tobacco.

Reporters like to turn slow-moving, complicated, and broad political fights into movie scripts.  Perhaps this paragraph is just an example of that.  But there does seem to be a genuine misconception that the fight about THR is new, and that there is something unique here.  In reality, that fight has been going on a long time, and the “public health” political movement has jumped the shark on this and numerous other issues (“Big Food”, 20 ounce sodas, smoking in cars, helmet laws, you name it) and has lost the support of many who are genuine public health advocates and researchers.  This is important context for understanding this fight.  There is, in fact, nothing unique going on here.

Also, it is not entirely fair to the anti-THR faction to claim they are represented by their court jester, Glantz.  Many of them are just as dishonest and evil as he is, but are not cartoon villains who spout easily verifiable lies.  It probably is reasonable to use Siegel as a representative voice in the narrow fights about e-cigarettes, but he is not a supporter of harm reduction more generally, or of individual freedom.  This may make him the “public health” faction’s pro-ecig guy, but missing from this entire movie script are the many voices from outside that faction.

The essence of their disagreement comes down to a simple question: Will e-cigarettes cause more or fewer people to smoke? The answer matters. Cigarette smoking is still the single largest cause of preventable death in the United States, killing about 480,000 people a year. Dr. Siegel, whose graduate school manuscripts Dr. Glantz used to read, says e-cigarette pessimists are stuck on the idea that anything that looks like smoking is bad. “They are so blinded by this ideology that they are not able to see e-cigarettes objectively,” he said. Dr. Glantz disagrees. “E-cigarettes seem like a good idea,” he said, “but they aren’t.”

The exaggerated toll from smoking and the “preventable” trope, in this context, matter little, so I will not dwell on them.  The notion that anti-ecig activism is motivated by vaping looking like smoking is far too narrow, and falls into the movie script simplification:  That seems to be what Glantz is motivated by, but it does not generalize.  The main motivation seems to be that THR stands in the way of “tobacco-free world” goals, as I have discussed at length, and is bad for business (it hurts the revenues of institutions and individuals who depend on concerns about smoking, and to a lesser extent those who sell anti-smoking products).

Science that might resolve questions about e-cigarettes is still developing, and many experts agree that the evidence so far is too skimpy to draw definitive conclusions about the long-term effects of the devices on the broader population.

“The popularity is outpacing the knowledge,” said Dr. Michael B. Steinberg, associate professor of medicine at the Robert Wood Johnson Medical School at Rutgers University. “We’ll have a better idea in another year or two of how safe these products are, but the question is, will the horse be out of the barn by then?”

The first bit of that seems like a simple statement of fact, but it is not. Following on the issue of whether e-cigarettes reduce smoking, the incorrect implication is that research on current behavior could tell us much about that.  But then notice the unacknowledged switching from the question of smoking cessation to the question of exactly how hazardous e-cigarettes are in themselves (which, incidentally, we also will know very little more about “in another year or two”). This conflation and changing of topic is a common tactic by anti-THR activists and a common error by non-activist commentators.  These are very different questions.

Equally interesting is the “horse out of the barn” metaphor, which seems to represent a common view.  First, it illustrates the ruling class attitude of “public health”, suggesting that their job is to control dumb animals, rather than to advise free and rational people.  Second, is patently wrong.  THR products can and will be improved upon over time.  And have been: worry about nitrosamines in smokeless tobacco (probably overblown, but leave that aside) has resulted in a huge reduction in their concentration over the last few decades.  E-cigarettes will be improved and the current technology will probably be mostly displaced by others.  In the extremely unlikely event that something very hazardous is found, many people will rationally choose to switch products, as happens all the time with other goods.  There is nothing irreversible here other than the embrace of THR and the rejection of the abstinence-only orthodoxy.  That, of course, is the main motivation of anti-THR.

After a couple of paragraphs about FDA regulation:

And many scientists say e-cigarettes will be truly effective in reducing the death toll from smoking only with the right kind of federal regulation — for example, rules that make ordinary cigarettes more expensive than e-cigarettes, or that reduce the amount of nicotine in ordinary cigarettes so smokers turn to e-cigarettes for their nicotine.

Activists who trust only themselves and believe they should control people do say that (though I would not suggest they should be described as either many or scientists).  But is it even a little bit plausible?  THR will replace smoking because it lowers the risk and keeps a lot of the benefits.  It is certainly true that high taxes on cigarettes (having nothing to do with “the right kind of federal regulation”) make e-cigarettes more appealing (just as high taxes on smokeless tobacco make that approach to THR less appealing).  But in most jurisdictions, the starter e-cigarette products are not cheaper than smoking, but people are still making a rational choice to switch.

What is more interesting to people who look beyond rich countries, is the issue of offering affordable THR products to the rest of the world.  Even if there were not cigarette taxes that made them price competitive, e-cigarettes would be affordable to Westerners.  But their real resource cost is so much higher than cigarettes that they are prohibitively expensive for most of the world’s population.  Since the article is exclusively focused on the USA, it is understandable that this is not mentioned, but it is still bothersome to make such general statements about tactics when they are only relevant to a small fraction of the world’s tobacco product users.

As for reducing the nicotine in cigarettes, this madness has been a pet fantasy of a few dozen people who now have a lot of influence.  But unless the goal is to actualize Glantz’s fantasy world where e-cigarettes are used primarily as a supplement to smoking rather than a substitute, it is insane.  Smokers who just want nicotine will switch products anyway.  With less nicotine in cigarettes, some people who want to smoke will smoke more, while others will supplement (and that does not require e-cigarettes, by the way: enroll in a stop-smoking program and get free nicotine patches, slap one on, keep smoking).  And, of course, the black market will benefit nicely from being able to offer not just a cheaper product than is available legally, but one that is higher quality — that is, assuming there is not an easy DIY recipe (“I have a bottle of inexpensive e-cigarette liquid in this hand and a cigarette without enough nicotine in my other hand.  Hmm….”; possible added bonus: flavored cigarettes!).

“E-cigarettes are not a miracle cure,” said David B. Abrams, executive director of the Schroeder National Institute for Tobacco Research and Policy Studies at the Legacy Foundation, an antismoking research group. “They need a little help to eclipse cigarettes, which are still the most satisfying and deadly product ever made.”

Despite being a card-carrying tobacco controller, Abrams has emerged as one of the most cogent voices on the topic.  It is not entirely clear whether he is responsible for the unfortunate preceding paragraph, about trying to lower the quality of cigarettes.  The quote seems to endorse it, so perhaps.  But maybe he is just pointing out that these particular products are not for everyone. Somehow lost in the fanaticism on both sides is the simple fact that like the THR products that predated them, e-cigarettes appeal to some people but not everyone.  As noted above, we are missing a lot of useful data, but we do know that most smokers who have tried e-cigarettes are still smokers.  People who find them appealing — and those who breathlessly call them a miracle or the greatest health technology breakthrough since penicillin — seem to overlook this.

I will skip over the standard background paragraph on e-cigarettes and uncritical reporting of the breathless predictions about the market from the usual stock flogger (who seems to exemplify the unawareness cited in the previous paragraph).  In the interests of length, I will also break here and resume this in my next post, picking up with:

Pessimists like Dr. Glantz say that while e-cigarettes might be good in theory, they are bad in practice. The vast majority of people who smoke them now also smoke conventional cigarettes, he said, and there is little evidence that much switching is happening. E-cigarettes may even prolong the habit, he said, by offering a dose of nicotine at times when getting one from a traditional cigarette is inconvenient or illegal.

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