Anatomy of a public health tweet

Professor Simon Capewell, the Vice President of Health Policy at the Faculty of Public Health, states in a tweet on […]

Capewell Tweet 30 Sept 2016
Professor Capewell is worried – but why?

Professor Simon Capewell, the Vice President of Health Policy at the Faculty of Public Health, states in a tweet on 30 September 2016.

Vaping adverts could lead children to try smoking cigarettes

But how true is that? And how much care did Professor Capewell take to ensure that it is a reasonable thing to say? Let us examine:

  1. How wrong is Professor Capewell’s tweet?
  2. How much blame is attributable to the study authors?
  3. In conclusion: what should we make of this tweet?

1. How wrong is Professor Capewell’s tweet?

The tweet links to an article published in The Daily StarVaping adverts could lead children to try smoking cigarettes, claims study – from 8 September. The Daily Star is a low rent mass circulation British tabloid. I don’t wish to be snobbish (I like The Star), but let’s just say it is not my first port of call for scientific insight. American readers, think National Enquirer.

What is in the tabloid story? It’s obvious that someone has had to work hard to get to that headline because The Star’s journalist at least has the integrity to include the following quote from the lead author of the study in the story (emphasis added):

“While we can be optimistic that the adverts don’t seem to make tobacco smoking more appealing to young people, they do appear to make occasional smoking seem less harmful.”

Oh dear, that seems to blow the story out of the water.  If only Professor Capewell had even just read the tabloid story properly, he would have found enough reason to doubt the headline and to look more closely.

It seems a speculative mechanism about occasional smoking is required to reach the headline (I shall return to this).  But the real findings actually say the opposite – something that any responsible commentator could confirm by looking at the study itself, which is easily done.

What does the actual study say? The study in question (if one bothers to look) is rather less bullish than The Daily Star. The Star’s article to refers to the following study from January 2016 (and lead author Milica Vasiljevic is quoted in the story).

Vasiljevic M, Petrescu DC, Marteau TM. Impact of advertisements promoting candy-like flavoured e-cigarettes on appeal of tobacco smoking among children: an experimental study. Tob Control. 2016 Jan; [PubMed][link]

Exposure to either set of adverts did not increase the appeal of tobacco smoking, the appeal of using e-cigarettes, or susceptibility to tobacco smoking. Also, it did not reduce the perceived harm of tobacco smoking, which was high.

Exposure to adverts for e-cigarettes does not seem to increase the appeal of tobacco smoking in children. Flavoured, compared with non-flavoured, e-cigarette adverts did, however, elicit greater appeal and interest in buying and trying e-cigarettes.

Oh dear. Even a cursory check on the abstract of the paper should have warned Professor Capewell that he was about to commit a serious error and his tweet is TOTALLY WRONG.

2. How much blame is attributable to the study authors?

The authors do seem disappointed by this conclusion, but nowhere in the abstract or full paper do they report that vaping adverts could “lead children to try smoking“.  So where did this story about occasional smoking come from?

We will come to that. But first, note how they summarise their work in the full paper:


How did the study authors approach their work? This “what this paper adds” section is quite revealing:

  • …with fears that [e-cigarette] use could lead to tobacco smoking“. Their paper does not add this, they just refer to vague evidence-free ‘fears’ (whose fears? why are they afraid?) that have never been substantiated, only asserted.  Their paper amusingly goes on to show these fears are baseless as far as e-cigarette advertising is concerned.
  • Internal tobacco industry documents…“. Ah yes, Big Tobacco.  That would be the Big Tobacco that doesn’t sell anything that can be construed as childish. They have not conducted a study of tobacco industry documents and they refer to ‘nicotine products’ to apply to e-cigarettes when any tobacco industry documents on this subject refer to tobacco, not e-cigarettes.
  • E-cigarettes are marketed in over 7764 flavours“.  They use an absurdly precise figure but it is designed to create a logical flow from the previous two statements.

This statement is revealing because it serves as an accidental conflict of interest disclosure, revealing the authors’ prior beliefs and mindset, notably their chosen framing of the issue.  It tells me they were not neutral investigators, but were looking for a link between e-cigarette advertising and smoking.

But they have to accept that their hoped-for zinger of a survey has not come up with any ammunition.  It seems kids are not daft and don’t just see an e-cigarette advert and think of taking up smoking. That should be a completely unremarkable finding given any familiarity with how normal people of any age think. So where did this story come from?

So what about the occasional smoking argument? As it turns out, for anyone looking for bad news about e-cigarettes there is some good news that can be salvaged from the study.  The lead author’s clutched at a straw in referring to occasional smoking. As Vasiljevic is quoted in The Star:

[e-cigarette adverts] do appear to make occasional smoking seem less harmful

Quite why this might be the case is unclear. But from this observation it is implied that by reducing the fear of occasional smoking there lies the path to the mythical gateway from e-cigarette ads to young people smoking.

Only let’s take a look at what the study itself has to say about their measurements of attitudes to occasional smoking. They tried three measures of attitude to smoking-related harm: (1) general smoking harm to health; (2) harm of heavier smoking (>10/day) and; (3) harm arising from smoking “one or two cigarettes occasionally”.

Perceived harm of smoking tobacco cigarettes
This was measured using three items developed by Wakefield et al: [28] ‘Smoking can harm your health’ rated from 1=Strongly disagree to 5=Strongly agree, ‘How dangerous do you think it is to smoke more than 10 cigarettes a day?’, and ‘How dangerous do you think it is to smoke one or two cigarettes occasionally?’ both rated on five-point scales, 1=Not very dangerous to 5=Very dangerous. The inter-item reliability was low for this scale (α=0.53). We therefore assessed this using the composite score and separately just the first item which has been most often used in the literature.

That means they discarded the results about occasional smoking as too unreliable to use in isolation. This is what they said in the results:

Since reliability analyses of the perceived harm of smoking tobacco cigarettes showed that item reliability for the scale was low, we also analysed the single item that is most often used in the literature; ‘Smoking can harm your health’.

As a result, the study itself doesn’t say anything about attitudes to occasional smoking. So what are we to make of Dr Vasiljevic’s quote to The Star reporter: “[e-cigarette adverts] do appear to make occasional smoking seem less harmful“?  To me it seems unethical to talk about data that were not reported to a tabloid journalist to support the point of view you appear to have held from the outset.

A more realistic conclusion:  to the extent that e-cig ads do encourage e-cigarette use by teenagers by raising interest in trying them, such ads would be more likely to be diverting teenagers from smoking. By the way, the study doesn’t show that ads do actually work in this way because the outcome measures are changes in attitudes, not behaviours.

3. In conclusion: what should we make of this tweet?

  • This is highly misleading and false spin tweeted by a vocal and opinionated anti-vaping academic who serves as the Vice President for Health Policy at the Faculty of Public Health.
  • It is based on a story placed in one of the UK’s more raunchy tabloids, but even the story itself contradicts the tweet by Professor Capewell.
  • The story bears no resemblance to the underlying study, which says the opposite – that e-cigarette advertising does not affect attitudes to smoking.
  • One of the study authors appears to have used discarded and unreliable results from the study to spin a story in The Daily Star. If so, that is disreputable and unethical.
  • The authors’ spin would be contributory negligence, but it does not absolve Professor Capewell of his responsibility to respect basic academic and communications disciplines, especially give the authority embodied in his position.
  • The abstract and full study are both easily available for fact-checking by any responsible, capable academic, or anyone representing a credible institution with concern to uphold its reputation.

I really think it is time for either a purge at the Faculty of Public Health or for the institution to close down because it has become an embarrassment. It certainly should not be in receipt of public money or charitable funds if this is its attitude to scientific integrity.  I get the feeling some of them treat this as a big game in which they are competing to be clever and witty – but it isn’t game and they are neither clever or witty.

[Note: this is may have been timed to coincide with the new Committee on Advertising Practice consultation on e-cigarette advertising, launched the day before.]

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20 thoughts on “Anatomy of a public health tweet”

  1. Andrew Thompson

    Well, seeing vaping adverts could lead youth to becoming an astronaut. Anything is possible. In that sense, his statement is both true and meaningless, the way most of the ‘research’ and commentaries on vaping are meaningless.

    ‘Could’, ‘may/might’, ‘we fear/worrying’, ‘possibly’, ‘show potential for’, ‘is associated with’ (without further evidence as to the reason for the association) are all meaningless wibble, and should be criticised as such.

    1. One gets the impression that if there were suddenly a drastic upsurge in youth cigarette smoking, people like Professor Capewell would be overjoyed.

  2. Andrew Thompson

    “While we can be optimistic that the adverts don’t seem to make tobacco smoking more appealing to young people, they do appear to make occasional smoking seem less harmful.”

    Gee, are we seeing the downside now, of not allowing e-cigarette adverts to make ‘health claims’?

    No ads for #eCigs as ‘#smoking cessation’? #NoShitSherlock!

    It seems to me that some in Public Health are both doing everything in their power to stop e-cigarettes from being successful, and then turning around and commenting (usually in a sneering (Chapman) or faux concerned (Capewell/Glantz) tone) at how they are failing! The only two reasons I can think of for this, are:

    1) They are completely unable to predict the end effect of their actions.
    2) They are deliberately sabotaging the potential of e-cigarettes to save lives of the public who smoke.

    I don’t know which is more ‘worrying’ (to borrow one of their ‘wibble terms’).

    1. 2nd try..

      occasional smoking seem less harmful.”</p>


      occasional smoking seem less harmful.”</p></blockquote>

  3. FFS! Is it not obvious that if vaping was leading people into smoking, most of those smokers who started vaping would have been back to smoking by now? Please; someone tell me exactly in simple language what is wrong with “vaping “.

    I don’t often go on a rant, especially in a public space. Not that I fear what others might think, but more so because I try to understand how it may affect others. Three years into this vaping phenomenon however has given me personal reasons to discover an overwhelming desire to share all of the benefits vaping has provided for me personally. Along with many others I have meet during my own journey; I also find myself angered more than I am used too; or perhaps comfortable with. Partly due to watching many others losing focus of the end goals of harm reduction, partly because if in real life if the chance ever comes for a face to face with individuals such as Professor Capewell and his mouthing off of arrogance and or ignorance just might set me over the edge of acceptable response.

    Regardless; I do believe it is well past time to address those trusted with the responsibility of insuring our rights and freedoms also be held accountable regarding the matter of science and political indifference. It is those front liners who have provided the difficult labor in research and study that also become victim to an overwhelming degrading of their work. Ignorance of the true science leaves many of these honest and hard working individuals credibility to question. When one’s future career becomes ransom towards any future advancements, isn’t it also time outside observers take the initiative to fully bring it to light, including additional measures on how to expose the exact wrongdoing.

    To me it is quite obvious that tobacco control is well out of control. So many have been negative;y affected by their supposed ” helping smokers ” charade. Nobody can help another if they refuse to include them in the discussion at hand. Smokers, clinicians, doctors, nurses, researchers, supporters and volunteers; alike have been missinformed, lied to and outright deceived. To me it boils down to one statement. What are we going to do about it!

    Thanks to all of you from tobacco control, health professionals, addictions, research and simply concerned fellow humans. You have all set the proper stage to do for those wh have no chance of doing for themselves. I admire and salute you. Don’t let it beat you. Solidify and all VAPERS; please… support those efforts as if our lives depend upon it.

    Ray – aka Anecdotal Evidence

  4. Roberto Sussman

    A particularly annoying feature of the Vasiljevich et al study that you analyze (twitted by Chapwell) is the usage for fear mongering purpose of the very ill defined category of “occasional smoking”. As far as I know, the relative risks for smokers in the very low end spectrum of smoking is not well studied, as it lies in the diffuse boundary between smoking and not smoking. The issue is at which point somebody actually becomes a smoker and enters as such in epidemiological studies?

    Just to look at a typical example, consider the classification in “Cigarette smoking and lung cancer – relative risk estimates for the major histological types from a pooled analysis of case- control studies” [Int J Cancer. 2012 September 1; 131(5): 1210–1219]:

    “A regular smoker was defined as someone who had smoked more than one pack-year (py) and a current smoker was defined as a regular smoker who still smoked in the year of interview or in the year before. We excluded the year of the interview and the previous year for the calculation of py, average intensity, and duration of smoking. Subjects who had ever smoked but had not accumulated one py were considered occasional smokers; these were treated as nonsmokers in this analysis”

    To be classed as “occasional smokers” requires to accumulate 20 cigarettes (a pack) per year, which means like 2 cigarettes per month. I would speculate that a lot smoke this level and less. However, to input useful and reliable statistical information on this low and volatile level of smoking (and below) is very difficult. In the article I cited, “occasional smokers” are in practice classified as “non-smokers”. In fact, I have looked at various epidemiological studies and have found the same problem: no information on risks for smokers smoking less than 1 cigarette per day.

    Therefore, even of we assume as true the contention by Vasiljevich et al: that vaping advertisements encourages people to think that “occasional smoking” is not harmful, as far as epidemiological research is concerned people making such assumption would NOT be mistaken. Of course, none of this fact checking matters for those in Public Health espousing an ideological prohibitionist agenda and pursuing a fear mongering format to publicly communicate their results.

  5. So the substance of this is the same old: anti-THR propaganda, lousy reporting, and dishonest journal authors. Indeed, it is a fairly mild case of that. So what is interesting here is the question of identity and medium.

    Your implicit premises are that people with particular roles/titles have particular obligations and violating them should be job-ending, that Capewell is such a person, and that these obligations include when they are communicating in casual media. I am not setting out to disagree with any of these positions, but I do think they bear some consideration.

    This particular tweet hardly seems to be among the most egregious. Yes, he did more than just tweet the default “tweet this” button headline, so it was a statement from him, but it was really basically just the headline. People on all sides of this debate (and every other) frequently do just that without vetting (or being capable of vetting) the headline. In this case the vetting to show the headline was easy, but that is not exactly rare. You can find plenty of examples that are pro-ecig too. Where do you draw the line? (Note that I am not suggesting total equivalence, but this is not an absurd false equivalence like “both Trump and Clinton lie”; it may be 60-40 or 70-30, but not 95-5.)

    Yes, his credentials are a reason he might have greater obligation than the average tweeter on this topic. But where do you draw the line on that? Besides, plenty of credentialed pro-ecig commentators are guilty of tweeting misleading headlines. (Again, not one-for-one equivalence, but it is not wholly one-sided.)

    But, wait. What are is professional obligations? Public health is filled with junk science claims on this topic and others. So does it become a sackable offense if there is an strong political opposition to it? Or is any clearly unsupportable tweet (reciting a headline or authored) about a health topic grounds for that?

    Moreover, what exactly is his job? It is pretty clearly accepted within public health that attacking any tobacco product in any way, regardless of accuracy, is part of the job description. So this may stand as part of what is wrong with the profession, but not an individual act of malfeasance.

    Finally, what about the question of free expression. I do notice that you do not call upon his actual university to sanction him, though some would. So presumably the suggestion is that a partially(?) government-funded organization imposes different obligations. It is difficult to see any defense of CDC official spox lying about tobacco products, as is common. But when someone exists in a self-styled (“Faculty…”) weird quasi-university environment, do those rules apply, or university rules? And does it matter that it is a tweet from a personal account rather than an official interview on behalf of the organization? Or a piece of prose that is long enough to be higher quality?

    Again, I am not suggesting my positions differ from your implicit claims (though they inevitably do at least somewhat). But I am suggesting that the leap from ‘he tweeted a falsehood that he was surely capable of seeing was wrong’ to “purge” requires a few intervening steps (which might have embarrassing implications for one’s friends — compare the current controversy about allowing 9-11 victims to sue Saudi in US courts). Otherwise it is just saying “anyone who says something false **that is a threat to my cause** should be sacked. And this inevitably starts to lose the “false” in practice.

    1. I suspect that Clive was simply hoping that people in positions of relative power should be honest brokers, a position which Capewell is clearly incapable of sustaining when it comes to vaping.

      In the case of Capewell, McKee, Glantz, Daube etc. this is obviously an untenable position, since they are well known to take any position that could damage a harm reduction perspective when it comes to smoking. I applaud Clive’s optimism, but would never consider it to be realistic.

      Capewell et al are liars, and have been for years; they’re so used to their word being taken as gospel that they think they can get away with it in the age of social media. I fondly hope that they are wrong and that they will be called to account – only time will tell.

    2. Obviously, I don’t have the time or will to perform and anatomical examination of everything that comes from this source. As you say, I didn’t challenge his right to free speech. He can talk rubbish to his heart’s content, with two caveats:

      Firstly, without violating the professional standards of the professional body in which he is a senior office holder. FPH has a Code of Good Public Health Practice which is serially violated by its senior officials. I think if you have personnel who can’t stick to an organisation’s own rules, they should be given the freedom to say what they wish outside of the organisation.

      Secondly,without expecting to be paid by other for it. I very much doubt he has private sector funding, so he is in receipt of public money and/or charitable funding. So, I think those funders – and the public that stands behind them – have a right to expect reasonable intellectual standards in return. He can say whatever he likes, but I don’t think he can expect others to pay for the privilege unless he meets some standard of quality, which I contend he often fails to meet.

      I have no objection to contrarian thinking and commentary – in fact I’d like to see much more of it. I’m objecting to intellectually flaccid nonsense pouring from these comfortably appointed academics and their hollow institutions – and the expectation they should be taken seriously and paid for the privilege.

    3. I am still fascinated by this. As I said, I was not implying any important difference in personal opinion about what a better world would look like, nor much objection to the process rules implicit in the post that would get us there. Still, I cannot really get my head for how it could be justified in this case.

      FPH is just a special-interest think tank. The job of people working for such operations is to say whatever its puppet masters (usually the funders, occasionally a leadership that has some independence from the funders) want said. Presumably he was doing his job.

      Perhaps the problem is that people do not recognize that these are special-interest activists, which is indeed a problem. Perhaps we do not want our government backing that particular special interest. Those do indeed seem to be legitimate complaints. But they are different complaints than the suggestion he was not doing HIS JOB properly.

      As for that code of conduct, the short version could be further shortened to: “be perfect in every way”, a standard that is both unattainable (so obviously he fell short) and quite malleable (so who is to say he fell short).

      As for tweeting scientific nonsense, there is probably no one working around public health, and who tweets much, who has not sometime implied endorsement of some utter nonsense claim from the field. Indeed, of the professors and think-tankers tweeting and blogging about ecigs, almost all have repeatedly tweeted unambiguous endorsements of claims that were no more scientifically defensible than the present one. (Rodu and Baeyens are the exceptions, for whom I am not sure I could come up with an example of that.)

      Is the difference merely a political litmus test, then? That if someone’s general message is the “right” one about ecigs, then their playing fast-and-loose (or genuinely ignorant) about scientific inference is not really a problem; it is only when it is the wrong message? That might not be the wisest position to take when you underlying point is “these people who are the official government-funded arbiters of what is right and wrong in this area are saying something wrong.” It seems like that heavy hammer might not end up falling where you want it to.

      1. Carl, whilst I respect your ability to argue, I think this is a silly argument. Clive’s points are very valid. And I have to agree with him, that some action needs to taken to get publically-funded ‘public health’ bodies to become accountable for what they say whilst representing those bodies.
        This is no different from expecting politicians to behave with integrity or civil servants to behave ethically. Both may be said to be wishful thinking, in this corrupted day and age, but still, these are things that the public has a right to expect from publically-funded officials.

      2. I get the impression my concerns with this are being thought of as technicalities or idle chatter. They are not. They deal with two serious issues that are each rather more important than ecig propaganda.

        First is the free speech issue. If that operation is really a “faculty”, as it claims, then he and others are very free to say what they want to say, even if it is wrong (i.e., no matter who says it is wrong). Apart from that, is it reasonable for a man to be sacked for saying something incorrect on his unofficial twitter feed.

        Second is the process issue. If FPH is properly thought of as a government contractor, rather than a student-free university, as has been implied, then are you so sure he is not doing his job correctly? Perhaps his job is to say whatever he thinks ought to be said in the name of public health, which takes it back to being faculty-like; in that case, he is doing his job. Perhaps part of his job — assigned overtly or as a nudge-nudge — is to badmouth ecigs; in that case he is doing his job. Now you might really and truly hate the idea that the government is paying someone to do that, but the recourse there is to try to change government policy, not to attack the hireling. It is similar to a military contractor who, following orders, fires a missile into a crowd of civilians. We might be so appalled we want him prosecuted. But if we start acting down that path it is a threat to the entire governmental process.

        These issues are both particularly salient because tobacco controllers are willing to throw out the rights, norms, and processes that make our society function, in the name of their silly obsession. In many ways, this is a worse crime than their war on tobacco consumers itself.

        1. I do not think that anyone in public office has a right to “free speech” if they then abuse that freedom to tell deliberate untruths that undermine the very thing that their office is meant to be working towards (in this case, public health). If a civil servant misbehaved in this way in this country, whether in their office or in their personal life, they could be disciplined – and even sacked – for bringing the civil service into disrepute.

          As for the supposition that perhaps Capewell is just doing his job (and maybe the UK government might be paying him to undermine electronic cigarettes), if that WERE true, then he would be under a duty to “blow the whistle”, since his job is to promote public health and neither his faculty nor the UK government has any mandate to promote untruths that are detrimental to public health.

          And just as we would not excuse a Nazi soldier for inhumane behaviour on the basis that he was “just following orders”, nor should we excuse a publically-funded official working in the realm of public health for promoting misinformation that is detrimental to public health on the basis that he was “under orders” to do so.

          Not that I really think that Simon Capewell WAS paid or under orders to do any such thing.

        2. Irish, you offer some arguments as to why the sanction should be applied that do respond to some of my concerns to the “it is just obvious this is ok to do to him” tone of the OP. Props for that. It turns out I do not actually find them compelling for the reasons that follow, but the fact that you offer a process argument (rather than just taking the attitude shown by the other side: “process be damned — do whatever it takes to get the outcome I like in this case”) makes this a legitimate ethical debate rather than just a power politics play.

          So for the substance, he is not in public office. As I pointed out, his title is one that implies that he is expected to act like a faculty member, not a civil servant. If we are expected to think of it otherwise, a case needs to be made for that (and the fact that his institution is government-funded is not such an argument; the same is true of most free-inquiry positions like professorships). In any case, people who actually work for government (in free countries) tend to be in one of two positions: cogs in the machine who are allowed to be private citizens on their own time (and thus can tweet what they want) or policy makers whose authority includes arguing for particular policies (even if someone else considers them to be wrong). Either way, offering an opinion (at least not one that is considered treasonous/criminal or in violation of some VERY major norm — e.g., overtly racist) is within his rights.

          The “blow the whistle” and war crimes metaphors ignore the sharp contrast between bright-line material violations of a major law or fundamental human rights and engaging in a purely speech act that is a debatable claim about specific policy area. Put another way, lying about THR may have some things in common with war crimes, but it is not so clear and it is not a matter of inflicting physical harm, and therefore it does not justify suspending incrementalism and process as war crimes might.

          Also there is the fact that it is a harder case to make that lying is lying, as opposed to shooting noncombatants. I don’t know who you are, but I will play the odds and say that you actually could not establish that he was lying if you were a prosecutor, other than by enlisting the testimony of people like me. That is not a criticism. We all have different expertise. But the point is that it is not so blindingly obvious that there is no defense for his claims (at least in some big picture, even if the details are wrong). I happen to think there is not, as apparently do you and Clive. I could write a very compelling indictment to that effect. But that is not sufficient to call for an overturning of normal process.

          Oh, and speaking of that, government officials often have the duty to make the best case for a particular position, regardless of what is True (if there is such a thing) — as with prosecutors or public defenders.

          Again, the point of all this is that ignoring proper processes and trying to assassinate individual members of the opposition is an extremist move — of the type that the other side of this fight uses — and is extremely dangerous to flirt with.

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  7. I can’t work out from this what you want to change. If you post comment saying change “…. original text ….” to “…. new text ….” I will do that and delete these comments.

    1. Roberto Sussman

      Clive, please replace the following text in my first post:

      “Likely for this reason, the “occasional smoker” category is omitted in all the article results on risk factors in the displayed tables. The article does not clarify if “occasional smokers” are in practice classified as smokers or non-smokers”

      with the following text:

      In the article I cited “occasional smokers” are in practice classified as non-smokers”.

      With this correction you can delete my second post and keep only the first post.


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