Canada takes a wrong turn after a flawed paper induces moral panic about youth vaping and smoking

Canada takes a wrong turn after a flawed paper induces moral panic

Summary

In June 2019, an influential and well-respected research group published a paper in the BMJ showing both a sharp rise in youth vaping in Canada between 2017 and 2018 – mirroring the rise in the United States.  But the truly shocking finding was that there had also been a sharp rise in youth smoking (not seen in the United States).

Starting from well before publication, the paper had a strong negative influence on Canada’s approach to tobacco harm reduction, causing a reversal from a promising and insightful pro-public health approach to making ad hoc responses to a mounting moral panic.  Yet it turns out the smoking figures were wrong – a consequence of a flawed weighting procedure.

By July 2020, a correction had been issued in the BMJ noting that with revised weighting, smoking had, in fact, fallen.  But, absurdly, the correction was buried in a statistical supplement and the published paper still states, inaccurately, that youth smoking increased in its results and conclusion.  The discussion section of the paper continues to discuss an increase in smoking that never happened. Given the political salience of this paper, a proper correction or retraction and resubmission is essential.

In this blog post, I unpick what happened and when. I finish with thoughts on lessons for researchers using this type of research to promote regulatory policies. Continue reading “Canada takes a wrong turn after a flawed paper induces moral panic about youth vaping and smoking”

The past is not the future – what lies ahead for tobacco and nicotine?

“Prediction is very difficult, especially about the future” – Niels Bohr, Physicist

Let’s have some debate on the future of tobacco, nicotine, tobacco control and the tobacco and vaping industry. Here are three provocative pieces to get things moving. Continue reading “The past is not the future – what lies ahead for tobacco and nicotine?”

Louise Ross: Pragmatism versus dogma: freeing the inner vaper in smokers – Michael Russell Oration 2020

The highlight of this year’s Global Forum on Nicotine will be the Michael Russell Oration given by the superb Louise Ross on 11 June 2020.  Louise has kindly given permission to reproduce the text of her oration on this blog. This joins the collection of outstanding writing by Louise we host here on the Counterfactual.

My reaction on Twitter…

So here it is, the tex as given… and if you prefer, please see video below. Continue reading “Louise Ross: Pragmatism versus dogma: freeing the inner vaper in smokers – Michael Russell Oration 2020”

International experts in tobacco policy say WHO is blocking innovation and wasting opportunities to save millions of lives

WHO NCD poster
WHO Tobacco Free Initiative and Framework Convention on Tobacco Control – you have one job!

As the World Health Organisation’s World No Tobacco Day takes aim at low-risk alternatives to smoking, several international experts have made critical comments in response. Continue reading “International experts in tobacco policy say WHO is blocking innovation and wasting opportunities to save millions of lives”

US vaping lung injury outbreak was a public health fiasco or worse – comment to FDA

Public health actors are now routinely more manipulative than Big Tobacco ever was

Update: I subsequently published a detailed rebuttal of the claim that nicotine vaping is implicated in these lung injuries: The outbreak of lung injuries often known as “EVALI” was nothing to do with nicotine vaping, Qeios, July 2021.


The Food and Drug Administration of the United States has requested information on “Vaping Products Associated With Lung Injuries” – see Regulation.gov and Docket FDA-2020-N-0597 to make a submission or read the views of others.

In my view, the sly attribution of this problem to e-cigarettes and nicotine e-liquids by activists, academics and supposed public health agencies has been as bad as the worst ‘merchants of doubt’ operations of Big Tobacco in the 1970s.  I have labelled it a mere “fiasco” only out of politeness because the word implies that only incompetence and negligence lay behind it.  But I think it was much more deliberate than that – and we know that because virtually nothing has been done to correct misperceptions that were created and spread across the US and worldwide from July to December 2019.

I don’t wish to indulge this propaganda operation by providing straight-up evidence to the FDA on this.  Pretty well everything that needs to be known is already known about the cause and consequences. What is missing is a truthful account of the response.  So instead, I would like to take the opportunity to speak truthfully and directly about what was done here. So here is my brief response to FDA’s call for information.

Continue reading “US vaping lung injury outbreak was a public health fiasco or worse – comment to FDA”

New nicotine science and policy Q & A published

I have just published a new question and answer (Q & A) resource on nicotine science and policy.  It is available as a page accessible from the top menu of this blog and also at this address: Nicotine science and policy Q & A.  I am hoping to keep it up to date… the questions as they stand at present are as below.  My answers are on the Q & A page above – please visit, leave comments, suggestions for other questions, better answers or further reading. Continue reading “New nicotine science and policy Q & A published”

World Health Organisation fails at science and fails at propaganda – the sad case of WHO’s anti-vaping Q&A

WHO’s anti-vaping propaganda is so bad it discredits the whole organisation

On 20 January 2020, the World Health Organisation published a question and answer page on “ENDS” (Electronic Nicotine Delivery Systems) or e-cigarettes and vaping products for nicotine as they are more commonly known: E-cigarettes: how risky are they? (current live version)

Update (31 January 2019) – WHO’s amended version: almost certainly in response to severe criticisms, WHO published an update to its Q & A some time on 29 January.  The 20 January original version, (archived) which WHO heavily publicised (e.g. see Twitter thread) is the subject of this blog, not least because it allows debunking of some especially absurd anti-vaping statements.  WHO has not notified readers of the changes or issued any acknowledgement of correction or error. So for comparison purposes, I have compared the original and updated versions side-by-side in the final section of this blog: go to Update: what WHO has changed.  Much of my original criticism applies to the amended version, which mainly removes some of the most blatantly false and misleading statements. Update ends.

There are nine questions and every single answer provides false, misleading or simplistic information, and this remains true of the 29 January update.  It is a disgraceful travesty of science communication and policymaking advice and again puts in question the competence of the WHO – if there is still any doubt about this. But it is so bad that it even fails as anti-vaping activist propaganda – and that is a low bar.

I will briefly set out the nine questions in the original Q&A and the World Health Organisation’s answers in quote boxes, each followed by my assessment of the answer. Continue reading “World Health Organisation fails at science and fails at propaganda – the sad case of WHO’s anti-vaping Q&A”

Vaping is still at least 95% lower risk than smoking – debunking a feeble and empty critique

An empty and feeble critique misses its target and adds nothing

This paper turned up in my weekly search of PubMed.

Invalidity of an Oft-Cited Estimate of the Relative Harms of Electronic Cigarettes.
Eissenberg T, Bhatnagar A, Chapman S, Jordt SE, Shihadeh A, Soule EK.
Am J Public Health. 2020 Feb;110(2):161-162. doi: 10.2105/AJPH.2019.305424.

The commentary claims to show the “invalidity” of the statements made by Public Health England (PHE) and the Royal College of Physicians (RCP) regarding the relative risk of vaping and smoking – in short that vaping is likely to be at least 95% lower risk than smoking.  As this is an important harm-reduction risk communication, it is worth asking: how valid is this critique?

I thought this might be a better critique than it actually is. But somewhat to my surprise, it is very poor indeed.

Short version

At best, the authors try to show the absolute risk of vaping is not zero and that some harm is plausible. In doing so, they are refuting a claim that neither PHE or RCP make and challenging an argument not used by anyone sensible in tobacco harm reduction. However, not a single word of their paper addresses the supposed foundation of their critique – that PHE/RCP are wrong and the risks of vaping are likely to exceed five per cent of those of smoking. As well as a number of baseless assertions that are not even relevant to the “at least 95 per cent lower” relative risk claim (gateway effects, smoking cessation efficacy and second-hand aerosol exposure), there is just nothing in the paper about the relative magnitude of smoking and vaping risks. No analysis, no data, no evidence – nothing that discusses relative risk and why PHE/RCP are supposedly wrong. Niente. Nada. Rien. Nichts. Nothing.

New (20 Jan 2020). See concise comment on PubPeer here: A critique that does not even address its target

Anyway, despite being an empty and feeble piece of work, it does provide an opportunity to discuss some of the issues raised, so I will proceed with a critique.

Longer version

The authors’ supposed refutation of PHE/RCP rests on six propositions.  You can read the article here and I will respond to the authors’ main points in the order they make them. Continue reading “Vaping is still at least 95% lower risk than smoking – debunking a feeble and empty critique”

Brexit and vaping

In this post, I try to anticipate what Brexit means for the UK, for the Tobacco Products Directive and what that might mean for UK and European vapers. it’s in two parts because we need to speculate a little on how Brexit will play out and then how that will affect the TPD compliance in the UK as the TPD evolves from TPD2 to TPD3.

Part 1. Brexit: what next?  

Part 2. Brexit, Tobacco Products Directive and vaping – the outlook

Continue reading “Brexit and vaping”

Vaping policy – rapid questions and answers

Vape shop in Manila, Philippines Vaping House Manila Play,Chill & VAPE

I just filed a submission with the Philippines House of Representatives for its Joint Trade & Health Industry Committee hearings on e-cigarettes, to be held 10 December.

The full submission (PDF) starts with an introductory Q&A and then goes on to provide more detail about specific issues with some backup material. I thought the 15 questions and answers might be of more general interest, so I have reproduced it below.

Continue reading “Vaping policy – rapid questions and answers”