One of the worst ever tobacco control papers is ‘corrected’

Researchers were told their allegations were false, but they still went ahead and attacked a leading vaping company with baseless claims

Papers by tobacco control academics are often truly awful – thinly disguised self-serving polemics masquerading as objective inquiry. But sometimes, the scientific paper and research conduct are so terrible that they become usefully revealing. This blog looks at a case in point.

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My application for Editor-in-Chief of Tobacco Control

A vision for a journal covering all aspects of nicotine in society based on open science, curiosity and organised scepticism

I saw the advert for the Editor-in-Chief of the journal Tobacco Control.

I must apply!

What follows is my application for the position in pre-print form. Following helpful comments and critical reviews, I will finalise and submit by the deadline of 31 January 2023.

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Will Brazil rethink its vaping prohibition?

“O Brasil vai repensar sua proibição de vaping?” Brazil is consulting on lifting its ban on vaping products. Will it recognise the perverse consequences of prohibition and shift to risk-proportionate regulation? We argue it should rethink its approach to nicotine.

Prohibition is about the worst regulatory response to safer alternatives to smoking

Brazil’s public health agency, ANVISA, has been consulting on whether the long-standing policy of prohibition of vaping products should be retained or lifted. The consultation questionnaire seeks comments on a technical document.

Shortcut to full response (PDF).

Here’s my take…

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E-cigarette risk perceptions – an American crime scene

Most Americans now incorrectly believe that e-cigarettes are just as harmful or more harmful than cigarettes. US health organisations have unethically cultivated this misunderstanding and compare unfavourably with UK equivalents. Their duplicitous behaviour resembles that of Big Tobacco 50 years ago.

Note: ‘Don’t know’ is handled inconsistently across the surveys, so I have merged ‘don’t know’ and ‘never heard of e-cigarettes’ (some care needed)

I have drawn the chart above from the US National Cancer Institute HINTS survey, picking up results from 2014, 2017 and the most recent data from 2020. The current situation is shocking and the trend is a disgrace. But how has this happened?

In this blog, I compare the vaping risk communications of four major American health organisations with four similar UK organisations. The comparison is damning.

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Holding the Bloomberg anti-vaping propaganda complex to account

An investigative report criticising Bloomberg’s anti-vaping stance draws a petulant response – we review the case

Bloomberg scrutinised. Unusually, a journalist decided to take a sceptical look at Bloomberg Philanthropies and its many proxies and the impact of their war against vaping.  The result is an excellent must-read piece by Mark Gunther (@MarcGunther) in the Chronicle of Philanthropy: Bloomberg’s Millions Funded an Effective Campaign Against Vaping. Could It Do More Harm Than Good? (web archive) (23 March 2021).

It is first-class public-interest journalism, with some hard messages for Bloomberg but plenty of balancing comment too.

The response. The interesting thing is that this drew a joint response from Kelly Henning of Bloomberg Philanthropies, Matthew Myers of the Campaign for Tobacco-Free Kids and Robin Koval of the Truth Initiative. See Vaping and Philanthropy: Debating Strategies That Work (web archive).  There is a substrate of anger and panic in the letter that suggests that Gunther hit a raw nerve.

What is unusual about this letter is that Henning, Myers and Koval actually try to defend their positions.  Normally, they don’t defend their positions, they just assert them with millions of dollars of amplification. It offers a rare opportunity to provide a critique of their stance.  So I have taken their response letter, broken it down into 15 propositions, and provided a response to each.  Each section starts with a quote from the letter pulled out in a quote box in bold dark-blue. The letter is analysed in its entirety.
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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”

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.

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Twitter Q&A: debunking tobacco harm reduction misconceptions

I did a Twitter chat with the Campaign for Safer Alternatives on the typical objections raised to tobacco harm reduction. For those interested in the responses but who missed the live chat or got as confused as I did in trying to follow threaded answers, here is the chat as it unfolded over 15 questions with everything in the right order.

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Lancet commentary – Nicotine without smoke: fighting the tobacco epidemic with harm reduction

Abstinence-only or alternatives?

I am proud to be a co-author of a commentary published today in The Lancet: Nicotine without smoke: fighting the tobacco epidemic with harm reduction (PDF) with Robert Beaglehole (lead author), Ruth Bonita and Ben Youdan. In a nutshell, we take issue with the anti-innovation stance of WHO and many groups working in public health:

Vaping and other smoke-free products have the potential to reduce the enormous harm of smoked tobacco products. The stakes of getting policy responses to smoke-free products wrong are high, especially if such restrictions stop millions of the world’s smokers accessing safer alternatives. It is disappointing that in its latest tobacco report,[3] WHO clings to outdated orthodoxy when it could embrace innovation. Equating smoke-free products with cigarettes only serves to protect the stranglehold of the cigarette trade on the world’s nicotine users and will nullify the potential of modern tobacco harm reduction strategies.

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The great American youth vaping epidemic. Really?

When senior officials claim that the is an epidemic of teenage vaping or nicotine addiction, what do they actually mean and does the claim makes sense? Most vaping is infrequent, and regular use is concentrated among smokers, where is may be benficial.

But is it really?

Updated: 15 February 2019 to add section 17

Update 19 July 2019: Note that Scott Gottlieb, who features in this post, left the FDA on 5 April 2019 and joined the board of Pfizer on 27 June 2019: Ex-FDA boss joins Pfizer 83 days after leaving US drug regulator, Financial Times. 

I have been following FDA Commissioner Scott Gottlieb on Twitter and was alarmed at the threat he issued to vapers and the vaping industry in response to recent trends in US adolescent vaping.

I disagree with the FDA’s analysis of what is happening with adolescent vaping and also what should be done about it. So I need to put some flesh on the tweet above and examine some of FDA’s claims in more depth. Please dip to these talking points… it’s a long blog but I hope at least some of it will be illuminating.

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