There is much discussion about willingness to enter debate about e-cigarettes following this letter from Professors McKee, Glantz, Chapman and Daube. I will return to this letter shortly, but in the meantime here’s an example of how it works in practice. In July, I sent an email to Professor McKee of the London School of Hygiene and Tropical Medicine, challenging some of the criticisms of legitimate scientists he had made in the media, suggesting he discuss his concerns with the scientists he was criticising, and personally offering to debate with him debate in a public forum. Here’s the what I sent:
To: Martin McKee, Professor of Public Health, London School of Hygiene and Tropical Medicine
CC: Signatories to the critical commentary (attached) of 129 person letter to WHO
31 July 2014
Dear Professor McKee
I notice that you are again striking a hostile public posture towards e-cigarettes and tobacco harm reduction and, in today’s case, criticising an evidence review just published in the journal Addiction. You also refer to a letter written to WHO signed by you and 128 others. I would like to offer some feedback and put some questions to you on this.
In this piece on the BBC this morning (E-cigarettes less harmful than cigarettes), you are reported as follows:
Prof Martin McKee, of the London School of Hygiene and Tropical Medicine, who was not involved in this analysis, told the BBC: “Health professionals are deeply divided on e-cigarettes.
“Those who treat smokers with severe nicotine addiction see them as offering a safer alternative to cigarettes.
“In marked contrast, many others, such as the 129 health experts who recently wrote to the World Health Organization, are extremely worried given the serious concerns that remain about their safety, the absence of evidence that they help smokers quit, and the way they are being exploited by the tobacco industry to target children.
“This report concedes there are huge gaps in our knowledge – yet, incredibly, encourages use of these products. This seems little short of reckless.”
What is the basis for your claims? Can you explain on what basis you make these statements and how you have assessed the significant body of evidence that does exist, including that considered in detail in the review just published? Why do you think it is ‘reckless’ to encourage smokers to try products likely to be one to two orders of magnitude safer than smoking? To me the recommendations by the authors look cautious and reasonable, not reckless and ‘incredible’.
Letters to WHO. You refer to the letter to WHO organised by Professor Stanton Glantz signed by you and 128 others. It is possible that you have not yet seen or found time to study the critical commentary on this letter detailing some of the many errors of fact and interpretation contained in it. I enclose this commentary (pdf attached) and I hope you will read it carefully and reflect on whether you should be publicly referring to your letter as though it is a source of authority. I have copied this letter to the signatories to the commentary, and I am sure many of them would welcome sight of your reaction as much as I would.
Responsibility of public health commentators. Can you also explain the extent to which you have considered your own responsibility and accountability in this area? It is quite plausible that the outcome of your campaigning against e-cigarettes is that people will believe the risks arising from e-cigarettes are far greater or more uncertain than they actually are, and, as a result, be deterred from using them and so continue to smoke. In that event, you may well be responsible for increasing avoidable smoking, protecting sales of cigarettes and causing more disease and death than there otherwise would be. It would be helpful to understand: (1) if you have recognised the plausibility of this risk at all? (2) If so, how you have weighed it up and concluded you are meeting the “first do no harm” test that should govern anyone involved in public health? If you do wish to think more carefully about these responsibilities, may I respectfully suggest reading: Turning the tables on public health – let’s talk about the risks they create – a short piece by me.
Engagement in scholarship. Rather than rushing to make rapid-fire comments to the media, perhaps you would do more for public health if you took the time to read in detail the published review you are criticising (Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit). Once you have considered the analysis, may I suggest you invite the authors to discuss it with you? That way, you could probe and understand their perspective and you would be able to challenge their findings with any contrary evidence, principle or argument you believe to be relevant. Wouldn’t that be a more fitting approach for a senior academic?
Consider the impact on real people. You are often making statements that many ordinary smokers and vapers believe bear no relation to their experience or to the facts as they know them, and at times they find your public comments upsetting or insulting. Yet you do this with the trust and authority, and access to media and political influence, that comes with being a professor in a prestigious institution. May I suggest that you take a few minutes to read what some ordinary people say of their experience and try to understand what this means to them? All public health should be grounded in respect and empathy for the people affected, and the dictum ‘nothing about us without us’ should apply in this field as in any other. Please see: Where is the humility, where is the empathy? – especially the dozens of testimonies left on my web site and others.
I hope you will respond to at least some of these concerns. I am sure I am not alone in worrying that the approach you take to e-cigarettes will cause far more harm than it prevents. You are of course entitled to hold whatever opinion you like, but it would be good to see you debate and defend your arguments openly. If you would like to debate with me in a public forum, I would welcome the opportunity – please let me know.
Professor McKee was so keen to respond to challenge, to discuss his concerns with the scientists he was criticising, or to have a debate with me… that he didn’t reply at all.