This is part one of a twin post. Part 2 is Five questions to put to the US Surgeon General on e-cigarette science (next posting).
To respond to the forthcoming publication of a new US Surgeon General publication on e-cigarettes, I have have expedited my long-planned guide to bad science in the field of e-cigarettes and vaping in the hope that commentators, opinion formers and members of the public will give this review proper critical scrutiny.
So here it is: Version 1.0 of a critic’s guide to bad e-cigarette and and vaping science. This is the informed critic’s plain language guide to questioning the science of sensationalist and alarmist e-cigarette studies.
Here it is: The critic’s guide to bad vaping science (PDF – 15 pages)
This is the table of contents, which I hope is in itself a handy guide to interrogating bad science.
1 Toxic chemicals have been identified in e-cigarette vapor or e-liquids
1.1 Did they show potentially harmful exposure?
1.2 How risky compared to smoking?
1.3 How risky compared to other risks?
1.4 Were measurements made in realistic human operating conditions?
1.5 Are inappropriate proxies being used for risk?
1.6 Are heroic but flawed analogies being used to suggest more risk than there is?
2 Adverse health effects from e-cigarettes are reported
2.1 Was vaping the cause?
2.2 Was the person suffering from adverse impacts a smoker before using e-cigarettes?
2.3 Is the study just observing the effect of nicotine on the body?
2.4 Is there evidence of actual harm or is it just a change in the body or brain?
2.5 Is it based on a cell culture study and are the limitations recognized?
2.6 Is it based on an animal study and are the limitations recognized?
3 Claims second-hand vapor is toxic and indoor vaping should be banned
3.1 Are exposures to second-hand vapor potentially harmful?
3.2 Is difference between risk and nuisance and its policy relevance understood?
3.3 Is the real question about who should decide: the law or the property owner?
4 Nicotine damages the adolescent brain
4.1 What is the specific nature of the harm to humans?
4.2 Where is the evidence for the damage in the human population of smokers?
4.3 How does this compare to damage from alcohol, cannabis or caffeine?
5 More children using e-cigarettes and gateway effects
5.1 Did they characterize use properly?
5.2 Could the rising use of e-cigarettes be a good thing?
5.3 High level of smoking associated with vaping?
5.4 Have they defined a gateway effect?
5.5 Are they assuming prior behavior caused the later behavior?
6 E-cigarettes keep people smoking and reduce quit rates
6.1 Has vaping been wrongly conceptualized as though it is a medical intervention?
6.2 Has the importance of product’s consumer appeal been recognized?
6.3 Was “dual use” described as problematic?
6.4 Did they claim there are no benefits to cutting down?
6.5 Not enough randomized controlled trials (RCTs)?
7 Flavors and e-cigarette marketing aimed at children
7.1 Do they assume it is just obvious that childish names appeal to kids?
7.2 Why would adolescents try to emphasize their childishness?
7.3 Have preference for particular flavors been misrepresented as a cause of vaping?
7.4 Could it be a benefit that some flavors are attractive to adolescents?
7.5 Who is young?
7.6 Is an e-cig ad an anti-smoking ad?
8 Citing uncertainty and appeal to the ‘precautionary approach’
8.1 Have they understood what is known?
8.2 Are they asking the impossible?
8.3 Do they realize that ‘precautionary approach can do harm to health?
9 Tobacco industry involvement implies inevitable harm
9.1 Is the malign influence of tobacco companies assumed or demonstrated?
9.2 Is there over-reliance on decades old statements, documents or behaviors?
9.3 Is there a proper understanding of how the nicotine market works?
9.4 Are the authors concerned about the right things?
10 Policy recommendations in a scientific paper
10.1 Do policy recommendations go beyond what their research justifies?
10.2 Have policy-making disciplines been followed?
10.3 Are the authors’ policy positions revealing biases?
10.4 Have unintended consequences been ignored?
This covers it all ! The only thing that niggles me is how can one respond to something that isn’t even published yet!!
By covering it all! At this point we just ask questions…
For section 5 [youth + gateway]
How do rates of youth smoking declines compare with youth vaping increase figures?
Was consideration given to whether youth might have experimented with tobacco products if vape products were not available?
Were subjects previous Have Tried tobacco users?
Was source of vape product acquisition included?
*** [Important since there are age restrictions in most areas for purchasing, that would be important — a local convenience store, black market, or taking someone else’s device is quite different from buying from a professional vape shop — i.e. is the product itself at fault, or are they circumventing legal restrictions to acquire the devices]
Were separate assignments of classification used to separate which e-cigs or vape products used e-liquids [with or without nic] compared to other vape formats [herb, hookahs, cannabis, etc] — the subject needs to be aware of which type is being studied rather than just generalizing them all as the same product
Did they ask if they’re a current smoker, and had previously only vaped, was that experience vaping the reason the subject decided to start smoking? (that question never seems to get asked, even though so many of the studies conclude vaping is the gateway)
What reasons were given for the subjects’ desire to start vaping?
Were any of the subjects members of any anti-smoking groups?
[while the numbers would be low, it’s still a consideration since lobby groups such as Campaign For Tobacco-Free Kids recruits youth in their anti-vaping efforts, so any conflicts of interests need to be disclosed since they might purposely respond contrary to their own usage or lack thereof]
Did the study differentiate between an e-cig [1st generation device] and an e-liquid vape device [2nd generation and higher]?
The usual categorization questions such as types of device, nic/no nic, (etc.) qualifiers included in the study?
Lot more questions too, but you pretty much already cover things brilliantly… I don’t want to convolute your lists with endless nit-picking additions since you already have the major points covered :)
Studies of youth need to ask what nicotine level (if any) they are using. It would appear that a significant number of youth are vaping because they enjoy the flavors, using liquids without any nicotine whatsoever. Ergo, reports of youth vaping rates need to specify whether nicotine is being used. Otherwise, quite false conclusions can be drawn.
Strikes me that this should be kept on the desktop of every journalist covering e-cigarette stories as a handy reference, right along with their style guide (they still use those?).
That is assuming they are actually doing “journalism” and not just publishers-for-hire, repeating study promoters’ press releases verbatim, or otherwise encumbered by an editorial policy hostile to the topic. Perhaps these conflicts should also be declared – at least by science and medical journalists.
Totally ludicrous….I have been smoke free for almost two years. I feel better…I breath better. I do not think they are really looking at the whole picture. To smell cigarettes now I get sick to my stomach. This is no different than going to a show that has water vapor for smoke. There is no nicotene in the water vapor. Seems biased to me.