Independent high-quality science in tobacco harm reduction – should we be thinking about calling it a day?

by Carl V. Phillips

Since about the time it became a wealthy and self-sustaining industry, anti-tobacco extremism has had no use for serious (i.e., high-quality and honest) science.  The trappings of science became mere propaganda tools to support political or financial goals (two analyses published in the last week provide examples, and thousands more exist).  Though there remains the illusion of science, there is very little interest in actual scientific analysis in that arena, and most of the serious scientists who worked in that area twenty years ago seem to no longer want to bother with cutting through all that, and either are coasting to retirement or found something to work on where legitimate analysis matters.  Despite dozens of publications a week, you can easily go months without seeing any important, useful, high-quality science on the topic.

Over the same period during which anti-tobacco abandoned science, research on tobacco harm reduction carefully adhered to scientific standards, not just above the quality of anti-tobacco junk science (which is not even faint praise) but also well above the accepted standards for public health journals or health advocacy in general.  I would argue that the independent research done on THR was almost all at the highest possible level, and not merely better than anti-tobacco or public health research; it was up to the quality of economics and other serious sciences.  But now I wonder if that era is over?

High-quality independent (i.e., done by people who are not employed by a large institution, like industry or government, and that is ultimately controlled by the scientists rather than someone like an employer or funder) research is being squeezed from three sides.  One of these is actually a good thing:  At least one tobacco company is doing serious highest-possible-quality research (which they have to do since so many powerful interests are out to denigrate their work) on several aspects of THR, and some others are making contributions.  [Disclosure: Sometimes the company that I think exemplifies this asks me for my advice or help with that research, so I have a obvious potential for bias in my assessment of the quality of their research.]  This represents a proper burden (who else is more appropriate to fund research into eliminating smoking?) and a mobilization of substantial resources that displaces the need for some less-well-funded independent groups to try to do research of the same quality.  The other two directions of the squeeze – government takeover and loss of integrity of the advocates – are not good news, however.

Government obviously has to be involved in the policy side of science-based policies.  But when government becomes involved in arbitrating the science in a big way, good science is threatened.  Notice that I phrased that completely generically, because I think it is true for most any topic.  But it is worst for a highly politicized topic like THR.  There have been many reports from government (by which I mean actual governments per se, but also quasi-governments, and quasi-NGOs that are answerable to them) regarding THR over the years.  Some of them were a serious threat to good science, like the junk science that was done under the name of the International Agency for Research on Cancer (IARC), the sloppy and misleading work done by the U.S. government, and the originally honest but twisted to political goals in the final presentation work by the European Commission’s SCENIHR.  But none of that crowded out legitimate research, and was not taken too seriously except by those who already supported the same political agendas.

But with the U.S. FDA taking over the issue (currently farming part of it out to the quasi-governmental Institute of Medicine (IOM)), good science faces a serious threat.  Science-by-committee is not always junk that reinforces the view of things held by those in power (either because they are the village elders in the science who have nothing better to do than sit on committees (read: they are behind the times) or more because of more venal power politics for issues like THR), but it is close enough to always that it is quite a bad thing.  It is even worse when the process is biased by the participants being chosen in a way that favors a particular political position (consistently the anti-THR position in this case).  The current and recent panels that are supposedly providing expert analysis of THR have avoided including anyone with experience in THR research (unless you count a career trying to attack THR, often by employing junk science, as expertise).

Science By Official Committee like this provides, in the absolute best-case scenario, a good analysis at a particular point in time, with sensible compromises between disparate beliefs, alternative possible emphases, and other points of competition that must be resolved in any given paper.  But having done so, it crowds out other analyses, or at least reduces attention to them, even when the other analyses cover neglected points, and might even be overall more valid.  This continues to be the case as time passes, and thus more up-to-date reports become undoubtedly better than the old committee report.  I would venture to say that 95% of serious thinking about THR has taken place in the last decade, and yet people still cite the decade-old IOM report that addresses the topic, not as a historical document, but as if it provides useful the most useful current insight.  And, as I said, that is the absolute best-case scenario.  The much more likely scenario is that the Official Poobah Authoritative Report is wrong in important ways when it is written, and that wrong information crowds out good science.

This crowding of good independent science, while quite a bad thing and a source of great annoyance and frustration, is certainly no reason to call it a day.  It is something that must be actively resisted, at the level of science, epistemology, and education.  It is the third source of crowding that makes me wonder if THR advocacy will soon cease to be based on good science.

I have noticed a disturbing drift, particularly over the last year – maybe a bit more or less – toward advocates embracing whatever sciencey (in the spirit of “truthy” – something that sounds like it ought to be science) claims might be written by anyone, so long as the stated conclusions are what the advocates like.  This is the behavior of anti-tobacco extremists and any number of other science-defying purely political and/or nutcase fringe causes.  It is a tactic that can be employed in support of a good cause too, of course, but one that seems likely to cause far more harm than good for a cause like THR.

If any scientifically-worded claim supporting the cause is treated as equally important, then there is no longer any reason to do good work.  Moreover, since it is so much easier for the thousands of people who know a bit about a topic to churn out junk science claims than it is for the few hundred scientific experts to provide careful analysis, the latter is quickly swamped by the former.  This is not just speculation, as I discuss below.

The incident that brought this to a crux, in my mind, was the recent uncritical embrace by some THR advocates of the report that was covered in this news story.  (A conversation about this flared up briefly in a private email conversation among some of us.  This post is to bring the issues discussed there to a public forum.  I am not attributing any particular thought to any particular people; any of the participants who want credit/blame should speak up in the comments.)  I wish I could write this without indicting any particular individual (naming names is quite appropriate when someone is recalcitrant, but not so much before that), though it is impossible to make the point without being critical of the author of the report in question – which is not inappropriate (write a public report on a topic, claiming authority, and you invite criticism if you get it wrong), but perhaps a bit distracting.

The report concluded that taxes on smokeless tobacco should be lower than the taxes on cigarettes.  There is nothing wrong with that conclusion, though it is not exactly interesting – I would venture to say that not a single person who has ever thought about THR had not reached that conclusion already.  Unfortunately, the analysis does not support the conclusion, other than with the observations that THR is a good idea and price differentials tend to make people change their behavior.  There is no other supporting analysis.  Instead, the rest of the report consists of:  a riff on “smoking is bad for you, but many people do not quit including many who try to quit” (not the worst one of the thousands of those that exist, but far from the best, so it is mostly a waste of space); a very inaccurate summary of the risks from ST use; a horribly inaccurate assessment of the comparative risks of smoking and ST; a spotty and not very useful report on what tax rates are in U.S. states (it uses the wrong units of measure and so is not so meaningful; some who saw it decided that they should compile that same information but do it right); and a misguided suggestion of what the relative tax rates should be (the author implied that it should be the same as the ratio of the risks, which is a totally wrong economic analysis, fitting nicely with the totally wrong analyses of the epidemiology).  In other words, all this report did right was assert a conclusion that probably thousands of us had already independently derived, and dozens of people have previously published.

The report was written by someone working for a lobbying firm (or one of those other Washington entities that is rather similar to a lobby firm for all practical purposes) and put out with fancy formatting, touted to the press, and so on.  In other words, it was designed to appear authoritative rather than as someone’s musings in a school term paper or non-scientific blog, and thus asks to be held to a high standard.  There is no reason given as to why the author or the firm decided to address this topic, rather outside of their normal expertise (which, as an aside point, invites suspicion that it was an industry plant; that crossed my mind, so you can be sure it will be the conclusion of those who have paranoid fantasies that they are the victims of a conspiracy of illuminati, space aliens the tobacco industry).

This was not a case of someone getting in a little bit over her head and getting some technical points wrong, or believing some plausible conventional wisdom that a few experts know is wrong.  The report really did read like a bad term paper:  A summary of a topic written by someone who has not yet mastered the methods of the field and had been thinking about the specific topic for only a few weeks, relying on Wikipedia and the above-mentioned Official Authoritative Summaries, not even figuring out who to email to ask for better information.  I emphasize this not to brutalize the author, but to point out that this is not a remotely ambiguous case.  If your attitude toward this is still “who cares about the analysis; I like the conclusion” you really have made it clear that you do not care about good science, so long as the scientific-sounding conclusion is one you like.  Sure, it is exciting to see someone agreeing with your minority position, but that does not make them worth citing.

Perhaps there would be some justification for highlighting this if the author had some kind of celebrity podium.  It is generally bad for scientific understanding to have the likes of Jenny McCarthy, Henry Waxman, Regina Benjamin, or other non-expert non-scientists weigh in, but I can understand the argument of wanting to take advantage of their podium if they support your cause.  (Personally I think it does more harm than good in the long run for causes that are battling for credibility, but there is room for legitimate disagreement on that.)  But absent such a podium, I cannot see any excuse for endorsing such poor analysis.

Naturally, I am not coming to my current fear as a result of just one observation – that was merely the one that really tipped me into worrying.  There were many other observations that laid the groundwork for it.  I have observed a tendency to embrace the views of commentators with limited scientific expertise who have thought about the topic for maybe a year, to the neglect of those with many years of expertise and strong scientific grounding (e.g., compared to many others who just recite simplistic conclusions, how often do you see Peter Lee cited in writing about THR (almost never) or even Brad Rodu (more, but not nearly as much as many commentators who have contributed no original scientific analysis)?).  Some industry actors contribute to the problem, with most of the e-cigarette industry acting like snake oil salesmen, and some companies who make ST seeming willing to damage the future of THR to get a small competitive edge in product sales or litigation.  Many activist slogans have crowded out accurate scientific information in the writings of people who should know better (e.g., the claim that e-cigarettes are lower risk than ST, which is supported by no science whatsoever, or that American ST is higher risk than Swedish ST, which is contrary to the evidence – I must have pointed out the inaccuracy of these claims fifty times in what I have written, but there seems little interest in the facts).

Notice that I am not saying that the existence of bad analysis that ostensibly supports one’s cause is a terrible thing.  It is kind of annoying, but it is inevitable and is no big deal.  The problem comes when those who are opinion leaders and who know better endorse it uncritically.  The report that I discuss above was actually only picked up by one newspaper, as far as I can tell, and so would have sunk without notice (and without my scathing criticism) had a few advocates not decided to publicize it.  A few years of endorsements like that, though, and the good science may be crowded out.

I have worked on a few issues in my life where my side had impeccable scientific backing (obviously that is my potentially biased opinion, but those of you familiar with my work know that I am about as hard-assed as it gets about my judgment of the quality of science, whether I like the conclusions or not – e.g., see above – so I expect you will trust my word) but the other side had much more money and power, and therefore had convinced most half-interested non-experts that they were right.  THR is one such issue.

Another that I worked on for years was support for encouraging, for various reasons, a move toward more-vegan diets and ending the inhumane treatment of factory-farmed animals.  You are, no doubt, familiar with all of the good scholarly analysis that has been done on that topic over the last ten or fifteen years, and how that has won over skeptical opinion leaders who originally saw it as a loony fringe issue, right?  Of course not.  You may well think of those views as being based entirely on fringe-group pseudo-science.  That is because most everyone who was trying to do good science on the topic got so fed up with dealing with the activists and their embrace of junk science, that they wandered off to do other work.  It is only in the last few years that a cohort of new authors, coming from journalism or other quarters that are unconnected with the activist community or academic science, have revived good thinking in the area.

By contrast, my current work on the health effects of wind turbines (those big towers with spinning blades that make electricity) on nearby residents, is characterized by community-based activists who are fiercely dedicated to doing the best possible science.  They know that their cause is often perceived as pseudo-scientific fringe (despite the fact that those of us who have become expert on the topic see that it is the industry that is trafficking in amazingly blatant pseudo-science and getting away with it so far), and so are making sure that their claims are impeccably supported.

There is something very refreshing, as a scientist, about working with the anti-wind-turbine activists, most of whom are quick to make clear their lack of scientific credentials but try very hard to keep high scientific standards.  But it is increasingly frustrating working with THR advocates, whose standards are slipping, often in spite of their scientific backgrounds.  It is one thing to go out on a limb to fight those in power and stand against The Official Reports – someone has to do that or everyone suffers.  Apparently I was born to be one of the evolutionarily-unfit minority who feels inclined to fight the power just because the power is wrong.  But that does not extend to keeping up a fight to get one’s allies to improve their integrity.  I tried that once, it was miserable, it was hopeless, and I do not intend to do it again.  I will admit that to some extent that is a matter of personal pique (why should I work so hard to do background research and construct careful analyses when someone who just churns out popular sciencey assertions is more likely to be taken seriously) but part is a matter of integrity (you really cannot have much more integrity than the company you keep; certainly everyone looking in from the outside will assume your integrity is no different from theirs).

In a few arenas related to THR, getting things right will always count.  I really doubt that attorneys looking for litigation support witnesses will become indifferent about whether someone is doing impeccable scientific analysis (those who are on the right side of the issue, that is – those working on the other side may prefer junk science).  No politicized committee report will crowd out a well-authored expert overview of the topic, looking at the epidemiologic, epistemic, policy-analytic, political, and ethical points that need to be considered, and no casual commentator would be able to pull it off.  So there will undoubtedly be plenty of good work to do, and I expect I will keep working in those specific niches.

But if governments, committees, the industry, and THR advocates combine forces to make independent scientific analysis irrelevant to the discussion, then I fear that THR will be delayed for several more very expensive years.  I predict with rather more confidence that there will cease to be much new good independent scientific analysis aimed at better understanding or figuring out how to promote THR.  Yielding to the Official Word of The Authorities will freeze the discussion and replace science with legalism, which may be good for the tobacco industry, governments, the FCTC, and other institutions, but will be bad for the people (public health, the cause).  Replacing careful analysis with whatever claims sound good will lead to profit-seeking battles between companies.  But most important, the inevitable embarrassment when junk science claims are embraced by advocates, and then highlighted by opponents, will reduce grassroots credibility with many of those who might be won over.  And there is really nothing that the scientific experts will be able to do about any of it.