Time to change the diapers on Pediatrics Journal

Pediatrics cries wolf so often that it would be difficult to identify any real threats to child health within those pages. Not only do they construct visions of disaster out of little more than phone polls (that third hand smoke lunacy), generalize from ambiguous results (as will be elaborated on here) or just plain mislead (as in child poisonings from new nicotine products), this journal, as we have opined before, gives The Onion a good run for the money. For instance, where else would anyone take seriously the idea that paternal smoking around pregnant women could lead to subsequent obesity in the to-be-born children?

Just paging through the last couple of issues I found this article on the effect of breastfeeding on later academic achievement with the conclusions in the abstract as:

Predominant breastfeeding for 6 months or longer was positively associated with academic achievement in children at 10 years of age. However, the effectiveness of breastfeeding differed according to gender; the benefits were only evident for boys.

Notice that the result is just as much one of “predominant breastfeeding is not positively associated with academic achievement in girls”. I do not have access to the whole article so for all I know it actually negatively impacts females however the point is that a specific conclusion is being generalized without reason. It might be an interesting question as to why boys and not girls and the conclusion should have mentioned that.

But to the matter at hand, the latest movies cause smoking “evidence”. And let’s just state those conclusions right up front:

These findings imply that, beyond direct influences, the relationship between adolescents’ sensation seeking and parental R-rated movie restrictions in explaining smoking onset is bidirectional in nature. Finally, these findings highlight the relevance of motivating and supporting parents in limiting access to R-rated movies.

Note the word “bidirectional”. The definition for that is “moving or operating in two usually opposite directions” Not really the sort of thing you would want to encourage when suggesting behaviors. So what the conclusion actually is saying is that “we don’t know what causes what, we think they might both cause each other, but we have no problem using this to give advice”. But let’s delve just a little deeper into this intriguing study. And I quote:

We found that adolescents with lower levels of sensation seeking and those who reported R-rated movie restrictions were at lower risk for trying smoking. The results also revealed negative associations between adolescents’ levels of sensation seeking and later R-rated movie restrictions, which indicates that sensation-seeking adolescents are at higher risk for starting to smoke not only directly but also indirectly through changes in parenting. Sensation-seeking adolescents seem to influence their parents to become more indulgent regarding their movie viewing, which subsequently is related to higher risks for smoking.

Now, forgive me if I am wrong but I do see this being reprinted in the Journal of Results So Obvious That Only a Fool Needing to Pad the CV Would Submit It. And the results are: kids who are curious about things are more likely to act on that curiosity than kids who are not, and they are also more likely to pester their parents, and those parents are more likely to give in than parents who had never been pestered. (If following form, the next Pediatrics article about smoking precursors should encourage parents to administer growth inhibitors since aging is probably the single greatest determiner for later smoking).

But now, and I do apologize for going on and on about this, Pediatrics has turned its attention to caffeine consumption in youth. (I know, yes, these articles do not share the same authors but they do all get printed at this journal so I think it is not unfair to suggest that the journal is to blame, hence the title about changing diapers; the authors may provide the food but it is the journal that puts out the crap).

In this case, the study is not quite as bad as the media reports that follow though the authors do flap their lips a little more loosely as well once in the spotlight. The study reported that the findings indicated either that caffeine consumption led to disrupted sleep patterns or that children consumed caffeine in response to not sleeping well the night before. They were not sure which way this went but it still led to concluding that caffeine should be restricted, not because it was harmful but on the basis that the beverages had “detectable pharmacologic effects”. It does not sound like a bad idea in general not to ply your kids with pots of coffee or coke but I really do not see the above as actually supporting that.

By the way, the other grand finding in the study was (and they took pride in that this had not been widely documented) that children’s sleep patterns on the weekends varied from that of the school week. (Maybe this is what they mean when they talk about the great work of science being built up one small brick at a time!)

But come the media and we have the headline Caffeine Can Harm Children. And the quote:

“Parents should be aware of the potentially negative influence of caffeine on a child’s sleep quality and daily functioning,” Dr. Warzak asserts.

And as we know, when you put in the word potentially anything after is quite true. We could potentially fall into the sun tomorrow. Absolutely true.

Or more to the point: Pediatrics Journal could potentially tighten up their editorial policies. The journal has been around long enough to move on to potty training.

– Paul L. Bergen

Spilling nicotine: safety concern or clumsy researchers?

It takes something quite spectacular to take my attention away from any of the research coming out of the Prue Talbot labs but I will have to save that for tomorrow or the next day (hint: it comes from an even more disreputable source -Pediatrics Journal- and it has to do with smoking and the movies). But today the Prue.

There is no need to do any deep analysis of this research since it has been covered quite well already by the Old Rambler at StandFast, by Michael Siegel, and James over at Ashtray Blog.

I just wish to add a few additional points.

1. As opposed to any good news about harm reduction, this half baked nonsense is being repeated from here to India by every news agency without any analysis of the content.

2. The researchers conclude on the basis of their concerns about the packaging and instructions that the product should be removed from the market. To go once again to our beloved seat belt analogy, if there was some substandard accompanying information packet with the seat belts or even the odd one that caused an allergic reaction let’s say, would it seem reasonable to take it off the market considering the alternative (driving without)?

Once a product is off the market the greatest impetus for improvement has been removed. There is no assurance it will ever be let back in whereas in market there are customers to satisfy, and in general, products in the marketplace are redesigned to be more effective and safer over time. (This is really the secondary reason: of course the first is quite simply that removing it will result in the premature deaths of many citizens).

3. For some reason, people are taking more seriously the conclusions about the everyday workings of a product from people who are seeing it for the first time rather than the experience of hundreds of thousands who have already been using it for years.

Anna Trtchounian and Prue Talbot seem to be spilling nicotine all over the place and extrapolate their own clumsiness to the world at large. Of course, if you already believe in third hand smoke, any leakage of nicotine, no matter how small, is a serious concern. However, if you are a normal human being, it really isn’t.

This apparently horribly unsafe product is being used quite safely by the hordes, and might I add, much more safely than they could ever could use cigarettes.

4. This kind of research by those who remain quite alien to both the concepts of harm reduction in general (Prue labs discovering harm reduction cigarettes) or the product they are testing (once has a vision of the apes in 2001 touching the monolith and running away chattering and frightened) seems to be gaining in popularity. Not long ago we had Thomas Eissenberg saying there was not enough nicotine in e-cigarettes for the product to actually be satisfying.

This is unfortunately quite consistent with tobacco and addiction research in general where anti-tobacco researchers and advocates have managed to convince the world that only addiction keeps people smoking (no one really enjoys it).

And even more unfortunately, these few befuddled researchers in their labs, who are able to discount the world outside quite effectively, are having a disproportionate influence on that same world they dismiss.

– Paul L. Bergen

Overly precautionary: tobacco policy needs to return to the real world

There has been a subtle yet crucial shift in ideology which has led tobacco policies astray.

Consider that the statement using tobacco can result in disease is markedly different from the statement using tobacco results in disease. The first recognizes that tobacco use is a risk factor and the second is a gross generalization. The second position might be more effective in countering initiation but it also ends up supporting a strong anti-harm reduction stance.

Stating simply that using tobacco leads to disease ceases to distinguish between the two and therefore the only reasonable action for removing the disease is to remove tobacco use. Saying it might result in disease leaves open the option for substitutions that have much lower risks.

We have come to a place where we expect smokers to get sick and die as a result. Those who don’t are considered anomalies and while many smokers do get sick as a result many who do not. The overwhelming “these things will kill me” characterization is more ideological and a mirror of the times than it is a statement of fact.

Once tobacco use is characterized as inexorably leading to disease you are left with the position that all tobacco use as immediately harmful, any level of exposure to that use (second hand and third had smoke) as harmful, all communing of smokers in public as harmful, all smoking in public as harmful, and also any use of any tobacco product of any kind as harmful and therefore tobacco harm reduction no longer has any place in the discussion.

Recently at SpikedOnline, Frank Furedi wrote about the shift in public thought to instead of using as worst case thinking as just one of many future scenarios using it as the prime policy driver.

Frequently, worst-case thinking displaces any genuine risk-assessment process. Risk assessment is based on an attempt to calculate the probability of different outcomes. Worst-case thinking – these days known as precautionary thinking – is based on an act of imagination. It imagines the worst-case scenario and demands that we take action on that basis. For example, earlier this year, the fear that particles in the ash cloud from the volcanic eruption in Iceland could cause aeroplane engines to shut down automatically mutated into the conclusion that they would. It was the fantasy of the worst case, rather than risk assessment, which led to the panicky official ban on air travel.

Implicitly, and sometimes explicitly, advocates of worst-case thinking argue that society should stop looking at risk in terms of a balance of probabilities. These critics of probabilistic thinking are calling for a radical break with past practices, on the grounds that today we simply lack the information to calculate probabilities effectively. Their rejection of the practice of calculating probabilities is motivated by a belief that the dangers we face are so overwhelming and catastrophic – the Millennium Bug, international terrorism, swine flu, climate change – that we cannot wait until we have all the information before we calculate their destructive effects. ‘Shut it down!’ is the default response. One of the many regrettable consequences of this outlook is that policies designed to deal with threats are increasingly based on feelings and intuition rather than on evidence or facts.

Human beings have always exercised caution when dealing with uncertainty. Today, however, caution has become politicised and has been turned into a dominant cultural norm.

The Furedi article helps to explain why tobacco use policy is fear driven rather than a process of finding the most reasonable solution to a problem. Can there be any other explanation of why a future possibility of all snus and e-cigarette users gravitating to smoking (without any evidence for this) carries more weight than the potential of reducing the risks for smokers now?

Take fear out of the equation and you are left with simply dealing with a behavior with existing and available safer alternatives which if adopted would remove virtually all of the associated health risks.

Tobacco harm reduction is already at work. Smokers are switching over despite the impediments erected by the anti-tobacco and anti-smoking organizations that lie about being concerned about the annual death toll.

-Paul L. Bergen

Residual tobacco smoke pollution in used cars for sale: more Nobel-worthy research

I was going to ignore any more of the 3rd hand smoke “research” for a while but this is just much too impressive a work of scholarship to pass up. And as much of the most important and well thought out tobacco related research, it comes out of California.

Though I have not been able to gain access to the source article yet, I believe the abstract (Residual tobacco smoke pollution in used cars for sale: Air, dust, and surfaces) gives us enough to comment on until that time. The lead author, Georg Matt, appears to be running with the ball that he originally kicked off a few years ago (you could say he is to 3rd hand smoke what Glantz is to smoking in the movies).

I’m sure that his team found exactly what they were looking for with their space age measuring devices (imagine a CSI scenario: barely lit but with flashlight beams striking out, and swabs, and knowing glances) -higher levels of nicotine contamination in vehicles used by smokers; the issue is what they have done with that information. The last sentence in the abstract reads: Disclosure requirements and smoke-free certifications could help protect nonsmoking buyers of used cars.

Protect them? So otherwise these buyers would suffer and possibly die if they bought one of these tainted autos? Or is Matt in the market to buy a vehicle and is looking for another way to get a discount?

If we buy the premise that we need to certify smoke free surfaces to protect consumers then any vehicle or structure that used to be smoked in remains contaminated and an actual risk to your health. You would need to be concerned about any airplane that is older than 10 years, any public structure and any house that was not built in the last few years. Though some might have never had a smoker on the premises, most have.

If you care about 3rd hand smoke, wait til they invent a personal device that you can use to scan for any contaminants on surfaces. You will no longer want to sit down anywhere, get into your bed, make food on your counter, and if you bother scanning your food, you won’t want to eat that either. And once you scan your own skin, it will be game over.

A contaminant free world is a sterile world, a dead world. Getting a little bit dirty is normal; it means you are alive.

-Paul L. Bergen

If one small lie could stop someone from ever smoking?

Years ago at a conference I attended, we had a discussion going about how much misleading information was present in materials which were aimed at getting people to stop or not start smoking. One of the more persistent ideas was that nicotine was poisonous. But a doctor who worked at an addictions clinic said that he supported leaving that in place because they had found that that one characterization had been their most effective tool in getting smokers to stop and stay stopped.

Later that day, my colleague asked me if I could stop my daughter from ever trying smoking just by telling one lie, would I do it?

Its easy enough to just say no because of course not only might one lie lead to another but any one lie would make all other communications suspect. But we are talking about parental impulses here and as much as I believe that everyone has the right to make their own choices about these things, and that there are worse things she could be doing, the thought of her drawing smoke into her pristeen lungs is not a pleasant one. I still said no.

But this question of whether it is permissible to lie (or deliberately manipulate popular pre-existing false beliefs) if it serves the greater good will always be with us.

In tobacco harm reduction we think that the most important thing is that people who use or might use tobacco should know about the health risks and should be aware (and have available) all the safer nicotine alternatives. Smoking is a choice but it should be within the context of the knowledge that there are safer ways to get nicotine. I guess one way of looking at it is, though for some people smoking is the best nicotine option given their circumstances, for many smokers that is not the case, and with that in mind, a decline in the number of smokers is a positive development.

So we want people to have options, but we would like to see smoking become less common. And not because it is smoking but because of those avoidable diseases.

We really would like to see smokers move to using smokeless tobacco or e-cigarettes but we have not used the fears of 2nd hand and 3rd hand smoke to do so. You will see some vendors using these arguments but we have not. And the temptation is there because tapping into those misperceptions could be quite effective. But the problem is that we don’t believe that stuff and we also like to think that one of the strict dividing lines between the standard anti-smoking dogma and our own is one of paying attention to the evidence.

Its more than just a question of strategies.

If we are evidence bound it means that we have to ignore certain tools and it means that when the evidence changes we have to change as well. We have that slight overlap with the anti-smoking groups of wanting to see the numbers of smokers decline but for us it is because that would indicate a healthier population and for them it just seems to be an aim in itself. Since they are ready to use each and every tool to fight smoking (including vilification) their movement is safe from any changes in the science.

For instance, if a week from now, incontrovertible evidence came out that smoking had about the same risk as using smokeless tobacco or e-cigarettes, and people knew about it, we would be out of business.

Would they?

This is also about the larger ethical implications. If we do not base our actions on what we think is the true picture of the world, then by extension we sanction others to knowingly manipulate our beliefs and actions with false information.

-Paul L. Bergen

Pork barrel science descends to new depths

Just a quick note on the latest call to wallow. Chris Snowden has all the relevant details over at Velvet Glove for those who enjoy the feeling of being both outraged and depressed at the same time.

Third hand smoke has made the transition from being an unsubstantiated bit of nonsense, an extrapolation of whimsy, to a very real expense to the taxpayer.

We often forget that we actually end up paying for this garbage. Third rate brains come up with ideas that any normal person would have discarded, such as cigarette butts being a substantial source of environmental degradation, and then come knocking at our door asking for our money to prove their case.

And we give it to them.

(By the way, third rate brains are like third hand smoke -the almost unmeasurable byproducts of second rate brains and found in seemingly unoccupied spaces).

– Paul L. Bergen

The contest continues…

At the risk of running multiple threads but with the potential of gaining new participants I am starting another post to buttress the good entries already in place.

Here’s one from me:

In a rare public appearance today, the typically reclusive NYT health writer and journalism professor Roni Rabin came forward to answer questions regarding her article with its endorsement of the Canary in the Mines Petition being circulated. Previously Rabin had helped nationalize the concern about 3rd hand smoke but had in that case remained silent after her influential piece.

As reported in the latest article, a consortium of anti-smoking health organizations following the lead of the Campaign for Tobacco Free Kids suggested that what was missing in tobacco control were the voices of the children themselves. What would address this need would be a panel of children who would decide whether the tobacco companies were indeed marketing to them with their new smokeless products.

The same group at Pediatrics who did such fine work in regards to third hand smoke were asked to design the study that would show how much we needed children to weigh in on this important matter that directly concerned them. In an earlier interview, one of that team said “its really just a question of asking people “do you think tobacco companies should be allowed to market to children?” and if you say “no” then that is a fair indication that they are already doing so and that we direly need this new way of dealing with it.

Of course, because they are children and it is unethical and quite dangerous to expose them to even the sight of tobacco products of any kind, the Pediatrics group suggested that adults would be exposed to the toxic goods and then describe the colors, tastes and package design to the children (and if it helps tell them what products they are familiar with that they resembled) and then the children could safely tell them if they thought they were attractive and if those companies were trying to make them use them. (The children would receive continual reassurance that the companies could not get to them in the testing rooms).

Asked whether children should also be part of the FDA new tobacco control plans, Rabin nodded and then waving her arms and backing up croaked “fear good; tobacco bad” a number of times. She became progressively more excited and before any more questions could be asked had backed herself right out of the room.

-PLB

Royal College of Physicians on Passive Smoking and Children

The Royal College of Physicians have just released their new report called Passive Smoking and Children and have already come under fire from Michael Siegel over at Rest of the Story and Chris Snowdon at Velvet Glove (writing about this BBC report on the report).

This report was particularly discouraging to me because the RCP was one of the few authoritative health bodies that endorsed tobacco harm reduction. They appeared to be sensible.

As my colleague put it, and I paraphrase, “on the bright side you can think that even a misguided group still knows enough to recognize a good idea when they see it”. And while that is true enough, I am now thinking that possibly they supported tobacco harm reduction not on the evidence (though their report is well grounded in the writing) but more on disliking smoking so much. And I do mean disliking rather than being concerned about the health effects.

As these other writers point out, the RCP argues against even the sight of smoking. That is when you know someone has abandoned reason, picked up a torch and joined the mob.

-PLB

Third hand smoke: should we bother?

Once again third hand smoke has reared its pea brain head and once again we all rise to the bait. (See recent postings by Michael Siegel, Christopher Snowden, and myself). Not so much the challenge since the challenge is not the concept or the science, which are laughable, but the iteration through the culture.

Were it not for the acceptance of this nonsense among so many, and the attraction it seems to hold for media outlets, it would be like bothering to debate flat earthers. Or like trying to debate John Banzhaf as if he was a reasonable man.

But as Siegel points out, this bad science has the real world effect of affecting policies which could be quite harmful. And for that reason, we have to keep on it even though through the argument it may seem as though the whole concept is stronger than it really is.

Perhaps we really should be promoting ASH-US, the anti-humanist ravings of Banzhaf, and all this third hand smoke garbage as a means to bring home to the average person how absurd the anti-smoking movement has become, and how if we want to move forward on addressing tobacco related health issues, they must be seen for the anti-health extremists that they are.

-PLB

Third Hand Smoke, Again!?

I see that Chris Snowdon has a great post on the absurdity and a bit of history on the third hand smoke meme that refuses to die. It seems that while good ideas are often unnoticed or ignored that the really bad ones, and this one is bad in so many ways, tend to get a lot of press. I suppose that they do serve a purpose in uncovering which journalists uncritically repeat items without examining the source materials (for instance, this article from Roni Rabin at the NYT).

The third hand smoke nonsense is particularly dear to us here as we responded (quite some time prior to this blog’s existence) to the Journal of Pediatrics article when it came out. At the time, we had noticed how fast and furiously this story spread throughout the news media and the blogs. It was as though so many had been waiting for this, just like someone suddenly getting some small evidence of what previously rated as little more than a conspiracy theory. You could hear the “I knew it” s resounding throughout the land. Perhaps the most risible of the follow up stories was of Apple techs refusing to touch smokers’ computers.

One small excerpt from our letter:

The authors, in the article, press release and subsequent interviews, argue the danger of third hand smoke, such that smokers are encouraged to change clothing and bathe before holding their children. And yet, the authors still encourage the smoker to breastfeed the innocent child, rather than substitute a tobacco-free bottle of milk or formula (6). This can only mean that, despite repeating the nonsensical mantra of there is no safe level of exposure, whatever this non-safe level of exposure is, it must be much lower than the toxicity of bottle-feeding. The authors also suggest, not in the article but in related interviews, that the nose is an accurate determiner of toxicity, an interesting but outdated pre-scientific method that cynically takes advantage of the lay population (8, 19, 24, 26).

Many educated readers already have a jaundiced view of what passes for epidemiological research, and this article not only justifies their attitude but serves as the epitome of sloppy science, of politics and opinion and desire masquerading as science. We predict that a decade from now, if books and blogs continue to claim that epidemiology is junk science, they will still be citing this article as a perfect example.

-PLB