Category Archives: media

Bad apple studies – pt 1

I was thinking about the persistence of that FDA assay despite the rounds of criticism from all the right quarters. Just about every article or health web site arguing against vaping will cite this one study and often no others. This became quite evident to me when I was writing about a possible ban on e-cigarettes in the Gulf states (curiously enough two years ago to the day).

Not only did I think it odd that it was that one study that kept getting referenced (as though none other existed) but that an American study would be used half way across the world as authoritative in a culture that not only has its own resources but that often as not decries American influence. And reversing the situation, can you imagine the American Lung Association using an e-cigarette study out of Qatar as the sole citation on a post?

However, as odd as this situation is, it is tobacco harm reduction history repeating itself.

In 1981 the New England Journal of Medicine published Deborah Winn et al’s Snuff dipping and oral cancer among women in the southern United States. I won’t retread old ground about the shortcomings of this article – see Brad Rodu’s excellent summary – however let’s just say that the paper makes better reading as anthropology than health risks. The authors managed to run down a group of white women who had used an antiquated version of powdered dry snuff for most of the hours of the day for over fifty years. In comparison to non-users, this group was determined to have about 50 times the risk of developing oral cancer. The figure mentioned in this deeply flawed study ended up being used to represent the typical risk to the average user using products that had little in common with the product in that study.

It used to be that every site warning off smokers who were thinking of switching to smokeless tobacco would cite this figure. Looking again for the first time in a couple of years I see that little has changed (see Web MD or Illinois Department of Public Health). Their overall message much like the one that attends bad vaping articles is that smokeless tobacco is as or possibly even more harmful than smoking.

Just as with the FDA case, there were plenty of other studies out there. In fact the situation was much more pronounced. As well as other American studies there existed a body of strong research from Sweden where more people were using snus than smoking and where the shift resulted in a decline in smoking related disease rates. You think that would have clinched the deal but rather than this one bizarre outlier being consigned to ignominy there seemed to be no effect at all on the messages that public health resources were giving out.

(In addition to other studies, it is this same Swedish data that allows us to be pretty sure that e-cigarettes are so very much safer than smoking).

Paralleling the situation with e-cigarettes you would typically also read that the authors felt there were no studies demonstrating that these alternatives were any safer than smoking.

So what you have are the bad apples, the early studies that don’t seem to be replicated or supported by any other studies, which go against everything that follows, and yet remain the official sources. Even more upsetting (and detrimental to public health), these official messages ended up becoming common knowledge – basic truths everyone “knows”.

The other thing to note is that both the Winn and FDA reports were obviously flawed in themselves. You did not require other information to know that these lacked credibility. And yet these bad apples stuck.

Part 2 will explore possible reasons why these zombie studies would not die.

More on this tomorrow….

Credit where credit is due: Some positive e-cigarette coverage

In the wake of the recent uproar regarding the Daily Mail’s “E-cigarette’s can cause more harm than smoking” (see Clive Bates for the before and after pictures of the webpage – deleted after a formal Press Complain was lodged) and the Marie Claire’s “Fears e-cigarettes could be more harmful than smoking” not to mention the iterations in Pakistan and India and who knows where else and not to forget the descent into madness at the Philippine Star, it’s pleasing to report that not all the news is nonsense.

In early January we had the Lionel Shriver article in the Guardian and just today in the National Post we have Jesse Kline’s “E-cigarettes are not your father’s smokes.” A couple of days ago we had Jacob Sullum at reason.com with “How E-Cigarette Alarmists Endanger Smokers’ Lives, or Why Eli Lake Should Not Switch Back to Marlboros.” And back in January at the Globe and Mail Lucy Kellaway wrote “Why e-cigarettes should be allowed in the office.”

When this blog began, e-cigarettes were hardly known and the most prominent safer nicotine alternative was smokeless tobacco, it was rare to ever find any positive coverage in the media. Though e-cigarettes do get a fair share of bad press they almost get as much good. Of course the bad articles seem to get all the traction.

International smoking news roundup

While we are putting the finishing touches on a discussion of the press release out of Star Scientific on their reduced nitrosamine smokeless product, here’s some of the more entertaining (and exasperating) developments in the world of smoking.

First of all, out of Spain, two stories.

The first out of Time Magazine reports on the resistance to the new smoking restrictions on bars with some owners posting “smoking allowed” signs, others working to form an organization to counter this threat to their livelihoods, and in one case, a restaurateur providing a free drink to anyone needing to go outside to grab a smoke.

The second story is a rant by a Brit who used to enjoy the previously less fettered society and now rues a country taken over not only by his fellow countrymen but more than suspects that the changes in the law were to cater to the same healthist Brits he went to Spain to avoid. It is titled appropriately Whatever happened to my Spain?

I obviously had not noticed the sign on the door so I extinguished my cigarette and asked her why. Her answer really angered me, first because it had always been one of my favourite restaurants, and second because I knew that both she and her late husband were also smokers. She told me that of late the restaurant had seen a large amount of trade from English customers and it was they, she insisted, who had pressurised her into going smoke-free. Needless to say, I have never been back to that restaurant, from that day to this.

What was happening to “my Spain” I asked myself? What will the English be insisting on next? No Spanish food because it contains too much garlic, maybe? Or how about no Spanish music? I mean, do we really want their mumbo-jumbo? Yes, we bloody well do. Well, I certainly do. I want Spanish music and Spanish food and the Spanish language, which I think more Brits should learn a little more of. And I want Spanish traditions such as spending hours chatting, drinking and smoking in little local bars and restaurants, long into the night.

And in Bhutan, supposedly ruled with an eye to the happiness quotient, dogs are being trained to smell out tobacco in people’s homes. This is part of the country taking steps to go entirely tobacco free. The Prime Minister’s justification for the move, which he says is not draconian, is that tobacco “is no different from psychotropic drugs, for which the penalty in certain countries is death”. Well, if they kill people for drug use in other countries, it can only mean that those drugs are really bad, and not much that wrong with killing people.

Though you can smoke in your home in the Netherlands, a peachy little informer culture is being fostered by local anti-smoking groups. I suspect that there are few in those groups who lived through the war years.

-Paul L. Bergen

Like candy to children

Experience helps determine perception. If you let a child have a whiff of ouzo, they would say its kind of like licorice allsorts. And you would be reprimanded for waving liquor in front of children.

If you take a group of children, have them smell some flavoured oral tobacco products and ask them what they think, they will say it smells like some kind of candy they are familiar with. (The better test would be to have them taste it but even though there is no real risk involved, that would be considered tantamount to child abuse, and the authorities would no doubt search high and low for some arcane statute to use to lock you up. But if they did taste it, they would be more likely to notice it was not really like the candy they would actually prefer.)

This most recent “study” (in English, study can also have the meaning of “stupid waste of time”) out of Utah, has state officials along with Santa (yes, really!) exposing children to these products and asking what they thought they were like.

Now, for those who are sticklers for the rules of evidence and such, no worries. This must generalize quite well to the population since all of three children were used but more importantly it did end up on television and online so it does qualify as good evidence that the tobacco companies are targeting children once again. Those bastards!

Actually, I would question whether these children are representative of the population since they seem to have accepted a rather unusual Santa.

Santa demonstrates danger of 'sweetened' tobacco products

Its a good thing it was not tobacco companies doing this study because that would qualify as enticement, but since anti-tobacco officials (and the jolly red fat man) were behind exposing these children to their first experience of tobacco and letting them know that these flavoured versions existed, just for them, it remains good public spirited tobacco control science.

Now, let’s blindfold those kids again and have them smell some fruit flavored sexual lubricants. If they do not identify them as sex aids and rather as candy, then we can be damn certain that those lubricant producers are targeting the child market. And mark my words, take those same kids a few years down the line, and they will be engaging in sex.

(Its laughable but could end up as tragic too since this sort of nonsense could actually lead to banning these products from adult users who otherwise would smoke.)

– Paul L. Bergen

E-cigarettes and smoking; life as a balancing act

It will be quite obvious to anyone following the e-cigarette trend that when smokers started switching here and there that the news reports were for the most part positive. In general, the articles described how smokers who had tried to quit more than once, and through all the usual methods, finally had found something that worked. They quit smoking, their immediate health improved and since they had solved that constant irritation of worrying about the risks of doing something they felt they could not stop doing, they were also much happier.

And then the tide turned.

Scanning the web or the papers, almost every article is now about the potential dangers of e-cigarettes and typically concludes with the suggestion that they should be removed from the market until extensive testing (over time) has proven their long term safety.

Nobody can really argue with that except for the not so minor point that smoking already exists.

If using electronic cigarettes resulted in one out of a hundred users contracting pancreatic cancer (and no one is claiming this, nor is it remotely likely) it would seem like a particularly dangerous product and smokers knowing that would probably not switch to it. And yet, it would still be much much safer than smoking.

The problem right now is that it is much safer for authorities to err on the side of caution. If you say e-cigarettes will sicken some people and they do, you feel that you have at least warned people. If no one gets sick then your reputation is still intact (you were just being cautious). If you say e-cigarettes are safe and some people sicken, then you appear to have abdicated your position of maintaining public safety.

Yet those relationships only hold when there is no real world context. In this case, if you say e-cigarettes are harmful and smokers avoid them because of that, you have in fact failed to protect smokers.

All risks occur in a larger context.

I sit at my terminal and type encouraging obesity, muscle degeneration and carpal tunnel syndrome. I decide to exercise instead and encourage muscle injury and possible long term disability. I drive to see a movie with a friend and risk an accident or stay at home watching a dvd and face social isolation which has its own risks. Perhaps an increase in my drinking.

Life is a balancing act with few absolutes. Knowing relative risks is a lot more useful than how harmful some behavior or substance might be in isolation. Because, being alive is all about doing things, its all about accumulating risks.

-Paul L. Bergen

Biggest public health advance of the century: new nicotine products could virtually wipe out smoking related disease!

If a doctor’s obese patient starts exercising a little and eating less, and losing some weight, that doctor will be pleased. And if they have a smoker who has cut their smoking in half, they will praise that patient. And if on a national scale obesity levels dropped by half, it would be cause for drinks all round. But though smoking has dropped as much the news and public health authorities have portrayed this positive turn of events as some sort of failure.

There could be good tobacco related news every day but all the good news is given a negative spin and any bad news is exaggerated. And this is why this column ends up being so argumentative all the time; those of us active in tobacco harm reduction are faced with this unending grimness, this little pocket of health where the traditional approaches and philosophies are all discarded in favor of prohibitionism.

Just once, I would love to see a headline like the one above followed by an article highlighting quotes from some of the big names in public health saying something like:

You know I’ve always hated tobacco and I always will but the fact is that whenever smokers switch to snus or e-cigarettes they are cutting their disease risk dramatically. We are happy when people take in a little less sugar, when they exercise more, and we should be happy about this We should get behind this and encourage it because damn it, it means people will be living longer and better.

If we can get everyone behind these products it could be the greatest advance in public health since the discovery of insulin. If most smokers switched to snus or electronic cigarettes, we could end up recategorizing tobacco associated illness as almost negligible and use those billions of dollars we have been using to war against these panaceas for other more worthwhile causes.

But you know they could have had those same kind of headlines about the drop in smoking rates but somehow that did not qualify as momentous. For a more recent example when Katherine Heigl appeared on Letterman and showed how she had finally quit smoking, most of the news after was not to congratulate her, or to praise the now higher profile of this safer alternative but to question her method and her motives. It seems that political correctness matters even when you are trying to quit smoking.

Well, it is unlikely that there will be any sea changes in the near future when the dark forces have managed to convince most everyone that their death maintaining policies are in the public interest, that safer products are actually more dangerous than the harmful one and that smoking is the prime threat to everyone’s well being.

It does not bode well when you have Sweden, a country with the lowest tobacco related disease rates in the developed world, not coincidentally since their dominant form of tobacco use among men is snus, and even there, anti-tobacco sentiment runs high within the public health authorities. In 2008, Gunilla Bolinder was recognized by WHO for her efforts to restrict domestic and international availability of snus -rather bizarre when you know that she comes from a country that has strong population level evidence that snus substitution for smoking has resulted in many saved and healthier lives.

-Paul L. Bergen

Filed under: this is news?

Really super article in the UK Maidenhead Advertiser titled TV chef’s staff told to butt out.

I thought this was worth repeating in its entirety because it is so groundbreaking, so edgy, and cuts straight to the heart of so many contemporary issues. This is journalism at its finest.

So sit yourself down (but not for too long, bad for you you know -perhaps better just stand pat), take a firm grasp onto your hat, bestill your heart already beating in anticipatory fervor and read on.

Staff working at a celebrity chef’s restaurant have been smoking and leaving behind cigarette butts in a quiet churchyard, say Bray Parish councillors.

They say that Hinds Head employees have been using a bench in St Michael’s Church, to smoke, in a quiet spot used by recently bereaved families.

Cllr Christine Aspey said: “It is disrespectful and a misuse of the area.”

The issue was highlighted at a Bray Parish Council meeting on Monday after the clerk said the council had been approached by Heston Blumenthal’s company with an offer to replace the bench.

The council agreed it would not accept the offer because the company may feel that by replacing the bench, it would mean it owned it.

A ward councillor volunteered to contact the company and ask staff to not use the area.

Speaking yesterday, a Hinds Head spokesman said: “It was brought to our attention that Hinds Head staff were using a bench in St Michael’s Church during break period to smoke.

“This was immediately addressed by our management and stopped. We have offered to cover any repairs or renewal necessary and we are extremely sorry for any upset this has caused.”

I thought it prudent to provide an executive summary for those who either couldn’t make it through that intellectual thicket or who were just too enthralled to keep their eyes firmly on the page.

The story: 1. some people were smoking in an area where other people did not like it 2. they were asked not to 3. they apologized and left.

-Paul L. Bergen

Worst e-cigarette article to date? And from a two time Pulitzer winner

I am not one for conspiracy theories but the events of the last month or so have me wondering if I should throw out my well worn rose coloured glasses. The FDA attack on flavored product and now with the letters to the major e-cigarette groups, and the recent American Heart Association policy statement (all working to remove safer alternatives to smoking) are political actions masquerading as public health concerns and being gleefully reiterated across the web without any seeming realization that the main effect of these actions will be to further entrench smoking as the dominant source of nicotine and to keep those mortality stats much higher than they need to be.

Today AOL News published a particularly incendiary report by writer and two time Pulitzer winner Andrew Schneider titled E-Cigs: Popular With Kids, but What’s in Them?. This jaw-droppingly shoddy example of “investigative reporting” would be gold to any journalism teacher looking for examples of bad reportage.

Of course what better way to lead but with the fear of children buying nicotine (in this case, eighth graders who hop off an Amtrak with an envelope stuffed with cash to buy e-cigarettes for their friends; the story is almost certainly fiction though it is not impossible that it could occur at least once given a population of over 300 million people). By the way, if the story is true, shouldn’t the real concern be about two 12 year old girls being alone on trains and in train stations far from home?

This sets the stage for saying that e-cigarettes are “enormously popular among kids” and that common vaping flavors are such kiddie sounding ones like fudge and cookie dough. I have seen some pretty odd available flavorings but I suspect those would mostly be used as gag gifts or novelty items.

Overall the impression is of a lawless land with unscrupulous salespersons selling drugs to children against the will of the people. Newsflash to this reporter and others unfamiliar with the e-cigarette world: the industry is more scrupulous than most in self policing these issues and essentially agrees with polls such as the cited one done by C.S.Mott Children’s Hospital showing that most adults were concerned about quality control and selling to minors though Schneider works hard to imply the opposite. Not that I have much use for polls when the pollsters make a point of reporting nonsense like “our poll results strongly indicate that many adults are worried about e-cigarettes leading kids to smoke tobacco.”

Worries are worries and facts are facts and though facts can lead to fears it does not work the other way around.

This article has really too much lunacy to fully address but one of my “high” points is the Canadians Ban E-cigs; Why Not U.S.?. This is one of those quite strange yet not uncommon arguments popular within Tobacco Control. For instance, the EU ban on snus is considered to constitute evidence of harm. You might as well say North Korea bans shorts in public, Why not U.S.? Or in the words of mothers everywhere: well if Johnny jumped off the bridge, would you?

We come to a part which I like to think years ago would never have seen the light of day. Schneider uses an unidentified source (who apparently kept changing his name) for detailed but unsubstantiated information about an industry when many above board reputable sources like CASAA exist. He tries to communicate with Matt Salmon who most of us know left the building some time ago and being the dogged Pulitzer winning investigative reporter he is, concludes this is a secretive industry.

Lest it be concluded that I have only contempt for journalists and journalism, I don’t. I think done well and responsibly, it can be a great and noble thing. I leave the last words to a journalist Carl Bernstein.

The lowest form of popular culture – lack of information, misinformation, disinformation, and a contempt for the truth or the reality of most people’s lives – has overrun real journalism. Today, ordinary Americans are being stuffed with garbage.

-Paul L. Bergen

Science and Journalism (from Bishopblog)

Dorothy Bishop has a posting Science and journalism: an uneasy alliance that is very worth reading.

Excerpt:

So here we come to the nub of the matter, and the reason why scientists tend to get cross about misleading reporting: it is not just down to human error. The errors aren’t random: they fall in a particular pattern suggesting that pressure to produce good stories leads to systematic distortion, in a distinctly Orwellian fashion. Dodgy reporting comes in three kinds: propaganda, hype and omission.

Fits in well with some of the posts we’ve written around this same topic:

1. The persistence of illogical statements; three failing filters

2. Promising treatment for lung cancer and the press

3. SCOOP! Leaked UPA Guidelines for Tobacco Reporting

-Paul L. Bergen