by Carl V Phillips

As I alluded to yesterday, there is another bit of anti-ecig junk science out today. Once again, it is from the Glantz shop at UCSF. Glantz did not put his name on this paper (presumably to create the illusion among the naive that this is not all part of a single organized disinformation campaign), but that hardly matters.

The little study (published as a “research letter”) followed a small group of smokers for one year, and compared quit rates for those who had recently tried an e-cigarette at the baseline survey and those who had not. They found that those in the former group had a slightly lower abstinence from smoking at followup. Clive Bates does a good job of pointing out how this thin result led to overblown conclusions, and then UCSF created a misleading press release, and this tricked the press into reporting out-and-out falsehoods. Do read Clive’s post for more — there is no reason for me to repeat it here. (If the NYT picks up the story, I might respond to that, but I am not inclined to spend any effort responding to random stories from unsophisticated news sources.)

It should be noted that unlike Glantz’s last paper, in which the conclusions did not follow at all from the study results, in this case the results do lean slightly(!) in the direction of their claims. That is, an honest reader, whatever he believed about the effectiveness of e-cigarettes for smoking cessation before seeing this result, should be moved slightly in the direction of believing that they are less effective, assuming he believes the researchers are presenting their research honestly.

It is important to attend to those italicized words. This group has such a long and consistent record of misrepresenting their studies, that a sophisticated reader will not put any stock in their claims without seeing a review of the instrument and data by an honest scientist. But even ignoring that, the information content of the result is so close to nil that it should not have much effect on people’s beliefs. Clive quotes the ACS’s Thomas J Glynn about the most obvious weaknesses with the study: small sample size and paltry information about e-cigarette use (in particular they did not try to distinguish between “tried one puff on an e-cigarette as a lark” or “not trying to quit and just use e-cigarettes in one particular non-smoking venue” from “actively trying to switch to e-cigarettes”, or from everything in between).

The more fundamental weakness is one that you are not going to hear from anyone in tobacco control, because it requires acknowledging that tobacco users are different kinds of people acting on different preferences, not biological agents with a condition that needs to be cured. Brad Rodu and I will soon release a paper that shows how this view is harmful to smoking cessation efforts. One minor point from that line of research: Confounding matters. [Confounding is the challenge that exists when the exposed and unexposed groups have systematically different outcomes for reasons that are not caused by the exposure.] This is at the core of any half-decent Epidemiology 101 course, but apparently they do not have one of those at UCSF. If smokers who are more likely to not smoke at a given date in the future (say, because they do not actually smoke all the time, or because they have decided to just stop unaided) are less likely to try e-cigarettes (for obvious reasons) then that will give you the correlation that was reported. This is why real social scientists always try to deal with confounding (not always very successfully, of course). Tobacco controllers, who believe that tobacco users are just dumb automata, and not people, do not even realize they are doing social science.

Clive also takes a swipe at a tobacco control crank who was foolish enough to enter into public debate on a previous post by Clive. That individual expressed glee about the upcoming publication of this study (which was circulated to tobacco control people in advance, so that they were all ready to use it for propaganda before the scientists had a chance to reply). Yes, glee is the attitude of tobacco controllers about a study that they (mis)interpret as showing that a stop-smoking tool does not work — they are such a compassionate bunch.

But what struck me most about Clive’s post was the observation:

Professor Stanton Glantz’ group … is rapidly becoming a slurry gusher of black propaganda, media-political spin and unethical practice. The release follows an established track….

That certainly seems to be the case. And that is hauntingly familiar to me, and probably to the handful of others like Brad and Clive who have been working on THR for more than a decade. Throughout much of the 2000s, one group of propagandists-cum-researchers at Sweden’s Karolinska Instetutet, took advantage of that university’s reputation as a medical school to spew out a series of biased and dishonest “studies” that claimed to show that smokeless tobacco (snus) caused a variety of diseases. Brad, I, and my colleagues at TobaccoHarmReduction.org, made a concerted effort to push back against this. (For those who want some background, here is some from all of us 1, from me and my colleagues 1 2 3 4 5, and from Brad 1 2 3 4.)

Despite it appearing long after smokeless tobacco had been demonstrated to be a very low-risk alternative to smoking — which would still be true even if some tiny risk were actually found — this junk science was used as political cover for those who wanted to restrict and otherwise attack THR, like those who wanted to maintain the ban on snus in the EU. This collection of lies continued through 2011 when it stopped abruptly. We would like to think that our efforts (including both extensive writing and an actual lawsuit) had something to do with that.

The comparison of Glantz et al. to the Karolinska group is a bit unfair to the latter. The Karolinska group was quite sophisticated, hiding their deception in statistical modeling choices that were only noticed by dedicated and sophisticated readers. Indeed, the aforementioned lawsuit was not an attempt at censorship, but a demand to see their data (which they were required to share under Swedish law, but never did) so we could demonstrate how the results would change if the data were analyzed honestly, rather than using their sneaky tricks. Moreover, there is every indication that some in that group did not believe that what they were doing was dishonest or bad science; manipulating modeling choices to intentionally fish for biased results is sufficiently common in epidemiology that they perhaps genuinely believed that it was not dishonest (kind of like the classic, “I am not doing anything wrong, everyone cheats on their resume/girlfriend/taxes!”).

This contrasts sharply with UCSF. It is difficult to imagine that they do not know they are lying. Their deception is not buried in complicated statistics that they could, perhaps, convince themselves to believe are not dishonest. Their lies are so obvious that every honest casual observer who reads their papers can spot them. Contrast the barrage with (usually accurate) criticisms of their claims, as opposed to only a dozen of us who were pointing out the lies from Karolinska.

This offers some reason for optimism. Karolinska went quiet in 2011, but it took almost a decade to make it happen. Their sophisticated deception was enough to fool honest scientists and could be used unhesitatingly by propagandists. By contrast, Glantz and his group are obviously clowns, and serious people (like, say, the FDA) are not going to buy into their silliness. Anyone who touts their claims immediately destroys his credibility. Even public health groups who do not exactly have a reputation for honesty about THR are balking — witness the ACS responses to both recent papers (though obviously such honesty and seriousness is not universal; e.g., the Robert Wood Johnson Foundation). Because the lies from UCSF are so blatant, there is already a concerted effort to shut them down, and it should not take a decade.

Unfortunately, even though the honest regulators are never going to buy this dreck, local city councils, often populated by people who barely passed high-school biology class, will believe it and naively implement restrictions on e-cigarettes. And millions of potential switchers will see the disinformation in the news and it will cause them to keep smoking. Thus, harm is being done — people are being killed — by UCSF’s lies every day.

By the time the Karolinska liars shut down, they were a voice in the wilderness. Pretty much no one else was still trying to make scientific claims that smokeless tobacco is measurably harmful. No serious observer will still question that e-cigarettes help many smokers quit in the year 2020 (roughly what 2011 was in the history of smokeless-tobacco-based THR). But let’s hope that the liars at UCSF are not allowed to continue to voice their lies until then.