February 5th, 2016

TPD implementation – maximising harm by going beyond the minimum

julie andrews

Caption contest: the hills are alive with the sound of…

It’s hard to keep up with the public health madness in Europe.  Not content with creating the worst EU Directive ever made, laden with unintended consequences, many member states are now working hard on compounding their error by gold-plating the directive’s wholly unjustified costs, burdens and limitations on e-cigarettes and smokeless tobacco with additional measures that go beyond the minimum.

Professor Gerry Stimson and I have made a small effort of resistance – here are two submissions to the Austrian consultation on TPD implementation. Austria proposes to ban internet sales of e-cigarettes and to ban all forms of smokeless tobacco, not just snus. We have tried to place these in the wider context of harm reduction and unintended consequences of poor policy-making. >> read the full post

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January 13th, 2016

Who will be duped by error-strewn ‘meta-analysis’ of e-cigarette studies?

Garbage

Done badly, meta-analysis can be a neat and scientific-sounding way of aggregating junk to create new and more convincing junk

[Note: backgrounder What is meta-analysis]

The Lancet Respiratory Medicine has been duped into publishing a ‘meta-analysis’ of e-cigarette studies authored by Professor Stanton Glantz and colleague [see Kalkhoran S, Glantz SA. E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis. Lancet Respir Med].

The expert reaction has been swift and devastating: “not scientific”, “grossly misleading”, “a major failure of the peer review system” are amongst the comments from Professor Robert West, Professor Ann McNeill, Professor Peter Hajek, Linda Bauld of Cancer Research UK and Roseanna O’Connor of Public Health England.

We knew this was coming because an earlier version of this thoroughly flawed exercise is available on Professor Glantz’s blog: Meta-analysis of all available population studies continues to show smokers who use e-cigs less likely to quit smoking.

I could go on at length about this exercise… but fortunately, I don’t have to.  The U.S. anti-smoking agency, Truth Initiative has already provided an extensive and credible critique of this meta-analysis and underlying studies in a submission to the FDA (please note it was known as Legacy at the time of the submission). Here is its acerbic dismissal of Professor Glantz’s meta-analysis (which is ref 73):

While the majority of the studies we reviewed are marred by poor measurement of exposures and unmeasured confounders, many of them have been included in a meta-analysis that claims to show that smokers who use e-cigarettes are less likely to quit smoking compared to those who do not.73 This meta- analysis simply lumps together the errors of inference from these correlations. As described in detail above, quantitatively synthesizing heterogeneous studies is scientifically inappropriate and the findings of such meta-analyses are therefore invalid. (emphasis added)

Dismissing this and much else, the experts at Truth concluded:

Findings from the studies with the strongest methodologies suggest that e-cigarettes are effective in helping adult smokers to quit or to reduce their cigarette consumption and that rates of smoking cessation with e-cigarettes are similar to rates of cessation with nicotine replacement therapy.

This is consistent with the Cochrane Review of e-cigarette studies, which

…finds emerging evidence that smokers who use electronic cigarettes can stop or reduce their smoking.

The Cochrane Review gave a cautiously positive assessment of e-cigarettes but stressed the weakness of the evidence base. In short, there are few RCTs because there is little incentive for any manufacturer to conduct RCTs – and the value of RCTs is limited in such an uncontrolled real-world behavioural eco-system as vaping. The solution to that is not to take on lots of studies that are completely unsuitable for addressing this question and then aggregate them, it is to draw on different strands of evidence to build up a picture.

We’ll hear more from Truth later in this post. As well as the insights from this preview of Professor Glantz’s analysis, we also know this work must be very poor indeed because it was initially pitched to at least one US journal, which normally publishes anything hostile to e-cigarettes, and it was even rejected by them.

Why might a journal reject this ‘meta-analysis’? Let’s go in deeper… >> read the full post

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December 30th, 2015

Credulous or cynical? Science journalists played yet again by e-cigarette pseudoscience and spin

junk-science
I’ve just written to Sarah Knapton, Science Editor at the once-proud Telegraph titles. She has picked up one of the most idiotic American press releases ever written and turned it one of the most idiotic UK news stories ever written*: E-cigarettes are no safer than smoking tobacco, scientists warn – an outrageous headline buffed up with a subtitle that invokes the spectre of cancer.

Cells exposed to the e-cigarette vapour showed several forms of damage, including DNA strand breaks, which can lead to cancer

Here’s the study and press release:

  • Study: Yu V, Rahimy M, Korrapati A, et al. Electronic cigarettes induce DNA strand breaks and cell death independently of nicotine in cell lines. Oral Oncol 2015;52:58–65. [link]
  • Eureka Alert Press release: Cell harm seen in lab tests of e-cigarettes

See if you can see how the headline can be justified by the study. On second thoughts, don’t waste your time: it can’t.

The UK’s statistics vigilante, Stats Guy Adam Jacobs, has already nominated the Telegraph article the “most dangerous, irresponsible, and ill-informed piece of health journalism of 2015” – Dangerous nonsense about vaping.

Here’s my letter to Sarah Knapton about it. >> read the full post

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December 22nd, 2015

Escaping the EU directive on e-cigarettes

Trash

I’ve written  and presented many times on the utter mess the EU Tobacco Products Directive (TPD 2014/40/EU) has made of regulating low-risk alternatives to smoking: notably Article 20 that regulates e-cigarettes and Article 17 that bans snus.

EU legislation is especially ill-suited to regulating new disruptive and controversial technologies that regulators don’t understand – see my discussion of regulating disruptive technology. Directives are produced by a kind of committee pinball game that reflect prejudices, esoteric beliefs and haggling of people with little knowledge of what they are dealing with and no accountability for the outcome or damage done.  But once agreed, they are really hard to reverse or amend, and they are a good reason to do only what is necessary at European level.

Here’re the escape routes I can think of. >> read the full post

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November 28th, 2015

A billion lives?

A promising new documentary film is on the way to our screens: A billion lives –“a true story of government failure, big business and the vaping revolution”. See trailer above.

It gets its name from the often-quoted figure that one billion lives may be lost to diseases caused by smoking in the 21st Century.  The eminent epidemiologist Sir Richard Peto summarised the outlook in a comment to the Independent newspaper: Smoking will ‘kill up to a billion people worldwide this century’ (8 Nov 2012)

Sir Richard Peto of Oxford University, a co-author of the Million Women study who worked closely with Sir Richard Doll, is also the scientist who first calculated how many people this century will die from tobacco-induced cancers. “We have about 30 million new smokers a year in the world. On present patterns, most of them are not going to stop, and if they don’t stop, and if half of them die from it, then that means more than 10 million a year will die – that’s 100 million a decade in the second half of the century,” said Professor Peto.

“So this century we’re going to see something like a billion deaths from smoking if we carry on as we are.

But where do these numbers come from? >> read the full post

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