March 10th, 2016

When horror pictures top-trump evidence: a lose-lose situation

Louise Ross, head of the Leicester Stop Smoking Services, took part in a debate on e-cigarette in front of an audience of respiratory nurses.  It didn’t go well.

In this guest blog, Louise describes her experience debating e-cigarettes and tobacco harm reduction with a consultant in respiratory medicine apparently prepared to say anything to rubbish e-cigarettes.

Her account starts here:

It was a session I had really been looking forward to – the chance to tell a conference full of respiratory nurses the good news about e-cigarettes, and how they could help their long-term smoking patients improve their breathing, by switching from tobacco cigarettes to e-cigarettes.

I’d prepared a presentation I was proud of, bringing together what experts in the field say (Robert West, Peter Hajek, John Britton, Ann McNeill, Linda Bauld), and what Public Health England say, with an added sprinkle of what our own stop smoking advisors say (real-life examples of patients with complex COPD, for example) and what service users say (‘It was a revelation’).

I’ve done lots of similar talks before, and have always been delighted with the way the audience visibly moves from sceptical to interested to welcoming of the notion that e-cigarettes could have the potential to get people away from smoking, and that even more importantly, people enjoy using them.

What I hadn’t factored in, naively, is that with me being the ‘pro’ speaker, the ‘con’ speaker would be willing to trot out every cynical ploy we’ve ever heard, to convince his audience that they could actually be responsible for the ghastly death of their patients, while helping the tobacco industry multiply its profits. Here’s just a sample:

‘They’re all made by British American Tobacco’ – BAT has much less than 10%.

‘We have no idea what’s in them’ – yes we do and we have for some time, see Burstyn I, 2014; Farsalinos KE & Polosa R, 2014; Hajek P et al, 2014 

‘There is no information on the packaging’ – there is plenty of info and consumers aren’t complaining.

‘They are not regulated in any way’ – they are regulated as consumer products and at least 17 EU directives apply – E-cigarettes are unregulated, right? Wrong!

‘Everything good you read about them has been ghost-written by the tobacco industry’ – PHE evidence review, NCSCT briefing on e-cigarettes , and ASH briefings really are not by the tobacco industry. Many independent academics are positive – take this example Professor Robert West and Jamie Brown in the British Journal of General Practice.  There is no evidence of tobacco companies ghost-writing anything, let alone everything – and no evidence has been presented to show they have.

‘We don’t know anything about them’ – this is all too true of certain individuals in the health community, but many public health professionals regard it as an ethical responsibility to be knowledgeable and truthful about them

He quoted the Hong Kong study comparing vapour with terrible air-quality, rubbished as completely implausible within minutes of publication here.

He emphasised that there is no clinical control over the amount of poisons in them – ‘clinical control’ is unnecessary and inappropriate, and no-one is being poisoned.

He lamented the fact that people can buy any devices without the supervision of a clinician – perhaps he would rather it was harder to buy e-cigarettes than cigarettes?

He seemed enormously troubled with consumers making their own choices and dealing with smoking in a way that works for them, and he felt that only by strict standardisation could we ensure anything approaching patient safety – no such restrictions apply to cigarettes.

He described patients harming themselves – some apparently even use an e-cigarette while they are still smoking! An awful choice apparently, doubling the risk they were exposing themselves to – he was probably referring to and misunderstanding ‘dual use’, often part of a pathway to switching completely.

He said one of the chemicals ‘discovered’ in the e-liquid was propylene glycol. ‘Do you really want your patients breathing this stuff in??’ he pleaded – PG has not been ‘discovered’, it’s a key ingredient and is the e-cig alternative to delivering nicotine on smouldering tobacco smoke particles.

As I was scribbling notes so that I could address these points during the debate to follow, I cringed as the audience seemed to loudly murmur assent, or shake their heads in unison, or gasp with shock as he claimed to have received personal threats from the tobacco industry and e-cigarette manufacturers (because they’re all the same, aren’t they!) – it is hard to imagine any e-cigarette company threatening anyone – no company would be that foolish – and no evidence was presented, of course.

The loudest audience gasp though was for the final full-screen slide, the picture of the man who had half his face burnt off by an exploding vaporiser. I can’t recall the exact words he used for commentary, but the meaning was clear – this is what you invite if you tell your patients they can vape – the irony is that battery safety would be a useful subject for regulation, but regulators have paid little attention to this while they wasted years trying to misclassify the products as medicines or negotiating really poor regulation in the TPD.

Some jaw-dropping observations came from the delegates: one reminded us all of the other momentous time when patients described something as a revelation – thalidomide. Another suggested that if a COPD patient was near to death, this could be an appropriate time to allow vaping, but certainly not for younger patients – do they think that people should smoke until they are almost dead or until e-cigarettes have somehow provided the impossible proof they don’t cause every conceivable condition?

The outcome… Sadly, there was hardly any opportunity to put the record straight or to discuss the evidence dispassionately. The vote at the start was in answer to the question ‘Would you encourage your patients to use an e-cigarette?’ 33% said they would, 67% said no. At the end, only 17% would, the No group had increased to 83%. Although the vote was a horrible moment for me, there were a few moments of sunshine in the gloom. Several people came up to me afterwards and said they wholeheartedly agreed that e-cigarettes could be a life-saver, and some of these had seen the benefits at first-hand, among friends and family members, reminding me that in the abstract, for clinical staff, imagining the worst outcome may prevent them taking risks with patients to whom they have a duty of care.

Also, many people took down the details of the new NCSCT guidance on e-cigarettes, and I can only hope that when NCSCT says that nicotine does not cause cancer, people believe that rather than the speaker, who said it might.

I left saddened and concerned. A cadre of health professionals had been misled by clichés and wild propaganda points into rejecting something we know could really help their patients.  When we debate, we should keep in mind the seven principles of the Public Health Registry Code of Conduct for public health professionals

  1. Make the health and protection of the public your prime concern
  2. Maintain high standards of professional and personal conduct
  3. Be honest and trustworthy
  4. Protect confidentiality
  5. Respect the dignity of individuals and treat everyone fairly
  6. Know the limits of your competence and act within them
  7. Cooperate with the teams with which you work and interact

If we reduce our debates to a slugging match, truth, subtlety and complexity will never win.  It seems to work for Donald Trump, but it has no place in public health.

Post-script: Dr Andy McEwen, Director of the NCSCT, has since offered to get a copy of the e-cigarette briefing to all attendees, to try and undo some of the damage that was done on the day.

Louise Ross

9th March 2016  (No Smoking Day)

Update: Clive Bates adds…

A message from one doctor to another.

 

27 comments to When horror pictures top-trump evidence: a lose-lose situation

  • This is pretty much what Doctor Graham (it might be Graeme) Burns did at the SSS event in Durham. I was scheduled to follow him onto the podium. He arrived “fashionably late” – that is to say after his allotted slot had begun, so I’d had to take his slot, which left him the opportunity to stand up and blatantly lie – using the exact same lies this other Burns did (although one or two bits of the latest crap were new since my event). The Burns we had even lied about a study, the author of which was in the room!! And told her she was wrong, to her face, then stormed out in a strop when she told him, politely, that he had lied. This looks like being a tactic. “They” are sending in respected consultants with big names and giving them the crap to spout, they lie through their teeth, but the audience is left in no doubt who is supposed to have kore “credence”.
    It disgusts me that these folks are allowed to lie like this and get away with it. I really feel for Louise – it’s an horrendous situation to be put in.

  • Roger Hall

    Slide 5 and the comment “within 8 weeks he was able to reduce his meds” clearly illustrates the reason why vaping is so vehemently attacked. I also wonder what other “lies” are the public inadvertently exposed to when Public Health and medical issues are concerned? Trust is a crucial ingredient of the relationship between patient and the medical fraternity and Louise Ross’s experience illustrates that the information being provided to Public Health professionals may not always be accurate or truthful.

  • Jonathan Bagley

    “He said one of the chemicals ‘discovered’ in the e-liquid was propylene glycol.”

    He was surely being disingenuous. Nobody in his position could be that lacking in general knowledge and basic chemistry. PG is pumped into the lungs of lung transplant recipients and pumped through hospital air con systems to kill bacteria.

    I hope your account of this meeting is widely circulated, Louise.

  • Lollylulubes

    It’s a huge shame there wasn’t time for a debate, because Louise would have won. Sadly, it’s instinctively normal for people to believe what a consultant has to say and you expect them to tell you the truth. This is clearly an orchestrated campaign to discredit ecigs because these people all come out with the exact same old drivel and outrageous lies. As a respiratory consultant, he has a duty of care to his patients, but he’s lying to them and others, causing great harm. He must be getting a reward of some kind to prostitute himself like that, or maybe pharma’s threatening to cut his funding, or are the highly lucrative cigarette taxes behind it – or all of the above? It’s time these people got a conscience, instead of seeing smokers and vapers as collateral damage. Do these puppets realise, I wonder, that they’re protecting cigarettes and big business with these lies.

    Louise, this tweet by Dr. Christian might make a powerful slide when up against liars. https://mobile.twitter.com/DoctorChristian/status/428918282503356416/photo/1?screen_name=DoctorChristian

  • Clive Bates

    That thing he said about being threatened by ‘the tobacco industry and e-cigarette companies’ seems completely preposterous to me – like a self-aggrandising fantasy in which he is engaged in some sort of imaginary heroic struggle with evil businesses.

    There are two reasons to doubt this:

    1. A quick Google search reveals that the gentleman in question has hardly done anything in this space (only signing this letter with 400+ others) and the fact that he seems to know so little about the issues tends to confirm that. I hadn’t heard of him until yesterday, and I know most of the prominent clown in public health. Why would anyone in the industry expend any attention on someone so irrelevant?

    2. Companies just don’t act that way in PR terms and rarely in any circumstance. It’s not unknown for companies to behave like criminal thugs, but not in this sort of situation. He is making a serious allegation – so it would be interesting to know who has allegedly threatened him, for what, and the nature of the threat.

    I don’t believe this claim is true. Given just about everything else he said was wrong, I’d say I have good grounds for scepticism.

    • Lollylulubes

      Clive, as you know, smearing vapers like this is a regular tactic that started some time ago, probably with the famous letter to our favourite waitress in Cornwall – Lorien and is perpetuated by McKee in his presentations …. I wouldn’t be at all surprised if he and his buddies are behind the homework this consultant was given to learn.

    • G. Karl Snae

      haha, he said a threat just trying to hide behind something he new too well about (his lie). By pointing to something else, here threat by “the bad guys”, thereby drawing everyones attention and making a emotional connection to the public to the word threat and Big Tobacco guys – which everyone in the room hates and by that he is in agreement with this listeners. Also trying to get the right emotions towards him and covering up for eventual thoughts about him being paid for his crap, he is just trying in a childish way to cover up on his lies. Cheap trick!

      In reality it most certainly was a treat, not a threat, by the tobacco company ;-) Just a simple trick used by a childish unscrupulous trickster. Would have enjoyed meeting him myself, have been tackling a few of my colleagues in my country like that, they just try to use everything, even still the Harvard diacetyl nonsense and the Pittsburg formaldehyde (NEJM). These are absolutely my favorite bogus ones, just love those guys naming those and a few more. Not going to mention anything about the charming Californian, Mr Glantz, just love that guy for his manoeuvre or acrobatics on the e-cigs.

      Have a nice day tackling your own in UK, just learn to enjoy the “fight” which is unavoidable where big money is in play. Not just pure science and the best there is in knowledge about it, even at the expense of the public. So fight back with knowledge and skill (sorry about my English) :-)
      ….and best to you Clive with deepest respect on the subject, which I have learned so much from your writings here from your blog and more and speeches (YouTube) ;-)

  • Mr Blog Dog

    I feel sorry for Louise. He’s a disgrace to his profession, but he’ll probably get a medal from some of less honest members of the BMA.

  • Chris Baxter

    I was saddened when I heard of Louise’s experience with the respiratory nurses. It must have been such a disheartening experience. So I was grateful that Louise could put together an account of it so quickly. But the comments by the nurse about COPD and vaping struck a very personal and recent chord with me. I hope you can bear a short tale:

    In the 1970s I was a very active and extremely fit caver. But not nearly so fit as my caving friend Richard – his strength and endurance often left me standing (or crawling). We were both heavy smokers.

    I stopped caving but I just couldn’t stop smoking. By the age of 58 I was still a heavy smoker and I was a mess. My health was failing, my outlook was bleak. I knew it, but I still couldn’t stop. The miracle happened on July 14th 2012 when I switched seamlessly to vaping. I phoned Richard within 24 hours and urged him to switch too. He didn’t.

    On June 11th this year I will be taking part in my third off-road marathon – across those same fells where Richard and I went caving. Training is going well and I hope to better my time when I was 60, which was better than my time at 59. To be high on the fells and feeling fit is like being born again. I owe it all to vaping.

    Last weekend I heard that Richard has COPD. He has difficulty on a flight of stairs.

    How could those nurses get it so wrong? This is for real. People are suffering needlessly because of misinformation. But, to be positive, how much worse would it be without people like Louise?

    So thank you Louise, thank you Clive, thank you to everyone trying to get the right information out there. And always remember: ‘Don’t let the b******* grind you down.’

  • Louise Ross

    Thanks for the support, you lovely people. The story behind it is that I was approached to do the pro side, and he was asked to do the con side. I really believe the organisers felt it would lead to a useful debate, or I wouldn’t have agreed to take part. I’ve debated this endlessly, with people who are willing to listen and consider the evidence, but this was just staggering showmanship by someone who is probably a highly respected physician but who wanted to win the debate, by using highly emotional ploys. In short, he carried intrinsic authority (think of the traditional nurse/doctor relationship) and although he said he had huge respect for Smoking Cessation Services, he seemed happy to rubbish the work of those of us who know (and we do know) that vaping is a gateway out of smoking.

    • John walker

      Louise ,as I think you know, the real subject of the conversation was, power.. His only love is of his own authority, nothing more..

      Hope it’s OK for me to pay;
      May the spirit: wisdom , courage ,and above all love, be with you. God bless!

      The best of the best serve only ‘nobody’. Be though my vision, and all that. Good luck mate.

  • Louise, I’ve run into this sort of situation many times over my years of fighting smoking bans and the lies about the “deadly threat” of secondhand and thirdhand smoke. There are certain debate techniques that Antismokers use regularly (Antivapers are simply Antismokers dressing up in new clothing for a night out) and one of their favorites, and the one you got hit with, is “The Gish Gallop.”

    When there’s a limited amount of time, the Anti can stand up there and quickly throw up a dozen or more horrible sounding things… with no backup, no evidence, nothing at all except quantity and fear.

    And they you or I or whoever is left with just enough time to really explain the errors behind perhaps two of the dozen claims… leaving the audience with the impression that we “cherry picked” those two while the other ten ARE ALL TRUE!

    About the only way I’ve found to fight that is to quickly point out at the start of your response that they’ve used a dishonest and sneaky debate tactic, name it, then VERY quickly list their claims all rammed together to show what they’ve done…

    And THEN … challenge your opponent to pick the strongest one (or two, depending on your time) from the bunch and stake their success or failure on being able to defend it, while YOU (or I) will stake OUR success or failure on our confidence that they are ALL lies… and we can show that for any and all of them that we have time for.

    It’s a tricky concept to get across, and sometimes not workable with time, but if you CAN do it, you can trash a Gish Gallop. It’s ***MUCH*** easier to trash here on the internet where you can take the time and space for each point and where you can point people to quickly checkable references that show that YOU are the one telling the truth.

    If this sort of debate is something you do regularly, it’s worth printing up a one or two sheet handout of “Expected Lies & My Responses” where you’d format and list a half dozen or so of the most common ones that you expect to hear and then, AFTER they’ve said their piece, show that their laundry list truly *IS* nothing but propaganda sound bites SO standardized that you were able to prepare your rebuttal sheet ahead of time for the audience to read.

    Again, it’s a bit tricky: they may not hit your points, or, even if they hit some of them, you are then in a position of sharing points on their side that they did NOT mention — generally not the strongest debate tactic.

    Best of luck in the future: you’ll be prepared for it next time!

    – MJM, who explains this stuff MUCH better than he actually performs it. LOL! I’m sure that whatever you do it’ll be FAR better than what I would do! :>

  • You can see a written variation on this Gish Gallop response in my http://bit.ly/SmokingBanLies booklet. It’s designed for printout for quick reading in dimly lit bars under attack, and basically I took the Antismokers’ strongest studies and briefly ripped each one of them to shreds while explaining that I deliberately picked their BEST and their STRONGEST scientific materials… materials THEY chose to hang their hats on in public.

    – MJM

  • Clive Bates

    Several people who this person is. We are reluctant to publicise his identity because he already has displayed a weird martyr syndrome and makes a show of his supposed victimhood. For our purposes, what matters is the sheer desperation, professional negligence and barrel-scaping of the ‘antis’, as revealed here.

  • Adam Williams

    It’s a sad world when some in the medical profession ignore the science and even go out of their way to discredit it. (Lie)

  • Sarah

    Now that it’s more widely known who he is I’d like to express my utter disappointment in him. He’s a respiratory consultant at one of the top heart and lung hospitals in the country, and one which I hold dear for personal reasons which some who know me will be aware.

    Another delegate at the conference has suggested on Twitter that he was “just role playing”, i.e. taking the anti side for the sake of debate and not because he had any real belief in what he was saying. To my mind that is absolutely disgraceful. He was addressing an audience of health care practitioners who work in the field of respiratory medicine, and spoke from a position of very high authority. Lou had lost before she even started.

    If this was some sort of game he and the organisers were playing clearly the audience weren’t aware and we now have countless respiratory nurses giving advice on the basis of the misinformation he imparted. It’s beyond disgusting.

  • Louise Ross

    Yes Sarah, I’m more disturbed by that than anything else! We have to work hard to convince sceptics, and to be rinsed by someone who was PLAYING A PART leaves me speechless.
    We were both promised a fee for our participation in the debate. I told the organiser on the Monday after the conference that I would be donating all of mine to the New Nicotine Alliance, to further increase knowledge and to undo prejudice.

  • I agree with Sarah, it’s irresponsible behaviour, made worse by a disingenuous attempt to cover their backs.

    Had this actually been a “game” did anyone say so, was this stated anywhere? How was the information staged/presented?

    I’ve seen this type of thing in action, we trained a group of HCPs in new policy & practice, gave practical demonstrations etc to them all (some of who switched as a result) but the most senior (coincidentally a resp nurse) went back to hospital and suddenly changed her tune. Why? “Oh, I asked my consultant and he told me what the BMA position was…”

  • Clive Bates

    The role playing thing is obviously back-covering bollocks. They would have told the audience and other participants and had some sort of wash up on the facts if it was role playing… And why would the e-cigarette opponents need to role play?

  • Hearing stories such as this leaves me angry and frustrated. It reminded me of my very first time to testify in a city council meeting in 2010. I had been told there would be a limited time for public comments, so I volunteered to go first. Big mistake. After the lobbyist for the American Lung Association testified to a number of factoids, I tried to get the opportunity for rebuttal, but was refused. Never again will I volunteer to go first. As for my personal experience, I tried for 45 years to quit, but giving up nicotine made me very ill. I came to believe that if I could just take in sufficient nicotine from a different source I’d be able to stop smoking, but patches, gum, and lozenges didn’t do the trick. I still had tremendous urges to smoke. I found e-cigarettes in 2008 and was a dual user until 2009 when I switched completely. After that, I noticed that the wheezing that was so loud it kept me awake at night had disappeared. So had the productive morning cough. And suddenly I was able to enjoy a good belly laugh again without going into a coughing jag. For future reference, CASAA has collected over 8,000 personal testimonials like mine. http://casaa.org/E-cig_User_Testimonials.html

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