December 15th, 2014

Debating e-cigarettes with Professor Martin McKee

Hiding

There is much discussion about willingness to enter debate about e-cigarettes following this letter from Professors McKee, Glantz, Chapman and Daube.  I will return to this letter shortly, but in the meantime here’s an example of how it works in practice. In July, I sent an email to Professor McKee of the London School of Hygiene and Tropical Medicine, challenging some of the criticisms of legitimate scientists he had made in the media, suggesting he discuss his concerns with the scientists he was criticising, and personally offering to debate with him debate in a public forum.   Here’s the what I sent:

To: Martin McKee, Professor of Public Health, London School of Hygiene and Tropical Medicine

CC: Signatories to the critical commentary (attached) of 129 person letter to WHO

31 July 2014

Dear Professor McKee

I notice that you are again striking a hostile public posture towards e-cigarettes and tobacco harm reduction and, in today’s case, criticising an evidence review just published in the journal Addiction. You also refer to a letter written to WHO signed by you and 128 others.  I would like to offer some feedback and put some questions to you on this.

In this piece on the BBC this morning (E-cigarettes less harmful than cigarettes), you are reported as follows:

Prof Martin McKee, of the London School of Hygiene and Tropical Medicine, who was not involved in this analysis, told the BBC: “Health professionals are deeply divided on e-cigarettes.

“Those who treat smokers with severe nicotine addiction see them as offering a safer alternative to cigarettes.

“In marked contrast, many others, such as the 129 health experts who recently wrote to the World Health Organization, are extremely worried given the serious concerns that remain about their safety, the absence of evidence that they help smokers quit, and the way they are being exploited by the tobacco industry to target children.

“This report concedes there are huge gaps in our knowledge – yet, incredibly, encourages use of these products. This seems little short of reckless.”

What is the basis for your claims? Can you explain on what basis you make these statements and how you have assessed the significant body of evidence that does exist, including that considered in detail in the review just published? Why do you think it is ‘reckless’ to encourage smokers to try products likely to be one to two orders of magnitude safer than smoking? To me the recommendations by the authors look cautious and reasonable, not reckless and ‘incredible’.

Letters to WHO. You refer to the letter to WHO organised by Professor Stanton Glantz signed by you and 128 others.  It is possible that you have not yet seen or found time to study the critical commentary on this letter detailing some of the many errors of fact and interpretation contained in it.  I enclose this commentary (pdf attached) and I hope you will read it carefully and reflect on whether you should be publicly referring to your letter as though it is a source of authority.  I have copied this letter to the signatories to the commentary, and I am sure many of them would welcome sight of your reaction as much as I would.

Responsibility of public health commentators. Can you also explain the extent to which you have considered your own responsibility and accountability in this area?  It is quite plausible that the outcome of your campaigning against e-cigarettes is that people will believe the risks arising from e-cigarettes are far greater or more uncertain than they actually are, and, as a result, be deterred from using them and so continue to smoke.  In that event, you may well be responsible for increasing avoidable smoking, protecting sales of cigarettes and causing more disease and death than there otherwise would be. It would be helpful to understand: (1) if you have recognised the plausibility of this risk at all? (2) If so, how you have weighed it up and concluded you are meeting the “first do no harm” test that should govern anyone involved in public health? If you do wish to think more carefully about these responsibilities, may I respectfully suggest reading: Turning the tables on public health – let’s talk about the risks they create – a short piece by me.

Engagement in scholarship. Rather than rushing to make rapid-fire comments to the media, perhaps you would do more for public health if you took the time to read in detail the published review you are criticising (Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit). Once you have considered the analysis, may I suggest you invite the authors to discuss it with you? That way, you could probe and understand their perspective and you would be able to challenge their findings with any contrary evidence, principle or argument you believe to be relevant. Wouldn’t that be a more fitting approach for a senior academic?

Consider the impact on real people.  You are often making statements that many ordinary smokers and vapers believe bear no relation to their experience or to the facts as they know them, and at times they find your public comments upsetting or insulting. Yet you do this with the trust and authority, and access to media and political influence, that comes with being a professor in a prestigious institution.  May I suggest that you take a few minutes to read what some ordinary people say of their experience and try to understand what this means to them?  All public health should be grounded in respect and empathy for the people affected, and the dictum ‘nothing about us without us’ should apply in this field as in any other.  Please see: Where is the humility, where is the empathy? – especially the dozens of testimonies left on my web site and others.

I hope you will respond to at least some of these concerns.  I am sure I am not alone in worrying that the approach you take to e-cigarettes will cause far more harm than it prevents. You are of course entitled to hold whatever opinion you like, but it would be good to see you debate and defend your arguments openly.  If you would like to debate with me in a public forum, I would welcome the opportunity – please let me know.

Yours sincerely

Professor McKee was so keen to respond to challenge, to discuss his concerns with the scientists he was criticising, or to have a debate with me… that he didn’t reply at all.

 

14 comments to Debating e-cigarettes with Professor Martin McKee

  • SteveW

    As ever, Clive, a very well reasoned criticism and a polite invitation.

    Cosidering this “…A recent Lancet—London School of Hygiene & Tropical Medicine Global Health Lab (held in London, on Nov 4, 2014) debating the tobacco endgame, that was widely advertised, was an opportunity to engage on this issue…” from their recent letter in The Lancet, his refusal to engage would, for most people, be deeply embarrassing; hopefully he will feel the same and get back to you.

  • godek

    Stan knows that he is just venting air. He will just sit this out.

  • Jon Fell

    Thanks Clive, I thoroughly agree with the points you raise in the letter, and find it troubling that you didn’t get any response. Something I do wonder about is how those supportive of harm reduction / ecigs leave room for those currently opposed to come round to a different point of view. I’m well aware that I don’t have answers here (indeed, might have made some contribution to making things worse). One of the problems with entrenched positions is that they have a tendency to get dug in deeper, especially in the glare of the public eye, social media etc. At the moment it quite hard to imagine one of the letter-writers appearing at an event like the e-cig summit. There seem to be quite a few events which are either pro or anti ecigs and vaping, but how much real dialogue is there? I’m assuming there must be some, because I can see that the position of some important organisations and individuals has shifted. How does that happen?

  • Pedaldog

    Mr Bates! May I, respectfully, request that you stop making sensible comments to the Self inflated bunch of “Emeritus syndrome sufferers” (I know everything as it was twenty years ago and I haven’t learnt any change in the situation yet) as it will probably upset their delicate, single string minds and could, in fact, lead them to the worrying conclusion that Everything they “Know” is WRONG!

  • Jon Holland

    I silently followed Professor McKee on twitter, I didn’t ever engage him but I am now blocked. I suppose a vaper I must represent some form of future threat.

  • Irish Lass

    Having read the letter in The Lancet, I have sent an email to the editor expressing concern that the authors declared no competing interests, when Stanton Glantz’ job appears to be heavily funded by pharmaceutical companies which manufacture NRTs, which are direct competitors to electronic cigarettes. I await the editor’s response with interest.

  • john

    Re Mr McKees refusal to “discuss his concerns with the scientists he was criticising, or to have a debate with me…”

    Is Martin McKee actually, a scientist I.e educated in the philosophy/ methodology (and the general ethos) of serious science ?
    He seems to have qualifications as a doctor, which is not the same thing at all.

    His unwillingness to discuss his concerns with trained scientists might be down to his not being a scientist. After all so many of the statements made by the Mr McKee and his gang on e-cigs are chock full of, obvious but unchecked confirmation bias, show little understanding of stats; seems to be a past master at statements like: ‘e-cigs , got 5%, ‘wrong’- fail ‘ and ‘ they are dangerous… if used while standing still in the fast lane of a autobahn’.

  • Irish Lass

    The question is, it seems to me, how to get any access to the politicians, in order to counteract the lies and put the correct facts to them.
    I tried writing to David Cameron, but my letter was forwarded to the Dept of Health, who gave me their stock anti-e-cig response.
    I wrote to the MHRA and, after pushing them a bit, got a slightly better response – but nothing that was likely to reach or otherwise help influence the politicians.
    I wrote to my local MP and got a very anti-e-cig response – though they have since been in touch with a (very) slightly more moderate response.
    I am currently writing to the media and their regulators every time I see rubbish published or spoken about e-cigs. Some success, but again very little.
    So I’m at an impasse.
    I can only hope that the efforts of more influential people than me – like Clive, Prof Farsolinos, Prof Britton and others – who can see the hope offered by e-cigs, will eventually have an impact on the law-makers.
    But I despair of our so-called democracy. Its better than living under the Taliban, for sure, but government of the people, by the people, for the people it AIN’T!

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