Epistemic and ethical failures in research on electronic cigarettesThey probably won't like my conflict of interest disclosure:
The exploding popularity of e-cigarettes, driven by health concerns and anti-smoke sentiment in many rich countries, has the potential to render marginal both traditional tobacco products and anti-tobacco/nicotine extremism. E-cigarettes represent both a consumer preference and an identity or community. But studies of this modern phenomenon are decidedly primitive, generally treating users with a level of disrespect that has been unacceptable in social science for generations and a paternalistic approach that has been absent from even most medical research for a couple of decades. Consumers' choice of e-cigarettes are inappropriately researched as if the products were medicines, to be handed out in restricted clinical settings that are unlike the real world of millions of smokers who might someday switch products. Concern about long-term health risks from e-cigarettes are discussed like a pharmaceutical rather than the much more appropriate analog (in terms of magnitude and the nature of the behavior), a food item. The preferences of consumers (the correct word, but one almost absent from the discussion) and knowledge are disregarded, showing less respect than in research on heroin users. The well-established experience of vapers, and the testimony of thousands of them, is dismissed as if it were less informative than a small artificial clinical trial despite e-cigarettes being a consumer, and not a medical experience.
The explanations for these misguided approaches can be found in disrespect for those who choose to self-administer nicotine, ignorance of proper scientific epistemology (by medical researchers who apply their methods to all research, even when clearly inappropriate) and efforts to intentionally delay recognition of the benefits of e-cigarettes by those with a vested interest in opposing them. Most current e-cigarette research seems destined to be as embarrassing, in retrospect, as anthropology in the 19th century or pregnancy and maternal health in the 1950s. A solution might be found in research by those who understand welfare economics and other relevant social sciences and the respect for choice and dignity demanded by them.
My personal beliefs and professional identity are as a supporter of individual autonomy, particularly including choices about tobacco harm reduction and other drug-use choices, and a critic of poor health research methodology. I am an advocate of tobacco harm reduction. I offer advice on these topics, mostly volunteered, but sometimes have been compensated by those who sell nicotine products (though never an e-cigarette merchant) or who otherwise profit from the market or fights about it.ote that this is separate from the statement of how this work was funded (to which I answered "self"). Those who follow my writing about conflict of interest know of my (quixotic?) effort to identify what my real COIs are in the hopes that a higher standard will emerge. That is, as opposed to the current "standard" which creates such absurdities as people apparently running through thought processes like, "well let's see, I am reporting a data-dredged result about how bad using _______ [fill in: smokeless tobacco -or- e-cigarettes] is for you; my entire career is based on being unyieldingly anti-tobacco/nicotine, and my salary and work network both depend on maintaining my goodwill with those who will instantly cut me off if I stray from that position; I am a true believer in anti-tobacco extremism; the anti-tobacco journal suggested there was a better chance this would get published if I made the conclusions stronger and more newsworthy; but I have only gotten funding from organizations dedicated to eradicating all self-administration of nicotine, never a ~corporation~, so I can check the 'I have no conflict of interest' box".
On an unrelated note, a few days ago I wrote about the absurd positions at both ends of the spectrum about "precaution" when it comes to companies exposing us to possibly harmful chemicals. Today the New York Times book review looked at a new book related to that. The reviewer noted that the book has some insightful parts, but pointed out that there were fundamental flaws in the reported claims, including this damning passage:
...fails to cite conflicting studies, and his breezy style sometimes borders on carelessness. He’s profligate with the word “toxic” (toxic to whom, and at what level?), and he’s vague about exposure routes. Sure, some Prius parts contain perchlorate, the primary ingredient of rocket fuel, but how many people eat their seat belts? If the exposure route is air, how and at what rate do seat belts degrade? He says baby shampoo contains formaldehyde, “which causes cancer and compromises the immune system,” but doesn’t explain at what level and through what exposure routes. (The E.P.A. recognizes formaldehyde as a human carcinogen under conditions of unusually high or prolonged inhalation exposure; I’m no formaldehyde apologist, but this glossing of detail left me feeling slightly distrustful of his reporting.) Jenkins also states that “premature births have jumped nearly 30 percent since 1981” and strongly implies a link with environmental chemicals. But a more significant factor may be the increasing use of fertility drugs, which lead to multiple births.So we have the good advice to stay away from this book if you are looking to learn, right? Well, no. Sadly, the reviewer gets breezy herself at the end, writing:
For anyone who knows too much about the perils of knowing too little about the human health impacts of chemicals, “What’s Gotten Into Us?” may prove frustrating. But it’s a fine, user-friendly introduction to avoiding environmental hazards in the home, and an even better catalyst to questioning how we got to this point….No no no! Doesn't she read Unhealthful News? Ok, fine, of course she doesn't. But the point is that this is a perfect example of how not to think and now not to read. Do not credit people who cannot get the basic facts right with insight. If a work presents factual claims that are likely to mislead non-expert readers, then it is the last thing they should be reading. The reviewer may be an expert in the subject matter, but her lack of expertise about how to aid critical reading wastes that. What should follow from "anyone who knows the subject matter will find this frustrating" is "non-experts may find it convincing, but should stay away from it to avoid being tricked by the bits that make it frustrating."