tag:blogger.com,1999:blog-82378465478056524022024-03-05T02:01:18.439-05:00EP-ology by Carl V. PhillipsCarl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.comBlogger300125tag:blogger.com,1999:blog-8237846547805652402.post-23957145244926213032014-02-10T11:56:00.000-05:002014-02-10T11:56:58.312-05:00New address for this blog: EP-ology.comThis blog can now be found at <a href="http://ep-ology.com/">EP-ology.com</a>. I expect this will be the last post at this location. <div>
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The archives will remain here here to preserve existing links (at least as long as Google keeps providing hosting for blogger archives -- and I should say I appreciate the hosting for all these years, but I now use another platform every day, and it is incredibly frustrating switching back and forth). The archives have also been copied to the new host/location and I suggest that any new links/searches/etc. use those rather than these. Comments on the archives here are now closed, but are open at the new site.</div>
Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com0tag:blogger.com,1999:blog-8237846547805652402.post-69058938414484579602014-02-06T11:16:00.003-05:002014-02-06T11:16:52.263-05:00Random rant about denominator-free statisticsNot particularly relevant to anything, but offering a chance for a random science lesson, I got really annoyed at a couple of items in my twitter feed over the last few minutes.<br />
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The <a href="https://twitter.com/TobaccoTacticss/status/431439033890529280">first</a> (in which the tweet was ridiculing the claims) linked to <a href="http://www.sciencedaily.com/releases/2014/02/140205103145.htm">this</a> article about a new journal paper which claimed: <br />
<blockquote class="tr_bq">
Cat bites to the hand are so dangerous, 1 in 3 patients with such wounds
had to be hospitalized, a Mayo Clinic study covering three years
showed. Two-third of those hospitalized needed surgery. </blockquote>
Regular readers will know my lack of respect for Mayo's attempts at research on anything other than medical treatments. But this is worse than usual. Contrary to the headlines that this claim is designed to generate, obviously only a tiny fraction of cat bites result in hospitalization. Their error, of course, is using "patients" as the denominator, a completely useless population to base the statistic on. Who becomes a "patient"? Obviously it is people who are suffering serious medical problems. In the case of cat bites, this consists of people who, after being bitten by their cat many times before, and suffering no serious problems from it, develop an infection that will not go away. Does this represent 1/1000th of all cat bites? 1/10,000th? Fewer? We have no way of knowing, so the statistic is worthless. More important, we do not know what degree of seriousness typically makes someone a patient. Someone with a non-trivial cat bite injury has no way of guessing her chance of needing hospitalization or surgery because there is no way of knowing how serious the condition of the average patient was in comparison. <br />
<br />
(Note: People bitten by stray cats of unknown rabies status might also end up as patients and be hospitalized on spec, which further biases the number away from how it is being interpreted.)<br />
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Note that this is exactly the same error that infection disease "experts" always make when there is an exciting disease like bird flu. They claim things like "half of those who get it die." Um, no. Half of those who get it <i>and</i> get so sick from it that they are willing to go to the almost-certainly-low-quality hospital that they cannot afford (think about the populations in question) end up dying. A bit different.<br />
<br />
(If you are particularly interested in that observation, I have written about it at some length in this blog, but I am feeling too lazy to go look for the link.)<br />
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The other version of denominator-challenged innumeracy was <a href="https://twitter.com/theCPBB/status/431318075539873792">this tweet</a> from a group calling itself the Center for Priority Based Budgeting, which was naively retweeted by the Robert Wood Johnson Foundation's public health feed. It included a coded map of the USA and the observation "Half of the nation's uninsured live in just 116 counties". I am not going to go check this, but eyeballing the map, I would guess that half of the nation's <i>people</i> live in those 116 counties, so this is not exactly exciting news.<br />
<br />
Seriously, did everyone who understands numbers from the last couple of generations go to Wall Street, Google, and the NSA, leaving the rest of the world innumerate?<br />
<br />Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com0tag:blogger.com,1999:blog-8237846547805652402.post-87284426788270555112014-02-02T15:59:00.000-05:002014-02-02T17:02:11.922-05:0022% of Australian tobacco controlers support genital mutilationOk, as you might have guessed, that is not true. (Presumably.) But I did get your attention to make the point that they favor something that is equivalent to genital mutilation. That is not some hyperbolic Godwin-esque comparison. There really is a pretty exact analogy, even if the harm caused differs quantitatively.<br />
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I have been meaning to search my archives for important posts that have not been read as many times as they deserve. The great tweeter, @TobaccoTacticss -- whose readership has doubled in the last week and a half (<a href="http://antithrlies.com/2014/01/24/we-just-dont-know-is-a-bit-old-isnt-it/">you're</a> <a href="http://antithrlies.com/2014/01/31/ash-uk-lies-to-censor-criticism-bogus-legal-claim-against-critic/">welcome</a> :-), helped me choose where to start by posting <a href="https://twitter.com/TobaccoTacticss/status/430017702455828480">this table</a> from <a href="http://tobacco.health.usyd.edu.au/assets/pdfs/publications/not-for-citation-draft-future-survey-paper.pdf">this survey</a> of Australian tobacco controllers. It shows that 22% expressed support or strong support for "Vaccinating children and/or adolescents against the effects of nicotine to prevent the uptake of tobacco use."<br />
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My archive post in question is <a href="http://ep-ology.blogspot.com/2012/03/second-order-preferences-and-ethics-of.html">here</a>, in which I observed:<br />
<blockquote class="tr_bq">
<span style="background-color: white; color: #333333; font-family: Arial, sans-serif; font-size: 14px; line-height: 18.25200080871582px;">Most of the discussion about the topic is not about the rational adult making an informed decision, but about involuntarily inflicting the vaccine [a drug that would -- theoretically permanently -- eliminate the body's ability to respond to nicotine] on kids. Those proposing it tend to gloss over that "involuntary" bit, and failure to even address this is a serious ethical problem in itself. But, of course, unless we are talking about a current user who is wanting to quit, this is the only interpretation. Either the kid is already choosing to not use nicotine, in which case he would see no reason to accept the side effects, or he is currently choosing to use nicotine, in which case he would prefer to avoid the vaccine.</span> </blockquote>
<blockquote class="tr_bq">
<span style="background-color: white; color: #333333; font-family: Arial, sans-serif; font-size: 14px; line-height: 18.25200080871582px;">Of course, we take actions that restrict kids' choices all the time. But there is something rather different when the method involves altering their bodies to make it impossible to enjoy a particular choice (and that choice is not "inflict violence on others" or "commit suicide" or something of that nature). If the effect were permanent, I think this would be an ethical no-brainer. I suspect that a permanent effect is the goal of those pursuing research on this vaccine, and inflicting that on someone would clearly be unethical. No, that is too mild -- it would be utterly appalling. </span> </blockquote>
<blockquote class="tr_bq">
<span style="background-color: white; color: #333333; font-family: Arial, sans-serif; font-size: 14px; line-height: 18.25200080871582px;">Consider the other example (the only other one I can think of) in which adults permanently alter the body of a child to prevent the child from engaging in a behavior that entails some costs, and where they (the adults) do not approve of the kids enjoying the benefits: the mutilation of girls' genitals practiced in some African communities, which you have no doubt read about. Before anyone who cannot follow a logical argument flips out, I will point out that I am not claiming that either the damage done or the loss of benefits from the vaccine is as great as that from genital mutilation. But the motivation and implications are otherwise similar: enjoyment of sex/nicotine by youth is considered evil by those in power for some reason; the benefits of sex/nicotine result in temptation that can be removed by altering someone's body to diminish the benefits; yes, the behaviors that are thus prevented can increase risks of disease, but this does not appear to be the genuine motivation (e.g., because there are other ways to avoid disease that the proponents oppose). I suspect that never in my life have I had a conversation with someone who thinks that genital mutilation is anything other than appalling, so why is there no hint of such ethical concern directed at the nicotine vaccine?</span></blockquote>
Frankly, I think I understated it a bit there because I was writing primarily for a group of young students and not my usual more hardened readers. It is really pretty much impossible for me to see any ethical distinction between the two practices. Presumably "vaccinating" children would only be done with the consent of the parents, but that is also true of genital mutilation as I understand. In both cases, doing whatever it takes to stop the disliked behavior in question is strongly supported in some communities, so no difference there. They are both about limiting the behavior of the adult that the child will become also. And so on. The only tiny bit of light I can see shining between them is the fact that for most (though not all) people the loss of much of the physical pleasure of sex is a larger cost than the loss of the benefits of nicotine -- but that is only a quantitative difference, not a fundamental one.<br />
<br />
The survey also found 38% support for "Vaccinating smokers against the effects of nicotine as a cessation method". This would not be <i>as</i> troubling if this were "making a vaccine available to smokers who wanted it", but it is actually phrased in terms of inflicting the vaccine, not merely providing the option. Perhaps most respondents interpreted it as the latter. But if not, it is arguably even worse. Not only do nearly half support it, but there is no hiding behind "we have to protect the children" because it is trying to deprive <i>adults</i> of free choice by maiming them. (You can decide for yourself whether this is even worse depending on your personal trade-offs about issues of freedom, children, etc.)<br />
<br />
Finally, notice that "<i>as</i>" I emphasized. Read the original post to see why merely offering a vaccine to interested adults is -- to borrow a favorite phrase of the tobacco controllers -- a wolf in sheep's clothing. The pitch, like the promise that accompanies the marketing of NRT and other stop smoking methods, would inevitably be that if you take the drug you will not want to smoke. The reality is that it would permanently (unlike other drugs) trap someone who wants to smoke or otherwise use nicotine in a body that could not use nicotine.<br />
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I wish I could take some consolation in the fact that Australia seems to have the most evil tobacco control people in the world. But I am afraid that the portion of those people who are willing to maim children and adults to control their behavior is not much lower elsewhere.Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com4tag:blogger.com,1999:blog-8237846547805652402.post-51745434788913825392013-12-03T13:20:00.002-05:002013-12-03T13:20:13.690-05:00Why tobacco use modeling need economic mechanisms - FDA workshop slidesI have not been doing a great job of creating updates about my THR modeling work, so here is one easy very-partial remedy for that. The FDA Center for Tobacco Products is holding a <a href="http://www.fda.gov/TobaccoProducts/NewsEvents/ucm372587.htm">workshop </a>about modeling and other methods that relate to their regulations and I am presenting a talk using <a href="http://www.scribd.com/doc/188974431/FDA-Modeling-Workshop-CVP-Nov2013">these slides</a>.<br />
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As those of you following my work on this subject know, I am rather critical of the usefulness of the existing "models" of tobacco use. (For those not familiar, follow the tag on this post for previous and future posts on the subject.) I use the scare-quotes because I argue that most of what are called models in this space fail because they are not actually a simplified version of the real system, but are really just complicated calculation tools. They completely omit the underlying mechanisms of the system -- the consumer economics -- and thus just translate high-level statistics (e.g., "assume 2% of the smokers transition to e-cigarettes each year") into high-level outcomes (e.g., "the smoking rate over time follows this path"). This does not mean they are not useful, of course. There is value in that. But the value is calculating the answer to high-level hypothetical questions, not actually representing the system.<br />
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My argument in this talk is about how the lack of that real representation of the system means, most obviously, that it is impossible to make predictions about previously unobserved phenomena. (If the only use of data is to say "we have observed that when X happened then Y resulted", you cannot say much about situations that have not happened before.) But it also means that even the high-level predictions are likely to be wrong because they are based on a misuse of the data (which I call superstition rather than science).<br />
<br />
I made the tactical error of offering to present on any of several aspects of my research agenda, but fortunately the organizers shared my opinion that this bit is the most crucial for people to understand at this point. (Note to self: Don't count on that in the future.) The talk is likely to come as a rather unwelcome coda (it is scheduled very late in the workshop) to a series of presentations about "models" that fail to do what I am saying must be done. Of course, I might be pleasantly surprised and discover that my message has already been covered. Such good news for the science would be bad news for my talk, of course, making it awkward with a lot of phrases like "this has already been discussed, but to reiterate the point". But I am not optimistic/pessimistic that there is much chance this will occur.Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com2tag:blogger.com,1999:blog-8237846547805652402.post-55706864347362756202013-09-01T21:25:00.001-04:002013-09-01T21:25:21.077-04:00Funny how those who worry about greenhouse gas emissions ignore their own biggest contributions<div dir="ltr">
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This has long bugged, me but Greg Mankiw's <a href="http://www.nytimes.com/2013/09/01/business/a-carbon-tax-that-america-could-live-with.html?emc=edit_tnt_20130901&tntemail0=y" target="_blank">op-ed</a> in
today's NYT prompted me to complain about it again. I have no
complaint about his actual thesis, which was the basic, obviously
correct economics: A carbon tax is a much better way to discourage
people from causing so much GHG emission (assuming we want to do that) than is the hodgepodge of often
inefficient regulations and incentives -- especially if the tax is offset by
tax cuts that are targeted at making the cost impact neutral for the
average person. But what bugged me was his musing about what he might
personally do to reduce his own emissions.</div>
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As
is typical for people discussing this, he mentioned driving a more fuel
efficient car, adjusting his thermostat, solar panels, and eating
locally. To his credit, he avoided mentioning totally useless and counterproductive gestures like
recycling. Also to his credit, he actually included one of the three
biggest things someone can do, three things that are generally ignored by the
typical bourgeois self-congratulatory worriers about climate change. Most important, of course, he was advocating an efficient alternative to
hodgepodge and voluntary action that would make the benefits of avoiding
particular consumption proportional to the costs of emissions impact of
it, solving this problem: With a carbon tax, the costs would be internalized for everything, including those actions that are typically ignored. Thus this screed should be seen as directed
at the chattering enviro types, not at Mankiw.</div>
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It
is pretty clear that there are four changes that matter for reducing the
carbon emissions you cause that you can do while still maintaining a basic modern
lifestyle: don't fly on airplanes, live in an urban apartment, don't
eat meat, and minimize gasoline use. Everything else is just a rounding
error. Of course none of these are absolutes -- the closer you are to
the minimum the less impact.</div>
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The
funny thing is, the activists who push this topic -- typically upper
class, though not 1%-ers -- tend to mention only the last of these, and
then only in terms of what to drive, which
is solidly down in fourth place. Why do they conveniently ignore the
actions they could personally take that matter a lot more? The most obvious answer is because they
want everyone <i>else</i> to make the sacrifices. Their only "sacrifice"
is driving a Prius and maybe installing solar panels, which are really visible status symbols for them, points of pride that make them happier, rather than sacrifices. Those actions are kind
of like giving up smoking for Lent because you want to quit smoking; a sacrifice is something that makes you worse off, not better. It much more appealing to offer gestures that actually make you happier and reserve the unhappiness for others.
So, for example, wealthy climate change activists try to force everyone to pay a lot more for electricity, a
cost that they personally can just shrug off or even consider a net gain because it makes them happy, but that is painful for the average
American or Canadian suffering that wealth shock (to say nothing of the average Chinese). </div>
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Mankiw did not mention living in an urban apartment per se, but he did cite both of its advantages compared to living in a suburban house (as most people I know who chatter
about this seem to):
You are closer to where you want to be so you drive far less (which matters a lot more than what vehicle
you drive, especially if you can avoid having a private car at all) and the space is smaller (though he only mentioned the
reduced climate control costs and not the important costs of building
the structure itself and cultivating a grass monoculture in space that could be growing naturally).</div>
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He
did not, however, mention not eating meat or minimizing how much you
eat. This action is something that most everyone can make without massively disrupting their lives, unlike the others (move to the city, minimizing transport), and is clearly the most effective GHG reduction step that fits that description. Yet it pretty much never gets mentioned
by the enviros as part of their agenda. Perhaps this is because they do not want to be staring that choice in the face: There is something huge that any meat-eater can personally do tomorrow, just by deciding to do it. If they admit that, they have to admit that is true then they cannot keep pretending to themselves that they are willing to personally sacrifice for their cause.</div>
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Most
notably, Mankiw did not mention what I am sure is his personal biggest
contribution to GHG emissions, flying. How many miles do you have to
fly in a year before the total contribution from that equals the sum of
all your other consumption (not just driving and household utilities,
but the energy impacts the material goods you consume too)? Don't quote
me on this because I am working from memory, but I recall that it is in
the order of 25,000. So for anyone who qualifies for even "silver"
level frequent flyer status, that flying is more than half your GHG
contribution for the year. I would be surprised if Mankiw flies less
than double that. </div>
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Avoiding
flying (or merely flying less), for the class of people who fly on
airplanes, dwarfs anything else any of us can do to personally reduce emissions.
This also means that a carbon emissions tax would fall most heavily on
plane tickets, where it should. We could let this create the right
financial incentive rather than relying on people who care about this issue to voluntarily avoid
flying -- since observation suggests that they do <i>not</i> voluntarily avoid flying. For the class of people who do not hesitate
to hop on a plane because they just want to be in another city for a
couple of days, foregoing that option -- and thereby reducing their emissions
more than everything else they can do, <i>combined</i> -- is a real sacrifice.
So they decide it is better to just stick to buying those recycling bins, solar panels, and a
cute cars (and put a wind turbine bumper sticker on them, of course).
That way when someone drives by their 3500 square foot house while they are
off visiting Paris, there will be no missing the message about just how wonderfully Green they
are.</div>
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Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com0tag:blogger.com,1999:blog-8237846547805652402.post-89289711488025287772013-08-03T22:21:00.004-04:002013-09-02T09:58:24.611-04:00Models v. Mechanisms at FDA Center for Tobacco ProductsObserved coincidences occur far more often than chance would suggest because we look for them and define our list of what would constitute an interesting coincidence based on what actually occurred (we have no intuition for just how huge the denominator is). I know that. Still, I find it pretty remarkable that for the last couple of days I have been trying to nail down exactly how to explain what is missing from the behavioral modeling by FDA CTP, and then discovered in my morning econoblogosphere reading, the answer I needed seems to be the topic of the hour.<br />
<br />
<a href="http://ep-ology.blogspot.com/2013/08/fda-on-menthol-cigarettes-some.html">Yesterday I posted</a> some advice to FDA CTP about the need to understand social science (mainly economics) in their modeling of behavior. There is relatively little economics that needs to be considered in traditional FDA missions, and that which is needed is relatively simple. But regulations that are intended to affect preferences about a freely-chosen consumer product where preferences vary across the population (i.e., like tobacco products, in contrast with medicines or food safety) are all about economics. The failure to include explicit economic analysis in the recent report on the possibility of banning menthol cigarettes illustrated the problems, both scientific and ethical.<br />
<br />
But if you were to suggest to the people working in the FDA orbit that they do not really have a model of people's choices about tobacco products (as I have argued), they would probably reply that they <i>do</i> have models. Several of them. (For those who are familiar with this field I am, of course, talking about Levy, Mendez, Environ. For those not familiar, that should present no obstacle to understanding this post -- just know that I am talking about a handful of well-known specifics.)<br />
<br />
Ok, there are models. But there is something fundamentally wrong with them. They do not offer us any reason to believe in what they say will occur at the micro level (that is, why each individual person whose actions, collectively, result in the outcome, will do what they suggest they will do). What I mean is that they tell us things like "if X% fewer people start smoking each year", say, due to a menthol ban, "then this graph shows the number of smokers in the future, which is lower than current trends by Y" (if they fill in other information and make a bunch of other assumptions about what is happening, of course). But as for why X% fewer people would start smoking, there is nothing at all. There is just the number.<br />
<br />
I have criticized these as being more like calculators than models. If a population starts at 1 and doubles, every period then the number after n periods is 2^n. But it is hard to call the equation "2^n" a model. Similarly, I argued, the preferred "models" used by the tobacco policy inner circle are just more complicated equations.<br />
<br />
I learned, however, that this point was not widely convincing based on sociological empiricism -- i.e., I tried to make the point to people and did not have much success. I realized perhaps why this was based on my <a href="http://stumblingandmumbling.typepad.com/stumbling_and_mumbling/2012/01/mechanisms-vs-models.html">blog</a> <a href="http://mainlymacro.blogspot.com/2012/01/mistakes-and-ideology-in-macroeconomics.html">reading</a> <a href="http://krugman.blogs.nytimes.com/2013/08/02/models-and-mechanisms-wonkish/?smid=tw-NytimesKrugman&seid=auto">from</a> this morning: I was using the wrong words to make my point. It is not that these are not models; any calculation, no matter how simple, can be called a model if it is representing a worldly phenomenon in some useful way (even that lowly 2^n). The problem with these models, and the reason they failed as legitimate models, is the lack of <i>mechanism</i>.<br />
<br />
A model uses numbers and equations to show how one variable/construct/point-in-time/etc. affects others. But the model may not capture <i>why</i> a particular effect occurs (the mechanism), as with that X% reduction in smoking initiation. In such cases, it is really just answering a hypothetical question ("if X were true, then Y") rather than making real predictions ("X appears to be true, therefore Y"). But the models that would be useful for FDA purposes are ones that tell us "therefore" not just "if...then". Of course, every model is going to have some simplified or hypothetical elements (if there are no simplifications it is not a model, it is reality) and, once again, there are no bright lines since the mechanisms generally are abstractions (i.e., models) in themselves. But for a model to offer predictions that do not just result from hypothetical inputs, there has to be some <i>"why"</i> built into it.<br />
<br />
It seems that the problem is that these models have been developed in a world where the only familiar social science is epidemiology. Epidemiology usually fails as a social science, and as a science more generally, because there is very little attention paid to mechanisms. That it fails as a social science is fairly easy to explain: most people doing it do not realize they are engaging in social science, and most people teaching it have no background in social science. They think they are just doing medical trials. Sometimes this is literally true, of course, and sometimes the observational epidemiology is legitimately an attempt to substitute for medical trials. But as soon as what is being studied is not purely biological, and involves people as people, not just as organisms, it is social science. Medical trials are easy because either the mechanism is obvious or it does not matter -- e.g., this drug makes cancer go away, and we probably have a guess about why, but that guess does not matter because the mechanism does not matter to the epidemiology (though obviously it does for the drug development process).<br />
<br />
The failure to be good science at all is less easy to explain or defend. For almost 15 years, mechanism-oriented methods have been developed and taught (in the few good epidemiology departments). These tend to be pretty simple, just boxes and arrows that show what is causing what, but that is most of what you need. Unfortunately these are (a) seldom used at all and (b) almost exclusively used just for identifying confounders. The latter is useful, of course, and doing it is far better than not doing it. But what is missing is use of these mechanistic models to address questions like "if X is really causing Y by affecting Z, then I should be able to observe not just an association between X and Y, but also..." Such scientific hypothesis testing is close to completely absent from epidemiology. Instead, mechanisms in epidemiology exist entirely in the untested conclusion statements. You have seen it: An association is observed and there is a discussion of how X must be to be causing Y as a result of Z, or whatever, <i>but whether that really seems to be true is never addressed scientifically</i>. It is worth reiterating: In epidemiology, mechanisms live almost entirely in the conclusions and not in the science.<br />
<br />
So circling back to the question of tobacco behavior modeling, when the models are developed in the tradition of epidemiology, it is little wonder that there is no mechanism. The "why" of what happens when a variable changes is not part of epidemiology, and so not part of the models. It is just assumed that if the effects of a particular variable changing were observed in the past -- or more likely, merely if there was just some association observed in the past, with no effects of changes observed -- then that same association will still occur if an intervention is imposed (e.g., menthol is banned). But there is usually no reason to believe that, and indeed, often a lot of reason to not believe it. To take an extreme case, one of the popular models assumes that without menthol, the rate of smoking initiation would drop by the rate at which smoking is initiated with menthol cigarettes. Put a little more simply, this basically is the assumption is that everyone who would have initiated with menthol will therefore never smoke (it is even a bit worse than that because it is based on past associations which might themselves change). I suspect I do not need to explain why the implicit mechanism about people choosing to initiate smoking menthol cigarettes is rather absurd. The absurdity of that seems unfathomable unless you recognize the mechanism-free mindset: "all we know [the mindset goes] is the association we observed before, so we just have to assume that association will always exist".<br />
<br />Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com3tag:blogger.com,1999:blog-8237846547805652402.post-82958407881957440282013-08-02T09:58:00.003-04:002013-09-02T09:58:43.624-04:00FDA on menthol cigarettes, some suggestions for research methods<div data-mce-style="text-align: right;" style="text-align: right;">
</div>
The
U.S. FDA is probably the most respected and influential medical
research organization in the world. Sure they have their hiccups and
there are criticisms (many legitimate, many not) about the science and
the choices about what risks to take (historically entirely in the
direction of them being too quick to keep a potentially useful drug off of the market,
more recently in both directions). But all in all, it is hard to imagine engineering an institution that does much better.<br />
<br />
But tobacco controllers (including a former head of FDA during his
tenure) and their pet congressmen got the bright idea of adding a
category of non-medical consumer goods to FDA's scientific purview. To
these non-scientists, it probably seemed that there was no contradiction
here. Science is science, right? Clinical trials of medicines,
monitoring food safety, consumer preferences, social forces, climate
change research, isolating the Higgs boson -- if they are good at the
first two, and experienced in the related ethical questions, then they must
be able to do the rest, right?<br />
<br />
Um, no. <br />
<br />
It is clear that the FDA scientists
who have been asked to look at tobacco products are trying, and it is
equally clear they are frustrated. Their latest report on menthol in cigarettes and the predicted effects of banning it [I got it <a data-mce-href="http://www.fda.gov/downloads/TobaccoProducts/ResourcesforYou/UCM361953.pdf" href="http://www.fda.gov/downloads/TobaccoProducts/ResourcesforYou/UCM361953.pdf">here</a> but that link seems to not work now], offers an opportunity for some unsolicited advice.
After I collect comments and my thoughts, I might include some of it as a
<a href="http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm361966.htm"> public comment</a>, [UPDATE: link fixed] which they are currently soliciting.<br />
<br />
Their
evaluation concludes that there is no measurable difference in the biological risk
between menthol and non-menthol cigarettes (keeping the quantity of
exposure constant). This is based on research that FDA is pretty good
at; it is not quite the same as their core competencies, medical trials and safety testing, but in the
neighborhood certainly.<br />
<br />
But the crux of the decision about whether to ban menthol is presented in
terms of economics. Unfortunately they do not say this. This is presumably because economics -- the relevant science when you are looking at consumer choices -- has never been part of what FDA does. Drugs and medical devices are evaluated based on people who "need" them and are generally assigned by gatekeeper rather than chosen, so there is limited need to consider economics. To the extent that economics is considered, it is the rump economics of "cost-effectiveness" and "quality-of-life" measures, which are definitely useful and nontrivial, but only a bit of the picture. The food side is rather closer to normal consumer goods, but the focus is still on what everyone "needs" (are not willing to give up at any plausible cost), like non-infectious food. When legitimate economic questions do come up (e.g., some people prefer to be able to consume raw dairy products, even though they are judged not safe enough by the simple bright-line standards), the system has no mechanism for balancing competing preferences, a hint of the challenge in regulating tobacco products.<br />
<br />
It is natural that there is no historical capacity to do much economics within FDA. I would argue that this is the biggest problem the normative side (i.e., ethics -- assessing what is the right thing to do to make people better off), though selling that message is a tough fight. But it is also a problem on the positive side (assessing how the world works when individual free choices are involved), which ought not to be too tough to sell. Understanding consumer choices, and being open and explicit about the science, really should be part of the Center for Tobacco Products.<br />
<br />
The specific economic question at hand is the effect of menthol on the number of
people who choose to smoke, the quantity they choose to smoke, and whether they
choose to stop smoking. These are all economic questions, and when someone tries to address them ad hoc, using epidemiology rather than welfare economics, it does not work out so well. Indeed, even the description of the question at hand, with the key word "choose" in it, defies the standard narrow medicalized method of looking at products (and does not seem to appear at all in the FDA report, despite how crucial the concept is).<br />
<br />
The questions being asked are in the form
of "whether" -- e.g., is there likely to be more smoking if menthol is
available -- rather than "how much". But a tiny bit of economics
reveals that the "whether" question is like asking "does this object have a
weight" rather than "how much does it weigh". <i>Of course</i> the
availability of a flavor that some people like leads to more product
use, and therefore its elimination would reduce how much people like the product. Somewhere out there is someone who is barely on the positive side
of indifferent between smoking and not, and very much likes menthol.
Remove the availability of menthol and he would not smoke.<br />
<br />
(Notice
that I am avoiding the question of implementation here, and simply positing the "removal" outcome. Merely banning
menthol cigarettes rather than magically removing them from the world
creates all kinds of interesting complications about black markets and
do-it-yourself mentholation, which is quite easy. I will come back to that in a later post.)<br />
<br />
The "how much" question is quite a bit more difficult to answer. To have any hope of making a useful prediction, it is critical to understand what is going on: people are using a product because they like it better than its close substitute (nonmenthol cigarettes), most of them probably prefer the substitute to abstinence, some of them like their product enough that they would defy the law, etc. Without these economic points, it is difficult to imagine making a useful prediction. Indeed, if you look at the models that have been used for prediction, they are clearly based on premises that are indefensible but probably the only premises that someone can come up with if they ignore economics.<br />
<br />
Some consist of assuming that any additional use or initiation of cigarettes that is associated with choosing menthol (i.e., smoking rates are higher in subpopulations that use menthol more often) is causal, and thus without menthol the rate would drop to the average. The economics shows that while this outcome is in the plausible range, it would be mere luck if it really turned out to be right because the basis for the claim does not actually support the claim. Which is to say, the prediction has no validity because the premise of it is clearly wrong. It actually gets worse than that, with some of the modeling going so far as to predict that <i>all </i>consumers of menthol cigarettes would be abstinent if menthol were not available, which is not even in the plausible range of values. (No, I am not kidding -- one of the most cited predictions about the effect of banning menthol is based on this premise.)<br />
<br />
Some of the most dramatic errors in the history of science, to say nothing of incorrect claims you see in the news today, result from confusing statistics with mechanism. That is, researchers who do not know why something is happening (e.g., atomic theory has not yet been discovered so they have no idea why samples of pure elements weigh what they do, to take a classic historical example; or they seem to not realize that people make choices based on preference, to take the example of tobacco control industry researchers) sometimes go to great lengths to make measurements. But when they try to interpret the observations without understanding the underlying phenomenon, and basically just assume that the measurements <i>are</i> the phenomenon (an example of which is assuming that all observed association is causal), then whether they are right becomes just a matter of luck.<br />
<br />
As I mentioned, the other problem with not understanding the underlying mechanism when dealing with worldly questions is that wrong (in the sense of accuracy) can also be wrong (in the sense of unethical). When tobacco control activists hide the phenomenon of people's preferences, choices, and happiness behind naive statistics, they avoid having to admit that they are a special interest group trying to impose a narrow "moral" view. Our nation's government is not a special interest group and generally does a pretty good job of resisting imposing narrow moral views on the citizens (thank you, James Madison et al.!). But if FDA research ignores the economics, it tends to prevent decision-makers from realizing they are making ethical, not technical, decisions. (And it allows those who know they are imposing narrow "moral" views to pretend they are not doing so.)<br />
<br />
Banning menthol would serve only one purpose: intentionally lowering the welfare of people who currently choose a particular product. As soon as you express the economic situation in economic terms, this becomes immediately apparent. So, is that justified by the (legitimately predicted) benefits it would produce? Is such an action by a for-the-people government ever justified? Do smokers deserve to have their welfare lowered? None of these questions are answered by economics or any other science, but economics has the advantage of forcing a recognition that those are the questions that need to be addressed. Anyone who suggests that the question "should we ban menthol cigarettes" can be answered scientifically, rather than ethically, is doing the wrong science.<br />
<br />
Finally, as a comparatively minor aside about how to do social science, I note that the first paragraph of the FDA report makes a claim about the portion of the US cigarette market that is menthol, citing it to a 2004 paper. 2004??! Folks, social science does not work that way. People who are used to dealing with biology and other sciences that study phenomena that do not change much over time get into the habit of ignoring when a measurement was made. This is a mistake even then, but it is a fatal error when dealing with social science -- just think about how much has changed in the tobacco product markets in the last decade. An economist wanting to make such a summary claim would either find a more recent estimate, make a rough general claim without citation (making clear that the exact number is not known to the author but that it does not matter much), or look at the most recent statistics themselves and do the calculation. Part of the problem is that people who are used to dealing with only one area of science, medical research, get the mistaken impression that all or most useful information is contained in journal articles. That is clearly not the case in social science, where constantly updated statistics, working papers, and the blogosphere generally contain much better current information and thinking. Indeed, as with many serious sciences, when an article appears in a good journal it is more like an archiving and awarding of a trophy, and is not really the publication, since anything worth reading has already been circulating long before the final version is etched in stone. These are just a few of the things that FDA researchers need to understand now that they have entered the world of studying people as people, and not just as biological agents.<br />
<br />
[More on this theme in the <a href="http://ep-ology.blogspot.com/2013/08/models-v-mechanisms-at-fda-center-for.html">next post</a>.] Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com2tag:blogger.com,1999:blog-8237846547805652402.post-88737517197108189162013-06-25T00:00:00.003-04:002013-06-25T00:08:18.684-04:00My take on the recent UK NICE Guidance on tobacco harm reduction<div class="MsoNormal">
The following is my take on the recent UK National Institute
for Health Care Excellence (NICE) <a href="http://publications.nice.org.uk/tobacco-harm-reduction-approaches-to-smoking-ph45">Guidance on “Tobacco: harm-reduction [sic] approaches to smoking”</a>.<span style="mso-spacerun: yes;"> </span>(I know I
am a bit late to this, but I kept interrupting my work on it for other projects.<span style="mso-spacerun: yes;"> </span>There was a lot in the Guidance to
dissect.)<br />
<u><br /></u>
<u>Background</u><br />
For those not familiar, NICE functions vaguely like the
USA’s Institute of Medicine – in terms of function it is basically a governmental
think-tank, but is <i style="mso-bidi-font-style: normal;">somewhat</i>
independent of the political process in terms of conducting analysis.<span style="mso-spacerun: yes;"> </span>This means that the Guidance does not
create or even explicitly propose government policy action, but it does carry
the weight of government imprimatur (for those who consider that to be a good
thing).<span style="mso-spacerun: yes;"> </span>As for the Guidance, it is
not actually about tobacco harm reduction (THR) in general as the name implies,
but rather is specifically recommendations about encouraging the use of
medicine-like products for THR as partial or total substitutes for smoking.<br />
<br />
NICE apparently considers this to be important – rather more
important that it really is judging from their (grossly inaccurate) <a href="http://www.nice.org.uk/newsroom/pressreleases/NICEGuidanceIsWorldFirstHelpingStopSmoking.jsp">headline claim</a> that this report is “a world first for people who cannot stop smoking in one
step”. I will resist discussing
the implications of this narrow view of many people working for governments
(namely, that something did not happen until they did it) and their apparent
obliviousness to what is going on in the real world. In reality, the Guidance is approximately the one thousandth
statement recommending strategies for helping smokers who do not choose to stop
smoking by just quitting. But
especially baffling is that this is not even the first such statement by the UK
government: The MHRA (the unit of
government that controls sales of medicines, like the CDER (drug) branch of the
US FDA), which actually makes binding policy rather than just recommendations,
has already created a category of medicines for THR and has approved one
product in the category (at least two others are under review).<br />
<br />
Though far short of the inaccurate self-promoting rhetoric,
the Guidance does have the potential to be somewhat influential.<span style="mso-spacerun: yes;"> </span>Much of the reaction to the Guidance from
the real public health community (i.e., THR supporters) has been rather
negative, but I tend to differ because I think that the real impact of the
negative aspects (which definitely do exist) will be trivial and short-lived,
while the positive implications will have legs.<br />
<br />
The main negative is that the guidance is specifically about
the use of “licensed nicotine-containing products” – that is, pharmaceutical
industry “NRT” products that are designed as abstinence-promotion medicines and
not as fully-satisfying consumer products.<span style="mso-spacerun: yes;"> </span>The authors were clearly so desperately worried that someone
might interpret their recommendations as applying to all
roughly-equally-low-risk products, like unlicensed e-cigarettes or (gasp!)
snus, that they included the phrase “licensed nicotine-containing products”
approximately once in every 40 words.<span style="mso-spacerun: yes;">
</span>The problem with that plan (and the reason this is not such bad news) is
that many people who read and make use of this are not stupid.<span style="mso-spacerun: yes;"> </span>Many readers will recognize that
everything they say applies equally to all of these products.<span style="mso-spacerun: yes;"> </span>Indeed, the Guidance authors make
basically no affirmative argument to the contrary.<span style="mso-spacerun: yes;"> </span>(They throw in a few lies about risks from snus, but they
are so buried deep in the research background section that they are unlikely to
be noticed.)<br />
<br />
You could imagine a document like this including a tedious
argument that there is something so different about non-“licensed” products
that the recommendations cannot be extrapolated to them.<span style="mso-spacerun: yes;"> </span>But it does not include that.<span style="mso-spacerun: yes;"> </span>Perhaps the authors actively wanted to
avoid such a claim.<span style="mso-spacerun: yes;"> </span>Perhaps they
just realized they would look like idiots if they tried to argue obviously
incorrect claims. <span style="mso-spacerun: yes;"> </span>One might even
conclude that some of the authors disagreed with the “licensed products only”
spirit of this initiative and managed to keep the document implicitly positive
about THR in general despite several of the authors clearly opposing this.<br />
<br />
Thus, the Guidance is good news merely because it has positive
things to say about one (albeit relatively unimportant) approach to THR.<span style="mso-spacerun: yes;"> </span>And moreover, whatever the reason why,
it was not actively anti-THR for other products, and therefore it will
contribute to the promotion of THR in general, even if some of those in charge
of the process might wish otherwise.<br />
<br />
It is worth noting that there are a couple of e-cigarette-type
products in the application pipeline for the aforementioned MHRA approval, and
the authors of the Guidance knew that.<span style="mso-spacerun: yes;">
</span>Thus, they knew that they were implicitly recommending THR using (some)
e-cigarettes.<span style="mso-spacerun: yes;"> </span>Of course, right
after the release of the Guidance, MHRA declared that they <a href="http://antithrlies.com/2013/06/13/casaas-take-on-the-recent-move-by-mhra/">planned to regulate</a> all e-cigarettes as medicines, requiring them to meet the licensing
requirements (which almost none could meet).<span style="mso-spacerun: yes;"> </span>But it is clear from conversations I had that at least some
of the authors of the Guidance did not expect that this would be MHRA’s move,
so not much can be read into this juxtaposition.<br />
<u><br /></u>
<u>Recommendations in the Guidance</u><br />
So, finally getting to the substance, what does the Guidance
recommend?<span style="mso-spacerun: yes;"> </span>It recommends everyone
involved in smoking cessation (government agencies, medics, specialty clinics,
etc.) provide smokers with information about the benefits of cutting down and
of substitution.<span style="mso-spacerun: yes;"> </span>These do not
appear until after the reader wades through the usual recommendations that they
tell smokers the shocking news that smoking is bad for you and such, but that
is just boilerplate.<span style="mso-spacerun: yes;"> </span>The substance
is the recommendations about a THR approach.<span style="mso-spacerun: yes;"> </span>The same actors are supposed to tell people about the
licensed products themselves.<span style="mso-spacerun: yes;"> </span>But
unless the clinicians et al. lie about the more consumer-friendly products –
which, importantly, NICE clearly does not ask them to do – then people should
be able to extrapolate.<span style="mso-spacerun: yes;"> </span>Indeed we
can hope that anyone working with real live human smokers that they care about,
rather than just publishing information, will go ahead and actively recommend
e-cigarettes (or even semi-black market snus).<span style="mso-spacerun: yes;"> </span><br />
<br />
Of course, we will not know what private conversations clinicians
will have with people. <span style="mso-spacerun: yes;"> </span>But the
Guidance also calls for those who create self-help information to incorporate
these recommendations.<span style="mso-spacerun: yes;"> </span>Will those
who did not already endorse THR in their writings start doing so now?<span style="mso-spacerun: yes;"> </span>It is not clear that the Guidance will
actually have that kind of impact, but at least we will be able to observe this
if it happens, unlike the personal conversations.<span style="mso-spacerun: yes;"> </span><br />
<br />
The word “reassure” appears a lot in the Guidance, as in
“Reassure them that it is better to use these products and reduce the amount
they smoke than to continue smoking at their current level.”<span style="mso-spacerun: yes;"> </span>This is a nice touch, acknowledging
that the anti-tobacco extremists’ years of efforts to mislead people into
believing there are no benefits from THR necessitates an affirmative effort to
undo.<span style="mso-spacerun: yes;"> </span>I am sure this really grated
on those members of the authorship committee who are part of the extremist
clique and personally contributed to the disinformation that needs to be
corrected.<span style="mso-spacerun: yes;"> </span>Or maybe it just flew
over their heads – part of the tobacco control job description is to avoid
thinking critically, after all.<br />
<br />
The discussion of how to counsel smokers about perhaps
choosing THR is quite lucid and rational.<span style="mso-spacerun: yes;">
</span>It reads like the recommendations that good pro-THR medics or real
public health people would write.<span style="mso-spacerun: yes;">
</span>It even includes the advice to warn smokers that the recommended
products are not so satisfying as smoking, so need to be used differently (not
in so many words, of course, but that is the upshot of it).<br />
<br />
The recommendation that those who educate clinicians educate
them about these recommendations is pretty paltry, but it is there.<br />
<br />
There are even recommendations about advising smokers about
strategies for “temporary abstinence”.<span style="mso-spacerun: yes;">
</span>This is not explained, but it seems that it must refer to helping
smokers deal with smoking place restrictions.<span style="mso-spacerun: yes;"> </span>If so, this is a rather surprising move in the direction of
good government – helping people be happier given the constraints they face, rather
than trying to force their choices.<span style="mso-spacerun: yes;">
</span>The anti-smoking activists, if they actually think through what this
implies, are not going to be happy about this; while they publicly justify
place restrictions based on protecting bystanders from smoke, most of them
clearly consider the fact that the restrictions can make smokers miserable to
be a feature, not a bug.<span style="mso-spacerun: yes;"> </span><br />
<br />
I wonder if on this point NICE may actually have been a
little <i style="mso-bidi-font-style: normal;">too</i> respectful of people’s
choices.<span style="mso-spacerun: yes;"> </span>They failed to push the
recommendation to communicate “now that you have discovered that these products
are appealing when you have to deal with place restrictions, you should
consider using them all the time.”<span style="mso-spacerun: yes;">
</span>There is one buried sentence on this theme, but it is a missed
opportunity that they did not make the point more clearly. <span style="mso-spacerun: yes;"> </span>(Of course, perhaps they recognized that
few smokers with these motives are going to find their licensed products to be
so satisfying that they might want to use them all the time.)<br />
<br />
Manufacturers are encouraged to include the THR information
on their packaging and such.<span style="mso-spacerun: yes;"> </span>Of
course, this only applies to licensed products and does not change any laws, so
unapproved claims about “unapproved” products are still, well, unapproved.<br />
<u><br /></u>
<u>Criticisms of the narrow-mindedness</u><br />
As noted above, the Guidance is restricted to “licensed
products” and this provoked a lot of ire when it came out.<span style="mso-spacerun: yes;"> </span>The closest they come to acknowledging
the reality that exists beyond their licensing paywall is, “little direct
evidence is available on the effectiveness, quality and safety of
nicotine-containing products that are not regulated by the MHRA. However, they
are expected to be less harmful than tobacco.”<span style="mso-spacerun: yes;"> </span>While better than denying that they are less harmful, this
is still a lie at a couple levels:<span style="mso-spacerun: yes;">
</span>There is a <i style="mso-bidi-font-style: normal;">lot</i> of evidence
about effectiveness, quality, and safety. <span style="mso-spacerun: yes;"> </span>(Perhaps they were trying to hide behind the word “direct”,
but since it is basically meaningless, there is no refuge there.)<span style="mso-spacerun: yes;"> </span>These products are <i style="mso-bidi-font-style: normal;">known</i> (not “expect to be”) a lot less harmful than smoking, but not
less harmful than “<i style="mso-bidi-font-style: normal;">tobacco</i>”, a
category that clearly includes smokeless products that are just a
low-risk.<span style="mso-spacerun: yes;"> </span>(Indeed, in the minds of
many, all the products mentioned here, when used on a long term basis for
non-medical reasons, form the category “tobacco”, though that does not tend to
be the UK way of thinking).<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Just because you cannot buy low-risk smokeless
tobacco in the UK is no excuse for pretending that it does not exist.<span style="mso-spacerun: yes;"> </span>Still, this cryptically acknowledges
that e-cigarettes, despite the government not officially granting people
permission to use them, are low risk.<br />
<br />
The Guidance goes so far as to say, “Electronic cigarettes
are becoming increasingly popular. If the MHRA starts regulating them, or there
is positive new evidence of effectiveness, …this guidance should be considered
for a rapid update.”<span style="mso-spacerun: yes;"> </span>Of course, if
e-cigarettes are MHRA-licensed products, the only thing that needs to be
updated is adding them to the list of “approved” product types.<span style="mso-spacerun: yes;"> </span>Nothing else would need to change.<br />
<br />
There are probably a hundred incorrect specific claims in
the document, but I am not going to go into that level of detail.<span style="mso-spacerun: yes;"> </span>The count goes up to several hundred if
you include their “review of the evidence” back-matter; that section is bad enough
that it makes me wonder how the recommendations turned out as good as they
are.<span style="mso-spacerun: yes;"> </span>Indeed, it appears that the
authors pretty much used that section for window-dressing and were motivated by
better general knowledge, which is a good thing.<br />
<br />
A more subtle failure is the refusal to acknowledge how we
know that smoke-free tobacco/nicotine products are low risk.<span style="mso-spacerun: yes;"> </span>In their desperate attempt to avoid
even recognizing the existence of smokeless tobacco, they attribute the
knowledge that “licensed” products are low risk to the paltry data about
long-term use of those products.<span style="mso-spacerun: yes;"> </span>That
level of evidence about, say, e-cigarettes would be derided by those who like
the medicines as entirely inadequate.<span style="mso-spacerun: yes;">
</span>The reason we know that the level of risk caused by smoke-free nicotine
is indistinguishable from harmless is the extensive research that shows that smokeless
tobacco has no measurable risks.<span style="mso-spacerun: yes;"> </span>It
is that knowledge that NRT makers cite when they try to argue that their
products are low risk.<span style="mso-spacerun: yes;"> </span>Too bad NICE
could not be as honest.<br />
<br />
The recommendations also fail because they think that
tobacco harm reduction is really just about harm reduction (see my <a href="http://ep-ology.blogspot.com/2013/06/tobacco-harm-reduction-its-not-just.html">recent post</a>).<span style="mso-spacerun: yes;"> </span>They clearly communicate
that the use of low-risk products is always the second-best choice, behind
abstinence, and fail to explicitly acknowledge the advantages compared to
abstinence.<span style="mso-spacerun: yes;"> </span>This was inevitable,
of course, but just because it is not surprising does not mean it is not wrong.<span style="mso-spacerun: yes;"> </span>The Guidance acknowledges that some
smokers do not want to become abstinent, and thereby implicitly acknowledges
that there must be some disadvantages to abstinence.<span style="mso-spacerun: yes;"> </span>But this is never recognized.<span style="mso-spacerun: yes;"> </span>But on the glass-half-full side, those of us inclined to do
so can point out that NICE acknowledges that there are benefits from tobacco
use.<span style="mso-spacerun: yes;"> </span><br />
<br />
Interestingly, the only place where they mention the
favorite bogeyman of anti-THR activism, the possibility that some people who
would have quit smoking will only reduce if there is any encouragement to do
so, is in the cost-effectiveness analysis discussion. <span style="mso-spacerun: yes;"> </span>While engineered worries about this in
the popular discourse are 90% trumped-up lies, it seems like this should have
gotten a bit of explicit attention in the substantive part of the
Guidance.<span style="mso-spacerun: yes;"> </span>Yes, their
recommendations repeatedly include the observation that switching completely or
otherwise quitting smoking is much healthier than just reducing, but I would
have really liked to have seen some suggested model advice about how to say,
“since you are cutting down by using an alternative, you should really consider
finishing the switch because any smoking is a lot less healthy than none”.<br />
<br />
As an aside from the details of tobacco policy, putting on
my political scientist or ethicist hat:<span style="mso-spacerun: yes;">
</span>A disturbing theme in the research section of the Guidance (in common
with a lot of government activism) is the notion that government should think
like a business.<span style="mso-spacerun: yes;">
</span>Cost-effectiveness type analysis is great (it is at the core of what I
taught for years), but it needs to consider <i style="mso-bidi-font-style: normal;">all</i>
social costs and benefits.<span style="mso-spacerun: yes;"> </span>For a
business, something is a good move if it reduces expenditures or increases
revenue (or, more precisely, improves the net of those two added together),
regardless of its other impacts on the world, and that is exactly why a lot of
people, including a large portion of “public health” types, despise business
and use “profit” as a rough synonym for “evil”.<span style="mso-spacerun: yes;"> </span>But that is what businesses are supposed to do, more or
less.<span style="mso-spacerun: yes;"> </span>However, it is not what
government is supposed to do.<span style="mso-spacerun: yes;"> </span>When
the government starts trying to maximize its profits, we are all in trouble –
that is what feudal and warlord governments do.<br />
<br />
Yet the analysis of costs and benefits focuses totally on government
net profits.<span style="mso-spacerun: yes;"> </span>There is no apparent
acknowledgement of the costs and benefits to the product users, by far the most
significant costs and benefits.<span style="mso-spacerun: yes;">
</span>This is rather odd since the substance of the Guidance acknowledges that
people might prefer switching to abstinence – that is, there is a recognition
of the real costs and benefits built in.<span style="mso-spacerun: yes;">
</span>At least that makes it much better than the usual “analysis” that
bludgeoning smokers into abstinence, even though it makes them unhappy, is
“cost-effective”.<span style="mso-spacerun: yes;"> </span>In some ways,
though, that makes the business balance-sheet analysis even more pathetic.<br />
<br />
Besides, should the government require cost-effectiveness <i style="mso-bidi-font-style: normal;">at all</i> before deciding it should tell
its citizens the truth about something very important to them?<span style="mso-spacerun: yes;"> </span>Should the government lie if it looks
like it would save money?<span style="mso-spacerun: yes;"> </span>(Yes, I
know the answer is that they will often do just that.<span style="mso-spacerun: yes;"> </span>But they certainly should not.)<br />
<u><br /></u>
<u>Concluding thoughts</u><br />
I really think that this Guidance is good for the promotion
of THR – not as good as it could be, obviously, but not harmful.<span style="mso-spacerun: yes;"> </span>Because there are no affirmative
arguments against any aspect of THR, it is difficult to see the harm.<br />
<br />
The statement that smokers who reduce but do not quit
entirely (or, more precisely <i style="mso-bidi-font-style: normal;">have</i> not
quit entirely, since they still might do so) get some health benefits flatly contradicts
currently popular anti-THR lies.<span style="mso-spacerun: yes;"> </span>The
Guidance agrees with the point that the experts have long been making, that in
many cases reducing represents a transition, and in any case the much demonized
“dual use” is better than just smoking.<span style="mso-spacerun: yes;">
</span>Of course, the anti-THR activists (who do not actually consider
evidence, but rather start with their conclusion and then concoct
rationalizations for it) can still retreat to their claim that all those people
who have cut down would have quit already if they were not taken in by the
allure of alternative products, but that is so clearly silly that it becomes
much harder for them to defend their rationalization.<br />
<br />
It is also gratifying to see the repeated use of language
that refers to preferences about tobacco use, rather than suggesting it is some
kind of volition-free tic.<span style="mso-spacerun: yes;"> </span>There
are a few appearances of the “cannot quit” type language, but mostly the
languages is about what smokers want – e.g., “may want to stop smoking without
necessarily giving up nicotine”, “want to reduce the amount they smoke”, or
“may not be able (or do not want) to stop smoking in one step”. <span style="mso-spacerun: yes;"> </span>(Yes, they still throw in a bit of the
“cannot” language, but at least they still recognize the relevance of “want”).<br />
<br />
The implicit acknowle<a href="http://www.blogger.com/blogger.g?blogID=8237846547805652402" name="_GoBack"></a>dgments of both
the use of non-“licensed” products and of the downsides of abstinence are quite
useful.<span style="mso-spacerun: yes;"> </span>Those of us who want to
make points about other products and motives can cite this Guidance and just
let the extremists sputter their vapid protests about it just being about
medicines.<br />
<br /></div>
Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com1tag:blogger.com,1999:blog-8237846547805652402.post-29261682242595433482013-06-18T20:49:00.000-04:002013-06-19T09:28:26.288-04:00Tobacco harm reduction, it’s not just about harm reduction<style>
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It has recently occurred to me that perhaps the terminology that I and other pioneers of tobacco harm reduction developed is starting to be a drag on our efforts. I refer specifically to our defining phrase, “tobacco harm reduction”.<br />
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When my colleagues at the University of Alberta and I launched our website in 2005, it was not entirely clear what to call it. We settled on “TobaccoHarmReduction.org”, but there were other candidates at the time. That term already existed, though was not in widespread use. The widespread adoption of that term over the ensuing decade validated our choice (though this might be somewhat circular since our use of the term presumably contributed to the validation). <br /></div>
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<br /></div>
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The term is now locked-in as the description of everything
related to efforts to promote low-risk tobacco/nicotine products, including all
efforts at education and defending people’s rights to access to these products.<span style="mso-spacerun: yes;"> </span>That “everything”, however, is perhaps
unfortunate, because it tends to over-medicalize the entire effort, focusing
all attention on the reduction (i.e., the value of alternatives as compared to cigarettes).<span style="mso-spacerun: yes;"> </span>The tendency to treat the decision to
use low-risk tobacco products as purely as a “cure” for the “disease” of smoking
was most recently exemplified by the <a href="http://antithrlies.com/2013/06/13/casaas-take-on-the-recent-move-by-mhra/">MHRA decision</a> to classify e-cigarettes
as medicines, though the tendency is hardly new. (I had already drafted most of this post long before that came out.) <span style="mso-spacerun: yes;"> </span></div>
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<br /></div>
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It is more politically correct to focus on
low-risk tobacco products as purely a cure for smoking, but sometimes
politically correct is not optimal for the long-run, or merely for being fully
correct.<span style="mso-spacerun: yes;"> </span>I try to hedge a bit when
I define THR in my writings, with something neutral like “the substitution of low-risk
tobacco/nicotine products for cigarettes”.<span style="mso-spacerun: yes;"> </span>This does not actually say that the only reason for using
the is because otherwise someone would smoke.<span style="mso-spacerun: yes;"> </span>However, it is intended to be close enough to pass for that in the eyes of those who demand such a view, suggesting that efforts related to THR are all about getting people
off of smoking, and so probably does not provide any benefit with respect to
the issues presented here.</div>
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<br /></div>
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It is clearly true that for many people, this is exactly
what e-cigarettes and other THR products are – a cure for their smoking habit
that they could not find another acceptable path away from.<span style="mso-spacerun: yes;"> </span>I trust it is obvious that I am not
trying to downplay that at all.<span style="mso-spacerun: yes;"> </span>I do
a lot of work focused on exactly that angle (e.g., <a href="http://fluidsurveys.com/s/THR-testimonial-CASAA/">CASAA’s effort to collectstories from people who successfully used THR to stop smoking</a> -- please give us your story if you are one of them).</div>
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<br /></div>
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But suggesting that low-risk tobacco products are merely a
cure for smoking narrows the discussion, hurts the cause, and unintentionally
fuels the opposition. Recognizing
that low-risk tobacco products are more like coffee than they are like
cigarettes, and a lot more than they are like medicines, is crucial for a
sensible policy discussion and advocacy.<span style="mso-spacerun: yes;">
</span>Breaking the grip of the narrow-minded “public health” types over the
discourse cannot be done by adopting their rhetoric.<span style="mso-spacerun: yes;"> </span>These products can be enormously welfare enhancing compared
to either smoking or abstinence (I have written more about this in my paper
about the basic economics, which I finally released – I will write more about
the content of that analysis soon, but you can <a href="http://healthpolicyscholars.org/sites/healthpolicyscholars.org/files/w50_phillips.pdf">check it out now</a>).</div>
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<br /></div>
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Of course, not everyone who has positive things to say about
low-risk tobacco products agrees that it is right to think this way.<span style="mso-spacerun: yes;"> </span>Many prominent THR supporters come from
a medical or public health background, and still fall into those fields’
unfortunate tendency to ignore any human preference other than health.<span style="mso-spacerun: yes;"> </span>To them, THR really is only about the “R”.<span style="mso-spacerun: yes;"> </span>They often explicitly state that
abstinence is always “better” (without defining their basis for that normative
claim), which leads conclusions like "we should restrict education about
low-risk products so that they only attract smokers who would not otherwise
quit smoking" (setting aside the fact that such targeting is impossible, and
recognizing that they may well understand this, they still would prefer to do it if it were
possible).</div>
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<br /></div>
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This thinking – whether it comes from those who support THR,
oppose it, or are reasonably neutral – invites comparisons to methods for
abstinence promotion and implicitly denies that substitution has advantages
over abstinence.<span style="mso-spacerun: yes;"> </span>This results in
the typical discussions about how THR is a more effective method for quitting
smoking (for those who are not inclined to just quit) than the alternative
methods.<span style="mso-spacerun: yes;"> </span>I certainly engage in
plenty of those discussions, and I believe it is true.<span style="mso-spacerun: yes;"> </span>But focusing entirely on this gives
comfort to those who would prefer smokers not have access to a pleasant way to reduce
their risks (why would anyone prefer that? read <a href="http://antithrlies.com/about/">here</a>).<span style="mso-spacerun: yes;"> </span>It makes it easy for them to make up claims
that THR is not really proven to be more effective for many smokers, and that there are officially
“approved” alternatives which therefore must be better, and such.<span style="mso-spacerun: yes;"> </span>Those claims are generally full of utter lies, of course,
but they is effective at tricking casual observers into doubting the value of
THR – so long as THR is only about not smoking.</div>
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<br /></div>
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But since low-risk tobacco products occupy basically the
same consumer niche as coffee, I would argue that this is not the battle we
should be fighting.<span style="mso-spacerun: yes;"> </span>It should be
possible to move one step above that fight and argue that low-risk products are
<i style="mso-bidi-font-style: normal;">better</i> than abstinence for many
people.<span style="mso-spacerun: yes;"> </span>I am not talking about the
constructed and often-invoked (but, in reality, empty) category of those who
“cannot” quit smoking.<span style="mso-spacerun: yes;"> </span>A focus on
that category suggests that THR advocates are conceding that
that abstinence is best for everyone in theory, and are merely
arguing that a second-best solution is needed for some people.<span style="mso-spacerun: yes;"> </span>This, in turn, invites the retorts that
“better” cessation methods eliminate the need for this second-best and that
low-risk tobacco products really are medicines.<span style="mso-spacerun: yes;"> </span>After all, if the only reason we should allow people to buy
and use e-cigarettes is because otherwise they would continue their smoking
habit, which their personal history shows they are unlikely to stop anytime soon, then why not
make them available only by prescription to long-term smokers?<span style="mso-spacerun: yes;"> </span>(One answer might be “because under
that rule, the only products available would be as unappealing as NRT is”,
which is a valid worry, but is a rather different point; a market <i style="mso-bidi-font-style: normal;">could</i> be created that is still
makes high-quality and innovative products, but is open only to those with diagnosed “cannot quit smoking”
syndrome.)</div>
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<br /></div>
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So if this is not just about those who need low-risk tobacco
products to “cure” their smoking because nothing else will, who is it about?</div>
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<br /></div>
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To some extent it is about those who experience identifiable
health benefits from nicotine, or perhaps other aspects of tobacco use, those
who find it to be a good treatment for various psychological conditions and a
few physical conditions.<span style="mso-spacerun: yes;"> </span>That
group that represents one my major motivations for working on this topic.<span style="mso-spacerun: yes;"> </span>Efforts by “public health” people to
deny such people access to low-risk tobacco, insisting on quit-or-die to those
who would suffer terribly from tobacco abstinence (both now, in the world of
e-cigarettes, but also for a decade before that when it was demonstrated that
smokeless tobacco was a low-risk alternative), is cruelty that is arguably
genuinely evil.<span style="mso-spacerun: yes;"> </span>It is indefensible
from the perspective of any accepted modern ethical system, and exists merely
as religious persecution of people who are “different”, with all that
implies.<span style="mso-spacerun: yes;"> </span></div>
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<br /></div>
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But it is not just that group either.<span style="mso-spacerun: yes;"> </span>This is also about the welfare of everyone that likes or might
like the experience of using low-risk tobacco products enough to accept the
risk that they <i style="mso-bidi-font-style: normal;">might</i> cause a very
small reduction in life-expectancy (or they might be beneficial for health on net – we do
not know for sure).</div>
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<br /></div>
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Many such individuals are, of course, the aforementioned
groups of those who “cannot” quit – i.e., do not quit despite every legal
effort being taken to make them suffer for their choice – and those who get
serious psychological or other health benefits from smoking (these categories
probably refer to mostly the same group of people).<span style="mso-spacerun: yes;"> </span>There are many such people who will smoke if there were no
other satisfying option, and so this their harm is indeed being reduced if
low-risk products are made satisfying and available.<span style="mso-spacerun: yes;"> </span>But they will also benefit from the products as compared to
abstinence.<span style="mso-spacerun: yes;"> </span>If they would choose
smoking over abstinence but choose the low-risk product over smoking, then they
are almost certainly getting great benefit from using the low-risk product rather than being
abstinent.</div>
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<br /></div>
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But for those who are or will be abstinent rather than smoking,
possible use of low-risk products is not about the harm reduction.<span style="mso-spacerun: yes;"> </span>There is no harm to reduce.<span style="mso-spacerun: yes;"> </span>Since this includes everyone who could be
bludgeoned into abstinence using other methods, failure to consider the welfare
of this group is what gives comfort to the enemy.<span style="mso-spacerun: yes;"> </span>In the extremists' rhetoric, everyone will soon be in this category
(never mind that this is some combination of mistaking a hope for a plan and
out-and-out lying on their part – they still make the claim), and so in their
imaginary world there is no harm to reduce.<span style="mso-spacerun: yes;"> </span>Arguing that “tobacco-free 2025” is an absurd fantasy is
simply not effective – it ought to be because the idea is utterly crazy, but
somehow it is not.<span style="mso-spacerun: yes;"> </span>I am tending
toward the conclusion that only by pointing out that this fantasy future is
<i>inferior</i> to a world of minimally-harmful or non-harmful tobacco use, rather than merely arguing that the fantasy is not happening, is it possible to
gain the upper hand.</div>
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If it is just about harm reduction, then their solution of discovering
some magic bullet that will eliminate all harm by eliminating all use is indeed
a superior option.<span style="mso-spacerun: yes;"> </span>Never mind that a
hope is not a plan and there is no legitimate expectation; experience makes
clear that the anti-tobacco extremists can make such claims without being
subject to any scrutiny from the government or the press, or from most of the
public.<span style="mso-spacerun: yes;"> </span>But they also might find a slightly more
honest argument looking at “clinical” interventions (i.e., treating
e-cigarettes or other low-risk products as if they were medicines and, in a
medical-like setting, trying to push them on average smokers to try to get them
to quit) and finding that – when you do not focus on the right group, smokers who <i>want</i> an
alternative – relatively few can be pushed to switch.<span style="mso-spacerun: yes;"> </span>As evidence about such artificial and inappropriate efforts
to push or cajole random smokers into switching trickles in, it shows that this does not work much better than any other aggressive
approach.<span style="mso-spacerun: yes;"> I</span>f (and only if)
these products are medicines, then such evidence indeed represents a failure.</div>
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<br /></div>
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But what if we were to focus on the fact that any risks
are minor – down in the range of everyday hazards – and there are net benefits
to be had?<span style="mso-spacerun: yes;"> </span>In other words, this is
a choice that is not very similar to cigarettes, and is more like coffee, soda,
snacking, travel, sports, and computer games, all of which have their health costs,
but substantial and widely-appreciated benefits.<span style="mso-spacerun: yes;"> </span>Moreover, as a choice and not a clinical intervention, any observed failure of trying to clinically force products on currently uninterested
smokers is is not damning.<span style="mso-spacerun: yes;"> </span>That is
simply not the role of the products among free living adult consumers.</div>
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<br /></div>
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Yes, there is some such effort now.<span style="mso-spacerun: yes;"> </span>But it is not very concerted, and it is
overshadowed by the harm-reduction-only rhetoric (which, again, is
unfortunately partially locked-in due to terminology).<span style="mso-spacerun: yes;"> </span>Yes, that effort would have to struggle
against decades of fairly successful demonization of people who use tobacco
products.<span style="mso-spacerun: yes;"> </span>But that is the
point.<span style="mso-spacerun: yes;"> </span>Even if people understand
that low-risk tobacco use creates about 99% less risk than smoking, it is still
creates 50% or perhaps even 99% of the scorn.<span style="mso-spacerun: yes;"> </span>This will clearly no longer be the case after low-risk
tobacco product use becomes the norm and those who have been brainwashed by
anti-tobacco rhetoric slowly come to their sense (or die off).<span style="mso-spacerun: yes;"> </span>But that is a long time, and in the
meantime there will be needless loss of welfare, both among smokers who are
discouraged from quitting and those who benefit from tobacco/nicotine who are
discouraged from using anything.<span style="mso-spacerun: yes;"> </span>Perhaps
the process can be accelerated.</div>
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One challenge is that there will be pushback from some
people who support THR, but only as HR.<span style="mso-spacerun: yes;">
</span>For them, the term is exactly right.<span style="mso-spacerun: yes;"> </span>This seems to include most of the medics who have been won
over to THR, and includes a few of those who are considered strong public
backers of THR.<span style="mso-spacerun: yes;"> </span>These are good
people trying to make the world better; they genuinely care about health (they
want to improve health rather than merely make people behave “correctly”) and
they are pragmatic (they favor something that works over mere hopes). But ultimately,
a lot of them are still anti-tobacco extremists – that is, they ultimately hold the extreme anti-tobacco view of preferring a world in which there were no tobacco use, regardless of whether the benefits of
use might exceed the costs for many people.<span style="mso-spacerun: yes;"> </span>Many of them long refused and still refuse to embrace smokeless
tobacco as a THR product (even though it is the proven low-risk product and
probably lower risk than e-cigarettes) and endorse e-cigarettes only because
they can take refuge in the rather tortured rationalization that “they are not <i style="mso-bidi-font-style: normal;">really</i> tobacco”.<span style="mso-spacerun: yes;"> </span>While far from being like the “public
health” people who actually care more about destroying tobacco companies than
they do about improving people’s health, there are plenty of e-cigarette
advocates who ultimately still hate all free-chosen tobacco/nicotine use and
only like the product that they can think of as being like a medicine. </div>
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<br /></div>
<div class="MsoNormal">
It is my assessment that attempts to defend access to and
promote awareness of low-risk tobacco products – even if motivated primarily or
entirely by trying to reduce harm for current smokers – would benefit
substantially if there was more attention devoted to arguing that low-risk
tobacco products are little different from everyday consumption choices (except
in the minds of an zealous minority who think that there is something evil
about this plant).<span style="mso-spacerun: yes;"> </span>Many of the popular
protests about the MHRA announcement focused on the point about e-cigarettes
being a consumer choice, not a medicine.<span style="mso-spacerun: yes;">
</span>But that may not push quite far enough.<span style="mso-spacerun: yes;"> </span>They are not just a choice, but a fairly unexceptional
choice – with the added benefit that if a smoker chooses to use them to “cure”
their smoking, they can.</div>
Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com12tag:blogger.com,1999:blog-8237846547805652402.post-28036262716215059762013-05-22T15:39:00.001-04:002013-05-22T15:39:29.609-04:00How to convince someone they really don't understand what they are talking about<span style="font-family: inherit;">Finally some time to do some general knowledge journal reading! On my list was a fascinating paper (<a data-mce-href="http://www.fox-lab.org/papers/FernbachRogersFox&Sloman%282012_wp%29.pdf" href="http://www.fox-lab.org/papers/FernbachRogersFox&Sloman%282012_wp%29.pdf">pdf of the free working paper version</a> - the journal <a data-mce-href="http://pss.sagepub.com/content/early/2013/04/24/0956797612464058.abstract" href="http://pss.sagepub.com/content/early/2013/04/24/0956797612464058.abstract">version </a>is paywalled) by
Philip M. Fernbach, Todd Rogers, Craig R. Fox and Steven A. Sloman that
investigates how to convince people that they really do not understand a
topic they think they understand. It has been <a data-mce-href="http://theincidentaleconomist.com/wordpress/how-to-debate-a-wing-nut/" href="http://theincidentaleconomist.com/wordpress/how-to-debate-a-wing-nut/">blogged</a> <a data-mce-href="http://www.bloomberg.com/news/2013-05-20/how-to-humble-a-wing-nut.html?wpisrc=nl_wonk_b" href="http://www.bloomberg.com/news/2013-05-20/how-to-humble-a-wing-nut.html?wpisrc=nl_wonk_b">about</a>
in the context of extreme political positions, but it seems to have
even greater relevance to more technical science-based topics like
tobacco harm reduction (though, of course, much of traditional political
extremism involves a failure to understand science also -- e.g., IS/LM macroeconomic models).</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">The most promising approach to persuade someone that something they strongly believe is just not so is definitely not to present contrary evidence. It has clearly been demonstrated, repeatedly, that for most people (the vast majority who do not think like scientists or philosophers, including most "scientists" in health, and presumably in lots of other fields), presenting contrary evidence leads to a non-intellectual gut-level defensive reaction which tends to just harden their belief. Expecting to get a rational reaction to evidence is usually a nonstarter. Sigh! But it is not much more useful to simply ask people to explain the basis of their claims -- they will just do a biased search for confirmatory evidence (or, quite likely, mere assertions of others who agree with them) an<span style="font-size: small;">d, again, become more hardened in their position. Rather, the solution is to ask them to explain the <i>mechanism </i>that supports their view of the world.</span></span><br />
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span>
<span style="font-size: small;"><span style="font-family: inherit;">The abstract reads:</span></span><br />
<div data-canvas-width="5.319999694824219" data-font-name="g_font_p0_1" dir="ltr" style="left: 578.69px; top: 174.07px; transform-origin: 0% 0% 0px; transform: scale(0.899155, 1);">
</div>
<blockquote class="tr_bq">
<div data-canvas-width="479.2511085083008" data-font-name="g_font_p0_1" dir="ltr" style="left: 175.649px; top: 763.952px; transform-origin: 0% 0% 0px; transform: scale(0.910518, 1);">
<span style="font-size: small;"><span style="font-family: inherit;">People often hold extreme political attitudes about complex policies. We hypothesized that people typically know less about such policies than they think they do (the illusion of explanatory depth; Rozenblit & Keil, 2002) and that polarized attitudes are enabled by simplistic causal models. We find that asking people to explain policies in detail both undermines the illusion of explanatory depth and leads to more moderate attitudes (Experiments 1 and 2). We also demonstrate that although these effects occur when people are asked to generate a mechanistic explanation, they do not occur when people are instead asked to enumerate reasons for their policy preferences (Experiment 2). Finally, we show that generating mechanistic explanations reduces donations to relevant political advocacy groups (Experiment 3). The evidence suggests that people’s mistaken sense that they understand the causal processes underlying policies contributes to polarization.</span></span></div>
</blockquote>
<span style="font-family: inherit;">As motivating examples, the authors note that most people will express confidence that they understand how such familiar mechanisms as toilets and combination locks work, but when asked to explain the mechanism, they change their mind and recognize that they do not really understand after all. To the extent that extreme political positions often result from similar overconfidence (as the authors claim), a similar tactic can be used to show someone his beliefs are based on overconfidence. Causing a recognition, by asking for a mechanistic explanation, goes a long way to lowering misplaced confidence. This then might(!) lead to a softening of malformed extreme positions (I am not so sure that the author's conclusions that this <i>does </i>happen, based on their artificial experiment, is completely convincing). </span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">In my mind, the more obvious uses of this observation do not relate to policies at the big picture level, but specific individual claims.</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">An obvious application is one I always thought was a good idea (and, indeed, embedded in some of my analysis on the topic): "So you think that snus or e-cigarettes might be as harmful as smoking? Can you tell me what particular diseases you think might be caused, and at what rates, that would add up to the total risk from smoking?" Of course, someone can still retreat into a nihilistic "we just don't know, and therefore anything is possible", and those who are just generating rhetoric in support of some hidden financial or "moralizing" interest will not be persuaded because they never really cared whether it was true or not. But those who actually believe the claim is true, and care whether that is really the case, tend to rapidly realize it is absolutely implausible.</span><br />
<br />
<span style="font-family: inherit;">A related example is the claim that low-risk tobacco/nicotine products are a "gateway" to smoking. But just ask someone to explain the mechanism by which a consumer who would not otherwise choose to smoke would choose to smoke after learning about a low-risk alternative and trying it. Among those who actually believe the myth and are motivated by (not those reciting it to support some hidden goal), lightbulbs appear over their heads.</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">Of course, sometimes this step alone gets you nowhere because someone is way too far from understanding for one question to get them there. For example, if you ask someone who thinks that installing a lot of industrial wind turbines are a good idea to explain the mechanism by which benefit is created, he will probably assert that they reduce the awful pollution from coal burning and produce electricity with no emissions, and feel not the least bit less confident of their knowledge. The naive belief is simply so far away from the actual mechanism in this case that the believer does not even understand that there is an ultimate mechanistic process. The situation is unlike the case of "should we impose unilateral sanctions on Iran?" (one of the questions in the </span><span style="font-family: inherit;">Fernbach study, which lends itself to simple "how might that accomplish what you think it accomplishes" thinking) and more like "should we be fighting a war in Afghanistan?" (which is several layers away from the goals someone might support).</span><br />
<br />
<span style="font-family: inherit;">This still might open the door for better conversation. You could to explain why the electricity from IWTs displaces the relative benign burning of gas, not coal, and that the manufacture and installation of IWTs, and the extra gas burning that is needed to stabilize the power grid because of their intermittent performance, are obviously not emissions-free. But at that point you are back to relying on someone being open to hearing evidence and actually learning something, because if you try to continue the proposed tactic, it will fail: If you ask, "so how can IWTs substantially reduce coal burning or the installation of fossil fuel plants when they always need to be backed up by dispatchable [can be turned on immediately] gas-burning turbines", you are depending on them being willing to recognize the truths implicit in the question, not their mere inability to answer it.</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">But with such caveats in mind, this is still a very promising tactic. I suppose I have always recognized that and used it, but this study is a great reminder to do it more, and that other approaches that seem similar really are not, and that they seldom work.</span>Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com0tag:blogger.com,1999:blog-8237846547805652402.post-66110225987238899432013-03-26T18:19:00.000-04:002013-03-26T18:42:14.603-04:00A primer on the buffoonery of Simon Chapman for Australian IWT opponents (part 2) <br />
There is a self-deprecating joke in academia how to recognize a scholar (I am talking about myself here, not giving credit for that status to the subject of the post): You know you are a true scholar if you consider every project you have ever worked on to be a work in progress. I wrote <a href="http://ep-ology.blogspot.com/2012/04/primer-on-buffoonery-simon-chapman-for.html">Part 1</a> about what a buffoon Simon Chapman is a while ago. But, hey, it was not even a full year ago, so of course it was still a work in progress. Also on this blog I have written <a href="http://ep-ology.blogspot.com/2011/05/unhealthful-news-138-another-side-of.html">this</a> and <a href="http://ep-ology.blogspot.com/2012/08/a-bit-more-on-economics-of-cigarette.html">this</a> and especially <a href="http://ep-ology.blogspot.com/2012/03/how-can-you-tell-simon-chapman-is.html">this</a>.<br />
<br />
There has been a renewed flurry of interest in what a dangerous oaf he is. See, e.g., the <a href="http://stopthesethings.com/">Stop These Things</a> blog or the new <a href="https://twitter.com/SlMONCHAPMAN">Twitter parody of him</a> -- though a search for him in any of several other forums will show that there has never been any end to his dangerous games -- e.g., <a href="http://nannyingtyrants.blogspot.com/">Nannying Tyrants</a>, <a href="http://dickpuddlecote.blogspot.com/">Dick Puddlecote</a> (especially this <a href="http://dickpuddlecote.blogspot.com/2013/03/tobacco-controller-condemns-tobacco.html">recent gem</a> -- read through to the end to get to the punchline), <a href="http://velvetgloveironfist.blogspot.com/">Velvet Glove, Iron Fist</a>. So I realized it was time to return to
this project a bit.<br />
<br />
It is quite remarkable how much damage this one nasty individual has inflicted on the lives of smokers (especially those who he killed because he kept them smoking, campaigning for Australia to ban low-risk alternatives rather than letting smokers switch to those alternatives as they have done elsewhere), and now to people suffering the effects of wind turbines in Australia (fortunately he has little reach beyond the sea, though there are <a href="http://dickpuddlecote.blogspot.com/2013/03/more-from-hotline-to-sydney.html">hints</a> that he has meddled in UK politics). He has also done rather substantial damage to the scientific integrity of public health, and has contributed to a general feeling in the rest of the world (among those who are aware of "public health" and nanny state issues) that Australia might be better off being re-colonized. Influential nasty idiot is a bad combination. The only saving grace is that he does not have the self-discipline of a high-functioning sociopath, which would have allowed him to succeed in politics, else he might have done even more damage. <br />
<br />
And, yes, I know that people like him thrive on the attention generated by their vandalism, bullying,
and bravado. It is so transparent in his case that I feel kind of silly taking the time to
mention it. But this particular vandal does so much damage that trying to avoid rewarding his antics with attention, like we might if trying to train a pet or educate a child, is not socially responsible. Those of us who care about public health and good public policy have to fight back against people like him. In the big picture it does not matter that we are just playing into what he wants, because it is his victims that matter. <br />
<br />
So, just one point of substance today and more later (work in progress, you know). As those involved with the wind turbine and health issue know, despite Chapman spouting off in support of the electric power industry's denialism about the harms that are being caused, he has only made one "contribution" to the knowledge base: He poured through the adverse event reports (AERs) of nearby residents who suffered the health effects looking for mentions of odd diseases that were probably not actually caused by the wind turbines. He then proceeded to claim that because so many diseases were mentioned once, somehow the clear pattern of diseases that is consistent across these reports somehow does not count. And, no, I have no idea why someone might think such a thing. (For more information on the importance the adverse event reports as epidemiologic evidence and how to <i>properly</i> interpret the evidence, you can read <a href="http://ep-ology.blogspot.com/2013/01/my-health-effects-of-wind-turbines.html">my paper</a> on that topic.)<br />
<br />
He seems to have spent most of a year on this utterly pointless exercise. And yet I debunked the whole thing in one paragraph in some testimony I wrote recently:<br />
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<blockquote class="tr_bq">
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<span style="font-size: 11.0pt; mso-bidi-font-size: 10.0pt;">It is
true that many individual AERs also report various health problems that are not
apparently related to wind turbine exposure.<span style="mso-spacerun: yes;"> </span>This is not surprising since people will have various health
problems that start after they are exposed to wind turbines purely by
coincidence, just as they would have had those problems had they not been
exposed.<span style="mso-spacerun: yes;"> </span>We would expect people to
report these, along with the common outcomes that do seem to be caused by the
exposure, in an attempt to provide a complete record of their experiences.<span style="mso-spacerun: yes;"> </span>Indeed, such reporting is good
scientific practice; it is optimal to report all of your data because you do
not know what might prove to be useful information.<span style="mso-spacerun: yes;"> </span>Some non-expert commentators have tried to claim that this
scattering of apparently unrelated problems is evidence that the AERs are
uninformative.<span style="mso-spacerun: yes;"> </span>But this is
obviously not true, since the occasional apparently unrelated disease does not
change the almost universal pattern of commonly reported diseases.<span style="mso-spacerun: yes;"> </span>The misinterpretation represents a
failure by non-experts to understand that scientific analysis always involves
identifying the signal amidst the inevitable noise (which in this case is quite
easy), rather than obsessing about the noise.</span></div>
</blockquote>
And, yes, I think this means that the rough equivalence is that 5 minutes of my time is what is required to rebut a year's worth of Chapman pseudo-science. I did not take the space in that testimony to mention that in most cases, he was probably misrepresenting the claims (though because he did not actually report actual results or methodology it is hard to be sure -- he not only got the science wrong, but he did not even know enough to ape how science is done): He presents these claims as if everyone expressed certainty that the ailments were caused by wind turbines, when in fact many probably did not make such causal claims, but merely reported their experiences. This is good scientific practice (what the <i>residents</i> did, that is); someone reporting adverse events they have experienced cannot necessarily know which of them might fit a pattern, and thus be scientifically useful, so the proper thing to do is to report everything and let the experts who have the big picture sort it out.<br />
<br />
But Chapman did not merely demonstrate that he lacks a rudimentary understanding of how science works. He opened a window into a rather evil soul. As he was collecting these examples, he repeatedly published expressions of his glee about what he was finding, openly mocking and actively expressing his joy in people's reports that they had gotten cancer or some other disease. Any normal human being who actually cared about people -- someone who was honestly disagreeing with a particular causal claim -- would say something like "I am sorry to hear about your suffering, but it seems there is really no basis for claiming the cause is what you think it was". I realize that people in "public health" often get away with doing junk science that is proven wrong, time and again, for a very long time. But it is difficult to understand why anyone listens to him after he has also so clearly revealed his lack of humanity.Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com5tag:blogger.com,1999:blog-8237846547805652402.post-60717372679561614042013-02-15T12:45:00.001-05:002013-09-02T09:59:33.051-04:00Monte Carlo uncertainty as a method for hiding uncertainty (wonkish)I am writing this mostly as a placeholder for some thoughts emerging from modeling work I am doing right now. I thought that some of my more technical readers would find it interesting and maybe some of you (or at least one -- talking to you, Prof. I.B.) could help me think this through or maybe even identify where others have made the same observations.<br />
<br />
The work that really put me on the map (presented to much acclaim in 1999 though I could not get it <a href="http://journals.lww.com/epidem/Abstract/2003/07000/Quantifying_and_Reporting_Uncertainty_from.15.aspx">published in final form until 2003</a>) was presenting a way to properly report the uncertainty around epidemiologic estimates. To explain, the only uncertainty around point-estimates results in epidemiology that was (and still almost always is) the confidence intervals. These provide a heuristic measure of about how much random sampling error there is in a result. But the reporting of CIs tends to obscure all the other non-random errors in the result for most readers (including most people who claim to be experts in the field). People see this error bar around the estimate and assume that it really represents how uncertain the estimate is, which it most certainly does not do. Thus, in some sense, the dutiful reporting of one measure of uncertainty serves as much to hide uncertainty as it does to report it.<br />
<br />
What I did was propose a way to report an estimate of the impact of other types of errors (measurement error, sampling bias, etc.) in addition to the random sampling error. The method that I used to do the calculation for this model was Monte Carlo simulation. This was purely a calculation technique -- MC is the easiest way to do complex calculations when you are working with uncertain inputs.<br />
<br />
(For those who do not know, the method consists of taking a random draw from each uncertain input and calculating one model result, and then repeating that many thousands of times with different random draws to show the distribution of possible results based on the distribution of inputs. It is theoretically possible to calculate the same result directly using equations, but that is mind bogglingly difficult, whereas MC is easy. It is basically equivalent to doing a calculation using a computer, or digging a hole with a backhoe, rather than doing it by hand -- the MC simulation, computer, or digger is just a tool to make the job easier, not the essence of what is being done.)<br />
<br />
Much to my annoyance, almost everyone (I can think of only one exception) who took these ideas and ran with them did two things that were utterly contrary to the spirit and goals of what I was presenting: 1. They treated the MC tool as if it were the important essence in itself, rather than properly treating it as just the method to get to a goal. 2. They started using the approach to replace one misleadingly precise claim (the epidemiologic point estimate that ignores the errors) with a more complicated misleadingly precise claim (that the rough distribution that can be calculated is a precise estimate of the results of uncertainty).<br />
<br />
Fast forward to today, when computers are quick and cheap (it took my best computer 2.5 weeks to run the simulation that was the core of what I produced in 1999), and we see MC error calculations of various sorts in many calculations. But these seem all to serve mainly to impress naive readers with the fancy tools, but also to pretend to account for the uncertainty and thereby hide the real uncertainty.<br />
<br />
I have started thinking of it as "Monte Carlo porn".<br />
<br />
So, for example, a model might ask what will happen to smoking rates over time when a predicted 6.3 percent reduction in smoking initiation caused by some anti-smoking policy filters through the population over time. The modelers then report "the uncertainty" by allowing the reduction to differ by +/-10% of the predicted value, run a MC simulation using random draws from that range, and report a simple summary of the distribution of results. This adds nothing of genuine scientific value. Anyone who is capable of understanding the modeling in the first place can figure out that if the predicted reduction is high by 10% then the difference in the medium-run impact between the reduction scenario and the baseline scenario is going to be about 10%. Maybe it will be a bit more and maybe a bit less, but that really does not matter.<br />
<br />
But an unsophisticated reader (i.e., most everyone to whom the results are touted) is going to interpret that reported uncertainty as being a genuine measure of total uncertainty (just as the same people misinterpret the bounds of CIs as representing the range of possible values that could result from random error). Never mind that a perfectly plausible estimate of the effect of the policy is a 1% or even 0% reduction in smoking initiation. When the typical reader sees the reported overly-narrow range of uncertainty, they are tricked into believing that it is the real uncertainty (just as they are usually tricked, by the reporting of CIs, into believing that the only possible source of error is random sampling).<br />
<br />
So, basically, the current practice -- some unknown portion of which actually traces back to my work that was about trying to fix the problem of failing to quantify uncertainty -- serves to hide genuine uncertainty by making a mock presentation of uncertainty. So much for progress.Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com1tag:blogger.com,1999:blog-8237846547805652402.post-115255430828643562013-01-14T09:00:00.002-05:002013-01-14T09:00:17.080-05:00My "health effects of wind turbines" paper, unpaywalled #pdftributeMost everything I have written for public consumption, or at least everything that is still worth reading, is publicly available somewhere. As my readers know, I am a harsh critic of that joke/horror of an institution called the academic publishing industry, and tried to have as little to do with it as I could manage. But one paper that ended up behind a paywall is my analysis of why the epidemiologic evidence clearly shows that industrial wind turbines (IWTs) cause health problems in nearby residents.<br />
<br />
In honor of the <a href="http://www.huffingtonpost.com/2013/01/13/academics-tweet-tribute-aaron-swartz_n_2468272.html">#pdftribute campaign for Aaron Swartz</a> I am breaking the paywall and making that paper freely available <a href="https://docs.google.com/file/d/0B3FU0iObJqKKRk82QjFoNXNPX3c/edit">here.</a><br />
<br />
He was a true champion for making information that is part of our common heritage (and paid for by all of us) available to all of us. And, sadly, apparently also an example of the toll that depression takes on many people with great vision.Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com0tag:blogger.com,1999:blog-8237846547805652402.post-59703842887393089822012-11-07T10:32:00.001-05:002012-11-09T13:43:30.127-05:00Orwellian language in anti-tobacco, an exampleWhen Orwell's 1984 is invoked in the context of anti-tobacco and other drug wars, it is usually a reference to totalitarian control. But a rather more specific use of "Orwellian" in reference to those is the twisting of language to make it impossible for people to use the language to question those in power. This is a tactic that is carefully and intentionally employed by the tobacco control industry to prevent reasoned discourse (which they would surely lose). I have been meaning to write more about it, especially in the context of "addiction", but for today, one quick example.<br />
<br />
<a href="http://www.nwcn.com/home/?fId=177496131&fPath=%2Fnews%2Flocal&fDomain=10202">This article</a> reports that grey/black market cigarettes now account for more than 1/3 of all consumption in the state of Washington, where per-pack taxes are extremely high (though hardly the highest in the world). It points out (not in so many words) that such tax create an incentive to avoid taxes by buying "contraband" (i.e., untaxed) cigarettes. There is no mention that this is further exacerbated by the fact that this tax is designed to be punitive and so people resent it. (Average people -- unlike bankers and other millionaires -- typically pay their taxes without attempting to evade them, but when a law is perceived as being wrong and unfair, this changes.)<br />
<br />
The punchline of all this is the statement in the article:<br />
<blockquote class="tr_bq">
By the state’s estimate, illicit cigarettes cost Washington taxpayers a staggering amount of money.</blockquote>
Oh really? Exactly how does not paying taxes cost <i>taxpayers </i>money? And yet the Orwellian nature of the language around tobacco means that they can get away with that claim, unquestioned.<br />
<br />
I realize, of course, that if forced to defend it, they would point out that it costs the <i>state</i> a lot of tax revenue, and that this needs to be made up for by raising other taxes. But this just means the statement should be that the grey market "forces nonsmoking taxpayers to pay their fair share of taxes rather than offloading a <i>staggering amount</i> of that burden onto smokers."<br />
<br />
It is obvious that, at worst, the impact on <i>taxpayers</i> (as a collective group) is neutral. Of course, that assumes that tobacco/nicotine users are considered to be people, and people who are due the same consideration as everyone else. The bottom line is that the language has been twisted so that taxes on cigarettes (etc.) are not treated as taxes, or burdens on people at all, so absurd statements like that quoted above pass without notice.Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com7tag:blogger.com,1999:blog-8237846547805652402.post-68776609129916085762012-11-02T10:00:00.001-04:002012-11-02T10:00:10.992-04:00As if getting rich off of taxes imposed on poor smokers was not enough for CTFK...A friend sent me a screenshot of a Google search of "Campaign for Tobacco Free Kids" which reveals an interesting twist on that organization's fund raising strategies: the headline content for their website appears to be an ad for "generic Viagra".<br />
<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPRIiPDa9P9147iUpFX2MUtC_6C8Ojvx2cWg96Xpmmbxw2-5_5DceqyxLMJTc-AyEFK1ysUQpl5RJYM7V5TRE0X8ildyW18ZU4E6_617EFn8EN-JIkXp6tGKe5P_goALkFTmrEo5b7ERpu/s1600/2-SearchGoogle-CTFK-Ad+Campaign.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="376" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPRIiPDa9P9147iUpFX2MUtC_6C8Ojvx2cWg96Xpmmbxw2-5_5DceqyxLMJTc-AyEFK1ysUQpl5RJYM7V5TRE0X8ildyW18ZU4E6_617EFn8EN-JIkXp6tGKe5P_goALkFTmrEo5b7ERpu/s640/2-SearchGoogle-CTFK-Ad+Campaign.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Campaign for Impotence-Free Kids?</td></tr>
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<br />
So either they are not satisfied to confiscate untold riches from the involuntary contributions of overtaxed smokers, and so are picking up a bit of extra revenue, or they are trying to encourage the creation of more kids so that they have reason to demand more funding.<br />
<br />
<br />
I suppose there is a third explanation, that they are the victim of some kind of hacking, but I like my other theories better. If you do the search soon, you can probably see the same result (it worked for me), though I have to assume they will fix it eventually. But they will probably not discover it via this blog -- it is pretty clear that they carefully avoid reading anything outside of their echo chamber for fear of encountering legitimate criticism and troublesome questions. And besides, they are probably busy right now, trying out their free samples of generic Viagra.<br />
<br />Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com2tag:blogger.com,1999:blog-8237846547805652402.post-44228543723829975792012-10-28T16:43:00.000-04:002013-09-02T10:00:21.525-04:00Agent-based model of THR adoption (and basic case for THR from City Health 2012)I recently presented a talk on tobacco harm reduction at the <a href="http://www.cityhealth.org.uk/">City Health 2012</a> conference in London. I believe that a video of the actual presentation and ensuing discussion will appear on their website eventually (and I will update this post to link to it). In the meantime I recorded a voiceover version of the slideshow:<br />
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<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/UfNkEylI0vI?feature=player_embedded' frameborder='0'></iframe></div>
<br />
[I will suggest/request that anyone who wants to link to the video please link to this post instead. I would like to encourage comments and discussion here, and will probably not monitor the comments on the youtube page itself. Also, there is more background that might be useful.] <br />
<br />
The heart of the presentation is a social dynamics model of how THR (e.g., switching from smoking to e-cigarettes) occurs in a community thanks to the education and communication of social norms that come from social interaction. It starts out with a general overview of THR since many in the audience were not familiar with that. If you are not interested in the overview, you might want to skip to about 9:30 and just see the presentation of the new model. (On the other hand, I have been told that it is one of the better existing presentations about the core concepts and justifications for THR. Not as good as what I presented at the Beirut IHRA conference, unfortunately, but I do not have a recording of that. So you might want to view that part even if you already are familiar.)<br />
<br />
The presentation speaks for itself so I will not try to summarize it here. But to provide a bit more background on the modeling (and if this is confusing, just watch the video -- it is less technical than what follows, but still explains what you need to know): There is an interest in predicting THR behavior, in part for obvious reasons, and in part because of a make-work exercise that the US FDA is imposing on anyone trying to promote THR. As with any modeling of population dynamics, there are various methods available.<br />
<br />
The simplest is to just project a trend by extending past numbers. This is largely useless for anything that involves conscious choices by people, and utterly useless when there are emerging technologies involved. Despite this, these are the models that are used when people make simplistic predictions about how many smokers there will be 20 years in the future, which others then report as fact. Such projections about tobacco/nicotine use are perhaps slightly better than trying to project a trend about how many people will be using 11-inch tablet computers 20 years from now, but not much better.<br />
<br />
Next simplest is Markov modeling, which basically divides people into different bins (smoker, e-cigarette user, non-user, etc.) and assumes that knowing how many people are in each bin is all you need to know to know about them to determine what happens in the next period (i.e., the next day or year). This allows for much more robust modeling of <i>some</i> interacting influences, but under the hood, it is still based on projections of population level trends (e.g., what portion of current smokers will adopt THR as a function of how many have already done so). Allowing for subpopulation-based trends is an improvement over just projecting graphs into the future, as it were, but at its core it is still just a version of that, with all its limitations.<br />
<br />
Agent-based models are based on the recognition that the behavior of a population, when considering a decision-based process like THR, is really the aggregation of a lot of individual decisions. Thus, such models are based on individual actors rather than just population percentages, and the population statistics are emergent properties of the actions of individuals. The individual decisions are based on economic motives (i.e., considerations of costs and benefits) which are affected by various global factors as well as social interactions. Individuals can be realistically modeled as having different preferences and other characteristics rather than being all the same. The agent-based models also allows for social interactions at an individual level -- i.e., people can affect their neighbors and those they encounter, and the results of this may not be the same as treating everyone as if they just have the "average" experience ever period.<br />
<br />
The model that we have created is about the simplest model possible that still captures the social dynamics, individual variability, and economic decision making that affects a population's adoption of THR. It allows for THR adoption to be a social contagion, with someone's chance of adopting it being a function of how much of it they encounter, as well as global forces. People learn (and their level of learning persists through time) and decide (based on individual motives). This contrasts with a simple projection or subpopulation-based model, where the future is basically determined by the choice of a single function -- e.g., "P% of the population smokes and that is trending down at a rate of R, so next year the number of smokers will be...." or "if X people have adopted THR in period t, then D% of the rest will adopt it in period t+1, for a total of X+D". As shown in the video, this produces population outcomes that are not just the obvious immediate result of the choice of those functions.<br />
<br />
Update: I discuss some of the implications of this model in the context of anti-THR claims <a href="http://antithrlies.com/2012/10/28/thr-adoption-model-illustrates-several-lies/">at the antiTHRlies blog</a>.<br />
<br />
Update (13 Nov 12): The <a href="http://www.youtube.com/watch?v=wcdHwyOGhV0">"live" version of this</a> (the presentation I actually gave in London) has been posted by the conference. As is usually the case, it is a bit rougher than the studio version, but for those who are are completists (are there any Phillips completists? I doubt it -- I am not even one :-), there it is. I think there are also some bootlegs, but I don't have them. Unlike most live versions, this one is a bit shorter (the studio version includes a bit more information).Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com9tag:blogger.com,1999:blog-8237846547805652402.post-33804848854936346182012-10-19T12:39:00.000-04:002012-10-19T12:40:23.877-04:00Nobel Peace Prize curse?A random thought while waiting for a program to run. I know I am late to this topic, but this only just occurred to me:<br />
<br />
Obama won the Nobel Peace Prize.<br />
<br />
He responded to this honor by continuing to fight multiple wars, jumping into another one without congressional approval (whatever you think of its value, that is the truth of it), keeping the illegal Guantanamo prison running without major changes, and initiating the worst campaign of assassinations / "extra-judicial executions" (via drone strikes) ever perpetrated by the United States.<br />
<br />
The EU won the Nobel Peace Prize.<br />
<br />
Perhaps it is time to re-fortify the Maginot Line.Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com0tag:blogger.com,1999:blog-8237846547805652402.post-4382366422418615132012-09-21T21:13:00.002-04:002012-09-21T22:36:49.594-04:00Stanton Glantz declares that hospitality workers' exposure to ETS is not "involuntary"[Note: This is a spinoff of <b><a href="http://antithrlies.wordpress.com/2012/09/21/stanton-glantz-is-a-liar-as-if-thats-news/">this post at the anti-THR Lies blog</a></b>, but (a) was slightly off topic for that blog and (b) deserves its own post. See the other post for complete background.]<br />
<br />
In a <a href="https://tobacco.ucsf.edu/e-cigarettes-release-toxic-chemicals-indoors-should-be-included-clean-indoor-air-laws-and-policies#comment-183">recent blog post</a>, Stanton Glantz, one of the most prolifically dishonest proponents of banning smoking everywhere, regardless of private preferences, declared "OSHA PEL is not an appropriate standard for involuntary exposure". He was arguing that OSHA workplace standards for chemical exposures are irrelevant to determining the acceptable level of environmental exposure from electronic cigarettes. In so doing he was grossly misrepresenting the arguments he was responding to (see the Lies post), but his statement, <i>per se</i>, was a valid one.<br />
<br />
Funny thing though: The trouble with being willing to say anything to further one's political aims, regardless of whether it is honest or accurate, is that you eventually contradict yourself. Few people have the intelligence and intellectual discipline to lie all the time that without tripping themselves up.<br />
<br />
You see, the <a href="http://en.wikipedia.org/wiki/Logic">logic</a> of what Glantz said (note: I provided a link to a definition of "logic" in case Glantz reads this and is not familiar with the term) is that in a job setting, someone is there voluntarily. They are accepting the exposures in the workplace as part of what they endure by working (alongside spending their time and energy, etc.) but are getting compensated for (i.e., paid). Workers in unpleasant or hazardous environments do indeed make more money than comparably-skilled workers in clean and easy environments. That is perfectly reasonable.<br />
<br />
But Glantz's main crusade, and the main topic of his lies (search the archives here or the Lies blog post for more details), is banning smoking anywhere he can. To justify banning smoking in bars -- private places where people gather voluntarily -- he and his ilk claim that the <i>workers</i> need to be protected from their "involuntary" exposure to smoke. Any non-idiot will immediately realize that employment in a bar is obviously not involuntary. And guess what? Apparently Glantz himself recognizes it. He recognizes that workplace exposures are different from involuntary exposures to passers-by, and it is normal and acceptable to allow workers to accept possibly health-affecting exposures and demand whatever wage premium that warrants.<br />
<br />
In short, Stanton Glantz just declared that the entire stated justification for banning smoking in pubs and other private gathering places is false.<br />
<br />
I will go ahead and pre-respond to his obvious first response to this (or what would be his first response if he actually read beyond his own echo chamber): He responds that an exposure in, say, a chemical plant is different from an exposure to vaping because chemical manufacture is "necessary" while vaping is not. This fails for several reasons. Economics easily shows that concepts like "necessary" are inherently nonsense. Moreover, a particular level of exposure in a plant could always be reduced (and thus is not "necessary" in a different sense). Moreover, there is a simple factual point: If Glantz had some expertise in public health, he would know that among the worst jobsites for exposure to the types of chemicals he is fretting about are not chemical plants, but beauty salons and auto body repainting shops. These hardly seem any more "necessary" than e-cigarette use.<br />
<br />
If he has any further response, other than to sputter and insist -- with no basis other than his personal pique -- that e-cigarette use is somehow different from beauty salons, I cannot think of it. Assuming no response is forthcoming, I encourage everyone who is interested in the smoking ban issue to cite Glantz's statement as a retort anytime someone tries to justify smoking bans in private gathering places with some version of, "but think of the workers! won't someone please think of the workers?" Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com4tag:blogger.com,1999:blog-8237846547805652402.post-61475046606222848292012-09-13T13:37:00.002-04:002012-10-30T14:46:51.149-04:00Tobacco control gets another failing grade in economicsThis failing grade adds to their already underwater marks in epidemiology and philosophy, to say nothing to their ethics which would simply get them thrown out of school.<br />
<br />
A few stories about tobacco smuggling came across my desk this week including <a href="http://theviewfromcullingworth.blogspot.co.uk/2012/09/now-about-that-cigarette-smuggling.html">these</a> <a href="http://www.smh.com.au/nsw/from-the-dockyards-to-the-dock-20120908-25la6.html">two</a> that were sober and balanced, as well as <a href="http://www.dailymail.co.uk/news/article-2200633/Human-excrement-asbestos-dead-flies-The-ingredients-fake-cigarettes-Britain.html">this</a> "reefer madness"-esque one from the Daily Mail. The latter described the detection of contaminants in black market cigarettes as (emphasis added) "Fake cigarettes <i>made from</i> human excrement, asbestos, mould and dead flies". (I think a "mould" is some kind of British house pet -- not sure.) I hate to complain about the newspaper that gave me a smile by <a href="http://www.dailymail.co.uk/home/moslive/article-2199284/Wind-farms-Are-wind-farms-saving-killing-A-provocative-investigation-claims-thousands-people-falling-sick-live-near-them.html">calling me</a> one of the US's most distinguished epidemiologists, but what can you do.<br />
<br />
Those reminded me that I had meant to comment on <a href="http://velvetgloveironfist.blogspot.com/2012/09/remarkable-coincidence.html">this post by Chris Snowdon</a>, following on his and my <a href="http://ep-ology.blogspot.com/2012/08/cigarette-plain-packaging-understanding.html">previous</a> <a href="http://ep-ology.blogspot.com/2012/08/cigarette-plain-packaging-understanding.html">posts</a> on the subject of the interaction of taxes and "plain packaging". Snowdon's post quotes a prediction: Because the Australian "make cigarette packages ugly" initiative was unlikely to have much effect on consumption, but that the tobacco control people had staked their meager reputations on there being an effect, they would probably do something like raise taxes at the same time so they could claim that the packaging had an effect. And guess what has been proposed?<br />
<br />
But here is the thing: Camouflaging the lack of effect of the packaging with a simultaneous tax increase only works if there is room to drive down consumption by increasing taxes, and it seems unlikely that this is the case. <br />
<br />
The possibility of consumers switching to a black or grey market is the "competitive discipline", as it were, that keeps the government from further raising the price. It is similar to any market situation where a producer would like to raise its prices but cannot because of the discipline imposed by competition. In this case, the government acts as a near monopolist in a sense -- they can increase the price on all legal market cigarettes and capture the monopoly rents (profits) for themselves -- but not quite: They still have an imperfect substitute to compete with in the black market.<br />
<br />
Now I realize that many readers might not quite follow all of that, but you probably get the gist of it (and there is more explanation in my previous posts). The thing is, the people making government policy need to thoroughly understand things like that -- and if they do not, they need to at least hire a second-semester economics student to explain it to them. But apparently economics students have ethical standards that prevent them from working for Big Tobacco Control, because the tax proposal that Snowdon cited seems to be grounded on serious ignorance of some fairly unambiguous economics.<br />
<br />
As I mentioned in the previous posts, there is general agreement that plain packaging will tend to drive down consumers' willingness to pay for premium brands, driving down the prices. This will then make the cheaper brands less competitive and so the prices of those will be driven down also. The distinction between any brand and black market product will also be reduced, so more consumers will be inclined to switch to the black market. This will put additional downward price pressure on the legal market to reduce switching to the much cheaper black market. But since most of the price of cigarettes is taxes, if the adjustment in price relies entirely on manufacturers cutting into their net revenue, it will likely not be "enough".<br />
<br />
What do I mean by "enough"? Well, there is a tradeoff in setting prices between making more profit and driving customers away. Let us be charitable and assume that the government is not merely interested in making monopoly rents from cigarette sales, but genuinely want to drive down demand too. Their tradeoff, then, is keeping prices high to lower demand (and capture revenue), but not so high that they tip too many people into the black market (at which point they lose all revenue, lose the ability to regulate at all, increase profits of organized crime, etc.). It seems safe to conclude that the current taxes are set pretty close to what is considered the optimum for that tradeoff -- some consumers are driven into the arms of the competition, but not too many, and this cost is just balanced by the benefit (as defined by government: income and demand reduction) of having the price as high as it is.<br />
<br />
So if the black market becomes relatively more attractive, as is expected with ugly packaging and the loss of premium brand cache, then to keep prices at the optimal level, they will have to come down. Since the manufacturers make so little of the total profit (the government makes most of it), it is almost certain that the adjustment that manufacturers will make in prices to keep their profits maximized will not lower prices nearly enough to maintain the optimal tradeoff from the government's perspective (it would require running some numbers to calculate how far short the change will fall, but it seems likely that it would be substantial). So too many consumers will be driven to the black market, and a lower price would be better to optimize the government's tradeoff described above. Thus the government, which collects most of the profit and has the most room to adjust, needs to adjust their per-unit profits (taxes) down too to fulfill their goals. Of course, this will not happen. The result will be "too many" people switching to the black market (again, from the perspective of the government's preferred tradeoff between the advantages and disadvantages of higher prices).<br />
<br />
Thus if they <i>raise</i> taxes, the prices are going to be even more "too high".<br />
<br />
The result of the camouflaging tax increase will indeed be lowered consumption of legal cigarettes, providing faked support for what was dishonestly predicted by tobacco control. But there will also be an increased shift to the black market, increasing the effect that was honestly predicted by everyone else. Indeed, there is a good chance that total consumption will increase: Once someone crosses the behavioral barrier ("tipping point") to start buying their cigarettes from the black market, they do not have much difficultly continuing to do so. And since they are then paying a much lower price per unit, this quite likely results in them consuming more. Moreover, the greater the market penetration by the black marketeers, the more likely they will become the first choice of new smokers.<br />
<br />
Of course, as the black market increases in market share, both the legal industry and Big Tobacco Control will be scrambling to get their pet media outlets to publish scare stories about that nasty black market product, and this alliance might get some traction with the message. But ultimately, the forces of economics always win -- millions of people acting in their own interests are a force that a few people acting against those interests can do little to stop. Not until they get to the point of have troops on the street and a tenth of the population informing for the secret police, and that is still a while off, even in Australia.Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com0tag:blogger.com,1999:blog-8237846547805652402.post-49117405383226079662012-09-12T16:31:00.000-04:002012-09-12T16:31:23.438-04:00Unhealthful News 219 - Why the news is so unhealthfulTwo interesting articles just came across my desk (both h/t @themorrigan1972). One is a study that <i>shockingly!</i> revealed that a lot of the hype in science news reporting has its origins in the hype in the paper's abstract or press release. <a href="http://blogs.scientificamerican.com/science-sushi/2012/09/11/scientists-play-a-large-role-in-bad-medical-reporting/?WT.mc_id=SA_Facebook">This</a> is a good summary of the study. <br />
<br />
Unfortunately, there is some suggestion that this lets the news writers off the hook. But it really offers them no excuse. Are they really going to argue, "oh, gee, it seems like someone is putting out information with hype and spin -- what can I, a mere newspaper reporter, working as a paid employee whose job it is to understand and communicate useful information, possibly hope to do about that?" Nope, I am not buying it.<br />
<br />
This new study is not really news to anyone familiar with modern science publishing. No health reporter has any excuse for not already knowing about the tendency toward hype. Would you expect political reporters to just blindly repeat everything candidates claim without running a reality check based on at least some basic knowledge of public policy. Ok, bad example. But presumably you do not <i>want</i> that, even though you <i>expect</i> it. How about this: Do you expect tech reporters to just blindly repeat Apple's press release rather than actually evaluating their new toy? Smart expert reporters know how to deal with inevitable hype.<br />
<br />
Of course, hype is not quite inevitable in health research press releases. When the obvious hype would be politically incorrect, it is mysteriously absent. Consider <a href="http://www.vancouversun.com/health/Vancouver+researcher+finds+shot+linked+H1N1+illness/7217283/story.html#ixzz26GS3WAmL">this story</a> of ongoing research that points to the conclusion that the flu shots from one or more years actually increased the risk of at least one strain of flu (in particular, the nasty one that everyone was worried about). The message from the study author is:<br />
<blockquote class="tr_bq">
the findings should not deter people from getting flu shots</blockquote>
Huh? It is perfectly fine to say something like "we are still not sure of this, and some data does not support the claim" (true) or "the benefits of the vaccines still outweigh the costs" (might or might not be true -- I suspect that this researcher has no idea one way or the other -- but at least it is not absurd). But "should not deter"?? Of course it should deter. However good you thought the idea of getting a flu shot was before, you should think a bit less of it now, which should make you a bit less likely to get it. Such deterrence is the only rational reaction to the news.<br />
<br />
Just imagine a study of a consumer behavior that the public-health-industrial-complex opposes which finds sliver of a hint that the behavior was a tiny bit more harmful than previously believed. You can bet that they would be insisting that was a definitive reason to avoid the choice. (Or course, you do not have to imagine that. You can instead read our new <a href="http://antithrlies.wordpress.com/">"Anti-THR (tobacco harm reduction) Lie of the Day" blog</a>.)<br />
<br />
But if, instead, a study finds evidence to suggests that the H1N1 vaccine may well have caused rather than prevented cases or H1N1? Well don't worry your pretty little heads about that -- just trust us.<br />
<br />
Health and other science reporters need to be able to see through the hype and not over-report things. But they also need to apply a bullshit filter in the other direction too.Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com0tag:blogger.com,1999:blog-8237846547805652402.post-21644572707846593492012-09-07T10:17:00.003-04:002012-09-07T18:22:23.809-04:00Unhealthful News 218 - The blind polling the blind: WSJ on IWTsNo UNs for a while, but I have two right now. The next one will be based on my current series at the <a href="http://antithrlies.wordpress.com/">Anti-Tobacco-Harm-Reduction Lie of the Day</a> blog (which you have probably already seen if you are interested in THR, but if not, check it out). Today's is based on <a href="http://blogs.wsj.com/ideas-market/2012/09/04/vote-should-solar-and-wind-power-be-subsidized/">this article/poll in the Wall Street Journal</a> which asks readers their opinion about whether the government subsidies for "alternative" electric generation, which are the only reason for anyone builds industrial wind turbines (IWTs), should be continued. The rumor is that a reporter plans to write a story about the poll.<br />
<br />
That fact in itself suggests a certain innumeracy: Put out a self-administered survey on a highly contentious issue, and you get a measure of which side can better inspire their supporters to bother with the survey -- not exactly an interesting or easily interpretable quantification. In this particular case, the edge currently goes to the industry, which is not too surprising: They have legions of paid flacks some of whom are probably sitting around voting and re-voting all day. After all, there is only so much time they can spend pretending to be ordinary citizens writing pro-IWT comments on every single newspaper article that appears on the subject, and it does not appear they do much else.<br />
<br />
On the opposition side, those who are most highly motivated are those concerned with the terrible health effects of IWTs, but they are not so likely to have all day to spend rigging a poll result. In this case, the most highly motivated on each side -- paid on one side, concerned citizens on the other -- are joined, respectively, by the useful-idiot enviro lefties who mistakenly think that IWTs are "green" and many of the WSJ's regular readers, who <i>might</i> stumble across this page, and who generally opposed the government trying to pick winners.<br />
<br />
What makes this health news is the <i>lack</i> of mention of health -- no mention that the most adamant opposition to IWTs comes from those of us who care about public health (or those who care about their own health if they are at risk of having them cited nearby). I suppose that the only "people" that the WSJ cares about are the ones who are actually corporations, or who are rich enough to be able to insulate themselves from health hazards like IWTs. The short article leading into the poll describes as the entire reason for opposition as:<br />
<blockquote class="tr_bq">
Critics want to scale back or eliminate the subsidies, arguing that
renewable sources have had decades to get established but still aren’t
cost-competitive with conventional energy.</blockquote>
That is all. The single argument they present is not even one of the many good arguments. It is either extremely naive or a strawman. If IWTs actually were a good thing (producing moderately efficiently, while being clean and not hurting a lot of people -- which they fail on all three counts), and yet remained permanently a bit more expensive than less clean options, the subsidy would be justified. We do not expect every actions that provides net social benefits to also provide net private benefits (well, at least those of us who realize that <i>Atlas Shrugged</i> is a work of fantasy, though remember, we are talking about the WSJ here).<br />
<br />
The correct argument along those lines is something like, "the subsidies are not encouraging innovation and leading to much better technologies; rather, they are just paying for mass installations of the current bad tech which is extremely inefficient and harmful". To explain it in terms the WSJ should understand, the current system is like "welfare queen" entitlements, that create incentives for people to continue to live in a socially costly way; it is not at all like the goals of Clinton welfare reform which tries to provides subsidies that move people toward becoming producers rather than leeches (someone who has read <i>Atlas Shrugged</i> more recently than I will have to tell me if I got the terms right).<br />
<br />
But what interested the policy analyst in me enough to write about this is actually none of those points, but the form of the survey. It did not just ask "subsidies: good or bad?". It offered four answers: they [subsidies] should be increased; they should remain the same; they should decline; they should be eliminated. Yeah, right. I wonder how many people responding to this (other than the ones who are paid by the energy industry companies that are lining their pockets with the subsidies) could even tell you how big the subsidies are, or more important, describe it in some useful metric (even if they can recite the number, no one has any intuition for what "X billion dollars" really means, after all). How is someone who has no understanding of the scale supposed to make a judgment about whether they are too high or low? More to the point, since those who support the subsidies are in control of the government right now, presumably they have set the level of subsidies based on what someone thinks is not too high and not too low, based on what the marginal dollar causes to happen. How can the WSJ possibly think that its respondents -- among those who generally favor the subsidies -- have any idea whether the marginal dollar is well spent or not.<br />
<br />
Of course, as you would expect if most of the votes are indeed coming from paid industry flacks (who are usually not the brightest bulbs on the tree), almost all of the responses that favor the subsidies say they should be higher. Presumably most of the industry's useful idiot "greens" are doing the same thing. They have no idea how big the subsidies are and how badly the marginal dollar is wasted (even as measured from the perspective of those who like the industry and the subsidies), but they want more more more. I wonder if they would change their minds if they were told that the subsidies would be paid for by a highly regressive tax (which is basically and accurate description of the situation)?<br />
<br />
Anyway, if you happen to click over to the story, please click the "eliminated" response and make a tiny little stand for people's health over corporate welfare leeches. Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com0tag:blogger.com,1999:blog-8237846547805652402.post-26795801327807976662012-09-01T16:14:00.005-04:002012-09-01T16:14:44.395-04:00Does the press just have no idea how criminal markets work?Time and again, I have marveled at the stupid comments in the press about black markets and how they work. Those are not always as stupid as the comments by the "public health" people and other Drug Warriors, though the mainstream media does often just act as a transcriptionist for their claims.<br />
<br />
As a general rule, illicit markets work just like any other markets: delivering a wanted good at a price that provides adequate profit, supply and demand, market clearing price, and all that. The major difference is that monopolies are often enforced with violence, which as with any monopoly situation, is bad for consumers (oh, and for the people who get shot too). Also, the consumers have to pay the risk premium to compensate the sellers for the risk of arrest and violence that they face.<br />
<br />But mostly, illicit markets are markets. Which was why <a href="http://www.nytimes.com/2012/09/01/world/americas/maple-syrup-theft-casts-pall-over-canadian-breakfast-plates.html?_r=1&emc=tnt&tntemail1=y">today's news from Canada</a> was so funny. It turns out there was an astonishingly huge burglary of maple syrup from a Quebec warehouse. That part is not funny (other than the fact that the day's top news from Canada is about maple syrup). What is funny is the headline that appeared in the NYT:<br />
<blockquote class="tr_bq">
Canada: A Theft Casts a Pall Over Breakfast Plates</blockquote>
They seem to think that the theft of the syrup means that pancake eaters are going to be bereft of their beloved sugar. But what, exactly, do they think the thieves are going to do with their haul? Pour it into the Saint Lawrence River? Of course not. They have probably already sold it to maple syrup distribution networks, and someone is eating it right now.<br />
<br />
Obviously there is a lot that is bad about this, most obviously including the fact that someone is making undeserved profit from the labors of others (you know, kind of like Wall Street, the Master Settlement Agreement, or lots of other organized criminal activity). But one thing that did not happen was the commodity disappearing from the world just because it was stolen.Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com2tag:blogger.com,1999:blog-8237846547805652402.post-15813689466830548242012-08-29T10:24:00.002-04:002012-08-29T10:26:30.542-04:00New York AG vs. "energy drinks"I do not have too much to say about this or too much time, but since I have been following this issue here, I thought I would make a brief mention of <a href="http://www.nytimes.com/2012/08/29/business/new-york-state-is-investigating-energy-drinks.html?_r=1&emc=tnt&tntemail1=y">this story</a> about the New York Attorney General investigating energy drinks.<br />
<br />
A few random observations:<br />
<blockquote class="tr_bq">
The state investigators are also examining whether some additives, like
black tea extract and guarana, may contain additional caffeine that is
not reflected when the drinks are labeled. </blockquote>
It is really hard to complain about that. I know that there are some people who think that even informational labeling mandates are anti-liberty. But as an economist, I have to say that providing accurate information, and trying to provide as much decision-relevant information as possible, even if that involves mandates, is necessary for real informed autonomy (i.e., liberty).<br />
<br />
However, once again (as I have pointed out numerous times), what makes these drinks unique in the human experience is the other active ingredients, other than the caffeine (which is often quite modest in quantity). But, hey, investigating the full picture would be <i>hard,</i> and the newspapers would not give the politicians free press for doing it because the health reporters would have to try to understand something, so never mind.<br />
<br />
This, however, is rather unfortunate:<br />
<blockquote class="tr_bq">
The attorney general...is also looking at whether the companies...violated federal law in promoting the drinks as dietary supplements rather than as foods, which are regulated more strictly. </blockquote>
It is pretty difficult to think of these concoctions as food. The only reason to define them that way would be to be able to ban them as "adulterated". (That silly word, in itself, makes the case: How does it make any sense at all to refer to an engineered, completely artificial product as "adulterated"? It is what it is.)<br />
<blockquote class="tr_bq">
<div itemprop="articleBody">
[Amelia M. Arria, an epidemiologist who serves
as director of the Center on Young Adult Health and Development at the
University of Maryland School of Public Health] added. “The term ‘energy
drink’ is misleading. Energy should come from calories — this is more about stimulation.” </div>
</blockquote>
I like that point. That is the kind of simple truth in labeling that could nudge people into making better decisions without needless restrictions or manipulative games. A refreshingly rational and non-doctrinaire point, given the title of the speaker. Oh, but wait...<br />
<blockquote class="tr_bq">
<div itemprop="articleBody">
“A person who co-ingests an energy drink and alcohol doesn’t understand
how drunk they are,” Ms. Arria said. “Caffeine keeps you awake so you
can keep drinking, and high levels of caffeine can mask intoxication.”
</div>
</blockquote>
Huh? One of the effects of being drunk, for some people, is drowsiness and the like. Caffeine and other drugs can <i>eliminate</i> (not "mask") that particular effect, but certainly not the other effects. Perhaps she is arguing that getting groggy and falling asleep is a feature of drunkenness, rather than a bug. But, funny, you never hear "public health" people arguing that this is a good self-correction built into drinking, even though they are happy to implicitly evoke it when condemning some other product.<br />
<br />
Finally, there is this:<br />
<blockquote class="tr_bq">
The amount of caffeine differs widely among drinks but can range from
about 80 milligrams to more than 500 milligrams. By comparison, a
12-ounce cola contains about 50 milligrams of caffeine, while a 5-ounce
coffee has about 100 milligrams. </blockquote>
The 80 mg is more typical, so that range is rather misleading. But more important, why did they not just compare, say, 20 ml of coffee, if they were going to report an absurdly small quantity. Who pours only 5 oz. of coffee?Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com0tag:blogger.com,1999:blog-8237846547805652402.post-38036608135334976942012-08-24T16:52:00.000-04:002012-08-24T16:52:08.992-04:00Lance Armstrong - some thoughts on science and fairnessThis week's apparent final <a href="http://www.nytimes.com/2012/08/24/sports/cycling/lance-armstrong-ends-fight-against-doping-charges-losing-his-7-tour-de-france-titles.html?pagewanted=all">surrender</a> of Lance Armstrong to those who want to charge him with doping and strip him of his most important cycling awards is interesting to me at so many levels. I so much enjoyed cheering for him during his glory days (at a time when I was cycling myself). I am not really one to idolize a performance entertainer, as you might guess, but I enjoy and value the entertainment as much as the next guy. So this is disappointing to me (though since I, like most people, do not really care what the official records say, it is not like I feel like those great Tours have vanished from memory).<br />
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On the other hand, Armstrong's LIVESTRONG cancer charity used to be a particularly high-profile source of disinformation designed to discourage tobacco harm reduction, with its erroneous claims about the risks from smokeless tobacco. These lies were a pale shadow of the American Cancer Society, who was one of the leaders in producing anti-THR junk science and disinformation, but they were bad enough. With that in mind, I always saw a bit of a bright spot as the news kept trickling out over the years about Armstrong's increasingly losing battle with his accusers.<br />
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But notice the use of past tense in the previous paragraph. I just checked the livestrong.org website, and most of the anti-THR disinformation has quietly disappeared since THR.o last looked at it (a few years ago). I found only one paragraph in <a href="http://www.livestrong.org/Get-Help/Learn-About-Cancer/Cancer-Support-Topics/Physical-Effects-of-Cancer/Reducing-Risk-for-Cancer">one document</a> that really parroted the standard anti-THR party line from the anti-tobacco extremists, and a few random mild anti-smokeless-tobacco bits. So sometime in the last few years, someone at Livestrong must have learned something about THR and stopped repeating the lies from ACS and their ilk. So much for the schadenfreude. Livestrong did not go so far as to endorse tobacco harm reduction, though, which leaves them on the wrong side of the most promising way to reduce cancer in the US today <br />
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So what about the science of this? One of the most absurd things about the whole matter is that the best evidence in support of stripping Armstrong of his Tour de France (etc.) victories is that he won the Tour de France. How is that for Catch-22? <br />
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To win that and other major bike races requires that someone be near the top, among the entirely population of people who have ever tried to ride fast, in each of: useful genetic freakishness, practice, choice of the right strategy (short and long term), getting in with the right people, luck, etc. This is true for coming out on top of any highly competitive activity, be it a sport, politics, entrepreneurship, or whatever. It is not good enough to be near or at the top in one or two factors because there are too many other people who also do quite well at those one or two, and if they are way ahead of you in the others, then they will come out ahead. (Those familiar with statistics or economics will recognize this is the same phenomenon that creates regression toward the mean, when luck of the moment is one of the factors.)<br />
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The catch is that one of the elements of the "etc." -- a big one in cycling during Armstrong's glory days, according to the evidence -- is using banned performance enhancing drugs. This means that the most likely way to win was to be a freak of nature and train hard with a good team, <i>and also</i> to dope. (Or at least this is the way it was a decade or so ago. There are claims that drug detection has temporarily moved ahead of drug hiding in the arms race between them -- though if it were the other way around, would we know?)<br />
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So, the logic goes, since there were other people out there who had great genetics, training, teams, etc. and who were, in addition, using great drugs, then even they were a bit inferior to Mighty Lance in most ways, if he did not use drugs also, he still would not have been able to dominate them. This is perfectly valid scientific reasoning. The scientifically sensible prediction from this information is that he doped. <br />
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But such logic is not generally acceptable for making rules-based decisions. Armstrong's statement this week <a href="http://www.guardian.co.uk/sport/2012/aug/24/lance-armstrong-full-statement-doping?intcmp=239">complained</a>, quite reasonably, about the lack of due process, in particular the fact that he (supposedly) passed all of his drug tests -- the accepted definitive measure. Therefore he should be off the hook. Indeed, in some sense, passing the drug tests (however one manages to do that) can be considered part of the game. It is kind of like a hand-ball that is not seen by the official or an umpire calling a dubious out at the plate. The results are based on whatever was called, which becomes the only truth that matters for the game. There are no appeals.<br />
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The really disturbing part of the due process, though, (even worse than the double/triple/quadruple jeopardy, or the question of how a US organization can strip someone of his French victories) is the power of a few unsubstantiated claims by people with serious conflicts of interest. As Armstrong observed:<br />
<blockquote class="tr_bq">
any begrudged ex-teammate can open a USADA case out of spite or for
personal gain or a cheating cyclist can cut a sweetheart deal for
themselves</blockquote>
A great point. Unfortunately, this observation will likely not generate concern about the countless people who are convicted of street crimes in the U.S. based on similar "evidence"? For most of them, the testimony that the cops extract from some convenient "witness" does not leave them as a millionaire living a life of leisure, of course, but utterly ruins their lives.<br />
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In sum, I will not be wasting any sympathy on Lance Armstrong, and I really don't feel like this diminishes the great Tour memories... winning a time trial looking like a salt lick for lack of a water bottle, surviving 30 meters down through the grass after coming off the road on a switchback, and most of all, blowing past Ullrich and Kloden in 2004, after they refused Armstrong's attempt to give a deserved stage win to his teammate and, ironically, his eventual primary accuser. Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com3tag:blogger.com,1999:blog-8237846547805652402.post-6187962803809333742012-08-23T19:00:00.004-04:002012-08-23T19:00:45.295-04:00@FDATobacco et al. are an embarassment to the US governmentThere is a lot to complain about regarding the FDA's tobacco regulation unit. The really important bits involve complicated legal and scientific questions, and in a few places even some room for legitimate debate (though you might not be able to dig through the muck to find it). Someone <i>might</i> even say that in many cases they are doing what they have been assigned to do, and could even be doing about as well as can be expected, given the conflicting legal constraints and the plethora of bad advice they are getting. The same cannot be said for their communications to the general public, which are both inappropriate (not in keeping with the legitimate mission of the FDA) and so embarrassing and amateurish that it makes the entire operation look worse than it really is.<br />
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I have previously pointed out: (a) FDA has no business trying to do consumer manipulation "education" since, even to the extent that someone might argue that such Big Brother-ism is a legitimate mission of CDC, it is clearly not a legitimate mission for FDA. (b) This is especially true given how bad at it they are; their material reads like it is coming from some third-rate county health department or non-scientific activist group -- indeed, that it pretty clearly where they are copying some of it from. (c) The @FDATobacco twitter feed is especially pathetic, with a large portion of its traffic consisting of thanking people by name for following and retweeting, and much of the rest being material that could have come from the aforementioned third-rate departments or non-scientific charities, rather than a scientific arm of our national government. It is truly a national embarrassment. <br />
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I was reminded of this when @FDATobacco "favorited" a tweet from Jeff Stier (s/o to Jeff for alerting me to this), in which he ridiculed them for offering advice on how to talk to your teen that recommended being honest and open -- two things that FDA Tobacco is very much not known for. Apparently they did not recognize that it was sarcasm, which is about par for their general savvy. <br />
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But what really prompted me to even bother to comment was running into <a href="http://www.fda.gov/TobaccoProducts/NewsEvents/ucm315345.htm?utm_source=Quiz&utm_medium=Twitter&utm_campaign=BtS">this silly little quiz</a>, put out by the FDA tobacco unit, so that the kiddies (who the FDA has neither the mandate nor the skill to communicate with) can test their knowledge about tobacco. To give you a picture of its content:<br />
<blockquote class="tr_bq">
True or False: Tobacco use is the leading cause of preventable death in the United States.</blockquote>
The details of this are probably a little complicated for the kids, but this statement is, and has always been and is well documented as being, nonsense. I am not just talking about the built-in implicit lying about low-risk products by referring to "smoking" as "tobacco", though that is probably the most harmful aspect of it. The problem is that if it is "preventable", why are we not preventing it? Because we actually do not know how to do so, of course. Then why is it "preventable"? Because they are quite sure it can be prevented just as soon as they figure out how to do it. But by that definition, cancer or apoptosis is a preventable cause of death too.<br />
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Of course, this nonsense statement is a convoluted way of trying to avoid making the true statement, "of all the things that people choose to do, smoking is the one that kills the most". But then they would have to admit that people are choosing to do it, and admitting that would be very hard on their self-identity and job security.<br />
<blockquote class="tr_bq">
True or False: In order to purchase tobacco products in the United States, an individual must be at least 16 years of age.</blockquote>
When I answered True, it told me I was wrong and that individuals must be at least 18 years of age. Which, of course, means that they also must be at least 16 years of age, so the correct answer is indeed True. False would mean that you could buy at younger than 16. Numeracy is not the strong point of these people.<br />
<blockquote class="tr_bq">
True or False: Youth are sensitive to nicotine and can feel dependent sooner than adults.</blockquote>
The first bit of that conjunction is rather odd to even ask (does anyone really think that young people are immune to nicotine?) so the truth value hinges on the latter part. They assert "the younger they are when they begin using tobacco, the more likely they are to become addicted to nicotine and the more heavily addicted they will become." Since there is no scientific definition of "addicted", let alone "more heavily addicted" this is a little hard to judge. It turns out there is remarkably little solid evidence on this topic (once you replace the dramatic words with something scientific), given the huge confounding problem.<br />
<blockquote class="tr_bq">
True or False: Smokeless tobacco is addictive and can lead to dependence.</blockquote>
Of course they say True, which is not an absurd claim if you are not bothered by the pesky little problem of their being no accepted meaningful definition for "addictive". But their answer is still clearly wrong, reading: "True. Smokeless tobacco contains 28 cancer-causing agents. Adolescents who use smokeless tobacco are more likely to become cigarette smokers." <br />
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Wow, wasn't that sneaky of them? They ask a question that while somewhat fuzzy and misleading (trying to demonize smokeless tobacco without actually declaring it to be harmful), but that is not completely outlandish. And then they provide an answer that is all lie. 28? A better estimate would be 1000, which is also a good estimate for any plant or animal matter we eat (though I suppose in the spirit of "at least 16", above, I gotta give that one to them). Of course, when you say something "contains cancer-causing agents" you are communicating that it causes cancer to some measurable degree, which is a lie according to the evidence about the smokeless products that the target audience is likely to be using. As for "more likely to become smokers", this is either false (if you interpret it to mean "more likely than they would have been had they never used smokeless", which is how most readers will interpret it) or a lie via literal truth (if you interpret it to mean "almost everyone who chooses to use smokeless tobacco is someone who is also more inclined than average to smoke, and thus more likely than average to become a smoker").<br />
<blockquote class="tr_bq">
True or False: Tobacco smoke contains about 70 chemicals that can cause cancer.</blockquote>
If they had said "at least 70", then in the spirit of "at least 16" they would have been literally correct. Of course, since so many chemicals can cause cancer in the right dosage and location, and you can never conclude that a particular chemical never causes cancer, this is pretty unscientific phrasing from people that are supposed to be a scientific organization. But that is not the worst of it. The answer (True, of course) goes on to say "Therefore, it's no surprise, then, that smoking causes about one in three of all cancer deaths in the United States." Huh??? Even setting aside the accuracy of the statistic, how they hell do they translate "contains 70" to "causes 1/3"? It is bad enough that they are so scientifically illiterate that they think that makes sense. But should they really trying to keep American youth ranked so low in math and science literacy?<br />
<blockquote class="tr_bq">
True or False: Youth who are exposed to images of smoking in movies are more likely to smoke.</blockquote>
[Insert your own joke about not understanding the difference between inevitable social correlations and causation here -- I have run out of energy.]<br />
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Anyone feeling good about the fact that we are being looked over by the beneficent and honest scientific experts at FDA?<br />
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<br />Carl V Phillipshttp://www.blogger.com/profile/01919902852457771666noreply@blogger.com0