Tuesday, January 15, 2013

When You Don't Like the Evidence, Ignore It: The New Anti-Tobacco Mantra

Anti-tobacco groups, researchers, and advocates who have a pre-existing bias against electronic cigarettes and who have already made up their minds that these cigarette-like substitutes are evil are faced with a perplexing problem: how to respond to the personal stories of literally hundreds of thousands of vapers who have successfully used these products to quit smoking or to cut down substantially on the amount that they smoke.

This is a major problem for these anti-tobacco researchers and advocates because they must continue to assert that there is no evidence electronic cigarettes are helpful in smoking reduction or cessation. Once the acknowledge that electronic cigarettes are useful for smoking cessation or reduction, then their ideological opposition to these products becomes untenable.

So how to respond to the fact that more than 2.5 million smokers in the United States find these products helpful in their efforts to quit smoking or to cut down on the amount that they smoke? How to respond to the hundreds of thousands of personal testimonials of vapers who have succeeded in using these alternatives to cigarettes?

To me, this would seem like a vexing problem. After all, you can't simply ignore this evidence, can you?

The Rest of the Story

Yes - you can ignore the evidence! This is the modern-day anti-tobacco movement and in 2013, ignoring the scientific evidence is perfectly acceptable in the movement.

Yesterday, a leading anti-tobacco researcher - Dr. Stan Glantz - admitted that his approach to the evidence that millions of smokers are using electronic cigarettes successfully as an alternative to the real ones is very simple:

Ignore it.

Yesterday, Dr. Glantz wrote, on his tobacco blog, that smokers who have succeeded in quitting smoking using electronic cigarettes have not actually demonstrated the usefulness of the electronic cigarette. Instead, he argues, they have simply experienced a placebo effect.

In a column entitled "Why I don't post personal testimonials about e-cigarettes on by blog," Dr. Glantz explains that: "There is a long and well-developed literature about the placebo effect where people think a treatment worked when, in fact, it was no better than a sugar pill. Personal testimonials about the benefits of e-cigarettes do not constitute scientific evidence that they are effective ways to quit smoking."

In this case, Dr. Glantz' argument makes no sense because a placebo-type effect is precisely how the electronic cigarette works. In other words, the electronic cigarette works by simulating a real one. The similarity of the electronic cigarette to a real cigarette is the precise mechanism of action by which electronic cigarettes work. The issue of a "placebo" effect is only relevant as far as the question of whether the vaper is quitting because of the nicotine in the e-cigarette or the behavioral aspects of e-cigarette use.

Moreover, while case reports are obviously not the highest standard of scientific evidence, they are undeniably a valid form of scientific evidence. In the case of electronic cigarettes, the fact that millions of vapers are using these products with success is undoubtedly a valid piece of scientific evidence that these products are useful as alternatives to smoking. This evidence is not the only piece of evidence we need. Obviously, we also need clinical studies that document the cessation rates and the amount of smoking reduction achieved with electronic cigarettes. But to deny that the case reports are part of the overall scientific evidence is to ignore the science.

And if you are willing to ignore part of the science, why should anyone believe that you are not going to ignore other parts of it? We've already established that Dr. Glantz is willing to ignore some of the scientific evidence regarding electronic cigarettes. Now it just remains to be seen how much of the scientific evidence he will choose to ignore. To be honest, it's not clear to me that clinical trials would sway his opinion, regardless of their results.

After all, there has already been one published trial, showing that an amazing 54% of smokers were able to quit smoking or to cut down their smoking by more than half. And this result was achieved among smokers who were not motivated to quit. Dr. Glantz is apparently ignoring this evidence as well. He writes that: "such studies simply do not exist."

The truth is that one such study does exist and Dr. Glantz is ignoring it. Obviously, these results need to be replicated in other studies with larger sample sizes, but you can't simply pretend that the study was never done.

The question may occur to my readers: What would I do if I received testimonials from smokers who tried electronic cigarettes and failed to quit smoking or to cut down on the amount they smoke? Would I simply ignore these testimonials or find some bogus reason to dismiss their experiences?

Absolutely not. Such personal experiences are part of the scientific evidence that must be considered. In fact, there are a large number of smokers who try electronic cigarettes and simply do not find them to be a satisfactory substitute. This is important evidence that becomes a part of the totality of evidence that I consider when rendering scientific judgments. I don't simply ignore evidence because "I don't like it."

At this point, I have to admit that I'm not at all surprised that a prominent anti-smoking researcher would choose to simply ignore scientific evidence about electronic cigarettes that doesn't comport with his preconceived ideology. What does surprise me, however, is that he readily admits it and that he would feature such an acknowledgment on his blog.

If you are going to ignore scientific evidence that you don't like, why would you readily admit to it? And why would you voluntarily publicize your dismissal of scientific rigor on your own blog?

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