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s2smodern

Harry Shapiro Director DrugWise

This cry from the heart from Dr Joel Nitzkin:

“After all this time, we are still dealing with the same mentality within the tobacco control community. To them "tobacco" is the problem, not smoking. To them, the industry is evil and anyone or any paper disagreeing with that perception is dismissed as a tobacco industry spokesperson or someone who has been snookered (taken for a fool and now plays the role of a useful idiot for the industry). To them, the only reason anyone in any tobacco-related industry would ever produce or promote any relatively low risk product would be to addict another generation of teens, who would then, predictably, transition to cigarettes for a bigger and better nicotine hit.

“Thus, the zeal for the almost-no-nicotine cigarette as the only way to end the pandemic of cigarette-related illness.

“The vast majority of tobacco control advocates are advocates, not scientists, even if they have an MD or PhD after their name. Add to that the fact that their survival in this role (and their current job) is dependent on funding from or through CDC, FDA, or one of the major voluntaries (at least in the USA) and all but FDA are at least partially dependent on funding from the pharmaceutical industry for their research, meeting and advocacy agendas, Any change in mind-set is very unlikely.

“Having worked as hard as I know how to try to deal with this issue within the medical and public health communities, I must admit, that I see remarkably little progress in securing endorsement for a tobacco harm reduction initiative using anything other than one of the nicotine pharmaceuticals.

“All this is further aggravated by the bias by journal editors, willing to publish articles with major obvious flaws, and with conclusions and abstracts that to not reflect the actual findings of the study, so long as the paper supports an anti-tobacco-harm reduction policy.

I am open to suggestion as to any ideas that we could pursue, as scientists and public health professionals - not dependent on federal, voluntary or pharmaceutical funding - that might enable us to secure more success in putting the tobacco harm reduction issue on the medical and public health table for discussion”.

I was led to some very interesting psychological research by Joe Gitchell of Pinney Associates concerning the ‘backfire effect’. This is a phenomenon whereby those who have their views challenged will not only ignore the challenge, but will actually become more entrenched in their beliefs. The scary bit of this was revealed by researchers from the Brain and Creativity Institute, at the University of California, who demonstrated through MRI scans that the brain reacts to these challenges as if you were under physical threat. So somebody who strongly believes in the dangers of e-cigarettes would react to 'the evidence' as if they were being attacked by a bear in the woods. And in those circumstances, an appeal to logic and reason will fall on deaf ears, or what's left after the bear has chewed them up.

Dr Brad Radhu spotted an op-ed by Steve Koonin, writing in the firewalled Wall Street Journal, about the red/blue team methodology for increasing transparency in scientific debate. Although this article relates to climate change, it could be applied to the intense debate about e-cigarettes

Koonin wrote, “The national-security community pioneered the ‘Red Team’ methodology to test assumptions and analyses, identify risks, and reduce—or at least understand— uncertainties. The process is now considered a best practice in high-consequence situations such as intelligence assessments, spacecraft design and major industrial operations. It is very different and more rigorous than traditional peer review, which is usually confidential and always adjudicated, rather than public and moderated.

“ The focus would be a published scientific report meant to inform policy...A ‘Red Team’ of scientists would write a critique of that document and a ‘Blue Team’ would rebut that critique. Further exchanges of documents would ensue to the point of diminishing returns. A commission would coordinate and moderate the process and then hold hearings to highlight points of agreement and disagreement, as well as steps that might resolve the latter. The process would unfold in full public view: the initial report, the exchanged documents and the hearings.

“A Red/Blue exercise would have many benefits. It would produce a traceable public record that would allow the public and decision makers a better understanding of certainties and uncertainties. It would more firmly establish points of agreement and identify urgent research needs. Most important, it would put science front and center in policy discussions, while publicly demonstrating scientific reasoning and argument.”

It sounds like a great idea, but even if you could bring the e-cig naysayers to the table, would this not appear, to the public anyway, as just another bunch of scientists and doctors slugging it out?

John Cook from the Global Change Institute, University of Queensland, and Stephan Lewandowsky, School of Psychology, University of Western Australia, have been tackling the issue of debunking myths. They conclude that just dumping more of the evidence-base into the public's lap and hitting one myth about e-cigarettes with a barrage of counter-arguments simply reinforces the backfire effect. And as Dr Nitzkin points out, the situation with e-cigarettes is far trickier than Cook's work with climate change because, unlike with e-cigarettes, most reputable national and international institutions and the bulk of the scientific community all agree that climate change is a reality. Whereas public antipathy towards e-cigarettes is driven and reinforced by similarly reputable agencies. So what can be done?

Cook and Lewandowsky produced The Debunking Handbook, which can be summarised as:

  • Core facts - a refutation should emphasise the facts, not the myth. Present only key facts to avoid an Overkill Backfire Effect (where you try and overwhelm detractors with facts);
  • Explicit warnings —before any mention of a myth, text or visual cues should warn that the upcoming information is false;
  • Alternative explanation —any gaps left by the debunking need to be filled. This may be achieved by providing an alternative causal explanation for why the myth is wrong and, optionally, why the misinformers promoted the myth in the first place;
  • Graphics – core facts should be displayed graphically if possible.

The nine-page booklet can be downloaded here https://www.skepticalscience.com/docs/Debunking_Handbook.pdf and it is worth considering how a coordinated public awareness campaign could work. Has one been tried?

For more about the neuroscience and psychology of the backfire effect go to the three part podcast on https://soundcloud.com/youarenotsosmart

US Surgeon-General Vivek Murty has been sacked by the Trump administration causing some thoughts that a new incumbent might deem e-cigs not so bad after all. Well, I wouldn't hold your breath, but I was taken by the W ashington Post item on this ,which referenced what it called Vivek's “biggest accomplishment” in producing a report on drug and alcohol addiction. Other media called this a 'landmark' report implying that a US Surgeon General has never produced such a report before. So what was so special? Presumably his comment that “regardless of persistent beliefs, addiction is a brain disease, not a moral failing...Part of the reason for the report is to change attitudes about addiction and the stigma that users feel, he explained. “I’m calling for a culture change in how we think about addiction,” he said. “Unless we eradicate the negative [stereotypes] . . . we won’t create an environment where people feel comfortable coming forward and asking for help.” Yet rather confusingly, he also called the current catastrophic opioid addiction and overdose epidemic in the States (step up Big Pharma) as a 'moral test for America”.

https://www.washingtonpost.com/national/health-science/landmark-report-by-surgeon-general-calls-drug-crisis-a-moral-test-for-america/2016/11/16/4214bf2a-ac49-11e6-977a-1030f822fc35_story.html?tid=a_inl&utm_term=.567208980774

Well personally, I don't believe addiction is a brain disease, but that's a whole other story, mainly because it locates addiction purely as a consequence of individual pathology and ignores many other factors. Seems like the choice for drug users (the majority of whom are not drug dependent) is to be condemned either as a 'dope fiend' or be tagged as 'diseased'. But the moral issue remains; addiction is not a moral issue, nor is intoxication. The human desire to alter mood states takes you back into the earliest days of recorded history and beyond, well before industrialisation and the Protestant work ethic demanded sobriety. If we are hard-wired to resist attacks on our deeply held views, we are no less driven to change the way we feel with drugs including caffeine, alcohol and nicotine.

Just how committed are PMI to a cigarette-free world? Not just yet if a talk to investors by Martin King, President of PMI's Asia Region, is anything to go by, or at least not so much in the emerging economies. He said, “ We will continue to pursue geographical expansion, with particular focus on those emerging markets where we have a limited presence....Although we already hold sizeable market shares in countries such as Indonesia, the Philippines and Thailand, other geographies such as Vietnam, India and Bangladesh represent significant opportunities for business expansion with favourable demographics and economic growth potential in the mid to long-term”

To be fair though, he also noted “We believe that iQOS and our other RRPs have the potential to change the future of the tobacco industry. Building on our exceptional performance in Japan, we anticipate that iQOS will have a significantly favourable impact on our mid to long-term results.

Furthermore, our valuable learnings in Japan will help us succeed as we expand RRPs to additional markets in Asia.”

Back in the States, Ed Lehrer, writing in The Hill, suggested that the rise of vaping has nothing to do with Big Tobacco. He makes some fair points about how much of the vaping industry operates independent of Big Tobacco and how the companies as yet don't have a squeeze on the market. But as we all know draconian legislation especially in the USA could kill off the small businesses leaving the field open for as much of it as Big Tobacco wants.

http://thehill.com/blogs/pundits-blog/healthcare/329829-the-rise-of-vaping-has-nothing-to-do-with-big-tobacco