Tuesday, November 28, 2023

Judith Curry Perfectly Describes a Bad Recipe for Tobacco Science


Judith Curry is a brilliant American climatologist and former Chair of the School of Earth and Atmospheric Sciences at Georgia Tech.  The author of over a hundred scientific papers, she served on many high-level government panels: the National Research Council's Climate Research Committee; NASA’s Advisory Council Earth Science Subcommittee; the National Oceanic and Atmospheric Administration’s Climate Working Group; and the National Academies’ Space Studies Board and Climate Research Group. 

Professor Curry publishes a blog, Climate Etc., which “provides a forum for climate researchers, academics and technical experts from other fields, citizen scientists, and the interested public to engage in a discussion on topics related to climate science and the science-policy interface.”

Her recent blog entry, “A Bad Recipe For Science,” which addresses political corruption of science generally, perfectly describes the terrible recipe to undermine tobacco harm reduction that has been concocted by the World Health Organization and its partners.  Following are excerpts from the blog, with my added tobacco harm reduction-related emphasis and [note]. 


Politically-motivated manufacture of scientific consensus corrupts the scientific process and leads to poor policy decisions

An essay with excerpts from my new book Climate Uncertainty and Risk.

In the 21st century, humankind is facing a myriad of complex societal problems that are characterized by deep uncertainties, systemic risks and disagreements about values. Climate change and the Covid-19 pandemic are prominent examples of such wicked problems. For such problems, the relevant science has become increasingly like litigation, where truth seeking has become secondary to politics and advocacy on behalf of a preferred policy solution.

How does politics influence the scientific process for societally relevant issues? Political bias influences research funding priorities, the scientific questions that are asked, how the findings are interpreted, what is cited, and what gets canonized.  Factual statements are filtered in assessment reports and by the media with an eye to downstream political use.

How does politics influence the behavior of scientists? There is pressure on scientists to support consensus positions, moral objectives and the relevant policies.  This pressure comes from universities and professional societies, scientists themselves who are activists, journalists and from federal funding agencies in terms of research funding priorities. Because evaluations by one’s colleagues are so central to success in academia, it is easy to induce fear of social sanctions for expressing the ideas that, though not necessarily shown to be factually or scientifically wrong, are widely unpopular.

Activist scientists use their privileged position to advance moral and political agendas. This political activism extends to the professional societies that publish journals and organize conferences. This activism has a gatekeeping effect on what gets published, who gets heard at conferences, and who receives professional recognition. Virtually all professional societies whose membership has any link to climate research have issued policy statements on climate change, urging action to eliminate fossil fuel emissions.

The most pernicious manifestation of the politicization of science is when politicians, advocacy groups, journalists, and activist scientists intimidate or otherwise attempt to silence scientists whose research is judged to interfere with their moral and political agendas.

The road ahead requires moving away from the consensus-enforcing and cancel culture approach of restricting dialogue surrounding complex societal issues such as climate change [and smoking-related mortality]. We need to open up space for dissent and disagreement.  By acknowledging scientific uncertainties in the context of better risk management and decision- making frameworks, in combination with techno-optimism, there is a broad path forward for humanity to thrive in the twenty-first century and beyond.




Tuesday, November 21, 2023

Why Can’t Smokers Quit: Part II


Last week I introduced our new study of persistent smokers in five waves of the FDA’s Population Assessment of Tobacco and Health (PATH) Study.  I explained that menthol cigarettes and vaping had almost no effect on persistent smoking or quitting in this population, which was followed for about six years.  This week I’ll discuss some differences that distinguish persistent smokers from quitters.

Over 85% of persistent smokers puffed every day, a much higher rate than among smokers who quit in the following wave.  For example, in Wave 1, 87% of persistent smokers puffed every day, compared with 52% among quitters at Wave 2.  More persistent smokers smoked 21+ cigarettes per day, smoked within 30 minutes of waking up in the morning, and had a higher objective measure of nicotine addiction than quitters.

Fewer persistent smokers tried to quit completely in all waves, compared with those who quit.  For example, in the first wave, 19% of persistent smokers reported they had tried to quit completely during the past 12 months, compared with 30% of those who quit by the next wave and stayed smoke-free for the rest of the study.  As many as 22% of persistent smokers had stopped for a month or longer at Wave 2, compared with 42% of quitters. 

Persistent smokers’ lack of quitting success may have been due to their experiencing more adverse symptoms, including anxiety, restlessness, difficulty concentrating or sleeping, feeling depressed and/or weight gain.  Quitting cold turkey is unpleasant, and some smokers may not be able to exist comfortably when nicotine-abstinent.  Persistent smokers were honest about their likelihood to succeed: Only 31% were optimistic in Wave 1, compared to 60% of quitters.

In the previous post, I described our less-than-impressive findings with respect to quitting with e-cigarettes, but in subsequent waves, both persistent smokers and quitters showed decreased use of any quit aids.  In fact, the percentage of all smokers who reported using no aid at all increased during the study.  In our analysis, we looked at all aids, including nicotine replacement therapy (NRT) and prescription medicines such as Chantix, varenicline, Wellbutrin, Zyban, and bupropion; and others, such as family and friends, counseling and self-help material. 

In summary we wrote, “Compared with smokers who became and stayed quit, [persistent smokers] were more likely to smoke every day, have higher measures of nicotine dependence and have more adverse effects of nicotine withdrawal.  They were less interested in cessation, less likely to make a quit attempt and less confident that the attempt would be successful.  While [vapor products] and menthol are topics of current debate, neither played a prominent role in continued smoking or quitting.” 

None of these findings are new.  The reasons smokers can’t quit have been known for a long time, but our study demonstrates that these characteristics persisted throughout the six-year PATH follow-up.  Let’s consider what this means.

During our study period 2013-2018, 2.9 million Americans died from a smoking-related illness.  Over 40% of persistent smokers in our study were age 45+ years when they enrolled, so they were at risk of becoming a mortality statistic.  Another 42% were 25-44 years old, the perfect time for them to quit.  It is tragic, therefore, that the sponsor of the PATH survey, the FDA, is slow-walking reviews of smoke-free cigarette substitutes, in keeping with its ultimate goal of eliminating the entire tobacco and nicotine market.

It is long past time for FDA to alter its prohibitionist crusade and, instead, focus on truly protecting the health of persistent smokers.



Wednesday, November 15, 2023

Why Can’t Smokers Quit: Part I


Along with my research colleague Nantaporn Plurphanswat, I recently published a study entitled “Why can’t smokers quit? Longitudinal study of smokers in the US using the Population Assessment of Tobacco and Health (PATH) waves 1 to 5.”  It was published in Addictive Behaviors Reports.

We attempted to determine the factors that may be associated with persistent smoking.  There have been many other studies of this subject, but most have only involved a single cross-sectional survey.  The FDA’s PATH survey is different, because it has followed thousands of people for several years.  We started with 5,860 current (C) smokers enrolled in the PATH study (i.e. Wave 1) in 2013-14 who had follow-up smoking information in the next four waves, or six years.  Almost 4,000 smokers continued to smoke (designated CCCCC), while others became former (F) smokers and and stayed quit in subsequent waves (CFFFF, CCFFF, CCCFF, and CCCCF).  Our analysis focused on differences between persistent smokers and quitters.  We made sure that we adjusted our results for differences in demographic factors such as age, sex, race/ethnicity, education, marital status and where they lived.

This was a big effort, so it will take more than one blog post to describe our results.  In this post I’ll provide results for two hot topics, menthol cigarettes and vaping.

Everyone knows about the FDA’s intention to ban menthol flavored cigarettes, which the agency says lures teens into smoking.  Our goal was to determine whether menthol was associated with persistent smoking or less quitting, because previous studies have produced mixed results (here, here, here, here).

We found that 39–45 % of all smoker groups reported that they had initiated with menthol or mint flavored cigarettes, and 36–48 % currently used menthol or mint flavor in all waves.  Furthermore, among smokers who initiated with menthol, 53–66 % continued to smoke them in all waves. However, we found no statistically significant differences between persistent smokers and quitters with respect to initiation with or current menthol smoking.

In general, vaping produced mixed results. First, the bad news was that the proportions of everyday vape use among persistent smokers were relatively stable throughout all five waves, and the percentage of former vaping grew. However, quitters had higher current vaping in the wave they became former smokers, and smokers who quit in the next wave tended to increase the percentage of everyday vaping at that wave. Our findings are consistent with other PATH studies revealing that vaping has helped some smokers to quit (here, here and here).  We also found that CFFFF who quit after Wave 1 and continued to vape did not return to smoking.

In summary, menthol didn’t play a role in persistent smoking or quitting in the first five waves of the PATH survey.  But there wasn’t a lot of evidence that vaping played a major role.  Stay tuned for more results.