NOT PEER REVIEWED
In the last decade, electronic cigarettes (EC) have become
increasingly popular in particular among smokers. Most EC users choose to
use nicotine containing liquids (electronic nicotine delivery system,
ENDS); these ENDS can be considered as similar to nicotine replacement
therapies. Among the several questions EC use raises, one is of major
importance: Are EC a smoking cessation aid and if yes to...
NOT PEER REVIEWED
In the last decade, electronic cigarettes (EC) have become
increasingly popular in particular among smokers. Most EC users choose to
use nicotine containing liquids (electronic nicotine delivery system,
ENDS); these ENDS can be considered as similar to nicotine replacement
therapies. Among the several questions EC use raises, one is of major
importance: Are EC a smoking cessation aid and if yes to what extent
compared to existing pharmacotherapies such as nicotine replacement
therapies, varenicline or bupropion?
Several systematic reviews tried to approach the role of EC as a smoking
cessation aid. As of today, only two randomized trials assessed the
efficacy of EC with controversial results (1,2). As an editorial (3) and
the last systematic review (4) concluded, because of the absence of well-
designed and sufficiently powered randomized, controlled, head-to-head
therapeutic trials the current accumulation of data originating
essentially from observational studies does not allow us to make any
conclusion as to EC's therapeutic efficacy in smoking cessation.
Manzoli et al. (5, 6) assessed abstinence from tobacco cigarettes or
tobacco and electronic cigarettes ('any product') in a prospective
cohort study. They included at baseline EC only users, individuals using
tobacco cigarettes and EC (dual use) and those using only tobacco
cigarettes. They reported the 12-month (5) and 24-month (6) results in
two separate papers the latter published online in the June 2016 issue of
Tobacco Control. For both papers, the analyses were restricted to
individuals whose data were available at 12 or 24 months (completers).
This study raises the question whether observational studies assessing
efficacy should be analyzed similarly to randomized efficacy trials for
which the gold standard approach is the intent-to treat-analysis (ITT)
(7) which defines the population submitted to the main data analysis.
Table 1.
https://docs.google.com/document/d/1RM5mvK1s85N1iZZ_kKiHkKiMsS1SVl4YMPTj6ALHvS8/edit?usp=sharing
compares Manzoli et al. results for the 12-month and 24-month abstinence
outcomes (5,6). For all baseline categories, completers' abstinence rates
are higher than abstinence rates of the baseline population that we can
call here as the "ITT" population i.e. of all individuals included. Of
particular interest is that EC only users had higher tobacco cigarettes
but not 'any product' abstinence rates both at 12 and 24 months than the
two other groups. The (unadjusted) "ITT" tobacco cigarettes abstinence
rates are 42% and 40.8 % versus the completers abstinence rates of
61.9% and 61.1 % at 12 and 24 months, respectively; all higher than among
dual users or tobacco cigarette only users suggesting that EC can be an
aid to quit smoking. Unfortunately, both papers report only confounder
adjusted odds ratios for completers and not for the "ITT" population.
Observational studies looking for treatment efficacy could be analyzed
like randomized efficacy trials (8,9) to narrow the gap between randomized
clinical trials and observational data (8). Non-ITT, usually completer
analyses, aim to estimate the effect of treatments received as opposed
to treatments assigned under the ITT approach and by this exclude all
factors contributing to non-completion of the trial (lost to follow up,
adverse events, discontinuation for any reasons). The advantage of the ITT
analysis is that it evaluates the true treatment effect which is the sum
of the biological effects, positive or negative such as adverse events,
and study adherence. The limitation of the ITT analysis of randomized
efficacy trials is the underestimation of efficacy because of non-
treatment related confounders (e.g. lost to follow-up for moving to
another city). On the other hand, completer analysis overestimates
efficacy by ignoring e.g. discontinuation because of adverse events and
cannot, therefore, help to assess the benefit/risk ratio of a given
intervention.
Until results of high-quality, large-scale, comparative, randomized trials
of EC' efficacy will be available, data of well conducted prospective
observational studies as that of Manzoli at al. (5,6) could estimate EC's
efficacy by analyzing "ITT" data and not completers' data while adjusting
for all available and potential confounders. Thus, in the Manzoli et
al. study (5,6) adjusted "ITT" population abstinence rates would have
provided more convincing results about EC's efficacy as an aid for
smoking cessation than completers' adjusted abstinence rates.
REFERENCES
1. Caponnetto P, Campagna D, Cibella F, et al. EffiCiency and Safety of an
eLectronic cigAreTte (ECLAT) as tobacco cigarettes substitute: a
prospective 12-month randomized control design study. PLoS One. 2013 Jun
24;8(6):e66317. doi: 10.1371/journal.pone.0066317. Print 2013.
2. Bullen C, Howe C, Laugesen M, et al. Electronic cigarettes for smoking
cessation: a randomised controlled trial. Lancet. 2013 Nov
16;382(9905):1629-37. doi: 10.1016/S0140-6736(13)61842-5. Epub 2013 Sep 9.
3. Bernstein SL. Electronic cigarettes: more light, less heat needed.
Lancet Respir Med. 2016; Feb;4(2):85-7. doi: 10.1016/S2213-2600(16)00010-
2. Epub 2016 Jan 14
4. Malas M, van der Tempel J, Schwartz R, et al. Electronic Cigarettes for
Smoking Cessation: A Systematic Review. Nicotine Tob Res. 2016 Apr 25.
pii: ntw119. [Epub ahead of print] Review.
5. Manzoli L, Flacco ME, Fiore M, et al. , Electronic cigarettes efficacy
and safety at 12 months: Cohort Study. PLoS One. 2015 Jun
10;10(6):e0129443. doi: 10.1371/journal.pone.0129443. eCollection 2015.
6. Manzoli L, Flacco ME, Ferrante M, et al. Cohort study of electronic
cigarette use: effectiveness and safety at 24 months. Tob Control. 2016
Jun 6. pii: tobaccocontrol-2015-052822. doi: 10.1136/tobaccocontrol-2015-
052822. [Epub ahead of print]
7. Detry MA, Lewis RJ. The Intention-to Treat principle. How to assess the
true effect of choosing a medical treatment. JAMA 2014; 312:85-86.
8.Wilcox A, Wacholder S. Observational data and clinical trials. Narrowing
the gap? Editorial. Epidemiology 2008;19: 765.
9. Herna?n MA, Alonso A, Logan R, et al. Observational studies analyzed
like randomized experiments: an application to postmenopausal hormone
therapy and coronary heart disease. Epidemiology. 2008;19:766-779.
NOT PEER REVIEWED Bauld et al [1] draw an analogy between indoor vaping and the use of
bronchodilators for asthma ("if and when vapour products with a medicinal
license become available, it will be important to allow their use indoors,
just as asthma inhalers, which dispense a drug and propellants into the
atmosphere, can be used indoors.")
NOT PEER REVIEWED Bauld et al [1] draw an analogy between indoor vaping and the use of
bronchodilators for asthma ("if and when vapour products with a medicinal
license become available, it will be important to allow their use indoors,
just as asthma inhalers, which dispense a drug and propellants into the
atmosphere, can be used indoors.")
Surely, they cannot be serious here?
Newman et al showed the amount of dosed drug exhaled by asthmatics
ranged from just 0.2%-1.7% across different puffing behaviours [2]. A
typical person who uses an asthma puffer would be unwise to use it more
than 4-6 times a day [3] whereas vapers can take up to 610 puffs a day,
with an average of around 200 [4].
Conversely, the objective of many ENDS users is the absolute
opposite. As this article puts it "At the end of the day, Sub Ohm vaping
comes down to three words: big ass clouds" [5] Etter [6] notes that
"These newer devices deliver more power, more cloud density, [my emphasis]
more intense flavors and a better 'throat hit' than older models."
With this generation of ENDS becoming more popular, we would expect
to see clouding increase. As we know [7], many vapers in a room can send
particle counts above those recorded in room where smoking is allowed.
There is simply no comparison between the asthma medication and
propellant a few asthmatics might exhale into (for example) a crowded bar
over a few hours and what potentially dozens of vapers could generate in
the sort of exuberant clouding sessions that vaping in bars can entail.
And unlike vapers, asthmatics do not participate in asthma puffer social
events.
This vaper puts things plainly
https://www.youtube.com/watch?v=6c5Ln69hWUc
References
1. Bauld L, McNeill A, Hajek P, Britton J, Dockrell M. E-cigarette
use in public places: striking the right balance. Tob Control 2016;
doi:10.1136/tobaccocontrol-2016-053357
2. Newman SP, Weisz AWB, Talaee N, Clarke SW. Improvement of drug
delivery with a breath actuated pressurised aerosol for patients with poor
inhaler technique. Thorax 1991; 46:712-16.
3. Partners Healthcare. Asthma Center. Chapter 33: How many times a
day can I safely use my bronchodilator inhaler?
http://www.asthma.partners.org/NewFiles/BoFAChapter33.html
4. Martin E, Clapp PW, Rebuli ME et al . E-cigarette use results in
suppression of immune and inflammatory-response genes in nasal epithelial
cells similar to cigarette smoke. merican Journal of Physiology - Lung
Cellular and Molecular Physiology Published 10 June 2016 Vol. no. , DOI:
10.1152/ajplung.00170.2016
5. Kriegel D. What is sub ohm vaping? Our sub ohm vaping guide &
tips http://vaping360.com/what-is-sub-ohm-vaping-and-the-dangers-of-sub-
ohm-vapes/ 2015;May 26.
6. Etter J-F. A longitudinal study of cotinine in long-term users of
e-cigarettes. Drug and Alcohol Dependence 2016;160:218-221.
7. Soule EK, Maloney SF, Spindle TR, et al. Electronic cigarette use
and indoor air quality in a natural setting. Tob Control 2016;???.
doi:10.1136/tobaccocontrol-2015-052772
NOT PEER REVIEWED The American Indoor Hygiene Association (AIHA) i.e. Experts in in
this particular field on passive exposure, have, previously, concluded
conversely to Bauld et al (1). As they state:
"If the only individual affected by using e-cigarettes were the
vaper, the discussion could end here. That is not, however, the case.
Similar to secondhand smoke, the ingredients exhaled by the vaper include
nicot...
NOT PEER REVIEWED The American Indoor Hygiene Association (AIHA) i.e. Experts in in
this particular field on passive exposure, have, previously, concluded
conversely to Bauld et al (1). As they state:
"If the only individual affected by using e-cigarettes were the
vaper, the discussion could end here. That is not, however, the case.
Similar to secondhand smoke, the ingredients exhaled by the vaper include
nicotine, metals, flavorings, and glycol that accumulate in the ambient
air. Recipients of secondhand vapor have not chosen to - many, in fact,
have explicitly chosen not to - use e-cigarettes. The exposure to
secondhand vapor, just like secondhand smoke, raises issues of involuntary
exposure and competing rights. This is even more critical for groups that
may be, and probably are, more susceptible to adverse effects of
secondhand vapor, including children, pregnant women, and people with
already compromised health, some of whom may have limited ability to leave
the spaces in which vaping occurs or has occurred."
This scientific postulation of second-hand inhalation of e-cigarette
aerosol and subsequent adverse health effects has been further
substantiated: via users of e-cigarettes, in their own personal, real-
world experiences (2). They subsequently, and eloquently argue, that the
devices should not be utilised in enclosed public spaces, due to these
events occurring.
Linda Bauld has previously argued in an extended article that:
". . . there is no good evidence that [second hand] exposure is
harmful to bystanders . . . To argue otherwise is just factually
incorrect." (3)
However, the phrase "harmful to bystanders" provides a hyperlink to a
review paper (4) of the potential for second hand exposures that,
incongruently to Professor Bauld's claim, concludes that e-cigarettes:
". . . impart a LOWER potential disease burden than conventional TCs"
(my emphasis)
I.E. therefore, NOT zero potential disease burden.
It is to be commended that Bauld et al wish to enhance the potential
for adult smoking cessation maximally, however, in this case, there IS
evidence that such a policy of non-restricted use potentially infringes
the rights of non-users to avoid passive inhalation and subsequent adverse
health effects, as the AIHA postulate, and as users of e-cigarettes have
confirmed in real-world conditions.
1) American Industrial Hygiene Association:
https://www.aiha.org/government-
affairs/Documents/Electronc%20Cig%20Document_Final.pdf
2) "Vaping e-cigs in public" Available at:
https://www.youtube.com/watch?v=6c5Ln69hWUc
3) Linda Bauld (2015). Available at:
https://www.theguardian.com/science/sifting-the-
evidence/2015/feb/23/theres-no-evidence-e-cigarettes-are-as-harmful-as-
smoking
4) Oh, A. & Kacker, A. 2014 Do electronic cigarettes impart a
lower potential disease burden than conventional tobacco cigarettes?
Review on E-cigarette vapor versus tobacco smoke. Laryngoscope
124(12):2702-6. doi: 10.1002/lary.24750. Epub 2014 Oct 9.
David Bareham
"All views are my own and do not necessarily reflect those of my
employer"
Conflict of Interest:
I have 3 presentations to local clinicians in Lincolnshire within the last 18 months entitled:
"E-cigarettes: update on evidence", organised by GlaxoSmithKline. No payment was requested nor provided for this work.
NOT PEER REVIEWED
This is not a particularly well constructed argument. In particular, the paragraph that states:
"If ENDS emissions were really benign, indoor vaping advocates should take courage and call for it to be allowed in classrooms, crèches, hospitals and neonatal wards. That they do not rather suggests that they know well that such a position would be irresponsible."
is possibly the worst excuse for a genuine point of debate it has ever been my misfortune to encounter. it is not even a particularly well constructed straw man.
Many things are considered normal and appropriate for the general population that would not be considered appropriate for a crèche, classroom or neonatal ward.
To use merely the first two examples that sprang to mind (and the list is almost endless):
Incense sticks are widely used, and despite the clear emission of smoke, they are are not banned, or the subject of proposed bans, in most jurisdictions. Many people use them, but I doubt that any would do so in a crèche or neonatal ward. Yet, if we follow the same logic proposed here, this means that they are dangerous, and should be banned almost universally.
Similarly, fog machines are widely used in stage shows, nightclubs and even teenage discos. Despite the extremely strong similarity with vaping, both in chemical composition and particle size, there are not widespread calls for fog machines to be banned (I'm certainly not aware of...
NOT PEER REVIEWED
This is not a particularly well constructed argument. In particular, the paragraph that states:
"If ENDS emissions were really benign, indoor vaping advocates should take courage and call for it to be allowed in classrooms, crèches, hospitals and neonatal wards. That they do not rather suggests that they know well that such a position would be irresponsible."
is possibly the worst excuse for a genuine point of debate it has ever been my misfortune to encounter. it is not even a particularly well constructed straw man.
Many things are considered normal and appropriate for the general population that would not be considered appropriate for a crèche, classroom or neonatal ward.
To use merely the first two examples that sprang to mind (and the list is almost endless):
Incense sticks are widely used, and despite the clear emission of smoke, they are are not banned, or the subject of proposed bans, in most jurisdictions. Many people use them, but I doubt that any would do so in a crèche or neonatal ward. Yet, if we follow the same logic proposed here, this means that they are dangerous, and should be banned almost universally.
Similarly, fog machines are widely used in stage shows, nightclubs and even teenage discos. Despite the extremely strong similarity with vaping, both in chemical composition and particle size, there are not widespread calls for fog machines to be banned (I'm certainly not aware of any such calls by the authors of this article).
Does this mean that they would support the use of fog machines or incense stick in crèches and neonatal wards?
Somehow, I strongly doubt it.
Does this mean that they would support a ban on fog machines in smoke free public places? It doesn't seem particularly likely.
Logic does not easily allow us to conclude that because we feel something is not appropriate for places occupied by the most vulnerable of populations it should be more universally prohibited, nor that something we do not feel should be so prohibited is suitable for such populations.
Nor is it the case that any rational advocate for electronic cigarettes would claim that they are "benign". Every exposure has a risk attached to it. Some, like smoking, are massive risks while others, like a bacon sandwich, are not. Yet, in a debate as facile as this one, both can be stated to be carcinogenic. While this is indeed true in an absolute sense, equating the two would not be responsible risk communication, nor should it be an acceptable message to communicate to the public. It is not sufficient to identify a risk - some indication of the magnitude of it is also required.
So it is with the use of electronic cigarettes. Are they entirely, absolutely, risk free? Of course not. Do they have a good evidence base for positive risk/benefit? Yes.
One of the key benefits of electronic cigarettes is that vaping has been embraced and promoted by former smokers to their peers. No comparable culture exists for NRT products or unassisted quitting. Yet far from being encouraged, or even merely ignored, scorn is poured on these evangelical ex-smokers, notably by one of the authors of this article.
Some perspective is much needed, but this article will not provide it. It is, perhaps, telling that I feel my pre-existing view on harm reduction is an ideological COI, which it certainly is, and have listed it as such. The authors did not feel similarly inclined to declare theirs.
Positions are becoming increasingly entrenched, but a bastion of ideology makes it hard to change position when the evidence indicates a change is justified. There is much common ground between the two sides, yet increasingly it is a shell scarred no-mans land where people are afraid to stick their head above the parapet for fear of being attacked. Bitterness and mistrust is being generated by, and on, both sides of the debate, but who benefits from this hostility? It's not current or former smokers, it is neither Public Health or the health of the public. The only winners are likely to be the equally entrenched and embattled tobacco industry. Nobody wants that.
We need to move beyond facile arguments and veiled hostility to a sensible and rational debate. We all want less people to smoke, and less lives to be lost or marred. Articles like this do not - cannot - help.
NOT PEER REVIEWED David Bareham cites 'Rip Tripper' as evidence that e-cigarette users
report experiences of allergies being exacerbated in non users by vapour
and describes Mr Tripper's subsequent rather mangled argument that the
devices should not be used in enclosed public spaces as "eloquent".
Perhaps Mr Bareham is unaware that Mr Tripper has also claimed that
vaping causes limb cramps and dry knuckles which...
NOT PEER REVIEWED David Bareham cites 'Rip Tripper' as evidence that e-cigarette users
report experiences of allergies being exacerbated in non users by vapour
and describes Mr Tripper's subsequent rather mangled argument that the
devices should not be used in enclosed public spaces as "eloquent".
Perhaps Mr Bareham is unaware that Mr Tripper has also claimed that
vaping causes limb cramps and dry knuckles which was a surprise to most
vapers, until they spotted the affiliate link to where they could purchase
electrolytes and a lotion to 'cure' them (1).
(1) 'Rip Trippers exposed as a sellout' Jh Reviews
https://youtu.be/F1EJkbM0m7g (contains profanity)
Conflict of Interest:
I am a trustee of NNA(UK) which is a consumer driven charity which aims to improve health by increasing awareness and understanding of reduced risk alternatives to smoked tobacco.
NOT PEER REVIEWED Why is the LGBT at greater health risk?? and why was it necessary to
even add that?? This makes me very upset that we are "targeted" as such!
How is this.. or was this part of the study?
NOT PEER REVIEWED
The editors of this journal, Tobacco Control, and specifically the authors of the editorial “Blog fog? Using rapid response to advance science and promote debate” [1] highlight the need - or requirement, depending on the viewpoint - of utilising a specified platform to debate the finer points of an article.
From an academic standpoint, individuals that have an interest in a specific field of study - such as Tobacco Control - will see, and respond to, such articles in the appropriate manner. However, one of the pitfalls prevalent in any rapid response platform, and this isn’t limited to the journal Tobacco Control, is the necessity of the journal’s guidelines to adhere to a specific writing format. This does have some advantages in keeping the debate over an article related exclusively to the article. However, there are some respondents that prefer to write an unabridged version of a critique lest the comment not pass the rapid response system for publication.
There are several advantages to publishing a critique of an article outside the rapid response system [2] that allows for a broader audience to read and respond to both the article content and the critique.
Personal blogs often reflect the style of the author, and also allow for greater freedom of expression including the use of imagery to illustrate vital points that many readers find both enjoyable and informative.
Providing a platform within the journal must allo...
NOT PEER REVIEWED
The editors of this journal, Tobacco Control, and specifically the authors of the editorial “Blog fog? Using rapid response to advance science and promote debate” [1] highlight the need - or requirement, depending on the viewpoint - of utilising a specified platform to debate the finer points of an article.
From an academic standpoint, individuals that have an interest in a specific field of study - such as Tobacco Control - will see, and respond to, such articles in the appropriate manner. However, one of the pitfalls prevalent in any rapid response platform, and this isn’t limited to the journal Tobacco Control, is the necessity of the journal’s guidelines to adhere to a specific writing format. This does have some advantages in keeping the debate over an article related exclusively to the article. However, there are some respondents that prefer to write an unabridged version of a critique lest the comment not pass the rapid response system for publication.
There are several advantages to publishing a critique of an article outside the rapid response system [2] that allows for a broader audience to read and respond to both the article content and the critique.
Personal blogs often reflect the style of the author, and also allow for greater freedom of expression including the use of imagery to illustrate vital points that many readers find both enjoyable and informative.
Providing a platform within the journal must allow for reasoned debate, including contrary opinions. It is widely regarded within non-academic circles that some responses don’t get published due in large part to the contrary nature of the response. Would the editors of the journal be comfortable with constructive guidance for non-academic parties to respond to articles published?
This seems to be an unlikely proposition and will only serve to reinforce a lack of trust and transparency in the journal. Blogging is a good practice at writing in an accessible way, academic publications should be accessible too.
References:
[1] O’Connor R, Gartner C, Henriksen L, et al Blog fog? Using rapid response to advance science and promote debate Tobacco Control 2017;26:121 - http://tobaccocontrol.bmj.com/content/26/2/121
NOT PEER REVIEWED This seems a good case for encouraging rechargeable cigalikes and 3rd generation refillable systems in the locations that charge a low cigarette tax.
This is a test message to ascertain if BMJ and Tobacco Control have gotten the rapid response feature up and running. If so this message should appear and those scientists globally wanting to file responses will be immediately alerted that this is now possible. The essence of any critique I personally may have with the BlogFog article is summarized in my declarations of intellectual COI. Submitted March 2nd, 2017.
NOT PEER REVIEWED The authors of this editorial assert that a journal article’s authors are “entitled to be aware of and respond to critiques”, and imply that this is only possible if critiques appear in a forum attached to the journal. Setting aside the fact that authors can easily become aware of and respond to critiques on other forums, I am curious if the authors could offer some basis for claiming such an entitlement? It seems quite contrary to all existing laws, principles of ethics, cultural norms, and standard practices that relate to commentary about published work. Moreover the behavior of many of these very authors suggests they are willing to go to great lengths to avoid being made aware of critiques.
It seems safe interpret the statement as saying that at least these particular authors would like responses to their work to appear on this page. And so, I am fulfilling their request. (Assuming this is allowed to appear, that is. I say that not because I believe there is anything in this comment that would warrant censorship, but to emphasize the blindness of this process. That is, the commentator really has no idea what will be allowed to appear.) I call the authors’ attention to two blog posts I have written critiquing this editorial to ensure they have the requested opportunity to be aware: https://antithrlies.com/2017/02/20/editors-of-t...
NOT PEER REVIEWED The authors of this editorial assert that a journal article’s authors are “entitled to be aware of and respond to critiques”, and imply that this is only possible if critiques appear in a forum attached to the journal. Setting aside the fact that authors can easily become aware of and respond to critiques on other forums, I am curious if the authors could offer some basis for claiming such an entitlement? It seems quite contrary to all existing laws, principles of ethics, cultural norms, and standard practices that relate to commentary about published work. Moreover the behavior of many of these very authors suggests they are willing to go to great lengths to avoid being made aware of critiques.
It seems safe interpret the statement as saying that at least these particular authors would like responses to their work to appear on this page. And so, I am fulfilling their request. (Assuming this is allowed to appear, that is. I say that not because I believe there is anything in this comment that would warrant censorship, but to emphasize the blindness of this process. That is, the commentator really has no idea what will be allowed to appear.) I call the authors’ attention to two blog posts I have written critiquing this editorial to ensure they have the requested opportunity to be aware: https://antithrlies.com/2017/02/20/editors-of-tobacco-control-admit-they...https://antithrlies.com/2017/02/22/more-on-tobacco-controls-stop-talking... . In those posts I expand a bit on what appears in this submission. I welcome responses to anything in them, either here, in the blog’s comments sections (I promise their comments will not be censored), or wherever else. However, no familiarity with those posts is necessary to respond to the following questions.
The authors declare “a policy that editors will not respond to external blog posts or social media messages about specific studies.” This statement implies that in the past they have provided such responses. However, I am quite familiar with the scholarly blogs (my own and others’) that often criticize papers that appear in Tobacco Control, and cannot recall a single occasion in which an editor of this journal responded. With the exception of the editorial’s last author occasionally engaging in Twitter conversations about articles — a format which precludes serious debate — I am not aware of any social media engagement. Thus I would like to ask the authors to support their implication by characterizing how often actions that are precluded by this policy actually occurred in the past, and to provide a few examples.
The authors state, “Occasionally, an individual who has written a postpublication critique has declined invitations to review similar papers prepublication.” I am one author of such critiques, and highly qualified to review research papers, but have never once been invited to review for Tobacco Control. I am in close communication with other such individuals, and would be surprised to learn that they have received any such invitation. So I would like to ask for clarification: Is the claim here that on a single occasion, Tobacco Control asked someone to review a paper, but s/he declined, and then wrote a critique after it was published? Or did that happen twice, three times, or more? Or does this merely mean that someone who was once invited to review *some* paper at the journal, and declined, later write a critique of another paper the journal published (thus the use of the word “similar”)?
The authors state: “As noted above, the Rapid Response process provides a forum for exploring such issues. In contrast, placing personal blog posts or social media messages complaining about a study, alleging flaws in the review process, or making ad hominem attacks on authors or editors do not advance the field or allow an appropriate scientific dialogue and debate.” I have several questions about this:
Should we interpret this to mean that the Rapid Response process will censor any attempt to post something that “complains” about a paper or identifies flaws in the review process? Taken on its face, this seems to preclude literally any important criticism. If a commenter observed, say, that a causal inference suffers from enormous residual confounding, which was not acknowledged by the authors, and which renders the conclusions in the paper unsupported, how is that not a “complaint” about the paper? If the identified flaw is apparent to the reader, how is that not also an allegation of a flaw in the review process that allowed the paper to be published with that flaw? Some clarification is needed.
Are the authors of the editorial simply saying they object to *explicit* statements about the failures of the review process, and are saying that these are forbidden from this page? And thus the implicit indictment of the review process from noting there is a major flaw in a paper is acceptable? But would noting a major flaw still constitute a “complaint”? If not, what does?
I am also curious about what ad hominem attacks the authors are referring to. Those of us who criticize tobacco control are quite familiar with the experience ad hominem attacks on our analyses (or, more often, as rationalizations for simply ignoring our analyses). Indeed, such attacks are far more common than substantive criticisms of our work. By contrast, I cannot recall any cases of scholarly blogging critics of a paper in Tobacco Control or other tobacco control papers who have descended to ad hominem attacks. I would like to ask the authors to provide examples to support this allegation. (I will offer the reminder that drawing conclusions about an author or journal based on a paper is, roughly speaking, the opposite of an ad hominem attack. An ad hominem attack would consist of criticizing or dismissing a paper based on the identity or characteristics of the authors or journal.)
Finally, the authors state: “Our role is to facilitate the processes of peer review, transparency and accountability which underpin the legitimacy and independence of academic research.” I am curious about what transparency they are claiming. It appears to me that the journal (in keeping with common practice in this field) sends out papers to reviewers who are chosen based on a non-transparent basis, keeps those reviewers anonymous and the reviews secret, and then makes a decision to publish based on non-transparent criteria. Yes, there are some published statements about what is considered in this process, but they are sufficiently vague that they seem to preclude or guarantee nothing. Am I wrong about this? If not, what transparency is the editorial referring to?
More immediately relevant, there is no apparent transparency in the decision about whether to publish a particular Rapid Response submission. Again, there are guidelines which seem sufficient vague that they would allow an ad hoc decision in either direction about most any submission. It seems rather unreasonable to ask commentators to take the time and effort to submit to a system with vague requirements, particularly given the suggestion that merely “complaining” about a paper is grounds for censorship. Again, clarification is needed if, as the editorial claims, this page is a legitimate forum for serious debate.
I will suggest that a genuinely transparent rule would take a form like the following: Should a reader wish to post a comment on my blog, it will appear, unedited, so long as it is on topic. I suppose I would refuse to post a comment that was utterly outlandish — that, say, ranted about the sexuality of a paper’s author, or alleged criminal behavior — but I have never been forced to make such a decision. I will further note (as I have stated previously) that if authors or editors of a paper that I am criticizing wish to comment, I will allow them to say literally anything they want. I suspect the same transparent rules apply to my fellow scholarly bloggers.
NOT PEER REVIEWED In the last decade, electronic cigarettes (EC) have become increasingly popular in particular among smokers. Most EC users choose to use nicotine containing liquids (electronic nicotine delivery system, ENDS); these ENDS can be considered as similar to nicotine replacement therapies. Among the several questions EC use raises, one is of major importance: Are EC a smoking cessation aid and if yes to...
NOT PEER REVIEWED Bauld et al [1] draw an analogy between indoor vaping and the use of bronchodilators for asthma ("if and when vapour products with a medicinal license become available, it will be important to allow their use indoors, just as asthma inhalers, which dispense a drug and propellants into the atmosphere, can be used indoors.")
Surely, they cannot be serious here?
Newman et al showed the a...
NOT PEER REVIEWED The American Indoor Hygiene Association (AIHA) i.e. Experts in in this particular field on passive exposure, have, previously, concluded conversely to Bauld et al (1). As they state:
"If the only individual affected by using e-cigarettes were the vaper, the discussion could end here. That is not, however, the case. Similar to secondhand smoke, the ingredients exhaled by the vaper include nicot...
NOT PEER REVIEWED
This is not a particularly well constructed argument. In particular, the paragraph that states:
"If ENDS emissions were really benign, indoor vaping advocates should take courage and call for it to be allowed in classrooms, crèches, hospitals and neonatal wards. That they do not rather suggests that they know well that such a position would be irresponsible."
is possibly the worst excuse for a genuine point of debate it has ever been my misfortune to encounter. it is not even a particularly well constructed straw man.
Many things are considered normal and appropriate for the general population that would not be considered appropriate for a crèche, classroom or neonatal ward.
To use merely the first two examples that sprang to mind (and the list is almost endless):
Show MoreIncense sticks are widely used, and despite the clear emission of smoke, they are are not banned, or the subject of proposed bans, in most jurisdictions. Many people use them, but I doubt that any would do so in a crèche or neonatal ward. Yet, if we follow the same logic proposed here, this means that they are dangerous, and should be banned almost universally.
Similarly, fog machines are widely used in stage shows, nightclubs and even teenage discos. Despite the extremely strong similarity with vaping, both in chemical composition and particle size, there are not widespread calls for fog machines to be banned (I'm certainly not aware of...
NOT PEER REVIEWED David Bareham cites 'Rip Tripper' as evidence that e-cigarette users report experiences of allergies being exacerbated in non users by vapour and describes Mr Tripper's subsequent rather mangled argument that the devices should not be used in enclosed public spaces as "eloquent".
Perhaps Mr Bareham is unaware that Mr Tripper has also claimed that vaping causes limb cramps and dry knuckles which...
NOT PEER REVIEWED Why is the LGBT at greater health risk?? and why was it necessary to even add that?? This makes me very upset that we are "targeted" as such! How is this.. or was this part of the study?
Conflict of Interest:
None declared
NOT PEER REVIEWED
The editors of this journal, Tobacco Control, and specifically the authors of the editorial “Blog fog? Using rapid response to advance science and promote debate” [1] highlight the need - or requirement, depending on the viewpoint - of utilising a specified platform to debate the finer points of an article.
From an academic standpoint, individuals that have an interest in a specific field of study - such as Tobacco Control - will see, and respond to, such articles in the appropriate manner. However, one of the pitfalls prevalent in any rapid response platform, and this isn’t limited to the journal Tobacco Control, is the necessity of the journal’s guidelines to adhere to a specific writing format. This does have some advantages in keeping the debate over an article related exclusively to the article. However, there are some respondents that prefer to write an unabridged version of a critique lest the comment not pass the rapid response system for publication.
There are several advantages to publishing a critique of an article outside the rapid response system [2] that allows for a broader audience to read and respond to both the article content and the critique.
Personal blogs often reflect the style of the author, and also allow for greater freedom of expression including the use of imagery to illustrate vital points that many readers find both enjoyable and informative.
Providing a platform within the journal must allo...
Show MoreNOT PEER REVIEWED This seems a good case for encouraging rechargeable cigalikes and 3rd generation refillable systems in the locations that charge a low cigarette tax.
Time for subsidies?
This is a test message to ascertain if BMJ and Tobacco Control have gotten the rapid response feature up and running. If so this message should appear and those scientists globally wanting to file responses will be immediately alerted that this is now possible. The essence of any critique I personally may have with the BlogFog article is summarized in my declarations of intellectual COI. Submitted March 2nd, 2017.
NOT PEER REVIEWED The authors of this editorial assert that a journal article’s authors are “entitled to be aware of and respond to critiques”, and imply that this is only possible if critiques appear in a forum attached to the journal. Setting aside the fact that authors can easily become aware of and respond to critiques on other forums, I am curious if the authors could offer some basis for claiming such an entitlement? It seems quite contrary to all existing laws, principles of ethics, cultural norms, and standard practices that relate to commentary about published work. Moreover the behavior of many of these very authors suggests they are willing to go to great lengths to avoid being made aware of critiques.
It seems safe interpret the statement as saying that at least these particular authors would like responses to their work to appear on this page. And so, I am fulfilling their request. (Assuming this is allowed to appear, that is. I say that not because I believe there is anything in this comment that would warrant censorship, but to emphasize the blindness of this process. That is, the commentator really has no idea what will be allowed to appear.) I call the authors’ attention to two blog posts I have written critiquing this editorial to ensure they have the requested opportunity to be aware: https://antithrlies.com/2017/02/20/editors-of-t...
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