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NOT PEER REVIEWED The United Kingdom government is now recommending e-cigarettes as important tools in helping individuals to quit smoking (http://www.bbc.co.uk/news/health-41339790). It is widely acknowledged that, for many, smoking tobacco is detrimental to health. However, it is perhaps less widely appreciated that we have only a limited understanding of why smoking tobacco is bad for our health. Why, for example, might you be 40 times more likely of succumbing to lung cancer if you are a persistent heavy smoker? What is it in tobacco or in the act of smoking which is damaging to health? These are the enigmas of smoking tobacco which have remained largely unanswered. We are interested in the myriad ways that humans are exposed to aluminium in everyday life (http://pubs.rsc.org/en/content/articlepdf/2013/em/c3em00374d). Intriguingly one such way is smoking tobacco and the main reason for this is the presence of significant amounts of aluminium in tobacco (http://www.amjmed.com/article/S0002-9343(05)00710-2/pdf).When tobacco is smoked its components form an aerosol which is taken down into the lung before it is eventually expired. Anyone who has set up a ‘smoking machine’ to investigate this will no doubt have been impressed by the efficiency with which a surrogate lung fluid transforms th...
NOT PEER REVIEWED The United Kingdom government is now recommending e-cigarettes as important tools in helping individuals to quit smoking (http://www.bbc.co.uk/news/health-41339790). It is widely acknowledged that, for many, smoking tobacco is detrimental to health. However, it is perhaps less widely appreciated that we have only a limited understanding of why smoking tobacco is bad for our health. Why, for example, might you be 40 times more likely of succumbing to lung cancer if you are a persistent heavy smoker? What is it in tobacco or in the act of smoking which is damaging to health? These are the enigmas of smoking tobacco which have remained largely unanswered. We are interested in the myriad ways that humans are exposed to aluminium in everyday life (http://pubs.rsc.org/en/content/articlepdf/2013/em/c3em00374d). Intriguingly one such way is smoking tobacco and the main reason for this is the presence of significant amounts of aluminium in tobacco (http://www.amjmed.com/article/S0002-9343(05)00710-2/pdf).When tobacco is smoked its components form an aerosol which is taken down into the lung before it is eventually expired. Anyone who has set up a ‘smoking machine’ to investigate this will no doubt have been impressed by the efficiency with which a surrogate lung fluid transforms the black smoke coming out of the cigarette into the white wispy vapour which is eventually expired. The surrogate lung fluid, on the other hand, changes from a clear solution to one which is tinged with yellow. We found that a significant amount of aluminium (ca 50(micro)g/L), presumably originating from the tobacco, was retained by the surrogate lung fluid and we speculated that this aluminium could contribute towards tobacco-related illnesses.
The arrival of e-cigarettes encouraged us to repeat our previous experiments. In the first instance we measured the aluminium content of many commercially-available e-liquids. Their aluminium content ranged from 26(micro)g/L for pure propylene glycol (the usual vehicle for e-liquids) to 147(micro)g/L (<0.2ppm) for a Virginian e-liquid with high nicotine content. Nevertheless even the higher figure is considerably lower than the aluminium content of tobacco (ca 2.0ppm) and so we were not expecting e-cigarettes to be a significant source of aluminium to lung fluids. However, we were to be surprised! When a 0.5mL volume of e-liquid was ‘smoked’ to completion through 50mL of a surrogate lung fluid the aluminium content of the lung fluid varied between 2000 and 9000(micro)g/L which equated to between 100 and 500(micro)g of aluminium per 0.5mL of e-liquid. Further experiments where the branded e-liquid was replaced with propylene glycol (which contains only 26(micro)g/L aluminium) produced results up to 13000(micro)g/L aluminium in the surrogate lung fluid, equivalent to approximately 700(micro)g of aluminium per 0.5mL of propylene glycol vehicle.
Smoking e-cigarettes is potentially much more hazardous with respect to potential toxicity due to aluminium than smoking tobacco. The source of the aluminium is the e-cigarette itself and not the e-liquid though the latter may contribute towards the dissolution of aluminium from various components of the e-cigarette.
We do not know if some of the health-related effects of smoking tobacco are attributable to aluminium in tobacco. However, if they are then such will not be addressed by smoking e-cigarettes.
NOT PEER REVIEWED The authors point out that rates of adolescent ever use of e-cigarettes are substantial and increasing, but rates of regular use remain low. Yet it is also worth placing these rates of adolescent use in the context of other groups of e-cigarette users. In particular, a recent systematic review colleagues and I published into sociodemographic differences in e-cigarette use gives further salience to Conner et al’s findings. Although the availability of UK evidence for our review was limited, some very clear patterns emerged internationally. For instance, within the 38 studies reporting ever use and the 22 reporting current use, these outcomes were particularly prevalent in older adolescents and younger adults (versus younger children and older adults respectively). This therefore lends further weight to Conner et al’s recommendations around regulating the marketing and sale of e-cigarettes to minors in countries which lack sufficient legislation in this area. Both papers also show the importance of future studies stratifying findings by sociodemographic variables such as age to ensure more subgroup analyses are possible.
1) Hartwell G, Thomas S, Egan M, et al E-cigarettes and equity: a systematic review of differences in awareness and use between sociodemographic groups Tobacco Control Published Online First: 21 December 2016. doi: 10.1136/tobaccocontrol-2016-053222
NOT PEER REVIEWED In the second column of this article, the author describes findings from a survey in Japan (Tabuchi et al, 2016, reference 15). However, there is a misinterpretation of Tabuchi et al’s table 2 which leads to wrong percentages for having tried heat not burn products in Caputi’s article. The figures 8.4% and 7.8% are not the percentages who had ever tried these products in the population but instead percentages out of those respondents who had ever tried an e-cigarette or a heat not burn product.
The actual figures for the population are therefore about 0.6% for iQOS (8.4% of 6.6%) and 0.5% for Ploom (7.8% of 6.6%).
Further information on the ever use of different products by age, gender and smoking status (about 1% of 15-19 year olds had tried each of the two heat not burn products), is found in supplementary table 3 of Tabuchi et al.
NOT PEER REVIEWED
Without citing any sources or providing any related analysis or explanation, this paper makes several sloppy and misleading statements about the scope and impact of federal preemption relating to state and local restrictions of flavored tobacco products.
We know from the preemption provisions in the federal Tobacco Control Act that state and local governments may not regulate the ingredients or characteristics of a tobacco product if the state or local regulation is “different from, or in addition to” an FDA tobacco product standard. [Sec. 916(a)(2)] But we do not yet know how FDA or the courts will interpret or apply that “different from, or in addition to” phrase. For example, it could mean that state and local governments are free to prohibit or limit the use of certain flavorings in certain types of tobacco products unless or until FDA prohibits or limits flavorings for those same types of tobacco products. To assert and publish a more restrictive interpretation of federal preemption with no qualification or clarification is not only misleading but promotes a more restrictive interpretation than necessary or desirable.
The paper also fails to note that the courts have ruled that the Tobacco Control Act’s preemption provisions leave state and local governments free to restrict the sale of flavored tobacco products within their boundaries. [See, e.g., U.S. Smokeless Tobacco v. City of New York, 708 F.3d 428 (2nd Cir., 2013).] The...
NOT PEER REVIEWED
Without citing any sources or providing any related analysis or explanation, this paper makes several sloppy and misleading statements about the scope and impact of federal preemption relating to state and local restrictions of flavored tobacco products.
We know from the preemption provisions in the federal Tobacco Control Act that state and local governments may not regulate the ingredients or characteristics of a tobacco product if the state or local regulation is “different from, or in addition to” an FDA tobacco product standard. [Sec. 916(a)(2)] But we do not yet know how FDA or the courts will interpret or apply that “different from, or in addition to” phrase. For example, it could mean that state and local governments are free to prohibit or limit the use of certain flavorings in certain types of tobacco products unless or until FDA prohibits or limits flavorings for those same types of tobacco products. To assert and publish a more restrictive interpretation of federal preemption with no qualification or clarification is not only misleading but promotes a more restrictive interpretation than necessary or desirable.
The paper also fails to note that the courts have ruled that the Tobacco Control Act’s preemption provisions leave state and local governments free to restrict the sale of flavored tobacco products within their boundaries. [See, e.g., U.S. Smokeless Tobacco v. City of New York, 708 F.3d 428 (2nd Cir., 2013).] These rulings suggest that state or local laws that restricted the sale of any tobacco products that contained more than a specified amount of certain flavorings would not be preempted (at least if they did not totally prohibit their sale). The tobacco industry would certainly bring legal challenges against any such state or local law and argue for a more restrictive interpretation. But unless the courts actually adopt the tobacco industry’s preferred view of the Tobacco Control Act’s preemption provisions, it is inaccurate and counterproductive for publications in Tobacco Control to present that restrictive view as current law.
Finally, the paper also implies that state and local governments cannot use chemical testing to determine the quantities of added flavorings in specific tobacco products as part of their enforcement efforts to establish violations of their (not preempted) laws restricting the sale of flavored tobacco products. But there is a big difference between directly regulating the amount of flavorings in certain types of tobacco products (possibly subject to preemption) and measuring the amount of flavorings in a tobacco product to develop evidence that it is a flavored tobacco product being sold in violation of a state or local sales restriction (not subject to preemption). For example, federal preemption could not possibly apply to a state or local enforcement agency using chemical analysis to show that a tobacco product has as much or more cherry flavoring than tobacco products previously marketed and sold as cherry flavored in order to establish that the sale of the tobacco product at regular retail outlets violates a (not-preempted) state or local law that allows the sale of tobacco products with a characterizing flavor of cherry only at licensed, adult-only tobacconists.
NOT PEER REVIEWED
Background
E-cigarette is a delusive name for what the product actually is; an electronic vaporization device. Basic parts of an e-cigarette include: a tank containing the liquid to be vaporized, some sort of heating element, a battery to power the device, and a mouth piece. The liquid, often referred to as e-liquid, usually contains a base (for production of thick vapor) and flavor. E-liquid may or may not contain nicotine. The heating element converts the e-liquid into aerosol, which is then inhaled by the user. While many models resemble a conventional cigarette, others look nothing alike. Colloquially referred to vaporizers, such models have become more common in the recent years.
In the western world e cigarettes proposed as a tobacco control strategy for possible nicotine reduction and stressed on policy appraisals of harm and safety on regulation of other ingredients of the products. The related conflicts and controversies of e cigarettes as a contemporary tobacco control are discussed (1).
E-cigarettes began to appear in the Indian market around 2010. Today, E-cigarettes pose a complex challenge for the tobacco stricken country. According to Global Adult Tobacco Survey (GATS) 2010, 34.6% of the Indian adults were current tobacco users with 14% of adults indulging in current tobacco smoking (5.7% current cigarette smokers, 9.2% current bidi smokers) (2). Global Youth Tobacco Survey (GYTS) 2009 estimated current toba...
NOT PEER REVIEWED
Background
E-cigarette is a delusive name for what the product actually is; an electronic vaporization device. Basic parts of an e-cigarette include: a tank containing the liquid to be vaporized, some sort of heating element, a battery to power the device, and a mouth piece. The liquid, often referred to as e-liquid, usually contains a base (for production of thick vapor) and flavor. E-liquid may or may not contain nicotine. The heating element converts the e-liquid into aerosol, which is then inhaled by the user. While many models resemble a conventional cigarette, others look nothing alike. Colloquially referred to vaporizers, such models have become more common in the recent years.
In the western world e cigarettes proposed as a tobacco control strategy for possible nicotine reduction and stressed on policy appraisals of harm and safety on regulation of other ingredients of the products. The related conflicts and controversies of e cigarettes as a contemporary tobacco control are discussed (1).
E-cigarettes began to appear in the Indian market around 2010. Today, E-cigarettes pose a complex challenge for the tobacco stricken country. According to Global Adult Tobacco Survey (GATS) 2010, 34.6% of the Indian adults were current tobacco users with 14% of adults indulging in current tobacco smoking (5.7% current cigarette smokers, 9.2% current bidi smokers) (2). Global Youth Tobacco Survey (GYTS) 2009 estimated current tobacco use among Indian students at 14.6%, with 4.4% students reported to be current cigarette smokers (3). Alarmingly, the survey revealed that 56.2% of students who bought cigarettes in a store were not refused purchase because of their age. Allowing e-cigarettes to remain unregulated in such a setting is assumed by many to be be a recipe for disaster. However, a blanket ban without considering any potential health benefits also not without its cons. The smoking community is likely to feel further marginalized, deprived of what is perceived as an alternative with lower risk profile. (4–6)
E cigarettes in India
Initially, E-cigarettes were available only in a select smoke shops in metropolitan cities. They were generic, low quality models mostly imported from China, where the production had first begun in 2003. Over the years, a wide variety e-cigarettes and vaporizers have become available in many shops across urban areas. It isn’t uncommon to see a couple of low end models stocked in the neighborhood smoke shop.
Internet are rife with e-cigarette listings as well. The price ranges anywhere from 200 INR (~ 3 USD) for disposable models to 10,000 INR (~150 USD) for rechargeable imported ones. The price of entry level models doesn’t pose a significant barrier for adults or for students. A google search yielded more than 20 websites within first 5 pages of results, catering to sale of e-cigarettes and vaporizers, as well as related paraphernalia (7). These are not including the major online marketplaces like Amazon.in and Flipkart.com that too contain a number of listings for e-cigarettes. They can also be easily imported from other countries.
When ITC, the major tobacco player in India, released its first e-cigarette products (under ION brand) in 2014, it did so without seeking any prior approval (8). Earlier during the same year, India’s national carrier, Air India faced an inquiry for advertisement and sale of e-cigarettes to airline customers (9).
Legal Status in India
Under Poisons act, 1919, Nicotine is classified as a poisonous substance. In the form of Tobacco products, its sale is regulated under Cigarette and Other Tobacco Products Act (COTPA, 2003). Sale of Nicotine gums as a method of cessation is regulated under Drugs & Cosmetics Act, 1940. Since COTPA deals exclusively with Tobacco Products, and D&C Act doesn’t explicitly mention electronic Nicotine delivery devices, there exists an unregulated gray space for both the sale and advertisement of e-cigarettes in India.
Several State governments (Punjab, Chandigarh, Karnataka, Kerala and Maharashtra) have since issued a ban against the sale/intent of sale of e-cigarettes (10,11). Impact of these bans remains questionable despite the initial conviction receiving considerable media coverage (11). This is in part due to extensive availability of vaping products in online marketplaces.
When marketed as only flavor delivery devices, containing no nicotine whatsoever, there exists no regulation for manufacture/sale/possession/advertisement of e-cigarettes. This is often used by manufacturers/sellers to circumvent the rudimentary regulations that do exist to restrict sale of nicotine containing products, while offering an end-product with unknown risk profile and no health benefits. Popular online marketplaces like Amazon and Flipkart are flooded with such products.
The Dilemma
A balanced approach into this matter is warranted. COTPA should be appropriately revised to include e-cigarettes. Increasing delay is likely to lead to establishment of a more robust supply chain and consumer base. Furthermore, relevant inquiries must be made to assess the public and individual health impact of e-cigarettes in India.
As of now, it would be imprudent to classify it as anything more than a nicotine and/or delivery product. If anything, such a clean starting position allows us to adequately examine what this product means to different populations, and how closely do these images correlate with the reality.
References
1. Malone RE. Tob Control 2017;26:e1–e2
2.Global Adult Tobacco Survey (GATS) India: 2009-2010. [Last accessed on 20117 Mar 29]. available from: http://www.searo.who.int/LinkFiles/Regional_Tobacco_Surveillance_System_.... published by IIPS, Mumbai and funded by the Ministry of Health and Family Welfare, GOI 2010 .
3. Gajalakshmi V, Kanimozhi CV. A Survey of 24,000 Students Aged 13–15 Years in India: Global Youth Tobacco Survey 2006 and 2009. Tobacco Use Insights. 2010;3:23–3.
4. Berg CJ, Stratton E, Schauer GL, Lewis M, Wang Y, Windle M, et al. Perceived Harm, Addictiveness, and Social Acceptability of Tobacco Products and Marijuana Among Young Adults: Marijuana, Hookah, and Electronic Cigarettes Win. Subst Use Misuse [Internet]. 2015 Jan;50(1):79–89. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4302728&tool=p...
5. Brose LS, Brown J, Hitchman SC, McNeill A. Perceived relative harm of electronic cigarettes over time and impact on subsequent use. A survey with 1-year and 2-year follow-ups. Drug Alcohol Depend. 2015 Dec;157:106–11.
6. Tomashefski A. The perceived effects of electronic cigarettes on health by adult users: A state of the science systematic literature review. J Am Assoc Nurse Pract. 2016 Sep;28(9):510–5.
7.Google.Lovelites.in, littlegoa.com, vapeadda.com, vapourindia.com, litejoy.co.in, ecigindia.com, purevapors.in, evolvevapors.com, smokefree.in, planetion.in, indiabongs.com, evapeshop.in, esutta.com, ivape.in, vapecircle.com, tygrtygr.in, greenvapo.com, indianvapegarage.in, ecigarettecart.com, vape.co.in, vapin.in, epuff.in, ivapeindia.com, beyondvapeindia.com
[Retrieved 2017 Apr 1]
8.http://www.business-standard.com/article/companies/itcs-e-cigarettes-lik... Business Standard. 2014. [Retrieved 2017 Apr 1]
9.http://timesofindia.indiatimes.com/india/E-cigarette-sale-on-Air-India-f... Times of India. 2014 [Retrieved 2017 Apr 1]
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 editors of this journal, Tobacco Control, argue in their blog that debate about published articles should be concentrated on their rapid reaction facility. It is possible that they are making a constructive invitation to their critics to join a debating platform they might otherwise be wary of. However, the blog has been widely read as disparagement of other forms of engagement, notably social media and blogs. It is possible that the editors do not fully appreciate why people use blogs and social media to respond to papers they find problematic, and not Tobacco Control's rapid response feature. Here are several reasons:
1. Trust
Critics may consider, rightly or wrongly, that Tobacco Control has a track record of publishing papers that have dubious scientific merit, overconfident conclusions and policy recommendations that cannot be supported by the paper - almost always reinforcing a particular (abstinence-only) perspective. Critics may be concerned that their work will be treated unfairly or sidelined, or that they will be judged or ridiculed. They may distrust the editors, believe the journal is not impartial, or hold it in low esteem.
2. Conflict of interest and incentives
Not everyone is content to have their reactions edited or approved by the same people whose work they are criticising. Once a journal has published an article that is open to criticism, it develops a conflict of interest between its own r...
NOT PEER REVIEWED
The editors of this journal, Tobacco Control, argue in their blog that debate about published articles should be concentrated on their rapid reaction facility. It is possible that they are making a constructive invitation to their critics to join a debating platform they might otherwise be wary of. However, the blog has been widely read as disparagement of other forms of engagement, notably social media and blogs. It is possible that the editors do not fully appreciate why people use blogs and social media to respond to papers they find problematic, and not Tobacco Control's rapid response feature. Here are several reasons:
1. Trust
Critics may consider, rightly or wrongly, that Tobacco Control has a track record of publishing papers that have dubious scientific merit, overconfident conclusions and policy recommendations that cannot be supported by the paper - almost always reinforcing a particular (abstinence-only) perspective. Critics may be concerned that their work will be treated unfairly or sidelined, or that they will be judged or ridiculed. They may distrust the editors, believe the journal is not impartial, or hold it in low esteem.
2. Conflict of interest and incentives
Not everyone is content to have their reactions edited or approved by the same people whose work they are criticising. Once a journal has published an article that is open to criticism, it develops a conflict of interest between its own reputation and the pursuit of truth. Editors have personal and professional incentives not to look foolish or be shown up for the failure of peer review or editorial quality control. Critics may suspect that in the moderation process, editorial judgements of criticisms will be pedantic and be more concerned with the reputation of authors and the journal and be less concerned with an accurate reflection of the views of critics.
3. Style and expression
Many people prefer to communicate in their own style and not adopt the convoluted and opaque vernacular of science journal writing. They may have different types of knowledge and experience and wish to communicate in their own way. They may wish to adopt a more journalistic style or write in a way that encourages understanding. They may wish to be funny, satirical and engaging as well as rigorous. It may be a false perception that their voice is unwelcome, but it is not a surprising one. They may have their own audience which follows their commentaries, and they may wish to write for that audience.
4. Substantive reactions
Critics may wish to write at greater length and with more sophistication than a rapid response allows for, but not submit a paper for publication and wait months and spend many hours responding to poorly conceived or tactically obstructive questions from reviewers. They may not wish to have their work locked behind a paywall. They may wish to include graphics or formatting. In my own case, I wrote a comprehensive critique on my blog of the ['tobacco endgame' proposals published in 2013. There is no way I could spend months writing that up for publication in Tobacco Control, and the end result would have been a pale imitation of the original had I done so.
5. Responsiveness
Critics may be responding to 'moral panics' or media frenzies created by over-hyped science published in the journal. In this case, they need to respond rapidly and have the means to compose and publish according to their own timetable. They may wish to provide an initial reaction and then update it or add in other reactions. The "within 7-14 days" response time promised for publishing 'rapid reactions' is not consistent with the way news is consumed and commentary produced in the present era.
Other concerns include the following:
1. Wrong criteria for assessing the value of challenge
The dismissal of media other than the one preferred by and controlled by the journal's editors is disappointing. Surely, in public health, it should be the 'public' that decides where the debate is held? If criticism or insight is serious and thoughtful, then academics or editors should engage, because that's where the discussion is taking place. The journal has applied the wrong criteria by picking what sort of platform it is prepared to engage on. The decision should be based on the quality and seriousness of the criticism, not where it is produced or who produces it.
2. Self-limiting access to knowledge and insight
There is much high quality and readable analysis that is at least as valuable in intellectual depth, insight and accessibility as much formal publishing in this field [1] below. There are also trenchant and valid criticisms about motivation, ethics, intellectual quality, framing, inexperience etc on many other blogs that are well worth engaging with for anyone who wishes to - often these are opinion-formers. It is a mistake to believe that the real debate takes place in journals and everything else is just ignorant noise - it is a place to look for different insights. A bigger mistake is to disengage from 21st-century ways of communicating and sharing public knowledge. In other fields, this type of discourse is flourishing.
3. Where is the driven curiosity?
This is a critical field in which hundreds of millions of lives are at stake, and the pursuit of insight and the right thing to do should be relentless. I find it inexplicable that anyone involved should wish to shut themselves off from any form of engagement that that offers any useful insight. Where is the hunger for knowledge, the curiosity, the willingness to understand the views of people who are often the subject of study and often know far more than those doing the studying? Why would editors not want to be exposed to the feelings and adverse reactions to the research that is published in this journal? Why would they not engage more, instead of withdrawing?
Personally, I am committed challenging poor quality papers in whatever forum I can. I will continue to blog about them and expand my use of PubMed Commons, a neutral space for informed criticism. If Tobacco Control's rapid response platform provides a richer exchange, then I will try that.
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 The United Kingdom government is now recommending e-cigarettes as important tools in helping individuals to quit smoking (http://www.bbc.co.uk/news/health-41339790). It is widely acknowledged that, for many, smoking tobacco is detrimental to health. However, it is perhaps less widely appreciated that we have only a limited understanding of why smoking tobacco is bad for our health. Why, for example, might you be 40 times more likely of succumbing to lung cancer if you are a persistent heavy smoker? What is it in tobacco or in the act of smoking which is damaging to health? These are the enigmas of smoking tobacco which have remained largely unanswered. We are interested in the myriad ways that humans are exposed to aluminium in everyday life (http://pubs.rsc.org/en/content/articlepdf/2013/em/c3em00374d). Intriguingly one such way is smoking tobacco and the main reason for this is the presence of significant amounts of aluminium in tobacco (http://www.amjmed.com/article/S0002-9343(05)00710-2/pdf).When tobacco is smoked its components form an aerosol which is taken down into the lung before it is eventually expired. Anyone who has set up a ‘smoking machine’ to investigate this will no doubt have been impressed by the efficiency with which a surrogate lung fluid transforms th...
Show MoreNOT PEER REVIEWED The authors point out that rates of adolescent ever use of e-cigarettes are substantial and increasing, but rates of regular use remain low. Yet it is also worth placing these rates of adolescent use in the context of other groups of e-cigarette users. In particular, a recent systematic review colleagues and I published into sociodemographic differences in e-cigarette use gives further salience to Conner et al’s findings. Although the availability of UK evidence for our review was limited, some very clear patterns emerged internationally. For instance, within the 38 studies reporting ever use and the 22 reporting current use, these outcomes were particularly prevalent in older adolescents and younger adults (versus younger children and older adults respectively). This therefore lends further weight to Conner et al’s recommendations around regulating the marketing and sale of e-cigarettes to minors in countries which lack sufficient legislation in this area. Both papers also show the importance of future studies stratifying findings by sociodemographic variables such as age to ensure more subgroup analyses are possible.
1) Hartwell G, Thomas S, Egan M, et al E-cigarettes and equity: a systematic review of differences in awareness and use between sociodemographic groups Tobacco Control Published Online First: 21 December 2016. doi: 10.1136/tobaccocontrol-2016-053222
NOT PEER REVIEWED In the second column of this article, the author describes findings from a survey in Japan (Tabuchi et al, 2016, reference 15). However, there is a misinterpretation of Tabuchi et al’s table 2 which leads to wrong percentages for having tried heat not burn products in Caputi’s article. The figures 8.4% and 7.8% are not the percentages who had ever tried these products in the population but instead percentages out of those respondents who had ever tried an e-cigarette or a heat not burn product.
The actual figures for the population are therefore about 0.6% for iQOS (8.4% of 6.6%) and 0.5% for Ploom (7.8% of 6.6%).
Further information on the ever use of different products by age, gender and smoking status (about 1% of 15-19 year olds had tried each of the two heat not burn products), is found in supplementary table 3 of Tabuchi et al.
NOT PEER REVIEWED
Without citing any sources or providing any related analysis or explanation, this paper makes several sloppy and misleading statements about the scope and impact of federal preemption relating to state and local restrictions of flavored tobacco products.
We know from the preemption provisions in the federal Tobacco Control Act that state and local governments may not regulate the ingredients or characteristics of a tobacco product if the state or local regulation is “different from, or in addition to” an FDA tobacco product standard. [Sec. 916(a)(2)] But we do not yet know how FDA or the courts will interpret or apply that “different from, or in addition to” phrase. For example, it could mean that state and local governments are free to prohibit or limit the use of certain flavorings in certain types of tobacco products unless or until FDA prohibits or limits flavorings for those same types of tobacco products. To assert and publish a more restrictive interpretation of federal preemption with no qualification or clarification is not only misleading but promotes a more restrictive interpretation than necessary or desirable.
The paper also fails to note that the courts have ruled that the Tobacco Control Act’s preemption provisions leave state and local governments free to restrict the sale of flavored tobacco products within their boundaries. [See, e.g., U.S. Smokeless Tobacco v. City of New York, 708 F.3d 428 (2nd Cir., 2013).] The...
Show MoreNOT PEER REVIEWED
Show MoreBackground
E-cigarette is a delusive name for what the product actually is; an electronic vaporization device. Basic parts of an e-cigarette include: a tank containing the liquid to be vaporized, some sort of heating element, a battery to power the device, and a mouth piece. The liquid, often referred to as e-liquid, usually contains a base (for production of thick vapor) and flavor. E-liquid may or may not contain nicotine. The heating element converts the e-liquid into aerosol, which is then inhaled by the user. While many models resemble a conventional cigarette, others look nothing alike. Colloquially referred to vaporizers, such models have become more common in the recent years.
In the western world e cigarettes proposed as a tobacco control strategy for possible nicotine reduction and stressed on policy appraisals of harm and safety on regulation of other ingredients of the products. The related conflicts and controversies of e cigarettes as a contemporary tobacco control are discussed (1).
E-cigarettes began to appear in the Indian market around 2010. Today, E-cigarettes pose a complex challenge for the tobacco stricken country. According to Global Adult Tobacco Survey (GATS) 2010, 34.6% of the Indian adults were current tobacco users with 14% of adults indulging in current tobacco smoking (5.7% current cigarette smokers, 9.2% current bidi smokers) (2). Global Youth Tobacco Survey (GYTS) 2009 estimated current toba...
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 editors of this journal, Tobacco Control, argue in their blog that debate about published articles should be concentrated on their rapid reaction facility. It is possible that they are making a constructive invitation to their critics to join a debating platform they might otherwise be wary of. However, the blog has been widely read as disparagement of other forms of engagement, notably social media and blogs. It is possible that the editors do not fully appreciate why people use blogs and social media to respond to papers they find problematic, and not Tobacco Control's rapid response feature. Here are several reasons:
1. Trust
Critics may consider, rightly or wrongly, that Tobacco Control has a track record of publishing papers that have dubious scientific merit, overconfident conclusions and policy recommendations that cannot be supported by the paper - almost always reinforcing a particular (abstinence-only) perspective. Critics may be concerned that their work will be treated unfairly or sidelined, or that they will be judged or ridiculed. They may distrust the editors, believe the journal is not impartial, or hold it in low esteem.
2. Conflict of interest and incentives
Not everyone is content to have their reactions edited or approved by the same people whose work they are criticising. Once a journal has published an article that is open to criticism, it develops a conflict of interest between its own r...
Show MoreNOT 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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