E-cigarettes are less harmful – the 95% subjective ranking

I have been guilty of being imprecise on twitter – so I’ll elaborate on word press about my concerns with the e-cigs are 95% less harmful than cigarettes figure.

Firstly allow me to be clear – the public health England report on e-cigarettes is an important document that is excellent bar its reference to and use of the 95% figure. The report was needed to address growing irrational and prohibitionist agenda’s which seem to underlie some public health responses to e-cigarettes. This figure was arrived at after a panel of experts subjectively assigned a level of harm based on different criteria to different substances. Professor Larry Phillips, one of the authors of the study explains it on “More or less” and concedes it is a subjective ranking and that is ok because he asserts all other numbers arrived at in science are just as  “subjective”. This is where I disagree strongly. His throwaway comment when you consider it in detail makes a mockery of science to date. While science and the scientific process hasn’t been perfect it has enabled significant progress and is generally more objective than other processes. The process he used IS much more subjective than other studies used in science. Is he qualified to make this sort of pronouncement about the quality of his method relative to others? He isn’t a scientist. Perhaps it reflects his own profession’s tendency for rubbery figures and very speculative estimates (I’m attempting humour here by creating faux scientist versus economist repartee and making a sweeping generalisation). Whilst I acknowledge that any science involving people will have degrees of subjectivity creeping in – by and large there have been processes and methodologies evolved which do help minimise the subjectivity creeping into estimates.

My concern about the 95% figure is due in part to the below mentioned sort of outcome of discussions about it I’ve had with other people.

I’ve asked several friends, colleagues and acquaintances how they think the 95% less harmful figure was derived (these are people who are not scientists, most not involved in health care as professionals). It’s very unlikely they’ll ever question or look in detail at how the 95% figure was actually derived. Their response, prior to me telling them how the number is derived, is fairly consistently that it’s been derived from a study of health outcomes of real people or experiments/studies on the effects on cells etc or animals. When I explain that it was a ranking done by experts, albeit incorporating different categories of harm, they are dismayed and think it is deceptive and an untrustworthy way of presenting the relative harms or lack thereof.

This figure, the way it has been derived and Professor Larry Phillips assertion, I fear, contribute significantly to mistrust and discrediting of science.

Perhaps his method of assessing a complex issue will in time be another robust method for us but it is currently new, untested & the 95% figure is NOT robust or as equally “subjective” as other scientific methods that have had more road testing. It should not have been referred to in a government report which by this action gives the methodology an aura of credibility & rigour it doesn’t warrant.

I also think the Lancet has been disingenuous in it’s criticism of the report. One industry rep on the panel was not the problem and there is much about the report to support.

Thanks very much to Alan, Lorien and some other vapers who I really appreciate having twitter conversations with and who prompted this blog. I love your consistent careful and respectful questioning of my tweets. I appreciate your dedication and think you are a positive force currently in public health.

I probably have much less conflict of interest than most other people on e-cigs. I’m not making money from them, I don’t need to publish on them and I’m not funded to do tobacco control work. I work on vaccines and immunisation now. My Dad died of lung cancer and I hate the thought of many other people suffering in the same way he did.