Working paper: Phillips – Preferences, practices, and intentions of a population of U.S. adult enthusiast vapers (CASAA member survey)

Comments are welcome on this new working paper (pdf), either in the comments here or via email. Some readers will recognize it as an improved version of preliminary reports from this survey (which are referenced in the paper).

Abstract: Existing surveys of e-cigarette users have provided useful information, but have been limited to convenience samples with no identifiable target population. The membership of The Consumer Advocates for Smoke-free Alternatives Association, a U.S. NGO, offers a unique opportunity for a survey of enthusiasts vapers. The survey, conducted in 2015, included 20,000 adult current vapers residing in the USA, with a far higher response rate than any previous survey. The results support several pieces of conventional wisdom, also reflected in previous survey results, that enthusiast vapers prefer open systems, interesting flavors (particular sweet flavors), and have a history of failed smoking cessation attempts using most of the “officially approved” methods. Almost all subjects who quit smoking with e-cigarettes believe they would still be smoking without them. About 90% of subjects indicated an intention to flout regulatory restrictions on available products, notably including a scenario that basically describes the effects of the announced FDA regulation. This suggests that assessments of that regulation grossly understate the probability and scope of a black market and do-it-yourself manufacturing, and thus overstate the impact on actual consumption. There are clear contrasts between this population and the average e-cigarette user, which commentators frequently ignore, but these results are probably representative of half a million and perhaps a million U.S. vapers.

Opting out of hand-washing regulation: a great case-study in not understanding regulation

My attention was called to this story (which I don’t think is a parody, but it is sometimes hard to tell), in which a U.S. Senator proposed a thought experiment of “easing the regulatory burden” by letting restaurants opt out of (real) public health rules requiring employees to wash their hands after visiting the toilet. His claim was that the market can take care of this: If the restaurant were simply required to post a notice that they have opted out of that regulation, customers would stop going there and the problem would be solved. Continue reading

Working paper: Phillips-Burstyn-Carter, The limited value of journal peer review in public health: a case series of tobacco harm reduction articles

Our new paper is available here: Phillips-Burstyn-Carter, Peer Review Review, working paper 23jun15. The tables are linked from the document, but if that does not work: Table 1, Table 2. The appendices are linked from Table 1 (so you can read them all; go ahead, make a day of it…you know you want to).


Background: A widespread belief holds that the journal peer-review process has magical powers to ensure that published claims are correct. While this misperception has limited consequences in many fields, in public health it results in consumer, clinical, and policy decisions being based on blind faith in the accuracy of published claims. At best, the review process is merely a couple of readers — perhaps, but not necessarily, highly expert — reading through a paper to ensure the research and presentation are reasonably sound. In reality, even this is often not accomplished.

Methods: We conducted reviews of 12 articles that focused on tobacco harm reduction published in a mainstream public health journal, BMC Public Health, consecutively during 2012-15. We each wrote a reviewer report of the manuscript version that was sent to the journal reviewers, as if we were writing a review for a journal. We then compared these to the reviews written by the journal reviewers. Additionally, we reviewed the changes made to the papers as a result of the journal reviews.

Results: Almost all the papers in the dataset suffered from major flaws, most of which could have been corrected, but none were corrected by the journal review process. The journal peer reviews were almost all inadequate and many contained no substantive comments. Those that contained substantive observations still did not identify most of the blatant major flaws that we noted. In the single case where a journal reviewer identified many of the major flaws, the comments were basically ignored by the authors and the paper was published with no substantive changes. Other than cosmetic improvements, the journal review process was about as likely to make the published version worse than the submitted manuscript, rather than better. Papers with no apparent value were published by the journal and the potential value of other studies was lost because serious flaws in the paper were ignored. Unreported conflict of interest was common among both authors and reviewers.

Conclusions: Faith in the journal peer-review process is misplaced. Even at best, the process cannot promise that a published claim is correct, but in reality it does not even ensure that patent major flaws are not present. In public health, the phrase “according to a peer-reviewed journal article” seems to mean little more than “I read this somewhere.”

Comments on the paper are welcome, of course, either here or via email.