Dr. Robert West of the Department of Epidemiology and Public Health at the University College of London has published a video that walks you step by step through a variety of ways that bias emerges in health research. Dr. West is an expert in smoking and nicotine addiction and even he admits that the models used in his lab can account for only so many variables. But that is just the limitations of research, where things really go sideways is when the lack of variables can be manipulated to create the desired conclusion.
It is very easy to make a “gateway” claim when you measure a few factors and do not account for the majority. Gateway theories are among the easiest to claim. We have certainly seen this with vaping. Anti-vaping special interests will take minimal data and measure no other variable and the headlines scream that vaping is a gateway to smoking. Of course scrutiny and additional research disprove these claims but it’s like Winston Churchill said, a lie gets halfway around the world before truth can get its pants on.
Well, here is Dr. West’s video in which he explains some of these key problems. His lecture is paced in such a fashion to cohesively fashion a complete argument beginning with laying an initial foundation. Dr. West brings it all together to draw a very clear picture and brings up solutions to address bias. He also points out how easy it is to be swayed by our own bias when considering health studies and vaping studies.
The anti-vaping lies that we see on a daily basis sometimes leave us shaking our heads and wondering about the sorry state of honest research. Scarier yet, we know that anti-vaping lies are working and shaping public opinion negatively. At the 6:00 minute mark of this video, Dr. West exposes one of the most significant tools that highly paid special interest researchers use to manipulate the press and the science.
Specifically, Dr. West refers to how researchers make claims that are not even backed up by the research that they are presenting! As if the fight for vaping rights wasn’t hard enough. Talk about a rigged system. All too often we have researchers commenting on the conclusions of their studies and these comments become the stuff of headlines. The comments become quotes that claim certainties. But in reality there is no certainty. And that lack of certainty can be found in the small print of the research itself. Yes, these paid researchers do not claim causality in the published work but they sure do for the media and headlines.
Randomized Control Trials
As Dr. West discusses randomized control trials, which are considered the gold standard of research, it quickly becomes clear that vaping and smoking cessation are very difficult to quantify. This type of research requires voluntary participation and quite often people drop out of studies if they do not like conditions or the methods that have been assigned to them.
It can also take years to conduct a random trial. Vaping is evolving so fast that keeping someone on the same vape device for several years is very difficult. Naturally people will want to try a more advanced, new device to enhance their vapor experience. This is another reason why people will drop out of a study and further shows a huge hole on vaping research. Namely the variety of devices uses.
The consideration of what vapor device is being used is a major fail of vaping studies. The truth is that in most of the research results that we are seeing we do not even know what type of ecig was used. The differences and disparities between the best electronic cigarettes and the low quality brands is massive. E-cigarettes are not equal to each other! So as Dr. West says at the 9:00 mark, researchers are limited to very simple comparisons.
There Is No Gold Standard
There is no gold standard for public health research and especially for understanding electronic cigarettes. Much of the bias in e-cigarette and public health research comes from a reliance of randomized trial studies which very easily produce incorrect results. The simple process of follow up with random trial participants is deeply flawed. If people go back to smoking, they tend to disconnect from the trial and no longer participate so the result is based on a subset of people who continue to participate.
Had I ever been a part of a smoking cessation study and gone back to cigarettes, I just may be inclined to withdraw. The disappointment of failure would be a cause to reject participation. Or if I had quit, I may say to myself, I don’t need to be a part of this anymore. In either case, there may be a tendency to withdraw.
This factor could easily underestimate the number of people who return to smoking. This is an assumption but if someone disengages from a smoking cessation study it may be that they have returned to cigarettes and don’t want to talk about it anymore.
Any study may also be subject to bias. The bias of the researcher effects how ambiguous data is interpreted. Bias in research is what those of us who follow vaping trends are most aware of.
Bias In Vaping Studies
Where does the bias in vaping studies come from? You would think that the obvious answer can be traced to money. If a special interest group pays for a study they are looking for a certain result. If the researcher provides that result then the researcher may expect future grants or funding for additional studies. This happens but, interestingly, Dr. West does not see this as a major source of bias. In fact, he does not see it as much of a factor at all.
Where Dr. West does see bias interfering with electronic cigarette research is in ideology. Researchers who personally believe in autonomy of choice vs researchers who believe in collective decisions. A researcher who feels strongly that smokers should have choices may favorably interpret electronic cigarette study data. A researcher who feels that societal interests are at stake make negatively interpret that same data.
For other researchers there is an “us vs them” mindset and winning is the driving force of every action. For these folks, it is ideological warfare to crush and defeat the “other side”. This is essentially politicizing research. I think this is where Stanton Glantz and his vaping attacks can be categorized. For Dr. Glantz, everything is black and white, vaping is like tobacco and needs to be crushed. That’s his singular approach. He is certainly not alone.
To be fair, that bias goes the other way as well. As Dr. West points out many of us tend to look down on people who have a collective point of view as “do gooders”. Well do gooders many times have perspectives that we need to be open to as well. Rejecting each others perspectives out of hand is what creates division.
This one really hurts. The bias that we see in vaping research from fame seeking “scientists” is perhaps the most damaging. We can interpret data based on our own ideologies and that is a mistake of both sides, although a human mistake. We can work that out if we open up and listen to each other. But the fame seeking researcher looking for sensational results has done more to harm the conversation than anyone.
If it bleeds it leads. The media cannot resist sensationalist. Anomalies drive the news cycle. Think about it. Smoking kills thousands of people every day, not one of those people is mentioned because we’re immune to it. We know it but the carnage of smoking no longer even registers as a noteworthy event. The news is about anomalies. If an ecig catches fire in a purse, that story WILL be on TV and in papers from coast to coast. How messed up is that!
We see it all the time. One person can be outrageous all the time and no big deal. Then a straight laced person makes one mistake and its time for torches and pitchforks! This is how the news cycle works and it can be very easily manipulated. So fame seeking researchers can interpret data in such a way as to generate fear and fear sells. Fear gets a reaction. Fear gets you on the news.
Ecigs Causing Debate
Ecigs and electronic cigarette research have exposed serious flaws in health research. There is bias on both sides and it is easy to fall into a trap. How do we avoid bias? Dr. West has three suggestions. Number one he says that researchers need to strive for confidence, not certainty. Don’t feel like you are compelled to deal in absolutes and be prepared to change your interpretation if new data becomes available. In other words, a stubborn need to be right does not make for good research!
Next Dr. West says we need to apply forensic logic to public health questions. There needs to be a number of different methodologies applied to data and conclusions to get a clearer picture and what the data is really telling us.
Finally, Dr. West says researchers need to apply the same standard of criticism to both supporting and opposing views. Basically this would work to eliminate double standards. Dr. West feels this one step would make a big difference in resolving controversies in electronic cigarette research.