“Doubt is our product…”

Cigarette smoking is addictive. Cigarette smoking causes lung cancer. Today these statements are uncontroversial, but it’s easy to forget that this was not the case until relatively recently. The first studies reporting a link between smoking and lung cancer appeared in the 1950’s (although scientists in Germany had reported a link earlier), while the addictiveness of tobacco, and the isolation of nicotine as the principal addictive constituent, was not established until some time later. Part of the reason for this is simply that scientific progress is generally slow, and scientists themselves are typically not the kind of people to get ahead of themselves.

However, another factor is that at every stage the tobacco industry has resisted the scientific evidence that has indicated the harms associated with the use of its products. One way in which it has done this is by suggesting that there is uncertainty around the core evidence base used to support tobacco control efforts. A 1969 Brown and Williamson document outlines this strategy: “Doubt is our product, since it is the best means of competing with the ‘body of fact’ [linking smoking with disease] that exists in the mind of the general public”.

This approach seeks to “neutralize the influence of academic scientists”, and has since been adopted more widely by other lobby groups. The energy industry has used a similar approach in response to consensus among climate scientists on the role of human activity in climate change. But what’s the problem? There are always a number of ways to interpret data, scientists will hold different theoretical positions despite being in possession of the same basic facts, people are entitled to their opinion… That’s fine, but the tobacco industry goes beyond this and actively misrepresents the facts. Why do I care? Because recently our research was misrepresented in this way…

There is ongoing debate around whether to introduce standardised packaging for tobacco products. Public health researchers mostly favour it, while the tobacco industry is opposed to it. No particular surprises there, but there’s a need for more research to inform the debate. We have done some research here in Bristol suggesting that standardised packs increase the prominence of health warnings in non-smokers and light smokers. Interestingly, we didn’t see this in regular smokers. This research contributed to the recent European Commission Tobacco Products Directive and the UK government consultation on standardised packaging. British American Tobacco (BAT) submitted a response to this consultation, which cited our research and said:

“The researchers concluded that daily smokers exhibited more eye movements towards health warnings when the pack was branded than when it was plain, but the opposite was true for non-smokers and non-daily smokers”.

We didn’t find that, and we didn’t say that. This isn’t a matter of interpretation or opinion – this is simple misrepresentation. What we actually concluded was:

“…among non-smokers and weekly … smokers, plain packaging increases visual attention towards health warning information and away from brand information. This effect is not observed among daily (i.e. established) cigarette smokers”.

In other words, standardised packaging increases the prominence of health warnings in non-smokers and light smokers, but don’t seem to have any effect in daily smokers. This is an important difference compared to how BAT represents this research. In their response to the consultation, BAT argues that “plain packaging may actually reduce smokers’ attention to warnings”. Of course it’s possible that there could be negative unintended consequences to standardised packaging, but there is no evidence in our study for this.

Why does this matter? Maybe it doesn’t – people get misrepresented all the time. But scientists produce data and ideas, the latter ideally based on the former, and so to misrepresent their conclusions is fundamentally distorting. Unfortunately this sort of thing happens all the time, including in media coverage of scientists’ work. This often makes scientists less willing to engage in important debates where they could make a valuable contribution. If this happens, then those with clear vested interests will succeed in removing valuable evidence from these debates. More importantly, this example illustrates why it’s vital that scientists do engage with the public and the media. Only by doing so can scientists make sure that their research is accurately represented, and that attempts to misrepresent their research are challenged.

As the health effects of smoking became apparent, successive governments acted to reduce the prevalence of smoking in the population. In the United Kingdom these efforts have been pretty successful – the overall prevalence of smoking is currently around 20%, down from a peak of over 50% in the 1950’s. This is due to restrictions on tobacco advertising, increases in taxation on tobacco products, and other tobacco control measures, as well as public health campaigns to increase awareness of the health consequences of tobacco use and greater availability of services to help people stop smoking. We want these policies to be evidence-based, and we don’t want this evidence to be knowingly distorted. Scientists have an important part to play in this.

Posted by Marcus Munafo @MarcusMunafo


One for the road? The hidden risks of roadside alcohol availability

As JD Wetherspoon looks set to open its first motorway service station pub, it may be time to ask where to draw the line in the sale of alcohol, says Sally Adams

In the UK, you can purchase and drink alcohol in bars, restaurants, cafes, at the cinema, at the theatre and on planes and trains. However, how often have you had the urge for a pint while driving along the M40 and not had the opportunity?

Well fear not, this week sees popular pub chain JD Wetherspoon take to the motorways of Great Britain. In explaining the move, the company draws focus towards the franchise’s successful soft drink and food sales. However, what appears to be unspoken is the fact that this move will see alcohol served roadside. The successful application to a Buckinghamshire local council is alleged to include a licence to serve alcohol between 8am and 1am. The application is timely, given that the government is currently reviewing its alcohol strategy, including the sale of alcohol at motorway services.

One of the key aims of the government’s strategy is to regard “health as a new alcohol licensing objective … so that licensing authorities can consider alcohol-related health harms when managing the problems relating to the number of premises in their area”. In a UK where 17% of females and 26% of males drink above the weekly government recommendation for alcohol, increasing its availability at motorway service stations seems counterintuitive to this goal.

Firstly, let’s consider the proposed location of the first roadside JD Wetherspoon pub. This is a location that is only accessible by road. Therefore, for every group of customers there will be at least one designated driver. While it’s legal to drive after a drink, evidence has clearly demonstrated that even a small amount of alcohol is detrimental to driving performance.

One review concludes that there is no known threshold of blood alcohol concentration (BAC) at which impairment does not occur and no sufficient evidence that a certain category of driver will not be affected by alcohol. Alcohol-related impairments in driving are not consequence free. In 2010 it was estimated that 14% of road fatalities involved drink-driving. Figures from the same Department for Transport report indicated that almost 10,000 road traffic casualties occurred when the driver was over the legal alcohol limit.

These figures have the potential to be sobering if drivers are aware of their alcohol intake and the drink-driving limit. However, it is well documented that knowledge of alcohol units is weak. Moreover, awareness of the legal limit and penalties for drink driving are poorly understood.

Regardless of whether drivers are armed with this knowledge, the decision to drink alcohol, or of how much to consume, may be impaired as soon as you see that bar sign from the motorway. Cue reactivity is the principle that mere exposure to cues associated with alcohol use (eg a bar setting, or seeing others drinking) can trigger physiological and psychological responses indicative of arousal such as increased heart rate, sweating and alcohol craving. Importantly, these responses are often automatic, occurring without any conscious thought.

So imagine the scene: you stop at the services after a stint of driving and have to decide where to eat/drink. You are a regular drinker and recognise a familiar chain-pub brand, alcohol-related cue #1. You decide to go and refuel at this well-known chain and walk into a bar alcohol-related cue #2, with multiple drinks on display alcohol-related cue #3 and numerous other customers drinking alcohol alcohol-related cue #4. Before you have even made the decision whether to consume alcohol or not, you have been confronted with several alcohol-related cues.

Studies of alcohol cue exposure suggest that cues previously and repeatedly presented with drinking can become powerful cues in their own right, leading to cognitive and physical responses that can trigger alcohol seeking and consumption. Interestingly, the association between alcohol-related cues and reward can be especially powerful for heavier, more regular drinkers, meaning these drinkers are more vulnerable to environmental alcohol cues.

For social drinkers, cues can range from environmental context (being in a bar) and time of day (after work), to the external properties of alcohol (sight/smell of wine). These cues alone can be so strongly associated with alcohol-related reward that they promote alcohol use. A potential problem of roadside alcohol cue exposure is therefore the risk of drinking alcohol without any real intention to drink. This is particularly potent when you think of the potential damage alcohol consumption may cause in this context – namely, getting back in a vehicle and driving at high speeds.

Considering that the dawn of the new government alcohol strategy is upon us, increasing the presence of alcohol-related cues and availability of alcohol in a roadside location does not signal a step in the right direction. Is it time to call time on the availability of alcohol in seemingly hazardous and unnecessary places?

Sally Adams is a postdoctoral researcher in Experimental Psychology at the University of Bristol

This article first appeared on the Guardian science blog website on 5th June 2013 and is posted by Sally Adams