Grossly incompetent media reporting on research related to public health crises continues to expose vulnerable Americans to potentially lethal misinformation. Despite mounting mortality, public health, and social costs, there is no evidence of accountability, correction, or adaptive use of the overt failure of media watchdog and evaluative roles that helped fuel the lethal opioid crisis – a collaboration, as exposed here, in reporting by Sam Quinones in “Dreamland”, of medical, academic, research, and media institutions to market fabrications driving prescription of addictive opioids for common chronic pain, a non-medical condition, without evidence supporting effectiveness or safety.
Nothing has changed. In a recent egregious example, writers at Vox, the New York Times, other outlets in ignorance of the most basic of research interpretation errors promoted entirely unsupported conclusions promoting false confidence in effectiveness of use of electronic cigarettes or nicotine replacement therapy (NRT) products as treatments for the highly lethal condition of compulsive use of tobacco by smoking. As in the media/pharma/medical industry collaboration that created the lethal opioid crisis, significant harm is predicted by the distortions and false messaging, by promotion of false confidence in unsupported treatments for smoking. The harms include tobacco-related mortality and morbidity that eclipse that related to other drugs, and harms due to smoking linked to incidence of chronic pain syndromes and exacerbated pain perception, both factors driving opioid misuse and the opioid crisis.
Group think, the enemy of free, authentic, critical thought and critical discourse, is driven by fear, fear of exclusion and loss of deeply felt needs – for inclusion, positive regard, status, security, approval, likes, followers, advancement, employment, protection. Those fears drive utterances to function as currency that rewards and validates the perceived dominant position of a group (e.g. the most strongly or authoritatively expressed, the position expressed by a member(s) with the most cultural capital, the greatest power to confer or withhold inclusion, other rewards), rather than challenging it, in exchange for the reward of not losing what is needed.
Because the driving criteria for those utterances in groups is assent and inclusion, group think produces and reinforces positions independently of discourse and processes in which the criteria for and goal of utterances would otherwise be veracity, congruence with evidence, congruence with reasoning about evidence, and with ethical reasoning.
This Vox report, one of the first on the uncontrolled research study comparing vaping to nicotine replacement therapy (NRT) for smoking cessation, headlined the study as a “control” (sic) trial. But there was no control (= no treatment) group, critically and importantly determining limits of interpretation and effectiveness of treatment (vaping and NRT) effects for a potentially lethal condition that claims around a half million American lives each year, among other costs including contributing to the opioid crisis.
“Do e-cigarettes actually help smokers quit? Now, the first, large rigorous assessment offers an unequivocal answer: yes.”, asserting that smokers can expect cessation success rates by use of NRT and e-cigs of “18 percent among the e-cigarette group, compared to 9.9 percent among those using traditional nicotine replacement therapy”
violations of the most important and elementary of errors in research design and interpretation. Problems that on critical analysis of the research contextualized in the relevant bodies and science and associated research in this post, establish that the NEJM study points to a lack of any benefit for smoking cessation attributable to NRT or e-cigarettes, in contrast to the heralded and widely disseminated assurances, spreading through mass and social media, that the “treatments” were effective with 10% and 18% success rates, respectively.
This “seminal” study, widely popularized and celebrated as significant, published in the very medical journal with the key role in normalizing the fabrications generating the lethal opioid crisis, heralded in the NYTimes as establishing an “unequivocal answer: yes” to the question of whether “e-cigarettes actually help smokers quit?” – in fact on evaluation points to a clear lack of evidence supporting effectiveness, the celebratory headlines and media accounts providing medical misinformation to millions of compulsive users of tobacco, a condition with high risk of illness and death.
It is critically important to note that dismantling the fabricated and unsupported conclusions attributing smoking cessation benefit to both NRT and e-cigarettes did not involve a sophisticated analysis of statistical design or other features of the study, instead simply noting the obvious invalidating violations of the most basic and elementary principles of experimental design and interpretation:
– Lack of a control group
– “Treatment” groups that were not meaningful or useful for the hypotheses meant to be evaluated
– Lack of external validity
This is a seminal study,” said Dr. Neal L. Benowitz, chief of clinical pharmacology at the University of California, San Francisco, an expert in nicotine absorption and tobacco-related illnesses, who was not involved in the project. “It is so important to the field.”
The difference between the fabricated outcomes, the fake success rates, versus what is supported, actually established by the results – the basis for a decision to trust and invest in as a cure, a treatment for a life-threatening condition – between an 18% chance of benefit versus zero, or close to zero, is a lot, a big difference, a life-and-death difference.
But none of those most basic, fundamental errors in research interpretation mattered, none were considered, none came to light in the rapid assertions of assent, knowing approval and satisfaction of diverse authorities, experts and popularizers of the health-related information Americans rely on for help with life-threatening conditions.
The NEJM study and its pathologically incompetent and malfeasant interpretation and marketing to a vulnerable population trapped in life-threatening substance use epidemics is a single example, the tip of an iceberg, a symptom of massive underlying institutional and individual diminished capacity for critical thought, competence, integrity and ethical behavior, a predictor of opioid and substance use epidemics, of public harm.
It’s a pathology that creates and runs through allowable, constructed public discourse, the matrix that informs consumers of their options, a matrix managed by and serving forces with the cultural capital to fabricate it.
American Media love to “fact check” the statements of politicians and political candidates, individuals a jaded public rarely view as trustworthy or authentic in any case. That fact checking appearing to constitute, more than anything, a ritual and exercise meant to create a sheen of competence and aggressive investigative journalism in the absence of that role and in a postfactual cultural/media matrix in which repetition creates meaning and elects a pathological liar as a president.
The craven abdication of competent medical fact checking allowed a lethal opioid crisis to unfold with media along for the ride, now allows continuation of overtly unsupported lethal medical misinformation driving public health epidemics in substance use, depression, suicide, obesity.
If there had been in operation that critical watchdog, evaluative role of a free and uncowardlly press in a democracy, unbeholden, providing competent challenge and critical discourse, how many lives . . .