Recently a study was conducted in the University of California at San Francisco (USCF) in which researchers exposed participants to various types of warning labels to determine what effect each label might have on the subject’s likelihood to purchase low-risk tobacco products in the future.
They found that warning labels which imply a high level of risk often deterred participants from wanting to purchase these products (surprise!).
The researchers concluded that stronger warning labels are necessary for reducing tobacco use in the population, and urged the FDA to implement strict warnings on e-cigarettes and tobacco products to discourage their use.
In this study, 483 adults who do not use any kind of tobacco or vape were asked whether they had any interest in trying tobacco products in the future (note that the researchers include e-cigarettes as a ‘tobacco product’). They were then randomly sorted into six groups. Each group was exposed to an advertisement for moist snuff, snus, or an e-cigarette, with the following warnings:
- Group 1 – ‘WARNING: This product is not a safe alternative to cigarettes.’
- Group 2 – A graphic picture of a mouth tumor, along with ‘WARNING: This product can cause mouth cancer.’
- Group 3 – ‘WARNING: No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes.’
- Group 4 – ‘FDA approved.’
Group 5 was shown an ad with no warning, and group 6 were shown unrelated ads. Later the participants were asked if they would like a free sample of the product in the advertisement they saw (no sample was actually offered). Their responses were compared with their answers from the beginning of the study to see if the ads had changed their perceptions.
Of course, the researchers found that more severe or graphic warnings decreased the participant’s desire to try these products in the future, while the lower risk statements (what they referred to as ‘endorsements’) did not.
In conclusion, they stated that ‘this study provides the first evidence against allowing âreduced harm’ or âlower risk’ labels on alternative tobacco products,’ and that ‘Regulatory agencies should consider implementing graphic warning labels for smokeless tobacco and investigate use of warning labels for e-cigarettes.’
This paper contains several glaring ethical violations.
Misleading the Participants
For starters, they affixed false or misleading warning labels to advertisements of lower risk products. Throughout the course of this study the researchers actively led many of the study participants to believe that e-cigarettes are dangerous and even cause cancer, a claim which by all current knowledge of the subject is blatantly false.
To make matters worse, the researchers do not indicate anywhere in the paper that they debriefed the participants after the study was over to tell them that their claims were not true. So we now have a group of people who have a reason to believe that e-cigarettes contain carcinogens, and will likely tell their friends and family to avoid them.
In the course of conducting their study, these researchers may have actively led people to continue smoking rather than switch to a low risk product. That is just plain wrong.
Intentionally Ignoring the Truth
Throughout the course of this entire paper, the actual health effects of each of e-cigarettes were not discussed. At the beginning they flatly state that ‘tobacco use’ causes health problems, when in reality the majority of the problems they are referring to are caused by smoking.
The entire tone of the paper indicates that their primary goal is to reduce all ‘tobacco use’ as much as possible by any means necessary, yet they give very flimsy justifications for this. They noted, ‘While it has been suggested that e-cigarettes should be promoted as ‘reduced harm’ alternatives to combustible cigarettes for smokers, there are no long term data on the health effects of e-cigarette use, and widespread promotion may also result in uptake among non-users of tobacco, which would be inconsistent with harm reduction on a population level.’
In other words, the fears of the researchers are entirely speculative, based in a possible future that may not exist. There is no reason to believe vaping will lead to an increased number of smokers or cause serious health problems. There’s simply no evidence any of this is actually happening.
The entire paper is focused soley on how perceptions affect tobacco use. There is no discussion or concern at all about whether these perceptions are true. In fact, it is implied that it doesn’t matter if the perceptions are based in fact – all that matters is whether they will have the effect the researchers desire.
Making Policy Recommendations
As noted earlier, at the end of the paper they recommend explicitly that ‘regulatory agencies’ (read: FDA) implement strong warning labels for e-cigarettes. Their entire justification for this is that they work, i.e. they do lead to people being less likely to use the product.
However, if that is their only reasoning, then they have no business making such a recommendation. Warning labels serve the purpose of informing the consumer about the real risks of a product. Thus, if there is no risk, there should be no warning.
It is clear that the researchers do not view warning labels as a way to communicate risks. Rather, they seem to view it as a ‘necessary’ form of social control. They see no problem including false warning labels in their studies with intent to deceive (while also not informing their subjects that the warnings were false), and they think this tactic should be implemented nationwide.
If the researchers cannot even understand the purpose of warning labels, they should not be making any recommendations to the FDA on how and when warning labels are used.
This paper has, understandably, come under heavy criticism by public health experts.
Clive Bates, author of the Counterfactual, wrote a detailed point-by-point criticism of this paper. He began by saying, ‘A promising contender has emerged for the coveted Worst Published Paper of All Time awardâ¦’
He noted that, in addition to the problems I detailed above, the researchers failed to account for the public health problems their proposed recommendations may lead to by discouraging smokers from switching to lower risk products. He said they also overlooked the fact that if policymakers start promoting obviously false information, they will lose the trust of the public, which can be disastrous (imagine never trusting warning labels on anything).
Carl V. Phillips also had much to say about this study. He said, among many other things, that the use of graphic warnings of this nature amounts to ’emotional violence,’ whereby the intent is to use someone’s emotional response to manipulate them. He also said it is unethical to base policy recommendations on a single study, and that they give no real justification for their recommendation.
This study is overflowing with severe violations of basic research ethics and codes of conduct. So who signed off on this?
The study was conducted by Lucy Popova and Pamela M. Ling at UCSF, and was approved by their Committee on Human Research. It was paid for with a grant given by the National Cancer Institute, and it was published in BMC Public Health.
All of these organizations endorsed this study. Shame on them!