Thursday, 22 December 2016

The Norwegian Institute of Public Health censored their own top researchers

Last week I wrote that the TPD and plain packaging passed in the Norwegian parliament. The Norwegian Institute of Public Health, NIPH, played an important role in this, not only through their response to the public consultation prior to the vote, but also through their reports on e-cigarettes (which I've written about before) and their statements during a committee hearing in October this year. Now, some of NIPH's own researchers reveals that important information was held back during this committee hearing, and hence the members of parliament, that voted in favour of the new tobacco act, had inadequate information. Norwegian newspaper Dagbladet has gained access to emails showing this and they've talked to Erik Nord and Karl Erik Lund about it. This was published in an article last week (sadly behind a paywall).
Erik Nord
Karl Erik Lund
"NIPH handled this case in a way that Karl Erik Lund's and my own views on e-cigarettes were never submitted to the Committee. (...) This was in my opinion contrary to the general desire for the best possible  information on the case, and disloyal to the parliamentary committee on health and care services", writes FHI researcher Erik Nord in an email exchange Dagbladet has accessed.
Both Nord and Lund have argued that what we know about relative harm and usage patterns strongly suggests that a strict policy on e-cigarettes can lead to loss of a lot of lives. They wanted to get this view across to the committee, but instead their calculations and summary on the research done on e-cigarettes were omitted when NIPH held their presentation to the parliamentary committee.

Nord directs harsh criticism towards the leaders of NIPH that he in this case says are driven by a wish to satisfy the politicians instead of a wish to objectively impart knowledge. Nord and Lund both have their background from the The Norwegian Institute for Alcohol and Drug Research, SIRUS, that earlier this year was merged with NIPH. SIRUS researchers then expressed concerns that they risked loosing their freedom, credibility and freedom of speech as NIPH has a less independent role compared to SIRUS. It looks to me that they had a very good reason to worry. The two institutes have often disagreed publicly for several years in different questions, for example the use of snus. Karl Erik Lund have been a strong supporter of harm reduction through both snus and e-cigarettes and have expressed this publicly a lot of times while he was Research Director at SIRUS, and I'm happy to see he and his colleagues from old SIRUS still puts ethics and science above satisfying egocentric politicians.

This is not the first time Lund and Nord have ended up in this situation after the SIRUS/NIPH merge. They also wrote a report contradicting Minister of Health, Bent Høie's views on plain packaging. Despite that an article in newspaper VG revealed that this report was ignored and left out of the background material when the proposed changes to the tobacco act was written, nothing was done. The Australian lies fit Høie's agenda better, so they kept those instead.
"After the VG article about snus packaging some time ago I sent out an email about a crisis of confidence in the NIPH. In a meeting immediately afterwards Camilla (NIPH director Camilla Stoltenberg, ed note) asked what was needed to restore confidence. I have since pointed out that action, not words, is needed. The handling of this case was the opposite of what is needed", Nord write in his email.
Talking to Dagbladet Nord estimates that between two and three thousand Norwegian smoker will die prematurely as a direct consequence of a strict e-cigarette policy. "This is the reality that the politicians will have to expect", says Nord.
"When the health care committee requests to be presented with the different views, it is natural to do so. Instead the area director chose to give a kind of unified presentation where our calculation was completely gone", he explains to Dagbladet.
In an email that Dagbladet has read, Nord writes that NIPH in some cases obviously has "issues dealing with its dual role as a research / information provider on one hand and advisor on the other, and that it's leaders unfortunately sometimes ends up being political actors".

Area director Knut-Inge Klepp have been publicly sceptical to e-cigarettes all along. This also goes for NIPH director Camilla Stoltenberg, and that suits Bent Høies agenda quite nicely. Lund and Nord research and views on the other hand, doesn't fit this agenda at all. So one can only wonder... why did they decide to merge SIRUS and NIPH?

Klepp, of course, does not agree with Lund and Nord and says: "I disagree that we in any way attempted to withhold information. We have been completely open that there is scientific disagreement within the institute" What a load of crap. What he's actually saying is that they admit that their researchers (the people that actually know something about this) does not agree with the leadership, but they chose not to present their views anyway. Why? Because they've found other science that fits the politicians agenda better?

He then goes on with the usual "there is not much research done on the consequences of e-cigarettes and a fresh survey from the USA supports a stricter policy than Nord and Lund wants", and goes on:
The math is interesting. There is uncertainty about the numbers just as there is uncertainty about much of the knowledge about e-cigarettes. Here we get new results every week, and I think that it is wise not to be too firm, but monitor research on health effects both in Norway and internationally closely in the future. 
I'm not sure what to say to that? "Blah, blah, blah" might be fitting? There is a lot of research available, just not much supporting the views and agenda of Klepp and whatever politician he thinks he needs to satisfy to keep his job. Klepp goes on:
(...) It is not a problem that it appears there is scientific disagreement within such a large institute, but rather a strength. The challenge is of course that we can use the controversy to develop good research that can bring us results in this field.
More empty words from Klepp there. The research is already there, from researchers at his own institute among others. Still he was the one that chose to omit it when presenting what was supposed to be all the views and research to the committee, depriving them of the ability to make well informed decision.

Then again, would it really have mattered if Lund and Nord had been able to get their views across, telling the committee the real consequences of their actions? Apparently not. Tove Karoline Knutsen (Norwegian Labor party, AP) says that the committee members are well aware of the views of Lund and Nord but still:
Of curse we listen carefully both to NIPH and others, but for Labour it is also important to proceed somewhat incremental in cases where there is so little research as in this case, and in any case ensure that we don't do something that is irreversible. If at some point we get far more knowledge our view can be revised, but I think it is important now that we treat e-cigarettes as regular tobacco with the same restrictions, if they are primarily intended to be a tool for smoking cessation.
I get the feeling you've listened a lot to NIPH, and paid extra attention to Klepp's way of ignoring science. What really is irreversible is the damage done by the new tobacco act. Pigs will learn to fly before Norway removes or changes a law that complies with the EU TPD.

Last week I tried to figure out what motives the Minister of Health and his department have for doing this, even though they have to know by now that they will slow down the accelerating decrease in tobacco smoking. Here's a scary thought: What if that is exactly what they want? Why? From a purely egocentric point of view, just thinking of their own political life it makes sense though. Because no matter how poorly their plain packaging works, smoking rates will continue to decline. The Australian government have demonstrated how, by some simple statistical tinkering, they can make it look like this has worked. That looks great in a political campaign. Same thing with e-cigarettes, even if they manage to slow down progress, which will result in less lives saved, e-cigarette use will slowly become more visible and mainstream, and they can say that "hey, we legalized e-cigs... and have a look at our statistics now. Smoking is declining." (Which it would have done anyway, of course). What's even better from their point of view is that if the decrease in smoking is slow enough, they can continue to make up useless provisions to score political points for years to come as well.

The Norwegian Institute of Public Health has become the government's tool to deceive the public, making us believe that they're doing a great job for public health. As we've seen they are willing to go pretty far to do this, even censor their own top researchers if their research show the "wrong" results. We can only hope that Lund, Nord and the other researchers from SIRUS will create such hell that the house of cards eventually falls apart. These are the most experienced and best tobacco researchers we have here in Norway and they are the ones that should be responsible for NIPH's statements, views and presentations regarding this.

RDA

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