Tobacco control research: a tale of two Delphi groups.

Abstract

Professor David Nutt recently convened a group of experts to assess the relative harm of different nicotine delivery products 1. The paper published by Nutt and colleagues, on the basis of their assessment, formed part of Public Health England’s recent conclusion that electronic cigarettes were 95% less harmful than combustible tobacco 2. The method that Nutt and colleagues used in this study was a continuation of earlier work, in which they had used the approach of Multi-Criterion Decision Analysis (a form of Delphi technique in which the views of key experts on a given topic are collected and assessed) to rank the relative harm of a range of legal and illegal drugs 3. This earlier work on legal and illegal drugs was published in the Lancet medical journal and drew both widespread attention and critical comment 4-7. Nutt and his various colleagues might have been somewhat surprised, nevertheless, when the Lancet published an anonymous editorial criticizing the nicotine ranking study he had undertaken on the basis that the Multi-Criterion Decision Analysis method he had used was inadequate to the task of assessing the relative harm of electronic cigarettes compared to combustible tobacco products 8. The Lancet editorial produced further criticism of the Nutt study on Twitter from some leading tobacco control researchers (including Professor Capewell and Professor Simon Chapman), and a follow-up critical comment in the Lancet 9. Included within these criticisms of the Nutt study was the fact that three members of the group that Nutt had convened to assess the relative harm of various nicotine delivery products had declared past connections to the electronic cigarette industry. The various experts in Nutt's group must have begun to wonder at the wisdom of even participating in a study that drew such harsh criticism and, in the case of one of the experts involved (Professor Riccardo Polosa), unfair attacks on past declared research funding. Scroll back a couple of years and we have another Delphi group that produced a very different reaction from tobacco control researchers. This time the group was convened by Pechey and colleagues 10 and was focused upon eliciting the views of various tobacco control experts on the probable impact of tobacco plain packaging. The experts consulted were of one opinion—tobacco plain packaging would reduce smoking prevalence significantly. So convinced were the experts of the benefits of plain packaging that they opined that smoking prevalence would reduce by 1% in adults and 3% in children within 2 years of the policy being implemented. In the case of the Pechey study, tobacco control researchers voiced no criticism of the methods used or the experts consulted. Indeed, in the latter case it would have been all but impossible, because the names of the experts who provided the assessments were never declared. Instead, Pechey and colleagues provided a summary of the possible conflict of interests of the anonymous members of their expert group. By contrast, all the members of the Nutt group were identified and individual statements of their conflicts of interest were listed. It is hard to avoid the conclusion that when it comes to weighing the harms of different products, or assessing the impact of different policies, prominent tobacco control advocates and the high-profile organs that that offer them a voice embrace the research that reports the findings they like and rail against the studies that report those to which they object. The science of understanding human behaviour is difficult enough, without the added confusion generated by double standards when it comes to how different studies are assessed, and different researchers’ work is attacked. The Centre for Drug Misuse Research has received funding from British American Tobacco, Philip Morris International and Nicoventures to undertake research assessing the role of electronic cigarettes in reducing tobacco-related health harm. In 2014 Neil McKeganey prepared a report that was included in the Annex to the British American Tobacco (BAT) response to the UK Government consultation on plain packaging. Christopher Russell has received funding from Nicolife to consult on research assessing the risks and benefits of modified risk tobacco and nicotine products to current smokers. No part of either the tobacco industry or the nicotine industry has had any role (financial or otherwise) in the preparation of this paper or in the decision to submit the paper for publication. An earlier version of this paper appeared on the Nicotine Science and Policy website.