[updated 10 Jan, 2021.Note that the Ioannidis database has subsequently been updated till 2020. I have not gone through the updated rankings to adjust the list below, so this list is valid only for the date on which I last updated it]

The scientific impact maven John Ioannidis from Stanford University and his team have just published a massive ranking of the world’s most-cited authors across all scientific fields in a PLoS Biology paper titled A standardized citation metrics author database annotated for scientific field.

The Ioannidis group used Scopus to analyse the output and citations of 6,880,389 authors who had published at least 5 papers during the 22 years Jan 1996-Dec 31 2017, the latest date when full data were available. In this paper they report on the top 100,000 of these 6.88 million authors (in fact on 105,026). Two searchable supplementary excel tables can be downloaded, one for all 22 years and the other for the single year of 2017.

They ranked the top 105,026 authors across all scientific fields “based on their ranking of a composite indicator that considers six citation metrics (total citations; Hirsch h-index; co-authorship adjusted Schreiberhm-index; number of citations to papers as single author; number of citations to papers as single or first author; and number of citations to papers as single, first, or last author).” The authors argue that this database “provides a measure of long-term performance [and] also reflects their career-long impact or is a very good approximation thereof.”

I spent a couple of hours searching for authors who I know have made substantial research contributions in the tobacco control field.

The list below shows 100 names that I found in the list of the highest ranked 105,026 authors. Some of these published almost exclusively in the tobacco field, while others published more widely, including in the tobacco area (these I have italicised below).

If you know of others who should be in this top 100, please let me know via the comment button on this blog and I’ll check their details on the link above and add their names.

Several things stand out for me:

• huge male dominance (just 21 of the 100 are women)
• a near total dominance (90%) by anglophone nation authors (61 USA, 16 UK, 7 Australia, 4 New Zealand, 2 Canada)
• most of those on the list are older authors, reflecting their outputs across  22 years
• several are deceased

Many highly productive and influential authors I looked for were not shown in the 105,206 highest ranked. Many of these are younger people who have been publishing for fewer years. One, Geoff Fong from the University of Waterloo in Canada, was not on the list which stunned me. Geoff’s work has had 30,794 cites and he has an H index of 83. I find it incredible that such an output would not catapult him high in any world ranking, yet his name does not appear.

Ranking of authors with exclusive or major contributions in tobacco control related publications 1996-2017 (denominator 6,880,389 authors across all areas of scholarship who had published at least 5 papers)

* deceased

Richard Peto (UK) 314

Neal Benowitz (USA) 334

Michael Thun (USA) 399

Carlo La Vecchia (Ita) 564

Stephen Hecht (USA) 821

Richard Doll* (UK) 892

Jon Samet (USA) 1133

Jim Prochaska (USA) 1237

John Hughes *USA) 1460

Saul Shiffman (USA) 1760

Wayne Hall (Aus) 1793

Robert West (UK) 4157

Martin McKee (UK) 4483

Susan Michie (UK) 5685

Ernst Wynder* (USA) 5765

Wayne Velicer* (USA) 5955

Stan Glantz (USA) 6002

James Pankow (USA) 6196

Michael Fiore (USA) 6524

Judith Ockene (USA) 6708

John Pierce (USA) 7009

Ross Brownson (USA) 8184

Carlo DiClemente (USA) 9164

Robert Beaglehole (NZ) 11091

Lisa Bero (USA) 11395

Nancy Rigotti (USA) 11483

Steve Tiffany (USA) 12725

Gil Botvin (USA) 12821

John Britton (UK) 13193

Martin Jarvis (UK) 13298

Jean-Francois Etter (Swi) 13146

Ray Niaura (USA) 13736

Jack Henningfield (USA) 14041

Ruth Bonita (NZ) 14192

Cheryl Perry (USA) 14929

David Abrams (USA) 14963

Srinath Reddy (Ind) 15505

Simon Chapman (Aus) 15782

Meredith Minkler (USA) 17501

Ken Warner (USA) 17623

Ron Borland (Aus) 17636

Frank Chaloupka (USA) 19048

Gary Giovino (USA) 19705

Konrad Jamrozik* (Aus) 20719

Mike Cummings (USA) 21885

Rob Sanson-Fisher (Aus) 22486

Tracy Orleans (USA) 22558

Steve Sussman (USA) 23308

Stephen Schroeder (USA) 23376

Prakash Gupta (Ind) 23900

Gary Swan (USA) 24114

Sue Curry (USA) 25261

Jennifer Unger (USA) 25948

Karen Emmons (USA) 26139

Lynn Kozlowski (USA) 27047

Michael Russell* (UK) 27129

Judy Prochaska (USA) 27561

David Hammond (Can) 27701

Robert Klesges (USA) 28237

Riccardo Polosa (Ita) 29511

Richard Hurt (USA) 29999

Dorothy Hatsukami (USA) 30337

Joe DiFranza (USA) 30981

Ellen Gritz (USA) 31122

Karl Fagerstrom (Sweden) 31519

Hein de Vries (Nld) 31860

Wasim Maziak (USA) 32034

Paula Lantz (USA) 33216

Mark Nichter (USA) 33635

Prahbat Jha (Can) 35151

Tom Eissenberg (USA) 35676

Mohammad Siahpush (USA) 36716

TH Lam (HK) 37299

Tim Baker (USA) 38410

Tim Lancaster (UK) 38474

Robert Jackler (USA) 39747

Ann McNeill (UK) 41085

Melanie Wakefield (Aus) 42453

Michael Siegel (USA) 43187

James Sargent (USA) 43788

Peter Hajek (UK) 44012

Teh Wei Hu (USA) 45443

Scott Tomar (USA) 45658

Ed Lichtenstein (USA) 46483

David Hill (Aus) 47303

Doug Jorenby (USA) 48555

Lois Biener (USA) 49709

Peter Lee (UK) 49776

Derek Yach (USA) 52459

Tony Blakely (NZ) 55384

David Levy (USA) 55931

Ruth Malone (USA) 57070

Witold Zatonski (Pol) 57694

Gerard Hastings (UK) 59080

Harry Lando (USA) 59597

Lindsay Stead (UK) 60988

Robyn Richmond (Aus) 61224

Takeski Hirayama* (Jap) 63289

Jonathan Foulds (USA) 63709

Melbourne Hovell (USA) 63836

This week’s much discussed Four Corners program examining the extra-marital sexual relationships with staff of two Australian cabinet ministers had a giant blind spot.

Relationships between people who work together have always been extremely common. While social media are today the most common way that couples in long term relationships meet, hooking up with someone you meet at work remains one of the most common replies we get when we ask a couple “so how did you two meet?”

Sometimes workplace relationships are between those with equal or similar employment status. And here, in discussions I’ve had with several groups of friends this week, there seems to be consensus that this is acceptable. Yes, things can get awkward when the relationship fails and you have to continue working with a former lover. Those wisdoms in hindsight power age-old sexist axioms like “don’t dip your pen in the company ink” and the more gender neutral “don’t get your meat where you get your bread”.  

But workplace affairs and later permanent couplings also often involve asymmetrical power and status. In four couples I’ve discussed this with since Monday’s program, three started their relationships at work. One was between two who worked in the same small business in a county town, in different roles, with no line authority over each other, and on similar pay. Another was a male boss of a very small company who started having a relationship with a female employee which led to them now living together for several years, very happily.

The third was me and my wife. Trish was my son’s teacher in primary school. I was separated, she married. A casual remark I made to one of her colleagues who asked if I was seeing anyone, about how attracted I was to her was passed on the same day. Trish cornered me the next morning saying “I hear you’ve been saying nice things about me”. We got together that weekend and have been a couple for 30 years.

At the time there were several pinch-faced parents in the school  who found all this outrageously salacious and improper. I was, of course, apparently only trying to get my son higher marks by  having it on with his teacher. When he was made school captain five years later, Trish had obviously arranged that and rigged the voting with the full collusion of all the staff and students.

I’d not be surprised if there is a formal HR policy in the school system that makes it clear that teachers must not have sexual relationships with parents in their school. Perhaps Trish could have been transferred or sacked had any of the tongue-waggers taken it upstairs. But even if that was the case, should we feel guilty and unethical about our relationship today? Should I have “kept it in my pants” and she have “kept her knickers on”, in the parlance of the morally virtuous that got a spirited airing on the ABC’s Q&A panel program after Four Corners screened? Should we be perpetually yoked by the weight of an understanding that our coming together was “wrong” and that we were entitled to no ethical agency in navigating how we decided to conduct ourselves?

The bitter feelings of the ex-lover of Alan Tudge were framed by the program as a woman humiliated and hurt by the ways she perceived she had been treated as someone with far less power than her ministerial lover. The sub-text waving a very big flag was “it is always unethical for people with different levels of power in a workplace to have sex.” As neither Tudge nor Porter were interviewed, we had no opportunity to contextualise her account with his.

But given the countless numbers of couples over time who have met at work and begun affairs that didn’t end badly, this doctrinaire framing of office sex as almost always wrong doesn’t pass my pub test. There will be as many reading this who have lived that experience positively as those for whom lived to regret it.

I was left feeling that here was yet another chapter in the endless morality tale of public virtues vs private vices. If you make a virtue out of family values with your political megaphone, but are  living your life rather differently, that’s fair and important game.  And I’m also sympathetic to the view that honey or stud muffin traps which might compromise national security are a proper focus for elected officials to give very serious consideration. So Malcolm Turnbull’s bonk ban was understandable, if wildly optimistic.

Australia has about 2.7 million people with asthma, and some 464,000 with chronic obstructive pulmonary disease (COPD). Most of both groups use puffers for relief, sometimes in lifesaving attacks.

But none of the asthma drugs which are inhaled come in flavours which might make them more palatable. And respiratory medicine colleagues tell me that many users do not enjoy the medicinal taste. So you’d imagine that the manufacturers of inhaled medicines would jump at the opportunity to have flavours available if this would encourage more people to use their puffers when needed.

Here’s an example of someone enquiring to an on-line forum about whether puffer flavours are available. The advice back? “We still do not know the long-term consequences of inhaling concentrated flavourants, but I suspect that many are pretty bad for you… Also, many aromas (perfumes) are known to induce asthma attacks in people who are sensitive. So all-in-all probably not the best idea for people who are already at risk of reduced lung function.”

People who use puffers are advised that it’s safe to use them 4-6 times a day maximum. Contrast this with the number of times that the average vaper fills their lungs with propylene glycol, nicotine and flavouring chemicals, all vaporised from the liquid that is heated by the metal coil heated by the e-cigarette  battery.

This recent study monitored people vaping and found those who were exclusive vapers pulled this cocktail deep into their lungs 173 times a day — a mere 63,188 times a year. Those who were dual users (ie who smoked and vaped) took 72 lung-basting inhalations. The average 12 a day smoker takes about 96 puffs.

So the average exclusive vaper is inhaling vaporised flavours into their lungs at a rate some 35 times more than a person with asthma takes a blast from their puffer. And that’s before we even begin to count the secondhand vape that vapers (and the rest of us) also get when they vape around others.

Way back in 2014, there were 7764 unique vaping flavour names available online. It is likely there are many, many more in 2020.  So these flavouring agents have all been cleared as safe to inhale, right?

Errrm .. no, actually.

The peak flavour manufacturers association in the USA Flavor and Extracts Manufacturers Association (FEMA) stated earlier this year:

1. There is no apparent direct regulatory authority in the United States to use flavors in e-cigarettes.  In this context, it is important to note that the “generally recognized as safe” (GRAS) provision in Section 201(s) of the Federal Food, Drug, and Cosmetic Act (FFDCA) applies only to food as defined in Section 201(f) of the Act.

2. None of the primary safety assessment programs for flavors, including the GRAS program sponsored by the Flavor and Extract Manufacturers Association of the United States (FEMA), evaluate flavor ingredients for use in products other than human food.  FEMA GRAS status for the uses of a flavor ingredient in food does not provide regulatory authority to use the flavor ingredient in e-cigarettes in the U.S

3. E-cigarette manufacturers should not represent or suggest that the flavor ingredients used in their products are safe because they have FEMA GRAS status for use in food because such statements are false and misleading.

So in summary, flavouring chemicals likely to be used in e-juice may have been assessed as safe to injest, but not to inhale.

83% of New Zealand vapers name flavouring as a main reason they took up vaping. We know that flavours are a big factor that attract kids to vaping. And e-juice manufacturers have taken note. Here are a few examples of flavours that would be a big hit at any 5 year old’s birthday party.

Vaping advocates argue that regulators should keep their hands away from flavours because they are a major factor attracting smokers to try and keep vaping. Those worried about the dramatic rises in regular vaping by teens in several nations which have opened the e-cigarette access floodgates should get their priorities right, apparently.

By contrast, the pharmaceutical industry, which almost certainly would like to flavour its inhalable asthma drugs, has not gone down that road. One of the big reasons for this is undoubtedly that its asthma products have to go through therapeutic goods regulation. The two considerations there are efficacy (does a drug do what it is supposed to do? Answer with vaping: very, very poorly) and safety. The pharmaceutical industry knows it would struggle to demonstrate that inhaling flavours are acceptably safe.

This is why the vaping industry and its urgers are desperate to avoid therapeutic regulation and instead have its products avoid the safety standards that they would try in vain to demonstrate.

People living with asthma don’t abandon their unflavoured puffers in great numbers because they don’t taste the best. But undoubtedly, many who vape would not do so if they could not get flavoured e-juice.

But it is very wrong to imply that all who are vaping today are former and current smokers who are vaping to quit smoking and need support.  The just-published paper from the ITC-4CV four country (Australia, USA, UK, Canada) cohort survey found that “among smokers who also vaped, 46% planned to quit smoking within 6 months, 30% planned to quit in the future, but beyond 6 months, with the remaining 24% reporting that they did not know or did not plan on quitting, suggesting low motivation to quit smoking among many of the concurrent [both smoking and vaping] users.” 

Many dual users who vape are not at all desperate to quit smoking. Regulatory policy which fails to appreciate this and puts the flavour experimenting interests of vapers with no interest in quitting ahead of policies that keep beguiling flavoured vapes totally out of the reach of the great majority of kids, needs strong opposition. The Greg Hunt prescription access barrier is an obvious way to ensure this.