Supervenience and the Public Health Standard for Psychoactive Substances
Round 1
Reviewer 1 Report
The manuscript entitled "Supervenience and the Public Health Standard for Psychoactive Substances" is a prospective study well conducted and written.
The paper argues that the public health standard depends on the contextual environment, rather than the individual product’s intrinsic properties. Interpretation of the benefits or the harms of e-cigarettes or other harm-reduction products will depend on often unstated assumptions. In the conclusion, the author affirms that most of the research conducted does not contribute to our understanding of the potential impact of e-cigarettes.
I suggest improving the text discussing about the influence of the kind of population in particular the influence of the gender on the use of e-cigarettes, and the difference of impact of harm in the different ages.
A check of English language is necessary to correct same small spelling error.
Author Response
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Author Response File: 
Author Response.docx
Reviewer 2 Report
Reviewer comments on psychoactives-2068134
This perspective discusses that public health policies do not take supervenience into account, which according to the author is needed to really address public health policies. While this is an interesting perspective, and emergence is an interesting philosophical topic, I am not completely convinced. It has long been recognized that data at individual level, and individual risk factors, are not sufficient to predict disease rate at population level (e.g. the example given for hypertension). Obviously, factors at many other (social economic factors, cultural differences, juridical differences, etc.) are also important, and can lead to differences between groups and between countries. For tobacco use, several models have been proposed to take this into account, e.g. https://pubmed.ncbi.nlm.nih.gov/29931176/. Thus, introducing a product in one country will have different outcomes than in another country.
While I agree that some researchers may focus too narrowly on product factors such as lower emissions, I think this is certainly not the case for many regulatory bodies including the FDA. Usually, policy making is informed by collecting several types of evidence. Prevalence data are needed for different types of user groups, e.g. e-cigarette only users, dual users, tobacco smokers, never-users. Surveys also take into account gender, age, social economic status, and other environmental factors. By using longitudinal studies, shifts in overall prevalence and between user groups can also be studied, so that questions posed by the author e.g. whether there is gateway effect, whether the product is effective for cessation, etc. can also be answered. Furthermore, it is important to know how and why different user groups use a product. Toxicity and health impact studies are also needed, as well as studies on additive potential. Etc. etc.
Moreover, I do not agree when the author says “Consequently, research evidence based on individuals or aggregated from individual behaviour will not provide conclusive or meaningful evidence to-wards this standard.” I agree it will not provide conclusive evidence, but I disagree that it will not be meaningful.
The author also poses a false dilemma when saying “This paper will argue that there, the public health standard depends crucially on the contextual environment, rather than the individual product’s intrinsic properties.” This is repeated elsewhere. I do not agree at all. It depends on both. Effects of a product are a combination of product, person, and contextual factors. Thus, all of these should be studied. Similarly, “If we follow a public health standard, then we must examine the burden of harm due to a harm reduction product is not due to the product itself, but due to the context in which the product is introduced.” (And something seems to be missing in this sentence? Formulation is not completely correct). Such false dilemma’s, or black or white statements, are formulated at many places throughout the paper. This is not helpful.
Furthermore, sometimes sentences are difficult to read, e.g. the first sentence. Please check entire manuscript.
Author Response
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Author Response File: Author Response.docx
Reviewer 3 Report
Thank you for giving me oopertunity to review this manuscript. Over all paper lis interesting read. Authors have used appropriate citations. I do not have any suggestions on improvement and I beleive it can be accepted after some grammer improvement to make it flow better.
Author Response
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Author Response File: Author Response.docx
