Last week, Stan Glantz used a new study, published online ahead of print in the Journal of Adolescent Health, to mislead the public into thinking that there is now evidence that electronic cigarettes are leading to smoking initiation and addiction among adolescents. In a statement accompanying the study, study author Stanton Glantz proclaimed that electronic cigarettes are "a new route to smoking addiction for adolescents."
He also wrote that: "Use of e-cigarettes is associated with heavier use
of conventional cigarettes, which raises the likelihood that actual use
of e-cigarettes may increase harm by creating a new pathway for youth
to become addicted to nicotine and by reducing the odds that an
adolescent will stop smoking conventional cigarettes."
As I pointed out previously, the problem is that Glantz took results from a cross-sectional
study and misrepresented them as if they were derived from a
longitudinal study. Moreover, he failed to heed his own warning,
buried in the fine print of the paper, that: "Because the [survey] used
cross-sectional data, the directionality of our findings cannot be
Specifically, the study was cross-sectional so it cannot conclude whether electronic
cigarette use caused kids to smoke more or whether kids who smoked more
were more likely to try electronic cigarettes (perhaps because they
wanted to quit or cut down).
In response to Stan's statement on his blog, I submitted the following comment:
You're better than this. You know full well that this
is a cross-sectional study and that you cannot determine the direction
of causality. It could well be that the reason for the higher prevalence
of heavy smokers who use electronic cigarettes is simply that youths
who smoke more heavily are more likely to use such products, perhaps
because they are interested in quitting or cutting down. You cannot
credibly conclude that the use of electronic cigarettes preceded the
heavy smoking among these youth and that the e-cigarettes caused these
kids to smoke more heavily.
I appreciate your caution and
concern in embracing the use of electronic cigarettes for harm reduction
among current smokers, but it seems to me that your arguments for
caution -- and for regulating the sale and marketing of electronic
cigarettes to youth - are strong enough that you don't need to draw
unsupportable conclusions in order to put forward your case.
are many legitimate concerns regarding the potential appeal of
electronic cigarettes among youth. This truth alone should be
sufficient. There is no need to stretch the truth by distorting the
Michael Siegel, MD, MPH
Professor, Boston University School of Public Health
The Rest of the Story
Unfortunately, Stan did not allow my comment to be posted in his blog comments section. It appears that Stan is only interested in promoting his own view and has no interest in allowing any dissenting viewpoints. That is certainly his right; however, why bother having comments on his blog? Why not just post his commentaries without a comment section. It seems to me that once you make a decision to allow reader comments, then you need to allow reader comments, unless they are inappropriate (e.g., use inappropriate language, contain defamatory statements, etc.). Censoring reader comments because you do not agree with them is not appropriate.
For those who have had the courage to venture into the comments section on my own blog, you have readily seen that I do not censor comments because they disagree with my personal viewpoint. In fact, the overwhelming majority of the comments do not agree with my viewpoints, especially on the issue of secondhand smoke and tobacco industry regulation. However, I still allow those comments. The only comments I have ever deleted from the blog are those which were inappropriate, either by virtue of foul language or defamatory or personal attacks.
There is no need for a blog to allow comments, but once you make a decision to do so, it seems to me that it is not appropriate to censor comments that don't agree with your viewpoint. What's the point of having a comment section if you censor the comments on that basis?
Sadly, Stan's misrepresentation of the conclusions that can be reasonably drawn from his study is leading to the widespread deception of many reporters and policy makers. His propaganda campaign is working. And by suppressing and censoring dissent, he is working to make sure that his propaganda is unopposed.
Fortunately, it doesn't take advanced epidemiology training to see through his smokescreen. Anyone with critical analytic abilities can see that there are two possibilities why heavy smokers are more likely to use electronic cigarettes. One is that electronic cigarette use causes people to smoke more. Another is that heavier smokers are drawn to electronic cigarettes, perhaps because they wish to cut down or quit.
In a cross-sectional study, you can't figure out which explanation is correct. Unless, of course, you are an anti-smoking researcher, in which case you can apparently just draw whichever conclusion is most supportive of your pre-determined position.