Monday, March 03, 2014

American Thoracic Society is Discouraging Many Smokers from Quitting and Misrepresenting Scientific Evidence on E-Cigarettes

In a letter to the editor published in the New York Times last Thursday, the president of the American Thoracic Society  actually discourages thousands of smokers from quitting. At the same time, she misrepresents the scientific evidence on electronic cigarettes. In my opinion, this combination of lying about the scientific facts and providing harmful advice amounts to inappropriate medical practice.

In the letter, Dr. Patricia Finn, who is "president of the American Thoracic Society and chairwoman of the department of medicine at the University of Illinois Chicago" writes:

"a recent study of 76,000 South Korean teenagers indicates that users of e-cigarettes were less likely to succeed in quitting smoking...".

She also writes:

"The American Thoracic Society, as a member of the Forum of International Respiratory Societies, supports an age restriction and government regulation of the sale of e-cigarettes, which in many states do not exist. Until more research is done, it is dangerous to promote their widespread use."

The Rest of the Story

There are two irresponsible aspects to this action on behalf of the nation's chest physicians: (1) lying about the scientific facts regarding electronic cigarettes; and (2) providing harmful medical advice to the public. I'll deal with each of these in turn.

1. Lying about the Scientific Facts Regarding Electronic Cigarettes

The American Thoracic Society is claiming that the Glantz study of 76,000 South Korean teenagers fround that "users of e-cigarettes were less likely to succeed in quitting smoking." However, the study was a cross-sectional one and it did not compare the quitting efficiency of electronic cigarette users and non-electronic cigarettes users over time to see whether e-cigarette users were more or less likely to succeed in quitting smoking.

The authors clearly state in their paper that "Because the [survey] used cross-sectional data, the directionality of our findings cannot be established." In other words, it cannot be determined whether users of e-cigarettes were less likely to succeed in quitting, or whether youth who had trouble quitting were more likely to try e-cigarettes.

In addition, the study notes as a major limitation the fact that: "Because the [survey] did not ask whether students had smoked 100 cigarettes in their lifetime, we could not use the common definition of a “former smoker” as someone who had smoked 100 cigarettes in their lifetime but had not smoked in the past 30 days. Rather, we had to define a “former smoker” as someone who had smoked a single puff and who had not smoked in the past 30 days, which combines former 100 cigarette smokers with former experimenters who may only have used cigarettes briefly."

But this doesn't stop the American Thoracic Society from telling the public that the study found that e-cigarettes users were less likely to succeed in quitting smoking. In my view, this lying about the scientific evidence is a serious mistake.

2. Providing Harmful Medical Advice to the Public

The American Thoracic Society, apparently on the basis of its false portrayal of the scientific evidence, advises against the widespread use of electronic cigarettes. In other words, it is publicly discouraging smokers from using these devices to quit smoking.

Now, for smokers who have tried to quit and failed using NRT or other drugs and who are thinking of quitting using electronic cigarettes, the American Thoracic Society's advice is apparently not to use electronic cigarettes, which is tantamount to advising these smokers not to quit. The reality is that a recommendation to not use e-cigarettes is essentially a recommendation not to quit smoking if that smoker is someone who is considering e-cigarettes because their cessation efforts have failed with other alternatives.

This combination of bad medical advice to smokers and lying about the scientific evidence, in my view, amounts to irresponsible medical practice. Physicians should at very least do no harm. Here, however, the American Thoracic Society is doing much harm.

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