Friday, March 14, 2014

Cease and Desist: Clive Bates Tells Glantz to Stop Misrepresenting His Research on E-Cigarettes

On his wonderful science and advocacy blog, tobacco control practitioner and former director of Action on Smoking and Health (ASH-UK) Clive Bates issues a cease and desist order: an open letter to Stan Glantz urging him to discontinue the misrepresentation of his research to spread false and unsupported information about electronic cigarettes being a gateway to cigarette smoking.

The letter picks up on many of the precise points that I have been arguing during the past few weeks: post 1; post 2; post 3.

Clive's letter begins as follows:

"Dear Professor Glantz, Dr. Dutra:

Misleading use of survey data has no place in professional public health practice
I had intended to blog about your recent paper, but decided instead to write an open letter and to put these concerns to you directly. So, I write to express dismay at the false, misleading and damaging conclusions you have drawn from your recent paper in JAMA Pediatrics and related media communications. The errors of reasoning are elementary, but have been used to draw conclusions that are relentlessly hostile to e-cigarettes and the important public health concept of ‘tobacco harm reduction’.  

It should be stressed that misleading information in this arena can cause actual harm to real people if they react to misplaced concerns in ways that cause them to continue to smoke. Further dangers arise as physicians and other trusted professionals give bad advice based on false information. Finally, there is the danger that policy-makers and legislators will be misled into making excessively restrictive regulations that protect cigarette sales from competition from much safer and better alternatives.  I believe your study and the subsequent media work owe more to misguided activism than to responsible academic investigation, and as such they have no place in professional public health practice or a reputable university."

Clive goes on to cite two specific examples of conclusions that Glantz disseminated to the public which were not supported by his own research.

First, he cites the JAMA Pediatrics article in which Glantz and Dutra conclude that electronic cigarettes are exaggerating, rather than ameliorating smoking among youth. Clive writes: "somehow you have managed to position this study as showing there is a gateway from e-cigarette use to smoking. NOTHING in the study or the underlying data suggests this.  You would need information on how smoking, e-cigarette use and abstinence evolved over time to test these hypotheses, but your study does not have that."

Second, he cites the press release from that study, which opened with the admonition that electronic cigarettes are a gateway to smoking. Clive writes: "There is no basis for drawing this unequivocal ‘gateway’ conclusion from the data presented in the study.  None whatsoever – and the published study even makes this clear. In fact the data are consistent with the opposite hypothesis – that e-cigarettes are primarily used by smokers interested in quitting or cutting down. Indeed the observation  that users have a higher intention to quit smoking lends support to that hypothesis more than to your preferred explanation."

Clive further shows how the misguided headlines created by Glantz have already led to public policy makers being misled by this misrepresentation of the science.

The letter concludes: "I really hope you will reconsider your approach – it does not serve public health or the public interest. It is wrong simply to assume that e-cigarettes will play no part in reducing the expected one billion 21st Century deaths from smoking. The evidence that there is, taken as a whole, is actually very encouraging, and certainly not a reason to mount a ‘dirty tricks campaign’ against these products. In any event, there is never a case to mislead the public, policy-makers and legislators even if you are convinced the end justifies the means, which in this case it does not."

Like Clive, I do not criticize Stan for having a different opinion on the issue of electronic cigarettes. Having a diversity of opinions is a healthy thing and in the long run, it will help ensure that the best possible public policies result. However, misrepresenting scientific evidence, deceiving the public about the science and what it shows, and lying to the media and the public about the science are simply not acceptable. They serve no positive purpose and in the long run, they end up undermining the credibility of the entire tobacco control movement.

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