Tuesday, May 21, 2013

Anti-Smoking Advocate Uses Bogus Research to Deny Overwhelming Scientific Evidence on Electronic Cigarettes

On his tobacco blog, Stan Glantz is citing research published this month in the journal Nicotine & Tobacco Research to support his contention that electronic cigarettes are not useful in smoking cessation. Stan goes so far as to direct former Surgeon General Carmona to stop claiming that these products may help people to quit smoking.

Stan writes: "Katrina Vickerman and colleagues collected information on e-cigarette use from people who called state quitlines in Connecticut, Louisiana, Nebraska, North Carolina, South Carolina, and Texas.  Nearly one third (30.9%) of respondents reported ever using or trying e-cigarettes; most used for a short period of time (61.7% for less than 1 month). Consistent with what other surveys have found, the most frequently reported reasons for use were to help quit other tobacco (51.3%) or to replace other tobacco products (15.2%). Most important, both e-cigarette user groups were significantly less likely to have quit smoking 7 months after first calling the quitline compared with participants who had never tried e-cigarettes: Only 21.7% of people who used e-cigarettes to help quit and 16.6% of those who used e-cigarettes to replace other tobacco products had quit compares to 31.3% of people who did not use e-cigarettes (p < .001)."

The Rest of the Story

What Stan does not reveal is that instead of estimating cessation rates among a cohort of smokers who made quit attempts using these products, the study analyzed cessation rates of a large number of smokers who had previously tried to quit using e-cigarettes but failed, and then called a quitline because they had failed and wanted to try again. Then, they compared the quit rate among these smokers to that among smokers without such a history of a failed quit attempt using electronic cigarettes.

In other words, this study did not estimate quit rates among smokers trying to quit using e-cigarettes. Instead, it estimated quit rates among many smokers who were not using e-cigarettes in their quit attempt at all!

The truth is that many of the electronic cigarette users in the study did not use electronic cigarettes in their quit attempts! According to data provided in the paper, a full 28% of the sample of electronic cigarettes did not use these products in their quit attempts.

It should be clear to readers that this study was poorly designed to investigate the efficacy of electronic cigarettes. The study systematically sampled a group of quitline callers who were unsuccessful using electronic cigarettes. These people tried and failed using electronic cigarettes. How do we know they failed? Because they wouldn’t have had to call the quitline if they weren’t still smoking. This is clearly a harder core group of smokers and it is no surprise that their cessation rates were lower after 6-months than the comparison group. The study tells us nothing about the effectiveness of electronic cigarettes, other than that they do not work for everyone. This is exactly the kind of biased research, designed specifically NOT to find an effect of electronic cigarettes, that is characterizing the anti-smoking movement today, guided by an ideology that is apparently opposed to anything that merely looks like smoking, no matter how much safer it may be. Apparently, the researchers had already reached a pre-determined conclusion and the study was apparently designed to find no effect. Any researcher sincerely interested in testing the efficacy of electronic cigarettes would not test the research question in this way.

If the tobacco industry conducted precisely this same study in order to conclude that electronic cigarettes are ineffective as a smoking cessation tool, we would call it scientific fraud. What should we call the same study, but conducted by a company that makes its money by convincing the public that traditional methods for smoking cessation should remain the mainstay of treatment?
The rest of the story is that leading anti-tobacco researchers and advocates are now relying upon shoddy science to support what appears to be their pre-determined conclusions. I continue to be dismayed by the loss of scientific integrity in the tobacco control movement. The movement is so blinded by ideology that it has truly lost sight of the scientific quality of evidence. The quality no longer matters, merely the direction of the findings.

No comments: