Thursday, June 06, 2013

Researcher Continues to Use Bogus Data to Support Non-Efficacy of E-Cigarettes; Even Study Authors Admit Study Cannot Be Used to Evaluate E-Cig Efficacy

In my recent KQED radio discussion with Dr. Glantz about proposed California legislation to ban electronic cigarette use in public places, Dr. Glantz again cited data from a recent study by Vickerman et al. to support his contention that e-cigarettes are less effective than NRT for smoking cessation.

I have already explained in detail why the data from the Vickerman study cannot be used to assess the effectiveness of e-cigarettes for smoking cessation. Briefly, 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 Rest of the Story

Concerned that Dr. Glantz was misrepresenting the results of their study, the authors of the study - who are at Alere Wellbeing - publicly admitted that the study was never intended to assess the effectiveness of electronic cigarettes and that the data should not be used for this purpose.

The Alere Wellbeing blog states very clearly: "The recently published article by Dr. Katrina Vickerman and colleagues has been misinterpreted by many who have written about it. It was never intended to assess the effectiveness of the e-cig as a mechanism to quit."

Imagine that a tobacco company was concerned about the threat of electronic cigarettes to its profits and wanted to publicly disseminate a conclusion that electronic cigarettes are less effective than NRT for smoking cessation. A new study comes out, published in a reputable journal, that is not designed to evaluate the efficacy of electronic cigarettes for smoking cessation. It neither can nor should be used to gain information about the rate of successful cessation using e-cigarettes. But the tobacco company uses these data anyway, telling the public on a radio show that this study shows how ineffective electronic cigarettes are.

Without a doubt, anti-smoking advocates would view the behavior of this tobacco company as fraudulent. The company would be viewed as misleading the public, misrepresenting the results of research, and trying to pull the wool over the eyes of the people.

There is a reasonable discussion that can be conducted regarding the wisdom of banning vaping in public places. However, if we use bogus data to support a pre-determined position, this is no longer a scientific discussion.

It is clear to me that Dr. Glantz has a pre-determined opinion about electronic cigarettes and that this ideology is dictating his agenda, which is now blind to the actual scientific evidence. He is judging studies not based on their scientific rigor, but on whether their "findings" are "favorable" to his opinion. This is a perfect example of this. Here we have a study which, as the authors themselves admit, sheds no light whatsoever on whether electronic cigarettes are effective for smoking cessation. Yet Dr. Glantz used this study to publicly declare that e-cigarettes are less effective than NRT, a gross misrepresentation that deceives the public.

Dr. Vickerman herself explained that her results do not in any way indicate that electronic cigarettes are less effective than NRT, stating: "It may be that callers who had struggled to quit in the past were more likely to try e-cigarettes as a new method to help them quit. These callers may have had a more difficult time quitting, regardless of their e-cigarette use."

By the way, this is a study that Dr. Glantz called a "good study" on "the use of e-cigs for cessation."

Finally, I need to clarify another misrepresentation by Dr. Glantz. He stated on his blog that my main argument against the proposed California ban on vaping in public places is that this would harm vapers by decreasing electronic cigarette use. He states: "Mike's essential argument was that any restrictions on "life saving" e-cigarettes would discourage their use for smoking cessation."

This is not my argument. My argument is that the bill is not justified because there is no scientific evidence that vaping poses a substantial health risk for bystanders. My opinion is that we should not base coercive health legislation on pure speculation. I believe that we need solid scientific evidence of a public health hazard before we enact coercive legislation. 

Therefore, if there were evidence that vaping was harmful to bystanders, I would support a ban on vaping in public places, even if this would also discourage vapers from using these products to quit smoking. The point of my emphasizing this detrimental aspect of the legislation was simply to emphasize that while the bill offers no known benefits, it does create substantial harm. But I would support the legislation if there were known risks posed by passive vaping that would be minimized with such legislation.

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