IN MY VIEW: Why the Glantz Scientific Review of E-Cigarettes is Not Only Unscientific, But Dishonest

Yesterday, I explained that the review of electronic cigarettes by Stan Glantz and colleagues published this week in the journal Circulation is scientifically flawed because it draws conclusions about the efficacy of e-cigarettes for smoking cessation from studies that were not designed to measure such effects in the first place. These studies did not examine smoking cessation rates among a cohort of smokers who were identified at baseline as using e-cigarettes with the intention of quitting smoking. Moreover, smokers who use e-cigarettes are likely more heavily addicted to nicotine and may be more resistant to quitting, thus making inferences about cessation effectiveness from these studies inappropriate.

Today, I express my opinion that the use of these studies to draw conclusions about the efficacy of e-cigarettes for smoking cessation is not just unscientific, but dishonest as well.

The Rest of the Story

The rest of the story is that the review article's authors have actually acknowledged that the 5 studies they use to draw conclusions about the efficacy of e-cigarettes for smoking cessation cannot be used to draw conclusions about the efficacy of e-cigarettes for smoking cessation.

Therefore, their use of these studies to draw conclusions about the efficacy of e-cigarettes for smoking cessation appears to me to be knowingly dishonest.

In a separate article published in the same issue of Circulation, these same authors write: "As of March 2014, 5 population-based studies had examined the relationship between e-cigarette use and quitting smoking. Because these studies did not measure whether people were using e-cigarettes as a smoking cessation aid or other reasons for use such as to circumvent smoke-free laws, they did not directly test the efficacy of e-cigarettes as smoking cessation aids." [emphasis is mine]

Curiously, however, this knowledge doesn't stop Glantz from using these studies to draw a conclusion about the efficacy of e-cigarettes as smoking cessation aids in his review article. Moreover, his review article omits any mention of the fact that these 5 studies "did not measure whether people were using e-cigarettes as a smoking cessation aid" and that these studies "did not directly test the efficacy of e-cigarettes as smoking cessation aids."

In other words, Glantz has hidden this information from the reader in the review article, even though he felt it was important enough to mention in the other article. In my opinion, this is knowing dishonesty. It is hiding critical information from the reader that would affect the reader's assessment of the validity of the study's conclusions. Moreover, the review article proceeds to do precisely what the other article argues cannot and should not be done with these studies (i.e., draw conclusions about the efficacy of e-cigarettes as smoking cessation aids).