Wednesday, 12 March 2014

Dr. Glantz proves that e-cigarettes and cigarettes are associated with each other in some way. Thank you Dr. Obvious!


Dr. Glantz wants us to believe e-cigarettes will
turn young more people into smokers, but his
numbers are totally irrelevant
photo credit: Scott Charlesworth via photopin cc
Last Thursday (6th of March) Dr. Glantz and his co-author Lauren M. Dutra published their study that they claim finally proves the gateway argument: http://goo.gl/ez6nSP. Their conclusion was probably written a long time before that, most likely it was the first thing to be written in the report. Because, as Dr. Michael Siegel has pointed out as well (http://goo.gl/y3J7qE), the data collected in the study doesn't support that conclusion. The report even admits this: "This is a cross-sectional study, which only allows us to identify associations, not causal relationships. Our results are also limited by the lack of information about motivation for using e-cigarettes (eg, popularity, trendy, smoking cessation) and the fact that they only apply to middle and high school students, not all US youths." In other words: This study can't prove the gateway argument. But then in the conclusion they write: "While the cross-sectional nature of our study does not allow us to identify whether most youths are initiating smoking with conventional cigarettes and then moving on to (usually dual use of) e-cigarettes or vice versa, our results suggest that e-cigarettes are not discouraging use of conventional cigarettes. Among experimenters with conventional cigarettes, e-cigarette use is associated with established cigarette smoking and lower rates of abstinence from conventional cigarettes." Oh... so what you're saying is that there is no way this study, by it's nature, can tell us whether e-cigarette users tend to move on to smoking or if it's the other way around, but you conclude that this is the case anyway?

Dr. Glantz obviously has no intention of actually trying to find out IF the gateway argument is valid, I'd say he already knows that it's not, cause, as I have written before, it makes no sense. So his goal now is to find a way to make the public believe it's valid anyway, and this time, apparently confusion is his tactic. Just have a look at the some of results published. Pretty confusing stuff, lots of numbers and percentages, but he is Dr. Glantz, so we would assume all these numbers are actually put in there to support the conclusion right? Well, after reading it several times let me try to clarify: 
  • "Among cigarette experimenters (≥1 puff), ever e-cigarette use was associated with higher odds of ever smoking cigarettes (≥100 cigarettes; odds ratio [OR] = 6.31; 95% CI, 5.39-7.39) and current cigarette smoking (OR = 5.96; 95% CI, 5.67-6.27)."
    This tells us that e-cigarette experimenters have a higher odds of being smokers or at least have tried a cigarette. If anything this suggests smokers experiment with e-cigarettes, probably as a healthier alternative, trying to quit.
  • "Current e-cigarette use was positively associated with ever smoking cigarettes (OR = 7.42; 95% CI, 5.63-9.79) and current cigarette smoking (OR = 7.88; 95% CI, 6.01-10.32)."
    The same association is shown for current e-cig users. So e-cig users are either smokers (probably trying to quit) or former smokers (congratulations on the switch guys).
  • "In 2011, current cigarette smokers who had ever used e-cigarettes were more likely to intend to quit smoking within the next year (OR = 1.53; 95% CI, 1.03-2.28)."
    Smokers that had tried e-cigarettes intend to quit smoking within the next year. Good. Don't give up guys.
  • "Among experimenters with conventional cigarettes, ever use of e-cigarettes was associated with lower 30-day (OR = 0.24; 95% CI, 0.21-0.28), 6-month (OR = 0.24; 95% CI, 0.21-0.28), and 1-year (OR = 0.25; 95% CI, 0.21-0.30) abstinence from cigarettes. Current e-cigarette use was also associated with lower 30-day (OR = 0.11; 95% CI, 0.08-0.15), 6-month (OR = 0.11; 95% CI, 0.08-0.15), and 1-year (OR = 0.12; 95% CI, 0.07-0.18) abstinence. Among ever smokers of cigarettes (≥100 cigarettes), ever e-cigarette use was negatively associated with 30-day (OR = 0.61; 95% CI, 0.42-0.89), 6-month (OR = 0.53; 95% CI, 0.33-0.83), and 1-year (OR = 0.32; 95% CI, 0.18-0.56) abstinence from conventional cigarettes. Current e-cigarette use was also negatively associated with 30-day (OR = 0.35; 95% CI, 0.18-0.69), 6-month (OR = 0.30; 95% CI, 0.13-0.68), and 1-year (OR = 0.34; 95% CI, 0.13-0.87) abstinence.".
    These initially look like they prove Glantz's theory, but actually they don't, because this only talks about total abstinence from cigarettes: "Abstinence from conventional cigarettes for 30 days, 6 months, and 1 year was based on responses to the question "When was the last time you smoked a cigarette, even 1 or 2 puffs?". So this actually just tells us e-cigarette users, or experimenters, have a higher chance of being smokers, or still smoke from time to time, than people that haven't tried e-cigarettes. Why? Well as the first 3 statement tells us, e-cigarette users are probably former smokers or still smokers. And these last statements says nothing about whether e-cigarette use lead to smoking, but combined with the 3 first statement it might suggests that not all e-cig experimenters or users are able to completely stop smoking.
As you can see, the data collected in this study does not support the conclusion at all. He references several other studies as well, that I can't access without paying, and to be honest I doubt they are worth the money going by the quality of Dr. Glantz's study. The relevance of these references also needs to be questioned, seeing the conclusions that are presented from them: "A cross-sectional US study also found that unsuccessful cigarette quitters were significantly more likely to have ever tried e-cigarettes in comparison with individuals who had never tried to quit." So people who have failed to quit smoking has a greater chance of having tried e-cigarettes than people that have never tried quitting. How on earth is that even remotely relevant? This is just another example of how he is just throwing irrelevant numbers and data at us, trying to make them look like they support his invalid argument.

The reason the data in this study is irrelevant is of course the questions that have been asked when collecting the data:
  • "Have you ever tried cigarette smoking, even 1 or 2 puffs?"
  • "About how many cigarettes have you smoked in your entire life?"
  • "I plan to stop smoking cigarettes for good within the next…"
  • "During the past 12 months, how many times did you stop smoking for 1 day or longer because you were trying to quit smoking cigarettes for good?
  • "When was the last time you smoked a cigarette, even 1 or 2 puffs?"
  • "Which of the following tobacco products have you ever tried, even just 1 time?" (E-cigarettes were one of the answers)
  • "During the past 30 days, which of the following tobacco products did you use on at least 1 day?" (E-cigarettes were one of the answers)

Remember what they're trying, or rather should be trying to find out here: Do e-cigarette users that have never smoked before, start smoking? So why didn't they ask all the smokers in the survey this question: "Did you start using e-cigarettes before you started smoking?" Isn't that the obvious question? To me it is. So why wasn't it asked? Because Dr. Glantz already knew what answers he would get, and they really don't help his case. Dr. Glantz concludes that e-cigarettes are encouraging young people to start smoking, and smokers to keep smoking, rather than discouraging them. This means we should see an increase in tobacco consumptions. But the numbers are showing quite the opposite, here presented by Dr. Siegel: http://goo.gl/bHZY1s. Despite the fact that more and more young people are trying e-cigarettes, the decline in tobacco consumption is accelerating. This also supports my post from a couple of days (http://goo.gl/KZEHnK) ago where I argue that vaping replaces smoking, both by enabling current smokers to quit or cut down and by giving young people an alternative so they don't start.

By collecting a bunch of irrelevant answers, and turning them into irrelevant numbers, Dr. Glantz has successfully shown that vaping and smoking is associated with each other, cause people use e-cigarettes to quit smoking, or as an alternative to smoking... nothing more. Thank you Dr. Obvious.

(Dr. Glantz is not the first one to do this by the way: http://goo.gl/4gR10M)

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