I've been trying to make sense of what he's trying to say here, a difficult task in itself as most of it quite simply does not make sense, but I do believe the essence in his message is that if smoking prevalence goes down, quit ratios and quit attempts go up. Kind of a snowball effect or something like that. So basically there is no need for e-cigarettes or harm reduction for that matter.
It has been argued that as smoking prevalence declines in countries, the smokers that remain include higher proportions of hardcore smokers who are unwilling or unable to quit.This is what Glantz call "the hypothesis of hardening as smoking prevalence drops", and he claims that his study has rejected this hypothesis. To me that hypothesis sounds very logical. It quite simply says that the as the people finding it easiest to quit, quit and the ones left smoking are the "hardcore" smokers that find it hard to, or does not want to quit. So the smoking prevalence graph will flatten out in time. Makes sense, but now here comes Glantz claiming to have evidence that this is not true. He actually goes even further and says that the graph will become steeper. If he really has found evidence of this it would be remarkable, sensational actually... so lets have a look at the evidence. I think looking at the "limitations" part of his publication is a good idea:
Concerning the use of the quit ratio as one of our outcome variables, it is important to remember that we do not know when these people quit; the successful quit could have been at any point prior to the survey (not just the current year), so the relationship between quit ratios and prevalence is reflecting the integrated effects of the long-term changes we are documenting, not necessarily behaviour in a specific year.Soooo.... the quit ratio graphs in the study basically... well ... uhm ... why did you include them again? To show that quit ratio goes up, right? But you haven't really got any data to support this so you included something else instead hoping that no-one would notice didn't you, Glantz? So basically Glantz is left with his quit attempt graphs then, which proves that more and more people are trying to quit. And then:
The population-level data used in this analysis do not include individuals who are institutionalised or homeless. It is, however, among at least some of the segments of such populations where disproportionately more and heavier smokers can be found. Hence, the surveys we use might not include a portion of those who would be characterised as hardcore smokers.What were you trying to prove again? That hardcore smokers will "soften" right... so why not exclude them from the survey to make it a bit easier, shall we? It's quite amusing, or sad, or both, that this last quote is written right above the conclusion stating that they've proven that these hardcore smokers are softening up. So in other words, as you can see, Glantz is just twisting and turning his background data, picking out parts he think might be confusing enough to back up his agenda and (amazingly) he is allowed to keep his job.
Now, I just found out that the always excellent Dick Puddlecote has written a post on this matter as well. It is a great read, and Dick points out that since Glantz has proven that more and more people are trying to quit, but the (real-life) graphs still have been flattening out, Glantz has actually managed to prove that less attempts are successful. In other words he has proven himself wrong. And I think the graph showing smoking prevalence California, Glantz' own state, is quite interesting as well:
Stanton Glantz set out to prove that e-cigarettes are not needed because smokers will quit anyway (or something like that), but he have ended up showing us why vaping is such a great idea. Thank you Dr. Glantz.
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