Another day, another lie by Glantz

Sorry for the re-use of this photo, but I really
can't be bothered to find another one of Glantz

Stanton Glantz is really on fire these days. Today I noticed he proudly proclaimed that some of his friends have done another longitudinal study shows that kids at low risk of smoking who use e-cigs are a lot more likely to progress to cigarettes. Using his computer skills to make some of the text bold, and thereby, in quite a clever way I have to admit, he's able to emphasize his point and what he thinks his friends have proven with this study:

What they found was that the kids who used e-cigarettes were 8.3 times more likely to be actual smoking cigarettes a year later.

Oh, really? Is that what they actually found? Well apparently they think they did. From the "At a Glance"-section of the study:

In analyses that controlled for all covariates, baseline e-cigarette use was independently associated with progression to smoking (adjusted odds ratio [AOR], 8.3; 95% CI, 1.2-58.6) and progression to susceptibility (AOR, 8.5; 95% CI, 1.3-57.2) among initially nonsusceptible nonsmokers.

Hmm... this doesn't smell right? In what way did they twist reality to come up with those numbers? I have to admit I kind of cheated a bit and went straight on to Michael Siegels blog to see if he had already read the study and pointed out the lies. Of course he had, and he confirms a sneaking suspicion I had: They've created an alternative definition of a smoker. Well actually, from what I can see (I haven't really read the study that well yet), they don't really define a cigarette smoker in the study but rather a cigarette smoking initiator. Still they write about this as if they were the same thing. So what is a cigarette smoking initiator then?

... a cigarette smoking initiator, defined as someone who has smoked at least 1 puff of a cigarette in her or his lifetime

Oh? By that definition I'm actually still a smoker, right? Actually I think I remember taking a puff of my mothers cigarette when I was like 6 (sorry mum, I don't think I ever told you that), so I've been a smoker since I was 6 then. No wonder I was in such a bad shape when I hit 25. I'm also pretty sure my teenagers are alcoholics as I know for a fact they have tasted beer. Oh, Lord...

I guess most people can see why such a definition of smokers by itself makes this whole study was total waste of time, and the published results nothing more than a big fat lie. If you don't, or just want a good read, I recommend reading Dr. Siegels thorough explanation here.

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Glantz confirms vaping will have a positive impact on public health

Dr. Glantz, closing his eyes as usual

Our dear friend, Dr. Stanton Glantz has once again published a "study", claiming that e-cigarettes and vaping will have a negative effect on public health. But in fact it can be viewed as a strong argument for the opposite, that vaping will have a very positive impact. I'd say the title of his press release (or whatever this is) says it all: "Ecigs likely to have negative population health effects if more than 20-30% as bad as cigs". In other words, since e-cigs are nowhere near 20% as bad as cigs, but are estimated to be at least 95% less harmful, we're not going to see any negative health effects, but rather hugely positive ones.

I have to admit I haven't really read Glantz' study thoroughly, cause when I read his statement about it, the one I linked to above, I realized pretty quickly it simply does not study anything close to reality. In fact I do not believe Dr. Glantz possess the ability to relate to reality at all. He lists the following "interacting effects" of the introduction of e-cigarettes:

• Some people are switching to ecigs
• Some people end up continuing to smoke cigs because of dual use with ecigs
• Some people (kids and young adults) initiate nicotine use with ecigs, some of whom go on to smoke cigs
• The actual long-term risks of ecigs are not known, but there are reasons to think that they could be substantial (albeit lower than cigarettes).

Well, he might have a tiny grasp of reality anyway, since he have actually noticed that people are switching to e-cigarettes. But it stops there, as you can see. Blaming e-cigarettes for keeping people smoking makes about as much sense as blaming diet coke for all the obese people in the world. I mean, if it had not been for diet coke, they'd all be salad eating, marathon running fitness experts by now right? Besides, if this was to be true, wouldn't this apply Glantz' beloved nicotine gum and patches as well? I mean... we can't just lay it all on diet coke, water will have to take some of the blame as well. Also, Glantz seems to be one of the few people that haven't given up on the gateway theory yet. I'm not even going to go into that, as we still haven't seen a single gateway case yet, at least not in our version of reality, and the theory have been debunked so many times by now that I've lost count. The last "interacting effect" Glantz lists is also the reason for him believing that the headline of his article (or press release or whatever) is actually a bad thing. He actually believes, contrary to all common sense and the rest of the world, that e-cigs could actually be 20-30% as bad as cigs. I don't even think the WHO believes that. In fact, it turns out that Stanton would be surprised if he was wrong and the rest of the world was right:

The key finding of the paper is that under all the likely scenarios, if ecigs turn out to be 20-30% as dangerous as conventional cigarettes there will be net harm.  No one know what the actual risks will be, but I would be surprised if the risks are not at least that high.

This is about where I stopped reading. I can think of a gazillion other things to read if fiction was what I was after.

Glantz telling us why vaping is a great idea

In the beginning of this month I wrote a post about an article written by Tore Sanner and Tor K. Grimsrud, where they try to convince Norwegian politicians to heavily regulate e-cigarettes, in reality handing the market over to Big Tobacco. Pretty much the same kind of propaganda we're used to from Stanton Glantz, with conclusions drawn out of thin air, preferably backed up by some graphs and data that has nothing to do with the conclusion whatsoever. I mentioned back then that it's been a while since I had heard from Glantz, but a couple of days ago I saw what he's been working on: A study titled "The smoking population in the USA and EU is softening not hardening".

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:

Notice how the graph seems to start flattening out in the 90's, just like the "the hypothesis of hardening as smoking prevalence drops" says. But then something happens that makes the graph start dropping again. Which product do you think hit the American market around the time you see the graph start steepening downwards again?

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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Norway's biggest Stanton Glantz-fans strikes again!

It's been a while now since I've seen our dear Stanton Glantz spread his anti-vaping propaganda all over the internet. Maybe that's also the reason why a couple of his (apparently) biggest Norwegian fans decided to take matters into their own hands, trying to convince Norwegian politicians to regulate e-cigarettes to death by publishing their own far fetched version of reality. Tore Sanner and Tor K. Grimsrud has published an article in "Tidsskriftet for den norske legeforening" (Journal of the Norwegian Medical Association) that is so full of misinformation that I think the fact that these guys still can call themselves professor (emeritus) and dr. med., respectively, is no less than a tragedy. It's not the first time Sanner and Grimsrud publishes anti-vaping propaganda by the way. I've written about a couple of publications earlier here and here.

I'm not sure how good the google translation of the article will be, but I'm sure you'll be able to pick up the most important points. I'll translate and comment them here anyway. Let's start from the top shall we? Well actually there is some description of how e-cigs work first but then they start out with this, just to set the mood:

It is predicted that the current major tobacco manufacturers will soon dominate the market for e-cigarettes and sales in ten years will exceed the sales volume of conventional cigarettes.

Well, that doesn't seem to be happening in the real world now does it: http://goo.gl/CiLBBB. The source of this prediction is apparently an article from 2014 (with our dear friend Neal Benowitz who was thrown of the FDA TPSAC because of conflicts of interest as a co-author by the way). Actually this prediction might not be far from the truth if Sanner and Grimsrud gets it their way with heavy regulations that will favour Big Tobacco and kill all the competition, but if they don't it seems a lot more likely now that the independent vaping industry will dominate the market.

Then there is a whole paragraph on accidents and health effects where they talk about fires, poisoning, diacetyl, formaldehyde, acute effects of vaping and harmful effects of nicotine. They even throw in some words about e-cigs being used to do drugs, just so everyone will understand how dangerous this is. I haven't had time to go through all their references on this but when reading the next paragraph on passive exposure I noticed one of the passive exposure studies criticised by Dr. Farsalinos (Ballbè et al) was referenced so I bet most of their sources have been debunked thoroughly already. So I'll just skip that part. As for the e-cigs-used-to-do-drugs-part, I've covered this before here.

Moving on to the parts that worries me, frustrates me and makes me the most angry. Because these guys are not done with the gateway theory yet:

In a new Swedish study found that youth who had tried smokeless tobacco when they were 12-13 years old, had 3.4 times higher risk than others to be smokers when they were 17 to 18 year old. It is tempting to imagine that nicotine dependence has played a role here. In light of this, we must assume that young people who start with e-cigarettes also have an increased risk of later start smoking.

This shows how little contact the authors have with reality. Calling themselves experts on smoking and cancer and whatever, they still fail to mention that nicotine in itself is not very addictive. And even if it was, there is still no plausible reason why anyone would switch from a harmless, great tasting product to a deadly one that tastes like shit. It just doesn't make sense, and reality confirms this. The anti-vaping movement has been trying to convince us that e-cigarettes is a gateway to smoking for years, and they've spent an enormous amount of money on so called research to do this. But still they haven't found the only proof they need: A smoker that started out vaping. To me it seems like most of them has given up on this by now, focusing on the enormous amounts of young people that will start vaping and what horrible effects it will have on them, but Sanner and Grimsrud are a couple of stubborn bastards. But make no mistake, they also worry about never-smokers starting to use e-cigarettes, especially young people and kids: 

When e-cigarettes hit the market, it was mainly those already smoked, who tried the products. Later the use spread to never smokers, particularly young people. In 2013 6.8% of the population in the US used e-cigarettes. The use among young adults (18-24 years) was the highest, 14.2% of this age group used e-cigarettes.

According to a survey conducted in the UK 3% of the population used e-cigarettes regularly in 2010, while the proportion in 2014 was increased to 18%. 6% of children in the 10-11 age in Wales had tried e-cigarettes.

Let's have a look at a couple of their sources for this information, a study by McMillen et al and an ASH report from 2014. The study states in the result summary: "However, 32.5% of current electronic cigarette users are never- or former smokers." In other words this study does not differentiate between never-smokers and former smokers (quitters), which obviously (to anyone but Sanner and Grimsrud at least) makes it totally irrelevant in this context. What about the ASH report then? It states this in the summary:

Electronic cigarettes are proving more attractive to smokers than NRT while providing them with a safer alternative to cigarettes. There is evidence that they can be effective in helping smokers’ quit and little evidence that they are being used by never smokers.

So we really should worry about never-smokers starting to vape, shouldn't we? Sanner and Grimsrud presents numbers showing that e-cigarette usage is increasing like it is something very worrying. What they deliberately fail to mention is that this increase represents smokers trying to quit. Actually a big bunch of them has succeeded as well. I say deliberately fail to mention this, because if they really didn't know this it means they haven't even read their own sources. Even as little as I trust these guys I still think they've done that. They should also be interested in this years ASH-report that, again, confirms the fact that never-smokers don't start vaping: 

Regular use of the devices is confined to current and ex-smokers and use amongst never smokers remains negligible.

Sanner and Grimsruds conclusion is (no surprise) built an all these false conclusions drawn from more or less irrelevant and unreliable sources. Actually it looks to me that some of these sources have been included just for one single number or percentage, while ignoring the fact that they conclude totally opposite to Sanner and Grimsrud.

What we fear is the increased use of e-cigarettes among young people. Many can later start smoking, which can be seen among young people who have used snus. To prevent a "normalization" of smoking, we believe it is important not to allow the use of e-cigarettes in places where it should be smoke-free. Moreover, plain packaging is required, in the same way as for tobacco products. The price has the greatest impact on young people, and it is important that a sufficiently high fee is imposed on e-cigarettes.

As you can see, their suggestion is to hand the white market over to big tobacco, and make sure a totally unregulated black market emerges that will contain all the product that really work plus a good portion of dangerous ones. As if taxing e-cigs as we know them to death wasn't enough, they've even added plain packaging to make absolutely sure we minimize control, safety and tax income in addition to keeping as many smokers as possible smoking. Good God...