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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Authors of e-cig formaldehyde junk science: "We just wanted to get it out"

I'm sure you can find something
dangerous in that glass of 
water, Dr. Pankow. Use your 
imagination!

Last week we saw another formaldehyde scare story hit the news, with a couple of so called scientists proving nothing more than this: If you crank up the voltage of your vaporizer until it starts tasting like shit, and keep on vaping it, you might inhale some formaldehyde as well. In other words, if you intentionally want to inhale formaldehyde, it is perfectly possible to do so using some of the e-cigarettes available today.

The fact that the only vaper in the world that would willingly do that is a robot in Dr. Peyton and Dr. Pankow's lab is not the only problem with this study. In fact, the good doctors themselves goes a long way in saying that their study is shit. Some of their statements are summarized in this great post on reason.com: Does Formaldehyde Make E-Cigarettes Worse Than the Real Thing?

Pankow told NBC "we are not saying e-cigarettes are more hazardous than cigarettes," although that is the impression left by the NEJM letter. He noted that "we are only looking at one chemical" out of the thousands that can be found in tobacco smoke, of which hundreds are toxic or carcinogenic. "The jury is really out on how safe these drugs are," he said. According to Reuters, "Pankow conceded that the study could have contained more context about overall relative risk, but said the authors 'just wanted to get it out.'"

Wow, hang on there... so "just wanting to get it out" is now an excuse to publish science that is so bad that even Dr. Neal Benowitz, one of the scientist thrown off FDA's TPSAC (FDA Tobacco ProductsScientific Advisory Committee) because of... well corruption, questiones the legitimacy of some of it's conclusions (have a look at Reuters article mentioned in the quote above):

But he questioned the legitimacy of comparing the effect of formaldehyde delivered in a cigarette to that delivered via hemiacetal, in droplet form, in an e-cigarette. The effect on organs could be entirely different, he said. 

And, one of our dear doctors even agrees with this:

"There has never been a cancer study with hemiacetals," Pankow said in an interview.

In other words: We don't really have any proof of anything, so we just made up a conclusion "to get it out". Dr. Farsalinos was also quick to point out this error in his initial reaction to the study.

I'm seriously having problems deciding who I think is the biggest idiots here. The "scientists" deciding to publish this because they "just wanted to get it out" (how the hell did they get their PhDs anyway?), or the media? Like NBC that decided to go with this headline based on something that a couple of junk scientist just wanted to get out:

Before You Vape: High levels of Formaldehyde Hidden in E-Cigs

For now I think I'm just going to count them as equally useless. The saddest part is that neither has said or done anything to make this right yet as far as I know.