NEJM Fails to Correct Data on Children’s E-Cigarette Use

The New England Journal of Medicine and authors of a commentary on e-cigarette use (here) have ignored our call for correction of a substantial error regarding e-cigarette use among American schoolchildren in 2011 and 2012.  Authors Amy L. Fairchild, Ronald Bayer and James Colgrove of Columbia University double-counted some users in a figure they used to illustrate data from the National Youth Tobacco Survey (NYTS)(seen at left).

The commentary, published December 18, addressed the legitimate question, What is the appropriate public health goal: eradication of smoking or elimination of all tobacco products?

Clive Bates first raised the critical data error in a group email discussion; I responded because I had used the figure’s source data for blog posts earlier in December (here and here). 

Clive and I, along with my University of Louisville colleague Nantaporn Plurphanswat, submitted a letter to the NEJM editor on December 22.  We explained, “the [Fairchild] figure inaccurately represents data from the National Youth Tobacco Survey on use of cigarettes and e-cigarettes by U.S. students in 2011 and 2012 in a report from the Centers for Disease Control and Prevention (2). For example, the figure shows that 16.8% of high school students used either product in 2012. However, the correct percentage is 14.6% because of dual use, which was reported in another CDC publication (3). We submit a revised figure that accurately represents the information in both CDC reports.” (at left)

On February 19 Editor Debra Malina informed us that our letter and corrected figure would not be published. 

We subsequently sent an email request to Dr. Fairchild.  We advised that her figure was constructed incorrectly, noting, “it does not properly account for e-cigarette users who also smoke, and these are the majority.  Given this misconstruction, the chart should not be reproduced in its current form.  We have taken this up with the NEJM, but they do not wish to publish an alternative from us.  That being the case, the responsibility for amending the chart rests with you as lead author.   We urge you to submit a revised figure along the lines we included in our communication with the editor.  We attach our letter and revised chart and would be happy to discuss the underlying data (also available in the referenced CDC publications) that we used to create it.” Dr. Fairchild ignored that missive, and a March 3 follow-up email.

The NYTS survey has been subject to repeated and egregious abuse by anti-tobacco forces, all to serve the specious claim that e-cigarettes are a gateway to cigarette smoking. 

Tom Frieden, director of the Centers for Disease Control and Prevention, Dr. Tim McAfee, director of the CDC Office of Smoking and Health, and FDA Tobacco Center director Mitch Zeller started the gateway fallacy with reports and press releases, a tactic that I labeled “irresponsible theatrics” (here  ).  I also detailed how the CDC abused the data (here and here).

The inaccurate information in the NEJM is a dangerous error that can undeservedly gain traction through repetition.  This happened in 1981, when National Cancer Institute epidemiologist Dr. Deborah Winn misstated oral cancer risks related to smokeless tobacco (here and here).  Her erroneous data became gospel for anti-tobacco forces, despite her subsequent acknowledgement of the misstatement.

The NEJM is doing public health and science a disservice by refusing to correct the error.