Stanton Glantz’s Tainted Science: The Rest of the Story

 

Journalist Marc Gunther recently authored articles for Undark (here) and Medium (here) about “The tainted science of Stanton Glantz.” 

It is evident that Gunther interviewed or corresponded with numerous Glantz research critics. Gunther’s sources include the author of this blog, who provided extensive documentation of Glantz’s questionable work. However, since Gunther fails to tell the whole story, I will provide the rest of it here.

Fake Heart Attacks

The most important items in Gunther’s articles are his descriptions of Glantz’s flawed heart attack study that appeared in the Journal of the American Heart Association – a work that was retracted eight months after its publication in June 2019. Gunther described that study and its repercussions in his Undark article as follows:

“…when describing the second study, published in 2019 in the Journal of the American Heart Association, Glantz said it provided ‘more evidence that e-cigs cause heart attacks.’… Critics pounced on what they called glaring flaws in the analyses. Some of the e-cigarette users had previously smoked, for example, muddying the correlation. Brad Rodu, a University of Louisville professor who has numerous and longstanding connections to the tobacco industry, dug into the raw data and found that at least 11 of the 38 heart-attack victims cited in the Journal of the American Heart Association study had suffered their heart attacks before they started vaping — some as many as 10 years before. Glantz was made aware of the temporality problem before publication because it was raised by a peer reviewer, the journal’s editor subsequently realized.

 

“Sixteen tobacco researchers wrote to the journal editor asking for a retraction, and the Journal of the American Heart Association ultimately did just that — something it has done only a handful of times in its history. Its editor, though, was careful to state in a letter to Glantz that ‘the retraction notice is intentionally absent of any language suggesting scientific misconduct.’

 

“Andrew Gelman, a professor of statistics at Columbia University who followed the controversy on his blog, was unimpressed with Glantz’s response to the retraction, calling it ‘anti-scientific.’ He wrote: ‘If someone points out an error in your work, you should correct the error and thank the person. Not attack and try to salvage your position with procedural arguments.’”  

Gunther is correct: I had discovered that Glantz deliberately deceived the journal’s editors and readers by counting heart attacks before people had vaped. My comments on this appeared in a USA Today article by Jayne O’Donnell on July 17, 2019. O’Donnell wrote, “However, when Rodu obtained the federal data, he found the majority of the 38 patients in the study who had heart attacks had them before they started vaping — by an average of 10 years earlier. In his letter to the editors [dated July 11, 2019], Rodu called Glantz's findings ‘false and invalid…Their analysis was an indefensible breach of any reasonable standard for research on association or causation…We urge you to take appropriate action on this article, including retraction.’” (emphasis added) 

As noted, I publicly called for a retraction on July 17, 2019. But Gunther credited the retraction to “sixteen tobacco researchers,” linking to a letter they wrote to the journal editor on January 20, 2020. In the USA Today article I also called for a federal investigation, and I followed up a year later with a full analysis of the fraudulent findings, which was published in the journal Addiction (discussed here). 

Gunther correctly cited influential statistician Andrew Gelman. I had corresponded with Gelman in 2018 about Glantz’s woefully defective Pediatrics study, which also elicited a retraction demand from me (here, here, here and here). Gelman’s account of our correspondence is here (see Episode 1). Three months before Pediatrics retracted the study, Gelman ran the analysis of it that I had recommended to researchers world-wide in November 2019. 

In his Medium article, Gunther identifies a group of “respected veterans of the anti-smoking movement (Steven Schroeder, Ken Warner, David Abrams, Raymond Niaura and [Michael] Siegel),” and he provided links to their university profiles. Later in the article, he attributes the JAHA retraction to “other scholars”, followed by a comment from me, who he characterizes again with “whose work has been supported by the tobacco industry.” Gunther makes no mention of my 27 years of research into tobacco harm reduction, and provides no link to my university webpage profiles (here and here). 

Perhaps Gunther was influenced by the established (anti-) tobacco research and policy community, some of whom switched to support safer products only after e-cigarettes became popular. Gunther writes that they tolerated Glantz’s defective studies.

“‘Stan has always been an advocate and ideologue willing to twist the science,’ says David Abrams, a New York University professor and veteran tobacco researcher. He says that some scientists ignored flaws in his work when Glantz focused on combustible tobacco because they, too, strongly opposed smoking. ‘Frankly, none of us cared if he was a little bit sloppy with his research because the ends justified the means,’ Abrams says.” 

I never tolerated Glantz’s flaws and sloppy research, and I published numerous critical comments in journal forums and in my blog starting in 2004. Gunther mentioned two examples but did not acknowledge the active role I played in correcting Glantz’s record.

Fake Teen Gateway

Gunther’s biggest error is his description of Glantz’s “2018 study in Pediatrics, [which] also claimed that e-cigarette usage encourages more young people to smoke…a gateway effect, but the alleged link between vaping and smoking disappeared when other teen behaviors, such as using marijuana, were taken into account.”

I replicated that study’s analysis and proved that Glantz’s team had fabricated false results, which I described in detail in a letter to the editors that included a call for retraction (here). That led to an extended exchange with Glantz and Pediatrics editors, with the latter going to great lengths to defend the flawed research (here, here and here).   

The “Helena Miracle”

Gunther noted the “Helena miracle”, in which Glantz credited public smoking bans for a decrease in hospital admissions for heart attacks in the small Montana town. Gunther wrote, “The small sample size in Helena — four cases per month during the ban, compared to seven beforehand — should have raised red flags; random fluctuations could have explained the drop in hospital admissions.” As I had told Gunther, bright red flags were raised by me in comments to the BMJ in 2004 (here) and 2006 (here). My analysis showed that the number of hospital admissions in Helena and other miracle localities was so small that “the relevant question is whether [the Helena] report involves anything more than random variation.” (here)

I attempted to reproduce Glantz’s tiny city reports by conducting an analysis using state-wide data. My study, published in 2011 (discussed here), was subsequently referenced by other researchers (here). I found that rates of death due to heart attacks in states with smoking bans were no different than those in states with no ban, and that heart attacks had been declining everywhere for years. The last point is something Glantz never took into account; in fact, he freeloaded his second-hand smoke heart-attack results on the decades-long downward trend in heart attack rates.

Fake “Softening” of the Smoking Population

In 2015, Glantz proclaimed in Tobacco Control that there is no public health basis for advising smokers that smokeless tobacco and e-cigarettes are safer cigarette alternatives, because the smoking population in the U.S. was “softening”, i.e., becoming more likely to quit (abstract here). Once again, I found that his analysis was seriously flawed, as he failed to consider a number of other significant factors. My research group recreated his analysis and took into account the missing factors; we found that Glantz’s “softening” disappeared.  We published our study in the journal Addiction (discussed here). 

Other Glantz Publication Problems

Glantz Redefined Youth Smoking, 2014  https://rodutobaccotruth.blogspot.com/2014/04/ucsf-redefines-youth-smoking-journals.html

Glantz Falsely Linked E-Cigarettes to Smoking, 2014 https://rodutobaccotruth.blogspot.com/2014/03/ucsf-study-falsely-links-e-cigarettes.html

Glantz Misrepresented IQOS Studies to the FDA, 2017 https://rodutobaccotruth.blogspot.com/2017/11/smoke-but-no-fire-iqos-opponent.html

Glantz Used Complicated Models to Try to Change NYTS Data, 2017 https://rodutobaccotruth.blogspot.com/2017/02/complicated-models-cant-alter-data.html

https://rodutobaccotruth.blogspot.com/2017/02/complicated-models-cant-alter-data-part.html

Glantz’s Failed Attempt to Link Teen Smoking to Cinematic Smoking, 2017 https://rodutobaccotruth.blogspot.com/2017/08/teen-smoking-unconnected-to-cinematic_30.html

Another E-Cigarette Gateway Claim by Glantz Based on Tiny Numbers, 2018 https://rodutobaccotruth.blogspot.com/2018/04/another-uc-san-francisco-e-cigarette.html

Trace Toxins in Teens Improperly Blamed on E-Cigarettes, 2018 https://rodutobaccotruth.blogspot.com/2018/03/beyond-headlines-trace-toxins-present.html

Federal Funds Misspent on Glantz’s Research, 2020 https://rodutobaccotruth.blogspot.com/2020/02/federal-funds-misspent-on-anti-vaping.html

 

Since 2006, the National Institutes of Health has funneled $51 million to Glantz at the University of California San Francisco. In addition to the flawed heart attack work, which may be viewed as research misconduct using federal funds, he published 300 other articles. I list above only the worst offenders and note my attempts to correct them.

 

 

2020 National Youth Tobacco Survey Introduced U.S. Youth to Heat-Not-Burn Tobacco Brands

 

Anti-tobacco crusaders continue to promote e-cigarettes and vape products to the nation’s youth.

ABC News has published a screed by University of Chicago pediatric resident physician Chidimma Acholonu in which she claims that “now a new smoke-free alternative called heated tobacco  is slowly gaining a foothold in the U.S. market…While heated tobacco products [known as heat-not-burn, HNB] only became legal in the United States in 2019, the device have [sic] already started to catch the attention of high school students.”

Dr. Acholonu credits unnamed “experts” for news that “Tobacco companies are attempting to glamorize these products.” How? Erika Sward, assistant vice president for advocacy at the American Lung Association, says, “[Tobacco companies are] attempting to make the packaging and the marketing look white and clear and clean and very modern.”

Huh? A teen HNB epidemic is going to be driven by white, clear, clean and modern packaging?

Dr. Acholonu is wrong when she says that HNBs “only became legal in the United States in 2019.” Reynolds’ Eclipse has been on and off the U.S. market for about 20 years, although it has never proven to be a viable substitute for combusted cigarettes.

Dr. Acholonu was probably referring to IQOS. The FDA authorized IQOS sales in 2019, and the agency approved a reduced exposure claim in 2020, saying its decision “is expected to benefit the health of the population as a whole.” IQOS has driven an unprecedented decline in cigarette consumption in Japan, and it is now available in more than 60 countries.

To analyze Dr. Acholonu’s claim that HNBs are catching the attention of high schoolers, let’s take a close look at the 2020 National Youth Tobacco Survey, which described HNB products this way:

“Some people refer to these products as ‘heat-not-burn’ tobacco products. Heated tobacco products heat tobacco sticks or capsules to produce a vapor. They are different from e-cigarettes, which heat a liquid to produce a vapor. Some brands of heated tobacco products include iQOS, glo, and Eclipse.”

Only 202 of the 14,531 students surveyed had used HNBs during the past 30 days, which represents about 1.4% of all U.S. middle and high school students. But there’s more.

The NYTS survey asked participants “Before today, have you heard of heated tobacco products?”  The survey provided a handy description, saying that HNBs “are different from e-cigarettes, which heat a liquid to produce a vapor.”  Just in case the kids were still unsure, the survey taught them some brands to look for: “Some brands of heated tobacco products include iQOS, glo, and Eclipse.” 

Over 11,600 (80%) of middle and high school students had not heard of HNBs. For these youths, the NYTS was their first introduction to iQOS, glo and Eclipse.

Let’s get back to the 202 HNB current users: 61 of them had never heard of HNBs “before today.” If they never heard of them, they didn’t use them, so they shouldn’t be counted. 

Now we have 141 HNB users, 67 of whom said they had used one or more of the following HNB flavors: clove, spice, chocolate, wine, cognac, cocktail flavors, candy, dessert, or sweets.  This is impossible, as IQOS and Eclipse are not sold in any of these flavors. Those 67 should not be counted.

Now we have 74 kids who said they are HNB users, which works out to be 0.4% of middle school students and 0.7% of high schoolers. With only limited availability of HNB products, it is likely that many of those respondents were mistaken, answering “yes” to the HNB question when they meant e-cigarettes or vapor products. In fact, among current HNB users, 60% were current e-cigarette users; only 14% were not using any other tobacco product.

In summary, the 2020 NYTS introduced large numbers of middle and high school students to HNB products for the first time. No amount of misinformation, like the ABC News story, can alter the facts about the phony “next teen tobacco epidemic.”

 

Campaign for Tobacco-Free Kids VP Heedlessly Promotes Teen Vaping in TV Interview

Anti-tobacco crusaders are doing a great job of promoting e-cigarettes and vape products to America’s youth, using cartoons, hip images, photos of kids vaping, and attractive illustrations of vape flavors. 

Now we have a five-minute Austin, Texas, Fox 7 TV interview (here) with Laurie Rubiner, Executive Vice President of Campaign for Tobacco-Free Kids. The clip is titled, “Advocates offer tips to parents on spotting e-cigarettes,” but “Teen Vaping Guide” would be more accurate.

Right off the bat, Rubiner displays a JUUL device (at 0:50), followed by a Puff Bar (1:02), in case any teens needed educating.  She slipped up by observing that JUUL “looks like a Zip drive.” That was a 3.5-inch floppy drive introduced in 1994 and largely out of use when today’s high schoolers were born. She meant a USB flash drive.

Rubiner notes that JUULs “are designed to be easily hidden,” and it’s “so easy for kids to put [Puff Bars] in their backpacks and hide them away.” Puff Bars, she says (1:10) “come in 15,000 kid-friendly flavors.”  The video offers helpful flavor images at 1:20, then again at 3:15 and 4:32. 

The real focus of the video are images of teens vaping. While Rubiner was clearly targeting JUUL, there were only two clips of JUUL users.  All other vaping scenes show kids emitting large white clouds, primarily from oversized non-JUUL devices. 

How many vaping scenes can air in under five minutes? I counted 42.

This is a powerful, clearly misguided, vaping promotion for a teen audience.  Campaign for Tobacco-Free Kids continues down its rabbit hole of offering tips to teens.