Thursday, February 29, 2024

Exposing Defective Research, But Denied Credit: Case 3


Over the years, I have documented cases in which my colleague and I exposed fatal errors in published articles about smoke-free products, but neither authors nor editors acknowledged our efforts.

The first case involved researchers at the National Cancer Institute and the University of Minnesota, whose Journal of the National Cancer Institute Cancer Spectrum article (here) reported on overall and cause-specific mortality among users of various tobacco products. The second instance involved an article about e-cigarettes and respiratory diseases in which the authors, including a former member of an FDA Tobacco advisory panel, had deleted data on over 27,000 ever e-cigarette users with no mention or explanation, among other problems (here.

In both cases, our criticism was accepted as legitimate by the authors and editors, but the parties defied medical publishing ethics when they failed to publicly acknowledge our work and, instead, made it appear that the errors were discovered by the authors.

That same sequence is now playing out again.

Dayawa Agoons and coauthors published a study on November 22, 2021, in the American Journal of Medicine Open claiming, “There was a graded increase in the prevalence of fragility fractures among sole conventional cigarette smokers and dual users of traditional and e-cigarettes [among 5,569 men and women in their sample].  Electronic cigarette use may be detrimental to bone health.”  They used data from the 2017-18 National Health and Nutrition Examination Survey (NHANES). 

Working with the same data, my colleague Nantaporn Plurphanswat and I discovered that Agoons had overcounted the eligible sample.  There were only 3,069 participants, not the reported 5,569.  On December 22, we submitted a letter to the editor calling for retraction, since none of the study results could survive a sample change of this magnitude.

Six months later, on June 8, I was informed by the editor-in-chief that our letter was accepted.  On June 29, I reviewed and proofed our letter in the Elsevier system, but then it disappeared. 

I wrote to Elsevier on October 18, saying, “I made these [copy editing] changes almost 4 months ago.  Please let me know why this article has not been published.”  I received the following reply on October 19:

“Dear Dr. Rodu,

“Many thanks for your email. Your article has not yet been finalised as we are still waiting for the Editor in Chief to submit their proof of your article. I have sent them a reminder that this needs to be done and will let you know of any updates.

“Best wishes,

Poppy Biggs

Journal Manager

ELSEVIER | Operations | Research Content Operations”

Today I learned that Agoons and colleagues published a corrigendum that includes completely revised tables and figure.  It was “Available online 16 June 2022,” which was eight days after the editor accepted our letter. 

The corrigendum states, “it has been discovered that the study included subjects that should have been excluded.”  Our letter forced the authors to delete nearly 45% of their original study sample, yet they wrote, “the magnitude/significance of [the original] results remains unchanged.”

Authors and editors who behave this way undermine the quality of their work.  We don’t have the resources to conduct a full re-analysis of Agoons’s corrigendum, but one glaring item suggests its poor quality: Their new figure is labeled with the NHANES years analyzed “2107-2018.” 

When editors and authors collaborate to cover up egregious mistakes, they undermine the integrity and scientific value of their work.



Thursday, February 22, 2024

Further Evidence That CDC’s National Youth Tobacco Survey Exaggerates Teen Vaping Rates


The National Survey on Drug Use and Health (NSDUH) is a valuable federal resource for population-level research on tobacco and other substance use.  Analyzing its data, I have published research on how many Americans smoke (here, here, here and here), the illegitimacy of the gateway claim (here), and the role of smoking and smokeless tobacco (ST) use in past-year psychiatric disorders (here).  I have shared in this blog other important NSDUH insights into how many Americans use ST (here), who smokes menthols (here and here), and teen smoking declines before and during the e-cigarette era (here and here).  I have also noted that federal officials use NSDUH to spin their prohibition narratives (here).

Today I report an important development: In 2021 and 2022, NSDUH collected information on vaping.  The chart at left presents the most important data from these surveys: smoking/vaping rates among high schoolers, compared to data from the National Youth Tobacco Survey (NYTS). 

Now we have further evidence that NYTS grossly exaggerates teen vaping rates.  The chart at left shows that NSDUH vaping rates in 2021-2022 among high schoolers are much lower than the rates reported in NYTS, which I previously demonstrated were higher than those reported in the FDA’s Population Assessment of Tobacco and Health Survey (here and here) and the federal Knowledge Panel (here). 

As I documented in a peer-reviewed journal (here), NSDUH adult smoking rates tend to be higher than rates reported from NHIS.  That result also holds true for high schoolers, as seen in the chart. 

My research has shown that the higher adult smoking prevalence estimates in NSDUH may be due to the survey’s inclusion as current smokers those persons who smoked as infrequently as one day in the past month.  That is not the case here, however, as NYTS also counts as current any high schooler smoking one day in the past month.

It is unsurprising that the CDC counts high school vapers using only the bloated NYTS survey, and that little research has been conducted to assess its accuracy.  Furthermore, government officials at the CDC and other agencies largely ignore legitimate surveys from NSDUH, PATH and Knowledge Panel when they should consider all available evidence before making claims about teen vaping.


Monday, February 19, 2024

Scaremongering’s Forever Effects


With the emergence of nicotine pouches, claims from the 1980s about the health risks of smokeless tobacco (ST) use have reappeared. Nicotine pouches are an important addition to smokers’ options for reducing harm, but it is inappropriate to devalue them by overstating the risks of ST use, such as opining that it causes leukoplakia and periodontal disease.  This is not the case, and I wish to set the record straight.


In 1995, my research group published an article, “Tobacco Use and Cancer,” that discussed leukoplakia: “Oral leukoplakia was originally defined in 1978 by the World Health Organization as a ‘white patch or plaque that cannot be characterized clinically or pathologically as any other disease.’ This definition was recognized as overly broad, and in 1984 a revised definition excluded white lesions such as frictional keratoses and also specified tobacco-induced leukoplakias as a distinct category. Furthermore, [ST keratosis, STK] was separated from smoking-related leukoplakia on the basis of presentation with additional differences in prevalence, frequency of dysplasia, and rate of malignant transformation. STK is common; it occurs in up to 60% of ST users.” (references omitted)

While anti-tobacco zealots never adopted the accurate terminology, preferring the scarier term leukoplakia, findings from 92 biopsies in one of these scaremongering studies were consistent: “All lesions were benign, but one specimen had mild epithelial dysplasia.”  The term mild dysplasia is subjective, so it’s likely that none of the findings were significant.

When our article was published, we were unaware that the infamous study by Winn et al. in the New England Journal of Medicine involved only women who had used powdered dry snuff (here).  That misleading study led nearly everyone, including health professionals, to mistakenly believe that moist snuff (dip) and chewing tobacco use among men causes mouth cancer.  For confirmation of that fallacy, see the October 2016 report by Annah Wyss of the National Institute of Environment Health Science and 20 government-funded coauthors (discussed here) that found that American men had no excess mouth cancers associated with dipping or chewing tobacco (Odds Ratio, OR = 0.9), while women, who mainly use powdered dry snuff, had a 9-fold elevated risk (here). 

Periodontal Disease

The CDC describes gum or periodontal disease as “mainly the result of infections and inflammation of the gums and bone that surround and support the teeth.”  The same scaremongering study cited above also reported that “gingival recession and attachment loss [4 mm or more] were greater in sites adjacent to lesions in [ST] users.”  These findings aren’t the same as infections and inflammation in and loss of the supporting bone, which is periodontal disease.  In fact, a comprehensive review by Kallischnigg et al. in BMC Oral Health concluded, “Two of four studies report a significant association of snuff with attachment loss and four out of eight with gingival recession. Snuff is not clearly related to gingivitis or periodontal diseases. Limited evidence suggests chewing tobacco is unrelated to periodontal or gingival diseases.” (emphasis added)

These two conditions, leukoplakia and periodontal disease, pale in comparison to lung cancer and heart attacks, so why am I focusing on them?  Because misinformation, particularly about safer smoke-free cigarette substitutes, has a dangerously long shelf-life.

I have dedicated the past 30 years to setting the record straight about ST use, but the American public remains grossly misinformed due to misinformation published decades ago.  For example, the National Cancer Institute Health Information National Trends Survey documents that 86% of Americans don’t believe – or don’t know – that ST use is less harmful than smoking (here).  Similar fake science now inundating the medical literature about newer smoke-free products, if not stopped, will have the same long-term effects. Public health and tobacco experts need to approach misinformation about tobacco risks as seriously as physicians counter quackery in medicine.