Fake Science Denying the Relative Safety of Smokeless Tobacco Cost Millions of Lives; Don’t Repeat that Error with New Smoke-Free Products

 

Dr. Jay Bhattacharya, recently confirmed as director of the National Institutes of Health, tweeted on November 23, 2024, “If the NIH were serious about the replication crisis, it would devote a significant chunk of its budget to funding replication studies by independent researchers and require NIH funded researchers to make research materials available to replicators.”

I welcomed that statement because, over the past decade, my colleague Nantaporn Plurphanswat and I have challenged distorted and blatantly false studies concerning safer tobacco products (examples here, here, here and the list below).  Those efforts followed my earlier work with other authors on similar flawed research articles, but together they addressed only a fraction of defective FDA/NIH-sponsored tobacco research.  Because replication is time-consuming, it detracts from the performance of original research; additionally, findings are rarely published, and they often draw derision from the original authors and the research establishment. 

One might ask, why bother to address bad studies?  I answer that question in a new Sensible Medicine article titled, “Defining the Risk of Oral Tobacco Products,” in which I focus on the false narrative of a 1981 New England Journal of Medicine study that fatally undercut the fact that smokeless tobacco is vastly safer than cigarettes.  As a result of the 1981 publication, millions of smokers were denied information that could have extended their lives. 

Repeating that deadly error with vapor products, heat-not-burn tobacco and nicotine pouches will cost millions more lives.

 

 

List

Plurphanswat N, Rodu B.  Is the smoking population in the United States really softening?  Addiction, 2016 Jul;111(7):1299-303. doi: 10.1111/add.13340. Epub 2016 May 13. http://www.ncbi.nlm.nih.gov/pubmed/27177450

Farsalinos K, Rodu B.  Metal emissions from e-cigarettes: a risk assessment analysis of a recently-published study.  Inhalation Toxicology 2018. https://pubmed.ncbi.nlm.nih.gov/30384783/ 

Rodu B, Plurphanswat N.  A re‐analysis of e‐cigarette use and heart attacks in PATH wave 1 data. Addiction, First published 13 August 2020.  https://pubmed.ncbi.nlm.nih.gov/32794213/

Rodu B, Plurphanswat N. Heterogeneity and other problems in a pooled analysis of snus use and mortality. F1000Research 2021, 10:388 (https://doi.org/10.12688/f1000research.52127.1 )

Rodu B, Plurphanswat N.  Cross-sectional e-cigarette studies are unreliable without timing of exposure and disease diagnosis. Internal and Emergency Medicine 18(1):319-323, 2023. Epub 2022 Nov 25. https://link.springer.com/article/10.1007/s11739-022-03141-3

Plurphanswat N, Selya A, Rodu B. Questionable effects of electronic cigarette use on cardiovascular diseases from the National Health Interview Survey (NHIS, 2014-2021). Cureus 2024. DOI:10.7759/cureus.57119. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11055619/

Rodu B, Cole P.  Excess Mortality in Smokeless Tobacco Users Not Meaningful (Letter).  American Journal of Public Health 85:118, 1995. https://pubmed.ncbi.nlm.nih.gov/7832248/

Rodu B, Cole P. A deficient study of smokeless tobacco use and cancer (letter).  International Journal of Cancer 118: 1585, 2006.  https://pubmed.ncbi.nlm.nih.gov/16206262/

Rodu B. Snus and the risk of cancer of the mouth, lung, and pancreas.  Lancet 370: 1207, 2007.  https://pubmed.ncbi.nlm.nih.gov/17920914/

Rodu B, Heavner KK.  Errors and omissions in the study of snuff use and hypertension (letter).  Journal of Internal Medicine 265: 507-8, 2009. https://pubmed.ncbi.nlm.nih.gov/19019185/

Rodu B, Heavner KK, Phillips CV.  Snuff use and stroke (letter).  Epidemiology 20: 468-9, 2009.  https://pubmed.ncbi.nlm.nih.gov/19363361/

Rodu B, Plurphanswat N, Phillips CV.  Discrepant results for smoking and cessation among electronic cigarette users (letter).  Cancer 2015 Mar 4. doi: 10.1002/cncr.29307. https://pubmed.ncbi.nlm.nih.gov/25740231/

Rodu B, Phillips CV.  Regarding “Discontinuation of Smokeless Tobacco and Mortality Risk after Myocardial Infarction” (letter).  Circulation 2015 Apr 28;131(17):e422. doi: 10.1161/CIRCULATIONAHA.114.012038.  https://pubmed.ncbi.nlm.nih.gov/25918044/

Rodu B.  Re: Smokeless tobacco use and the risk of head and neck cancer: pooled analysis of US studies in the INHANCE consortium.  American Journal of Epidemiology 2017.  https://pubmed.ncbi.nlm.nih.gov/28911014/

Rodu B, Plurphanswat N.  Response to Bhatta and Glantz.  Addiction First published: 13 August 2020. https://pubmed.ncbi.nlm.nih.gov/32794301/ 

Rodu B, Plurphanswat N.  Gaiha et al. disregarded conventional publishing standards (letter).  Journal of Adolescent Health 68;215, January 1, 2021. https://www.jahonline.org/article/S1054-139X(20)30566-8/fulltext 

Plurphanswat N, Rodu B.  “Association between electronic cigarette use and fragility fractures among US adults” contains significant errors.  American Journal of Medicine Open 8: December 2022, https://doi.org/10.1016/j.ajmo.2022.100017 

Rodu B.  Methods questions.  Tobacco Control June 12, 2023. https://tobaccocontrol.bmj.com/content/early/2023/03/20/tc-2022-057717.responses 

 

Rodu B.  The many dangers of e-cigarette misinformation. Oral Surgery Oral Medicine Oral Pathology 2024.  https://www.oooojournal.net/article/S2212-4403(24)00893-9/fulltext  

 

 

Video on the Bad Science That Keeps Smokers Smoking, and Dying

 

I recently participated in a panel discussion about tobacco harm reduction (THR) at the Tobacco Merchants Association meeting.  While assembling my powerpoint presentation, I recalled that I presented to this group 18 years ago, in 2006, what was likely their first introduction to THR. 

To view my 10-minute primer on bad science – then and now – watch this video, starting at the 26-minute mark.  I discuss the genesis of the myth that smokeless dip and chew products present a high risk for mouth cancer (discussed extensively in this blog by searching for “Winn”), and my THR team’s attempts to correct fatally flawed vaping research articles.    

I’m happy to provide the slides upon request.    

For Women’s History Month, Noting a Historic Misrepresentation of Mouth Cancer in Women

 

This post honors Women’s History Month by focusing on a subject long-neglected by government-funded cancer investigators:

Why do American women who use smokeless tobacco have 10 times the risk for mouth cancer compared with American men who dip and chew tobacco?

This question arose in 2016, when Annah Wyss of the National Institute of Environment Health Science and 20 government-funded coauthors reported that American men had no excess mouth cancers associated with dipping or chewing tobacco (Odds Ratio, OR = 0.9), while American women, who mainly used powdered dry snuff, had ten times the risk (OR = 9) (here). 

Those findings weren’t outliers.  Epidemiologist Philip Cole and I in 2002 published a meta-analysis of smokeless tobacco and oral cancer (abstract here), concluding: “The use of moist snuff and chewing tobacco imposes minimal risks for cancers of the oral cavity and other upper respiratory sites, with relative risks ranging from 0.6 to 1.7. The use of dry snuff imposes higher risks, ranging from 4 to 13.”

Why did those 21 government-funded researchers, including one Debora Winn and at least seven other women, ignore these major differences?

Winn, as the first author of an epidemiologic study 43 years ago in the New England Journal of Medicine (abstract here), reported that “exceptionally high mortality from [oral cancer] among white women in the South is primarily related to chronic use of snuff. The relative risk associated with snuff dipping among white nonsmokers was 4.2.”  That study led the public and the medical establishment to falsely believe that smokeless tobacco was responsible for an American oral cancer epidemic. 

Winn had exaggerated her own findings. She claimed that smokeless tobacco produced an “exceptionally high mortality from [oral cancer],” even though her risk estimate only resulted in approximately 12 deaths per year among 100,000 long-term smokeless tobacco users. That mortality rate is not trivial, but it is not “exceptionally high.” It is comparable to the annual death rate of 12 -15 per 100,000 users of automobiles – a figure that does not deter American drivers.

Exaggeration is unacceptable, but Winn’s study has a special place in the annals of American smokeless tobacco misinformation. It focused solely on a niche tobacco product -- powdered dry snuff -- used by a tiny number of women in the southern U.S. But this passage in Winn’s article assigned dry snuff’s risk to all smokeless products: “The carcinogenic hazard of oral snuff is of special concern in view of the recent upswing in consumption of smokeless tobacco in the United States.” This misleading statement was featured in an AP wire story that was published throughout the nation.

Winn’s results actually did not apply to chewing tobacco and moist snuff, popular American smokeless products that have been used widely with significantly fewer medical consequences than powdered dry snuff. Long after her widely cited article was published, Winn acknowledged in two obscure scientific forums that her results were specific to powdered dry snuff. In 1986, Winn was asked whether the patients in her study had used “dry snuff or [moist] snuff.” She replied, “Almost exclusively dry snuff,” and then admitted that “Dry snuff is now [in 1986] a minor portion of the U.S. market.” Her late acknowledgment at a sparsely attended scientific meeting did nothing to deter tobacco prohibitionists from misapplying her mortality claims to all smokeless products, and to misdirection health professionals and the American public for the next 40+ years.