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of Glantz’s flawed heart attack study that appeared in the Journal of the American Heart Association – a work that was retracted eight months after its publication in June 2019.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.

 

 

Another Groundless Gateway, Courtesy of Children’s National Hospital

 

Pediatrics, the flagship journal of the American Academy of Pediatrics, published an article two and a half years ago asserting that e-cigarettes are a “gateway” to smoking.  After extensively analyzing the data from the FDA’s Population Assessment of Tobacco and Health, or PATH, on which the claim was based, I concluded that the study was so flawed that it deserved retraction.  I discussed this in several blog posts (here, here, here and here).

Now it’s déjà vu all over again.  Pediatrics has published another article by researchers at Children’s National Hospital and other institutions that is being touted by a CNH press release: “E-cigarettes can be a ‘gateway’ to conventional cigarette smoking for teens who had no prior intention to smoke.”

The hyperbolic release has generated headlines like these:

“E-cigarettes Can Be A ‘Gateway’ To Smoking For Teens!!!

“Vaping Lures Teens to Smoking: Study”

“Study: Teens Who Vape Are 4 Times More Likely to Smoke Cigarettes”

 It doesn’t require extensive analysis to recognize this as nonsense.  Here’s what the authors actually determined:

Ever e-cigarette use, even one or two times, is associated with ever cigarette smoking, even one or two puffs, 12 months later, for teens who had no prior intention to smoke.

You read that correctly.  The press release and subsequent news articles magically transformed that into VAPING CAUSES SMOKING.

If you’re wondering how the authors defined “intention to smoke,” they used a definition that I discussed in a blog six years ago, which has renewed value today.

  

Pediatrics Journal Wants to Rectify Teen “Inaccurate Beliefs” About Smoke-Free Tobacco Hazards

In the journal Pediatrics, University of Vermont’s Maria Parker, Ph.D., and 11 coauthors from four other institutions report that “Youth [age 12-17 years] who believed that noncombustible tobacco products posed ‘no or little harm’ at [wave 1 of the FDA Population Assessment of Tobacco and Health Study, PATH] were more likely to have tried those products at wave 2.” (here)

This finding is not particularly surprising.  It shows that, despite a relentless campaign against vastly safer smoke-free tobacco products, some youth recognize the truth: It’s the smoke that’s harmful.  Dr. Parker found that 85% of youth thought cigarettes conferred “a lot of harm,” while only 27% thought the same of e-cigarettes.  On the other hand, only 51% thought e-cigarettes were less harmful than cigarettes, 44% assessed them as equally harmful, and 5% believed them to be more harmful.

Skewing their findings against smoke-free products, Parker et. al. used “ever trying” the products between survey waves as their outcomes.  This is much less meaningful than “currently using”, which was not reported and might have produced negligible results.  

The take-away from the article is that youth who [correctly] believe that smoke-free tobacco products are less harmful than cigarettes are more likely to try the former.  Parker et al. imply that trying can be prevented by disabusing teens of their “inaccurate beliefs.”

Even though the study's findings are inconsequential, its 12 authors use them to justify aggressive intervention by authorities “across local, state, and national levels…to convey accurate information on and address inaccurate beliefs about the absolute and relative harms of tobacco products in an effort to reduce youth tobacco use.”  They highlight the FDA’s Real Cost Campaign, which conveys “accurate information” by depicting e-cigarette worms invading teen brains and bodies (here). 
Speaking of real costs, this study was supported by $62.3 million in NIH grants.    

The article’s recommendation was endorsed by the journal’s editor (here), who previously acted contrary to editorial standards for professional medical journals after publishing a flawed e-cigarette gateway study (here and here).