Following is another example of junk science published by
anti-tobacco crusaders, abetted by negligent journal editors.
The journal Tobacco Induced Diseases on April 7 published
an article by
Emine Bircan and colleagues at the University of Arkansas. They claimed that e-cigarette use “is
associated with increased odds of self-reported asthma, COPD, and [asthma-COPD
overlap syndrome] among never combustible cigarette smokers.” In their abstract,
the authors assert that “the age of those at risk in our study was 18–24
years.”
First, take a look at the chart. It is axiomatic that COPD is mostly seen in
current and former smokers age 55+ years.
Now look at Bircan’s vapers in the last
column: the distribution is completely upside down! This led me to
examine the article in greater detail, whereupon I discovered numerous obvious
errors.
Since the journal prohibits submissions from industry-funded
scientists (my research is supported by unrestricted grants
to the University of Louisville from tobacco companies), the only avenue to
attempt to correct the errors was to write the authors directly. I exchanged numerous emails with corresponding
author Mohammed Orloff and journal editor James Scott over the period April 22
– May 12. Copies of this correspondence are available here.
In addition to raising the issue of young adults with COPD,
I listed these significant errors:
1. There were two obvious wrong numbers of never cigarette
smokers.
2. The inaccurate and non-standard term “e-cigarette
smokers” was used throughout the article.
3. The authors referred to a question (“Do you still have
COPD?”) that did not appear in the analyzed surveys.
4. The authors reversed two numbers in a flow chart
describing important exclusions.
5. The authors failed to define “missing variables”.
These egregious errors should have been discovered and
corrected by the authors, and by the journal’s reviewers and editors. Among the
five authors is Pebbles Fagan, Ph.D., a former member of the FDA Tobacco
Products Scientific Advisory Committee.
Dr. Orloff responded to my letter: “I should say I feel very
embarrassed. Indeed this was sloppy on our side and we will fix and connect
with the Editors in Chief on how to move forward.”
Still, the mess wasn’t immediately resolved. I downloaded
the datasets from the U.S. government’s Behavioral Risk Factor Surveillance
System (BRFSS). But I was unable to
reproduce the article’s study groups, the first basic step of any serious
review. When Dr. Orloff disclosed further details of the analysis, I discovered
that the authors had deleted 27,000 participants from the BRFSS data who had
“ever” used an e-cigarette – even just one time – but did not use them at all
at the time of the survey. This critical deletion was made without mention
or explanation anywhere in the article. I advised Dr. Orloff that this large cohort
should be classified as non-users of e-cigarettes, and the analysis should be
re-run.
Dr. Orloff ended the correspondence shortly thereafter,
around May 12.
Fast forward to the week of October 12, when the journal
published a completely new version of the article, accompanied by the following
statement: “The authors would like to express their apologies and regret for
the errors in the original published version of the abovementioned article. The
corrected article follows.”
The authors corrected their obvious errors, but failed to correct
or add any reference to the 27,000 excluded ever vapers. Instead, they added the
following brand new text to the discussion section to explain it away, as if it
had been part of their research plan:
“Additionally, participants who reported having used
e-cigarettes in their lifetime and currently do not use e-cigarettes (defined
as former e-cigarette users) were excluded from the study population because of
lack of clarity of exposure status and residual effects that have resulted from
the e-cigarette derived chemical exposure which contribute to changes in the
continuum of the disease progression leading to molecular changes detectable by
biomarker analysis rather than reports. These former e-cigarette users have
used e-cigarettes sometime in their entire life and have quit for different
reasons. Studies have shown that while cessation of tobacco use diminishes the
risk of experiencing long-term adverse health effects, past history of tobacco
use is still associated with increased risk of lung diseases compared to never
having smoked [citation here to a 1997 article ‘Smoking, alcohol consumption,
and leukocyte counts.’]”
This explanation makes no sense. It is not valid to define
someone who ever used an e-cigarette – even one time -- as a former user. The
authors, post-hoc, unsuccessfully defended tossing out 27,000 ever vapers by
inventing a “chemical exposure…leading to molecular changes… sometime in their
entire life.” But they kept in their
study people who smoked up to 100 cigarettes – a far more toxic product.
While Tobacco Induced Diseases inappropriately deleted
the original article from their website, it is still available at the U.S.
National Library of Medicine (here). I have
also placed a copy of that original work here.
If the authors had adhered to professional standards, they
would have acknowledged my major contributions in their corrective comments,
but they did not.
I subsequently learned that Riccardo Polosa, a University of
Catania (Italy) physician specializing in respiratory diseases, submitted a
letter to the editor of Tobacco Induced Diseases, strongly questioning
the validity of respiratory diseases in 18- to 24-year-old e-cigarette users.
His letter was rejected.
