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of Glantz’s flawed heart attack study that appeared in the Journal of the American Heart Association – a work that was retracted eight months after its publication in June 2019.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

 

 

Mythic Tobacco Endgames

A new $1.2 million campaign to promote tobacco prohibition on college campuses was announced on September 19 (here). 

As I have noted, the federal government annually spends hundreds of millions of dollars in support of academic anti-tobacco research (here).  This time, the money is coming from pharmacy giant CVS’s Health Foundation as part of a five-year, $50 million campaign.  CVS collaborators include the misnamed Truth Initiative (see here and here) and the American Cancer Society, whose numerous prohibitionist exploits are reported in this blog (here, here, here, here, here, here, here, here, here, here).

Campaign awards to several Texas schools were reported in a Houston Chronicle article (here) that included illustrations offering and refuting four tobacco “myths”.  In this effort, the paper (or the campaign) repeated fantastical claims that are often made by prohibitionists.

Myth #1: “Almost no one smokes any more [sic].”  A myth, by definition, is a widely held view, so this attempt fails from the start. The latest data from the CDC, for 2016, shows 38 million smokers in the United States – a substantial and highly visible group of people, all in need of effective quit-smoking tools and support.

Myth #2: “e-Cigarettes, hookahs and cigars are safe alternatives.”  Again, few people hold this view (here).  Scientists, the industry and public health officials agree that no form of tobacco use is perfectly “safe.”  Eminent authorities like Britain’s Royal College of Physicians, however, have pronounced that vaping “is unlikely to exceed 5% of the harm from smoking tobacco.” (here)  Furthermore, FDA data shows that smoking one or two cigars a day have almost no health risks (here and here).

Myth #3: “Infrequent, social smoking is harmless.”  This is creating a myth when one doesn’t exist.

Myth #4: “Smoking outside eliminates secondhand smoke dangers.”  Myths convey false information.  This statement is entirely true.

Ironically, some viewers of the online Chronicle article are shown an advertisement for Nicorette gum, reproduced here.  While pharmaceutical nicotine has a known 93% quit-smoking failure rate (here), this ad touts one day of success – an extraordinarily low bar for cessation.

Colorado State Smoking Ban: No Impact on Heart Attacks

As early as 2004, various medical journals published articles claiming that small-community smoking bans resulted in nearly immediate reductions in heart disease.  For example, the high-profile BMJ reported that hospital admissions for acute myocardial infarction (AMI) declined 40%, from 40 to 24, in Helena, Montana, after implementation of a smoke-free ordinance (here).  Circulation, the journal of the American Heart Association, reported that AMI admissions dropped 27% “within months” in Pueblo, Colorado (here). Similar reports came from Bowling Green, Ohio (here), Monroe County, Indiana (here) and beyond. 

The striking implication was: Eliminating second-hand smoke saves lives by reducing heart disease.

There were two problems with these claims.  First, the declines, based on small numbers of observations, were actually consistent with random variation (here).  Second, none of the reports accounted for the long-term downward trend in heart disease in the U.S.; they credited no-smoking intervention with the lower number of AMIs at a time when rates were declining nationwide.

In 2011, I documented that state-wide smoking bans in California, Utah, Delaware, South Dakota, New York and Florida had little or no immediate measurable effect on AMI deaths. The study, published in the Journal of Community Health (here), eliminated the “tiny-number” problem and factored in the national downward trend in AMI deaths.

I discussed these findings in my blog (here), but the work was largely ignored, until now.

Recently, researchers from three Colorado institutions reported AMI rates before and after a statewide smoking ban there; their work appears in the American Journal of Medicine (here).  (Thanks to Chris Snowdon, who also blogged about it here).

Paul Basel and colleagues found that “No significant reduction in [AMI] rates was observed” after the Colorado ban was implemented.  They also referred to our study:

“[The Rodu et al.] study compared the decline in [AMI] mortality in 6 states with smoke-free ordinances, with the average decline among 44 states unaffected by smoke-free policy.  No state with a smoke-free ordinance had a significantly lower observed [AMI] mortality compared with that expected by the nationwide secular decrease in states without the ordinance.  This emerging evidence highlights the importance of accounting for secular trends in [AMI] incidence before definitive attribution to smoke-free ordinances can be made.” 

It is comforting to see unfounded second-hand smoke claims corrected, particularly in the pages of a prestigious journal.