Unlike most people my introduction to vaping was not so noble. I was active in the fight against smoking bans and made many friends in the forums like Topix. I was a very active member of Ban the Ban Wisconsin. I’m now a retired Broadcast Engineer but was working in those days. I had many stations in Minnesota and Wisconsin so I was constantly traveling. In 2007 Minnesota enacted their smoking ban. In our private email group I mentioned this and I wont mention her name but she was a School Teacher out of Ohio who picked up an ecigarette by the name Of Janty and she sent me the site. i NEVER intended to quit and it was not my intention when I bought it. My intent was to cheat when I couldn’t smoke. well as it turned out I could have never quit using the devices that were out at that time. The Janty was way underpowered and the battery life was horrible, I couldn’t get 1/4 of a day out of the two batteries that came with it and the carts that were suppose to be the equivalent to a pack of cigarettes was barely a quarter of a pack. And none of the so called tobacco flavors tasted anything like tobacco. they had a nasty chemical aftertaste. (I later learned that the flavor extracts contained alcohol, I learned this through DIY). But being an engineer and fascinated by new technology and the fact that I forked out a hundred bucks for it I kept at it. At this point I reduced my smoking very little. From the Janty I moved on to the Janty stick V2. It took the same carts but had replicable batteries. The battery life was better but still not there. From their carto’s came out so I picked up a 510 adapter for my Janty Stick and at the same time I discovered Johnson Creek (an eliquid made right here in Wisconsin). Between the Carto’s and the flavored eliquid it showed promise. But the carto’s had one drawback. You were constantly dripping, not exactly conducive to someone on the go and driving a good deal of the time, from their I went to the Janty ego as they would take all of the 510 carto’s out there. Still really hadn’t cut down much but I was enjoying it more. Then the clearomizers came out and they used the ego connection. I don’t remember which was my first one, I had many Ce4 Ce5 evod ect. Armed with 2 ego batteries and a couple of Spinner batteries my smoking consumption started to decline, but as a 3+ pack a day camel straight smoker the battery life just wasn’t enough, but I did manage to go from 3+ packs a day to 1/4 to 1/2 a pack a day. And surprise surprise my health improved. I use to get winded walking 3 or 4 blocks and then I was walking the dog several miles a day. Then I was at my sisters in Minneapolis for my godsons wedding and entered my first vape shop. I walked away with a Kanger K Box a Kanger Subtank and some juices I liked even better then the ones I was use to. I’m not even aware of when I stopped smoking, I just realized one morning that I got up, went to make coffee and the first thing I reached for was my vape.
Why do I tell this story now? Because Neo Prohibitionist like Stanton Glantz have ramped up their Bovine Excrement about dual use. Of course he will dismiss my story as anecdotal evidence and that is true, but you would be hard pressed to find a single user that didn’t have a marked improvement in health. And most of what he puts out doesn’t even come close to passing a logic sniff test. More on that later. First before we start you have to know about the different kinds of studies. Here is an article on the different types of studies and the strength and weaknesses of each with randomized control studies being the gold standard and observational being the least reliable. Health News Review wrote about a letter in JAMA internal medicine called Weak reporting of limitations of observational research in it they said.
“A research letter in this week’s JAMA Internal Medicine addresses an issue that has become a pet peeve of ours: the failure of medical journal articles, journal news releases, and subsequent news releases, to address the limitations of observational studies. Observational studies, although important, cannot prove cause-and-effect; they can show statistical association but that does not necessarily equal causation. . . “
From the actual letter.
Here’s what they found:
“Any study limitation was mentioned in 70 of 81 (86%) source article Discussion sections, 26 of 48 (54%) accompanying editorials, 13 of 54 (24%) journal press releases, 16 of 81 (20%) source article abstracts (of which 9 were published in the Annals of Internal Medicine), and 61 of 319 (19%) associated news stories. An explicit statement that causality could not be inferred was infrequently present: 8 of 81 (10%) source article Discussion sections, 7 of 48 (15%) editorials, 2 of 54 (4%) press releases, 3 of 81 (4%) source article abstracts, and 31 of319 (10%) news stories contained such statements.”
They close with.
We’ve written about dozens and dozens of examples of news stories and other media messages that have failed to address the limitations of observational studies, thereby misleading the public.
We’ve criticized major medical journal news releases for doing so – The BMJ and The Lancet, for example.
For years, we’ve posted a primer on this site for journalists, news release writers and the general public, to help them understand the limitations. The primer is entitled, “Does the Language Fit the Evidence? Association Versus Causation.”
The exaggeration should stop. Observational studies play an important role. But communicators should not try to make them more than what they are.
So what is an observational study? it’s basically a collection of anecdotal evidence usually gathered from surveys or questioners. These studies are presented as a range of numbers and supposedly there’s usually a 95% chance that the number falls within that range. 1 is considered null meaning no statistical significance. Less then one means the opposite or usually a protective effect. With that in mind we will go to one of Stanton’s recent blog posts entitled ” More evidence that dual use is worse than smoking”
In the blog he repeats his diatribe about the gateway effect which defies logic since even t t he height of the so called youth epidemic teen smoking is at historic lows. From his blog.
“This finding is consistent with the existing literature on respiratory effects of e-cigarettes. It is also particularly important because they found that dual use was twice as prevalent as people solely using e-cigarettes (2.7% vs 1.4%). In other words, most people who are using e-cigarettes are not “switching completely” from cigarettes, but simply adding e-cigarettes to their cigarette smoking.
While the study does not address why most people are dual users, it is likely that the youth in the sample started with e-cigarettes and then added cigarettes (the gateway effect) and the adults were smokers who tried e-cigarettes an unsuccessful smoking cessation device and ended up dual users.”
But he also linked to his own study which is not behind a paywall.
If you look at the conclusions of the abstract they are quite telling. No mention of confounders or limitation. It’s stated as if it were a fact.
You actually have to read the whole study to get the limitations.
Limitations
Several respiratory conditions were combined to obtain enough events to achieve adequate power. For the same reason, this study did not distinguish between daily and non-daily product use and included both established (smoked >100 cigarettes) and experimenters in the “former smoker” group.
There is a possibility of recall bias because use of e-cigarettes, conventional cigarettes, and other combustible tobacco products were self-reported as were clinical conditions. Participants with respiratory diseases might over-report e-cigarette, conventional cigarette, and other combustible tobacco use. There is also possibility of recall bias because doctor diagnoses of lung or respiratory diseases is reported by respondents rather than being based on actual hospital records but the questions. . .
CONCLUSIONS
Current use of e-cigarettes appears to be an independent risk factor for respiratory disease in addition to all combustible tobacco smoking. Although switching from combustible tobacco, including cigarettes, to e-cigarettes could theoretically reduce the risk of developing respiratory disease, current evidence indicates a high prevalence of dual use, which is associated with increased risk beyond combustible tobacco use. In addition, for most smokers, using an e-cigarette is associated with lower odds of successfully quitting smoking.4,37 E-cigarettes should not be recommended.
Of course the highlighted blocks are mine with the so called lower odds of successfully quitting to be addressed later as it pertains to another of his recent blog posts. Remember I said the more I vaped the less I smoked and the better my lung function was. I now walk miles with no problem. Also remember that clinical studies are the gold standard and much more reliable. So who’s anecdotal evidence is more convincing mine or his? Here’s where you have to apply a little logic. If you reduce a very risky behavior with a significantly less risky behavior logic would dictate that the resulting risk would be somewhere in between the high risk activity and the lowered risk activity, but he would have you believe that those magic ecigs magnify the risk. But thankfully real science says otherwise. Actual studies on actual COPD patients. Health effects in COPD smokers who switch to electronic cigarettes: a retrospective-prospective 3-year follow-up
” Results: Complete data were available from 44 patients. Compared to baseline in the EC-user group, there was a marked decline in the use of conventional cigarettes. Although there was no change in lung function, significant improvements in COPD exacerbation rates, CAT scores, and 6MWD were observed consistently in the EC user group over the 3-year period (p<0.01). Similar findings were noted in COPD EC users who also smoked conventional cigarettes (“dual users”).
Conclusion: The present study suggests that EC use may ameliorate objective and subjective COPD outcomes and that the benefits gained may persist long-term. EC use may reverse some of the harm resulting from tobacco smoking in COPD patients.”
But then Stanton believes that the magic in these vaping devices are so powerful that they double your chances of having a heart attack before you ever use them.
So exactly why could the survey that Stanton use be so far off? Easy, now we get to the FUD. The weekend before last I was watching a movie and was bombarded with this ad 9 times during the movie.
Do some ecigarettes have heavy metals in them Yes! You know what else does? Air! and also inhalable Pharmaceuticals, Can you imagine if the ad said Big Pharma was trying to kill you by putting heavy metals in your asthma inhaler? What is never mentioned is dose. As Dr Konstantinos Farsalinos points out.
Don’t believe him? This is from the FDA’s own website.
And then of course one of my personal favorites.
Of course if Nicotine damaged the adolescent’s brain there would be millions of us brain damaged Baby Boomers running around. And what kind of studies to they show to prove it? Brain fog? Vaping Could Cloud Your Thoughts
We’ve seen it in numerus ads and articles but there’s a limitation here that is never mentioned. From the article.
“While the URMC studies clearly show an association between vaping and mental function, it’s not clear which causes which. It is possible that nicotine exposure through vaping causes difficulty with mental function. But it is equally possible that people who report mental fog are simply more likely to smoke or vape – possibly to self-medicate.”
It’s easy to predict the outcome of this study since it’s long been known that people with mental disorders use nicotine. And according to the CDC almost 10% of the youth suffer from ADHD And what do they prescribe for it? Stimulants like methylphenidate (Ritalin) and amphetamine-based stimulants (Adderall). And of course there are advantages to self medicating since you can dose as needed. But studies have been done on non smoking young adults using nicotine patches. Acute nicotine improves cognitive deficits in young adults with attention-deficit/hyperactivity disorder
“Methods: 15 non-smoking young adults (20+/-1.7 years) diagnosed with ADHD-C received acute nicotine (7 mg patch for 45 min) and placebo on separate days. Cognitive tasks included the Stop Signal Task, Choice Delay task, and the High-Low Imagery Task (a verbal recognition memory task). Three subjects experienced side effects and their data was excluded from analysis of cognitive measures.
Results: There was a significant (p<.05) positive effect of nicotine on the Stop Signal Reaction Time measure of the Stop Signal Task. The SSRT was improved without changes in GO reaction time or accuracy. There was a trend (p=.09) for nicotine to increase tolerance for delay and a strong trend (p=.06) for nicotine to improve recognition memory.
Conclusions: Non-smoking young adults with ADHD-C showed improvements in cognitive performance following nicotine administration in several domains that are central to ADHD. The results from this study support the hypothesis that cholinergic system activity may be important in the cognitive deficits of ADHD and may be a useful therapeutic target.”
And of course these ads are not aimed at children, they laugh at them. Remember they are at the age where they eat spoonful’s of cinnamon and tide pods. Am I saying our youth are dumber then previous generations, nope. My generation ate live goldfish and sparked up a doobie laughing at the “This is your Brain” ads. So why would they target these ads towards adults? To gin up support for legislation denying these products from adults in the same way they did for smoking.
Clive Bates former head of ASH – Action on Smoking and Health Brought this up in his response to Stanton’s FUD. when he wrote Vaping risk compared to smoking: challenging a false and dangerous claim by Professor Stanton Glantz almost two years ago. It is a must read if you want to dissect Stanton’s FUD.
A paper on risk perceptions has disturbing results
The story starts with a report in JAMA Open that confirms what we already knew: (1) that a majority of the American public believes that e-cigarettes are as harmful or more harmful than cigarettes and; (2) only a small proportion believe, correctly, that they are much less harmful than cigarettes. Not only that, the accuracy of public perception is deteriorating and the misunderstandings are becoming more pronounced over time. This deterioration is happening despite hundreds of millions of dollars in research grants and despite FDA recognition of a ‘continuum of risk’ in nicotine delivery products.
Our analysis revealed a consistent pattern and a change in perceived relative harm of e-cigarettes among US adults in both surveys, which showed that a large proportion of US adults perceived e-cigarettes as equally or more harmful than cigarettes, and this proportion has increased substantially from 2012 to 2017.
Huang J, Feng B, Weaver SR, Pechacek TF, Slovic P, Eriksen MP. Changing Perceptions of Harm of e-Cigarette vs Cigarette Use Among Adults in 2 US National Surveys From 2012 to 2017. JAMA Netw Open. American Medical Association; 2019 Mar 29;2(3):e191047. [link]
He goes on to say that if Stanton gets his way we will never know the truth about the risks of vaping.
Response: if Professor Glantz is successful, we would never have the data. Those playing up fears of unknown risks are not tirelessly striving to resolve the uncertainties or conducting the necessary studies. Professor Glantz, for example, backs outright bans on e-cigarettes even in situations where cigarettes continue to be on widespread sale. Take as the recent ban in his institutional home town of San Francisco. As reported by Politico, 9th July 2019:
Stanton Glantz, director of UC San Francisco’s Center for Tobacco Control Research and Education and a strong anti-tobacco advocate, called the city ban “a totally brilliant way of a local government basically saying to the FDA and to Juul and the other e-cigarette companies that hey, we’ve got a law here and it should be followed.”
Professor Glantz favours outright bans pending FDA approval of individual vaping products (a process that will become mandatory in 2020) This approval regime is a highly disproportionate, expensive and burdensome process that will remove nearly all vaping products and most companies from the market. I have yet to see a single instance of Professor Glantz supporting the approval of a product or a relative-risk claim through the FDA’s regulatory system. For some, regulatory barriers to entry are best if they are insurmountable: de facto prohibition.
Again it is a must read if you want the lowdown on Glantz. But it’s not just Glantz. They actually monitor how their FUD campaign is working.
If you notice they are not measuring how well they are doing reducing teen vaping or smoking, they are measuring how well their prohibitionist movement is going. From the poll.
(WTNH) — State lawmakers are negotiating the next two year state budget. We are told the decision to ban all flavored tobacco products is wrapped up in those talks. A new poll from Mellman Group says there is widespread support to ban not only flavored e-cigarettes and vapes, but also menthol cigarettes.
The survey of 600-voters found that:
- 64% believe the state should ban flavored e-cigs and vapes
- 30% say they disagree
- 6% say they don’t know
Pollsters say support for the ban crosses all demographic lines.
In the above picture it says Progressivism, that does not mean the Democrat party, Progressivism infected both parties early in the last century and it infects both parties today. Mitt Romney is a classic example of a modern progressive Republican. If you think the cartoon is far fetched you may want to remember the same Michael Bloomberg that is funding the anti vaping campaign also banned Big Gulps in New York City. You should also remember that Obesity kills more people then smoking so if they get away with this how soon will it be that you can’t get your favorite carbonated beverage, or candy ect after all it’s for the children.
The following video was done by a good friend and founder of NYC CLASH Audrey Silk about 8 years ago.
Now we get to the blog post where Stanton tells you to ignore the science, and if you must believe the science it should be taken over by “Big Pharma” because you can’t be trusted to quit on your own. CDC’s new mask guidance and why FDA CTP should not assume e-cigs help smokers quit in the real world
The clinical trials show that, under clinical supervision, e-cigs have efficacy as smoking cessation aids. At the same time, the population studies show that e-cigs are not effective for smoking cessation.
As we have pointed out in detail, it is the effectiveness standard that the FDA Center for Tobacco Products (CTP) should use when assessing whether authorizing the sale of e-cigarettes as consumer products in “appropriate for the protection of public health,” the standard in the law. . . . The lack of effectiveness in the population means that if the FDA CEDR were to approve e-cigarettes as a clinical cessation aid, it should require that they be used under prescription. Why? To increase the chances that they were used under the same conditions as the clinical trials (as with COVID vaccines). In particular, the lack of effectiveness of e-cigarettes as unsupervised consumer products means that they should not be approved for over-the-counter (unsupervised) use.
So basically what he’s saying is ignore real science (clinical trials) and believe his statistically manipulated (meta analysis) on a combination of clinical trials and observational studies. Shall we look at his study he cites? E-Cigarette Use and Adult Cigarette Smoking Cessation: A Meta-Analysis
Methods. We searched PubMed, Web of Science Core Collection, and EMBASE and computed the association of e-cigarette use with quitting cigarettes using random effects meta-analyses.
Results. We identified 64 papers (55 observational studies and 9 randomized clinical trials [RCTs]). In observational studies of all adult smokers (odds ratio [OR] = 0.947; 95% confidence interval [CI] = 0.772, 1.160) and smokers motivated to quit smoking (OR = 0.851; 95% CI = 0.684, 1.057), e-cigarette consumer product use was not associated with quitting. Daily e-cigarette use was associated with more quitting (OR = 1.529; 95% CI = 1.158, 2.019) and less-than-daily use was associated with less quitting (OR = 0.514; 95% CI = 0.402, 0.665). The RCTs that compared quitting among smokers who were provided e-cigarettes to smokers with conventional therapy found e-cigarette use was associated with more quitting (relative risk = 1.555; 95% CI = 1.173, 2.061).
Conclusions. As consumer products, in observational studies, e-cigarettes were not associated with increased smoking cessation in the adult population. In RCTs, provision of free e-cigarettes as a therapeutic intervention was associated with increased smoking cessation.
Remember when I said when looking at these studies you have to look at The CI? I highlighted them in red. the only things that were statistically significant was:
Daily e-cigarette use was associated with more quitting (OR = 1.529; 95% CI = 1.158, 2.019)
and less-than-daily use was associated with less quitting (OR = 0.514; 95% CI = 0.402, 0.665)
The RCTs that compared quitting among smokers who were provided e-cigarettes to smokers with conventional therapy found e-cigarette use was associated with more quitting (relative risk = 1.555; 95% CI = 1.173, 2.061).
The rest had 1 in the CI and was statistically insignificant. But lets take this a step further, Meta analysis is totally unreliable on observational studies And Stanton Glantz knows it. Hell anecdotal evidence is more reliable. The only negative n the study is that if you don’t use it daily it won’t work? Use a little logic Stan. Again you flunked logic, Will the big pharma products you peddle work if you don’t use them daily? Didn’t the courts slam your use of Meta analysis in your first attempt at activism while you worked for the EPA. Even your Side kick there had the decency to admit it when he was the lead author of the SG report.
From Beware of Meta-analyses Bearing False Gifts.
Meta-analyses performed by strong advocates of a particular position in an ongoing controversy are at higher risk for bias. . . .
The interpretation of a meta-analysis is potentially subject to an author’s bias by what inclusion and exclusion criteria is selected, the type of statistical evaluation performed, decisions made on how to deal with disparities between the trials, and how the subsequent results are presented.
Whether the conclusions of a meta-analysis are broad reaching or limited can be affected by the inherent bias that the author of the meta-analysis brings to the study.
Human nature dictates that each of us tends to find it more satisfying to confirm a previously held opinion, particularly a published opinion, rather than create an analysis that refutes our own prior conclusions. Hence, interpretive bias is even more likely to occur when a meta-analysis is conducted by an author with a strong particular viewpoint in an area of controversy. When the meta-analysis is conducted by a strong advocate of a particular position, it is more likely to be biased in concordance with the author’s previously advocated opinion.
From the SG report that your buddy Jonathan M. Samet, M.D page 21
Judge William
L. Osteen, Sr., in the North Carolina Federal District
Court criticized the approach EPA had used to select
studies for its meta-analysis and criticized the use of 90
percent rather than 95 percent confidence intervals for
the summary estimates (Flue-Cured Tobacco Cooperative
Stabilization Corp. v. United States Environmental Protection
Agency, 857 F. Supp. 1137 [M.D.N.C. 1993]). In
December 2002, the 4th U.S. Circuit Court of Appeals
threw out the lawsuit on the basis that tobacco companies
cannot sue the EPA over its secondhand smoke
report because the report was not a final agency action
and therefore not subject to court review (Flue-Cured
Tobacco Cooperative Stabilization Corp. v. The United
States Environmental Protection Agency, No. 98-2407
[4th Cir., December 11, 2002], cited in 17.7 TPLR 2.472
[2003]).
Recognizing that there is still an active discussion
around the use of meta-analysis to pool data
from observational studies (versus clinical trials),
the authors of this Surgeon General’s report used
this methodology to summarize the available data
when deemed appropriate and useful, even while
recognizing that the uncertainty around the metaanalytic
estimates may exceed the uncertainty indicated
by conventional statistical indices, because of
biases either within the observational studies or produced
by the manner of their selection.
To any would be vapor or dual user, remember every cigarette not smoked is harm reduction, and as Stanton says if you don’t use it it won’t work.
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