Does a study from Canada prove that using e-cigarettes and nicotine reduction therapies (NRT) together makes it less likely that smokers will quit smoking cigarettes?
Stanton Glantz thinks so. The nicotine-hating California professor titled a blog entry about the study, “The evidence that e-cigarettes inhibit quitting smoking cigarettes just keeps piling up; strong longitudinal study from Canada.” But then, Prof. Glantz is a cheerleader for anything that supports his bias against anything that even looks like smoke.
The authors of the study write, “E-cigarette use was negatively associated with successful quitting in this large community sample of smokers accessing standard evidence-based smoking cessation treatment through primary care clinics, even after adjusting for covariates such as severity of tobacco dependence, gender and age. The findings suggest that concurrent use of e-cigarettes with NRT may harm cessation attempts.”
Why would that be? How could that be?
Bad study, questionable ethics
Successful vapers were left out
Dr. Michael Siegel of Boston University addressed the confusion. “The major flaw in this study is that it is very likely that the smokers who were dual users became dual users because they were unable to quit smoking,” he wrote.
The Canadian study didn’t give e-cigs to the participants and follow the results. The “dual-users” (people who both smoke and vape) were already dual-users when they signed up.
“Had they been successful in quitting smoking, they would not have become dual users (and thus their success would not have been observed in the study). This means that what the study is really comparing is smoking cessation rates among smokers who have failed to quit versus those who have not necessarily failed to quit. It would be shocking if the study did not find higher quit rates among the non-dual users.”
“Apparently, one question that was not asked of study subjects was their history of failed quit attempts,” added Siegel. “And another important question that was not asked was whether or not the subjects had previously tried NRT and failed. Without either of these two variables, the study was unable to control for the sampling bias that is inherent in this study design.”
The problem is that vapers who have succeeded in quitting cigarettes are simply excluded from the equation. Dr. Siegel: “Most smokers who use e-cigarettes for cessation are doing so specifically because they failed to quit using traditional methods in the past and/or because they don’t think they can (or don’t want to) completely eliminate nicotine or the “smoking” behavior. On top of this, of these smokers, it is only the ones who fail to quit who become dual users.”
“Skimmed off the top are all the successful quitters who, according to this study, do not exist,” writes Siegel. “Their experiences are not considered at all in the analysis of whether or not e-cigarettes can help smokers quit.”
Dr. Siegel goes on to address the question of why the authors would use such biased methodology. Could two of the authors’ strong ties to pharmaceutical companies that manufacture NRT products be a red flag? Dr. Siegel thinks they are.
“Both the lead author and the senior author of the study disclosed that they have received funding from Pfizer,” writes Siegel. “The senior author also disclosed having received honoraria and consulting fees from Johnson & Johnson, Pfizer, and NABI Pharmaceuticals.”
“These are significant conflicts of interest because all of these pharmaceutical companies are developing or marketing smoking cessation products,” he added. “They stand to lose financially if e-cigarettes are found to be effective cessation products. Therefore, these conflicts of interest create an appearance that the apparent bias in the interpretation of study results and in the design of the study itself may be related to financial interests in these pharmaceutical companies.”
In fact, senior author Peter Selby’s Ontario Tobacco Research Unit biography includes a spectacular list of pharmaceutical connections. “He has acted as a paid consultant for Johnson and Johnson Consumer Health Care Canada; Pfizer Inc. Canada; Pfizer Global; Sanofi-Synthelabo, Canada; GlaxoSmithKline, Canada; Genpharm and Prepharm Canada; NABI Pharmaceuticals: V-CC Systems Inc. & EHealth Bahaviour Change Software Co.; and Schering Canada.”
But wait, there’s more! “He has also received honoraria or been part of a speakers bureau for Schering Canada; Johnson and Johnson Consumer Health Care, Canada, Pfizer Inc. Canada; Pfizer Global; Sanofi-Synthelabo Canada; Glaxo Smith Kine Canada; Genpharm & Premfarm Canada and NABI Pharmaceuticals.”
Whether the authors’ pharma conflicts led them to purposely design a study based on questionable sampling techniques, or if they simply share the typical tobacco control suspicion and fear of e-cigarettes, doesn’t really matter.
The fact is that they did do this study, it is being amplified by sympathetic (and loud) tobacco control voices, and many of the public health functionaries who trust tobacco control orthodoxy will believe it and as a result they will recommend policies that reduce the potential of vaping to help smokers.