E-cigarettes

8 Months Later, This Journal Still Hasn't Corrected Its Study Implying That E-Cigarettes Magically Cause Heart Attacks Before People Use Them

The Journal of the American Heart Association has responded to critics with nothing but boilerplate promises of scientific integrity.

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E-cigarettes are so dangerous, according to a study published by the Journal of the American Heart Association (JAHA), that they can reach back in time to cause heart attacks before people use them. It has been eight months since the study appeared and seven months since critics identified the crucial error underlying that logically impossible conclusion. So far, the journal's public response has consisted of nothing but boilerplate promises of scientific integrity.

Based on data from the Population Assessment of Tobacco and Health (PATH), Dharma Bhatta and Stanton Glantz claimed to find that "e-cigarette use is an independent risk factor for having had a myocardial infarction." Glantz, a longtime anti-smoking activist and e-cigarette opponent who directs the Center for Tobacco Research Control and Education at the University of California, San Francisco, said the results provided "more evidence that e-cigs cause heart attacks." Notwithstanding the evidence that vaping is much less hazardous than smoking, Glantz and Bhatta (an epidemiologist at the center) concluded that "e‐cigarettes should not be promoted or prescribed as a less risky alternative to combustible cigarettes and should not be recommended for smoking cessation among people with or at risk of myocardial infarction."

But as University of Louisville tobacco researcher Brad Rodu pointed out, the analysis that Bhatta and Glantz ran included former smokers who had heart attacks before they started vaping. Once those subjects were excluded, Rodu and University of Louisville economist Nantaporn Plurphanswat found, the association described by Bhatta and Glantz disappeared. "The main findings from the Bhatta-Glantz study are false and invalid," Rodu and Plurphanswat wrote in a July 11 letter to JAHA. "Their analysis was an indefensible breach of any reasonable standard for research on association or causation." In another letter a week later, Rodu and Plurphanswat urged the journal's editors to "take appropriate action on this article, including retraction."

JAHA replied three months later with a letter that did not address Rodu's criticism but assured him that "the American Heart Association is steadfastly committed to ensuring an objective and thorough evaluation of any and all inquiries received about studies published in any of our journals." A month after that substance-free response, Andrew Gelman, director of the Applied Statistics Center at Columbia University, looked into the controversy and concluded, "It seems like a real article with a data issue that Rodu found, and the solution would seem to be to perform a corrected analysis removing the data from the people who had heart problems before they started vaping."

In light of that "data issue," where is the "objective and thorough evaluation" that JAHA promised? Last month, 16 prominent tobacco researchers, led by David Abrams, a professor of social and behavioral sciences at New York University, put that question to the journal's editors.

"Many of the myocardial infarctions (MI) used in the calculation of the association between e-cigarette use and MI risk occurred before subjects first used e-cigarettes," they noted in a January 20 letter. "The PATH survey includes timing data for MI and first e-cigarette use that the authors should have used to exclude these cases from the analysis. Further, the authors went on to conclude that the association was causal and made policy recommendations regarding smoking cessation practice on that basis. When the cases in which the MI occurred before e-cigarette use are excluded, the analysis does not show an association. Any residual association is, in any case, likely due to incomplete adjustment for almost complete confounding by smoking history. It follows that the conclusion is not supported by the underlying data and, therefore, the published findings could mislead practitioners and policymakers."

Despite the glaring problem with Bhatta and Glantz's analysis, Abrams et al. wrote, "the journal has not so far provided a substantive response to these concerns." They noted that guidelines from the Committee on Publication Ethics, which JAHA claims to follow, say "journal editors should consider retracting a publication if they have clear evidence that the findings are unreliable, either as a result of misconduct (e.g. data fabrication) or falsification (e.g. image manipulation) or honest error (e.g. miscalculation or experimental error)." The guidelines also say that complaints from "whistle blowers" such as Rodu should be carefully investigated.

JAHA responded three days later with a boilerplate assurance similar to the one Rodu got. "Does the journal accept the findings are unreliable and what does the journal propose to do about the published paper?" Abrams and company asked in a follow-up letter last week. "Can you confirm whether there is or has been an investigation into this complaint, outline its current status and set out the outcome of the investigation if there is one so far?"

I also have asked JAHA for responses to those questions and will update this post if I receive a reply.

The harm-reducing potential of e-cigarettes has been recognized by a wide range of public health agencies and organizations, including the Food and Drug Administration, the Royal College of PhysiciansPublic Health England, the American Cancer Society, and the National Academies of Sciences, Engineering, and Medicine. But the American Heart Association remains skeptical, and it warns that "the aerosol from e-cigarettes may be harmful to the lungs and the cardiovascular system." Bhatta and Glantz's study therefore reinforces the AHA's institutional prejudices. While that consideration has nothing to do with the study's scientific merits, it may help explain JAHA's reluctance to question the magical, time-bending powers that Bhatta and Glantz implicitly attribute to e-cigarettes.

NEXT: Louisiana Prosecutors Say They Can't Be Sued Over the Fake Subpoenas They Used To Pressure Witnesses Into Testifying

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  1. Who you gonna believe; my funded study, or the damn facts?

  2. Nantaporn Plurphanswat

    There is NO WAY that that is a real name.

    1. The Devil’s Dictionary has lots of quotes from names like that.

    2. It’s a pretty standard Thai name. I regularly get mail for someone with the first name of Porntip.

  3. Vaping is a sin and whatever means must be used to convince sinners to cease their sinning cannot themselves be sinful. Is it wrong to lie to a child in order to convince him to take his medicine? I think not.

    1. Once again you have explained things in a way with which no one can argue. Thank you, O Wise One!

    2. ..And parents wonder why their teenagers won’t listen to them and think they’re stupid.

      My position; Is it wrong to lie to a child in order to convince him to take his medicine? Yes, I think so.

  4. Wow! Nice sleuthing job, Jacob. Who is the guy in the pic at the top of the article? Is that Glantz?

  5. Oops. I just saw who it is in the fine print. My bad.

  6. All of the medical orgs get tons of $ from Pharma to promote their drugs. I am guessing that AHA gets a ton. E-cigs compete with their smoking cessation products, so of course they are going to be against them.

  7. Clearly JAHA thinks that putting anything in your mouth is bad, unless it is some Center for Tobacco Research Control and Education at the University of California dick. Or maybe the sucking is the other way around.

  8. There is a rational reason why vapers might have higher rates of heart attacks before they even started vaping. Consider the populations of people who smoke (but never started vaping) and the population of people who eventually tried e-cigarettes. Good epidemiology requires you to control for this sort of thing (which it looks like these people didn’t do), but these two groups of people may differ in ways in addition to e-cigarette use – correlation without causation. When stuff about lycopene and prostate cancer came out, some wondered if it wasn’t due to people on Mediterranean diets – more lycopene, but also more vegetables in general, more olive oil, and other differences as well – having a lower risk of clinically significant prostate cancer. So, aside from e-cigarette use, how do e-cigarette users differ from smokers in general?

    1. I smoked 2 cigars a day for 40 years and was perfectly healthy, the day after I switched to vaping I had a heart attack and while in the hospital they found I had COPD. Coincidence? I think not!

  9. E-cigs are so dangerous you could have a heart attack just by looking at one!

  10. I have it on good authority that if you are smoking a cigarette when you are run over by a truck, that is a ‘smoking related’ death, so there is no reason that these guys should correct their claims.

    1. Kind of like the NHTSA counts it as an alcohol involved vehicular accident if a drunk stumbles in front of your car and you hit him…

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  12. Hi Jacob: I hope you comment on this article Feb. 4 in NY Magazine:
    “Who Thought Sucking on a Battery Was a Good Idea? Vaping is a health crisis that’s only just begun.”
    By Stephen S. Hall
    https://nymag.com/intelligencer/2020/02/vaping-health-crisis.html

    1. They are insane.

      That is my comment.

  13. Cross sectional studies are the weakest of all epidemiology studies.

    You are taking one data point in time in effect. You try to compare x prevalence and y factor in a population. Yet disease z has many possible causes and occurs over time.

    It is reportable yet not anywhere an understanding of cause or useful information.

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  15. Hey look; yet another government-funded ‘PSYOP’ project.

    PSYOP (Psychological Warfare). A war tactic designed to influence the perceptions and attitudes of individuals and groups in order to destroy them.

    Our government has been funding a war against its own people in hopes their beliefs of having rights and liberty can be utterly destroyed.

    And the best part is the way they steal from their own to fund the war against their own by calling it code-name ‘The Research Project’ or code-name ‘Science’.

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  17. And they just can’t understand why I don’t trust “experts”. From margarine is better for you than butter to eggs will kill you to global climate cooling/warming/change/disruption (or whatever trendy term they’re using this week) they’ve lied to me, and yet I’m supposed to just believe whatever they say. It’s like you always have to believe the woman, no matter how ludicrous and obviously wrong her statement.

  18. The science on this is settled. Vaping is at a minimum 98% safer than smoking. That is the minimum value set by huge epidemiological studies. It could be higher, but the length and size of the study only allow for that conclusion.

    The history is more informative though.

    Anti-vaping arose out of the tobacco settlement funded anti-smoking movement. In California they began by attacking vaping in public because it “normalizes” smoking style behavior. One of the key components of the anti-smoking campaign was to make anyone who smokes a social pariah. So someone fake-smoking undermines that strategy.

    So they moved to outlaw vaping in public, explicitly for this reason.

    Fast forward a decade…. and they have morphed their rationalizations and their targets. Why?? Because they are professional grifters who make their money from extorting deep-pocket tobacco companies. They saw a new set of deep pockets. So they went after it.

    But they also have a fanatic base and some easily scared moms in their cross-hairs. So full ban it is.

    Which is fine with them. Because it isn’t about saving lives with the professional anti-smoking campaign people. It is about spending anti-smoking dollars raised from tobacco companies.

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  20. The science is settled!

    CB

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