May 9th, 2016

Professor Glantz brings his anti-vaping crusade to Europe - I review his presentation

Willkommen, Bienvenue, Welcome… Professor Glantz visits Europe

Regrettably, the influence of Professor Stanton Glantz of the University of California at San Fransisco is not confined to California or to the United States.  Last month he made a visit to Europe – to Austria in fact.  As good Europeans, we always take our American visitors seriously and listen to what they have to say. So I have done a review of the presentation he gave at the Austrian Acadamy of Sciences in Vienna.

Contents

There is much to say, so here is the outline….

The event

Professor Glantz gave a presentation on 5th April at the Austrian Academy of Sciences Tobacco Control: Big Fast Benefits (PDF of presentation).  See page 37-51 for his messages on e-cigarettes. Professor Glantz’s introduction for the event makes some bold and unequivocal claims, which I will analyse in this post and have highlighted below in red:

Tobacco Control: Big Fast Benefits 
Stanton A. Glantz, PhD Professor of Medicine
Truth Initiative Distinguished Professor in Tobacco Control
Director, Center for Tobacco Control Research and Education University of California, San Francisco
 
There is a widespread assumption that the benefits of tobacco control policies take many years to develop, which makes it difficult for policymakers to prioritize tobacco control efforts over perceived short-term benefits in terms of tax revenues and business opportunities for the tobacco companies. This presentation presents evidence that [etc etc].  E-cigarettes, which are often presented as harm reduction alternatives to conventional cigarettes are reducing quitting, expanding the youth nicotine market, and likely prolonging the tobacco epidemic. The bottom line: It is possible to get large rapid drops in smoking, together with immediate and substantial health and economic benefits if policymakers are willing to stand up to the tobacco industry. 
(emphasis added)

Tobacco policy and standing up to the tobacco industry

Professor Glantz makes a number of heroic claims for ‘fast and big’ tobacco control interventions. I’m not going to go into his views on tobacco policy, the evidence that supports the efficacy of these ideas or the economics of the tobacco industry. Let’s just say this, I think he is over-claiming the benefits and ignoring the costs of his preferred policies.

However, if this is an exemplary tobacco control model, we could briefly digress and check on the terrible toll this policy must be taking on the value of the most important US cigarette company. That would be Altria, which is mainly Philip Morris USA.  The chart shows growth in its share price from 1 Jan 2009 until 8 May 2016 (blue).  It compares that to the Dow Jones Industrial Average (red). Altria operates primarily in the United States and this covers the period over which FDA has regulated cigarettes under the 2009 US Family Smoking Prevention and Tobacco Control Act (bluffer’s guide).

Altria stock price trend from 1 Jan 2009 to 8 May 2016 – relative to Dow Jones (red)

So if “standing up to the tobacco industry” is the answer, how come Altria’s stock has quadrupled in value since 2009 (from $15 to $63) to be worth ~$125bn and outpaced the growth of the Dow Jones by more than three times? If that’s success, what would failure look like?

Professor Glantz’s views on e-cigarettes

However, I am much more concerned about Professor Glantz statements on e-cigarettes.  Let’s take the three main claims about e-cigarettes, shown in red in the intro above. According to Professor Glantz, e-cigarettes are:

  1. Reducing quitting
  2. Expanding the youth nicotine market
  3. Prolonging the tobacco epidemic

1. “Reducing quitting”

Professor Glantz displays his meta-analysis to make this claim… here it is… Elsewhere, he claims that this shows: “Vapers” Are 28 Percent Less Likely to Stop Smoking

Looks scientifically impressive!

I guess it looks sort of scientific and formal. But it is, in fact, nothing we should call science.  In their response to this just this published in The Lancet Respiratory Medicine, Peter Hajek, Hayden McRobbie and Chris Bullen patiently explain the error of lumping together studies with completely different designs, outcomes, exposures and populations and conclude:

There are other problems—such as the selective inclusion of studies, and selective reporting of data from studies that were included—and limitations the authors acknowledge in the text but ignore in their conclusions. Detailed criticism of the methods is, however, not needed, because lumping incongruous studies together—which were mostly not designed to evaluate the efficacy of e-cigarettes, and contain no useful information on this topic unless misinterpreted—makes no scientific sense in the first place.

But they weren’t the only ones to find this study wholly unscientific. Back home in the United States, experts at the Truth Initiative (formerly Legacy) severely criticised the pre-publication version of this meta-analysis in their evidence to the U.S. Food and Drug Administration. In its submission to FDA, the examination of the methodological issues begins on page 8 and the following comment appears on page 12, referring to this meta-analysis that was subsequently published in The Lancet Respiratory Medicine.

While the majority of the studies we reviewed are marred by poor measurement of exposures and unmeasured confounders, many of them have been included in a meta-analysis that claims to show that smokers who use e-cigarettes are less likely to quit smoking compared to those who do not. [73] This meta-analysis simply lumps together the errors of inference from these correlations. As described in detail above, quantitatively systhesizing heterogeneous studies is scientifically inappropriate and the findings of such meta-analyses are therefore invalid.” (emphasis added)

Professor Glantz was billed in Austria as the “Truth Initiative Distinguished Professor in Tobacco Control“.  That’s the same Truth Initiative, presumably in pursuit of ‘the truth’, that wrote the statement above. A further elaboration of its argument against misinterpreting observational studies can be found in its factsheet The Truth About Electronic Nicotine Delivery Systems, which describes some of the underlying issues on page 8.

Several observational studies measuring the effect of ENDS use on smoking cessation reported negative correlations between those who tried ENDS and smoking cessation. Due to (a) serious limitations of study design, measurement and methodology, including inadequate measures of exposure (e.g., ever use in one’s lifetime) to be a fair test for a cessation indication, (b) selection bias and (c) confounders (e.g., smokers who have repeatedly failed to quit are more likely to try ENDS), we consider the conclusions invalid. This is not without precedent, as some observational studies of NRT and smoking cessation showed similar negative correlations, while more than 80 randomized control trials of NRT show strong positive cessation effects. (for references please see the original)

Multiple studies suffering these failings were aggregated in Professor Glantz’s meta-analysis, hence drawing the withering criticism of Hajek et al.  This work should never have been dignified by publication a journal… as Professor Robert West, Professor of Health Psychology at University College London said at the time of publication:

Publication of this study represents a major failure of the peer review system in this journal.

My own critique is here: Who will be duped by error-strewn ‘meta-analysis’ of e-cigarette studies? and Carl V. Phillips gave it his customary unforgiving evisceration here: What is “meta-analysis”? (and why was Glantz’s inherently junk?).

The Cochrane Review is usually regarded as a benchmark of evidence assessment.  The review for e-cigarettes notes that there are few studies but on the basis of what has been done, the conclusions are tentatively positive. However, clinical trials are probably a poor way of assessing behaviour change in a rapidly evolving consumer market – a longer discussion that I shall return to.

2. “Expanding the youth nicotine market

We will need four subsections to address this claim. In summary:

  • The prominent spike shown in Professor Glantz’s main chart is an illusion – it is likely that adolescent e-cig use is dragging smoking down to record low levels
  • Most of the teens counted as e-cig users are very light users or experimenters – a much higher proportion of smokers are daily users
  • The vast majority of teen users report they are not using nicotine in e-cigarettes and are therefore not part of the ‘youth nicotine market’
  • The fact that vapers are more likely to be smokers is likely to be a good thing, not a sign of a gateway effect

2.1 The apparent 2014 surge in nicotine use is an illusion

Let’s start with chart 48 in his presentation, which I guess is how he makes this case e-cigarettes are ‘expanding the youth nicotine market’.

From Professor Glantz’s presentation – slide 48

Obviously, the visual point made by this chart is the big spike in 2014 – and, if you buy this as a true and fair representation of the data,  it looks like his point is well made. But is it true and fair?

Some care is needed in looking at Professor Glantz’s chart: note the yellow bar is not labelled with a legend and the age range is not given, though NYTS data covers middle and high school. I simply cannot recreate this chart from the NYTS data.  Note also that what appears to be trend line (blue) is not a trend line because the x-scale is non-linear – it would be a shame for the eye to be deceived by that.

So if Professor Glantz’s presentation is perplexing, perhaps we should turn to CDC, the main government public health agency, the owner of the data and hardly a pro-vaping interest group, for its interpretation.  This is how CDC displays the data for high school kids for the later part of the period, with my annotations in red.

CDC-NYTS data And this is how CDC actually describes this data:

Discussion
From 2011 to 2014, substantial increases were observed in current e-cigarette and hookah use among middle and high school students, resulting in an overall estimated total of 2.4 million e-cigarette youth users and an estimated 1.6 million hookah youth users in 2014. Statistically significant decreases occurred in the use of cigarettes, cigars, tobacco pipes, bidis, and snus. The increases in current use of e-cigarettes and hookahs offset the decreases in current use of other tobacco products, resulting in no change in overall current tobacco use among middle and high school students. (emphasis added)

Where is anything in that statement suggesting the youth nicotine market is expanding? The weird bureaucratic language of CDC, FDA etc counts e-cigarettes as tobacco products. But outside that strange world, it is common sense that vapour products containing pure pharma-grade nicotine are not tobacco products. So maybe that should be rephrased in a way that is not deliberately confusing. Here is what I would say: “within the range of products that (may) contain nicotine, there was a shift from tobacco to non-tobacco product use and from combustible to non-combustible product use.  This will be beneficial for health.

Or we could draw on a Truth Initiative graphic which gives a similar picture to CDC from the same NYTS data – but completely different to that conveyed by Professor Glantz’s chart:

Screen Shot 2016-05-08 at 16.45.34

The actual data tell a different story to the spike shown in 2014 in Professor Glantz’s chart – the basis for which is at best ‘unclear’. The actual picture suggests that e-cigarettes are being used instead of cigarettes – and smoking is falling rapidly as e-cigarettes rise. If they were a ‘gateway’, then where are the extra smokers?  The most compelling explanation of this data is that relatively low-risk e-cigarettes are displacing high-risk smoking in youth who are inclined to experiment with smoking or other risky behaviours.

2.2 Most of the teens using e-cigarettes are doing it occasionally or experimenting

The columns in the CDC and Truth graphics above are reasonable representations of nicotine use on a particular measure, but it turns out they are aggregating very different behaviours.

The National Youth Tobacco Survey (and I guess Professor Glantz’s chart) uses the 30-day prevalence measure favoured by CDC – i.e. if a person has used a tobacco or nicotine at least once in the last 30 days. But this measure of prevalence has been widely criticised as too broad, containing both daily use and occasional or experimental use, which are completely different behaviours (e.g. this recent critique)

To its credit, CDC itself published an analysis of the frequency of use in the NYTS within the 30-day prevalence figure. Sadly, the chart produced by CDC obscured the most interesting data, which I have presented in the chart drawn by me below.
frequency of use

Fewer than 1 in 6 teen e-cigarette users count as what one might call regular users (used on more than 20 days in a month), and more than half are using e-cigs less than once a week.  The proportion of daily or regular users is more than twice as high for smokers compared to vapers. So if you use a 30-day prevalence figure you capture very different behaviours.  The most concerning users are those for whom a consolidated smoking habit is emerging (i.e. the ones who may find it harder to quit later).

2.3 Most adolescent e-cigarette users are not using nicotine at all

The claim about “expanding the youth nicotine market” relies on counting large numbers of adolescents who are not actually using nicotine.  The U.S. University of Michigan Monitoring the Future survey suggests as few as 22% may be using nicotine, See this graphic from Monitoring the Future with my annotation in red:

Screen Shot 2016-04-17 at 18.36.13

Professor Glantz simply cannot make claims about “expanding the youth nicotine market” if most of the youth he is counting are not using nicotine.

2.4 E-cigarette use predicts smoking – implying a gateway effect?

Sadly, I wasn’t there to see what lesson Professor Glantz drew from this chart (49), but in case it was something like “e-cigarettes seem to cause teenagers to smoke” (why would it be included otherwise?), I thought it worth a pre-emptive clarification of what the data really means.

Screen Shot 2016-05-01 at 16.45.32

Let me explain how to read this chart honestly.  Imagine you observe a pronounced association between two behaviours, A (e.g. vaping) and B (e.g. smoking), as shown in this chart. Three mechanisms are possible to explain what’s happening:

  1. A causes B: you’ve found a ‘gateway effect’.
  2. B causes A: this is what you would see if young smokers were keen to try vaping to quit or reduce their dependence on smoking. The e-cigarette use only happens because they were smoking. – this is known as ‘reverse causation’.
  3. C (a third factor or set of factors) causes both A and B: maybe the same things that incline adolescents to smoke also incline them to vape (e.g. parental smoking, rebellious nature), what is sometimes called ‘shared liability’.  More generally, this effect is known as ‘confounding’.

Before anyone can claim that A causes B (a gateway effect) they would need to consider what would happen in the absence of e-cigarettes – in the case of explanations 2 and 3, the kids would just smoke: the emergence of e-cigarettes is a diversion from smoking and positive for health. This is discussed is my posting: We need to talk about the children – the gateway effect examined in which I show that the most likely pathways that young people will take improve with the addition of e-cigarettes as alternatives to smoking. In an excellent recent paper, Levy et al explore similar themes.

The studies presented here allow nothing interesting to be said about which of these three possible causal relationships explains the observed associations – so what point was “E-cig use predicts smoking” supposed to be making in this presentation?

Summarising…

The presentation of arguments showing that e-cigarettes are “expanding the youth nicotine market” contains at least four failures of reasoning, rendering it completely misleading:

  • It introduced an inexplicable spike in his graph that bears no relation to the actual picture, even as presented by CDC – and failed to draw the obvious and positive conclusion that smoking is declining faster than ever while e-cigarettes are rising, and that these observations might be causally related.
  • It failed to differentiate between occasional use and regular use and to recognise the difference in intensity of use between smoking and e-cigarettes use.
  • It counted people who are not using nicotine as nicotine users and so vastly inflated the account of the expanding youth nicotine markets
  • It probably implied that studies showing an association between vaping and smoking indicate that vaping causes smoking.

3. Prolonging the tobacco epidemic?

I think this claim is just entirely made up – I simply don’t know where this comes from.  Adult smoking prevalence in the US (and the UK) has fallen as e-cigarette use has risen – and e-cigarette use is concentrated among adult smokers. It doesn’t seem to be prolonging any tobacco epidemic as far as I can see. It looks more like the decline in smoking has accelerated during the rise of vaping, having stalled in the mid-late 2000s.

USsmoking-vaping

A very similar picture emerges from Britain (sources)… e-cigarette use is concentrated in smokers and smoking falling. Again, after stalling the decline in smoking has picked up again as vaping has risen.

GB smoking data
So where is all this stuff about ‘prolonging the tobacco epidemic’ coming from?

As I have explained in my critique of the prohibitionist tobacco control ideas in the “tobacco endgame” vapour or other low-risk nicotine technologies will reduce the burden of smoking related deaths and disease. This is because they allow those most at risk to radically reduce their health risk without having to take the harder step and unnecessary step of quitting nicotine use and by engaging in what many find to be a pleasurable consumer behaviour (see Sarah Jakes: the pleasure principle).

Underpinning this deeply misleading presentation is a deeply flawed framing of the issue: nicotine use isn’t the real problem  The real public health problem is the death and disease caused by smoking – and we should stick to doing what is right and proportionate about that.

This is why I always press tobacco controllers to state their objectives. Is it about reducing disease, reducing smoking, reducing tobacco use, reducing nicotine use, reducing bystander risk or reducing adolescent uptake? Or is it about destroying the tobacco industry? It matters because, in the complicated real world, several of these objectives are in tension.  For example, you can reduce smoking and disease faster if you don’t try to force nicotine abstinence on people.

A gift from Europe – the Swedish snus experience

If there is one thing I’d like an American tobacco control professor to take home from Europe to the United States it is this…  Adult smoking prevalence in Sweden in 2015 reached 10% and the reason for that exceedingly low level is snus, a tobacco product made by a tobacco company. This experience provides an important proof-of-concept for tobacco harm reduction, which Professor Glantz would do well to learn from.

Here are the official pan-European comparative data – in 2014 Sweden = 11% and EU average = 26% – all from a single large survey with the same questions done at the same time. The chart is mine with Sweden emphasised and EU average marked.

Eurobarmeter 429

European Union smoking prevalence – late 2014 – Eurobarometer survey.  All but one of these countries has a ban on snus.

It’s also compelling evidence of the sheer irresponsibility of many of his fellow travellers in tobacco control for insisting this product should be banned everywhere else in the EU other than Sweden.  It also shows that ‘population effect’ pseudo-arguments really are tactical – for use in arguing for prohibition and little else.  They have nothing to do with health as they persist well after the data unambiguously shows population health benefits – as in Sweden.  As recently as late last month, prominent figures from the public health establishment were sinking to the same level as the tobacco industry of 40 years ago in their denial that snus has had a significant public health benefit in Sweden: see Anti-vaping zealots in flat-earth letter to The Times.

Spare a thought for Austria

I hope no lasting damage has been done arising from the extensive misinformation is this presentation – unfortunately, I hear that may not be the case.  I hope members of the Academy of Sciences and Austrian officials and ministers will read this critique and ask Professor Glantz to address the criticisms and explain himself.  Gerry Stimson and I wrote to the Austrian government with some evidence-based advice here: TPD implementation – maximising harm by going beyond the minimum – I hope they pay attention to that.

Drop in on Britain next time!

Next time he’s over in Europe, I would like to invite Professor Glantz to come to London.  Here’s a possible itinerary:

  • A trip to the delightful Royal College of Physicians near Regent’s Park to hear more about the College’s new report, Nicotine without smoke, on tobacco harm reduction. Meet respiratory physicians who actually see patients who can barely breathe and take the trouble to find out what the science is telling them to do about it.
  • Over to the government quarter for insights into the excellent work of Public Health England.  Professor Glantz could then try to work out why FDA, CDC and its Californian equivalent are so intent on putting the lives at risk of the remaining Americans who still trust them by misleading them about the relative risks of different tobacco and nicotine products.
  • How about rediscovering those old-fashioned virtues about empathy in public health and treating the public with respect?  Look no further than the UK National Centre for Smoking Cessation and Training and a couple of hours discovering the innovative NCSCT approach to e-cigarettes.
  • Maybe pop in on England’s Smoking Toolkit headquarters and find out why we have better more frequent data on what’s happening in smoking and vaping – and talk to the people who’s work is to analyse it dispassionately rather than turn it into propaganda.
  • I would suggest a meeting with Louise Ross, our top e-cig friendly smoking cessation practitioner so he could benefit from her insights drawn from front line experience,  but I think that may put him in too much danger, given what tobacco control propaganda has done the perceptions of her clientele.

Finally, I’d like to pass a couple of hours with Professor Glantz myself. Over lunch, I’d like to explain why his presentation is so harmfully misleading, why his approach is so unethical, how he has become a global health liability prolonging and aggravating the smoking epidemic, and why everything he’s doing on e-cigarettes and tobacco harm reduction will protect the cigarette trade and shape the nicotine market for the benefit of the tobacco industry.

I’m open-minded, of course. Maybe he would persuade me I’m wrong. But he’ll have to do a lot better than this presentation.

Comments: please avoid abuse or unfounded allegations.

30 comments to Professor Glantz brings his anti-vaping crusade to Europe – I review his presentation

  • […] Clive Bates: Professor Glantz brings his anti-vaping crusade to Europe – I review his presentation http://www.clivebates.com/?p=3882 […]

  • […] Clive Bates, a retired civil servant for the Welsh government and outspoken advocate for Tobacco Harm Reduction, looked at the data from 2014 and compared daily vs occasional use in cigarettes and e-cigarettes (vapes). Here is what he states: […]

  • GE

    Great stuff!
    As effectively a ‘nicotine addict exterminator’, through propaganda, where does Glantz take his orders / funding from? Or does he have BPD? Even on a basic logic level his arguments fall down.

  • Thanks for sharing this interesting post. It’s really good to know that many people are showing interests on cigarette alternatives. It’s important to look into the benefits of e-cigs / vapes and how it can help those who want to get rid of their smoking habits. I agree, it is a must to look deeper into the issues associated with it to be able to create an accurate assessment of these products.

  • Gummy Bear

    Dissecting the flaws in Glantz’ methodology only tells us how he came to the blatantly absurd result that ecigs make you 28% less likely to quit. The claim is logically impossible from the start. The worst that could happen is that ecigs are completely useless and add nothing to smoking cessation. They are an additional option for those who want to quit. If you try them and they don’t work all other options are still available.

    Normally, when I get a result that is impossible or wildly implausible (such as a negative probability or an estimate completely beyond belief) I pause and check where I have made a mistake. Glantz, not so. He sets out to “prove” an impossible result and then tweaks the methodology until he gets it. And he doesn’t even notice that the claim is completely absurd to start with.

      • Gummy Bear

        Hi John,

        Yes, though most of it is not fraudulent. The study that “proved” that listening to a song changes your age was not to claim an impossible result, but to expose that with unlimited freedom to tweak methods you can “prove” even impossible claims. In the genuine empirical sciences the problem is more with results that are somewhat surprising but still plausible.

        “Having one quitting option more makes smokers less likely to quit, UCSF professor finds” is a quite a paradoxical headline. If you want to quit and you think Champix is your thing, why would your chances be lower just because other people use the new method? It may not be outright impossible, but something very weird would have to be going on. It’s a very extraordinary claim, and extraordinary claims require extraordinary evidence.

        The TC crowd has been very successful in obfuscating logic and sense. They make it sound like “Having more quitting options leads to less quitting” is just as plausible as “Having more quitting options leads to more quitting”. Or that “the efficacy of ecigs as a cessation aid is not proven” is a valid argument for banning them. It is not. But by jumping into the details of their methodological flaws rather than first exposing the extravagance of the claim itself we are somehow playing their game.

        • John walker

          Agree.
          The part that struck me most was the 2000 hours of work, it took to ‘ workout’ how just one ( ultimately truely fraudulent ) paper had dun it.

  • Anonymous

    Prof Glantz lecturing Public Health on the ills of vaping reads like deja vu from T.D Lisenko lecturing the Academy of Sciences of the former Soviet Union on the 1940’s on the ills of Western (Mendelian) genetics.

    For those unfamiliar with Lisenko: he is a leading historical example of how external dogma supported by political power can completely deconstruct scientific research, perverting beyond recognition science institutions and procedures (like peer reviewing, grants and jobs). Counting with full support from the high echelons of the Soviet bureaucracy, Lisenko practically eliminated all research contrary to stalinist dogma (on Mendelian genetics) in the former Soviet Union between the 1940’s and the late 1960’s. See details in this article published by the journal Science: http://www.scientificintegrityinstitute.org/Science071665.pdf

    Evidently, the Lisnko analogy is not perfect: the Tobacco Control bureaucracy is not the centralized Soviet state, so Prof Glantz and other Lisenko-like figures (Simon Chapman) will not be removed by the whims of a dictator, but likely by the change of perceptions, interests and politics of society (the zeitgeist), or simply by generational renewal: both Glantz and Chapman and similar characters are close to retirement age. Future historians will remember them as Lisenko’s children of the last XX and early XXI centuries.

  • john Walker

    Clive Glantz is a text book example of why ‘ academic’ ‘ health scientists’ ( and Glantz is simply a extreme example) should be barred from direct influence in policy. Glantz is academically ‘schooled’ in getting it ‘right’, no matter what.

    What you need are people who have the mindset of a , engineer:

    “Engineering is different than science. The primary goal of engineers is solving a specific problem with available resources, and an engineering solution can only be judged relative to its cost. Whereas the scientific method does not allow shortcuts to save time and money, the engineering method does. Engineering is by nature applied, and it has no scientific core, or general formal methodological prescriptions based on the scientific methods. Billy Vaughn Koen, (2003) who has written what appears to be the current standard methodological treatise for engineering defines the engineering method as “The strategy for causing the best change in a poorly understood or uncertain situation within the available resources.” He describes an engineer as an individual who solves problems using engineering heuristics. He argues that an 3 engineer makes no pretence of having found the truth, or having found the “correct” model. 1 An engineer focuses on finding solutions that work, and uses whatever methods he finds best leads to finding a solution to the particular problem he is trying to solve. In the engineering field, there are no rigid prescriptions guiding method.”

  • Bill Godshall

    Since Stan Glantz hasn’t responded to the last 250 e-mails I sent him criticizing his claims about vaping, and since he has blocked all of the many dozen comments I tried to post on his blog during the past five years (that similarly criticized his claims about vaping), I don’t think Stan will be interested in meeting (or debating) with Clive Bates.

    The underlying problem is that Legacy (which has lobbied FDA to ban vapor products since 2009), NIH, FDA and the CA DPH have given Glantz tens of millions of dollars to deceive the public about secondhand smoke, movies, THR, smokeless tobacco, vaping, tobacco companies, etc.

    After Glantz began grossly misrepresenting the scientific and empirical evidence several years ago, FDA and NIH responded by rewarding Glantz (and his UCSF colleagues) with millions of more dollars (purportedly to conduct research) to continue conducting and publicizing junk science, and to deceive the scientific community, the public health community, the news media, etc.

    As long as wealthy foundations (Legacy) and federal health agencies are giving Glantz millions of dollars to lie about, and lobby to ban vaping, he’ll continue to do what he’s been doing.

    One solution is to convince US Congress to halt DHHS funding for the junk science Glantz has been funded to conduct (and dozens of other federal funding recipients who have made false and misleading fear mongering claims about vaping under the guise of scientific research).

    • Clive Bates

      I agree, Bill. But we need to call out what he is doing until it becomes too embarrassing or risky to shovel public money into this sordid enterprise. This is my modest contribution to that.

      • Mike

        This contribution is FAR from modest. This accumulation and presentation of sound critique is exactly what I uses everyday to convince the US Congress that it is going down the wrong path wrt THR. We have inserted a requirement that our government FDA consider harm reduction strategies into the law. We have also this year inserted language requiring scientific methodology in government funded research (one would have assumed it was already required). Today I met with the staff overseeing all NIH, FDA, CDC funding and health policy in the US Senate – I used 3 of the above charts in dispelling their strongly held beliefs about youth and nicotine.

        As one who’s job it is to lobby for vapers in the US, I want you to know we are chipping away at this, and I can’t thank you enough.

  • Linda Hickerson

    Glantz is doing what he does best – skew the numbers. In order to understand his stance on vaping, you have to understand the motivation with tobacco control. Let’s first understand, this has nothing to do with health. If it had nothing to do with health for tobacco, it can’t have anything to do with health for e-cigs. It’s always been about the money and continues to be about the money. The winners are all of the alphabet do gooders like the Am. Cancer Society. They receive large sums of money from tobacco taxes. The government is the front runner in expanding their funds from tobacco; this is for both the fed and state levels. There are so many groups out there (like Glantz) who wouldn’t even exist if it weren’t for the tax. They are not about to allow e-cigs to drastically reduce or eliminate them. Of course, last but not least, is big pharma. They are upset that they are not selling as much snake oil as they were hoping; e-cigs have put a huge dent in their profits.

    For anyone interested in the lies that have been propagated on tobacco, google it. You’ll probably see Glantz name all over the place.

    With all of the money generated from the sale of tobacco, does anyone really not see the bigger picture? They would love for the majority to light up, thus, ensuring they continue to have fat pockets.

  • […] Regrettably, the influence of Professor Stanton Glantz of the University of California at San Fransisco is not confined to California or to the United States. Last month he made a visit to Europe …  […]

  • Chris Price

    OK – thanks.

    I think dismissing the possibility that some smokers may not answer truthfully is a little optimistic.

    The concept that such methods of data acquisition are accurate is disproved by their very significant variation.

  • Clive Bates

    Don’t know – could be down to weighting. Might be a different way of asking the question. Both surveys require the users to self-identify as a smoker or to say whether they smoke – there might be some bias in the way light or occasional smokers answer these questions.

  • Chris Price

    Just a quick practical question, Clive: why do we such such a significant variation in UK smoking prevalence estimates?

    Here we see a figure of about 22% used by the Eurobarometer report for 2015, but we have local figures of around 19% (or less) for 2015. I appreciate these are all estimates obtained by asking 1,000 people and then multiplying the figure up to overall population scale – but a 3% difference is quite significant if the figures are actually used for anything apart from dining table chatter. A 3% difference is probably almost as much as the difference in smoking prevalence measured by the usual ‘past 30-day use’ and the ‘daily smoker’ figures.

    Also, what upward adjustments are routinely applied to such figures, given that they are apparently all based on self-reported answers in surveys, and asking 1,000 people if they are paedophiles or smokers will inevitably produce a significant degree of under-reporting? Is an increment of, say, 3%, routinely added to such answers to give some degree of accuracy to the estimated totals?

    Or, perhaps, some surveys add the 3% or so they know must represent the under-reported figure, but others don’t?

    I’m sure you must know the answer, Clive, if anyone does. Only please don’t bring our beloved EU’s wonderful health management into it, I have just eaten my lunch.

  • Louise Ross

    Clive, if he ever books lunch with you, do invite me along! I’ll invite a few hundred service users who have transformed their lives with vaping.
    I assume people don’t challenge him because ignoring him denies him a platform, but he just never stops, does he

  • Sarah

    I would prefer not to try to guess Glantz’s motives but there is no doubt that the tobacco control industry created a monster which is now out of control. Some would say he has been for decades but that predates my experience. I wonder how many are reluctant to discredit him in the way which he so richly deserves because then so much else would unravel. ‘Oh what a tangled web..’ etc..

    I hope that one day the world will be able to look back on these tobacco control ‘deities’ and the monolithic organisations which are behind them and see their actions for what they are – utterly contemptible.

    • Clive Bates

      I think he gets negligible challenge and much reinforcing affirmation from within his own field. Either because his followers want to hear these messages maybe because it supports an undisclosed prohibitionist agenda, or because those who disagree with or are embarrassed by him are too timid to speak out.

    • Trollky

      Totally agree. When TC is not on the side of a simple harm reduction concept such as vaping then they are simply on the wrong side. I have no doubt that one day cooler, more pragmatic heads will prevail and the “flat earth” element of TC will be taken to task not just professionally but legally.

  • Roger Hall

    Prof Glantz is well aware of what he is doing. It isn’t borne out of ignorance, but a simple case of doing what he is paid to do. He’s simply acting out a role and using any evidence he can invent as stage props. I expect that most if not all within TC and Public Health are fully aware of his thespian attributes, but (and this is the most worrying aspect) they are all happy with his performances. They all need and want a high profile thespian to paint the pictures that protects the status quo and he then takes all the flak away from them. The highly educated and well paid PH and TC parasites can then relax, say nothing, do nothing and question nothing. He’s a diversionary high profile scapegoat and the real issue isn’t Glantz himself, but the fact that he’s allowed to get away with his well fabricated and obvious departure from the scientific truth, by his peers within TC and PH.

    • Clive Bates

      That’s a valuable insight. It reminds me of how we discuss malaria: it’s not the mosquito, you have to drain the swamp.

    • “the real issue isn’t Glantz himself, but the fact that he’s allowed to get away with his well fabricated and obvious departure from the scientific truth, by his peers within TC and PH.”

      We’ve seen that quite clearly since at least his Helena study (There was a lot before that as well, but Helena really “jumped the shark” as they say.) Glantz was a big name in the whole fabric of secondhand smoke lies and nonsense stretching at least back into the early 90s.

      – MJM

      • LVD

        The problem is indeed not Glanz, but the rest of them who decided to turn a blind eye for the sake of the “nobel cause”. Tobacco science is the only field in science I know of when somebody is caught red handed cheating, he’s getting an unanimous standing ovation of his peers… And this is going on for decades already.

        Furthermore they all are receiving their paychecks from tobacco taxes or from things like ‘the big settlement’. In short their pay consists solely of the revenue generated by tobacco sales. In my book that is a big conflict of interest; just wait and see until e-cigs are generating massive taxes, who will be first in line to collecting them.

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