An article by Professor Robert West*, Editor-in-Chief of the journal Addiction, titled ”Electronic cigarettes: getting the science right and communicating it accurately” has caught the IVVA’s attention. In this post we’d like to share and expand on some of the points raised.
The article begins:
”Electronic cigarettes are being used by millions of people worldwide, mostly in an attempt to reduce smoking or stop altogether. Policy makers, smokers, clinicians and the public in general need accurate information on their safety and potential for reducing smoking rates. Unfortunately in some notable cases the science is being misused, with findings being distorted, misinterpreted or misrepresented. Interestingly, up until now this appears to be mainly (though not exclusively) by those who are opposed to electronic cigarettes. Addiction’s goal in this debate is to present evidence as dispassionately as possible whatever it shows, and to correct misinformation where it appears.”
Professor West then identifies some of the ways scientific research is misused:
Failure to quantify
Such as saying ”electronic cigarettes contains many toxins”. This is misleading; it’s an incomplete fact, because it doesn’t say anything about the type of toxins, what amount of toxins are found to be present, or at what levels.
The IVVA would suggest that a failure to compare results with tobacco cigarettes, also constitutes a failure to quantify. Electronic cigarette products are a harm reduction alternative to smoking tobacco cigarettes, and therefore we would share the view with the many researchers who maintain that comparisons with the harm from tobacco cigarettes should always be presented.
Dr Konstantinos Farsalinos from the Department of Pharmacology, University of Patras, & The Onassis Cardiac Surgery Center, Athens is one of the most-published scientists on electronic cigarette research. He outlines an example of this, regarding a study conducted in 2013:
”Over the past month, a series of articles was published in a consumer magazine in France, presenting the results of a chemical study on e-cigarettes that was conducted on their behalf. The initial article mentioned that some e-cigarettes emit more toxic chemicals compared to tobacco cigarettes. However, there was no mention on the methodology or the results in detail. That article sparked worldwide media frenzy, with respected news-media reproducing the news with titles such as: “E-cigarettes are as harmful as cigarettes and could cause cancer” (Daily Mail), or “Cancer from e-cigarettes” (Greek newspaper). Obviously, no one cared about the true results of the study, it was the headline (and its distortion) that was “selling” to readers.
When the results were released (at first the range of findings was reported and subsequently a table with findings per sample tested), it was evident that the initial statement was not true. Chemicals like aldehydes (formaldehyde, acetaldehyde and acrolein) were indeed found, but the levels were similar to those found by Goniewicz and coworkers. In his study, Goniewicz concluded that the levels of such chemicals were 9-450 times lower in e-cigarettes compared to tobacco.”
Failure to account for confounding and reverse causality
The example Prof Wests uses is a statement like ”e-cigarettes reduces a smokers’ chance of quitting”. This is misleading, he maintains, because in cross-sectional surveys of smokers, ”the prevalence of e-cigarette use is higher in smokers than in recent ex-smokers.”
We’ve already seen an example of this in the Irish Cancer Society’s position paper on electronic cigarettes, and as we have already pointed out, presenting data using smokers who are already engaging in harm reduction by using electronic cigarettes to replace some of their daily smoking, and going on to accuse this ”dual use” of being of more harm is not only misleading. It’s frankly illogical.
We know the types of headlines that are written to garner clicks and shares in this digital age, and so often in reporting on electronic cigarettes. The body of evidence that does not show harm, or shows a reduction is rarely if ever quoted to give balance, and so the public is often left with negative-only spin.
Professor West has himself been quoted only this week in an article on the Mirror Online: “Bad studies on e-cigarettes are easy to do and easy to get into top journals, which are hungry for publicity. Good studies are hard to do and are difficult to get into top journals if they do not lead to scare stories.”
The IVVA strongly believe that scare stories do nothing to add to such a serious debate as tobacco harm reduction.
Misrepresentation of outcome measures
West writes ”Claiming that e-cigarette use is prevalent among youth by using data on the proportion who have ever tried and creating the misleading impression that they are all current e-cigarette users.”
The most prevalent example of this can be seen in the US Centre for disease Control, where the misleading headlines covered up the fact that the level of current users amongst never-before-users was merely 0.3%.
The same can be seen here in Ireland too, with the statistic from Tobacco Research Institute, where Prof Luke Clancy’s figures were 1 respondent from the 900+ surveyed, yet headlines would rather have us believe is that this figure constitutes widespread youth uptake. When in fact it does nothing of the sort.
Double standards in what is accepted as evidence
For example, reporting on findings that have major issues in the scope of the protocol design or testing methods used, simply because their results suggest harm, while ignoring studies that show positive results, and where the protocols were better designed and the testing methods were more in keeping with how products are used in real life by consumers.
The ”formaldehyde study” that was recently written about in an article in the New England of Medicine is a prime example of this, and one we’ll be writing about in more depth in a future post. Although both the study itself, and the conclusions headline writers came to, have been repeatedly discounted as flawed here, here, here, here, here, and here, we’re unfortunately going to see lawmakers and policy makers continue to quote it as accurate. Why? Because public fear seems to feed into over-zealous regulatory agendas. Forgotten of course, in the public’s mind, is the small fact that when the tested devices were used correctly, no formaldehyde releasing compounds were found.
Discrediting the source
e.g., arguing that researchers who have received financial support from e-cigarette manufacturers (and even companies that do not manufacture e-cigarettes) are necessarily biased and their results untrustworthy, and presenting themselves as having no conflicts of interest when their professional and moral stance represents a substantial vested interest.
In closing, the IVVA would like to point out that we have many fine journalists and commentators on medical and public health matters here in Ireland. They should step up and present the research they’re reporting on, correctly. It is incumbent on them to report on the emerging research on electronic cigarettes in a responsible manner.
Catchy, negatively-spun headlines may sell more papers and get more clicks and likes, but the Irish public should not be mislead about the truth surrounding e-cigarette science.
*Robert West is Professor of Health Psychology at the Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London