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Tobacco Control Expert Raises Alarm About Poor Quality of Vaping Studies

In order to develop strategies for properly regulating electronic cigarettes, we must first understand how they work and what effects they have on our health. For that, objective research is key, but as one German tobacco control expert points out in a recent editorial, e-cigarette research seems to be more quantity than quality lately.

In an interesting op-ed published in the prestigious German medical journal Aerzteblatt, Ute Mons, the Head of Cancer Prevention Unit at DKFZ (German Cancer Research Center), warns about what she calls “publish or perish”, a disturbing trend in the scientific community that pushes both researchers and journals to publish materials as fast as possible, even if it means sacrificing quality. E-cigarette research, Mons points out, is an excellent example of this.

“Meaningful study designs such as cohort studies are complex and require long observation periods, but politics and the public need quick answers,” Mons writes. “Less complex studies and shorter observation periods in turn lead to methodological problems. For example, there are often alternative plausible explanations for findings, such as reverse causality, distortion or obscuring of results, which must be adequately taken into account when interpreting the study results. However, this does not always happen.”

The German researcher goes on to suggest that where e-cigarette research is involved, the scientific system “promotes more mass than class”, pushing new studies to be published as soon as possible, and even favoring high novelty research, instead of focusing on offering the best information for public health.

One of the most important issues highlighted by Ute Mons regards the publication of poor-quality e-cigarette studies in renowned medical or scientific journals the reputation of which suggest an inherent high standard of published materials. Unfortunately, that has proven to be an incorrect assumption to make of late, at least as far as vaping research goes.

“The problem with this: The journal’s reputation suggests a high quality of studies and ‘refines’ weak studies,” Mons writes. “The central scientific self-control – the peer review system – unfortunately fails too often. The often non-transparent assessment system favors distorted decisions and thus does not always fulfill its role as an independent quality control.”

To back up her claims, the Head of Cancer Prevention Unit at DKFZ offers three notable examples of vaping-related studies the methodology of which was so poor that some had to retracted by their own authors.

The first example, a cross-sectional study that linked heart-attacks to e-cigarette use, was co-authored by infamous vaping opponent Stanton Glanz and published in the Journal of the American Heart Association. It concluded that daily users of electronic cigarettes had 80 percent greater risk of suffering a heart attack than those who did not use them. The problem was that it included people who had had a heart attack up to 10 years before taking up vaping, or who had switched to vaping after suffering the heart attack. It did not establish any kind of causality, making it possible to interpret that people who suffered heart attacks switched to vaping. It was retracted eight months after publication.

“A correct step,” Mons notes, “Which unfortunately came too late, because the media coverage had long since spread the wrong conclusions.”

Ute Mons also cites another famous cross-sectional study examined the relationship between e-cigarette consumption and smoking cessation, concluding that e-cigarette use prevented smoking cessation rather than supporting it”. The problem was that electronic cigarettes had only been on the market for a few years at the time, so the former smokers surveyed had probably quit before e-cigs were available.

Finally, the third example was one of the numerous ones that tried to paint vaping as a gateway to smoking for youths, by implying causality between vaping and smoking, without taking into account any other alternative factors that may have led study participants to start smoking.

The problem with all these studies is that they were all peer-reviewed, and despite suffering from serious methodology flaws, still ended up published in reputed journals. Mons thus suggests that an improvement to how vaping-related studies are conducted is urgently needed.

“The quality of research on e-cigarettes has to improve in order to serve as a robust evidence base for health policy decisions,” Ute Mons writes. “Because only a high scientific standard creates a solid evidence base for health policy decisions to promote public health. The credibility of tobacco control research is also at stake, as it is significantly damaged by methodologically questionable studies.”

Top photo: Michal Jarmoluk/Pixabay

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