Stan Glantz defames Brad Rodu, criticizes harm reduction articles on smokeless tobacco and e-cigarettes

Status
Not open for further replies.

Bill Godshall

Executive Director<br/> Smokefree Pennsylvania
ECF Veteran
Apr 2, 2009
5,171
13,288
66
Stan Glantz at glantz@medicine.ucsf.edu just sent out the following e-mail to several thousand anti tobacco folks, and posted it on his website at Two high profile uncritical media stories on industry-supported "harm reduction" | Center for Tobacco Control Research and Education (note that you may have to go to his website to access the referenced weblinks).

From: Glantz, Stanton A
To: STANGLANTZ-L@LISTSRV.UCSF.EDU
Sent: Wednesday, November 09, 2011 4:31 PM
Subject: Two high profile uncritical media stories on industry-supported "harm reduction"


USA Today and the New York Times recently published articles that uncritically accepted assertions that smokeless tobacco and e-cigarettes were useful as cessation tools. Both of these studies were funded by tobacco/e-cigarette companies that had direct financial interests in the outcome of the work.

The USA Today story on Brad Rodu's smokeless study did note that he was (and has been for years) supported by tobacco companies and included Rodu's claim that "There's absolutely no influence whatsoever" by the companies. USA Today did not mention all the evidence of bias in industry funded studies.

In both stories, people and organizations who questioned claims that smokeless and e-cigs were useful cessation measures we painted as closed minded prohibitionists

The reality is that the big cigarette companies now own the smokeless companies and are aggressively marketing smokeless as a way to keep people smoking despite the presence of clean indoor air laws. Our analysis of the likely effect of aggressive marketing of smokeless for harm reduction is that it is unlikely to produce any population-level benefits and could actually do harm.

Contrary to the assumptions made in these two newspaper stories (and assertions made by Rodu and like-minded people), a large longitudinal study of Air Force recruits found that "Among 114 baseline smokers initiating smokeless tobacco use after basic military training, most demonstrated harm escalation (87%), which was 5.4 times more likely to occur than was harm reduction (e.g., smoking to smokeless tobacco use). Harm reduction was predicted, in part, by higher family income and belief that switching from cigarettes to smokeless tobacco is beneficial to health. Harm escalation predictors included younger age, alcohol use, longer smoking history, and risk-taking."

There is also new evidence that snus, the allegedly "safest" form of smokeless is more dangerous than previously though. A large longitudinal study of snus users in Sweden found that snus more than doubled the risk of heart failure. (Had we used this risk in our model of the population effects of promoting snus for harm reduction, we might have found increased population harm, not just no benefit.)

With regard to e-cigarettes, what the FDA was demanding (and what the e-cigarette industry successfully fought in court) was actual evidence from clinical trials that the claims that e-cigarettes actually worked for smoking cessation. If such evidence was developed in a way that passed the usual scientific muster, people like me would not be expressing such skepticism. In contrast, the study the NY Times featured was small and conducted with industry funding.
 
Bill, the study referenced classifies "dual use" of smokeless along with continued smoking as "harm escalation", yet it does not provide any justification. Is use of Chantix according to manufacturers recommendation with a period of dual use considered harm escalation as well?
 

Placebo Effect

Ultra Member
ECF Veteran
Sep 19, 2008
1,444
1,562
The FDA case was all about e-cigarette companies being unable to prove cessation claims? Funny, I followed the case very closely and it certainly seemed like the FDA wanted to regulate e-cigarettes as medical devices regardless of cessation claims.

Brad Rodu on that Air Force study -- Tobacco Truth: Smoking Gun: Manipulating Definitions
 

MattZuke

Super Member
ECF Veteran
Feb 28, 2011
317
83
A, A
"Those numbers for non-ischemic heart failure were 209/10,000 versus 65/10,000 person-years-at-risk."

okay so a 144/10,000 increase in heart failures among construction workers.

"The CWC cohort was limited because it lacked information on potential confounders such as alcohol consumption and diabetes"

Given they're talking about 70+y/os, and an increase of heart failure from .65% to 2.1%, without knowing if they drank?

Golly that's beyond credible, that's incredible!
 

rothenbj

Vaping Master
Supporting Member
ECF Veteran
Verified Member
Jul 23, 2009
8,250
7,651
Green Lane, Pa
"Those numbers for non-ischemic heart failure were 209/10,000 versus 65/10,000 person-years-at-risk."

okay so a 144/10,000 increase in heart failures among construction workers.

"The CWC cohort was limited because it lacked information on potential confounders such as alcohol consumption and diabetes"

Given they're talking about 70+y/os, and an increase of heart failure from .65% to 2.1%, without knowing if they drank?

Golly that's beyond credible, that's incredible!

Matt, I think you're getting the two studies mixed-

From the Uppsala Longitudinal Study of Adult Men (ULSAM), they identified 1,076 older men (mean age 71), of whom 78 used a median of one tin of snuff a week. About 80% of snuff users also smoked cigarettes, while only 20% of nonusers smoked.

About this study it is also reported-

After a median follow-up of 8.9 years, 95 men in the ULSAM group experienced a first hospitalization for heart failure.

In the age-adjusted model, the incidence rate for heart failure among snuff users was 229/10,000 person-years-at-risk compared with 97/10,000 person-years-at-risk for non-users, Arefalk and colleagues reported.

Those numbers for non-ischemic heart failure were 209/10,000 versus 65/10,000 person-years-at-risk.

In this group, the hazard ratio for the age-adjusted model was 2.42 (95% CI 1.37 to 4.27) and 2.08 for the multivariate model (95% CI 1.03 to 4.22).

The CWC study is the one where they didn't look at the confounders. What bothered me about what was reported (without having the details from the studies) was that in the ULSAM study above they had a small population of older men studied for about ten years that had a mean age of 71. The way this is worded, they were 71 at the beginning of the study so the mean age after 10 years would have been 81. If I'm reading this right, of 1,076 men studied only 78 used snus and 80% of those also smoked which means they only had maybe 20 that used snus only. They also indicate about 200 smokers who didn't use snus were also in the study.

Now they extrapolate "something" out to a per 10k number. There is no indication whether any of those 20 snus using, non-smokers had heart attacks or how the exclusive snus users compared to smokers or snus/smoker users. This reminds me of the cherry picking we've seen of how smoking bans instantaneously lead to a reduction of heart attacks.

Then we get to the CWC study which is a large comprehensive study-

From the Construction Workers Cohort (CWC), researchers identified 118,425 men (mean age 31) who never smoked. A total of 32,821 used a median of 22.5 gm of snuff a day; another 2,439 were former snuff users.

Now we have some significant numbers to draw from and they were studied over " After a median follow-up of 18 years, 545 construction workers experienced heart failure."

Here they don't adjust for confounders and come up with-

The hazard ratio for current users of smokeless tobacco in the CWC group was 1.38 (95% CI 1.05 to 1.72) compared with those who never used tobacco. The hazard ratio for former snuff users was 1.02 (95% CI 0.46 to 2.29).

Now I'm not a statistician, but considering the bias they build into the study by not adjusting for confounders, this seems like a lot more study needs to be done before the antis get my attention.
 

Tom09

Super Member
ECF Veteran
Feb 22, 2009
504
125
Germany
Stanton A Glantz may just feel a bit ...... off, since his recent concerted move towards home smoking bans has not made it into „high profile“ media stories, despite the greased TC transmission wheel. Just to give him craved exposure:
Clean indoor air laws encourage bans on smoking at home
Public Smoking Bans May Spill Over to Households
http://www.ajpmonline.org/webfiles/images/journals/amepre/AMEPRE_3253-stamped.pdf
http://www.ajpmonline.org/webfiles/images/journals/amepre/AMEPRE_3257-stamped.pdf
http://www.ajpmonline.org/webfiles/images/journals/amepre/AMEPRE_3256-stamped.pdf
"Home Smoking Bans Among U.S. Households with Children and Smokers" and "Association Between Smokefree Laws and Voluntary Smokefree-Home Rules" | SciVee

Anyhow, the center piece of his heated mail was an attack on harm reduction, made by exploiting a longitudinal study of Air Force recruits (Klesges et al. 2010, Am J Public Health). There are certainly several limitations of this study, but for now I would like to run along with the Klesges et al. (2010) paper, just as invited by Stanton A Glantz.

First, however, we have to recall results from the e-cig study of smokers unwilling to quit (Polosa et al. 2011):
Sustained 50% reduction in the number of cig/day at week-24 was shown in 13/40(32.5%) participants; their median of 25 cigs/day decreasing to 6 cigs/day (p<0.001). Sustained 80% reduction was shown in 5/40(12.5%) participants; their median of 30 cigs/day decreasing to 3 cigs/day (p=0.043). Sustained smoking abstinence at week-24 was observed in 9/40(22.5%) participants, with 6/9 still using the e-Cigarette by the end of the study. Combined sustained 50% reduction and smoking abstinence was shown in 22/40 (55%) participants, with an overall 88% fall in cigs/day.

Now, following the definitions of Klesges et al. (2010), those 18/40 e-cig users of Polosa et al. (2011) who had lowered smoking by 80-50%, to a large extent replacing a high risk nicotine delivery method with a substantially lower risk method, would be classified in the „harm escalation“ group, because they became „dual users“. Those 3/40 users who had stopped all nicotine consumption would meet the definition of „harm elimination“ according to Klesges et al. (2010). Those 6/40 smokers who had quit smoking but continued to consume e-cigarettes would finally be accepted in the definition of „harm reduction“, as screwed by Klesges et al. (2010). According to the definitions of Klesges et al. (2010), highly endorsed by Stanton A Glantz, the former authors would have concluded an e-cig study, based on results of Polosa et al. (2011), by stating that “harm escalation was 3 times more likely than harm reduction”. Of course this makes no sense. Accordingly, people like Stanton A Glantz are truthfully “painted as closed minded prohibitionists”, as he called himself in his message.
 

MattZuke

Super Member
ECF Veteran
Feb 28, 2011
317
83
A, A
Stanton A Glantz may just feel a bit ...... off, since his recent concerted move towards home smoking bans has not made it into „high profile“ media stories, despite the greased TC transmission wheel. Just to give him craved exposure:

And what about
[Riccardo Polosa (e-cigarettes) also worked as consultants to the companies making products they were evaluating]


Declaration of competing financial interests : Treatment strategies for allergy and asthma : Nature Reviews Immunology
"Riccardo Polosa is a consultant for CV Therapeutics, Duska Therapeutics and NeuroSearch and has received lecture fees from Pharmaxis, Merck and Novartis."

Doesn't look like he was a paid consultant to an e-cigarette firm. Perhaps someone else with better information can verify this.
 

MattZuke

Super Member
ECF Veteran
Feb 28, 2011
317
83
A, A
There is no indication whether any of those 20 snus using, non-smokers had heart attacks or how the exclusive snus users compared to smokers or snus/smoker users.

Okay, thanks, that's where I was confused. I would have expected his citation to address heart attacks among snus users, thus I presumed they were the same group.
 

rothenbj

Vaping Master
Supporting Member
ECF Veteran
Verified Member
Jul 23, 2009
8,250
7,651
Green Lane, Pa
Matt, that article was not the best written that I've ever read, but it had the most detail I could find.

I really think that when these studies are released for public distribution as news items that it should be mandated that the actual study is released for public scrutiny. It would allow us to better understand the methodology and the results.
 
Last edited:

Vocalek

CASAA Activist
Supporting Member
ECF Veteran
From Polosa's study:

Competing interests

None of the authors have any competing interests to declare, but RP has received lecture fees from Pfizer and, from Feb 2011, he has been serving as a consultant for Arbi Group Srl.Arbi Group Srl (Milano, Italy), the manufacturer of the e-Cigarette supplied the product, and unrestricted technical and customer support. They were not involved in the study design, running of the study or analysis and presentation of the data.

It’s interesting how Stan sees the fact that the company supplied the product that was tested equates to “Polosa cheated on the results.”

Did Pfizer not supply the Chantix for the clinical trials that were used to gain FDA approval? Does that mean that the researchers who conducted Chantix studies were cheaters, too? And the researchers who studied the Johnson & Johnson nicotine replacement products must also have been cheaters. Gosh, now that I think about it, any product that has been approved by the FDA through clinical trials must have contained fudged results because all were funded by the manufacturers of the proudcts.

Perhaps Stan would like to fund independent testing of e-cigarettes out of his own pocket.
 

Vocalek

CASAA Activist
Supporting Member
ECF Veteran
Even though his link did not work, I tracked down the snus study. Arefalk G, Hergens MP, Ingelsson E, Arnlöv J, Michaëlsson K, Lind L, Ye W, Nyrén O, Lambe M, Sundström. Smokeless tobacco (snus) and risk of heart failure: results from two Swedish cohorts. J Eur J Cardiovasc Prev Rehabil. 2011 Aug 9. [Epub ahead of print] Smokeless tobacco (snus) and r... [Eur J Cardiovasc Prev Rehabil. 2011] - PubMed - NCBI

In multivariable-adjusted models, current snus use was moderately associated with a higher risk of heart failure (HR 1.28, 95% CI 1.00-1.64) and non-ischaemic heart failure (HR 1.28, 95% CI 0.97-1.68) relative to never tobacco use.

Yet Stan believes that he needs to plug in “doubles risk of heart failure” for switching from smoking to snus in his Monte Carlo prediction model. Quantifying the effects of promoting smokeless t... [Tob Control. 2010] - PubMed - NCBI

And I am stumped mathematically how an increase of 28% works out to “more than doubles the risk.” Must be the “new math” that they didn’t start teaching until after I graduated.
 

MattZuke

Super Member
ECF Veteran
Feb 28, 2011
317
83
A, A
tically how an increase of 28% works out to “more than doubles the risk.” Must be the “new math” that they didn’t start teaching until after I graduated.

Yeah, blasted Harvard Math, where Calculus means calculator.

So this is pretty consistent with other observed studies. Slight risk, nothing compared to sucking on flaming fags. Likely equal to the risk of NRP use.
 

Vocalek

CASAA Activist
Supporting Member
ECF Veteran
Yeah, blasted Harvard Math, where Calculus means calculator.

So this is pretty consistent with other observed studies. Slight risk, nothing compared to sucking on flaming fags. Likely equal to the risk of NRP use.

What's also pretty consistent is taking a comparison of snus use to never use and pretending that shows that snus use is more harmful than continued smoking.
 

Tom09

Super Member
ECF Veteran
Feb 22, 2009
504
125
Germany
... snus study Arefalk et al. 2011...
"current snus use was moderately associated with a higher risk of heart failure (HR 1.28, 95% CI 1.00-1.64) ... relative to never tobacco use"
Yet Stan believes that he needs to plug in “doubles risk of heart failure” [for switching from smoking to snus in his Monte Carlo prediction model (Mejia et al. 2010)
And I am stumped mathematically how an increase of 28% works out to “more than doubles the risk.” ...

There might have been a misreading, here:
The linked Arefalk et al. (2011) abstract gives results for two cohorts (ULSAM and CWC). Results for ULSAM reads “current snus use was associated with a higher risk of heart failure [hazard ratio (HR) 2.08, 95% confidence interval (CI) 1.03-4.22] relative to non-use.” This is what Glantz referenced to in his blog post “snus more than doubled the risk of heart failure”, i.e. an increase of ~108% (ULSAM), not ~28% (CWC). Of course, this does not explain why Glantz considers this ULSAM data to be more robust than conflicting data.

Although implied by Glanz, a “doubled the risk of heart failure” would not directly plug in his population model (Mejia et al. 2010). Glantz made this reference, though, to defend a global input parameter of this model. To account for "tobacco-related health effects" of different tobacco products, the authors assumed that smokeless tobacco comes with 11 % of the detrimental effects of smoked tobacco. This value was adopted from a panel consensus, is not actually quantitative data. Glantz defends the 11% as a lower estimate and most proponents of tobacco harm reduction consider this to be excessive. An expert on this topic would be Brad Rodu - but Glantz apparently prefers to ignore in publication and defame in the general public, not the most compelling scientific argument.
 

Vocalek

CASAA Activist
Supporting Member
ECF Veteran
Yes. The ULSAM cohort was much, much smaller. Furthermore it consisted of elderly men, which tells us that much of their snus use took place before the TSNA levels were reduced.

Two independent Swedish prospective cohorts; the Uppsala Longitudinal Study of Adult Men (ULSAM), a community-based sample of 1076 elderly men, and the Construction Workers Cohort (CWC), a sample of 118,425 never-smoking male construction workers.

There were 14 cases of heart failure among the 78 snus users, and 81 cases among the 998 non-users.

The thing I find most annoying is that Glantz is trying to use this study to prove that snus increases risk rather than reduces it. This is impossible to prove unless you are comparing the cases among former smokers who switched to snus to the cases among continuing smokers. In the larger cohort, all former or current tobacco smokers were excluded to avoid con-
founding from smoking. I guess this would make sense if what you are trying to prove is that if you are a non-user, you should not start using snus.

Nobody is advocating that never-uses become snus users to improve their health. Tobacco Harm Reduction (THR) involves switching from smoked to non-smoked tobacco. Since this study did not look at that question, it proves absolutely ZERO about the role of snus in THR.
 
Last edited:
Status
Not open for further replies.

Users who are viewing this thread