August 27, 2015
“The National Institutes of Health had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.”
A study by the University of Southern California was published in the Journal of the American Medical Association on August 18th. Lead author Adam M. Leventhal, PhD concluded:
“Among high school students in Los Angeles, those who had ever used e-cigarettes at baseline compared with nonusers were more likely to report initiation of combustible tobacco use over the next year.”
To this untrained observer’s eye, the study appears to be well done. The report provides specific details on Objective, Methods and Conclusion. And the research was conducted by highly educated professionals at a well-known and prestigious university.
The study also appears to be reasonably objective. While there are some suggestions of bias in the wording of the report, nothing jumps out as blatantly misleading. In spite of appearances, nothing could be further from the truth.
According to the NIH website:
“This study was funded by NIH’s National Institute on Drug Abuse under [research grant] R01-DA033296, and the National Cancer Institute under [research grant] P50-CA180905 with funding from the Food and Drug Administration, Center for Tobacco Products.”
Those familiar with the work of these federal agencies (e.g. vapers) might be tempted to suspect the presence of bias. The opening quote in this blog, taken directly from the study, attempts to dispel any concerns. It clearly states that NIH had “no role” in the conduct, preparation or publication of the study. Nothing could be further from the truth.
Those not familiar with the work of these federal agencies (i.e. 95% of the public) are confident that the NIH supports scientific studies that are objective and in the best interests of public health. They’re confident of that because it says so right on the NIH website. And…nothing could be further from the truth. Here’s why.
The Objective of the USC Study
“To evaluate whether e-cigarette use among 14-year-old adolescents who have never tried combustible tobacco is associated with risk of initiating use of 3 combustible tobacco products (ie, cigarettes, cigars, and hookah).”
Study Design Based on the Objective
- The focus of the study was students that had ever used an e-cigarette prior to the beginning of the study (baseline), and had never used a combustible tobacco products. “Use” was defined as a single puff. The survey did not collect data that would have allowed distinguishing between experimentation and regular, ongoing use. Not part of the objective.
- “Directionality” was an important aspect of the objective. From e-cigs to tobacco was evaluated. From tobacco to e-cigs was not. Not part of the objective.
- The study was longitudinal. Six and twelve month follow-ups were conducted to determine the number of students who subsequently “initiated use” of a combustible tobacco product. And again, “use” was defined as a single puff after six and twelve months. No distinction between a single puff and a pack a day smoker. Not part of the objective.
The objective of this or any study defines what data will be collected, the parameters that will be used to evaluate the data, and the question(s) the study is expected to answer.
- What data will be collected – directionality from e-cigarettes to combustible tobacco. Only.
- What parameters will be used for interpretation – use defined as a single puff. Quantity, frequency and duration – all beyond the scope of the objective.
- What question is expected to be answered – the risk of initiating use of combustible tobacco products. The objective assumes risk is present.
The results of the study are constrained by the bias of the objective. Hundreds of thousands of dollars to show that some of the students who had ever taken a single puff on an e-cigarette then went on to to take a single puff on a combustible tobacco product. The researchers themselves emphasize that no causal relationship was proven. No gateway effect was established. Not part of the objective.
Who wrote the objective?
- NIH’s National Institute on Drug Abuse
- The National Cancer Institute
- The Food and Drug Administration, Center for Tobacco Products.
So the process was write the objective. Award the grants. Wait for the “scientific” conclusions based on the data collected. Publish in a major journal. Release to the media. Watch the desired result unfold.
- NIH Press Release – “Teenagers Who Try E-Cigarettes Also Try Smoking, Study Finds”
- MedPage Today – “Today’s Teen E-Cig Users May Be Tomorrow’s Smokers” The headline was accompanied by the teaser – “Study suggests that vaping is a gateway to full-on tobacco smoking”
- The Wall Street Journal – “Study Finds Ninth-Graders Who Used E-Cigarettes More Likely to Smoke”
- PR Newswire – “JAMA Study Raises Concerns Youth E-Cigarette Use Could Lead to Smoking Other Tobacco Products, Shows Urgent Need for FDA Regulation”
Science can be manipulated. To the point where nothing could be further from the truth.
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Dave Coggin has a Master’s Degree in business and spent 35 years in corporate America. He is a co-founder and partner in DIYELS. He has spent the last five years actively researching and following the evolution of the e-cigarette industry. He is a strong proponent of e-cigarettes as the most promising option currently known for tobacco harm reduction. He may be contacted directly at firstname.lastname@example.org .
The opinions presented here are exclusively those of the author. Vaper’s Vortex is offered as a service to our customers and followers. Anyone considering e-cigarettes as an alternative to tobacco cigarettes should seek qualified advice from a medical professional.