What is the only argument for criticizing Public Health England Report on e-cigarettes? Funding of 1 of the 185 cited studies


By Dr Farsalinos

The well-known medical journal “The Lancet” released today an editorial criticizing the Public Health England (PHE) report on e-cigarettes. The editorial is titled: “E-cigarettes: Public Health England's evidence-based confusion”. One would expect to read scientifically-substantiated arguments against the Public Health England report, challenging the authors’ conclusion and providing a different perspective. Instead, the editorial is a personal attack on Riccardo Polosa (who was named in the editorial) and Karl Fagerstrom (who was not named in the editorial). Believe it or not, these scientists did not have any participation in the formulation of the PHE Report. Instead, they were 2 of the 12 authors in a 2014 study which was cited in the PHE report (1 of the 185 references of the report). Sounds confusing?

Let’s make it clear. Lancet has been annoyed by the announcement by PHE that e-cigarettes are 95% less harmful than smoking, and that this has been reproduced by the media. Lancet seemed concerned that the public may be misled by the claims in the PHE report. So, they quote PHE report saying: “While vaping may not be 100% safe, most of the chemicals causing smoking-related disease are absent and the chemicals that are present pose limited danger. It had previously been estimated that EC [e-cigarettes] are around 95% safer than smoking (10, 146).” Then, the editorial ignores the first sentence and focuses on reference nr 10, a paper by David Nutt and 11 other authors which estimated the harms of several nicotine-containing products (tobacco and non-tobacco) using a multi-criteria decision analysis model. In that study, the authors scored tobacco cigarettes with 99.6, while snus got a score of 6, e-cigarettes 4 and nicotine replacement therapy less than 2. Lancet accuses the authors of that study for not substantiating their decision on “hard evidence”. But more importantly, it questions the study validity because 2 of the 12 authors reported funding from e-cigarette companies. The Lancet editorial ends by saying: “But the reliance by PHE on work that the authors themselves accept is methodologically weak, and which is made all the more perilous by the declared conflicts of interest surrounding its funding, raises serious questions not only about the conclusions of the PHE report, but also about the quality of the agency's peer review process.

What the Lancet implies is that 2 of the 12 authors of the Nutt paper framed everyone else into creating a biased document to support their financial interests. That is insulting not only for the two authors mentioned (one by name) but also for the others. Of note, all authors in the Nutt paper were among the most active researchers in tobacco smoking (which Lancet seems to ignore). And of course they based their conclusions on evidence. The lack of hard evidence that Lancet invokes is like saying that there is no hard evidence parachutes help reduce the risk of falling from heights (yes, there was an attempt to review the available evidence but no study was found supporting the value of parachutes).  In fact, there is much more evidence for e-cigarettes allowing us to use common sense and support the conclusion of PHE than for parachutes. Finally, none witnessed the same sensitivity from Lancet on ridiculous news-media headlines, such as e-cigarettes being 15 times more carcinogenic than smoking (based on a study toasting the atomizers and burning the liquids), or that we are witnessing a new epidemic of nicotine addiction through e-cigarettes in a group of youngsters (Korean adolescents) when prevalence of tobacco cigarette ever use was 26.3% and of e-cigarette ever use was 9.4% (1.4% e-cigarette only users + 8.0% dual users!). Scientific journals have been silent on these claims.

It is more than obvious that the lack of any scientific and common sense argument has led once again to criticism based on the ghosts of conflicts of interest. It would be wiser to either present evidence contrary to the conclusions of PHE (which do not really exist) or at least try to produce that evidence and expose those who have produced science for the sole purpose of supporting their interests. Otherwise, silence is better than insulting hard-working scientists.



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