old man heart attack meme - smokes 50 years, has heart attack, switches to vaping, e-cigs did this

cause and effect

angry old man pictured is not Stanton Glantz

"You better not vape! Get off my campus!"

Stanton Glantz P.h.D is a professor and director of the Center for Tobacco Control Research and Education at UCSF. He has a long history of getting sensationalist press coverage and whenever he publishes a new study, he has more than enough journalists willing to write unquestioning coverage of it. He is an "tobacco control" expert after all.

Wikipedia actually calls him "a leading tobacco control activist",  the "Ralph Nader of the anti-tobacco movement", "an activist for nonsmokers' rights and an advocate of public health policies to reduce smoking."

Can some a person with his history of activism keep it from shading his scientific output?

It isn't as if the guy went into creating this study with an ax to grind or anything, right? While, Stanton Glantz is the director, he didn't conduct the entire study solo, he just "guided the analysis and helped revise and prepare the final manuscript".  His underlings surely aren't anti-vaping activists also, right?

Did you know that this study was partially funded by the FDA? I'm glad the government is paying for unbiased science that drives public policy.

How this Study was Conducted

I'm sure scientists don't ever base studies on a bad data
brendan frasier meme about being sad after reading some flawed scientific studies

is fair science dead?

The actual study is linked can be found here.

It seems obvious what the authors want casual readers and the general public to believe, but what does the study actually say?

Upon reading the study, not just the abstract, it is plain to see there is an agenda going on here. 

Over half of the references, 16 of 28, are burned in the fairly short introduction talking about what causes heart attacks, and there have been studies showing that cigarette smoke has effects on the cardiovascular system, but so do e-cigarettes. What is conveniently missing is the relative effects of smoking versus vaping. 

The whole introduction seems to just be poisoning the well so that anyone that reads it automatically is thinking vaping and smoking are both causing equal heart problems.

This study is based on survey data from National Health Interview Surveys (NHIS) from 2014 and 2016, with each having over 30,000 participants. The survey data was then used to examine any relationship between cigarettes, e-cigarettes and myocardial infarction. 

Keep in mind that e-cigarettes weren't available in the United States until 2009, according to the study, but vape devices weren't widely used until 2011 and later.

Medical histories, along with other information was taken and survey participants were asked:

  • "Have you EVER been told by a doctor or other health professional that you had a heart attack (also called myocardial infarction)?"
  • "Have you ever used an e-cigarette, even one time?" 
  • "Do you now use e-cigarettes every day, some days, or not at all? "
  • "Have you smoked at least 100 cigarettes in your ENTIRE LIFE?" 
  • "Do you NOW smoke cigarettes every day, some days or not at all?" 

Notice anything missing? 

  • When did you have your heart attack? 
  • Were you smoking or using e-cigarettes before it occurred? 
  • Did you switch to e-cigarettes before or after your heart attack?

Participants who have been a long term smokers, could have had heart attacks then switched to e-cigarettes after the infarction happened.

Flawed data leads to flawed results. The data being used isn't accurate enough to actually draw the conclusions that are being spread around.

How can any accurate conclusions be made about e-cigarettes at all based on the flaws at the heart of this study?

This is why the studies such as this can only say association, linked or "may" lead to such and such. If you can't show that e-cigarettes cause heart attacks you may as well scare the hell out of people, which is what the media in general does when covering vaping.

Check out this quote, which was buried in the discussion section:

In contrast to the lasting effect associated with being a former cigarette smoker, there was not a significant increase in MI risk for former or some day e-cigarette users
-- Study Authors

Oh, hmm. Weird. Are they saying if you vape frequently but not every day, you don't have any heart attack risk? 

Here is how the study authors try to head off any questions about the study flaws:

It is not known when the MIs occurred relative to e-cigarette use, and it is likely that some of the heart attacks subjects reported occurred before e-cigarettes became available in the U.S. (around 2009). This situation will bias the OR estimates toward the null, meaning that the study results likely underestimate the true risks associated with e-cigarette use.

One could argue that e-cigarette usage may simply be indicative of a smoking cessation strategy in traditional cigarette smokers who had their MI while they were smoking traditional cigarettes. The logistic regression explicitly allows for the eventuality that some people switched from cigarettes to e-cigarettes before the data were collected because it included both smoking behavior and e-cigarette use in the same model, including status as a former smoker. If someone switched from cigarettes to e-cigarettes in order to quit smoking after an MI and the increased risk was due to being a former smoker, that risk would be captured in the former smoker variable rather than appearing as an artifact in one of the e-cigarette variables. Moreover, for this situation to induce a spurious association between e-cigarette use and having had an MI, people who had MIs and subsequently quit smoking would have to have done so preferentially with e-cigarettes as a smoking cessation device more than smokers who had not had an MI. No data to support this assumption could be identified.

-- [emphasis added]

"No data to support this assumption could be identified" because the data set being used is not accurate enough and doesn't include the data to answer the posed arguments.

The survey has no questions about smoking cessation or methods of cessation either. 

This whole study just seems like it dressed up to have an anti-vaping societal effect.

Everyone has heard, "correlation doesn't equal causation", but the general public sees words like association and "can cause" as e-cigarettes causing heart attacks. 

Then, journalists write a headlines like "Vapers who use e-cigarettes every day are almost TWICE as likely to suffer a heart attack, and they're even more at risk if they switched from smoking" (an actual headline). 

A current smoker may draw the assumption that if they switch to e-cigarettes from smoking, they would be at an even greater risk so they may as well continue to smoke. E-cigarettes may not be even considered as a cessation method after reading a headline like that.

Press coverage like the kind generated by this study leads smokers as well as the general public to believe the risks from vaping and smoking cigarettes are the same, even similar or possibly even worse.