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Glantz Protegé’s Study Dismantled

Stanton Glantz’s protegé has attempted to continue his work linking vaping to heart attacks, but the work has been dismantled by Floe Foxon, Riccardo Polosa, Ray Niaura, Michael Cummings, Michael Siegel, and Neal Benowitz

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Stanton Glantz’s protegé has attempted to continue his work linking vaping to heart attacks, but the work has been dismantled by Floe Foxon, Riccardo Polosa, Ray Niaura, Michael Cummings, Michael Siegel, and Neal Benowitz. Leading harm reduction expert Clive Bates called it an “outstanding takedown”.

In his paper “Electronic Cigarette Use and Myocardial Infarction”, Talal Alzahrani makes the debunked claim that “current electronic cigarettes is associated with myocardial infarction”.

His study aimed “to determine the association between e-cigarette use and myocardial infarction among subjects who have never smoked cigarettes”.

Like his mentor, Alzahrani spurned the real world and relied on playing with data obtained from The National Health Interview Survey (NHIS) from 2014 to 2021.

He claimed he found that never-smoked vapers had a 2.6-fold increase in the odds of having a heart attack.

He concluded: “This study suggests that current e-cigarette use increases the risks of cardiovascular disease, including myocardial infarction and stroke, in subjects who never smoked cigarettes.”

Foxon, Polosa, Niaura, Cummings, Siegel, and Benowitz disagree. In their response, they express their concern that the research methods used meant it was impossible to draw the conclusion reached.

First up, “Which came first, e-cigarette use or heart attacks?” Glantz made the same error when he claimed vaping was responsible for heart attacks decades before the smokers had switched to ecigs.

Then the group raised “measurement, diagnosis, and biological plausibility concerns”, saying “The independent variable in the analysis is a binary measure (yes vs no) of current e-cigarette use, with no examination of duration and frequency of use, both of which are factors that are important in assessing the health risks of using e-cigarettes, especially for an outcome such as cardiovascular disease.”

They point out that only two types of heart attack would feature in this cohort self-reporting; one “is exceedingly rare in people with a median age of 28”, the other “is most commonly seen in the context of an extreme sympathetic stress, such as in association with methamphetamine or cocaine intoxication”.

The group go on to address “the most glaring omissions in the paper”, sample size. They repeated the analysis and discovered that from 139 thousand people, only 12 out of 1,237 in the current-e-cigarette-using group self-reported having a heart attack.

An unweighted event rate of 1.0%. With these small numbers, the estimated rates are extremely unstable and likely meaningless.”

Finally, with model design concerns and a warning about “uncareful language”, “We urge others to proceed with extreme caution in reading the paper by Alzahrani, which suffers from a number of fatal flaws, including heart attacks occurring before initiation of e-cigarette use; diagnosis and measurement issues; biologically implausible findings; insufficient sample size and problematic model design; and uncareful language. A previous study with these same flaws resulted in retraction.”

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Dave Cross avatar

Dave Cross

Journalist at POTV
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Dave is a freelance writer; with articles on music, motorbikes, football, pop-science, vaping and tobacco harm reduction in Sounds, Melody Maker, UBG, AWoL, Bike, When Saturday Comes, Vape News Magazine, and syndicated across the Johnston Press group. He was published in an anthology of “Greatest Football Writing”, but still believes this was a mistake. Dave contributes sketches to comedy shows and used to co-host a radio sketch show. He’s worked with numerous vape companies to develop content for their websites.

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