Paper Slams Glantz Findings
For the second time in one week, anti-vape Stanton Glantz finds himself and his work on the receiving end of an academic takedown – this time from Dr Farsalinos and Peter Lee
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by Dave Cross
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Drs Konstantinos Farsalinos and Peter Lee have published a paper criticising a meta-analysis by Stanton Glantz, claiming to link e-cigarettes with smoking-related diseases. The experts set out to verify the accuracy of the reported findings by Glantz et al., to examine whether the studies cited in the meta-analysis were relevant to the outcomes, to perform a new meta-analysis using studies with relevant outcomes, and to critically evaluate whether even the studies which included relevant outcomes were appropriate to generate conclusions about a causal association between e-cigarette use and clinical outcomes.
Farsalinos and Lee state: “A recent meta-analysis by Glantz et al. combined odds ratios (ORs) relating e-cigarette use (vaping) to cardiovascular disease, stroke, chronic obstructive pulmonary disease (COPD) and other endpoints. They assessed all included studies as having a low risk of bias, and concluded that vaping and smoking have a ‘comparable’ disease odds, with dual use associated with more risk than smoking.”
The meta-analysis, Population-Based Disease Odds for E-Cigarettes and Dual Use versus Cigarettes, by Glantz, Nguyen, and Oliveira da Silva, claimed: “Observational evidence from 124 odds ratios of disease in 107 population-based epidemiological studies of real-world use of e-cigarettes revealed that the odds of disease associated with e-cigarette use were not different from those associated with cigarette smoking for cardiovascular diseases, stroke, and metabolic dysfunction.”
Farsalinos and Lee say that one of the major way to determine the public health impact of vaping is to look at their effect on the risk of smoking related-disease. The best quality evidence, they continue, is expected to come from long-term epidemiological studies. The pair believe the time vapes have been available means it is still not possible to make any meaningful conclusions from available data, “Thus, any current analysis of the risk of vaping compared to smoking is based on short-term observational, often cross-sectional, studies of smoking-related disease rates, an approach that is susceptible to bias and limits the interpretation of association as causation.”
Looking at the studies cited by Glantz, Farsalinos and Lee say: “We did find that the set of studies they considered was not completely appropriate. Thus, there were some studies that should not have been considered at all.”
They concluded: “The analyses by Glantz et al. have numerous weaknesses, as discussed in detail for MI, stroke and COPD, that were largely ignored by the authors.
“Also, the source studies had various limitations. Notably, most of them were contrary to the assessment of having a low risk of bias of Glantz et al., since they frequently failed to take into account whether the switch to vaping occurred before or after the onset of disease, and failed to take account of duration of smoking and amount smoked before the switch to vaping.
“While the results suggest a higher risk of the diseases studied in those vaping and smoking than in those exclusively smoking, the studies considered have not properly adjusted for smoking history before the switch to vaping and for product consumption patterns after initiation of dual use. Glantz et al. obscured the fact that the lower risk observed for vaping than for cigarette smoking, based on the rather weak evidence used, was not only significant, but was actually consistent with the level of reduction expected for those who have quit smoking for a short period without the use of any alternative product.
“There is certainly a need for more, better designed, prospective studies to be conducted. However, the evidence considered by Glantz et al. certainly does not refute the possibility that vaping provides substantial harm reduction compared to cigarette smoking.”
References:
- Comparing smoking-related disease rates from e-cigarette use with those from tobacco cigarette use: a reanalysis of a recently-published study by Farsalinos and Lee - https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-025-01230-y
Dave Cross
Journalist at POTVDave 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 start-ups to develop content for their websites.
