Local vaping groups lauded the decision of the Journal of the American Heart Association to retract the publication of a study, which implied that e-cigarette use is associated with increased risk of having had a heart attack. The JAHA editors said they were “concerned that the study conclusion is unreliable.”
“We believe that any study should be based on sound methodologies, validated equipment, and internationally recognized practices. We are concerned by the growing number of studies that, like the Bhatta-Glantz study, do not meet these criteria, and whose communications may mislead smokers, vapers and the public in general. The retraction is a clear example of the validity of our concerns,” said Peter Paul Dator, president of The Vapers Philippines.
“The JAHA retraction of the Bhatta-Glantz study serves as a warning to those who misuse science and twist the facts to further their misguided agenda against e-cigarettes and other forms of tobacco harm reduction. The purpose of retractions is the correction of the scientific literature, and there are experts on the subject who will call out study findings that are invalid or unreliable,” said Clarisse Virgino, Philippine representative to the Coalition of Asia Pacific Tobacco Harm Reduction Advocates.
Originally published in the JAHA’s June 2019 issue, the study entitled “Electronic Cigarette Use and Myocardial Infarction Among Adults in the US Population Assessment of Tobacco and Health” concluded that “some-day and every-day e-cigarette use are associated with increased risk of having had a myocardial infarction [heart attack], adjusted for combustible cigarette smoking. Effect of e-cigarettes are similar as conventional cigarette and dual use of e-cigarettes and conventional cigarettes at the same time is riskier than using either product alone.”
It also concluded that “e-cigarettes should not be promoted or prescribed as a less risky alternative to combustible cigarettes and should not be recommended for smoking cessation among people with or at risk of myocardial infarction.”
The study authors are Prof. Stanton Glantz, a longtime anti-smoking activist and e-cigarette opponent who directs the Center for Tobacco Research Control and Education at the University of California, San Francisco; and Dr. Dharma Bhatta, an epidemiologist at the center.
Several experts raised significant questions about the validity of the study. University of Louisville tobacco researcher Brad Rodu pointed out that the analysis done by the study authors included former smokers who had heart attacks before they started vaping. Once those subjects were excluded, the association described by Bhatta and Glantz disappeared.
In a series of letters to the JAHA, Rodu and the University of Louisville economist Nantaporn Plurphanswat described the main findings from the Bhatta-Glantz study as “false and invalid” and the analysis as “an indefensible breach of any reasonable standard for research on association or causation.”
They urged the journal’s editors to “take appropriate action on this article, including retraction.” In January 2020, 16 prominent tobacco researchers wrote a letter to the JAHA reiterating the serious concerns raised by Rodu and Plurphanswat and expressing concern “that the primary finding of the study is based on a critical error.”
JAHA finally announced on Feb. 18, 2020, that it was retracting the publication of the Bhatta-Glantz study. “After becoming aware that the study…did not fully account for certain information in the Population Assessment of Tobacco and Health [PATH] Wave 1 survey, the editors of Journal of the American Heart Association reviewed the peer review process.”
The editors “identified the important question of whether the [heart attacks] occurred before or after the respondents initiated e-cigarette use, and requested that the authors use additional data in the PATH codebook (age of first heart attack and age of first e-cigarettes use) to address this concern.”
The authors did provide some additional analysis, but the journal editors were not able to “confirm that the authors had both understood and complied with the request prior to acceptance of the article for publication.”
After the study’s publication, the editors requested the authors to conduct the analysis based on when specific respondents started using e-cigarettes, which required ongoing access to the restricted use dataset from the PATH Wave 1 survey.
“The authors agreed to comply with the editors’ request. The deadline set by the editors for completion of the revised analysis was not met because the authors are currently unable to access the PATH database. Given these issues, the editors are concerned that the study conclusion is unreliable.”