Vaping and Lung Disease Study: Get the Whole Story

Researcher Stanton Glantz is on that bad science trip again with his latest vaping and lung disease study. But it’s not all his fault. There’s some bad reporting afoot here, too.

You’ve probably seen headlines about this study: Vapers 1.3 times more likely to develop lung disease. Glantz’s quotes were even more damning:

“What we found is that for e-cigarette users, the odds of developing lung disease increased by about a third, even after controlling for their tobacco use and their clinical and demographic information,” Glantz commented in a statement. “We concluded that e-cigarettes are harmful on their own, and the effects are independent of smoking conventional tobacco.”

Let’s take a closer look.

Is there a connection between vaping and lung disease?

  • Glantz’s team did a three-year, longitudinal study covering 30,000 people.

This in itself is acceptable. The important question is how the research is designed. In this case, they are really just assessing data collected by others—it’s a statistical argument.

There were controls who never vaped or smoked at all. Others—a small group—only vaped. The third group of dual users both vaped and smoked, at least at some point in their lives.

So, normal people who neither smoked nor vaped had 1.0 times increased risk of lung disease. They found that people who just vaped had 1.3 times increased risk of lung disease. People who just smoked had 2.6 times increased risk. People who both smoked and vaped experienced the highest risk: over 3.0 times more risk than controls.

In other words, vaping may not be totally safe, but it’s far safer than smoking. Other research bears this out: smoking’s effects are apparent long after you quit. Vaping nicotine may increase your risk of lung infections and make your recovery time longer—but not as much as combustible tobacco does.

Smoking can and will cause cilia paralysis. This means that you’re less able to cough productively. Of course, isn’t solely the result of exposure to nicotine. When you’re smoking, the process deposits many more harmful constituents, scarring the tissues, and eventually causing cilia paralysis. This is why smoking probably impairs lung function more than vaping, causing higher rates of illness.

Conditions included were bronchitis, emphysema, and asthma among a few others. So, for example, this does NOT cover cancer or EVALI, the “vaping disease” that’s triggering all of the vape bans.

Weak discussion of dual users and lung disease risk

Interestingly, too, there was no discussion of the fact that the group of dual users—people who both smoked and vaped—might have its own significance. Here’s what I mean.

Here’s how the defined the user categories in the study:

“Respondents who ever used an e-cigarette, ever used fairly regularly, and currently used every day or some days were considered current users. [Those] who reported that they ever used e-cigarettes but do not currently use e-cigarettes were considered former users. [Participants] who reported that they have never used e-cigarettes, even once or twice, were considered never users.”

“Respondents who currently smoked cigarettes, traditional cigars, filtered cigars, cigarillos, pipe tobacco, or hookah every day or some days (regardless of whether they have smoked 100 cigarettes in their lifetime) were considered current combustible tobacco smokers. [Those] who ever smoked and currently do not smoke at all were classified as former smokers. [Participants] who reported that they have never smoked, even 1 or 2 puffs, were classified as never smokers.”

I bring these definitions up because the occasional cigar aficionado is lumped in with me, the person who used to panic at the end of a pack of whatevers. People like me are dual users because we desperately turn to anything that might help us quit.

In other words: dual users might already be at higher risk because we had a more serious smoking problem in many cases. We became dual users because we needed help. We tried many methods, and this is where we ended up to save our own lives. It won’t be true for all dual users, but it will for some of us.

Factors like this cannot be addressed in a study like this—except in discussion. Of course these nuances were not considered here, slightly weakening the link between vaping and lung disease.

Other factors were also omitted from mere mention, such as potential presence of additives, or even possible metal damage issues.

Sample size? Bias? Not really. But…

  • In the cohort only one percent of people vaped alone. In other words, 99 percent of vapers in the study also smoked at some point.

However, although it’s a valid point, this may not be as fatal as it seems, for several reasons.

Because it’s a longitudinal study, this is less of an issue. Longitudinal studies often use small participant groups. The nature of longitudinal studies, which repeatedly observe conditions over time, mitigate some small sample size disadvantages. Depending on the design and scope of the research, 300 participants might be alright.

In this case, it’s not all that surprising to find a pretty small number of people who never smoked at all but still vaped. The larger numbers overall help correct the problem. A more robust discussion would also help, but so will more data.

  • These results are skewed.

Well, sort of yes, sort of no.

The team used the PATH dataset. This is free the FDA and the NIH manage it jointly. Here in the US, it’s probably the best dataset we have to use for a study like this, especially since at least we the public can see the data and independently validate it.

Now, this doesn’t mean that Glantz’s comments are exactly on point, or the reporting on the study is 100 percent tone-appropriate. Some was better than others!

Still, there’s no good reason to reject all of the data that the team used outright. And even if you accept the results on their face, they just tell us something about vaping and lung disease that most of us already assume. Vaping nicotine products may not be 100 percent safe—but it’s far safer than smoking.

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