Tobacco Control Researcher Calls for Boycott of Journal, Apparently Because the Editor Supports E-Cigarettes for Harm Reduction

In a comment posted on Dr. Stan Glantz’s blog yesterday, Dr. Thomas Eissenberg–a researcher studying electronic cigarettes at Virginia Commonwealth University–called for a boycott of the journal Addiction because of his claim that the editor of the journal exhibited bias in fast-tracking an article that reported low levels of aldehydes in e-cigarette aerosol.

Specifically, Dr. Eissenberg called for researchers to boycott the journal by not submitting articles to it and not reviewing for it “until it has published the means by which it will manage the apparent conflicts of conscience among its editorial staff…”. Presumably, Dr. Eissenberg is referring to what he views as a significant conflict of interest of the journal’s editor–Dr. Robert West–who he claims violated the peer review process in fast-tracking a 2015 article that defended e-cigarettes against the claim that they expose users to high levels of formaldehyde.

The situation is a bit complex, so let me try to summarize the background as best as I understand it:

In May 2015, Dr. Konstantinos Farsalinos and colleagues published an article in Addiction which reported the results of an experiment showing that e-cigarettes only produce aldehydes (such as formaldehyde, a carcinogen) under dry puff conditions. A dry puff occurs when a vaping device overheats the e-liquid, resulting in an unpleasant taste. Most vapers will discontinue vaping when they experience a dry puff. Therefore, if aldehydes are present only under dry puff conditions, then they do not present a major health concern for vapers.

In September 2015, Dr. Eissenberg–along with Dr. Alan Shihadeh and Soha Talih–published a letter to the editor of Addiction in which they accused him of having a “conflict of conscience” that led to a lack of rigorous peer review and inappropriate fast-tracking of the Farsalinos et al. article. The authors’ complaint was two-fold: (1) that the review period was only 11 days, which is uniquely brief for this journal; and (2) that the editor–Dr. West–has a significant conflict of interest because he was once quoted in a newspaper article as (according to Eissenberg et al.) stating that: “E-cigarettes are about as safe as you can get… E-cigarettes are probably about as safe as drinking coffee.”

Eissenberg et al. went on to accuse Dr. West of exhibiting bias in handling what they call a “flawed” manuscript: “These statements suggest a potential conflict of conscience in the handling of a flawed report that reinforces Dr West’s professed faith in e-cigarette safety…”.

Addiction published the extremely long letter by Eissenberg et al. (which itself is unusual), along with a response from Dr. West stating that the accusation is false because he didn’t even handle the paper: he designated the review to a different editor. Moreover, the paper went through the same peer review process as any other paper (although it was fast-tracked because of particular urgency of this topic). In fact, the authors went through not one, but two rounds of revisions before the manuscript was accepted for publication.

That is where the story stood until yesterday, when Dr. Eissenberg called for the boycott of the journal, apparently sticking to his accusation against Dr. West despite West’s response.

The Rest of the Story

Ironically, while Dr. Eissenberg is accusing Addiction of unscientific and biased actions that threaten scientific integrity, it is actually Dr. Eissenberg’s actions here that are inappropriate, biased, and a threat to scientific integrity.

First, Dr. Eissenberg makes a serious accusation against the editor of Addiction without sufficient evidence to justify the claim. He (and his co-authors) provide no substantial evidence that the peer review process was botched, that the Farsalinos et al. article was seriously flawed, or that a severe bias on the part of the editor led to a botched review and acceptance of an article that should not have been published.

As it turns out, Dr. West apparently had no role in the review of the manuscript, so Dr. Eissenberg’s accusation was incorrect. Moreover, the paper did go through the normal review process, although in expedited fashion. It is perfectly legitimate for journals to fast-track articles of particular interest, and many journals do that all the time. The article was peer reviewed and the authors were required to respond to reviewer comments twice. Thus, there was nothing qualitatively different about this peer review process from the review of any other paper submitted to the journal. No evidence is provided to support the accusation that the review process was flawed in any way.

Dr. West ended his response by stating: “I hope that this will give them (Eissenberg et al.) pause for thought before making serious accusations about colleagues.” I agree. The allegations against the editor and the journal were serious but no evidence was provided to support them. Making an unjustified accusation and then calling for a boycott of the journal based on that unsupported allegation is the threat to scientific integrity in this story.

Second, Eissenberg et al.’s claim that Dr. West has a “conflict of conscience” because he believes e-cigarettes are relatively safe is a perversion of the concept of conflict of interest. In fact, it would be impossible for any journal editor not to have a “conflict of conscience” according to the definition that Dr. Eissenberg and colleagues are asking us to accept. Everyone involved in tobacco control has some personal view on the relative safety of e-cigarettes. The idea that researchers should boycott the journal because the editor has expressed his personal views on the relative safety of e-cigarettes is ludicrous.

Interestingly, in making their accusation that Dr. West has some sort of unusual “conflict of conscience” that would make it inappropriate for the journal to consider papers on e-cigarettes, Eissenberg et al. only quoted a small portion of Dr. West’s comments in the newspaper article. I could just have easily accused Dr. West of having a strong personal bias against e-cigarettes by selectively quoting him from the newspaper article as stating:

“This is a danger. Regulators should monitor this.”

In fact, Dr. West’s views as expressed in the newspaper article appear to me to be balanced and evidence-based. His full comment to the paper explains the scientific reasoning behind his view, which I find quite reasonable:

“We have such a massive opportunity here. It would be a shame to let it slip away by being overly cautious. E-cigarettes are about as safe as you can get. We know about the health risks of nicotine from studies in Sweden into the use of “Snus”, a smokeless tobacco. Nicotine is not what kills you when you smoke tobacco. E-cigarettes are probably about as safe as drinking coffee. All they contain is water vapour, nicotine and propylene glycol [which is used to help vaporise the liquid nicotine].”

But more to the point, the entire concept of suggesting that researchers boycott a journal based on the scientific views of the journal editor is a dangerous one. It is basically setting up a system where the only journals that survive would be ones whose editors express opinions that are in line with the mainstream scientific opinion. In fact, the very idea that researchers should boycott journals based on the opinions of the journal editor is nonsensical. Should we boycott the journal Tobacco Control because the editor does not personally believe that e-cigarettes are orders of magnitude safer than real cigarettes? Once we start going down that path, we end up challenging the existence of scientific integrity in research reporting.

This is the reason why journals screen for financial conflicts of interest, rather than conduct a McCarthy-like witch hunt to determine whether a researcher may be biased because of opinions they have expressed. Believe me, we don’t want to go down that path.

There may be unusual situations in which an editor may have such a personal connection to an issue that it may be appropriate to recuse themselves from review and ask a deputy or assistant editor to handle the review, but that’s certainly not true in this case. Here, the review was apparently handed off to a different editor anyway, even though I don’t see any reason whatsoever why that would have been necessary.

What is perhaps most ironic about the letter to the editor by Eissenberg et al. is that although they accuse the editor and the journal of a serious conflict of interest, the letter itself fails to disclose an apparent financial conflict of interest of one of its authors. The letter fails to disclose any conflicts of interest among its authors (this link is to the PDF version of the letter which I checked to make sure a disclosure statement wasn’t just missing in the online version). Thus, one would assume that none of the authors has any connection to the tobacco industry, such as — for example — having received funding from an organization chaired by a tobacco industry executive.

But it appears that Dr. Shihadeh — the lead author of the letter to the editor — has failed to disclose that he has, in the past, received funding from an organization chaired by a tobacco industry executive. Dr. Shihadeh is the co-author of several papers that acknowledge funding from the International Development Research Centre, which — at the time — was chaired by Barbara McDougall, who was on the Board of Directors of the Imperial Tobacco Company.

In addition, Dr. Eissenberg — the senior author of the letter to the editor — also acknowledged having received funding from the same organization, which was at the time chaired by a tobacco company executive.

I find it ironic that the only real conflict of interest in this story is the fact that two of the authors of the letter to the editor have, in the past, received funding from an organization that was chaired by a tobacco industry executive. And that conflict of interest is not disclosed by the authors.

Now, to be very clear, I am not accusing Dr. Shihadeh or Dr. Eissenberg of voluntarily accepting tobacco industry-related funding. They stated that they were unaware, at the time of the funding, that the chair of the organization was a tobacco industry executive. So I’m not blaming them for accepting that funding. However, they were certainly aware in 2015 – when they wrote the letter to the editor – that they had been funded by an organization chaired by a tobacco industry executive. It seems to me that is a fact that should have been disclosed. That lack of disclosure, by the way, stands in contrast to Dr. West’s full disclosure of his industry-related funding from pharmaceutical companies and his clear statement that he has never been funded by the tobacco or e-cigarette industries.

The rest of the story is that in my view, Dr. Eissenberg is falsely accusing the journal Addiction of having violated scientific principles of peer review because of a personal bias on the part of the editor. Worse still, he has now called for a boycott of the journal based on these unsupported allegations.

It would truly be a shame if researchers followed this misguided recommendation.

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11.10.2017 – JBC: A harm reduction conversation with a Family Practice Physician

Yesterday, I started having conversations and asking questions of healthcare providers that I see almost daily about harm reduction and smoke-free alternatives. I will be posting each story as I organize my notes…I thought I would start with the difficult one first. A Physician who wanted only to be identified as a Family Practice Physician in the Sacramento, CA area for 20 years sat down with me, and this is the conversation we had:

I talked to him first about HIV/AIDS-related deaths now (around 12,000 per year) as opposed to the number of deaths at the height of the epidemic (over 50,000 per year), as well as the current all-time low new infection rates. My question to him was, “What strategies do you think got us here to the reduction in numbers”? His first answer was “abstinence” (I warned you this was a difficult conversation). I had to really go at him to get better answers out of him, and the abbreviated version is me asking how realistic that is, and finally asking that if someone is hell-bent on having sex, what do you tell them or prescribe to them so that they are as safe as they possibly can be? He said he gives people condoms and will prescribe either PrEP(Pre Exposure Prophylaxis) or PEP(Post Exposure Prophylaxis). I said, so harm reduction?. He said yes, harm reduction. I asked what he tells people who are IV drug users that come in and say that they have tried to stop using but can’t. He said, “I tell them to get off of whatever they are using.” I said again, what if they have tried and can’t quit? He said “needle exchanges”. So again I said harm reduction? He said yes, harm reduction.

Now the big question: I asked, “Do you think the same harm reduction strategies would be effective for people who smoke and can’t quit; ie, far less harmful alternatives like vapor products or Snus”? He said he would have a hard time telling someone it was ok because of the small percentage of risk. I asked why it was different for him with smoking, as opposed to sex, and furthermore the impact that lower risk products would have from a public health standpoint. He said he didn’t know why he felt different about harm reduction with smoking. He said he was going to go home and think about it for the weekend and try to figure out where his reservations are coming from. My final question to him was, “Do you tell your patients to wear seatbelts when they drive”? He said “Every day”. I asked if he wears his seatbelt. He said of course. Me: “Even though the CDC says that seat belts reduce fatalities and serious injuries by only around 50% and that it is by no means a guarantee that you won’t be killed in a car accident”? He smiled a big smile and said, “Yes, because harm reduction”.

The whole point of this story is that even though he didn’t emphatically agree with me, he did agree to go home and think about it and I saw the light go on. Sometimes, these conversations don’t end in huge, burning bush moments where people fall at our feet and proclaim their belief in what we propose. But changes can happen gradually. It’s better to start these conversations now, than scramble for support when it comes down to the wire. Go out and have conversations with people you know. If we all did it with just one person, we would have double the number of us during important election times. That’s how change usually starts. Slow and small. Don’t ever give up.

Jennifer Berger-Coleman

CASAA Director of Community Outreach

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NY – Onondaga Co. – Stop Tobacco (and Vapor) 21!

The Onondaga County Legislature is being pressured to consider and adopt a bill that would raise the age to purchase all vapor and tobacco products from 19 to 21-years-old.

Although no bill has been introduced, local anti-smoking activists recently organized to promote the policy. The policy is also being promoted by Onondaga County Health Commissioner, Indu Gupta.

Onondaga County already has a minimum tobacco purchase age of 19, which is higher than most of the rest of the state.

Please take this opportunity, before a bill is introduced, to reach out to county legislators and urge them to reject the Tobacco 21 proposal

Take Action – Send a Message

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Did you find this alert helpful? Please consider making a donation to CASAA. We rely on contributions to provide timely information and engagements to help protect everyone’s access to life-saving, low-risk nicotine and tobacco products.
CASAA is 501(c)(4) tax-exempt organization. While CASAA is a non-profit organization and pays no income taxes on the donations it receives, contributions or gifts to CASAA are not deductible by the donor as charitable contributions for federal income tax purposes.

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11.21.2017 – JBC: A harm reduction conversation with a Family Nurse Practitioner

Two weeks ago, I started a series of sit-downs with licensed health care providers on the topic of harm reduction, that either I currently work with, or in some cases have worked with. Since I started last week with the most difficult of the interviews, I will post this week about the easiest and most encouraging.

This person is a Board Certified Family Nurse Practitioner that has been licensed for 9 years. In those 9 years, she has worked in Women’s Health and a non-profit specializing in care for people with HIV/AIDS. I asked the same questions of her about harm reduction in general, as well as how it could be applied to tobacco harm reduction that I did with the Physician that I interviewed the week before:

I started with the questions about harm reduction with HIV/AIDS and gave her the statistics(which I think she is more familiar with than I) about the huge reduction in the numbers of deaths and new cases currently as opposed to the numbers at the height of the epidemic. If you didn’t catch it last week, at the height of the epidemic in the 80’s and early 90’s, about 50,000 people a year died from HIV/AIDS-related illnesses. Currently, the number is about 12,000 per year. My first question was, “What thing or things do you think got us to the reduction in numbers?”. She answered, “Education, testing, prevention, better medications, harm reduction services like condoms and needle exchanges, and most importantly, normalizing the conversations and getting rid of the social stigma, particularly among healthcare providers.” (This is already so much easier than the doctor last week whose first answer was “abstinence”).

I asked her if it surprised her that the number of deaths in people who identify as LGBTQ alone from tobacco-related illnesses is currently at about 30,000 per year, more than double that of HIV/AIDS in all the population in the US. She said that she wasn’t surprised. That LGBTQ identifying people have huge and disproportionate rates of smoking and substance abuse. I asked in her opinion, why she thought might be. She answered, “Social stigma, family/social issues, perception of lack of care and resources, and often housing issues.”

Now the good stuff…First, I showed her the report from the Royal College of Physicians that concluded that vaping is at least 95% less harmful than combustible cigarettes. I asked her if she thought the same principles of harm reduction could be applied to smoking with less harmful alternatives such as vapor products, smokeless tobacco, SNUS, etc., and what that would mean for public health. This is her entire answer:

“I would have absolutely no problem talking to patients about switching to vaping if they want to quit smoking. I would like to be more educated about it, and what the barriers might be to someone looking to switch, for example, ease of use, cost, etc. When I was in school, the only options we had to give to people were patches, gum, and Wellbutrin. It is not my job, nor is it ethical to refuse people something based on my opinion or social ‘morals’. It is my job to help someone who asks to lead a healthier lifestyle if they choose. I have a feeling that the new generation of healthcare providers in schools right now may become better educated on the subject, just like every new generation becomes more educated on the topic of the time. Social change and change in medicine come gradually, with each new generation of providers. What I learned in school is radically different from what someone 20 years ago learned. I suspect it will always be evolving.”

Needless to say, I could not have been happier with the way the conversation went. I happen to work in healthcare, so these are easy conversations for me to have. But EVERYONE can talk to their neighbors, family, friends, etc. The more the opinions of society change, the more opinions in all areas, including healthcare will change. It takes time and patience, but it WILL happen. Change always does. Go have a conversation with a non-smoker.

Don’t ever give up.

Jennifer Berger-Coleman

CASAA Director of Community Outreach

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MN – Plymouth, MN – Help stop a harmful tobacco 21 law!

The city of Plymouth is considering an ordinance that would limit adult access to low-risk tobacco and vapor products by raising the minimum legal purchase age from 18 to 21. A hearing will be held for this proposal on

Tuesday, November 28, 2017

7:00 PM

Council Chambers of City Hall

3400 Plymouth Boulevard

Plymouth, MN

In advance of the study session, please take this opportunity to contact Plymouth city council members and urge them to reject this proposal.

Take Action – Send a Message!

Please make plans to attend this hearing. Even if you do not plan to speak, your presence is important as it demonstrates the large numbers of people affected by this issue. A group of advocates in Detroit Lakes organized a small but impressive attendance at a recent hearing in which a Tobacco 21 law was voted down. Making your presence known at a hearing has a remarkable impact.

Tobacco 21 laws are predicated on the notion that more prohibition is the solution. But we know from past and recent experiences with such policies that there are grave unintended consequences. Instead, the public would be better served through smoking prevention education and awareness about low-risk alternatives for those who choose to smoke.

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Originally posted in the CASAA Minnesota Action Center

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IL – Elk Grove Village – Stop Tobacco 21!

The Elk Grove Village Board of Trustees will be considering an ordinance (Ordinance No. 3527) that would raise the age to purchase, possess, and sell all tobacco and vapor products from 18 to 21-years-old.

The public will have an opportunity to comment during a Committee of the Whole meeting on

Tuesday, November 14, 2017

4:00 PM

901 Wellington Avenue, Room E

Elk Grove Village, IL 60007

Please make plans to attend this hearing. Even if you do not plan to speak, your presence is important as it demonstrates the large numbers of people affected by this issue.

In advance of the hearing, take a moment to send a message to the village board urging them to reject this harmful ordinance.

Take Action – Send a Message

You can also send your comments via regular mail to:

  • Elk Grove Village Board of Trustees
  • 901 Wellington Ave., Elk Grove Village, IL 60007

Or call:

  • 847-439-4010

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11.10.17 – What we’re reading and watching this morning

(Illinois)

Elk Grove Village – Ordinance No. 3527, An ordinance amending section 3-6B-1 and Section 3-6B-4 of the village code by amending …

“WHEREAS, the Mayor and Village Board has determined that it will serve and advance the public’s health, safety and welfare and be in the best interest of the Village and its residents, to amend the Village Code of Elk Grove Village to increase the minimum age for the purchase and sale of tobacco products and electronic smoking devices to twenty-one (21) years of age.”

(Maryland)

Loyola University, The Greyhound, Jack Ebmeier – SMOKE-FREE CAMPUS INITIATIVE MISUNDERSTANDS PROBLEM

“First, it is important to draw a distinction between a “smoke-free campus” movement and a “smoke-free student body” movement. While the former would constitute a blanket ban of tobacco and nicotine products on campus, the latter would be a concentrated effort to help the student body wean off the addictive substance. While this seems like a meaningless distinction, it creates two vastly different futures for the Loyola community.”

(Massachusetts)

Middleboro, MA – The Enterprise, Eileen Reece – Middleboro board keeps tobacco-buying age at 18

“‘I am opposed to changing the age to make it up to 21. If the state thinks it’s a good idea, let the state issue the mandate. Cause I don’t believe I should create business for my surrounding towns by taking it away from my own town,’ said Selectmen Vice-Chairman Stephen McKinnon on Oct. 30.”

(Michigan)

Bridgemi.com, Michelle Minton – When Lansing writes laws based on emotion, rather than facts

“Laws that banned e-cigarette sales to minors, for example, seemed only to push teens into smoking traditional cigarettes at higher rates. Taxes on soda, meant to reduce the consumption of sugary beverages, only caused people to drink more beer. And keg registration laws only prompted underage drinkers to buy different forms of alcohol.”

(Oregon)

KTVZ.com news sources – Crook County tobacco sales ordinance takes effect on ‘Smokeout’ Day

“…November 16 also marks the day that Crook County Ordinance #300 goes into effect.  This ordinance requires all Crook County retailers who sell tobacco products, including e-cigarettes, to post Oregon Tobacco Quitline contact information at the point of sale.”

(USA)

The Washington Times, Laura Kelly – E-Cigarette users save more money than smokers, poll shows

“Users who switched to e-cigarettes reported saving an average of $1,416.60, according to the online poll conducted by LendEDU, an online marketplace that helps students refinance their loans.”

(Canada)

National Post – Big Tobacco urges Canada to ensure legal nicotine competitive with black market

“Imperial isn’t lobbying for lower taxes for traditional cigarettes but is against future increases as well as the federal government’s plan to require plain and standardized packaging…”

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11.09.17 – What we’re reading and watching this morning

(Minnesota)

Mankato/N.Mankato – Mankato-N. Kato resolve to decide tobacco issue after Jan. 1

Mankato Free Press, Mark Fischenich

“A divided Mankato-North Mankato Intergovernmental Committee couldn’t agree on a recommendation on the Tobacco 21 initiative Wednesday night.”

Robbinsdale, MN – City Council Meeting 11.07.17

Section 9, Old Business, Item A: First Reading: Amendment to Robbinsdale’s Tobacco License Regulations (click on the item under the video)

(Rhode Island)

Middletown, RI – New tobacco rules coming under scrutiny

The Newport Daily News, Matt Sheley

“Late last month, a complaint in Newport Superior Court from two local convenience stores said the town overreached by passing rules banning the sale of flavored tobacco and the aggressive marketing of those products and also didn’t properly advertise the changes before they were approved.”

(Wisconsin)

Juneau County, WI – Addiction expert warns about smoking at Mauston presentation

Juneau County Star-Times, Jake Ekdahl

“Macmaster emphasized that tobacco addiction should be approached and treated like other harmful substance addictions, such as alcohol or drugs.”

(Research)

Aldehyde levels in e-cigarette aerosol: Findings from a replication study and from use of a new-generation device

Science Direct, Konstantinos E. Farsalinos, Kurt A. Kistler, Alexander Pennington, Alketa Spyrou, Dimitris Kouretas, Gene Gillman

“A recent study identified high aldehyde emissions from e-cigarettes (ECs), that when converted to reasonable daily human EC liquid consumption, 5 g/day, gave formaldehyde exposure equivalent to 604–3257 tobacco cigarettes. We replicated this study and also tested a new-generation atomizer under verified realistic (no dry puff) conditions.”

Smokers Turn to e-Cigarettes in Attempt to Quit

Medscape, Maureen Salamon

“In the Tennessee-based study, current cigarette smokers were seven times more likely than nonsmokers to be e-cigarette users. Additionally, tobacco smokers who also smoked e-cigarettes were at least 3.5 times more likely than non-e-cigarette users to have quit smoking for a day or longer during the past 12 months for the sake of quitting.”

(Watch)

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