Research on the safety and efficacy of vaping has been hotly contested for over a decade. The two sides are neatly drawn. Pro-vapers routinely cite researchers who report that vaping is vastly safer than smoking and helps people quit. The anti-vapers cite research that disputes those results.
So what’s going on and who is right? An international team of researchers examined the 24 vaping studies, published in scientific journals, that were “most read and most cited in other literature and policy discussions,” according to the Google algorithm. The majority were conducted in the US—with subjects such as smoking initiation, respiratory issues, and smoking reduction and cessation among vapers. The large majority had findings that seemed to weigh against the case for vaping as harm reduction.
The researchers—including Dr. Cother Hajat of the United Arab Emirates University and Dr. Riccardo Polosa, founder of the Center of Excellence for Acceleration of Harm Reduction (CoEHAR) at the University of Catania, Italy—just published their article, “Analysis of common methodological flaws in the highest cited e-cigarette epidemiology research.”
They were shocked! Almost all the studies were methodologically flawed. They variously lacked a clear hypothesis, used inadequate methodology, didn’t collect data relevant to the study objectives, and/or didn’t correct for obvious confounding factors.
“I’m astounded that such low-quality studies have made it through editorial review in prestigious scientific journals.”
The researchers were too polite to say it, but what they found was irrefutable evidence of junk science.
“I’m astounded that such low-quality studies have made it through editorial review in prestigious scientific journals,” Dr. Polosa stated. “The credibility of tobacco control scientists and their research is on the line.”
Among others, the researchers debunked studies that claimed to demonstrate the so-called “gateway effect,” which has been widely used to scare the public into believing that vaping nicotine leads to combustible tobacco use. “The studies we analyzed lacked sound research methods, and as such, could not reliably establish causation or identify a gateway effect,” the authors wrote.
It’s not the first time a supposed gateway effect has been deployed in the service of a drug panic. For almost a century, researchers claimed that cannabis was a gateway to “harder” drugs. All along, it was a lie.
“In our paper we offer practical recommendations that can massively improve the quality and rigor in future research in the field of tobacco harm reduction,” explained Dr. Hajat.
They include: Acknowledge the health consequences of previous smoking history (critical when the vast majority of vapers are former smokers); detail vaping (and smoking) habits and history in terms of their duration, amount, and frequency; ensure allocation and randomization of research participants to avoid selection bias; ensure that implications and conclusions don’t assume a causal relationship, unless causality has been established; discuss biases, limitations and alternate explanations honestly and transparently, and discuss how they impact findings.
The need for unbiased research is urgent.
That these basic recommendations even have to be made speaks volumes about the state of research into vaping and how hell-bent some researchers are on distorting the evidence.
Other scientists have rightly pointed out how e-cigarette research is massively flawed. In one of the most egregious examples, the Journal of the American Heart Association in 2020 retracted the article, “Electronic Cigarette Use and Myocardial Infarction Among Adults in the US Population Assessment of Tobacco and Health.” Its authors, Drs. Dharma Bhatta and Stanton Glantz, had claimed that e-cigarette use was associated with increased risk of heart attacks.
The need for unbiased research is urgent. Over a billion smokers, 8 million of whom die of smoking-related causes each year, deserve studies that honestly examine and explain safer nicotine alternatives.
Photograph by Helen Redmond
Both CoEHAR and The Influence Foundation, which operates Filter, have received grants from the Foundation for a Smoke-Free World. Filter’s Editorial Independence Policy applies.