E-cig studies from England twice as likely to support e-cigs as studies from other countries

England is unquestionably the most pro-e-cigarette country on the planet, most recently evidenced by the fact that the government is giving away free e-cigarette starter kits to one million smokers despite the fact that e-cigarettes as consumer products don’t help smokers quit and may, in the long run, keep them smoking (even in England). The government’s action is consistent with the loud cheering section for e-cigarettes coming from English researchers, who (with a few notable exceptions) have been publishing work supporting e-cigarettes for harm reduction.

Now Desiree Vidana-Perez and her colleagues at the Mexican National Institute of Public Health have quantified this bias among English researchers. Specifically, they just published a formal analysis of papers on e-cigarettes and shown that papers from England had over twice the odds of reporting positive results for e-cigarettes than work originating in other countries.

They also showed that papers that disclosed possible conflicts of interest with the tobacco companies (including their agents such as the Foundation for a Smokefree World) had 30 times the odds of reporting results favorable to e-cigarettes.

Conflicts with the pharmaceutical industry were also associated with twice the odds of a pro-e-cigarette conclusion.

To reach this conclusion they analyzed 697 papers published between 2017 and 2020 on vaping and categorized them by whether they reported conflicts of interest and the country of origin of the study. As they note, their results likely underestimate the effect of industry conflicts because some authors may not have disclosed the conflicts and they collected their sample before COVID-19 hit and the tobacco companies supported a lot of COVID-related papers.

These results are consistent with and extend earlier work by Charlotta Pisinger and colleagues that found that the odds of concluding e-cigarettes were not harmful were increased by a factor of 67 for studies with an industry-related COI than in studies without a COI. Likewise, Yogi Hendlin and colleagues found that industry-funded articles favored tobacco harm reduction significantly more than non-industry funded articles.

While the situation in England is probably hopeless, policymakers, regulators, public health practitioners and clinicians in the rest of the world need to keep these results in mind and not take papers from England or authors associated with the tobacco industry at face value when making decisions about e-cigarettes.

Here is the abstract for the new paper:

Objective: To explore the association between reporting conflict of interest (COI) and having a positive outcome toward vaping in scientific articles.

Methods: A cross-sectional study that analyzed a sample of 697 articles published between 2017 and 2020 regarding vaping. Information on the reporting of COI, type of COI (no conflict, conflict with the tobacco industry, pharmaceutical industry, or other), and country of publication were collected. To explore the association between reporting COI and having a positive result for vaping, two logistic regression models were fitted, both adjusted by country of publication.

Results: From 88 articles that reported COI, 23 reported COI with the tobacco industry, 44 with the pharmaceutical industry, and 21 reported another type of conflict. We found that reporting any type of COI increased by 4.7 times the odds (OR 4.70; 95% CI [2.89, 7.65]) of having a positive result for vaping. Additionally, compared to other countries, manuscripts published in England had 2 times higher odds (OR 2.40; 95% CI [1.16, 4.98]) of reporting a positive result for vaping. Reporting COI with the tobacco and pharmaceutical industries increased the odds of favorable results by 29 times (OR 29.95; 95% CI [9.84, 90.98]) and 2 times (OR 2.87; 95% CI [1.45, 5.69]), respectively.

Conclusions: In scientific articles, reporting COI and having positive results for vaping are highly associated. COI should be considered and caution should be exercised when using data for policy-making.

The full citation is: Vidaña-Perez D, Reynales-Shigematsu LM, Antonio-Ochoa E, Ávila-Valdez SL, Barrientos-Gutiérrez I. The fallacy of science is science: the impact of conflict of interest in vaping articles. Rev Panam Salud Publica. 2022 Jun 10;46:e81. doi: 10.26633/RPSP.2022.81. PMID: 35702716; PMCID: PMC9186096. It is available here.