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<STRONG;This was never responded to:</strong;
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<STRONG;From:</strong; Bareham David (LCHS)<STRONG;Sent:</strong; 11 February 2016 16:00<STRONG;To:</strong; '[email protected]'<STRONG;Subject:</strong; Formal Complaint Regarding "More or Less" Radio 4 Broadcast Regarding Electronic Cigarettes: "On the mixing of apples with oranges".<STRONG;Importance:</strong; High
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Hi,
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Please may I make a formal complaint regarding the poor quality research and lack of scientific critical appraisal of this “More or Less” Radio 4 Broadcast regarding Electronic Cigarettes:
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http://www.bbc.co.uk/programmes/b06zcg4v";http://www.bbc.co.uk/programme...
The presenter, along with a “Reviewer”, Wesley Stephenson, provided a “critique” of a recent research paper: http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(15)00521-4/abstract";“E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis”. There are several issues with their “critique” that reveal poor quality research, and an absence of scientific curiosity and questioning regarding the views of the “experts” used to challenge the validity of the study in question.
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1)&nbsp;&nbsp;&nbsp;&nbsp; In the Introductory Section, the Presenter notes the recent licensing of an http://www.mhra.gov.uk/home/groups/par/documents/websiteresources/con616...“electronic cigarette” by the MHRA, suggesting/insinuating that this is evidence that contradicts the findings of Kalkhoran/Glantz paper. However, if the researchers involved had reviewed this issue, they would discover that even “vapers” themselves do not consider this to be an electronic cigarette: it does not heat a liquid; it does not emit “vaper”/aerosol, as per this link http://vaperanks.com/first-e-cigarette-to-be-awarded-medicine-license-in... . This is confirmed in the email, as attached, from Action on Smoking and Health. This was initial evidence that the “researchers” undertaking this program have not produced a well-researched, scientific broadcast of quality, but one of misinformation and sound-biting.
<OL;
<LI value="2";The subsequent section predominantly utilises multiple verbal quotes from “experts” critiquing the paper. These included opinions from: Professor Linda Bauld, who stated that it is “too early” to undertake a review such as this i.e. a meta-analysis, and that “if you put garbage in you will get garbage out”; Professor Ann McNeill, who argued that the paper is “not scientific”; Professor Peter Hajek (a co-author of the http://www.cochrane.org/CD010216/TOBACCO_can-electronic-cigarettes-help-... Review on Electronic Cigarettes that is cited by Wesley Stephenson in the broadcast), who states that the Kalkhoran/Glantz paper is “grossly misleading”; and Professor Robert West.</li;</ol;
Professor West’s comments are particularly interesting to focus on initially. He stated that the paper being reviewed inappropriately combined the results of studies of users of electronic cigarettes who were <EM;trying to quit tobacco</em; with other, different studies, <EM;where the users were not trying to quit</em;. They are fundamentally “heterogeneous”, although he does not use the term, and he states, simply, that paper under review is “mixing apples with oranges”. In effect, this is the major “confounding variable” and “fundamental flaw” that he focuses on, and it makes the study results invalid.
This is NOT, however, what Professor West stated regarding the aforementioned Cochrane Review (as per the above link): <STRONG;<EM;which does exactly the same thing</em;</strong;. Specifically, the two Randomised Controlled Trials that the Cochrane Review put through the mathematical analysis of meta-analysis were (and I quote from the Review directly):
“The ASCEND trial (Bullen 2013) randomized 657 smokers (middle- aged, highly dependent, with one-third being of New Zealand Maori origin) <EM;who wanted to quit</em; . . .”. (my emphasis) and
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“the three-arm ECLAT trial (Caponnetto 2013a), 300 smokers (again middle-aged and highly dependent) <EM;who were not intending to quit smoking</em; . . .” (my emphasis).
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When these clearly heterogeneous studies were “mathematically mixed” by McRobbie et al in the Cochrane Review, Professor West publically, but incongruously, stated:
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“This study tells us that even the older style electronic cigarettes improve smokers’ chances of stopping by about 50 per cent.” (http://www.dailymail.co.uk/health/article-2877321/E-cigarettes-help-peop... ).
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There is no criticism regarding erroneous methodology, fundamental flaws and confounding variables. It is apparently “OK”, according to Professor West, to “lump” heterogeneous data together: <EM;if you get a result you that agree with and approve of</em;.
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Moreover, there is no mention from Professor West, nor mention from the Presenter of the broadcast, nor Wesley Stephenson, that the Cochrane Review actually states, with regard to the quality of the evidence analysed in it, that:
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“ . . . the small number of trials, low event rates and wide confidence intervals around the estimates mean that our confidence in the result is rated 'low' by GRADE standards.”
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Why did Wesley Stephenson not include this key methodological issue in his “broadcast/critique”, but simply just cite The Cochrane Review, without reviewing it for issues that, ironically, correspond to exactly those he and Professor West have with the Glantz/Kalkoran? Mr. Stephenson has applied a “Blind Faith” approach to, not only the quality of the Cochrane Review, but to the opinion of “expert” Professor West, who via his incongruous and contradictory viewpoints, puts a self-inflicted hole below the waterline in his “expert” status. Mr. Stephenson erroneously used the Cochrane Review and West’s opinion to challenge the validity of the more recent meta-analysis.
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Moreover, if Mr. Stephenson had properly researched this issue, he would have discovered that the “objections” regarding the paper were not just partly tackled in the body research, as he points out, but were specifically responded to, “expert by expert”, in the time period immediately after publication: http://tobacco.ucsf.edu/our-new-meta-analysis-entire-relevant-literature... . This omission in reporting is concerning, and represents poor quality research, or, worse case, bias.
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<EM;Alternatively</em;, as the Cochrane Review successfully passed through Peer Review, maybe it is in fact appropriate to try to combine this type of heterogeneous data, but try to allow and control for it? Presumably, that is what the authors of both the Cochrane AND Glantz/Kalhkoran Reviews believe they did. Either way, Professor West’s comments are clearly contradictory and sophistic in nature: and Mr. Stephenson falls for them, hook, line and sinker. It could bring the Editor at The Lancet some comfort in the recognition that the Cochrane Collaboration apparently also believe it is appropriate to positively Peer Review and publish papers, that attempt to “mix apples with oranges”.&nbsp;
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Furthermore, if Mr. Stephenson had undertaken more substantive research around the statements made by Professor West and others, he might well have spotted that the publication of the comments were made via the http://www.sciencemediacentre.org/expert-reaction-to-meta-analysis-looki... Media Centre : at exactly the same time that the paper was published in The Respiratory Lancet. The Science Media Centre has an “interesting” history, as is made explicitly clear here from https://powerbase.info/index.php/Science_Media_Centre";“Powerbase”. The objectivity of this Centre has been clearly called into question, including, ironically, “issues” that it has previously had with the BBC. A key criticism, however, gleaned from this review reads:
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“The Science Media Centre (SMC) is... not as independent as it appears. It was set up to provide accurate, independent scientific information for the media but its views are largely in line with government scientific policy.” Dr David Miller, Stirling Media Research Institute.
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Subsequently, if the comments of the aforementioned “experts” are again reviewed, in the light of this discussion, important questions include:
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<UL;
<LI;If it is “too early” to undertake such a study i.e. a meta-analysis, and utilise data of low quality as both Linda Bauld and even the Cochrane Review acknowledge, why are http://www.mdpi.com/1660-4601/12/12/15048";Linda Bauld et al so <EM;comfortable</em; in citing The Cochrane Review/Meta-Analysis elsewhere? Could it again be that she, and significant co-authors, are simply satisfied with the conclusion, and therefore do not challenge the methodology in the same, robust and passionate fashion? Wesley Stephenson does not comment on this, because he has not fully researched the issue: his approach is one of blind faith.</li;</ul;
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<UL;
<LI;Professor McNeill, being a co-author with Professor Hajek of https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil... Health England’s Review of Electronic Cigarettes, cites the aforementioned Cochrane Review with glee: however, predictably, with no mention of the “fundamental flaws” that Professor West highlights. If she&nbsp; believes in a scientific debate on electronic cigarettes, and a https://nicotinepolicy.net/n-s-p/2003-glantz-letter-to-who-the-importanc...“dispassionate” approach, as she has voluntarily signed up to: why are she and others so http://onlinelibrary.wiley.com/doi/10.1111/add.12550/full";comfortable in citing a blog article, written by a http://www.tobaccotactics.org/index.php/Carl_V_Phillips";tobacco industry funded “scientist”, entitled: <STRONG;http://www.bing.com/search?q=Stanton+Glantz+is+such+a+liar+that+even+the...“Stanton Glantz is such a liar that even the ACS balks: his latest ecig gateway “study” </strong;? The Glantz/Kalkhoran paper has been published in the context of an on-going, antagonistic “dispute” regarding the evidence, and Wesley Stephenson does not make this clear in his Review, which he should have done, if he had properly researched it.</li;</ul;
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<LI;Wesley Stephenson, who merely cites the Cochrane Review and does not critique it, in doing so fails to note that Professor Hajek incongruously claims that the Glantz/Kalkhoran paper is “grossly misleading”, for using similar methodology that he did.</li;</ul;
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<LI;Wesley Stephenson has clear issues with the Peer Review process for this paper. He claims that, apparently, one of the Peer Reviewers believed that the study should never have been published. It is imperative to note therefore, considering the co-authors already discussed, that the Public Health England Reviews of both 2014 and 2015 were published: <EM;with no Peer Review process</em; e.g. no review by the U.K. Faculty of Public Health. This is revealed https://www.researchgate.net/publication/289674033_On_the_Safety_of_E-ci..., very recently, in a highly critical appraisal of the PHE Report, by two English Professors of Toxicology. This leaves the validity of their review in extreme jeopardy, as presumably Mr. Stephenson would agree?</li;</ul;
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One final comment. The write-up on the BBC Radio 4 Webpage regarding this programme is tainted by inappropriate, loaded language. It states:
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“Do e-cigarettes make quitting smoking more difficult?
Research last month claimed to show that e-cigarettes harm your chances of quitting smoking. The paper got coverage world-wide but it also came in for <STRONG;<EM;unusually fierce criticism from</em;</strong; <STRONG;<EM;academics who spend their lives trying to help people quit</em;</strong;. It's been described as 'grossly misleading' and 'not scientific'. We look at what is wrong with the paper and ask if it should have been published in the first place.” (my emphasis).
Arguably, this infers that the authors of the paper being reviewed are NOT involved in trying to help people quit tobacco, which is misleading and erroneous. Professor Glantz, for example, has a forty year history of http://pdf.oac.cdlib.org/pdf/ucsf/tcarc/glantzin.pdf";successfully challenging the Tobacco Industry, including legally ground breaking work with the resultant +/- $250 Billion http://www.publichealthlawcenter.org/topics/tobacco-control/tobacco-cont... Master Settlement Agreement, plus input on https://scholar.google.co.uk/scholar?q=stanton+glantz+tobacco&hl=en&as_s... papers related to tobacco and cessation. The written language utilised is worryingly loaded against the authors. The true nature of <EM;why</em; the criticism was so “unusually fierce” was never properly researched and reviewed by Mr Stephenson. This was, therefore, not at all a properly researched, balanced, scientific review of the Glantz/Kalhkoran paper.
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; I look forward to hearing the BBC’s responses to these representations shortly.
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Yours sincerely,
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David Bareham
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<STRONG;David W Bareham BSc Hons (Physiotherapy) MSc (Pain Management).</strong;
<STRONG;Specialist Respiratory Physiotherapist</strong;
<STRONG;Lincolnshire Community Health Services NHS Trust</strong;
<STRONG;Locality Office</strong;
<STRONG;Louth County Hospital</strong;
<STRONG;Louth</strong;
<STRONG;LN11 0EU</strong;
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<STRONG;Tel:&nbsp; 01205 315247 Option 5</strong;
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<STRONG;Fax: 01507 354957&nbsp; </strong;
<STRONG;non secure email </strong;mailto:[email protected]";<STRONG;David.Bareham@lincs-chs.nhs.uk</strong;
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