New claims about burden of disease from smokeless tobacco are utter junk (the short version)

by Carl V Phillips

There have been a spate of claims recently, stemming from this junk science paper (“Global burden of disease due to smokeless tobacco consumption in adults: analysis of data from 113 countries” by Kamran Siddiqi, Sarwat Shah, Syed Muslim Abbas, Aishwarya Vidyasagaran, Mohammed Jawad, Omara Dogar and Aziz Sheikh) that there is some huge health burden from smokeless tobacco. This piece of utter crap — bad even by the standards of tobacco control “research” — deserves a detailed point-by-point critique, but it is just so bad that I cannot stand to do it right now. So I am going to provide the short version.

1. The headlines from the study include the claim that most of the burden from smokeless tobacco use is in India. This should be a sufficient clue that the whole thing is junk, since people in India and neighboring countries do not use smokeless tobacco (within a rounding error of not at all). A lot of people in that region use oral dip products that are measurably harmful, some of which contain tobacco as a tertiary agreement. But since we know that the tobacco itself causes little or none of the health effect (based on evidence about using actual smokeless tobacco), it is lying to suggest that the problem has anything to do with tobacco. It is basically like speaking of the “obesity burden from tomatoes”, which are frequently a tertiary ingredient (as sauces, condiments, etc.), when reporting the effects of eating too much pizza, fries, burgers, etc.

Basically any analysis that calls South Asian dip products “smokeless tobacco” (e.g., the Nutt et al. paper I have mentioned a few times recently because it is the source of the claim that e-cigarettes are 5% as harmful as smoking) is either the product of unforgivable ignorance or intentional lying. More on this here, particularly here.

2. The deaths attributed to cancer from smokeless tobacco use are based on a meaningless mash-up of the measured effects of the South Asian products that cause health problems due to their non-tobacco ingredients (which there is epidemiology about, though it is mostly very poor quality), Western smokeless tobacco (where the epidemiology shows no measurable risk), and other dirtier forms of smokeless tobacco (e.g., East African) which might cause some risk but we do not really know.

3. The deaths attributed to cardiovascular disease come from the junk INTERHEART study, which basically threw together data from a random collection of people from very different populations worldwide and attributed outcome difference to differences in tobacco use. I hope I do not even need to explain why the elevated death rate of Iraqis and Sudanese compared to Australians should not be attributed to the former populations using more tobacco (or any other particular lifestyle choice).

That is all. As I said, this is the short version — enough to show that this was clearly junk, though only scratching the surface of its problems.

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4 responses to “New claims about burden of disease from smokeless tobacco are utter junk (the short version)

  1. Reblogged this on caprizchka and commented:
    At some point one has to recognize the pattern of all antitobacco research as entirely agenda-ridden.

  2. While the authors inaccurately classified many non tobacco products used in India (that are sometime used with smokeless tobacco) as smokeless tobacco, the authors did acknowledge that their ischaemic heart disease estimates were unsubstantiated:
    “For cancer, our extrapolation was based on estimates obtained from several studies; for ischaemic heart diseases, extrapolations were mostly based on a single although large multi-country study (INTERHEART). As a result, almost three-quarters of the estimated SLT disease burden, which is attributed to ischaemic heart disease, is uncertain. Therefore, a cautious interpretation would be to exclude ischaemic heart disease burden figures from our estimates.”

    But this study, however, is NOT all junk, as the authors estimated that smokeless tobacco is attributable for just 215 cancer deaths in America each year.

    Although Carl may dislike the 450,000 estimated deaths caused by cigarette smoking, compared to 215 deaths attributable to smokeless tobacco (and assuming there are ten times more cigarette smokers than smokeless tobacco users), the authors estimated that cigarettes are 200 times more harmful than smokeless tobacco (450,000 / 215 x 10 = 209.3), or that US smokeless tobacco is just .5% as harmful as cigarette smoking.

    Even by including the unwarranted ischaemic heart disease estimates, the authors estimated that cigarettes are 50 times more harmful than US smokeless tobacco (or that US smokeless tobacco is 98% less harmful than cigarettes).

    • Carl V Phillips

      No study is all junk, not even stuff by Glantz or Chapman. It is hard to get everything wrong. However, getting an approximately accurate conclusion (about one point) via ridiculously invalid methods is not right, it is just lucky.

  3. Upon further analysis, the study (see table 4) actually estimated zero SLT attributable cancer deaths in the Americas A subregion , which includes US, Canada and Cuba.
    http://www.who.int/choice/demography/american_region/en/

    But after apparently applying the absurd 1.57 odds ratio from the INTERHEART study, the authors estimated there are 10,889 deaths annually from SLT attributable ischaemic heart disease in the US, Canada and Cuba, which is impossible.

    The 216 SLT attributable cancer deaths (I miscounted yesterday) were in Americas B subregion, which includes 26 countries in Central and South America and the Caribbean.

    In Europe A subregion (which includes all countries in Western and Northern Europe), the authors estimated 378 SLT attributable cancer deaths annually.
    http://www.who.int/choice/demography/euro_region/en/
    They also estimated 684 SLT attributable ischaemic heart disease deaths annually in the UK due to SLT products imported from Asia (but the authors didn’t include INTERHEART data for the rest of Europe A)

    I’ll contact the author requesting clarification on their estimates for America and Europe, and point out that they misclassified many non tobacco products used in India as SLT.

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