The Glantz Critique (2026)
In a 2026 paper published in Nature, researchers Ling and Glantz argued that e-cigarettes "increase harm and should be discouraged." Their key claims:
- Dual use is common and associated with higher risk of cardiovascular, metabolic, respiratory, and oral diseases than smoking only
- One case-control study found daily dual users had nearly 40 times the odds of developing lung cancer as nonsmokers, compared to 10 times for exclusive smokers
- No specific flavor is associated with increased smoking cessation; menthol/mint use is associated with a lower likelihood of stopping vaping
- The three assumptions underlying e-cigarette harm reduction (vaping helps smokers quit, dual use is less harmful than smoking, and vaping is a gateway for youth) are all wrong
Context: Glantz is a prominent tobacco control researcher. His critique has generated significant academic debate. Other researchers have questioned the methodology, particularly the conflation of dual use with vaping harm and the reliance on observational data that cannot establish causation. The FDA, in its JUUL2 authorization, explicitly weighed youth appeal against adult switching benefit and sided with adult benefit — a direct rejection of the "increase harm" framing.
The Duke University Blind Spot (2025)
A 2025 Duke University study published in Nicotine and Tobacco Research highlighted a critical research gap: more than 80% of e-cigarette clinical trials never reported rates of dual use. Of 71 clinical trials reviewed, only 12 reported dual use directly, and just one clearly defined the term. This means much of the evidence base — both for and against e-cigarettes — may be missing the variable that matters most: whether participants actually stopped smoking.
