Medical research has always been a crucial component of public health, and the COVID-19 pandemic has made us all hyper-aware of each new study advertising some advancement in our understanding of the virus. Now, an attention-grabbing 2020 study that suggested smoking may reduce the risk of COVID-19 infection has been retracted due to two co-authors having undeclared connections to the tobacco industry.
The study, “Characteristics and risk factors for COVID-19 diagnosis and adverse outcomes in Mexico: an analysis of 89,756 laboratory-confirmed COVID-19 cases” was published as an “early view” in July 2020 in European Respiratory Journal with the claim that smoking cigarettes made patients 23 percent less likely to be diagnosed with COVID-19. The work was a joint effort by researchers at the University of Patras in Greece, the University of Utah, and in Mexico. It received coverage in the media along with other studies suggesting similar findings, including in the Daily Mail.
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This claim is contrary to what many other studies have found regarding the connection between smoking and COVID severity. In fact, in some US states smoking is considered a comorbidity. This claim itself is not what caused the paper to be retracted on March 4th, rather, two co-authors failed to declare their connections to the tobacco industry before submitting their work.
“[O]ne of the authors (José M. Mier) at the time [of submission] had a current and ongoing role in providing consultancy to the tobacco industry on tobacco harm reduction,” the journal wrote in its retraction statement. “And another (Konstantinos Poulas) at the time was a principal investigator for the Greek NGO NOSMOKE.”
The journal’s statement explains that NOSMOKE has funding connections to the Foundation for a Smoke-Free World (FSFW), which is funded by the tobacco industry. According to the University of Bath’s Tobacco Tactics website, NOSMOKE “develops new vaping products and shares pro e-cigarette research from the tobacco industry,” which is itself invested in developing vaping technology and promoting it as a safer way to ingest nicotine than smoking. Vaporizers are referred to by the tobacco industry and by NOSMOKE as modified risk tobacco products, or MRTPs. NOSMOKE is located at the Patras Science Park, which according to Tobacco Tactics received grants in 2018 from the tobacco industry for the establishment of “an institute, which operates as a research and innovation center in the field of modified risk products (MRTPs) and tobacco harm reduction.”
According to the journal’s retraction notice, undisclosed conflicts of interest are not typically enough reason to retract a study. However, the journal has a strict policy against considering papers from authors with ties to the tobacco industry. On balance, “the editors felt the decision was justified based on the nature of the undisclosed relationship, in the context of the sensitive subject matter presented, and on the need to align the published journal content with the bylaws of the publishing society,” the journal said. Additionally, there was no question of scientific misconduct.
Konstantinos Farsalinos, one of the study’s co-authors and a frequent collaborator on NOSMOKE-affiliated research who was not named by the journal as having links to the tobacco industry, told Motherboard by email that he considers this retraction decision “unfair and unsubstantiated.”
“I was contacted by the editors of the journal only after the decision for retraction was made,” Farsalinos continues. “I proposed to publicly release the full dataset and the statistical script so that all findings could be independently verified. The editors declined.”
Farsalinos also said that the conflicts related to the study’s retraction were “irrelevant to the study’s main aims” which was to identify COVID-19 risk factors to prioritize in low-income populations.
Additionally, Theo Giannouchos, the study’s first author who was not one of the authors named as having undisclosed ties to the tobacco industry, pointed out to Motherboard by email that the conclusion the study came to was still by no means an encouragement of smoking.
“It is currently unclear whether nicotine exerts any positive effect, however, there is no doubt that smoking cannot be used as a protective measure and smoking cessation should be encouraged during the COVID-19 pandemic,” the study reads.
The retracted study is also not the only one to hint at a possible connection between smoking and reduced COVID-19 infection. A 2020 study by researchers from Israel’s Clalit Health Services provider, published as a preprint, found a similarly curious possible connection. A French study also uncovered similar findings. Still, many other studies and official guidance from public health organizations indicate that smoking is a risk factor for COVID-19 and for people’s health generally.
Despite the dishonesty that stems from conflict of interest (COI) omissions, failure to declare COIs are not always a one-way ticket to retraction. But when it comes to the tobacco industry, this can be more complicated.
“Unfortunately, the tobacco industry and tobacco industry-funded scientists have a long and notorious history of withholding, falsifying and manipulating research data,” said Sven-Eric Jordt, an associate professor in anesthesiology at the Duke University School of Medicine who studies tobacco regulatory science and was not involved in the retracted research, in an interview. “This is why the European Respiratory Society categorically excludes research manuscripts by the tobacco industry and industry-funded scientists.”
Jordt also said that while the “retraction doesn’t necessarily say that the results are invalid,” transparently disclosing industry connections in research are essential to promoting public trust in science, which is important now more than ever.
“Many faculty at US universities start companies and provide expert and consulting services to industry, governments, non-profits and law firms,” said Jordt. “Declaring conflicts of interest is a measure to increase public trust in research.”
