Faculty Spotlight: Stanton Glantz, PhD

Cigarette smoking causes about 500,000 deaths in the US each year, making tobacco the leading preventable cause of mortality, including from heart disease. The Center for Tobacco Control Research and Education at UCSF is a world leader in reducing this deadly toll, and is led by Dr. Stanton Glantz, Truth Initiative Distinguished Professor of Tobacco Control and a Division of Cardiology faculty member.

The Center recently celebrated its 15th anniversary, and today includes more than 50 faculty from a wide range of disciplines, an online archive of 14 million tobacco industry documents, and a premier training program for future leaders in tobacco control.

Dangers of E-Cigarettes

One of the latest areas of investigation has been e-cigarettes, which are unregulated by the US Food and Drug Administration and have been marketed as a safer alternative to cigarettes, as well as a way to help smokers quit.

Dr. Glantz and his colleagues recently published some of the first papers demonstrating that e-cigarette smokers are actually less likely to quit smoking. “The original idea was that smokers would switch to e-cigarettes, but we’ve found they are actually becoming ‘dual users,’ smoking both cigarettes and e-cigarettes,” said Dr. Glantz. “The overall evidence is that smokers who use e-cigarettes are less likely to quit by about 25 to 30 percent than smokers who don’t use e-cigarettes. We think one way that happens is that you can use e-cigarettes in a lot of places where you can’t smoke [conventional cigarettes].

Although e-cigarettes emit fewer toxic chemicals than cigarettes, scientists still don’t know the full effects of “vaping” on health. “Just because e-cigarettes are less dangerous than cigarettes doesn’t make them safe,” said Dr. Glantz. Many people are unaware that cigarettes actually cause more cardiovascular deaths than lung cancer deaths. This happens because cigarette smoke can trigger a complex series of events making blood clots more likely to form and impairing blood vessels’ ability to carry increased blood flow when needed. More research is needed to understand whether e-cigarettes have similar effects on the cardiovascular system, but the ultrafine particles that both cigarettes and e-cigarettes produce is one of the likely causes.

E-cigarettes have been aggressively marketed to youth through television and radio ad campaigns, as well as design aspects such as fruit flavors that are more likely to appeal to children. Because e-cigarettes are not regulated by the US Food and Drug Administration, they are not subject to the advertising restrictions on cigarettes. Dr. Glantz and his colleagues were among the first to publish research showing that minors who initiate nicotine use with e-cigarettes are more likely to become smokers, and are also less likely to quit.

Deception Uncovered

Dr. Glantz earned a doctorate in applied mechanics and engineering from Stanford University, and his early research as a UCSF faculty member focused on the mechanical interactions between the chambers of the heart. His interest in the health impacts of cigarettes was a hobby, sparked in part by a request to serve as an expert witness for seemingly healthy, thin, non-smoking waiter who worked in a smoky restaurant. The waiter filed a worker’s compensation claim after he had a heart attack, suspecting it was caused by the restaurant’s secondhand smoke. “I started digging into the literature, and that’s what got me interested in smoking and heart disease,” recalled Dr. Glantz. He and Dr. William Parmley, former chief of the Division of Cardiology, began conducting lab research on that topic.

A few years later, in 1994, Dr. Glantz received a box containing secret documents from the Brown & Williamson tobacco company. The whistleblower’s return address was listed as “Mr. Butts,” the cigarette-shaped Doonesbury cartoon character. Dr. Glantz and his colleagues sorted through 4,000 pages documenting that Big Tobacco lied to the public while knowing cigarettes were addictive and harmful. “The documents show industry executives saying things like, ‘We’re in the business of selling nicotine, an addictive drug,’ in 1963,” he said.

Dr. Glantz and his team published five groundbreaking papers based on the documents in the Journal of the American Medical Association and published the source documents online – the origins of today’s vast online archive, which is freely available to the world. This evidence helped fuel litigation against the four largest US cigarette manufacturers, resulting in the Master Settlement Agreement that, among other provisions, restricted advertising, required tobacco companies to pay more than $200 billion to compensate the states for the cost of treating tobacco-related disease, and made the millions of pages of internal tobacco industry documents publicly available that are now on the Internet at UCSF.

On the Vanguard

Two of Dr. Glantz’s current projects include:

• Smoke-free movies: The US tobacco industry has a long, documented history of collaborating with the film industry to promote youth smoking by portraying it as cool and attractive. The US Surgeon General has estimated that giving an R rating to movies with smoking would significantly reduce the youth smoking rate, based partly on studies published by Dr. Glantz and his team.
• Marijuana policy: Dr. Glantz and his colleagues recently published an analysis of two proposed California ballot initiatives which would legalize marijuana. “The initiatives are written primarily to create a new business and only include minimal protections for public health,” said Dr. Glantz. “We’re saying, we should legalize it so we stop throwing people in jail, but do it in a way to actively discourage its use – using the same kinds of product regulation, labeling, taxation and clean indoor air laws that we know work for tobacco [control].”

Dr. Glantz is also proud of the Center for Tobacco Control Research and Education’s fellowship program, which has trained more than 60 scholars since 2001. The fellows come from a broad range of disciplines, including medicine, public health, biochemistry, epidemiology, psychology, law, anthropology, economics, history and communications.

“One thing that has made me effective is being conversant in biology, epidemiology and policy,” said Dr. Glantz. He encourages trainees to learn from each other’s diverse backgrounds and explain jargon, whether it’s a doctor describing endothelial function or an economist describing the basics of price elasticity.

The program draws trainees from all over the world who have gone on to lead tobacco control and education efforts in their home countries. In recognition of tobacco’s global reach, the program trains international as well as domestic fellows, including:

• Dr. Catherine O. Egbe, a psychologist and current fellow, studies the tobacco industry’s influence on tobacco control policies in Nigeria.
• Dr. Quan Gan, a public health specialist in China, works at a non-governmental organization which has collaborated with the Chinese government to pass indoor smoke-free laws in Beijing and Shanghai.
• Dr. Nick Schneider, a physician in the German Ministry of Health, chaired the World Health Organization Framework Convention on Tobacco Control’s working group on developing guidelines for education, communication, training and public awareness.

“When I first came to UCSF, most people thought it was nuts to bring a non-physician PhD engineer into a Division of Cardiology,” said Dr. Glantz. “But hanging out with clinicians like Tom Ports, Nelson Schiller and Elias Botvinick and listening to the problems they were having led me to a whole different career than if I had been in an engineering or physiology department. I think that’s what the university is for – a place where you’re pushing boundaries and can pursue things that everyone else thinks is crazy.”

Related article from Frontiers of Medicine.

– Elizabeth Chur