Investigation Pokes Holes in Idea That Smoking Cuts COVID Risks

In the early days of the pandemic, preliminary data out of France suggested that COVID-19 was occurring less frequently in smokers. Studies and articles published in the spring of 2020 contemplated the “unanticipated protective effect on COVID-19 incidence in smokers and a less clear association with disease severity.”

A year on, more evidence has disproved the theory that smoking can have a protective effect against COVID-19; one U.K. study analyzing 17.3 million primary care records found that smokers had a 14% increased chance of COVID-19-related death after controlling for age and sex.

In March, the European Respiratory Journal issued a retraction notice for an article published in July 2020 upon the discovery that some of the authors had failed to disclose their highly relevant financial ties to the tobacco industry. The now-retracted article posited that smokers had a significantly lower risk of getting infected by COVID-19, and that smoking was not associated with adverse outcomes for smokers who did contract the disease.

Among the authors who failed to report their conflicts of interest was Konstantinos Farsalinos, MD, MPH, a Greek cardiologist who has spent years steeped in the world of tobacco harm reduction (THR) research and advocacy.

In an investigation published in The BMJ, French journalist Stéphane Horel and Dutch journalist Ties Keyzer found that, for other journal publications over the years, Farsalinos had disclosed receiving fees and funding from a number of nonprofits and organizations with THR interests, such as the American E-Liquid Manufacturing Standards Association, the Tennessee Smoke Free Association, FlavourArt, and Nobacco.

Since the beginning of the pandemic, Farsalinos, of the University of Patras and University of West Attica in Greece, has led the charge in authoring studies that promote the nicotine benefit hypothesis. And in a re-analysis of smoking prevalence and COVID-19 severity and mortality published in the Harm Reduction Journal in January, he again emphasized the potential benefits that nicotine might have for hospitalized patients.

In its retraction, the European Respiratory Journal also stated that co-author Konstantinos Poulas, PhD, was a principal investigator for a Greek NGO called “NOSMOKE” at the time the article was published. The Greek NGO is based out of Patras Science Park, a science and innovation hub funded by the Foundation for a Smoke-Free World — a nonprofit that was founded in 2017 by Philip Morris International, the largest cigarette manufacturing company in the world.

According to Horel and Keyzer, since 2014, e-cigarettes and smokeless products have grown to make up nearly 19% of the tobacco titan’s sales. They noted that Philip Morris International is still the only funder for the Foundation for a Smoke-Free World, pledging $1 billion to the organization to promote “harm reduction science” and to ultimately “end smoking in this generation.”

Poulas did not respond to multiple requests for comments made by Horel and Keyzer for their investigation.

Poulas also serves as the head of the Molecular Biology and Immunology Laboratory at the University of Patras, where Farsalinos is affiliated. The lab has received funding from Nobacco, which leads the market in Greek e-cigarette production. In an emailed response to The BMJ, Farsalinos wrote that he was not aware of the relationship between Nobacco and Patras University, and thus did not mention it to the European Respiratory Journal.

Additionally, the retraction noted that another co-author, José Mier, MD, PhD, of the Hospital Angeles Lomas in Mexico, did not disclose his “current and ongoing role in providing consultancy to the tobacco industry on tobacco harm reduction.”