The problem is that in this cross-sectional study, there is no way to determine the direction of the observed relationship.

The paper defends its ethical standards by arguing that it "was consistent with Facebook's Data Use Policy, to which all users agree prior to creating an account on Facebook, constituting informed consent for this research."

I had intended to blog about your recent paper, but decided instead to write an open letter and to put these concerns to you directly. So, I write to express dismay at the false, misleading and damaging conclusions you have drawn from your recent paper in JAMA Pediatrics and related media communications. The errors of reasoning are elementary, but have been used to draw conclusions that are relentlessly hostile to e-cigarettes and the important public health concept of ‘tobacco harm reduction’.

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