Anti-vaping rhetoric misleads public about e-cigarette safety, study finds

The evidence is clear at this point: vaping is less dangerous than smoking and helping many people quit their deadly smoking habit. No one who honestly examines the data can dispute either conclusion, but federal tobacco control researchers, activists, and regulators routinely deny or downplay both observations. Scientific denial is always irritating, but it’s particularly troublesome in this case because it has polluted the public’s understanding of vaping and discouraged smokers from trying a potentially life-saving alternative.

As an ex-smoker who quit using an e-cigarette, I have a dog in this fight. But you don’t have to take my word for it. The conclusion of the previous paragraph comes from a study recently published in the American Journal of Preventive Medicine. “Adults in the United States increasingly perceive electronic cigarettes, or e-cigarettes, as ‘more harmful’ than traditional cigarettes,” Medscape reported June 20. More important again,

… [T]e percentage of people who used traditional cigarettes exclusively almost doubled between 2019 and 2020 among those who perceived e-cigarettes as more harmful, rising from 8.4% in 2019 to 16.3% in 2020… Since e-cigarettes entered the US market in 2006, experts in Public Health have questioned manufacturers’ claims that the products work as a harm reduction tool to help traditional smokers quit.

16 years ago, it was reasonable to question the harm reduction utility of e-cigarettes. The fact that researchers continue to express the same doubts today is simply inexcusable. Let’s take a closer look at the study.

Why is the public afraid of vaping?

The authors analyzed data collected from the Health Information National Trends Survey (HINTS), a nationally representative email survey that asks American adults about their perception of cancer and other cancer-related information. health. Data was collected in five cycles between January 2018 and May 2020. Responses from over 3,000 respondents (2018: 3,360; 2019: 3,217; 2020: 3,677) from each year were included in the final analysis . The authors reported that

Relative perceptions of the harms of e-cigarettes versus cigarettes were assessed using the following question which offered a choice of 6 responses: Compared to cigarettes, would you say that the electronic cigarette is… Respondents were ranked as perceiving e-cigarettes as relatively Less harmful (answered much less harmful Where Less harmful), as harmful (answered just as harmful), and more harmful (answered more harmful Where much more harmful) than cigarettes.

The negative shift in perceptions, the authors suggested, may have been due to media coverage of the so-called “EVALI epidemic.” Between 2019 and 2020, when more than 2,000 people were hospitalized for lung damage associated with vaping product use and 68 died.

I write “supposedly” because these cases weren’t caused by vaping per se, as the CDC has wrongly argued for months, but by illegally purchased devices that were used to vape THC or CBD. These chemicals, which originated in marijuana, not tobacco, were mixed with vitamin E acetate, which likely caused the reported lung damage. Dr. Josh Bloom helpfully explained the chemistry behind this phenomenon in this story; later research confirmed his analysis.

During the EVALI outbreak, reporters did what they usually do when they don’t have all the facts: They amplified the risks—again, with the implicit blessing of the CDC—but showed little of interest in reporting the resolution of the controversy. According to the study authors:

more harmful relative perceptions were present at high levels in March 2020 and April 2020, suggesting that misperceptions persisted long after the vitamin E acetate link…was initially identified in September 2019, possibly to be because media coverage was not maintained at initial levels after the source of the outbreak was identified.

The trend continues

EVALI is no longer a major public health issue, but the ideological activism and sloppy reporting that fueled controversy continue to undermine vaping as a harm reduction tool today. Researchers publish substandard research alleging that e-cigarette use has serious health consequences, and the media dutifully reports the findings. ACSH and other science-based media correct propaganda; Unfortunately, this good news doesn’t get as much attention as the sexy and scary headlines.

Experts recognize this problem and know that it needs to be fixed. “We’re good at public health at getting the message out that cigarettes are bad, that tobacco is broadly harmful,” said Dr. Ashley Brooks-Russell, associate professor at the Colorado School of Public Health. Medscape Medical News. “We’re really bad at talking about lesser options, like if you go for a smoke, e-cigarettes are less harmful.”

Dr. Russell is right, but I would go further. Even when documenting the harm caused by common anti-vaping tropes, tobacco researchers cannot let go of their skepticism of e-cigarettes. As the authors of the study themselves wrote,

E-cigarettes…contain high levels of nicotine and youth-appealing flavors that may contribute to addiction and progression to the use of combustible tobacco products in adolescents and young adults.

Every word in this sentence is at least partially wrong. Many electronic cigarettes contain little or no nicotine. Flavored vapes do not encourage teens to use tobacco products; there is no solid evidence to substantiate this speculation. The authors also repeated an anti-vaping claim that has become an article of faith among tobacco researchers: “The risks associated with long-term use are unclear.” This is necessarily true because no one has a crystal ball, but public health researchers regularly use this statement to imply that we will find serious risks associated with vaping in the future.

“The long-term risks of exclusive e-cigarette use are not fully known,” states the American Cancer Society, “but evidence is accumulating that e-cigarette use has negative effects on the system. cardiovascular and lungs.Without immediate action to stop the epidemic use of these products, the long-term adverse health effects will increase.

Could you imagine a major medical institution making a similar statement about COVID-19 vaccines or puberty blockers used to treat gender dysphoria? After all, we don’t know what long-term effects these powerful drugs can have on people who take them (see here and here). Surely we need to stop the “epidemic use” of these products until we know more about them, right?

If these loaded questions irk you, then maybe you’re beginning to see why the popular rhetoric about vaping is so absurd. Proper assessment of any product requires that we accurately balance the risks and benefits of using it. No one says vaping is risk free; it is an effective intervention designed to reduce tobacco use, which continues to kill people around the world.

With that standard in mind, speculating what harms we might one day find is a foolish thought experiment. Tell the public what we know today: vaping is a low-risk alternative for adult smokers who want to quit.

About Margaret Shaw

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