Joanna Cohen is the Bloomberg
Professor of Disease Prevention and the Director of the Institute for
Global Tobacco Control at Johns Hopkins University’s Bloomberg School of Public
Health. Together with other editors of
the prohibitionist journal Tobacco Control, she published a screed aiming to change
the words people use to talk about tobacco, and particularly reduced risk
products.
Dr.
Cohen, in a public email, further claimed that common, accurate terms such as “e-cigarette
and heated tobacco products” serve “tobacco industry interests… We should not be
doing the tobacco industry’s work for them.”
Dr.
Cohen knows something about wording and misperception. Here are the results and conclusions of a
2022 study for which she
served as senior author:
“About
61.2% of smokers believe nicotine causes cancer or don’t know… High perceived
threat of tobacco may be overgeneralized to nicotine…The current study supports
the need for corrective messaging to address the misperception that nicotine
causes cancer. Identifying that nicotine misperceptions are associated with
higher harm perceptions about tobacco smoking suggests that there may be unintended consequences of
high perceived harm of tobacco smoking that
need to be addressed. As nicotine misperceptions are significantly more
prevalent among those already at higher risk of tobacco smoking caused diseases, care should be taken to
ensure equity in message dissemination.” (Cohen text, Brad Rodu
corrections for accuracy)
The
point of the above corrections is to underscore that Tobacco Control
editors should not be advocating changes in terminology when they are guilty
themselves of conflating the tobacco plant with lighting it on fire and
inhaling smoke. This is a topic I have
blogged about before (here and here).
Dr.
Cohen ought to direct her efforts toward the worst example of improper
terminology – “e-cigarette or vaping product use-associated lung injury (EVALI).” First coined by the CDC, this misleading
formulation has been adopted by tobacco harm reduction opponents in order to
obfuscate differences between vaping marijuana and vaping nicotine. Rather than correcting their error, prohibitionists
have doubled down, as seen in a recent EVALI endorsement by the American Thoracic
Society
(ATS).
Clive
Bates explains in the following 10 paragraphs the damage caused by adoption of
the EVALI fallacy:
“Truly
appalling to the point of being cynical and sinister...The most notably absent
feature of the [American Thoracic Society] workshop is any real recantation of
the massive wave of misinformation about EVALI generated by the anti-vaping
tobacco control community from 2019 to the present day, despite the fact that
nicotine vaping was not (and could not have been) implicated in the 2019-20
outbreak of lung injuries in the United States (see analysis here).
Instead, there is something far worse: an attempt to redefine EVALI so
that the misinformation was right all along.
“‘EVALI:
This term will be used to refer to all e-cigarette–related lung injury. This
term will be used as an umbrella, as the EVALI epidemic has brought attention
to e-cigarette–related health effects and is used broadly to document lung
injury/disease attributable to e-cigarettes. It should be noted that the CDC
does not limit EVALI diagnosis to those exposed to particular active
ingredients, and use of all e-cigarettes were considered under the diagnostic
criteria.’
“One wonders
if this was a premise or finding of the 2021 ATS workshop
or whether it has been added to the write-up retrospectively as an ex-poste
justification for the flawed framing of the issue at the
workshop. As we've seen on Stanton Glantz's
blog and with Laura Crotty Alexander's statements, this definition
is a kind of escape from accountability for the misleading attribution of EVALI
(the 2019 US lung injury outbreak) to nicotine vaping. There is nothing
on the (now archived) CDC
website that
suggests CDC intended EVALI to refer to anything but the US lung injury
outbreak and the agents and mechanisms that caused it.
“This
formulation allows a single case of an adverse respiratory reaction to nicotine
e-cigarettes anywhere in the world to be classed as ‘EVALI’, and for
academics/activists to say, ‘nicotine vaping causes EVALI.’ The effect of that,
however, is to load the negative perceptions associated with the US outbreak of
lung injuries (a large outbreak of 2,800 hospitalisations and 68 deaths) into
risk perceptions about nicotine vaping, which did not cause these. It is deeply
unethical and misleading to do this. Scientists should be trying to clear up
misunderstandings and confusions (many of which they have created or
amplified), not adding to them through unwarranted conflations.
“They
could try to justify this on the basis that ‘we are scientists, and we can
use whatever terminology we like, as long as we are clear about it.’
However, it would still be unethical because the predictable consequence
(whether unintentional or deliberate) will be a conflation of radically
different risks and, therefore, the promotion of misunderstanding. Just like
saying, ‘all tobacco products are harmful,’ but worse. Scientists behaving
ethically would actively take care not to do this and to dismantle the
confusions that they had previously worked so hard to promulgate. There
is perfectly good language available to describe effects other than the EVALI
caused by THC-VEA for the extremely rare (and usually contested) cases where
nicotine vaping may be implicated in adverse pulmonary reactions, for example,
in people with allergies or pre-existing conditions.
“The
inclusion of this is designed to increase the confusion and inappropriate
conflation:
‘Although
most affected individuals reported use of cannabinoid e-cigarettes,
approximately 20% reported using only nicotine e-cigarettes [citation removed].
It is unknown whether these patients were unintentionally exposed to VEA
through cross-contamination of e-liquids or sharing of e-cigarettes or whether
additional ingredients, such as medium-chain triglycerides (MCT), can lead to
EVALI [citation removed].’
“We
need to be absolutely clear here. This 20% of cases were not and cannot
have been caused by nicotine vaping. That is just inconsistent with the
epidemiological evidence (the outbreak was confined in time and place and ended
without any changes made to nicotine vaping products. the causal agent VEA
cannot be added to nicotine e-liquids and would serve no purpose if it could
be). The reason people deny using THC is that illicit drug use presents
problems with law enforcement, parole officers, employers, colleagues, schools
and parents. How obvious do things need to be before they are understood by
tobacco control academics? It is also possible that some people were sold
fake THC vapes with no active ingredients, just the cutting agent. So the
statement above is pure merchant-of-doubt.
“Personally,
I suspect at least some of the authors are doing this deliberately. Firstly to
cover their tracks over the massive misinformation sprayed over the public in
2019-20, but more insidiously because they want these products to be
seen as harmful to deter use of them. Further, they need
nicotine vaping to be harmful, or they lose the rationale for control (the
purpose of tobacco control - it's in the name) and, therefore, their
reason to exist.
“There
are two ways to look at this: a disgraceful cynical, defensive fear play or so
naive as to be negligent. Sorry, no nice way to put it.”
George
Orwell, in his seminal book “1984”, coined the term “newspeak”, defined today by
Merriam-Webster as propagandistic
language marked by euphemism, circumlocution, and the inversion of customary meanings.
George, meet Dr. Cohen and her fellow-travelers.
