E-Cigarette Falsehoods from the President of the American Medical Association

 

American Medical Association President Bruce A. Scott, M.D., authored an article, posted on the AMA website today, “Flavored e-cigarettes pose dire threat to youth and public health,” that includes the following: “Tobacco products cause cancer. Overwhelming evidence demonstrates that multiple types of cancer are linked to tobacco products, including e-cigarettes”

This is grossly incorrect, as Dr. Scott intentionally conflates the risks of tobacco use with those of smoking. He provides links to another AMA article that discusses youth and E-cigarette and vaping associated lung injuries (EVALI), but cancer is not mentioned there.

In today’s piece, Dr. Scott writes, “The use of tobacco in various forms remains the nation’s leading cause of preventable death.  According to the Centers for Disease Control and Prevention (CDC), it claims the lives of 1,300 Americans every day, or about one in every five deaths annually. As an ear, nose and throat surgeon in Louisville for more than 30 years, I’ve seen up close the devastating damage that cigarettes and e-cigarettes cause—mouth and throat cancers that too often change lives forever or end lives prematurely.” (emphasis added) The article linked here by Dr. Scott discusses smoking only.

Conflation of tobacco and smoking is a common practice among prohibitionists, as I have noted before (here, here, here), but it is beyond the pale for the president of the AMA to treat “tobacco use” as a synonym for “smoking”, and worse, to unequivocally claim that he has “seen up close” that e-cigarettes cause mouth and throat cancer.

 

Federal Surveys Demonstrate E-Cigarettes Have Been Successful Quit-Smoking Aids For a Decade

 

New research based on U.S. government survey data shows, “The most popular methods used to stop smoking were nicotine products (53.9%; 1.5 million adults), especially e-cigarettes in combination with other methods (40.8%; 1.2 million) and e-cigarettes alone (26.0%; 0.7 million)” [confidence intervals removed by me]. Additionally, “Prescription drug products (8.1%; 0.2 million) and non-nicotine, non-prescription drug methods (6.3%; 0.2 million) were less popular.”

Tobacco researchers Floe Foxon (Pinney Associates) and Ray Niaura (New York University) made those observations in their new report, “Use of nicotine products, prescription drug products, and other methods to stop smoking by US adults in the 2022 National Health Interview Survey,” appearing in the journal Internal and Emergency Medicine (abstract here).

Foxon and Niaura analyzed “U.S. adults who self-reported having stopped smoking cigarettes for 6 months or longer in the last year and the methods they used, or who did not stop smoking but tried in the last year.”  The survey that supplied the raw data is the standard instrument used by the Centers for Disease Control and Prevention to count 29 million adult current and 56 million former U.S. smokers each year. 

The researchers note that their results are similar to those in an earlier analysis of adult smokers in the FDA’s Population Assessment of Tobacco and Health (PATH) Survey.  I conducted that study along with Nantaporn Plurphanswat and noted in a blog post, “e-cigarettes were one of the most commonly used quit aids by American smokers in 2013-2014, and that they were the only aid more likely to make one a former smoker (i.e., a successful quitter) than quitting cold-turkey.”

Now we have definitive population-level evidence, provided by the federal government, that e-cigarettes have been the most popular and among the most successful quit-smoking aids for almost a decade.  It is long past time for government officials to acknowledge these facts.

 

5 Vaping “Facts” You Don’t Want to Know

 

Dr. Michael Blaha, Director of Clinical Research at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, has published an article titled, “5 Vaping Facts You Need to Know.”  The piece contains a number of glaring falsehoods.

I should note my profound disappointment with this article, as Dr. Blaha recently joined me and Sally Satel as faculty members of the since-cancelled Medscape medical education course on tobacco harm reduction (THR).  Despite Dr. Blaha’s involvement with the tobacco-prohibitionist American Heart Association, I appreciated his cooperative attitude and moderate opinions.  The shortcomings of his subsequent article are all the more disappointing.

Here are highlights from Dr. Blaha’s piece, followed by my corrections.

1. “Vaping is less harmful than smoking, but it’s still not safe.”

While Dr. Blaha acknowledges “that vaping exposes you to fewer toxic chemicals than smoking traditional cigarettes,” he follows with five paragraphs on the CDC-labeled subject of e-cigarette or vaping use-associated lung injury (EVALI).  This is grossly misleading, as the cause of EVALI was identified years ago as illicit marijuana

2. “Research suggests vaping is bad for your heart and lungs.”  

Dr. Blaha states what every health professional should know: Nicotine is addictive, and it “raises your blood pressure and spikes your adrenaline, which increases your heart rate…”  But he doesn’t include the critical phrase, “transiently, while you’re using it.”  He then cites studies claiming associations of vaping and lung/heart diseases, most of which have been demonstrated by my research team as unreliable or bogus (here, here and here)

3. “Electronic cigarettes are just as addictive as traditional ones.”

Here Dr. Blaha ignores the fact that nicotine is no more harmful than caffeine, which is also addictive.  Further, he claims, “many e-cigarette users get even more nicotine than they would from a combustible tobacco product: Users can buy extra-strength cartridges, which have a higher concentration of nicotine, or increase the e-cigarette’s voltage to get a greater hit of the substance.”  This is irrelevant, as all tobacco users titrate their dose for satisfaction and enjoyment.

4. “Electronic cigarettes aren’t the best smoking cessation tool.”

This is false.  Population evidence that smokers are switching has been ignored for years by federal officials and others (here and here).  I disagree with Dr. Blaha about the need for consumer vaping products to be proven in clinical trials (here), but two smoking cessation trials, published in the New England Journal of Medicine in 2019 and 2024, clearly demonstrate that vapor products outperformed Dr. Blaha’s preferred “FDA-approved smoking cessation options.”

5. “A new generation is getting hooked on nicotine.”

This is another falsehood.  I have demonstrated that only a tiny fraction of high school vapers are at risk of nicotine addiction and have not used other tobacco products (here). 

6. “Getting hooked on nicotine often leads to using traditional tobacco products down the road.”

No.  Federal surveys show that the minuscule smoking rates among high schoolers is being maintained by young adults (here).

One could surmise from Dr. Blaha’s concerns about why e-cigarettes are attractive to young people that the following steps should be taken:

·       Because many teens believe vaping is less harmful than smoking, we should lie to them.

·       Since e-cigarettes have a lower cost-per-use than traditional cigarettes, we should raise prices.

·       As e-cigarettes have no smell, thereby reducing the stigma of using tobacco, we should make them stink.

None of the above make sense, as all the facts about vaping show there is no youth vaping crisis to fix.

President-elect Donald Trump has nominated Dr. Blaha’s Johns Hopkins colleague Dr. Marty Makary to be FDA Commissioner.  I hope Dr. Blaha’s article isn’t his application to be Director of the FDA Center for Tobacco Products.