Washington Post Attack on E-Cigarettes Deserves Emergency Room Treatment

 

Dr. Leana Wen, an emergency physician and Washington Post columnist, attacked tobacco harm reduction in a Post column last week, “The New Nicotine Product Replacing e‑Cigarettes to Addict Teens” (paywalled).  It dealt mainly with Zyn nicotine pouches, but it touched on the gamut of safer cigarette substitutes. 

Matt Holman, Ph.D., Chief Scientific and Regulatory Strategy Officer at U.S. Philip Morris International, has responded (here) with an accurate point-by-point rebuttal of Dr. Wen’s numerous misstatements. 

I’d like to focus on one especially egregious statement in Wen’s article: “Mitch Zeller, former director of the FDA’s Center for Tobacco Products, explained that as much as 70 percent of people who vape continue to smoke. He showed me industry data from two years ago that showed 84 percent of adult pouch users kept up cigarette use.”

I was astonished that Zeller would cite 70 percent, when he can readily access updated information from the gold standard CDC National Health Interview Survey (NHIS). In this chart of the smoking status of 17.8 million vapers estimated from the 2024 NHIS, the highest percentage were former smokers, while only 26 percent were current smokers.

While dual use is a transition period for many smokers, dual use has another, more ominous driver: misinformation from federal agencies and major medical organizations.  For example, Matt Holman noted: “under the helm of Mr. Zeller, [the FDA Center for Tobacco Products] authorized more than 2,800 cigarette products to be marketed while only authorizing 30 novel smoke-free products (heated tobacco products, Swedish snus, and vapes). These actions resulting in 100 times more authorizations for combusted tobacco than novel smoke-free products are in direct opposition of CTP’s stated mission ‘To protect the public health of the U.S. population from tobacco-related death and disease...’”

Additionally, in 2018, CTP director Zeller launched the FDA Real Cost E-Cigarette Campaign, which is a misinformation circus.  It ostensibly targets kids, but I calculated – using the FDA’s formula – that this campaign also dissuaded hundreds of thousands of smokers from switching to safer vape products (here).

The Washington Post should run a major correction for Dr. Wen’s article.

Follow-Up to My Exposé on the American Lung Association

 

Last week I shared my objections to the American Lung Association’s specious screed on vaping, noting, among other concerns, a non sequitur about popcorn lung from the ALA chief medical officer: “Dr. Rizzo offers an entire paragraph devoted to a disease that has never been diagnosed in a vaper.  The definitive article on [popcorn lung] is by Clive Bates (here).”

In a subsequent comment on X, Jukka Kelovuori observed that the “@Clive_Bates  article is about ‘EVALI,’ not ‘popcorn lung.’” 

 I stand corrected, sort of. 

A search of the medical literature for articles about “bronchiolitis obliterans” (i.e., popcorn lung) and e-cigarettes yields the following results:

 

 In summary, there is just one publication, a 2019 article in the Canadian Medical Association Journal, “Life-threatening bronchiolitis related to electronic cigarette use in a Canadian youth.”

The title references only “bronchiolitis,” not “bronchiolitis obliterans.”  This is important, because, despite the authors alluding to popcorn lung, the only diagnosis they could make in this case report was the former.  The subject was a 17-year-old male who had vaped flavored e-cigarettes “bought through an online Canadian retailer,” but the authors also reported that he “inhaled marijuana via a bong” and “regularly added THC to his vaping fluid.” 

Thus, there still hasn’t been a confirmed case of popcorn lung caused by vaping e-cigarettes.  In fact, one of the article’s commenters correctly noted that cigarette smoke contains far more of the toxic compounds that cause popcorn lung, and still, the condition has never been seen in smokers.

The definitive article on the subject is still by Clive Bates (here).    

 

 

Wave Goodbye With Your Wallet to the American Lung Association

 

It’s the 10^th Anniversary of my call for tobacco users and their friends and families to stop contributing to the American Cancer Society, owing to their false and misleading claims about lifesaving and vastly safer tobacco products.  Today I note that the American Lung Association (ALA) is acting against its stated mission to “save lives by improving lung health and preventing lung disease,” as they, too, are espousing a false narrative about vapor products that have saved many smokers’ lives.

The ALA recently published a particularly specious screed, “Vapor Hiding Dangerous Ingredients.”  The source for much of the article was ALA Chief Medical Officer Dr. Albert Rizzo, a pulmonary physician who has published a few peer reviewed articles, but none on e-cigarettes or vapor products. 

In a 2015 interview with the Delaware Academy of Medicine, Dr. Rizzo acknowledged that it is difficult to get smokers to quit: “we know that a lot of pulmonary diseases could be prevented if we could get people off of cigarettes…but the challenge is many people have been smoking for many years, and it’s a chronic disease, so the most I’m going to be able to do for some of these patients is to help them have a better quality of life, but I can’t necessarily cure them.”

When asked about e-cigarettes in that interview, Dr. Rizzo said, “I certainly don’t include them as a routine effort for smoking cessation.”  His reasoning was vague: “The short answer is we don’t know enough about it. I think the public health community has individuals who look at it at as a safer cigarette, and we just don’t know that, some people look at it as a way to quit smoking and we don’t know that, we just don’t have the evidence that e-cigarettes are all their carried to be.” [emphasis added]

In truth, over the past 10 years, a wealth of data demonstrated that vaping is vastly safer than smoking.  We also know from two clinical trials and population evidence that e-cigarettes help people quit.  Back in 2015, Dr. Rizzo said, “the FDA hasn’t been able to come out and speak clearly about what they’re going to recommend.”  Since then, the FDA has approved 39 vapor products as appropriate for the protection of public health. 

Dr. Rizzo ignores the scientific reality, claiming, “E-cigarettes are addictive and dangerous due to the presence of nicotine, a highly addictive substance, and other harmful chemicals in the vapor.”

His current screed visits many of the common false or misleading claims, including those below. 

Nicotine.  The article invokes all the usual scares, including a threat to teen brains and addiction, but then goes off on a tangent.  “Nicotine also stimulates the adrenal glands, which increases blood pressure and heart rate and can, over time, lead to cardiovascular disease.”  As I have thoroughly documented, increases in blood pressure and heart rate are transient, and they don’t lead to any serious medical issues.   

Propylene Glycol (PG) and Vegetable Glycerin (VG).  The article asserts: “Though they are common additives in food and believed to be safe for ingestion, they are also used to make things like antifreeze, paint solvents and artificial smoke in fog machines which are dangerous when inhaled.”  The ALA is artificially painting a pernicious phantasm misleading smokers into believing that switching to vapor will kill them.

Popcorn Lung.  Dr. Rizzo offers an entire paragraph devoted to a disease that has never been diagnosed in a vaper.  The definitive article on this is by Clive Bates (here).

Heavy Metals and Volatile organic compounds.  Dr. Rizzo: “The composition of e-cigarettes is not as regulated as traditional cigarettes. There are a variety of harmful substances beyond just nicotine, including carcinogens like formaldehyde and acrolein, heavy metals like lead, and ultrafine particles that can damage the lungs contained in e-cigarettes and the amounts vary from product to product.”

Dr. Rizzo ignores the fact that these contaminants, if present at all in vapor, are in minuscule amounts compared with cigarette smoke.  He is right about one thing: “traditional cigarettes” aren’t regulated at all.  They were grandfathered into the market, whereas e-cigarettes like JUUL NJOY, Logic and Vuse underwent years of FDA review to satisfy the agency that they are “appropriate for the protection of public health.”

The ALA brags, “Our work directly touches more than 20 million individuals each year and supports millions of people.”  I urge everyone to stop funding this organization; it is contributing to the untimely deaths of smokers within its target audience.