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.

Tobacco Controllers, Denying Harm Reduction Facts, Promote Orwellian Newspeak

 

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.