Tobacco Prohibitionists Kill Safer Cigarette Substitutes… and Smokers

 

Dr. Michael Siegel has published a blog entry criticizing a “new article in American Journal of Medicine claim[ing] that youths who use e-cigarettes are 5 times more likely to become cigarette smokers.”  The commentary was authored by tobacco and nicotine opponents Pamela Ling and Edward Goetzl.

Dr. Siegel correctly notes, “the article in question fails to provide any citation or source for its preposterous claim… Apparently, we are supposed to just take it on faith that this is true.”

Reviewing the Ling-Goetzl screed, I found that the authors specified that the five-fold claim was for “tobacco-naive adolescents.”  While that claim was not attributed, the commentary’s authors did include in their reference list one possible source: another commentary, authored by fellow prohibitionist Jonathan Winickoff and coworkers in September’s JAMA. 

Winikoff did not provide a source for his claim either, but he hinted at it with a reference to a 2019 article by Kaitlyn Berry, et al., in JAMA Network Open.

Further complicating the matter, I, along with David Abrams and Ray Niaura, had published a critical comment in that journal, documenting how Berry, et al., engineered their study to make e-cigarettes seem to increase smoking rates by 4 times (in their abstract), not 5.  I also wrote a blog entry on the subject in February 2019 that contained this highlight:

“While Berry, et al., and [then FDA] Commissioner Gottlieb, emphasized the 4.0% probability of current smoking among e-cigarette first users, we found a reverse result buried in a supplemental table: The probability of current e-cigarette use at follow up among cigarette first users was 8.3%.  This means that twice as many first-smoking teens currently used e-cigarettes at follow-up than first-vaping teens who currently used cigarettes.”

The critical lesson here is not about the transgressions of Ling-Goetzl, or Winikoff, or Berry.  It is how the incessant repetition of exaggerated, distorted and sometimes falsified research dangerously distorts public perceptions about vastly safer cigarette substitutes.  It happened with smokeless tobacco; it is happening today with vapor and nicotine pouches.  Millions of smokers will die, and prohibitionists will never be held accountable.

 

Exploiting Outlier Lung Disease Cases Does a Disservice to Public Health

In her excellent August 28 USA Today article on the recent emergence of vaping-related lung illnesses, Jayne O’Donnell noted that “Some state health department and news reports suggest many of the cases of lung problems involve tetrahydrocannabinol, known as THC, the chemical in marijuana that causes psychological effects.”

I fully agree with Boston University’s Dr. Michael Siegel, who said, “The Centers for Disease Control and Prevention is being ‘unnecessarily vague’ about describing the injuries as simply vaping-related when many people might have been injured by vaping THC oil.”  As he and New York University public health professor Ray Niaura pointed out, millions of Americans have vaped nicotine e-liquids over the last ten years, yet no lung problems were reported until recently.  The sudden appearance of these cases and links to THC strongly suggest that contaminated street liquids are at fault, not legitimate retailers’ e-cigarettes or vape products.

Despite this, as noted by Jacob Sullum, the CDC Office on Smoking and Health’s Dr. Brian King focused his public remarks primarily on a purported general link between e-cigarettes and vapor products with lung disease:

“So there’s a variety of harmful ingredients identified, including things like ultrafine particulates, heavy metals like lead and cancer causing chemicals. And flavoring used in e-cigarettes to give it a buttery flavor.  Diacetyl and it’s been related to severe respiratory illness.  That being said we haven’t specifically linked any of those specific ingredients to the current cases but we know that e-cigarette aerosol is not harmless…But the bottom line is there’s a variety of things in e-cigarette aerosol that could have implications for lung health.  A review recently identified a number of adverse health effects associated with e-cigarette use.”  

Dr. Siegel excoriated federal officials for this approach:

“In a disease outbreak such as this one, responsible public warnings need to be as specific as possible about the risk. In an outbreak of E. coli caused by a contaminated batch of lettuce, we don't tell the public that the disease is associated with eating, or even that it is associated with eating lettuce. People need much more specific guidance if they are to take appropriate action to avoid or reduce the risk of further spread of the outbreak.

“Here, we need to start telling the public the truth. However much physicians or anti-nicotine groups may not like it, the truth is that the outbreak we are seeing is not due to the risks of using standard vaping products. It appears much more likely that the outbreak is mostly, if not completely attributable to illicit products--especially THC extracts--that are being sold by unlicensed sellers on the black market. Unless people are provided with this specific information, they will not take action to avoid the products that could put them at risk.”

The potential downside of this scaremongering is even worse.  How many thousands of former smokers who currently vape will conclude that the risks aren’t worth it, and return to smoking?  How many millions of smokers will never consider this vastly safer smoke-free option?

CDC’s hypocrisy was demonstrated in the August 23 statement of Director Dr. Robert R. Redfield:

“We are saddened to hear of the first death related to the outbreak of severe lung disease in those who use e-cigarette or ‘vaping’ devices…This tragic death in Illinois reinforces the serious risks associated with e-cigarette products. Vaping exposes users to many different substances for which we have little information about related harms – including flavorings, nicotine, cannabinoids, and solvents.”

The lung disease fatality was tragic, but Dr. Redfield exploited it by implicating all e-cigarettes and vapes.  Where is CDC’s sorrow for the 1,300+ smokers who die every day from cancers, circulatory diseases and emphysema?

September 5, Reported by the Washington Post: "State & federal health officials investigating mysterious lung illnesses... have found the same chemical in samples of marijuana products used by people sickened in different parts of the country. The chemical is an oil derived from vitamin E."