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.

 

Economists Document the Harms of Vapor Bans

 

Throughout my tobacco research career I have found conventional public health professionals inflexibly intolerant of tobacco harm reduction.  So I have worked with talented economists who are doctrinal agnostics.  That is, they are driven by data and evidence.

And the evidence increasingly shows the damage of vapor bans.  In this guest post, Clive Bates highlights the findings of recent studies by economists.

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Abigail Friedman and colleagues have published a fascinating new study on the impact of flavour bans on smoking and vaping behaviours.  This one uses survey data on the prevalence of product use from 2016 to 2023 in Behavioral Risk Factor Surveillance System (BRFSS) surveys.

Friedman, A. S., Pesko, M. F., & Whitacre, T. R. (2024). Flavored E-Cigarette Sales Restrictions and Young Adult Tobacco Use. JAMA Health Forum, 5(12), e244594.https://doi.org/10.1001/jamahealthforum.2024.4594

“… state restrictions on flavored ENDS sales were associated with a 3.6−percentage point (ppt) reduction in daily vaping as well as a 2.2 ppt increase in daily smoking relative to trends in states without restrictions.”

This adds further confirmatory evidence to findings from other studies that use economic analysis to examine what happens when these policies are implemented and evaluated.  Vaping may come down, but smoking (a far greater harm) goes up.

Here are three others: 

1. Friedman, A. et al. (2023). E-cigarette Flavor Restrictions’ Effects on Tobacco Product Sales. SSRN https://papers.ssrn.com/abstract=4586701. Used retail sales data from Information Resources Incorporated’s (IRI) retail sales data to look at changes in consumption:

“We find a trade-off of 12 additional cigarettes for every [one] less 0.7 mL ENDS pod sold due to ENDS flavor restrictions.” 

2. Saffer, H., Ozdogan, S., Grossman, M., Dench, D. L., & Dave, D. M. (2024). Comprehensive E-cigarette Flavor Bans and Tobacco Use among Youth and Adults (Working Paper 32534). National Bureau of Economic Research. https://www.nber.org/papers/w32534. Used pooled data from four surveys: Youth Risk Behavior Survey (YRBS), Monitoring the Future (MTF), Population Assessment of Tobacco and Health (PATH), and the Behavior Risk Factor Surveillance Survey (BRFSS)

“Our findings suggest that statewide comprehensive flavor bans may have generated an unintended consequence by encouraging substitution towards traditional smoking in some populations.” 

3. Cotti, C. D., Courtemanche, C. J., Liang, Y., Maclean, J. C., Nesson, E. T., & Sabia, J. J. (2024). The Effect of E-Cigarette Flavor Bans on Tobacco Use (Working Paper 32535). National Bureau of Economic Research. https://www.nber.org/papers/w32535. Used data from State and National Youth Risk Behavior Surveys for youth and the Behavioral Risk Factor Surveillance System for young adults ages 18-20.

“… we find that the adoption of an ENDS flavor restriction reduces frequent and everyday youth ENDS use by 1.2 to 2.5 percentage points. […]. However, we also detect evidence of an unintended effect of ENDS flavor restrictions that is especially clear among 18-20-year-olds: inducing substitution to combustible cigarette smoking.”

The examples above have great merit in looking at outcomes and include effects on smoking and vaping.  Given that the unintended consequences of flavour bans are likely to be the main consequences (when weighted for health impact), these studies show the way to go. 

I am not seeing a lot of formal evaluations of the various flavour bans in Europe. Why would that be?

Here is a survey of adult vapers in the Netherlands by ACVODA, a vape trade association consumer organisation (correction 30 December by CB): Survey among Dutch vapers about the consequences of the online sales and flavour ban (30 August 2024).  This follows a highly restrictive Dutch ban introduced in 2023.

80% of consumers circumvent the flavour ban: 50% go abroad and 30% of respondents still order online and via social media, thanks to the lack of controls. Only 2% of users have switched to the tobacco flavour that is mandatory in the Netherlands. Almost 10% of e-cigarette users have returned to smoking.

None of this should be unexpected. Disgracefully, it seems the billionaire-led, money-soaked campaigns for flavour bans ignore disconfirmatory evidence. It seems they would rather do harm or call for more enforcement than admit they are wrong, for obvious foreseeable reasons. 

Please note that I keep track of some of the policy evidence in a Briefing for Policymakers. This is one of four "Evidence Briefs" on my website. I use these to formulate consultation responses without starting from scratch each time.

Clive Bates

 

FDA Creates, Decries Illegal E-Cigarette Tsunami

 

An article in the LA Times January 2^nd bemoaned the “thousands of new flavored products…pouring into the country from China.”  It claimed, “Nearly all the new products are disposable e-cigarettes, according to sales data gathered from gas stations, convenience stores and other shops. The products generated $3.2 billion in the first 11 months of this [sic] year.”

The response from Brian King, director of the FDA Center for Tobacco Products, was naïve: “Those committing illegal acts don’t advertise their crimes, and those trying to import illegal tobacco products into the United States are no different.  The FDA and our federal partners are using tools, like import alerts, to stop these illegal tobacco products at the border and to deter countless others.” (emphasis added)

Dr. King ignores history.  A contemporary account of the first day of Prohibition in the U.S., January 17, 1920, noted, “Canadian liquor in quantities from one gallon to a truckload is being hidden in the northern woods and distributed by automobile, sled and iceboat, on snowshoes and skis.”

Neither Dr. King nor his FDA colleagues are going to stop the illegal vape tsunami.  When the FDA issued a toothless warning letter last May to the Chinese maker of Esco Bars e-cigarettes, it failed to note that the product’s name is a salute to one of history’s most successful illegal importers – Pablo Escobar. 

My readers will recognize another tobacco prohibitionist in the LA Times article -- Stanford University’s Bonnie Halpern-Felsher.  I’ve criticized her previous research, but here she comes across as a realist: “FDA whacks one product and then the manufacturers get around it and the kids get around it.  It’s too easy to change your product a little bit and just relaunch it.”

Halpern-Felsher wants all vapes banned… for the children, foreseeing a vaping apocalypse: “If we continue down this path that we’re on, we’re just going to have new and continuing generations of young people addicted to nicotine.”

Yes, regardless of what the FDA or anyone else does, some teens and young adults will become addicted to nicotine.  But as shown in the chart below, few will die from nicotine over the next 30 years, as almost none of these vaping youth smoke.