CDC’s Misuse of EVALI Misleads Americans That Smoking Safer Than Vaping

In a campaign of disinformation, culminating in the prolonged mischaracterization of the EVALI (e-cigarette, or vaping, associated lung injuries) crisis, the Centers for Disease Control and Prevention has caused more Americans to believe the untruth that vaping is more dangerous than cigarette smoking.

Bentley University economist Dhaval Dave and colleagues at the City University of New York and Cornell have authored an article titled “News That Takes Your Breath Away: Risk Perceptions During an Outbreak of Vaping-Related Lung Injuries,” published by the National Bureau of Economic Research.  It analyzes the effect of actions taken by the CDC.

Dave et al. describe the federal response to EVALI: “Statements issued by the CDC during the early ‘crisis’ period were direct and clear suggesting that individuals should stop using all vaping products in the late summer of 2019.” (emphasis added). 

The CDC was silent on marijuana until December 10, 2019, when it acknowledged in a tweet that “products that contain THC, particularly from informal sources…play a major role in the current lung injury outbreak.”  The agency had delayed focusing public attention on cannabis products for over three months, as it was clear by early September to many observers, including me (here) and Boston University’s Dr. Michael Siegel (here), that the lung injuries were unrelated to nicotine-based e-cigarettes and vaping products which had been used by tens of millions of consumers for some 10 years with no serious lung problems.    

Figure 5 in Dave’s article, seen above, shows the effect of the anti-vaping misinformation campaign that has been supported since 2012 by the transfer of hundreds of millions of dollars from the FDA to the National Institutes of Health to cooperating university researchers.  This scheme has generated hundreds of laboratory and epidemiologic studies reporting exaggerated or downright false vaping harm. 

The chart shows the success of the misinformation campaign from 2012 to 2019.  The percentage of Americans viewing e-cigarettes as more harmful than cigarettes grew at a consistent rate of about two percentage points per year. 

The 2019 EVALI debacle took the public’s fear of nicotine e-cigarettes and vaping products to new heights.  As Dave et al. write, “the immediate impact…was to increase the fraction of respondents who perceived e-cigarettes as more harmful than smoking by about 16 percentage points.”  After the CDC issued its December 10 tweet emphasizing “the role of THC e-cigarette products, e-cigarette risk perceptions were partially revised downwards.”

That downward movement was minimal, as Figure 6 from the analysis illustrates:

Dave et al. generously refer to the CDC’s delayed identification of marijuana as the cause of EVALI as “precautionary” but they suggest that it may have had “unintended consequences. More targeted advice about the risks of THC e-cigarettes might have more effectively reduced the use of those products, potentially preventing EVALI cases. Moreover, the increase in e-cigarette risk perceptions might discourage adult smokers from using e-cigarettes…the increase in e-cigarette risk perceptions might slow the downward trend in youth smoking.”

By not announcing early on that contaminated marijuana products cause EVALI, the CDC increased the number of injuries and deaths.  The agency inaction also discouraged smokers from switching and might have even encouraged teens to smoke.

FDA and CDC’s Irresponsible Covid-19 Actions and Inactions

Long after today’s Covid-19 crisis, Americans will remember the catastrophic failures of the Centers for Disease Control and Prevention, and the Food and Drug Administration, the two federal agencies tasked with protecting public health.

Covid-19 infections were first reported in Washington State in late January, virtually at the same time as in South Korea.  According to a detailed timeline, that country immediately “pursued a trace, test, and treat strategy that identifies and isolates those infected with the coronavirus while allowing healthy people to go about their normal lives…the U.S. lost six crucial weeks because regulators stuck to rigid regulations…” which “proved disastrous in a pandemic.”  A Reuters headline put it succinctly: “…Korea trounced U.S. in [a] race to test people for coronavirus.”

John P.A. Ioannidis, professor of medicine, epidemiology and population health at Stanford University, opined: “Covid-19 has been called a once-in-a-century pandemic. But it may also be a once-in-a-century evidence fiasco.”  He noted that as a consequence of the testing disaster, officials have been required to institute draconian countermeasures, including extreme social distancing and lockdowns.  “But,” he observes, “with lockdowns of months, if not years, life largely stops, short-term and long-term consequences are entirely unknown, and billions, not just millions, of lives may be eventually at stake.  If we decide to jump off the cliff, we need some data to inform us about the rationale of such an action and the chances of landing somewhere safe.”

Bureaucrats at the CDC and the FDA delayed the rapid development of Covid-19 testing by failing to adapt to emergent conditions and stuck to rigid regulations that take months and years.  These failures have been documented in publications from across the political spectrum, including conservative and libertarian outlets, and the liberal New York Times (here and here).

The FDA’s primary error was its failure to quickly approve Covid-19 tests from university and commercial laboratories.  This sort of “regulatory purgatory” has plagued the sale of vastly safer cigarette substitutes (examples here, here, here and here) -- inaction that contributes to the premature deaths of 480,000 inveterate smokers annually.  Delayed Covid-19 testing has already resulted in tens of millions of Americans having lost their livelihoods, and for far too many, their lives.

The FDA is continuing its unscientific anti-vape campaign with a Covid-19 twist.  Spokesperson Michael Felberbaum provided this warning to Bloomberg News: “People with underlying health issues, such as heart or lung problems, may have increased risk for serious complications from Covid-19.  This includes people who smoke and/or vape tobacco or nicotine-containing products.  E-cigarettes can damage lung cells.”

There is absolutely no evidence that individuals who vape have increased Covid-19 risks.  It is irresponsible for the FDA to make unscientific and unsubstantiated allegations about e-cigarettes without a shred of evidence.  

High School Seniors Keep Drinking, Toking and Vaping, Especially Marijuana

The 2019 Monitoring the Future (MTF) survey results, released in December (here), confirm the sharp decline in high school cigarette smoking that I reported in my recent analysis of the 2019 National Youth Tobacco Survey (NYTS) (here).  The decline in smoking in both surveys coincides with increased vaping. 

The rates of current (in the past 30 days) use of various drugs among high school seniors are seen in the chart.  The MTF recently added vaping categories (labeled on the right) to those for conventional agents like cigarettes, alcohol and marijuana (labeled on the left). 

The rate of current smoking plummeted in 2019 to 5.7%, from 7.6% the year before, and 9.7% in 2017.  That represents an astounding 70% drop from 2011, when teens began vaping (evidence here).

The most important graph lines represent current use of intoxicating drugs, notably marijuana, which was used by 22.3% of high school seniors in 2019; it has tracked in this range since 1995.  They also still used alcohol – which was barely below 30% for the first time (29.3%) – and many still got drunk (17.5%) in the past month.

Current vaping of any or no drug increased in 2019 to 31%, reflecting use of nicotine (26%) and/or flavors alone (10.7%).  The MTF began analyzing JUUL use, finding that it was currently used by 20.8% of seniors. 

The big news in the MTF survey is the sharp increase in current marijuana vaping – 14%, or almost double the year before.  This finding underscores the inexplicable decision by NYTS administrators to omit the marijuana vaping question in the 2019 NYTS after using it in prior surveys.

The MTF provides context for the government’s obsession with flavor bans.  Flavors were vaped far less frequently than marijuana and nicotine.  The survey confirms that the main reason teens vape is to get a buzz; flavors are secondary.  The federal ban on flavors is therefore simply a feel-good measure that will have little impact.