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."

Federal Officials Admit That Smoking Among Young Adults E-VAPORates

One month ago I used data from the federal National Health Interview Survey (or NHIS, which is administered by the Centers for Disease Control and Prevention) to illustrate that smoking among young adults (age 18-24 years) is evaporating.  In fact, the prevalence of current smoking in this group, defined in NHIS as every day or some days, was 7.8% in 2018. 

The federal National Survey on Drug Use and Health (NSDUH) is another annual survey that measures smoking.  It is administered by the Substance Abuse and Mental Health Services Administration (SAMHSA).  Although the NSDUH collects information on smoking, in addition to alcohol and many other drugs, it does not use the every-day or some-day questions.  Instead, it asks about use in the past month.

Recently SAMHSA published a report on the NSDUH, which contained information about smoking in young adults (defined as 18-25 years) and teens (12-17 years) from 2002 to 2018.  I’ve illustrated those results in the chart at left.      

First, note that the green and blue lines demonstrate considerable decline in both age groups across the entire period.  The lines start at least 8 years before e-cigarettes were used by anyone in the U.S.  More importantly, note the numbers above the lines indicating the average annual decline over the periods outlined by the faint vertical lines.  There is no question that the declines accelerated during the last two periods, when vaping occurred at so-called epidemic rates among teens and young adults.

It is remarkable that the prevalence of smoking among young adults in NSDUH is nearly the same as that in NHIS in 2018.  This is important, because NSDUH always has higher prevalence than NHIS, as I documented in previous research using these surveys.

Curiously, the NSDUH does not collect information on vaping.  However, the government officials who wrote the NSDUH report commented, “Some of this decline [in smoking] may reflect the use of electronic vaporizing devices (‘vaping’), such as e-cigarettes, as a substitute for delivering nicotine.”

A surprising and welcome admission from a federal source.  FDA and CDC: follow the data.

H/T to Jacob Sullum for writing about this story.

Nick Buonoconti Spoke Truth to Power on Smokeless Tobacco

Nick Buonoconti, a 15-year All-Pro NFL linebacker who contributed to the Miami Dolphins’s 1972 perfect season and Super Bowl win, died on July 31 at age 78, following a battle with dementia.  Buonoconti’s tenacity, dedication and intelligence made him an NFL star, despite the fact that scouts had considered him undersized.

Buonoconti found success well beyond football.  The new HBO documentary “The Many Lives of Nick Buonoconti,” describes his influential roles as lawyer, advocate and negotiator for pro athletes; NFL commentator; and dedicated fundraiser for the Miami Project, where he generated nearly $500 million for spinal injury research following his son’s catastrophic injury in a 1985 college football game. 

Buonoconti was also an unlikely hero for smokeless tobacco users.  According to Sports Illustrated, in the 1970s he started working with US Tobacco, the maker of Copenhagen and Skoal dip products.  In 1983, he became executive vice president for legal and federal affairs and public relations; two years later he was named president and chief operating officer.

As I noted previously, the campaign against smokeless tobacco started in 1981, with an article in the New England Journal of Medicine.  In February 1985, Buonoconti squared off with Ed Bradley on the influential news show “60 Minutes”.  The following exchange from that appearance appears at 24:35 in the HBO Buonoconti documentary:    

Ed Bradley: “The people who are dipping smokeless may think they are avoiding the dangers of tobacco by not smoking.  But there is substantial evidence that they’re not.”

Buonoconti: “The science as we know it today tells us that smokeless tobacco has never been scientifically established to cause any harm to humans.  That includes oral cancer.  There is no one saying it does cause a problem.”

Bradley: “The Surgeon General says it does.  The American Health Foundation says it does.”

Steve Croft, another “60 Minutes” correspondent, defends Buonoconti in the HBO documentary: “My feeling is he handled it very well, better than most CEOs that we interview and ask tough questions.”  However, the interview inaccurately and permanently stained Buonoconti as a tobacco industry shill.  He assumed that he had made a terrible mistake, noting, “I have to live with it.”

It turns out that Buonoconti was perfectly on target in challenging the bogus claim that dip and chew products cause mouth cancer.  Like everyone else, he was deceived by three decades of distorted research, exaggerated findings and unscrupulous campaigning by supposedly credible medical organizations.  His remarks proved prescient when a large 2016 federal study found no elevated risk for mouth cancer among American men who dip or chew tobacco.

HBO has done a public service in chronicling the many achievements of this multi-talented football legend.