By Sally Satel
Source: American Enterprise Institute
C. Everett Koop, Surgeon General under President Ronald Reagan, was an ardent crusader against smoking. As he said of himself in 1998, “I frequently spoke of the sleazy behavior of the tobacco industry in its attempts to discredit legitimate science as part of its overall effort to create controversy and doubt.” Koop was referring to doubt surrounding the relationship between smoking and lung cancer.
The word “doubt” carried special resonance. It conjured an infamous 1968 internal memo from the Brown and Williamson Tobacco Company. “Doubt is our product,” a B and W executive instructed his colleagues… “[It] is the best means of competing with the ‘body of fact’ that exists in the mind of the public… of establishing a controversy.”
The tobacco companies are no longer blowing smoke about the hazards of combusted-tobacco cigarettes. But the critics of electronic cigarettes — an important new technology that has the potential to replace smoking worldwide – have begun mass-producing doubt about the product.
E-cigarettes, as most of us now know, are battery-powered devices that heat a nicotine solution to produce an inhalable nicotine vapor that does not contain tobacco, let alone burn it. E-cigs release a vapor that contains none of the carcinogenic tar present in cigarette smoke.
Last month, the Centers for Disease Control and, independently, the California Department of Public Health launched public education ad campaigns aimed at derailing the future of e-cigs. The ads are teeming with half-truths, speculative harms, and massive spin.
The CDC’s 20-week installment called “Tips from Former Smokers” includes a print ad featuring a woman named Kristy who announces, “I started using e-cigarettes but kept smoking. Right up until my lung collapsed.”
The Kristy spot unmistakably suggests that e-cigarettes caused her collapsed lung.
This is deeply misleading. Kristy’s lung, it turns out, collapsed after she stopped using e-cigarettes and resumed smoking. There are no reported cases of e-cigarette use resulting in collapsed lungs. If anything, when many smokers with COPD and asthma switch to “vaping” e-cigarettes, their lung function improves.
Also misleading is the warning of Dr. Thomas Frieden, CDC director: “There are things we don’t know about [e-cigarette] toxicity.” To the contrary, there is a lot we do know. The vapor contains propylene glycol, a substance regarded as generally safe by the FDA. It is used in toothpaste, food, and cosmetics as well as in asthma and nicotine inhalers. There remain questions surrounding long-term exposure to propylene glycol, and this needs to be tracked, but it is virtually certain that even continued use of e-cigs is safer than smoking.
And what of the CDC’s concern that “e-cigarettes are getting kids hooked” on regular cigarettes? No evidence thus far. The CDC’s own data show that the percentages of high school students who used e-cigs at least once within 30 days, tripled from 1.5% to 4.5% between 2011 and 2013. But high school smoking declined from 15.8% to 12.7%, the lowest it has ever been, in parallel. This pattern is less a “cause for concern” than for encouragement: it suggests, but does not prove, that teen smokers are switching to vaping.
The California campaign, Still Blowing Smoke, keeps up the drum beat of fear. It touts a bogus formaldehyde scare which has its roots in a report the New England Journal of Medicine entitled “Hidden Formaldehyde in E-Cigarette Aerosols.” The report described what happened when researchers used two different voltage settings on the vaping device.
When they tested the device at a realistic voltage setting of 3.3V, no formaldehyde — a carcinogen — was detected. But at a wildly elevated temperature setting of 5.0V, formaldehyde concentrations five- to fifteen-fold that of cigarettes were measured.
This tells us one thing: that when overheated, vaping devices yield unacceptable levels of formaldehyde. The experiment was conducted via machine; there is no way a living person could physically force himself to inhale such acrid vapor.
Still Blowing Smoke also makes some flatly absurd statements. It claims that e-cigarettes are more harmful than real cigarettes because they “contain more particles.” False. Particles per se are not a measure of harmfulness – asthma inhalers deliver particles to the lungs.
As far as nicotine residue on walls and table tops, this is a trivial matter presented in the ads as a threat. The concentrations of ambient nicotine emitted by e-cigarettes are well below biologically meaningful levels. Nicotine, keep in mind, is not a cause of cancer. It is not completely benign, but it is widely sold in medicinal form and does not cause any serious illness.
Only 8 percent of all former smokers have converted to vaping. That percentage needs to grow. But agencies such as the CDC and state of California are doing their best to halt the progression.
On top of this, news about inaccurate labeling, shoddy counterfeits and poorly made e-cigarettes that emit toxins understandably makes some smokers nervous about relinquishing the devil they know. The remedy here is straightforward. The FDA should put a rush on promulgating regulations on manufacturing safety, traceability of hardware, ingredient standards, child-proof packaging, and labeling as soon as possible.
Amidst the propaganda, it’s easy to lose sight of the function of e-cigarettes. They are a less harmful alternative for chronic smokers who can’t manage to quit or don’t want to give up nicotine. What is key, is that e-cigarettes are far safer than smoking. Their vast harm-reduction benefits must be weighed against their unintended effects, such as regular use of e-cigs by young people or vapers’ potential escalation to cigarettes. To date, there is no evidence that those are pressing issues.
The CDC and the California Department of Health have ripped a page from the Big Tobacco playbook. “Strongly call out the point – Controversy! Contradiction! Other Factors! Unknowns!” as Hill and Knowlton, the PR firm that advised the tobacco industry, urged it to do in the 1950s and 60s.
By warping the perception of risk, these agencies will surely create enough doubt about the very real benefits of e-cigarettes that smokers will simply say to themselves, “Why switch?” And keep inhaling dangerous smoke. If there were such a thing as public health negligence, the nation’s flagship public health agency and California’s health department could rightly stand accused.