Wednesday, March 27, 2013

According to the American Legacy Foundation, There's No Evidence that Smoking is More Harmful than Using Non-Tobacco Electronic Cigarettes

In 2013, even the tobacco companies have acknowledged for more than a decade that cigarette use is very hazardous to health and refrain from minimizing the risks of smoking by comparing it to clearly less hazardous activities such as using non-tobacco products.

Not so for one of the leading national anti-smoking organizations: the American Legacy Foundation.

In its apparent zeal to squelch the phenomenon of smokers using something that looks like a cigarette to potentially save their lives, the American Legacy Foundation is telling smokers, and the public, that there is no evidence that cigarette smoking is any more hazardous than vaping, which involves the use of a product that contains no tobacco.

Even the tobacco companies themselves would not dare make such a bald claim in 2013 - that cigarettes may be no more hazardous than the use of a non-tobacco product.

However, on its web site, Legacy states the following:

"Electronic cigarettes are designed to give you an experience that’s like smoking but without any smoke. Since they don’t burn tobacco, they’re marketed as less harmful than regular cigarettes. But so far, there’s no evidence to prove that claim. There’s also no evidence that electronic cigarettes help you quit smoking."

The Rest of the Story

There are actually two false statements in the American Legacy Foundation's "fact" sheet about electronic cigarettes.

First, Legacy is misleading the public by suggesting that there is no evidence that smoking is any more harmful than vaping. This is a dangerous and misleading statement. Legacy is implying that smoking is not all that hazardous, since if it is no worse than electronic cigarette use, it involves only exposure to minute levels of carcinogens (as has been documented to be the case with electronic cigarettes).

It doesn't take a rocket toxicologist to figure out that the current data on the levels of carcinogens in cigarettes versus electronic cigarettes does provide strong evidence that vaping is less hazardous than smoking, and specifically, that vaping is associated with a lower cancer and chronic lung disease risk than active smoking of cigarettes that combust tobacco.

In fact, I have estimated that the level of tobacco-specific nitrosamines in electronic cigarettes is about 1400 times lower than that in Marlboros. In light of these data, how can Legacy possibly argue that there is no evidence that smoking Marlboros is any more dangerous than using an electronic cigarette?

It is problematic enough to disseminate irresponsible advice to the public about such an important a health issue as quitting smoking. But to base that advice on blatant misrepresentations of the available scientific data to the public is even worse.

Why is Legacy ignoring the available data which clearly show that the levels of carcinogens in electronic cigarettes are orders of magnitude lower than in regular cigarettes?

Frankly, this isn't science anymore. It's becoming pure propaganda.

Unfortunately, there appears to be a very strong bias operating which does not allow anti-smoking groups - like Legacy - to objectively view the scientific evidence on electronic cigarettes. I believe that the very fact that these devices are similar to cigarettes blinds many anti-smoking groups to the actual scientific evidence that is readily available. It is apparently not the documented hazards of vaping which are troubling the anti-smoking movement, but the fact that it looks like smoking. How can anything which looks like smoking be a good thing, even if there is strong evidence that these products are bringing immense and immediate health benefits to thousands of users?

According to the American Legacy Foundation, smokers who have quit smoking successfully using electronic cigarettes may just as well return to their Marlboros than remaining ex-smokers with the use of electronic cigarettes because there is no evidence to prove that they have lowered their health risks by quitting smoking and using non-tobacco electronic cigarettes instead. Any physician who gave that medical advice would be doing a great disservice to his or her patients. What the American Legacy Foundation is doing, then, is committing public health malpractice on a massive scale.

Legacy makes a second false statement by asserting that there is "no" evidence that electronic cigarettes can help people quit smoking. There is actually subtantial evidence, coming both from the testimonials of thousands of electronic cigarette users who have reported successfully quitting using these products and from a clinical trial demonstrating that even among smokers with no desire to quit, electronic cigarettes helped more than half of them to achieve smoking cessation or smoking reduction.

In light of the existing evidence, how can one Legacy deceive the public by asserting that there is no evidence for the potential of electronic cigarettes in smoking cessation. To do so is to completely ignore the results of the clinical trial evidence, as well as to ignore the multitude of anecdotal evidence based on personal reports of ex-smokers.

Moreover, the advice from the American Legacy Foundation is irresponsible because it suggests that the many electronic cigarette users who have quit successfully using these devices should discontinue their use and take their chances with NRT or Chantix. But because a large proportion of these ex-smokers are vaping specifically because they tried NRT or Chantix and failed, this advice is tantamount to urging these ex-smokers to return to cigarette smoking. It is difficult to imagine more irresponsible medical advice.

In fact, many vapers have reported dramatic improvement in their health, such as increases in lung function and physical stamina. Discontinuing electronic cigarette use and returning to smoking is the last thing in the world these individuals should be encouraged to do. Returning to smoking will undoubtedly harm the health of these individuals and perhaps even ruin what would have been a great opportunity to keep them off cigarettes permanently.

Making Legacy's statement even more problematic is the fact that it fails to disclose anywhere on the web page that it has a financial conflict of interest in recommending NRT and Chantix while shunning electronic cigarettes by virtue of its having received funding from pharmaceutical companies that manufacture the former products.

As I revealed last week, the American Legacy Foundation has received substantial funding from Pfizer - the very company which manufactures Chantix, a smoking cessation drug which stands to lose severely if electronic cigarettes become more and more popular. Thus, the Foundation's receipt of funding from Pfizer is a conflict of interest that I believe should have been revealed in its statement providing medical advice to smokers, urging them to use a drug like Chantix rather than to try electronic cigarettes.

The rest of the story is that the American Legacy Foundation is doing something that even the tobacco companies would not dare: claiming that there is no evidence that cigarette smoking is more hazardous than using a non-tobacco, non-combustion product that has been shown to contain levels of carcinogens that are up to 1400 times lower than in cigarettes.

Of course I applaud Legacy's efforts to support smoking cessation among smokers and fully support the Foundation in those efforts. But it is also important to be truthful and to maintain a high level of scientific integrity. And it undermines the very purpose of the Foundation when it discourages literally millions of smokers from attempting to quit using a strategy that has been successful for thousands of (now) ex-smokers. We can certainly have differences of opinion about the appropriate role of electronic cigarettes in a national smoking cessation strategy, but if we can't even get past arguing that there's no evidence smoking is any more hazardous than vaping, then there's no possibility of having any kind of evidence-based discussion. We're left in the land of ideology and propaganda, not science.

1 comment:

Nance said...


The new electronic cigarette is already a very popular item. Because of this, many different types have been created. This can be great because it offers many different options for all different types of people.
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