Tuesday, June 09, 2015

University of Kentucky Center for Smoke-Free Policy Lying to Public About Effects of Smoking

It used to be that we could turn to the tobacco industry if we wanted to see examples of lies being told to the public that minimized the hazards of smoking. But ironically, it is the University of Kentucky Center for Smoke-Free Policy, a public health group, that is lying to the public about the hazards of smoking.

According to a "fact sheet" produced by the Kentucky Center for Smoke-Free Policy, the acute effects of smoking on the lungs are similar to the effects of vaping. Since vaping has no clinically meaningful effects on the lung and has been shown not to affect lung function as measured by spirometry, the Center is essentially telling the public that smoking has very little acute effect on lung function. This is of course not true because smoking does cause an acute decrement in lung function as measured by spirometry.

The Kentucky Center for Smoke-Free Policy states as follows:

"Using electronic cigarettes for even a span of five minutes has been found to cause lung effects similar to smoking."

The clear insinuation of this statement is that the acute effects of vaping and smoking on lung function are about the same. This is not true. While smoking has been documented to acutely affect lung function, electronic cigarettes have been shown not to cause any clinically meaningful decrement in lung function. What has been shown is that e-cigarettes can cause mild respiratory irritation which can result in sub-clinical signs of increased respiratory resistance. However, this irritation does not cause a measurable change in lung function as measured by spirometry. In contrast, cigarette smoking does cause such a change.

Specifically, Flouris et al. reported that: "Neither a brief session of active e-cigarette smoking (indicative: 3% reduction in FEV1/FVC) nor a 1 h passive e-cigarette smoking (indicative: 2.3% reduction in FEV1/FVC) significantly affected the lung function. In contrast, active (indicative: 7.2% reduction in FEV1/FVC) but not passive (indicative: 3.4% reduction in FEV1/FVC) tobacco cigarette smoking undermined lung function." The authors concluded that: "The assessment of lung function demonstrated that neither a brief session of active e-cigarette smoking nor a 1 h passive e-cigarette smoking session significantly interfered with normal lung function. On the other hand, acute active and passive tobacco cigarette smoking undermined lung function, as repeatedly shown in previous studies... ."
In fact, it has been documented that asthmatic smokers who switch to electronic cigarettes experience immediate improvement in their lung function, both subjectively and objectively. Thus, the evidence is extremely strong that the acute lung effects of electronic cigarettes are strikingly different than those of real cigarettes.

If the tobacco industry made such a claim, anti-smoking advocates would nail them to the wall. We would immediately attack the companies, accuse them of undermining the public's appreciation of the severe health hazards of smoking, and condemn them for claiming that the respiratory effects of smoking are only as bad as those of vaping (which we know are minimal).

If the public actually believes what the Kentucky Center for Smoke-Free Policy is saying, they will think that smoking is only a mild respiratory irritant, nothing more. Even the tobacco companies of old didn't make such a claim.

Elsewhere, the Kentucky Center for Smoke-Free Policy repeats this bogus claim that smoking and vaping have essentially the same effect on the lungs. In another "fact sheet," the Center writes that vaping "hurts your lungs like smoking."

Once again, the clear insinuation is that the respiratory effects of smoking and vaping are similar.

Sadly, this brochure actively discourages smokers from quitting via e-cigarettes, asking: "Why spend your money on some new way to get hooked?" While I have criticized some physicians and anti-smoking advocates for not embracing electronic cigarettes, this is much worse. It is actively discouraging smokers who might otherwise quit successfully (as thousands have done) from making a quit attempt using e-cigarettes. This is irresponsible and damaging medical advice.

I have already pointed out that the Center manufactured a claim that e-cigarettes cause cancer, without any supporting evidence. Interestingly, while the Center believes that we need more information before we can conclude that e-cigarettes are safer than smoking, it apparently doesn't need any clinical evidence to conclude that vaping causes cancer. The basis of the Center's claim was the finding of trace levels of nitrosamines in e-cigarette aerosol. What the Center fails to inform the public is that the levels of nitrosamines in e-cigarette aerosol are about the same as those present in nicotine patches and nicotine gum. However, the Center does not claim that nicotine gum causes cancer. Apparently, tobacco-specific nitrosamines only cause cancer when they are present in e-cigarettes, not in other nicotine-containing products, even if the levels of nitrosamines are the same.

The Rest of the Story

Let me first make it very clear that I fully support the mission of the Kentucky Center for Smoke-Free Policy. As my readers know, I have lobbied extensively throughout the country for smoke-free workplace, bar, restaurant, and casino policies.

However, I don't see why there is a need for us to lie in order to advocate public health policies. Why do we need to completely undermine the public's appreciation of the severe hazards of smoking by equating the effects of smoking on lung function with those of electronic cigarettes? Why do we have to try to convince the public that vaping for just 5 minutes is just as bad as smoking? Why do we have to manufacture evidence that doesn't exist, such as telling the public that e-cigarettes cause cancer, when there is not a shred of clinical evidence that this is true?

Even though I disagree with the Kentucky Center for Smoke-Free Policy regarding their position on the role of e-cigarettes in smoking cessation, I would fully respect their right to oppose the use of e-cigarettes as a harm reduction strategy in tobacco control if they would only tell the truth. I cannot respect lying to the public in order to demonize e-cigarettes.

At the end of the day, when we lie to the public we are acting no more ethically than the tobacco companies of old, from which we would always separate ourselves on the basis of us being honest and them being liars. Sadly, we cannot do that any more. And what is gained by our lying?

Nothing. We can promote the public's health by simply telling the truth. It is enough and always has been.

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