Wednesday, April 13, 2016

Vaping Opponent Attacks E-Cigarette Companies for Urging Smokers to Quit; Hides Conflict of Interest

A paper published online ahead of print in the journal Tobacco Control blasts electronic cigarette companies and a consumer vaping advocacy organization for creating "knock-off" advertisements that urge smokers to quit by switching to vaping instead. The senior author of the paper - Dr. Robert Jackler - is a professor in the Department of Otolaryngology at the Stanford University School of Medicine.

There are two sets of advertisements in question. Both are parodies of anti-smoking ads by government health agencies.

The first is a parody of the Australian government's "Stop Smoking Start Repairing" campaign. These are advertisements that highlight the benefits of quitting smoking. In the parody ads, entitled "Stop Smoking Start Vaping," the same benefits of quitting smoking are depicted. The tag line remains the same: "Every cigarette you don't smoke is doing you good." These ads are aimed at educating smokers about the health benefits of switching to electronic cigarettes and they urge smokers to quit smoking by using electronic cigarettes.

The second campaign is a parody of the CDC's "Tips from Former Smokers" campaign. The CDC campaign features former smokers giving advice to current smokers to quit smoking. In one ad, the spokesperson is a woman who had tried unsuccessfully to quit smoking using an electronic cigarette and then suffered a pneumothorax ("collapse" of the lung). The ad attributes this unfortunate consequence to the fact that she tried vaping.

In the parody ads, the consumer vaping advocacy group NOTBlowingSmoke (which itself is a parody of the California state health department's "Still Blowing Smoke" anti-vaping campaign), responds to the deception in the "Still Blowing Smoke" ads by pointing out that rather than having devastating health effects, quitting smoking by switching to e-cigarettes is associated with the immense health benefits associated with quitting smoking. After all, it is quitting smoking. The ads feature tips from smokers who have quit using e-cigarettes, emphasizing how much their health has improved after having quit smoking.

Dr. Jackler and colleagues attack the ads on two grounds. First, they argue that these ads are deceptive and not evidence-based. Second, they argue that the ads represent copyright infringement. Specifically, they write:

"Unlike government-issued antismoking advertisement parodies, which are based on scientific evidence, the knock off advertisements by the e-cigarette industry are misleading and deceptive. They also make no attempt at humour or parody. These copycat advertisements hijack the intended purpose of antitobacco material for use in either pro e-cigarette propaganda or promotion of a specific e-cigarette brand. Their adaptation of antismoking advertisements can not only create confusion among the public, but is an illegal infringement of their creators’ copyright privilege."

The Rest of the Story

The authors are wrong on both counts.

First, these advertisements are not deceptive or misleading. Instead, they tell the truth. It is an undeniable fact that quitting smoking will greatly improve your health. The fact that you quit using e-cigarettes as opposed to some other form of treatment does not negate those benefits. There is scientific documentation of substantial health benefits - both in terms of cardiovascular and respiratory health - associated with quitting smoking with the use of e-cigarettes.

Moreover, in the case of the CDC ad parodies, the campaign is actually correcting misinformation being disseminated by the CDC and the California Department of Health Services. The CDC ads imply that the attempt to switch to vaping was the cause of the pneumothorax experienced by the smoker. This is misleading because it wasn't the vaping that caused the problem; it was the smoking. Had the smoker actually switched to vaping, it is highly unlikely that she would have experienced the lung collapse. It was her failure to switch to vaping that resulted in an adverse health consequence. Since the CDC is apparently urging smokers not to quit using e-cigarettes, we can expect many more adverse health consequences to occur as a result of this campaign, as thousands of smokers who might otherwise have quit by switching to vaping will no longer do so.

In the case of the California Department of Health Services, the NOTBlowingSmoke ads are helping to correct numerous statements made by the government. Some are not just deceptive, but are outright lies. Today, the California Department of Health Services claims that vaping causes "popcorn lung," which is not true. Smoking itself has not been associated with "popcorn lung," and the levels of diacetyl in electronic cigarette vapor is on average 750 times lower than in cigarette smoke. And nowhere does the Department warn smokers about the dangers of "popcorn lung." This is incredibly misleading and inappropriate.

Second, the Department claims that vaping causes asthma, infection, and heart disease. There is no evidence to support any of these claims. In fact, the overwhelming evidence demonstrates that switching to vaping actually improves asthma symptoms and lung function in asthmatic smokers.

Third, the Department claims that vaping is as dangerous, or even more dangerous than smoking. This is an outright lie. And in this way, the campaign is not only fraudulent, but also shameful and destructive.

Fourth, the Department claims that Big Tobacco has informed the public that vaping is "harmless." This is false and probably defamatory.

The second argument made by the authors of the paper is also incorrect. These ad campaigns do not represent copyright infringement because they are protected by "fair use." They are clearly parodies of the original ads, and they transform them by correcting their misinformation and showing how the same claim being made against e-cigarettes actually supports the use of e-cigarettes. Moreover, these ads serve an important public health cause by correcting misinformation that is being disseminated by the government. And furthermore, because the ads being parodied were produced by government agencies, not private companies, the "fair use" doctrine applies. There is no copyright for CDC materials, which are essentially in the public domain because the CDC is a federal agency.

There are, however, two aspects of deception going on. But in contrast to what the authors argue - that the deception is coming from the e-cigarette advocates - the truth is that the deception is coming from the authors of this paper.

First, the authors imply that NOTBlowingSmoke is essentially an electronic cigarette industry front group. The truth is that the organization was formed by vaping consumer advocates, not by any e-cigarette company.

Second, Dr. Jackler states in the article that he has no conflicts of interest in writing it: "Competing interests: None declared." But the truth is that Dr. Jackler has what I consider to be a significant conflict of interest; namely, that he has received grant support from Pfizer, a company that markets a smoking cessation drug and stands to lose a huge amount of profits if smokers use e-cigarettes to quit rather than varenicline.

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