Monday, September 02, 2019

Tobacco Company Claims that Smoking is No Worse than Vaping for Human Lung Disease

A major U.S. tobacco company on Saturday issued a press release boasting that smoking its cigarettes is no more harmful than vaping an e-cigarette that contains no tobacco and involves no combustion, at least in terms of lung disease. A spokesperson for the company was kind enough to allow The Rest of the Story to interview him. The transcript appears below, with only slight editing for purposes of clarity. I was given permission to publish the interview, but under the condition that I not name the spokesperson.

The Rest of the Story: Let me first make sure I have this correctly. You are saying that in terms of lung disease, smoking is no more dangerous than using an e-cigarette?

Tobacco company spokesperson: That's right. E-cigarettes are as dangerous as cigarettes for human lung disease."

The Rest of the Story: But that is almost impossible to believe. I mean, cigarettes cause more than 400,000 deaths a year, and more than 100,000 of those deaths are from chronic obstructive lung disease. You're saying that soon we're going to have more than 100,000 vapers dying every year from emphysema and chronic bronchitis?

Tobacco company spokesperson: Yes.

The Rest of the Story: But we haven't seen a single case. Shouldn't we observe a single case of vaping-induced COPD before we draw such a massive conclusion? I mean, as you know, there is probably no human disease that we conclude is caused by a particular exposure before we actually have at least one case. There were hundreds of thousands of deaths from smoking when the Surgeon General concluded that smoking causes heart disease, lung cancer, and chronic lung disease.

Tobacco company spokesperson: No, we don't need to wait for the evidence. We can conclude that vaping is as dangerous as smoking based on what we know right now.

The Rest of the Story: There are three types of epidemiological studies that are typically used to draw causal conclusions about an exposure and a disease. Going from the most definitive to the least, we have cohort studies, case control studies, and case studies. But even in the case studies - which are the weakest form of evidence - you have at least one case of the disease!

Tobacco company spokesperson: But there is evidence.

The Rest of the Story: OK, what is the evidence.

Tobacco company spokesperson: Well, a paper came out recently in the American Journal of Respiratory and Critical Care Medicine showing e-cigarette use increases neutrophil elastase and matrix metalloprotease levels in the lung. The levels of enzymes in the vapers were actually about the same as those in the smokers. Thus, smoking is as hazardous as vaping.

The Rest of the Story: And?

Tobacco company spokesperson: And we know that higher levels of elastase and protease in the lung can lead to chronic obstructive lung disease.

The Rest of the Story: OK, so how many of the vapers in the study had signs of chronic lung disease?

Tobacco company spokesperson: None.

The Rest of the Story: Well, what about a marker for early disease? How many of the vapers in the study had abnormal spirometry measurements?

Tobacco company spokesperson: None.

The Rest of the Story: Now will you acknowledge that if a lot of the vapers in the study were actually ex-smokers and they had a long history of smoking in the past, the observed changes in their lung enzymes might be attributable to their smoking history?

Tobacco company spokesperson: Yes, and the paper clearly states that is the case.

The Rest of the Story: OK, so how many vapers were there in the study, and how many were nonsmokers as opposed to former smokers?

Tobacco company spokesperson: There were a total of 14 vapers in the study. Nine of them were former smokers. Only five were nonsmokers.

The Rest of the Story: OK, so the majority of the vapers had actually smoked in the past. For how many years did they smoke and how long had it been since they quit smoking?

Tobacco company spokesperson: It's not reported in the paper.

The Rest of the Story: OK, well I assume that they reported results just for the vapers who were neversmokers. How did their enzyme levels compare with those of the smokers?

Tobacco company spokesperson: It's not reported in the paper?

The Rest of the Story: So the results of this paper could possibly be due to the fact that ex-smokers had suffered lung injury in the past, rather than that the investigators were finding signs of chronic lung damage in never smokers who started vaping?

Tobacco company spokesperson: I suppose so.

The Rest of the Story: Well, if that remains a possibility, then how can you possibly conclude that vaping as just as hazardous as smoking, even if you're only talking about the risk of chronic obstructive lung disease?

Tobacco company spokesperson: We're not going to worry about the nit-picky details. This is simply a wonderful marketing opportunity for us. By equating smoking with being no more dangerous than vaping, which people don't generally view as particularly hazardous, we are able to make smoking look much less benign than was previously thought. This is helping us to undermine decades of public health education about the severe hazards of smoking.

The Rest of the Story: Well aren't you worried about being attacked by anti-tobacco groups? I mean you're making a statement that is not supported by scientific evidence and which undermines the public's appreciation of the severe hazards of smoking.

Tobacco company spokesperson: We don't worry about the anti-tobacco groups any more. They are too obsessed with criticizing vaping companies. They have practically forgotten that we even exist. They have basically forgotten that there are still 35 million smokers out there who are enjoying our products and sending our profits and stocks soaring. Frankly, the only thing that stands in the way of achieving our full stock value is the threat that e-cigarettes pose as an alternative for many smokers. So being able to convince people that vaping is just as bad as smoking is a dream-come-true for us. And we're licking our chops waiting for the FDA's regulations to go into effect next May. That's going to decimate the vaping product market and basically hand over the entire nicotine product market to us.

The Rest of the Story: Sounds like I should go out and buy some stock in your company.

Tobacco company spokesperson: You're not the only one. Our financial outlook has never been more positive.

The Rest of the Story

CORRECTION: I apologize. I made a mistake. I pulled the trigger too quickly. Hearing that a press release was issued claiming that smoking was no more hazardous than vaping, I naturally assumed that it must have originated from a tobacco company. Who else would draw such a sweeping conclusion from a single study showing cellular changes in vapers, most of whom had a long history of smoking? And especially in light of the fact that the paper didn't even bother to present the results for the vapers who didn't smoke? But I stand corrected. The claim was actually made by an anti-tobacco researcher on his blog. I apologize for any inconvenience my mistake may have caused.

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