Thursday, January 28, 2010

Published Article in British Medical Journal Concludes that Smoking is Probably No Worse Than Using Electronic Cigarettes

According to the authors of a published "Views and Reviews" article in this week's issue of the British Medical Journal, active smoking is probably no worse than using electronic cigarettes.

The article, entitled "Electronic Cigarettes: Miracle or Menace?," reviews the current state of scientific knowledge about the safety of electronic cigarettes compared to traditional cigarettes. It concludes that: "The scarce evidence indicates the existence of various toxic and carcinogenic compounds, albeit in possibly much smaller concentrations than in traditional cigarettes."

The paper then concludes: "More rigorous chemical analyses are needed, followed by extensive research involving animal studies and, finally, clinical trials in humans. Until these crucial implementation stages are completed, physicians and other healthcare professionals must inform consumers of the probable fallaciousness of the claims of manufacturers of e-cigarettes."

The Rest of the Story

The main claim being referred to in the commentary is the claim that electronic cigarettes represent a safer alternative to traditional cigarettes. If such a claim is fallacious, it would mean that electronic cigarettes are no less hazardous than regular cigarettes. In other words, it would mean that regular cigarettes are no more hazardous than electronic ones. Thus, what the authors of this article are actually stating is that regular cigarettes are probably no more harmful than electronic ones.

Such an assertion is beyond belief. It is completely inconsistent with everything we know about toxicology and pathology and there is no scientific basis for such a statement. It conflicts directly with even the stated conclusion of the article itself, which acknowledges that the levels of hazardous components in electronic cigarettes are likely much lower than in traditional cigarettes. By what law of chemistry or medicine do the authors assert that the presence of much higher levels of many more toxins and carcinogens fail to make cigarettes more hazardous than these electronic devices?

I believe that this conclusion is not only unsupported by scientific evidence or common sense, but it is also irresponsible. Because it is telling physicians to inform their patients of something which is almost certainly untrue: that smoking cigarettes is no more hazardous than inhaling vaporized nicotine from a tobacco-free device that delivers primarily nicotine and propylene glycol and which for at least some major brands has been found not to contain any detectable levels of tested carcinogens.

The danger of this statement is that it could encourage ex-smokers who have successful quit by using electronic cigarettes to return to smoking. That would be medical malpractice in my view.

The most troubling aspect of this commentary, to me, is the twisted (and inaccurate) logic used in presenting the final argument. After presenting a fair and balanced summary of the state of scientific knowledge, the authors make a sudden and it seems almost mandatory assertion that electronic cigarettes are probably no safer than real ones. The logic is flawed, however, because they confuse the failure to prove a hypothesis with the likelihood of that hypothesis being true.

In other words, the authors argue that because the hypothesis that electronic cigarettes are safer than real ones has not been definitively proven, it is probably not true. But the likelihood of the hypothesis being true has nothing to do with whether it has been studied or not. These are completely independent!

Not according to the logic of these authors. Based on their logic, because it has not been demonstrated that electronic cigarettes are safer than real ones, it is most likely not true. But again, the fact that this hypothesis has not been definitively studied does not affect the likelihood of its being true.

By this logic, anything that has not yet been studied is most likely untrue. Since we have not yet studied whether smoking six packs of cigarettes a day is more harmful than smoking one pack a day, it is most likely untrue. Since we have not studied whether an electronic cigarette which delivers pure water is safer than a Marlboro, it is most likely not true.

This is obviously absurd and fallacious reasoning.

The presence of this twisted and fallacious reasoning in this scientific paper is disturbing to me because it suggests that the bias against smokers has become so strong that it is tainting even the published scientific literature, and even in as prestigious a journal as the BMJ.

Sure, it is true that there are no clinical trials which have demonstrated that electronic cigarettes are safer than regular ones. Such studies are urgently needed. But the absence of those studies does not provide evidence that electronic cigarettes are as hazardous as smoking Marlboro 100's.

We cannot let ideology wipe out our ability to make sound scientific judgments and use rational analysis in evaluating public policy. In this case, the blinding ideology is apparently the view that the very act of doing something which looks like smoking is bad.

Remember, there have been no clinical trials proving that the use of a parachute protects people from the potential deadly effects of gravity when jumping from an airplane. That doesn't make it probable that parachute manufacturers are making fallacious claims when they assert that parachutes can save your life.

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