Thursday, August 23, 2012

Tobacco-Free UK Declares that Electronic Cigarettes Cause Cancer

A poster on the University of Kentucky campus sponsored by Tobacco-Free UK warns the campus community that electronic cigarettes cause cancer.

The text of the poster states:

"E-cigarettes. 3 Strikes. You're out.

1. In Your Brain
You think e-cigs help you quit real cigarettes. There's no evidence of this.

2. In the Vapor
Acetone and Xylene. Nail polish remover and paint thinner? You're going to breathe that? Really? And what about the friends next to you?

3. In the Cartridge
Nitrosamines. Known carcinogens. That means it causes cancer.
Formaldehyde. Highly toxic to all animals, including you. Good for embalming dead bodies. Causes cancer."

The Tobacco-Free UK organization appears to be a UK Tobacco-Free Task Force, which is headed up by Ellen Hahn, the professor who has made misleading claims about electronic cigarettes and apparently, has also falsely claimed that Professor Brad Rodu, a harm reduction proponent at the University of Louisville, is on the Board of Directors of U.S. Tobacco.

The Rest of the Story

This poster contains a host of misleading statements, a scientific claim without any evidence, and an outright lie, as well as extremely damaging and irresponsible medical advice.

The Outright Lie

The poster asserts that there is "no evidence" that electronic cigarettes can be helpful in smoking cessation. This is untrue, as it ignores the Polosa et al. clinical trial, which reported a six-month smoking cessation rate of 22.5% among smokers who were not even motivated to quit smoking. This certainly provides evidence that electronic cigarettes may be useful in smoking cessation.

If Tobacco-Free UK had asserted that the effectiveness of electronic cigarettes in smoking cessation has not been proven, that would be fine. But to claim that there is no evidence that electronic cigarettes may be helpful in smoking cessation is simply a lie. 

The Misleading Statements

The poster claims that the vapor exhaled by vapers contains significant levels of acetone and xylene, and that the levels of these chemicals poses a risk to innocent bystanders. There is no evidence to support this statement. The poster also claims that electronic cigarettes contain nitrosamines. However, it fails to inform the viewer that the levels of these nitrosamines are extremely low, that the levels are about 1000 times lower than in cigarettes, and that the level of nitrosamines in electronic a

The Tobacco-Free UK poster is equivalent to a poster warning smokers not to use nicotine replacement therapy because nicotine gum and the nicotine patch contain carcinogens and are therefore carcinogenic. Would Dr. Hahn claim that the nicotine patch causes cancer? Would she warn smokers who might want to quit by using the nicotine patch that they should avoid the patch because it contains nitrosamines that cause cancer?

Remember that all nicotine-containing products are going to have trace levels of tobacco-specific nitrosamines because the nicotine is derived from tobacco. If the evidence is sufficient to claim that electronic cigarettes cause cancer, then it is also sufficient to claim that NRT causes cancer. But I don't see Tobacco-Free UK warning the campus community about the cancer risks associated with NRT. Why not?

But the most misleading aspect of this communication is that it fails to provide any context. It fails to put the risks of electronic cigarette use in the context of the risks associated with tobacco cigarettes. That is the comparison which is relevant, since these products are intended as a safer alternative to cigarettes for smokers who want to quit or cut down on their cigarette consumption in order to improve their health.

What the poster fails to inform the UK campus community is that electronic cigarettes have much lower levels of nitrosamines than regular cigarettes, have much lower levels of formaldehyde, acetone, and xylene, and contain essentially none of the other thousands of chemicals and scores of carcinogens in tobacco smoke.

The Scientific Claim without Any Evidence

The claim that electronic cigarettes cause cancer is without scientific evidence. While it is true that trace levels of tobacco-specific nitrosamines have been detected in electronic cigarettes, similar trace levels are also present in nicotine gum and nicotine patches. If electronic cigarettes can be said to cause cancer, then so can nicotine replacement therapy.

There is simply no scientific evidence that NRT causes cancer, because it is unclear that the trace levels of tobacco-specific nitrosamines in these products have any clinical significance, are capable of inducing cancer, or that there has ever been a human case of cancer caused by NRT.

Similarly, there is simply no scientific evidence that electronic cigarettes cause cancer, because it is unclear that the trace levels of tobacco-specific nitrosamines in these products have any clinical significance, are capable of inducing cancer, or that there has ever been a human case of cancer caused by electronic cigarettes.

The Extremely Damaging and Irresponsible Medical Advice

The poster is essentially providing the following medical advice to smokers: Do not try to quit using electronic cigarettes.

And it is providing the following medical advice to ex-smokers who have quit by virtue of electornic cigarettes: Stop using the electronic cigarettes (which means, for most vapers, going back to cigarette smoking).

This is irresponsible advice because it asserts 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.

Putting it All Together

I find this poster, and the campaign it represents, to be extremely dangerous and damaging to the public's health. If the campaign is successful, it is going to discourage ex-smokers from continuing to stay smoke-free because it will scare them into thinking they are going to get cancer (as if they are less likely to get cancer from smoking Marlboros!). And it is going to discourage current smokers from making quit attempts using electronic cigarettes - smokers who might otherwise have joined thousands of other vapers in finding the tremendous advantages of these products for smoking cessation or smoking reduction.

To make matters worse, it appears that Dr. Hahn may have a financial conflict of interest, as a disclosure was apparently made that she has either served on a speaker's bureau or received honoraria from Pfizer (the maker of Chantix), a company which stands to lose severely if electronic cigarettes continue to rise in popularity. If accurate, then this conflict should have been disclosed in the poster because the advice is apparently coming from a conflicted researcher. The public has a right to know this.

To be sure, more research needs to be conducted on electronic cigarettes to more clearly define their effectiveness in smoking cessation and to more fully understand their precise health effects. However, notwithstanding the need for more research:

(1) It is incorrect to state that there is no evidence that these devices are useful in smoking cessation or reduction. Clinical trial evidence suggests that these products could be very useful, even among smokers with little motivation to quit.

(2) It is deceptive to scare people by asserting that electronic cigarettes deliver carcinogens, without noting the level of those carcinogens and the fact that the same carcinogens are also present in nicotine replacement products.

(3) It is imperative that researchers giving national advice on electronic cigarettes disclose significant financial conflicts of interest, so that the public has the ability to take this into consideration when evaluating the validity of that advice.

Finally, it is important that public health campaigns not lie to the public. The false and misleading information in this hatchet job on electronic cigarettes not only does the public a disservice because the advice is medically irresponsible, but it also threatens the credibility of public health practitioners.

(Thanks to Bill Godshall for the tip.)

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