One of the most dramatic effects that has been observed in a large proportion of e-cigarette users who are not successful in quitting completely is a substantial reduction in the amount of cigarettes that they smoke. In fact, studies have shown that a solid majority of e-cigarette users are successful either in quitting or in reducing their cigarette consumption substantially. By substantially, I mean reductions around the order of 75% to 90% or higher.
A key argument used by e-cigarette opponents to demonize these products is that these huge smoking reductions have no health benefits because unless you quit completely, you are not improving your health. The opponents have to make this argument because if it were true that these substantial reductions in smoking were improving the health of smokers, then the public health benefit of these products would be enormous.
E-cigarette opponents have therefore attacked the phenomenon of "dual use" of both cigarettes and e--cigarettes as being a bad thing that does nothing for health. This allows them to include as benefits of e-cigarettes only complete cessation.
For example, on his blog, Dr. Stan Glantz argued that reductions in cigarette consumption are not a "meaningful clinical outcome."
The truth about this question is vital, as it has implications for most of the millions of vapers in the country. If dual use has no benefits, then any vaper who is not able to quit completely might as well just return to cigarette smoking.
And, in fact, if smokers/vapers believe what researchers like Dr. Glantz are saying, they are likely to indeed return to cigarette smoking.
However, the claim that there are no health benefits of substantially reducing cigarette consumption is one of the greatest myths in the anti-smoking movement.
The Rest of the Story
First of all, even if there were no direct health benefits from substantially reducing one's cigarette consumption, it would still have health benefits. Research has demonstrated that reducing cigarette consumption enhances the likelihood of complete smoking cessation. In other words, it is a first step along a pathway to cessation. This approach works for a large percentage of smokers. In fact, a study published earlier this week showed that using varenicline for smoking reduction is an effective technique for getting smokers to quit completely. If this works for varenicline, then it would be expected to work for electronic cigarettes as well.
But it turns out that beyond the above health benefit of substantial smoking reduction, there is, in fact, a clinically meaningful direct and immediate benefit.
The dangerous myth that has been disseminated by electronic cigarette opponents is based on the observation that a number of studies have found that severe smoking reduction does not reduce the risk for heart disease and is associated with only small reductions in cancer risk.
But what these e-cigarette opponents are forgetting (or ignoring and suppressing) is that smoking does not only cause heart disease and cancer. It also causes lung disease, and there is no question that severe smoking reduction decreases the rate of progression of lung disease and produces a dramatic improvement in respiratory symptoms. Any smoker who has accomplished such a reduction can tell you this.
This fact is demonstrated by a study which reports that asthmatic smokers who switched partially to e-cigarettes, thus becoming dual users, experienced a significant improvement both in their respiratory symptoms and their lung function. Dual users also experienced a significant reduction in asthma exacerbations.
It makes sense that even severe reductions in cigarette consumption will not decrease heart disease risk because the adverse processes caused by smoking that lead to heart disease saturate at very low levels of exposure. However, the risk of cancer is generally linearly related to carcinogen dose (this has been established for lung cancer), so one would expect to see some cancer risk benefit. But the area where one would expect to see the greatest benefit is respiratory health. It is the ongoing insults due to smoking that lead to progression of chronic obstructive lung disease. Greatly reducing smoking will slow that progression. But most importantly, greatly reducing cigarette consumption will improve respiratory symptoms in smokers who are experiencing them.
In my own clinical experience, substantial
smoking reduction unequivocally was associated with significant health
benefits. These patients experienced a dramatic reduction in their respiratory
symptoms, often making a significant difference in their quality of life.
There is no reason for e-cigarette opponents to continue to lie to the public about what they say is a complete lack of health benefit from substantial reduction in cigarette consumption. This propaganda is undoubtedly causing public health harm by convincing many smokers who cannot quit completely that it is not even worth cutting down.
Friday, February 27, 2015
Thursday, February 26, 2015
Anti--Smoking Groups' Campaign of Deception About E-Cigarettes Has Completely Undermined the Public's Appreciation of the Severe Hazards of Smoking
For decades, public health organizations have attempted to educate the public about the severe hazards associated with cigarette smoking, with tremendous success. However, in the past year or two, many of these same organizations have succeeded in completely undermining the public's appreciation of how hazardous smoking is. They have accomplished this, albeit unintentionally, through a campaign of deception about the hazards of electronic cigarettes.
In their zeal to demonize e-cigarettes, they have not only resorted to misleading and even lying to the public, but have done substantial public health damage. This damage comes in two forms. First, they have succeeded in convincing many smokers not to attempt to quit smoking. Second, they have succeeded in convincing about 50% of the public that smoking is not as hazardous as they previously thought.
The Rest of the Story
Today, I reveal a shocking finding that was reported two days ago in the American Journal of Preventive Medicine: Of all adults who have heard of electronic cigarettes, a whopping 49% believe that smoking is no more hazardous than using e-cigarettes, which contain no tobacco, involve no combustion, and have been found to significantly improve respiratory health in smokers who switch to them, even partially.
This undermining of the public's appreciation of the hazards of smoking has already taken its toll: smokers are being convinced not to quit. Many of them actually believe the propaganda coming from anti-smoking groups and researchers, and these smokers have therefore decided they might as well continue smoking rather than switch to electronic cigarettes. After all, if e-cigarettes are just as harmful as tobacco cigarettes, then what's the point of quitting smoking by substituting e-cigarettes?
In addition, for the same reason, some ex-smokers who have quit using e-cigarettes are deciding they might as well return to cigarette smoking.
Ironically, the roles of Big Tobacco and the anti-smoking community have completely switched. For years, we in public health tried to convince the public of how harmful smoking is, and the tobacco companies tried to undermine that. Now, the tobacco companies are telling the public that smoking is far more harmful than vaping, and it is the anti-smoking groups which are trying to completely undermine that understanding. And these new data demonstrate that they are succeeding.
In their zeal to demonize e-cigarettes, they have not only resorted to misleading and even lying to the public, but have done substantial public health damage. This damage comes in two forms. First, they have succeeded in convincing many smokers not to attempt to quit smoking. Second, they have succeeded in convincing about 50% of the public that smoking is not as hazardous as they previously thought.
The Rest of the Story
Today, I reveal a shocking finding that was reported two days ago in the American Journal of Preventive Medicine: Of all adults who have heard of electronic cigarettes, a whopping 49% believe that smoking is no more hazardous than using e-cigarettes, which contain no tobacco, involve no combustion, and have been found to significantly improve respiratory health in smokers who switch to them, even partially.
This undermining of the public's appreciation of the hazards of smoking has already taken its toll: smokers are being convinced not to quit. Many of them actually believe the propaganda coming from anti-smoking groups and researchers, and these smokers have therefore decided they might as well continue smoking rather than switch to electronic cigarettes. After all, if e-cigarettes are just as harmful as tobacco cigarettes, then what's the point of quitting smoking by substituting e-cigarettes?
In addition, for the same reason, some ex-smokers who have quit using e-cigarettes are deciding they might as well return to cigarette smoking.
Ironically, the roles of Big Tobacco and the anti-smoking community have completely switched. For years, we in public health tried to convince the public of how harmful smoking is, and the tobacco companies tried to undermine that. Now, the tobacco companies are telling the public that smoking is far more harmful than vaping, and it is the anti-smoking groups which are trying to completely undermine that understanding. And these new data demonstrate that they are succeeding.
Wednesday, February 25, 2015
Wall Street Journal Op-Ed Exposes Campaign of Deception About E-Cigarettes, Shows How Anti-Smoking Groups are Harming the Public's Health
My op-ed, entitled "The Misbegotten Crusade Against E-Cigarettes," appears today in the Wall Street Journal.
In the piece, I argue that many anti-smoking and health groups, including the CDC and the California Department of Public Health, have been waging a war against e-cigarettes, but that this war is based on a campaign of deception. These groups are misleading the public, and sometimes even lying about the relative health effects and effectiveness of electronic cigarettes.
Further, I argue that this campaign of deception is working. E-cigarette use is tailing off or even decreasing, and this is due to the misleading information which is scaring smokers into thinking that vaping is just as hazardous as smoking, thus removing any incentive to quit smoking using e-cigarettes. This, I argue, is doing profound harm to the public's health.
In the piece, I also share my initial impressions about e-cigarettes, to demonstrate that I understand why anti-smoking groups are reacting in the way they are. However, whereas I changed my mind when I saw the scientific evidence and actually took the time to talk to vapers, many of the anti-smoking groups are so blinded by ideology that they have come to a pre-determined conclusion and don't actually care about the scientific evidence. Or, they are displaying the confirmation bias, where they interpret the evidence to fit their pre-existing conclusions.
Here is a brief excerpt from the piece:
"When electronic cigarettes came to the U.S. about 2007, I was skeptical. My assumption was they were a ploy by the tobacco industry to hook more people into smoking under the guise of being a safer product—the notorious low-tar cigarette scam all over again. But as I talked to many e-cigarette users, known as “vapers,” conducted research (Journal of Public Health Policy, 2011) and reviewed a growing body of scientific evidence, I became convinced that e-cigarettes have dramatic potential for reducing disease and death caused by smoking."
"Yet many in the antismoking movement—in which I have been involved for decades—are conducting a misleading campaign against these products. And this campaign may be doing harm to public health."
"The most common claim about e-cigarettes is that they are a “gateway” to smoking. In September 2013 Thomas Frieden , director of the Centers for Disease Control and Prevention, said “many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes.” He added that electronic cigarettes are “condemning many kids to struggling with a lifelong addiction to nicotine.”"
"These statements had no basis in fact when he made them, and the evidence is that they are bogus. One recent study in the American Journal of Preventive Medicine (January 2015) suggests that e-cigarettes are not acting as a gateway to smoking among youth. Another study in the journal Drug and Alcohol Dependence (February 2015) suggests the addictive potential of e-cigarettes is substantially lower than that of tobacco cigarettes." ...
"Bloomberg Business reported last summer that e-cigarette sales began to slip in the U.S., and their use by smokers may even be declining in the U.K. The percentage of the public that believes smoking is more hazardous than electronic cigarettes has fallen to 65% in 2013 from 85% in 2010, according to a 2014 study in the American Journal of Preventive Medicine."
"This is a tremendous lost opportunity. Vaping technology—or something like it that may be developed—has the potential to be one of the greatest antismoking breakthroughs. I would hate to see its promise wasted because of misinformation by the very public-health authorities who should be in the vanguard of reducing the harm from cigarettes."
In the piece, I argue that many anti-smoking and health groups, including the CDC and the California Department of Public Health, have been waging a war against e-cigarettes, but that this war is based on a campaign of deception. These groups are misleading the public, and sometimes even lying about the relative health effects and effectiveness of electronic cigarettes.
Further, I argue that this campaign of deception is working. E-cigarette use is tailing off or even decreasing, and this is due to the misleading information which is scaring smokers into thinking that vaping is just as hazardous as smoking, thus removing any incentive to quit smoking using e-cigarettes. This, I argue, is doing profound harm to the public's health.
In the piece, I also share my initial impressions about e-cigarettes, to demonstrate that I understand why anti-smoking groups are reacting in the way they are. However, whereas I changed my mind when I saw the scientific evidence and actually took the time to talk to vapers, many of the anti-smoking groups are so blinded by ideology that they have come to a pre-determined conclusion and don't actually care about the scientific evidence. Or, they are displaying the confirmation bias, where they interpret the evidence to fit their pre-existing conclusions.
Here is a brief excerpt from the piece:
"When electronic cigarettes came to the U.S. about 2007, I was skeptical. My assumption was they were a ploy by the tobacco industry to hook more people into smoking under the guise of being a safer product—the notorious low-tar cigarette scam all over again. But as I talked to many e-cigarette users, known as “vapers,” conducted research (Journal of Public Health Policy, 2011) and reviewed a growing body of scientific evidence, I became convinced that e-cigarettes have dramatic potential for reducing disease and death caused by smoking."
"Yet many in the antismoking movement—in which I have been involved for decades—are conducting a misleading campaign against these products. And this campaign may be doing harm to public health."
"The most common claim about e-cigarettes is that they are a “gateway” to smoking. In September 2013 Thomas Frieden , director of the Centers for Disease Control and Prevention, said “many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes.” He added that electronic cigarettes are “condemning many kids to struggling with a lifelong addiction to nicotine.”"
"These statements had no basis in fact when he made them, and the evidence is that they are bogus. One recent study in the American Journal of Preventive Medicine (January 2015) suggests that e-cigarettes are not acting as a gateway to smoking among youth. Another study in the journal Drug and Alcohol Dependence (February 2015) suggests the addictive potential of e-cigarettes is substantially lower than that of tobacco cigarettes." ...
"Bloomberg Business reported last summer that e-cigarette sales began to slip in the U.S., and their use by smokers may even be declining in the U.K. The percentage of the public that believes smoking is more hazardous than electronic cigarettes has fallen to 65% in 2013 from 85% in 2010, according to a 2014 study in the American Journal of Preventive Medicine."
"This is a tremendous lost opportunity. Vaping technology—or something like it that may be developed—has the potential to be one of the greatest antismoking breakthroughs. I would hate to see its promise wasted because of misinformation by the very public-health authorities who should be in the vanguard of reducing the harm from cigarettes."
Tuesday, February 24, 2015
Tomorrow's SRNT Annual Meeting: Brought to You by Pfizer
Tomorrow marks the start of the annual meeting of the Society for Research on Nicotine and Tobacco (SRNT) in Philadelphia.
According to the 2015 meeting program, a major purpose of the conference is: "Through scientific exchange, integrate current research with implications for clinical practice." Specifically, a major focus of the conference is discussing recommendations for the treatment of smoking addiction, including the use of drugs such as Chantix and newer alternatives such as electronic cigarettes.
In fact, there will be at least 12 presentations on the use of Chantix for smoking cessation. In addition, there will be one talk on the potential suicide risk that has been observed in post-marketing studies of Chantix users. However, that talk is based on a published paper which concludes that "there is consistent evidence that varenicline either does not cause increased suicide outcomes, or if it does, the effect is very small." That paper makes recommendations for the labeling of the drug.
In addition, there will be nearly 20 presentations on electronic cigarettes.
The Rest of the Story
This would be an awesome conference if it represented an objective, unbiased, and non-conflicted view of the scientific evidence regarding the benefits and risks of Chantix as well as the evidence regarding the relative safety and effectiveness of its chief competitor: electronic cigarettes.
So there's just one problem:
The conference is sponsored by ...
... you guessed it
Pfizer - the manufacturer of Chantix, the very drug whose clinical use will be discussed at the conference.
While there is nothing wrong with conducting clinical trials or other research studies funded by pharmaceutical companies, there is something wrong with having such companies sponsor scientific meetings at which clinical recommendations for the use of their very drugs are going to be discussed in what is supposed to be an objective manner.
By accepting the Pfizer sponsorship, SRNT is sacrificing the scientific integrity of the conference.
There is no way that the conference can objectively consider the role of Chantix (or electronic cigarettes, a Chantix competitor) as part of a broad, national strategy for smoking cessation when the conference is being funded by the very manufacturer of one of these products.
Can you imagine if this conference were being sponsored by independent (not related to Big Tobacco) electronic cigarette companies? There would be an outrage in the anti-smoking community. People would immediately question the objectivity of the conference, especially as it pertains to the discussion of the role of e-cigarettes in national smoking cessation strategy and in clinical recommendations.
In fact, I would agree that if the conference were sponsored by electronic cigarette companies, that would preclude the possibility of truly objective consideration of the appropriate role of electronic cigarettes in a national smoking cessation strategy as well as an objective consideration of clinical recommendations for the use of electronic cigarettes.
The bias introduced by the Big Pharma sponsorship of the conference is readily apparent. While there are multiple talks about the role of Chantix in smoking cessation, noticeably absent from the conference program are the following talks:
Specifically, Dr. John Hughes - who will apparently tell the audience that there is no major suicide risk associated with Chantix - has conflicts of interest by virtue of his having consultancies, honoraria, and research grants/contracts with many pharmaceutical companies, including Pfizer.
It is completely inappropriate to have this conflicted scientist be the one to opine on the potentially fatal observed side effects of Chantix.
In a 2008 article published in the journal Drug and Alcohol Dependence (Volume 98, Issue 3, 1 December 2008, Pages 169-178), Dr. Hughes disclosed that: "In the last 3 years he has received research grants from the National Institute on Health and Pfizer Pharmaceuticals and Sanofi-Synthelabo Pharmaceuticals both of whom are developing smoking cessation treatments. In the last three years, he has accepted honoraria or consulting fees from the following profit or non-profit institutions regarding nicotine or other drug abuse topics: Academy for Educational Development, Acrux DDS; American College of Chest Physicians, Adelphi Consulting, Aradigm; Atrium, Baltimore Research, Campus Consulting, Cambridge Press, Cline, Davis and Mann; Concepts in HealthCare, Constella Group; Consultants in Behavior Change; Cowen Inc, Cygnus, Edelman, Fagerstrom Consulting; Free and Clear; Healthwise, Health Learning Systems, International Marketing Systems, Insyght; Johns Hopkins University; Maine Medical Center, McNeil, Medicus, Nabi, National Institutes on Health; NCI Consulting, Pfizer Pharmaceuticals; Pinney Associates; Research Triangle Institute, Shire Health London; Temple University of Health Sciences; University of Arkansas, University of Auckland; University of Cantabria; University of Greifswald; University of Kentucky, University of Memphis, Warner Pharmaceuticals, Wolters Press, Xenova, and ZS Associates."
Thus, Dr. Hughes is essentially a walking conflict of interest with Big Pharma.
More recently, in a 2015 paper, Dr. Hughes discloses as follows: "Dr Hughes reports receiving personal fees from Alere/Free and Clear, Cicatelli, DLA Piper, Dorrffermeyer, Embera, Equinox, GlaxoSmithKline, Healthwise, Nicoventures, Pfizer, Pro Ed, Publicis, Selecta, and nonfinancial support from Swedish Match." Moreover, that paper presents the results of a clinical trial that was funded by Pfizer.
The rest of the story is that although its main purpose is presumably to foster objective scientific consideration of the issues regarding nicotine and tobacco control, SRNT is apparently heavily funded by the pharmaceutical industry. This funding, in my view, creates a substantial conflict of interest that precludes the objective consideration of many important scientific issues; in particular, the role of smoking cessation drugs as part of national or international tobacco control strategies.
This is in no way to fault the individual scientists who will present on these issues at the conference. Nor is it to suggest that any wrongdoing is occurring. It is merely to point out that the pharmaceutical sponsorship creates, by its very existence, an unavoidable bias that precludes a truly objective consideration of any scientific issue that may have significant implications for the profitability of smoking cessation drugs, and therefore, for their manufacturers who are conference sponsors.
It is also important to point out that bias does not necessarily have to be conscious. In fact, the most concerning bias is that which could arise subconsciously by virtue of the sponsorship of the conference by Big Pharma.
According to the 2015 meeting program, a major purpose of the conference is: "Through scientific exchange, integrate current research with implications for clinical practice." Specifically, a major focus of the conference is discussing recommendations for the treatment of smoking addiction, including the use of drugs such as Chantix and newer alternatives such as electronic cigarettes.
In fact, there will be at least 12 presentations on the use of Chantix for smoking cessation. In addition, there will be one talk on the potential suicide risk that has been observed in post-marketing studies of Chantix users. However, that talk is based on a published paper which concludes that "there is consistent evidence that varenicline either does not cause increased suicide outcomes, or if it does, the effect is very small." That paper makes recommendations for the labeling of the drug.
In addition, there will be nearly 20 presentations on electronic cigarettes.
The Rest of the Story
This would be an awesome conference if it represented an objective, unbiased, and non-conflicted view of the scientific evidence regarding the benefits and risks of Chantix as well as the evidence regarding the relative safety and effectiveness of its chief competitor: electronic cigarettes.
So there's just one problem:
The conference is sponsored by ...
... you guessed it
Pfizer - the manufacturer of Chantix, the very drug whose clinical use will be discussed at the conference.
While there is nothing wrong with conducting clinical trials or other research studies funded by pharmaceutical companies, there is something wrong with having such companies sponsor scientific meetings at which clinical recommendations for the use of their very drugs are going to be discussed in what is supposed to be an objective manner.
By accepting the Pfizer sponsorship, SRNT is sacrificing the scientific integrity of the conference.
There is no way that the conference can objectively consider the role of Chantix (or electronic cigarettes, a Chantix competitor) as part of a broad, national strategy for smoking cessation when the conference is being funded by the very manufacturer of one of these products.
Can you imagine if this conference were being sponsored by independent (not related to Big Tobacco) electronic cigarette companies? There would be an outrage in the anti-smoking community. People would immediately question the objectivity of the conference, especially as it pertains to the discussion of the role of e-cigarettes in national smoking cessation strategy and in clinical recommendations.
In fact, I would agree that if the conference were sponsored by electronic cigarette companies, that would preclude the possibility of truly objective consideration of the appropriate role of electronic cigarettes in a national smoking cessation strategy as well as an objective consideration of clinical recommendations for the use of electronic cigarettes.
The bias introduced by the Big Pharma sponsorship of the conference is readily apparent. While there are multiple talks about the role of Chantix in smoking cessation, noticeably absent from the conference program are the following talks:
- Suicidal ideation and completed suicide as adverse side effects of Chantix: should varenicline be taken off the market or its warning label be strengthened?;
- Case reports of varenicline-related deaths among patients with no prior history of depression;
- Population-based data show that smoking cessation drugs are not effective;
- Population-based data show that cold turkey quitting remains the most effective strategy;
- Problems of blinding in clinical trials of smoking cessation drugs; and
- Weaknesses of the transtheoretical model in explaining the process of smoking cessation: the need for anti-smoking media campaigns rather than smoking cessation drugs as the mainstay for a national smoking cessation strategy.
Specifically, Dr. John Hughes - who will apparently tell the audience that there is no major suicide risk associated with Chantix - has conflicts of interest by virtue of his having consultancies, honoraria, and research grants/contracts with many pharmaceutical companies, including Pfizer.
It is completely inappropriate to have this conflicted scientist be the one to opine on the potentially fatal observed side effects of Chantix.
In a 2008 article published in the journal Drug and Alcohol Dependence (Volume 98, Issue 3, 1 December 2008, Pages 169-178), Dr. Hughes disclosed that: "In the last 3 years he has received research grants from the National Institute on Health and Pfizer Pharmaceuticals and Sanofi-Synthelabo Pharmaceuticals both of whom are developing smoking cessation treatments. In the last three years, he has accepted honoraria or consulting fees from the following profit or non-profit institutions regarding nicotine or other drug abuse topics: Academy for Educational Development, Acrux DDS; American College of Chest Physicians, Adelphi Consulting, Aradigm; Atrium, Baltimore Research, Campus Consulting, Cambridge Press, Cline, Davis and Mann; Concepts in HealthCare, Constella Group; Consultants in Behavior Change; Cowen Inc, Cygnus, Edelman, Fagerstrom Consulting; Free and Clear; Healthwise, Health Learning Systems, International Marketing Systems, Insyght; Johns Hopkins University; Maine Medical Center, McNeil, Medicus, Nabi, National Institutes on Health; NCI Consulting, Pfizer Pharmaceuticals; Pinney Associates; Research Triangle Institute, Shire Health London; Temple University of Health Sciences; University of Arkansas, University of Auckland; University of Cantabria; University of Greifswald; University of Kentucky, University of Memphis, Warner Pharmaceuticals, Wolters Press, Xenova, and ZS Associates."
Thus, Dr. Hughes is essentially a walking conflict of interest with Big Pharma.
More recently, in a 2015 paper, Dr. Hughes discloses as follows: "Dr Hughes reports receiving personal fees from Alere/Free and Clear, Cicatelli, DLA Piper, Dorrffermeyer, Embera, Equinox, GlaxoSmithKline, Healthwise, Nicoventures, Pfizer, Pro Ed, Publicis, Selecta, and nonfinancial support from Swedish Match." Moreover, that paper presents the results of a clinical trial that was funded by Pfizer.
The rest of the story is that although its main purpose is presumably to foster objective scientific consideration of the issues regarding nicotine and tobacco control, SRNT is apparently heavily funded by the pharmaceutical industry. This funding, in my view, creates a substantial conflict of interest that precludes the objective consideration of many important scientific issues; in particular, the role of smoking cessation drugs as part of national or international tobacco control strategies.
This is in no way to fault the individual scientists who will present on these issues at the conference. Nor is it to suggest that any wrongdoing is occurring. It is merely to point out that the pharmaceutical sponsorship creates, by its very existence, an unavoidable bias that precludes a truly objective consideration of any scientific issue that may have significant implications for the profitability of smoking cessation drugs, and therefore, for their manufacturers who are conference sponsors.
It is also important to point out that bias does not necessarily have to be conscious. In fact, the most concerning bias is that which could arise subconsciously by virtue of the sponsorship of the conference by Big Pharma.
Monday, February 23, 2015
Anti-Smoking Groups' Demonization of Electronic Cigarettes is Leading to Devastating Consequences
According to an article in the Gloucester (UK) Citizen, the health scare over electronic cigarettes has led many adoption agencies in the UK to prohibit anyone who uses e-cigarettes from adopting children. In fact, some districts preclude anyone who has used an e-cigarette in the past 12 months from adopting.
According to the article:
"A couple has been stopped from adopting a child after the would-be father was seen smoking an e-cigarette. The decision by social workers at Staffordshire County Council came after the pair had passed a long series of tests to qualify as parents. They were told they could not adopt if either of them had used an e-cigarette in the past 12 months – despite experts saying that ‘vaping’ poses little or no threat to children in the home. The couple told The Mail on Sunday: “When there are so many children desperate for a family and a stable home, to put up such trivial barriers is ridiculous.” According to its investigation at least 13 councils in England ban e-cigarette users from fostering or adopting young children." ...
"Abigail’ and ‘Brian’, who do not want to give their real names, approached the council in December 2013 after several failed IVF attempts costing over £20,000. By last September, having undergone medicals and interviews, and having proved they were of sound character and financially capable of raising a child, the pair thought they were on track to adopt. But when a social worker saw Brian using an e-cigarette, everything changed. Brian, 45, said: ‘By then I’d stopped smoking completely and hadn’t had a real cigarette in months. I was using e-cigarettes as a cessation aid, to ease the nicotine cravings.’"
The Rest of the Story
This story really turns my stomach. Moreover, it is just heartbreaking. How misguided this policy is. How devastating the consequences. Due to the anti-smoking groups' dissemination of false and misleading information about the hypothetical consquences of vaping, actual harm is being done to many people.
This story reveals that not only is this harm being done to smokers who have decided to continue smoking rather than engage in a behavior that many health advocates say is as dangerous as smoking, but serious harm is also being done to smokers who have successfully quit using electronic cigarettes.
In other words, smokers who quit successfully using e-cigarettes are actually being punished for using e-cigarettes rather than an "FDA-approved" method.
The sad reality is that despite the most important ethical principle of medicine and public health being "to do no harm," the anti-smoking movement is doing tremendous harm, both to the public's health and to the lives of many ex-smokers.
That health is hardly the paramount value in tobacco control in 2015 is demonstrated by the fact that it's not the fact that you quit that is important, it's that you quit "the right way."
According to the article:
"A couple has been stopped from adopting a child after the would-be father was seen smoking an e-cigarette. The decision by social workers at Staffordshire County Council came after the pair had passed a long series of tests to qualify as parents. They were told they could not adopt if either of them had used an e-cigarette in the past 12 months – despite experts saying that ‘vaping’ poses little or no threat to children in the home. The couple told The Mail on Sunday: “When there are so many children desperate for a family and a stable home, to put up such trivial barriers is ridiculous.” According to its investigation at least 13 councils in England ban e-cigarette users from fostering or adopting young children." ...
"Abigail’ and ‘Brian’, who do not want to give their real names, approached the council in December 2013 after several failed IVF attempts costing over £20,000. By last September, having undergone medicals and interviews, and having proved they were of sound character and financially capable of raising a child, the pair thought they were on track to adopt. But when a social worker saw Brian using an e-cigarette, everything changed. Brian, 45, said: ‘By then I’d stopped smoking completely and hadn’t had a real cigarette in months. I was using e-cigarettes as a cessation aid, to ease the nicotine cravings.’"
The Rest of the Story
This story really turns my stomach. Moreover, it is just heartbreaking. How misguided this policy is. How devastating the consequences. Due to the anti-smoking groups' dissemination of false and misleading information about the hypothetical consquences of vaping, actual harm is being done to many people.
This story reveals that not only is this harm being done to smokers who have decided to continue smoking rather than engage in a behavior that many health advocates say is as dangerous as smoking, but serious harm is also being done to smokers who have successfully quit using electronic cigarettes.
In other words, smokers who quit successfully using e-cigarettes are actually being punished for using e-cigarettes rather than an "FDA-approved" method.
The sad reality is that despite the most important ethical principle of medicine and public health being "to do no harm," the anti-smoking movement is doing tremendous harm, both to the public's health and to the lives of many ex-smokers.
That health is hardly the paramount value in tobacco control in 2015 is demonstrated by the fact that it's not the fact that you quit that is important, it's that you quit "the right way."
Thursday, February 19, 2015
Washington Governor Asserts that Smoking May Be No More Hazardous than Vaping
According to a "fact sheet" on electronic cigarettes put out by the office of Washington governor Jay Inslee, cigarette smoking may be no more hazardous than using a product which merely heats nicotine and propylene glycol, contains no tobacco, and involves no combustion.
According to the policy brief:
"“Vaping” may not be safer than smoking traditional cigarettes."
What is the reasoning behind the governor's proclamation that smoking is no more hazardous than vaping?
"E-cigarettes emit more than water vapor."
The policy brief goes on to state that:
"Former smokers and new smokers may be attracted to e-cigarettes because of unproven claims that they are safer and more accepted than traditional cigarettes."
Governor Inslee concludes by calling for taxes on e-cigarettes and restriction of e-cigarette flavors.
The Rest of the Story
I find it despicable that a state governor is publicly asserting that cigarette smoking may not be any more hazardous than vaping, given the abudant scientific evidence that electronic cigarettes are far less damaging to health than real ones.
The governor's action is undermining decades of public education about the severe hazards of smoking. Moreover, is essentially lying to the public, since it is widely accepted by reputable scientists that vaping is less hazardous than smoking.
The governor wants some of the tax revenue from the imposition of an e-cigarette tax to go to smoking prevention programs. But what's the point of having a smoking prevention program if, out of the other side of your mouth, you are telling the public that smoking is probably not very hazardous (since vaping is almost certainly not very hazardous)?
And why would you want to put a tax on e-cigarettes when such a tax will certainly result in more smokers sticking with their deadly smoking, rather than switching to e-cigarettes and potentially saving their lives?
The stated purpose of the e-cigarette tax is to prevent e-cigarette use. But preventing e-cigarette use - among adults - is tantamount to a campaign to encourage cigarette smoking because realistically, this is the alternative for most smokers who are considering using e-cigarettes. These folks are not deciding between NRT, Chantix, Zyban, electronic cigarettes, and smoking. They are almost by definition accepting the fact that they do not believe they can quit smoking using the traditional methods. So the choice is essentially electronic cigarettes or continued smoking. Why does the governor of Washington want smokers to choose continued smoking?
The governor's actions are essentially promoting cigarette use and protecting cigarette profits at the expense of the improvement of the public's health.
While one part of his proposed legislation - the restrictions on selling e-cigarettes to minors - makes sense, the other two major provisions - the e-cigarette tax and the limitation of flavors - would significantly harm the public's health by promoting cigarette smoking.
It is one thing for a state to do nothing about preventing smoking. That is completely unacceptable. But for a state to make public statements and push for legislation that would promote smoking is almost sickening to me. It really turns my stomach to think that this is what the anti-smoking movement has come to.
According to the policy brief:
"“Vaping” may not be safer than smoking traditional cigarettes."
What is the reasoning behind the governor's proclamation that smoking is no more hazardous than vaping?
"E-cigarettes emit more than water vapor."
The policy brief goes on to state that:
"Former smokers and new smokers may be attracted to e-cigarettes because of unproven claims that they are safer and more accepted than traditional cigarettes."
Governor Inslee concludes by calling for taxes on e-cigarettes and restriction of e-cigarette flavors.
The Rest of the Story
I find it despicable that a state governor is publicly asserting that cigarette smoking may not be any more hazardous than vaping, given the abudant scientific evidence that electronic cigarettes are far less damaging to health than real ones.
The governor's action is undermining decades of public education about the severe hazards of smoking. Moreover, is essentially lying to the public, since it is widely accepted by reputable scientists that vaping is less hazardous than smoking.
The governor wants some of the tax revenue from the imposition of an e-cigarette tax to go to smoking prevention programs. But what's the point of having a smoking prevention program if, out of the other side of your mouth, you are telling the public that smoking is probably not very hazardous (since vaping is almost certainly not very hazardous)?
And why would you want to put a tax on e-cigarettes when such a tax will certainly result in more smokers sticking with their deadly smoking, rather than switching to e-cigarettes and potentially saving their lives?
The stated purpose of the e-cigarette tax is to prevent e-cigarette use. But preventing e-cigarette use - among adults - is tantamount to a campaign to encourage cigarette smoking because realistically, this is the alternative for most smokers who are considering using e-cigarettes. These folks are not deciding between NRT, Chantix, Zyban, electronic cigarettes, and smoking. They are almost by definition accepting the fact that they do not believe they can quit smoking using the traditional methods. So the choice is essentially electronic cigarettes or continued smoking. Why does the governor of Washington want smokers to choose continued smoking?
The governor's actions are essentially promoting cigarette use and protecting cigarette profits at the expense of the improvement of the public's health.
While one part of his proposed legislation - the restrictions on selling e-cigarettes to minors - makes sense, the other two major provisions - the e-cigarette tax and the limitation of flavors - would significantly harm the public's health by promoting cigarette smoking.
It is one thing for a state to do nothing about preventing smoking. That is completely unacceptable. But for a state to make public statements and push for legislation that would promote smoking is almost sickening to me. It really turns my stomach to think that this is what the anti-smoking movement has come to.
Wednesday, February 18, 2015
Utah Department of Health Refuses to Acknowledge that Cigarette Smoking is Any More Hazardous than Vaping
In 2015, even the cigarette companies readily acknowledge that cigarette smoking is much more hazardous than vaping, which involves no tobacco and no combustion.
Not so for the Utah Department of Health.
In a "fact" sheet, the Department asks the question "Are e-cigarettes worse or better than regular cigarettes?" and then answers it by stating:
Not so for the Utah Department of Health.
In a "fact" sheet, the Department asks the question "Are e-cigarettes worse or better than regular cigarettes?" and then answers it by stating:
"Since e-cigarettes are not yet regulated as tobacco products, there is
very little information about the ingredients of liquids or the
approximate exposure to harmful and potentially harmful constituents
when using e-cigarettes over the short-term or long-term. While several studies found lower levels of carcinogens in the
e-cigarette aerosol compared to smoke emitted by traditional cigarettes,
both the mainstream and the secondhand e-cigarette aerosol have been
found to contain chemicals known to cause cancer, birth defects or other
reproductive harm, including acetaldehyde, formaldehyde, lead and
nicotine. Nicotine is both a highly addictive drug and a neurotoxin that can
cause nausea, vomiting, sweating, and an increased heart rate. Even
though nicotine levels in e-cigarette refill solutions are often high
enough to be fatal to small children, the FDA does not regulate e-liquid
manufacturing. Recently, Salt Lake County Health Department partnered with the Center
for Human Toxicology at the University of Utah to measure the amount of
nicotine in 153 e-liquid samples the department obtained from retailers
around the county. In the study, 61% of the e-liquid samples differed
by at least 10% from the labeled nicotine content, with discrepancies
ranging from 88% less to 840% more than stated."
The Rest of the Story
It is quite clear that the Utah Department of Health is unwilling to acknowledge that e-cigarettes are safer than real cigarettes.
The Department provides a long-winded response to the simple question of whether e-cigarettes are safer than tobacco cigarettes, but none of the response actually answers the question directly. However, the response seems to imply that it is the Department's opinion that e-cigarettes are not safer than tobacco cigarettes, and I certainly believe that most readers will interpret the answer in that way.
Why is this public health department so afraid to acknowledge the truth: that e-cigarettes are much safer than tobacco cigarettes?
I don't believe it is because the health officials are inept scientists who cannot tell the difference between nicotine and tens of thousands of chemicals and nicotine plus a couple of chemicals. Instead, I believe it is because there is a firmly entrenched ideology that anything which looks like smoking is terrible and so cannot in any way be condoned.
This is reminiscent of other harm reduction debates, where opponents cannot bring themselves to supporting a much less hazardous alternative to drug use, despite the enormous public health benefits. Perhaps the best example are opponents to the use of methadone for heroin addicts. These opponents of methadone argue that addicts are still remaining addicted to an opiate, and all opiates are hazardous. That may be true, but the use of methadone instead of heroin has been documented to have enormous public health benefits. No needle use. No spreading of AIDS, hepatitis, and other infections. No risk of thrombophlebitis, abscesses, and endocarditis. No need to commit crimes to support the drug activity.
Sadly, opponents of e-cigarettes are relying on arguments that are nearly identical to those which were used by opponents of methadone. And in both cases, I believe that the arguments are largely driven by ideology, rather than science.
Tuesday, February 17, 2015
Washington State Health Director Corrects Statement about Electronic Cigarettes; Hopefully Other Health Officials Will Show the Same Integrity
Today, I applaud Dr. John Wiesman - Secretary of the Department of Health for the state of Washington - for his immediate correction of his statement which I noted yesterday.
As I wrote yesterday, in a press release issued last week by Washington governor Jay Inslee, the state's Secretary of Health (Dr. John Wiesman) was quoted as stating that active smoking is no more hazardous than vaping. The press release quoted Dr. Wiesman as follows: "This is an urgent health concern that must be immediately addressed. Many kids believe e-cigarettes are safer, but scientific evidence suggests they are not."
Apparently, immediately after becoming aware of my critique of this statement, Dr. Wiesman corrected it. The statement now reads: "This is an urgent health concern that must be immediately addressed. Many kids believe e-cigarettes are safe, but scientific evidence suggests they are not."
By changing "safer" to "safe," the statement has been corrected because it is indeed true that electronic cigarettes are not safe in an absolute sense.
The Rest of the Story
I applaud Dr. Wiesman for his immediate response and correction. This demonstrates tremendous scientific integrity, and I greatly respect him for that.
Anyone can make mistakes (I have made plenty), but a willingness to correct such mistakes is what is most important.
Now, I hope that the other anti-smoking and health groups which have made false or misleading statements about electronic cigarettes will correct those statements. Unfortunately, this is unlikely to occur, as while Dr. Wiesman merely made a mistake, the misleading statements by many other health groups are part of a deliberate campaign to demonize e-cigarettes.
As I wrote yesterday, in a press release issued last week by Washington governor Jay Inslee, the state's Secretary of Health (Dr. John Wiesman) was quoted as stating that active smoking is no more hazardous than vaping. The press release quoted Dr. Wiesman as follows: "This is an urgent health concern that must be immediately addressed. Many kids believe e-cigarettes are safer, but scientific evidence suggests they are not."
Apparently, immediately after becoming aware of my critique of this statement, Dr. Wiesman corrected it. The statement now reads: "This is an urgent health concern that must be immediately addressed. Many kids believe e-cigarettes are safe, but scientific evidence suggests they are not."
By changing "safer" to "safe," the statement has been corrected because it is indeed true that electronic cigarettes are not safe in an absolute sense.
The Rest of the Story
I applaud Dr. Wiesman for his immediate response and correction. This demonstrates tremendous scientific integrity, and I greatly respect him for that.
Anyone can make mistakes (I have made plenty), but a willingness to correct such mistakes is what is most important.
Now, I hope that the other anti-smoking and health groups which have made false or misleading statements about electronic cigarettes will correct those statements. Unfortunately, this is unlikely to occur, as while Dr. Wiesman merely made a mistake, the misleading statements by many other health groups are part of a deliberate campaign to demonize e-cigarettes.
Monday, February 16, 2015
Washington State Director of Health Claims that Smoking is No More Hazardous than Using Electronic Cigarettes
In a press release issued last week by Washington governor Jay Inslee, the state's Secretary of Health (Dr. John Wiesman) is quoted as stating that active smoking is no more hazardous than vaping.
The press release quotes Dr. Wiesman as follows:
"This is an urgent health concern that must be immediately addressed. Many kids believe e-cigarettes are safer, but scientific evidence suggests they are not."
The Rest of the Story
What exactly is the evidence suggesting that e-cigarettes are no safer than tobacco cigarettes?
It doesn't exist.
There is no such evidence, and even the tobacco companies do not claim that their cigarettes are just as safe as e-cigarettes. In fact, should such a company make such a claim, they would be immediately attacked by anti-smoking groups. But ironically, when a health official makes precisely the same claim, the major anti-smoking groups are silent.
Not only is this statement wrong, but it is damaging to the public's health. By convincing smokers that their smoking is no worse than vaping, it discourages many smokers from using e-cigarettes to quit smoking. It also leads ex-smokers who quit via e-cigarettes to revert back to smoking. After all, what's the point of remaining on e-cigarettes instead of real cigarettes if the e-cigarettes are just as hazardous?
For the life of me, I cannot remember a time when day after day, public health official after public health official lies to the public, undermines decades of education about the hazards of smoking, discourages smokers from quitting, and does profound public health damage. And all because of narrow adherence to an ill-advised but deeply entrenched ideology.
The press release quotes Dr. Wiesman as follows:
"This is an urgent health concern that must be immediately addressed. Many kids believe e-cigarettes are safer, but scientific evidence suggests they are not."
The Rest of the Story
What exactly is the evidence suggesting that e-cigarettes are no safer than tobacco cigarettes?
It doesn't exist.
There is no such evidence, and even the tobacco companies do not claim that their cigarettes are just as safe as e-cigarettes. In fact, should such a company make such a claim, they would be immediately attacked by anti-smoking groups. But ironically, when a health official makes precisely the same claim, the major anti-smoking groups are silent.
Not only is this statement wrong, but it is damaging to the public's health. By convincing smokers that their smoking is no worse than vaping, it discourages many smokers from using e-cigarettes to quit smoking. It also leads ex-smokers who quit via e-cigarettes to revert back to smoking. After all, what's the point of remaining on e-cigarettes instead of real cigarettes if the e-cigarettes are just as hazardous?
For the life of me, I cannot remember a time when day after day, public health official after public health official lies to the public, undermines decades of education about the hazards of smoking, discourages smokers from quitting, and does profound public health damage. And all because of narrow adherence to an ill-advised but deeply entrenched ideology.
Thursday, February 12, 2015
Oregon Physician Calls for Ban on Electronic Cigarettes, But Not On the Real Ones
In one of the most irresponsible and ill-advised recommendations I have heard from a physician in a few days, an Oregon physician has called for a complete ban on the sale of electronic cigarettes in Multnomah County.
The County Board is currently considering an ordinance that would ban the sale of electronic cigarettes to minors, but to this physician, that is not enough. He would like to see a ban on the sale of electronic cigarettes to anyone.
His reason:
"We are responsible citizens who want to see an addictive product with no known benefits and a host of potentially dangerous hazards kept off the market until we see proof that it won't hurt children."
The Rest of the Story
Curiously, nowhere in his commentary does this physician call for a similar ban on tobacco cigarettes, despite the fact that we have documentation of a host of dangerous hazards that smoking causes, including severe effects on children.
Why the special treatment for cigarettes, which kill hundreds of thousands of people each year in the U.S., over e-cigarettes, which so far have killed an estimated zero people in the U.S.?
The author suggests that the only purpose of e-cigarettes is to make money by generating new nicotine addicts and relieving withdrawal symptoms in existing addicts. But if that's the case, then why is he not calling for nicotine patches to be taken off the market, since their purpose is to make money for pharmaceutical companies by relieving withdrawal symptoms in existing addicts?
The author fails to realize, or to acknowledge, that electronic cigarettes have an amazing public health benefit: they help smokers quit. In addition, they help many smokers cut down on the amount they smoke and they reduce the level of addiction to smoking and nicotine.
Nor does the author provide any evidence that e-cigarettes create new nicotine addicts. There is currently no evidence that this is the case.
In a bizarre twist, the anti-smoking movement appears to be totally pre-occupied with demonizing electronic cigarettes and to have lost its focus on the actual product that is killing hundreds of thousands of Americans each year: the damn real ones.
The County Board is currently considering an ordinance that would ban the sale of electronic cigarettes to minors, but to this physician, that is not enough. He would like to see a ban on the sale of electronic cigarettes to anyone.
His reason:
"We are responsible citizens who want to see an addictive product with no known benefits and a host of potentially dangerous hazards kept off the market until we see proof that it won't hurt children."
The Rest of the Story
Curiously, nowhere in his commentary does this physician call for a similar ban on tobacco cigarettes, despite the fact that we have documentation of a host of dangerous hazards that smoking causes, including severe effects on children.
Why the special treatment for cigarettes, which kill hundreds of thousands of people each year in the U.S., over e-cigarettes, which so far have killed an estimated zero people in the U.S.?
The author suggests that the only purpose of e-cigarettes is to make money by generating new nicotine addicts and relieving withdrawal symptoms in existing addicts. But if that's the case, then why is he not calling for nicotine patches to be taken off the market, since their purpose is to make money for pharmaceutical companies by relieving withdrawal symptoms in existing addicts?
The author fails to realize, or to acknowledge, that electronic cigarettes have an amazing public health benefit: they help smokers quit. In addition, they help many smokers cut down on the amount they smoke and they reduce the level of addiction to smoking and nicotine.
Nor does the author provide any evidence that e-cigarettes create new nicotine addicts. There is currently no evidence that this is the case.
In a bizarre twist, the anti-smoking movement appears to be totally pre-occupied with demonizing electronic cigarettes and to have lost its focus on the actual product that is killing hundreds of thousands of Americans each year: the damn real ones.
Tuesday, February 10, 2015
Anti-Smoking Groups Doing More Harm than Good on E-Cigarettes: The Insanity Has to End
In one of the most ironic twists in my 30-year career in tobacco control, the anti-smoking movement is doing more to harm the public's health than to protect it with respect to its position and actions on electronic cigarettes. What started as an exponentially increasing trend of dramatically rising quit attempts, successful quitting, and substantial cutting down due to e-cigarettes has now plateaued and may even be starting to decline, thanks to the inane actions of anti-smoking groups, which have successfully scared the public about e-cigarettes, so much so that they have convinced huge numbers of smokers that vaping is just as hazardous as smoking. The end result? A huge increase in the number of smokers compared to what we would have seen in the absence of the misleading and sometimes dishonest public health campaign against electronic cigarettes.
When electronic cigarettes first came onto the U.S market in about 2007, I, too, was skeptical. I assumed, incorrectly, that this was a new tobacco industry ploy to hook smokers, under the guise of being a safer product. I thought it was the low-tar scam all over again. However, I was willing to change my mind in response to scientific evidence, and as I learned more about the product, talked to many vapers, conducted initial research, and reviewed the burgeoning body of research on the topic, I came to realize that this was not a repeated of past tobacco industry ploys. In fact, until 2012, the tobacco industry had nothing to do with the promotion or sale of electronic cigarettes. Instead, these were bona fide products whose companies' value proposition was that they wanted to make combustible cigarettes obsolete. The entrance of Big Tobacco into the e-cigarette market has changed things, but not enough to challenge the basic ideas that electronic cigarettes are a threat to continued success of combustible tobacco products and that the greater shift in nicotine use from cigarettes to e-cigarettes, the greater the degree of improvement in the public's health.
Many anti-smoking advocates rightly pointed out that we must consider and weigh the costs and benefits of e-cigarettes. However, over the past three years, adequate research has been conducted to indicate that while the benefits of electronic cigarettes are immense, there are very few known costs. These products are not acting as a gateway to smoking among youth, they are not particularly addictive among youth, and they may even be serving as a deterrent to youth who might otherwise become addicted to cigarette smoking. Nor are these products enticing ex-smokers to return to nicotine use and then back to cigarette smoking. And finally, there is no evidence that e-cigarettes are hindering the quitting process for smokers who - if not for e-cigarettes - would have quit completely.
So we are left with a situation where the existing evidence all points in the direction that e-cigarettes are indeed a gateway. They are a one-way gateway away from combustible cigarettes and toward a much safer alternative product that is literally saving thousands of lives.
Are electronic cigarettes safe? Of course not. If they were absolutely safe, this wouldn't be a debate. By definition, harm reduction involves an alternative product that is much safer, but not safe in absolute terms. But e-cigarettes don't need to be absolutely safe. They need to be orders of magnitude safer than cigarettes, and it appears that they most likely are.
There are legitimate concerns about electronic cigarettes that need to be addressed. But none of the anti-smoking groups are actually working toward such ends. What is needed is simple: the FDA should set uniform safety standards for all e-cigarettes and vaping products. These standards should include things like leafproof containers, childproof packaging, no sale or marketing to minors, adequate warning labels and instructions to keep away from infants and children, battery safety, quality control standards for nicotine labeling and for production of e-liquids, modest regulation of flavorings (such as a ban on diacetyl), and regulation of the coil temperature to prevent overheating of the e-liquid.
Instead of working toward these much-needed regulations, which go far to allow the benefits of e-cigarettes to unfold while minimizing the risks, the anti-smoking movement has instead been demonizing these products, using a widespread campaign of cherry picking, misrepresenting scientific evidence, deception and sometimes outright lying. The campaign was worked. Huge numbers of smokers have been convinced (wrongly) that vaping is actually no safer than smoking. This has resulted in large numbers of smokers eschewing the opportunity to quit smoking using e-cigarettes and instead, remaining stuck on tobacco cigarettes.
It has been a tremendous lost opportunity for public health. I can only hope that the insanity ends soon, so that the promise of vaping technology - or something like it - will not be wasted. This has the potential to be one of the greatest anti-smoking developments in my lifetime. I hate to see it go down the tubes because of immovable ideology. And I especially hate to see it go down the tubes because anti-smoking groups are misleading and lying to the public.
When electronic cigarettes first came onto the U.S market in about 2007, I, too, was skeptical. I assumed, incorrectly, that this was a new tobacco industry ploy to hook smokers, under the guise of being a safer product. I thought it was the low-tar scam all over again. However, I was willing to change my mind in response to scientific evidence, and as I learned more about the product, talked to many vapers, conducted initial research, and reviewed the burgeoning body of research on the topic, I came to realize that this was not a repeated of past tobacco industry ploys. In fact, until 2012, the tobacco industry had nothing to do with the promotion or sale of electronic cigarettes. Instead, these were bona fide products whose companies' value proposition was that they wanted to make combustible cigarettes obsolete. The entrance of Big Tobacco into the e-cigarette market has changed things, but not enough to challenge the basic ideas that electronic cigarettes are a threat to continued success of combustible tobacco products and that the greater shift in nicotine use from cigarettes to e-cigarettes, the greater the degree of improvement in the public's health.
Many anti-smoking advocates rightly pointed out that we must consider and weigh the costs and benefits of e-cigarettes. However, over the past three years, adequate research has been conducted to indicate that while the benefits of electronic cigarettes are immense, there are very few known costs. These products are not acting as a gateway to smoking among youth, they are not particularly addictive among youth, and they may even be serving as a deterrent to youth who might otherwise become addicted to cigarette smoking. Nor are these products enticing ex-smokers to return to nicotine use and then back to cigarette smoking. And finally, there is no evidence that e-cigarettes are hindering the quitting process for smokers who - if not for e-cigarettes - would have quit completely.
So we are left with a situation where the existing evidence all points in the direction that e-cigarettes are indeed a gateway. They are a one-way gateway away from combustible cigarettes and toward a much safer alternative product that is literally saving thousands of lives.
Are electronic cigarettes safe? Of course not. If they were absolutely safe, this wouldn't be a debate. By definition, harm reduction involves an alternative product that is much safer, but not safe in absolute terms. But e-cigarettes don't need to be absolutely safe. They need to be orders of magnitude safer than cigarettes, and it appears that they most likely are.
There are legitimate concerns about electronic cigarettes that need to be addressed. But none of the anti-smoking groups are actually working toward such ends. What is needed is simple: the FDA should set uniform safety standards for all e-cigarettes and vaping products. These standards should include things like leafproof containers, childproof packaging, no sale or marketing to minors, adequate warning labels and instructions to keep away from infants and children, battery safety, quality control standards for nicotine labeling and for production of e-liquids, modest regulation of flavorings (such as a ban on diacetyl), and regulation of the coil temperature to prevent overheating of the e-liquid.
Instead of working toward these much-needed regulations, which go far to allow the benefits of e-cigarettes to unfold while minimizing the risks, the anti-smoking movement has instead been demonizing these products, using a widespread campaign of cherry picking, misrepresenting scientific evidence, deception and sometimes outright lying. The campaign was worked. Huge numbers of smokers have been convinced (wrongly) that vaping is actually no safer than smoking. This has resulted in large numbers of smokers eschewing the opportunity to quit smoking using e-cigarettes and instead, remaining stuck on tobacco cigarettes.
It has been a tremendous lost opportunity for public health. I can only hope that the insanity ends soon, so that the promise of vaping technology - or something like it - will not be wasted. This has the potential to be one of the greatest anti-smoking developments in my lifetime. I hate to see it go down the tubes because of immovable ideology. And I especially hate to see it go down the tubes because anti-smoking groups are misleading and lying to the public.
Thursday, February 05, 2015
New Study Reports Adverse Effects of E-Cigarette Aerosol on Mouse Respiratory Epithelial Cells
A study published yesterday in PLOS ONE reports that mouse respiratory epithelial cells exposed to e-cigarette vapor showed signs of oxidative stress and inflammation and that mice exposed to e-cigarette aerosol experienced impaired pulmonary bacterial clearance.
It didn't take long for the conclusion that e-cigarettes can cause pneumonia to be disseminated across the world. For example, a WKYC news article headline told readers: "Study Links E-Cigarettes to Increased Risk of Viral Infections."
In this article, one of the study authors was quoted as stating:
"We have provided strong evidence that the liquid used in e-cigarettes, whether it contains nicotine or not, has negative effects on the airways and on the lungs. The problem is, these products aren't regulated and there are no standards to control how much nicotine or other chemicals they contain. I think e-cigarettes could prove dangerous, especially with long-term consumption."
The Rest of the Story
There's just one problem with the alarmist conclusion from the study and the alarmist headlines being spread by the media: they are inadequately supported by scientific evidence.
This study was conducted on mice, and we know that there are severe problems with extrapolating from findings in mice to clinically meaningful findings in humans.
All the study really demonstrated was something we already knew: that e-cigarette aerosol can cause respiratory irritation. We've known that for years. The question of whether that irritation could translate into clinically meaningful lung disease remains unanswered, and there certainly is no evidence at the current time to suggest that there are any clinically significant adverse lung effects, at least acutely.
In fact, the only existing clinical evidence is that switching from smoking to e-cigarettes can actually reverse one form of obstructive airways disease (i.e., asthma). That study concluded: " This small retrospective study indicates that regular use of e-cigs to substitute smoking is associated with objective and subjective improvements in asthma outcomes. Considering that e-cig use is reportedly less harmful than conventional smoking and can lead to reduced cigarette consumption with subsequent improvements in asthma outcomes, this study shows that e-cigs can be a valid option for asthmatic patients who cannot quit smoking by other methods."
The danger in extrapolating from this finding in mice to clinically meaningful effects in man is demonstrated by a nearly identical study which found that mice treated with aspirin exhibit impaired clearance of bacteria from their lungs. The study concluded: "When challenged with a sublethal inoculum [of aspirin], pretreated and immediately treated animals demonstrated significant impairments in their ability to clear viable pneumococci from the lungs; the inefficient pulmonary clearance was associated with a marked attenuation in the ability of aspirin-treated mice to recruit granulocytes and macrophages into the bronchoalveolar spaces. Survival in mice administered aspirin 6 h after pneumococcal challenge was not adversely affected; however, the pulmonary clearance and cellular response were significantly impaired. We conclude that aspirin can disrupt host defense against pneumococci by blunting the normal pulmonary inflammatory reaction to organisms deposited into the lower respiratory tract."
Based on that study, would researchers conclude that aspirin causes pneumonia in humans? Should the author of that study have warned the public that based on his findings, aspirin could be dangerous? Should the media have disseminated to the public the widespread conclusion that "Study Links Aspirin to Increased Risk of Bacterial Infections?"
Clearly, such conclusions would have been premature (and, as it turns out, wrong). Thus, the dangers of extrapolating from mice to men.
It didn't take long for the conclusion that e-cigarettes can cause pneumonia to be disseminated across the world. For example, a WKYC news article headline told readers: "Study Links E-Cigarettes to Increased Risk of Viral Infections."
In this article, one of the study authors was quoted as stating:
"We have provided strong evidence that the liquid used in e-cigarettes, whether it contains nicotine or not, has negative effects on the airways and on the lungs. The problem is, these products aren't regulated and there are no standards to control how much nicotine or other chemicals they contain. I think e-cigarettes could prove dangerous, especially with long-term consumption."
The Rest of the Story
There's just one problem with the alarmist conclusion from the study and the alarmist headlines being spread by the media: they are inadequately supported by scientific evidence.
This study was conducted on mice, and we know that there are severe problems with extrapolating from findings in mice to clinically meaningful findings in humans.
All the study really demonstrated was something we already knew: that e-cigarette aerosol can cause respiratory irritation. We've known that for years. The question of whether that irritation could translate into clinically meaningful lung disease remains unanswered, and there certainly is no evidence at the current time to suggest that there are any clinically significant adverse lung effects, at least acutely.
In fact, the only existing clinical evidence is that switching from smoking to e-cigarettes can actually reverse one form of obstructive airways disease (i.e., asthma). That study concluded: " This small retrospective study indicates that regular use of e-cigs to substitute smoking is associated with objective and subjective improvements in asthma outcomes. Considering that e-cig use is reportedly less harmful than conventional smoking and can lead to reduced cigarette consumption with subsequent improvements in asthma outcomes, this study shows that e-cigs can be a valid option for asthmatic patients who cannot quit smoking by other methods."
The danger in extrapolating from this finding in mice to clinically meaningful effects in man is demonstrated by a nearly identical study which found that mice treated with aspirin exhibit impaired clearance of bacteria from their lungs. The study concluded: "When challenged with a sublethal inoculum [of aspirin], pretreated and immediately treated animals demonstrated significant impairments in their ability to clear viable pneumococci from the lungs; the inefficient pulmonary clearance was associated with a marked attenuation in the ability of aspirin-treated mice to recruit granulocytes and macrophages into the bronchoalveolar spaces. Survival in mice administered aspirin 6 h after pneumococcal challenge was not adversely affected; however, the pulmonary clearance and cellular response were significantly impaired. We conclude that aspirin can disrupt host defense against pneumococci by blunting the normal pulmonary inflammatory reaction to organisms deposited into the lower respiratory tract."
Based on that study, would researchers conclude that aspirin causes pneumonia in humans? Should the author of that study have warned the public that based on his findings, aspirin could be dangerous? Should the media have disseminated to the public the widespread conclusion that "Study Links Aspirin to Increased Risk of Bacterial Infections?"
Clearly, such conclusions would have been premature (and, as it turns out, wrong). Thus, the dangers of extrapolating from mice to men.
Tuesday, February 03, 2015
New Study Suggests that Electronic Cigarettes are Much Less Addictive than Real Ones
A new study published this week in the journal Drug and Alcohol Dependence suggests that electronic cigarettes are far less addictive than tobacco cigarettes, and that their addiction potential is probably closer to that of nicotine gum.
(See: Etter JF, Eissenberg T. Dependence levels in users of electronic cigarettes, nicotine gums, and tobacco cigarettes. Drug and Alcohol Dependence 2015; 147:68-75.)
The researchers surveyed: "(a) 766 daily users of nicotine-containing e-cigarettes with 30 daily users of nicotine-free e-cigarettes; (b) 911 former smokers who used the e-cigarette daily with 451 former smokers who used the nicotine gum daily (but no e-cigarette); (c) 125 daily e-cigarette users who smoked daily (dual users) with two samples of daily smokers who did not use e-cigarettes."
The major findings were as follows: "Dependence ratings were slightly higher in users of nicotine-containing e-cigarettes than in users of nicotine-free e-cigarettes. In former smokers, long-term (>3 months) users of e-cigarettes were less dependent on e-cigarettes than long-term users of the nicotine gum were dependent on the gum. There were few differences in dependence ratings between short-term (≤3 months) users of gums or e-cigarettes. Dependence on e-cigarettes was generally lower in dual users than dependence on tobacco cigarettes in the two other samples of daily smokers."
The authors concluded that: "Some e-cigarette users were dependent on nicotine-containing e-cigarettes, but these products were less addictive than tobacco cigarettes. E-cigarettes may be as or less addictive than nicotine gums, which themselves are not very addictive."
The Rest of the Story
In contrast to the statements of many anti-smoking groups, which have been claiming that electronic cigarettes are as addictive as real cigarettes because they contain nicotine, the rest of the story is that electronic cigarettes do not appear to be anywhere close to cigarettes in terms of their addictive potential, and in fact, they are probably much closer to nicotine gums, which are not particularly addictive.
The primary reason for this is probably the inferior of delivery via electronic cigarettes compared to real cigarettes, a phenomenon that Dr. Eissenberg demonstrated in one of his previous studies.
While use of electronic cigarettes by youth remains an important concern, it does not appear that there is major potential for huge numbers of youth to become quickly addicted to these products, despite the fact that they contain nicotine. Even among formers smokers who "relapse" to nicotine use by using e-cigarettes, their level of dependence on electronic cigarettes appears to be less that the level of dependence that nicotine gum users display for the gum.
Interestingly, users of nicotine-containing e-cigarettes were only slightly more dependent than users of nicotine-free e-cigarettes, suggesting that the nicotine in e-cigarettes is not powerfully addictive as it is in cigarettes.
Let's face it. The cigarette companies have perfected the method to most efficiently and consistently deliver nicotine to the user in a way that maximizes addictive potential. The e-cigarette cannot come close. And it is not designed to come close. A huge part of the action of the e-cigarette is the simulation of smoking. The delivery of nicotine is only one component of the effectiveness of these products. In fact, in the clinical trial by Bullen et al., electronic cigarettes were not substantially different in their effectiveness whether they delivered nicotine or not.
This study should help allay the fears of electronic cigarette opponents who are claiming that huge populations of youth are going to quickly become addicted to nicotine via electronic cigarettes and then transition to active smoking. This does not appear to be the case, based either on conceptual grounds or actual observation.
(See: Etter JF, Eissenberg T. Dependence levels in users of electronic cigarettes, nicotine gums, and tobacco cigarettes. Drug and Alcohol Dependence 2015; 147:68-75.)
The researchers surveyed: "(a) 766 daily users of nicotine-containing e-cigarettes with 30 daily users of nicotine-free e-cigarettes; (b) 911 former smokers who used the e-cigarette daily with 451 former smokers who used the nicotine gum daily (but no e-cigarette); (c) 125 daily e-cigarette users who smoked daily (dual users) with two samples of daily smokers who did not use e-cigarettes."
The major findings were as follows: "Dependence ratings were slightly higher in users of nicotine-containing e-cigarettes than in users of nicotine-free e-cigarettes. In former smokers, long-term (>3 months) users of e-cigarettes were less dependent on e-cigarettes than long-term users of the nicotine gum were dependent on the gum. There were few differences in dependence ratings between short-term (≤3 months) users of gums or e-cigarettes. Dependence on e-cigarettes was generally lower in dual users than dependence on tobacco cigarettes in the two other samples of daily smokers."
The authors concluded that: "Some e-cigarette users were dependent on nicotine-containing e-cigarettes, but these products were less addictive than tobacco cigarettes. E-cigarettes may be as or less addictive than nicotine gums, which themselves are not very addictive."
The Rest of the Story
In contrast to the statements of many anti-smoking groups, which have been claiming that electronic cigarettes are as addictive as real cigarettes because they contain nicotine, the rest of the story is that electronic cigarettes do not appear to be anywhere close to cigarettes in terms of their addictive potential, and in fact, they are probably much closer to nicotine gums, which are not particularly addictive.
The primary reason for this is probably the inferior of delivery via electronic cigarettes compared to real cigarettes, a phenomenon that Dr. Eissenberg demonstrated in one of his previous studies.
While use of electronic cigarettes by youth remains an important concern, it does not appear that there is major potential for huge numbers of youth to become quickly addicted to these products, despite the fact that they contain nicotine. Even among formers smokers who "relapse" to nicotine use by using e-cigarettes, their level of dependence on electronic cigarettes appears to be less that the level of dependence that nicotine gum users display for the gum.
Interestingly, users of nicotine-containing e-cigarettes were only slightly more dependent than users of nicotine-free e-cigarettes, suggesting that the nicotine in e-cigarettes is not powerfully addictive as it is in cigarettes.
Let's face it. The cigarette companies have perfected the method to most efficiently and consistently deliver nicotine to the user in a way that maximizes addictive potential. The e-cigarette cannot come close. And it is not designed to come close. A huge part of the action of the e-cigarette is the simulation of smoking. The delivery of nicotine is only one component of the effectiveness of these products. In fact, in the clinical trial by Bullen et al., electronic cigarettes were not substantially different in their effectiveness whether they delivered nicotine or not.
This study should help allay the fears of electronic cigarette opponents who are claiming that huge populations of youth are going to quickly become addicted to nicotine via electronic cigarettes and then transition to active smoking. This does not appear to be the case, based either on conceptual grounds or actual observation.
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