Physicians Continue to Make Unsupported Claims About E-Cigarettes

In an op-ed piece published in the Daily Hampshire Gazette (MA), the vice president of the Hampshire District of the Massachusetts Medical Society claims that vaping is a proven path to smoking addiction. In the piece, entitled "Vaping is proven path to tobacco addiction," she writes:

"New state regulations limiting the sale of e-cigarettes to children take effect Friday. And they come not a moment too soon. This is because of the association of “vaping” in children with their regular use of tobacco cigarettes — a link around which there is a growing consensus. ... All the data are not yet in, but it is clear from multiple studies that young people using e-cigarettes are more likely, not less, to smoke cigarettes."

The Rest of the Story

Contrary to the claims made in this article, it is not at all clear that experimentation with e-cigarettes leads young people to tobacco addiction. In fact, all of the evidence at the current time points in the other direction: it appears that e-cigarettes may actually be deterring youth from using the real thing.

In fact, a new study out of the Florida Department of Health revealed that while youth experimentation with e-cigarettes is rising rapidly, youth smoking in Florida is rapidly disappearing. Frequent smoking among high school students has dropped to just 2.5%, and among middle school students is only 0.6%.  As the article notes:

"Frequent cigarette smoking youth are now almost extinct in the state. With just 0.6 percent of middle-schoolers and 2.5 percent of high-schoolers have smoke more than 20 cigarettes in the past 30 days at the time of the survey. That's down from 5.4 percent of middle-schoolers and 13.3 percent of high-schoolers in 1998.  You might remember that Gov. Lawton Chiles won a $11 billion dollar lawsuit against the tobacco industry and used that money to launch one of the most thorough anti-smoking campaigns targeted at kids in the country back in 1998. Since then Florida's youth tobacco use has plummeted and remains well below national levels. However, in the past couple of years it appears that drops in rates of traditional cigarette smoking have more to do with the emergence of e-cigarette alternatives."

The survey results also provide evidence that e-cigarettes are not leading many youth to nicotine addiction. While 14.7% of middle school students reported having tried e-cigarettes, only 0.9% were frequent e-cigarette users. Similarly, while 37.6% of high school students reported having tried e-cigarettes, only 2.9% were frequent users. With smoking rates plummeting to historic lows in Florida, this suggests that:

(1) Electronic cigarettes are not particularly addictive (and are much less addictive than regular cigarettes); and

(2) Electronic cigarettes appear to be deterring many youth who would otherwise have chosen to become smokers.

I happen to agree with the author of this piece that state regulations which ban the sale of e-cigarettes to minors are warranted. However, I think we can support these policies with the truth. I don't feel a need to support the regulations by lying to the public about the scientific evidence or by misrepresenting the evidence.

Through the constant and persistent misrepresentation of the science, I fear that the anti-tobacco movement is going to lose its credibility and reputation. And once we lose that, we have nothing.

And so I ask: Why is the truth not enough?

The answer is clear: Because the truth does not support our position that e-cigarettes are a gateway to youth smoking addiction and that e-cigarettes are renormalizing smoking. But rather than accepting the truth, we are twisting it to conform to our pre-conceived notions. This is known in psychology as "confirmation bias."

The largest problem with confirmation bias is that it leads to poor decision-making. This is precisely what we are observing in the anti-tobacco movement, as evidenced by actions of numerous government agencies, including the CDC, FDA, and California Department of Health Services.

Perhaps the best, and most recent, example of the poor decision-making which is resulting from this confirmation bias is the recent action of doctors and health groups in South Australia, who called for a ban on the sale of e-cigarettes, but want tobacco cigarette sales to continue unencumbered.