Thursday, September 10, 2015

Why are Anti-Smoking Groups and Agencies Lying to the Public About E-Cigarettes: A Political History Explanation

For the past 5 years, I have been trying to figure out why anti-smoking groups are so opposed to electronic cigarettes and why they have gone so far as to spread hysterical and false propaganda about the health and safety issues regarding vaping and smoking (and especially about the relative risks between the two). Up until now, the most compelling explanation I could come up with is that the anti-smoking movement is largely blinded by ideology, which prevents it from objectively analyzing the actual scientific evidence. This ideology has led to a pre-determined conclusion and all evidence is interpreted to support this conclusion, even if the facts need to be manipulated to conform with the entrenched ideology.

I still believe that this is at least a partially valid explanation for the campaign of lies and deception being waged by so many anti-smoking groups and agencies. However, after reading a new book by Andrew Burt (Fellow at Yale Law School) entitled "American Hysteria," I now have another possible explanation for the anti-smoking movement's behavior.

The Rest of the Story

In the book, Burt characterizes and analyzes the recurrent episodes of political hysteria that have occurred in the United States, such as the Red Scare of 1920 and McCarthyism, attempting to describe their defining characteristics as well as to find an explanation for the origins of these episodes. Ultimately, Burt comes to the conclusion that episodes of political hysteria occur when groups that previously enjoyed status experience a loss of their prestige. Usually, this loss of prestige occurs because of a philosophical, cultural, or ideological threat. But because this threat is intangible and abstract, that is, it cannot actually be seen, the groups project real threats onto these symbolic threats to create "a physical stand-in to symbolize the harm its constituency is actually confronting" (Burt, 2015, pg. 16). Because these threats are contrived and not based on evidence or truth, the movement is overcome by political hysteria.

How does this relate to the anti-smoking movement and its political hysteria regarding electronic cigarettes?

I believe that the advent of electronic cigarettes presents a threat to the status of the tobacco control movement in four ways.

First, the concept of using a cigarette-like device that delivers nicotine without using or burning tobacco as a smoking cessation strategy came from outside the tobacco control movement. We did not think of it. We did not develop it. It was essentially thrust upon us suddenly and without warning. And it is precisely because the strategy appeared to be so successful, with exponential growth of the market, that we felt threatened. It is because this technology has the potential to completely transform the nicotine market by producing drastic reductions in combustible tobacco use and an unprecedented improvement in the public's health that we feel a threat to our status. After all, we have been working for decades to reduce smoking and now suddenly outsiders come along and develop a new strategy that appears to be more effective, or at least as effective, as the strategies that we developed.

To make matters worse, this new strategy was developed and implemented by corporate entities -- entities outside of the pharmaceutical field. The tobacco control movement has long been tied to pharmaceutical companies and their cessation products. The financial relationships and partnerships run deep. The concept of using drugs that affect nicotine receptors is one that was conceived of by our movement and which was then developed in collaboration with the pharmaceutical industry. However, the electronic cigarette companies came out of nowhere. They had nothing to do with us. So neither the idea itself or the entities that were promoting and developing the strategy were part of our movement.

I firmly believe that if the idea of an electronic cigarette was conceived by individuals, researchers, or groups within the tobacco control movement, our reaction to these products would be completely different. It would not represent a threat to our status and prestige because we could claim credit for the "victory," for the accomplishment, for the transformation of the tobacco industry, for the unprecedented magnitude of the saving of lives. Even if the idea were conceived and developed by the pharmaceutical industry, it would not have represented a threat to us because pharmaceutical companies and products are a part of the entrenched and accepted system.

Second, electronic cigarettes represent a philosophical and ideological threat to the tobacco control movement because they involve a strategy in which a behavior which looks like smoking is embraced as a method of quitting smoking. This is completely beyond the mindset of 95% of tobacco control practitioners, researchers, and organizations. It is not even conceivable. Thus, it represents a severe threat to us from a philosophical and ideological standpoint.

I firmly believe that if "vaping" involved a behavior that did not look like smoking, it would have been received quite differently by the tobacco control movement. For example, if it involved some sort of inhaler-type device, I don't think anti-smoking groups would have so vehemently demonized the idea. Certainly, when nicotine inhalers were found to deliver tobacco-specific nitrosamines, we didn't hear a peep from any anti-smoking group about the potential risks of these devices. But when electronic cigarette aerosol was found to contain tobacco-specific nitrosamines at exactly the same concentration, anti-smoking groups hysterically informed the public that these devices were full of carcinogens, with some groups going as far as telling the public that e-cigarettes can cause cancer.

Third, electronic cigarettes also represent a philosophical and ideological threat to the tobacco control movement because they involve a harm reduction rather than an abstinence approach. Furthermore, the strategy involves continuing the use of an addictive substance. Neither of these concepts are within the ideological framework of the tobacco control movement. These ideas represent a severe threat to our "grand design." Our blueprint only has room for complete abstinence from nicotine use and complete elimination of addiction. When combined with an activity that looks like smoking and was developed by outsiders, the threat becomes intolerable.

Finally, electronic cigarettes also represent a philosophical and ideological threat to the tobacco control movement because they challenge the entrenched principle that nicotine is the sine qua non of smoking addiction. In fact, the tobacco control movement almost never refers to "smoking addiction." We almost always refer to "nicotine addiction." Nicotine itself, rather than morbidity and mortality, has become the villain. All of our beloved smoking cessation drugs are based on the theory that if nicotine withdrawal can be addressed, smokers will quit.

The truth, however, is that smoking addiction involves far more than simply the delivery of nicotine. Every smoker will tell you that there are other aspects of the addiction which are equally important. These include behavioral, psychological, and social factors, such as the feel of the cigarette, the oral sensation, the throat hit, the behavioral associations with smoking a cigarette, and the social aspects of smoking in groups or being identified as a smoker.

Ironically, the reasons for the widespread success of electronic cigarettes is precisely that they violate the entrenched anti-tobacco movement's philosophy, which has led to smoking cessation strategies with dismal effectiveness. Our "accepted" therapies work only about 10% of the time. By challenging the principles that abstinence and freedom from addiction are paramount, that a behavior which looks like smoking could improve the health of smokers, and that nicotine is the sine qua non of smoking addiction, the developers of e-cigarettes were able to create a product which overcomes the major limitations of existing cessation products. For once, we have a product that addresses both the physiological and behavioral/psychological/social aspects of smoking addiction. For once, we have a product that allows smokers to quit smoking without having to give up smoking "behavior." For once, we have a product that allows smokers first to quit smoking and then to work on eliminating their addiction to nicotine, but to do so under conditions of relatively low risk.

The tobacco control movement has responded to these threats exactly as Burt describes. Instead of addressing the actual perceived threat (the challenge to our prestige and to our ideology), we have created a symbolic threat (the ideas that every youth is going to try electronic cigarettes, become addicted, and progress to cigarette smoking, the idea that e-cigarettes will normalize smoking, the idea that e-cigarettes are significantly harmful and not necessarily safer than cigarettes, and the idea that e-cigarettes actually inhibit quitting) that has been taken to hysterical extremes (such as the claims that vaping is as hazardous as smoking, that vaping is as addictive as smoking, that e-cigarettes are a gateway to smoking, etc.). These claims are being made either without any evidence or with evidence to the contrary. And because of the severity of the threat, the truth no longer matters. As is typical with political hysteria, we are so threatened, our philosophical underpinnings so challenged, our prestige so undermined, that we have resorted to lying, deception, and the misrepresentation and misinterpretation of scientific evidence.

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