Tuesday, November 24, 2015

Thanks to Invalid NEJM Formaldehyde Study, Public is Being Told that Cancer Risk from Vaping is 15 Times Higher than from Smoking

According to an article published yesterday at CapeCod.com, the cancer risk from vaping is 5 to 15 times higher than the cancer risk from smoking.

The article states: "A look at the dangers of inhaling formaldehyde published in the New England Journal of Medicine earlier this year included two studies that showed that the risk of developing cancer from long-term vaping is five times as high as that of smoking a pack of regular cigarettes a day. The second study suggested the risk was 15 times higher."

This alarming statistic was echoed by a physician who was interviewed for the story. Dr. John Mendelsohn, an emergency room physician and toxicology expert at Falmouth Hospital, was quoted as stating: "Formaldehyde is present in cigarettes as well, but it’s felt that the exposure of formaldehyde in the e-cigarette compared to a regular cigarette has probably a five times greater risk of toxicity."

Indeed, the article from the New England Journal of Medicine did conclude that: "Among persons with a body weight of 70 kg, the incremental lifetime cancer risk associated with long-term cigarette smoking at 1 pack per day may then be estimated at 9×10−4. If we assume that inhaling formaldehyde-releasing agents carries the same risk per unit of formaldehyde as the risk associated with inhaling gaseous formaldehyde, then long-term vaping is associated with an incremental lifetime cancer risk of 4.2×10−3. This risk is 5 times as high (as compared with the risk based on the calculation of Miyake and Shibamoto shown in Figure 1), or even 15 times as high (as compared with the risk based on the calculation of Counts et al. shown in Figure 1) as the risk associated with long-term smoking."

My colleagues and I have already pointed out that the formaldehyde in the NEJM study was only detected during high voltage conditions and was not a problem at the low voltages typically used by electronic cigarette users. Moreover, the high voltage condition produced a phenomenon known as the "dry puff," which creates a terrible taste that would not be tolerated by the vaper. As I have previously argued: "the researchers actually argued that vaping might be 15 times worse than smoking in terms of cancer risk! Yet it turns out that their conclusion was invalid and that while e-cigarettes can produce formaldehyde under normal conditions, the levels appear to be minimal and certainly do not produce a risk that compares to that of smoking."

The Rest of the Story

This story demonstrates just how misinformation about the relative risks of smoking vs. vaping are spreading widely to the public and policy makers.

It all starts with a misrepresentation in a scientific article: in this case, the article claimed that the long-term cancer risk associated with vaping is 5 to 15 times higher than that associated with smoking one pack per day.

Then, that misinformation spreads to the media, which widely disseminate it to the public.

Next, physicians reading this misinformation incorporate it into their own beliefs on the health risks of electronic cigarettes.

They then feed back the misinformation to the media, which further disseminates the scary but inaccurate information to the public and policy makers.

It becomes a self-perpetuating, vicious cycle.

We now know that the campaign of deception being waged by anti-nicotine researchers and groups is working. The public is widely confused about the relative risks of smoking and vaping. In fact, over time, the public has become more likely to falsely believe that smoking is no more hazardous than vaping.

As Jacob Sullum has noted: "misinformation about e-cigarettes, including sensational press coverage of weak or overinterpreted studies, is warping public perceptions of the risks posed by vaping, possibly deterring smokers from making a switch that could save their lives. British surveys indicate that misperceptions have increased in recent years. A survey of adults sponsored by the British group Action on Smoking and Health—which, unlike the American group of the same name, supports e-cigarettes as an aid to quitting—found that the share of respondents who incorrectly described e-cigarettes as “more harmful” than tobacco cigarettes or “equally harmful” rose from about 8 percent in 2012 to 20 percent in 2014."

Sullum is absolutely correct that this misinformation is problematic not only because it is unethical to lie, but because the "warped" public perceptions of the risks posed by vaping compared to smoking may actually deter smokers from trying to quit using e-cigarettes and potentially save their lives. The misinformation may also cause former smokers who quit using e-cigarettes to return to smoking, since if vaping is no safer than smoking, what's the point of giving up real cigarettes?

It is high time for another "truth" campaign. This campaign, however, is necessary not to correct damage done by the historical lies of the tobacco companies, but to correct the damage done by the current lies of the tobacco control movement.

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