Over the past two months, San Francisco’s City Attorney Dennis Herrera has attacked anti-vaccine doctors and e-cigarette sales. In doing so, Herrera has replaced one fake fear with another and will endanger more lives than any anti-vaxxer could.
In the wake of an outbreak of measles in Europe and America, elected officials have sought to stop the spread of anti-vaccination fearmongering responsible for the recent measles outbreaks. News outlets, advocates, medical societies, and social media platforms – where the myth that vaccines are both ineffective and dangerous incubate and go viral – are rolling out campaigns to counter myths about the benefits and particularly the dangers of immunization.
The campaign to combat vaccine disinformation is important. Vaccines are effective because they block or prevent underlying causes of infectious diseases. Each year 95 percent of most vaccine-preventable diseases including cancer-causing infections are stopped each year. In the US alone that’s about 20 million illnesses; 40,000 deaths costing about $70 billion annually. That is why the World Health Organization cited the reluctance to vaccinate one of the ten leading sources of disease and why public health experts regard the spread of scientific misinformation on social media as a global public-health threat.
However, for all the harm anti-vaccination fabrications have had on public health, a more recent campaign of medical disinformation about the dangers of e-cigarettes is likely to be more damaging by far.
The US Centers for Disease Control and Prevention (CDC) notes “nearly half a million Americans die prematurely of smoking or exposure to secondhand smoke. (That’s about one of every 5 deaths.) Another 16 million live with a serious illness caused by smoking. Smoking-related illness in the United States costs more than $300 billion each year in health care spending and lost productivity.”
E-cigarettes, while not a cure for nicotine dependence, can help reduce the death and disease caused by combustible tobacco. Public Health England (PHE), the United States equivalent of the CDC, concluded best estimates show e-cigarettes are 95% less harmful to your health than normal cigarettes, and when supported by a smoking cessation service, help most smokers to quit tobacco altogether. The most recent studies show that e-cigarettes are more effective in reducing smoking than any other device or approach., and yet almost two thirds of Americans believe vaping is deadlier than cigarette smoking. This is no accident. Just as the anti-vaccine zealots have turned vaccine hesitancy into one of the World Health Organization’s top global health challenges, anti-vaping groups such as the Truth Initiative and Campaign for Tobacco Free Kids have spread warnings about the hidden dangers of e-cigarettes to reduce consumption and spread uncertainty.
The two movements are alike in many other ways. Anti-vaxxers want to reduce use of vaccines because they claim it benefits the public health and yet have no problem holding measles or chicken pox parties to provide their kids “natural immunity.” Anti-vapers want to ban e-cigarettes while leaving cigarettes and other tobacco products on the market.
The fact San Francisco’s Herrera wants to prohibit both retail and on-line sales of e-cigarettes while doing nothing about tobacco is an artifact of the anti-vaping movement’s application of the precautionary principle: the belief that no new technology should be used and, in fact, should be considered deadly unless every possible safety risk, no matter how unfounded, is addressed. Both anti-vaxxers and anti-vapers invoke the precautionary principle to establish themselves as saviors of the public health. Both sow fear and confusion about dangers using pseudo science to divert attention from the established benefits of products. And perhaps most important, both legitimize fear mongering through the willful spread of bad science by people with medical credentials stoking overblown or unfounded fears.
The most common ploy is identifying a toxic chemical in a product and claiming it is associated with a higher risk of disease and death. Both movements deploy the “linear no-threshold hypothesis” which presumes that toxic “causation is a linear process, meaning that there is no safe dose and that damage occurs at a constant rate as exposure increases.”
For example, anti-vaxxers claims that trace amounts of formaldehyde in vaccines increase the risk of cancer have been ridiculed and debunked. And rightfully so. As vaccine safety expert and immunologist Paul Offit notes, “quantities of formaldehyde at least 600 times greater than the amount contained in vaccines have been fed safely to animals in drinking water.”
That hasn’t stopped scientists from trying the same trick to scare people about vaping. An article in the New England Journal of Medicine entitled Hidden Formaldehyde in E-cigarette Aerosols asserts that“high-voltage e-cigarettes have greater exposure to formaldehyde, a suspected carcinogen, than those who keep the voltage low.” The publication ignores the fact that the overall health risk of conventional cigarettes, which contain 7,000 toxins in addition to formaldehyde, is far greater than any formaldehyde risk associated with e-cigarettes or that the levels of formaldehyde are also non-detectable.
Similarly, an article entitled “Association Between E-Cigarette Use and Myocardial Infarction” claims e-cigarettes “double risk of heart attack.” Yet, the study showed no such relationship. Instead, it looked at the heart attack rate of people who switched from smoking to vaping, regardless of whether the heart attack occurred before taking up e-cigarettes and concluded that the increased risk of heart attack is due to e-cigarette use.
None of this is to suggest that e-cigarettes are 100 percent safe. Rather, it is to demonstrate that many in the scientific community are affirming the precautionary principle by conducting research designed explicitly to scare the public from using a product that, relative to smoking, does less harm to our health. Epidemiological studies clearly show that the use of other nicotine replacement products such as patches and gum dramatically decrease their risk of heart attack rather quickly. In fact, real world evidence suggests that NRT should be used by people who smoked immediately after a heart attack.
Further, several randomized studies have shown that biomarkers predicting risk of heart attacks and lung disease decline when people switch to e-cigarettes. Indeed, this real-world evidence demonstrates up to a 98 percent reduction in disease-related toxins found in tobacco smoke. “In many cases, this was to the same extent as that seen when they quit smoking completely. “
Finally, critics also claim that the surge in vaping among teenagers is an epidemic. However, surveys show that rapid increase in vaping between 2014-2018 occurred as adolescent use of all combustible tobacco products dramatically declined. This doesn’t mean e-cigarettes should be sold to minors. It does mean a more nuanced approach to nicotine addiction is required. Adolescents, particularly those who suffer from a cognitive deficit or mental illness are more likely to become dependent on nicotine than other age group. Ironically, kids may be self-medicating with nicotine to enhance cognitive and attentional processes...” and are getting addicted through the same pathways also simultaneously improve cognition.
In this context, testing and developing a product that can reduce nicotine craving or withdrawal symptoms associated with quitting smoking would help such kids in particular. Underage use of any nicotine product should therefore be dealt with as a separate public health issue, one in which vaping is considered and evaluated as a harm-reduction technology relative to truly lethal forms of tobacco consumption. Yet the anti-vapers do not want e-cigarettes to be available especially if they reduce the risk of using a combustible tobacco product.
Indeed, the anti-vapers want to make it illegal for e-cigarette companies which encourage consumers to switch from tobacco to an electronic nicotine delivery system. In marketing its product, JUUL is telling people, as did former FDA commissioner Scott Gottlieb that quitting smoking can lower a person’s chances of having lung disease, heart disease or getting certain types of cancer.” Incredibly, the coalition wants the FDA to stop JUUL from saying this in their ad and from offering a program to help smokers switch from combustible cigarettes to e-cigarettes.
Smoking takes a bigger toll on human life and well-being than any other habit. Indeed a goal of the fear mongering is to distract public attention from the fact that eliminating any product that reduces tobacco related risk will cause more death and suffering, not less. Never mind that e-cigarettes have fewer and lower levels of toxins that cause tobacco disease or that such devices are at least twice as effective in reducing smoking compared to other products and programs designed to achieve the same goal. And never mind that wiping out JUUL and other products would likely lead to more smoking just as reducing immunization levels has led to outbreaks of measles, whooping cough, and even polio.
The fact is, the anti-vaping zealots regard increased use of tobacco products as an acceptable consequence of their campaign. Which is why debunking their junk science and standing up to their fear mongering is critical. The zealot’s success would make them the biggest boosters of tobacco use on the planet and a bigger threat to human health than the anti-vaccine movement or smoking itself. And San Francisco will be leading the way.
Robert Goldberg is vice president at the Center for Medicine in the Public Interest.