Like millions of other Americans, I was hooked. I knew I needed to quit smoking, but I just couldn’t give up cigarettes.
I tried everything: nicotine gum, patches, medication, even cold turkey. None of it worked, and I feared I was destined to keep smoking until it killed me.
But my smoking-cessation failures came to an unexpected end when I discovered e-cigarettes, more commonly called “vapes” today. And after years as a pack-a-day-smoker, I was done with cigarettes forever.
I’m certain that vaping saved my life. And since saving lives is what America’s public-health establishment exists to do, I was sure that they would avidly endorse the technology. Sadly, and inexplicably, I was wrong.
Even as the evidence in support of vaping as a smoking-cessation tool has grown stronger, tobacco-control advocates have become more hostile to it. The result is that many Americans who could give up combustible tobacco instead continue to smoke, and face the deadly consequences of that decision.
The science-based case for vaping
We know two big things about vaping based on the extensive evidence in the public record. First, it is probably 95 percent saferthan smoking, according to independent experts at Public Health England. This is because the aerosolized nicotine produced by vaping devices contains almost none of the harmful chemicals found in tobacco smoke. Critically, there is no evidencethat nicotine, the chemical vaping is designed to deliver, causes any of the diseases typically associated with cigarette smoking.
Second, vaping helps people quit cigarettes. Countless ex-smokers have a story just like mine. If you review any of these 13,500 accountsfrom former smokers, certain commonalities will begin to stand out. “Marlboro menthol was my fav cig for over 20 years!” a woman named Carolina explained. “In July 2018 I decided to invest in a vape because [cigarettes] were too costly … It’s been 4 years now and I have not tried … one cigarette.”
Scientific evidence confirms these anecdotes. The UK’s National Health Service reports that “About two thirds of people who use a vape along with expert support successfully quit smoking.” More than 50,000 peoplein England have quit thanks to vaping. In France, the number of ex-smokers who credit vaping for their success reaches a staggering700,000. Research shows thateven smokers with no plans to quit often stop once they try vaping.
A recent systematic review and meta-analysis performed by the highly regarded Cochrane Collaborationconfirmed that these numbers aren’t incidental. The Cochrane team evaluated 78 studies involving just over 22,000 people, concluding that “There is high‐certainty evidence that ECs [electronic cigarettes] with nicotine increase quit rates compared to NRT [nicotine replacement therapy].”
These results were bolstered the same month by another studyconducted in France, which found that vaping was “significantly associated” with smoking abstinence at six, 12 and 24 months. In contrast, the study concluded that “NRT use does not appear to help sustainable abstinence in the long term,” and that its lifetime efficacy as a quit-smoking aid may have been overestimated by 30 percent.
Vaping denialism
The fact that so many people quit cigarettes by switching to vaping is a major public health victory. Tobacco-control advocates must be promoting vaping from the rooftops, right? Not exactly. If you Google “vaping,” one of the first results you’ll find is this article from Johns Hopkins School of Medicine:
“Although they’ve been promoted as an aid to help you quit smoking, e-cigarettes have not received Food and Drug Administration approval as smoking cessation devices.
Similar denials of the documented benefits of vaping are widespread.“E-cigarettes should not be used to quit smoking,” the American Cancer Society states bluntly. “Despite what e-cigarette companies … want you to believe, switching to vaping (e-cigarettes) is not quitting smoking,” the American Lung Association warns. “The growing evidence of potential health risks related to e-cigarette use has led some researchers to question whether e-cigarettes are safer than combustible cigarettes,” The Truth Initiative boldly asserts.
But look for this “growing evidence of potential health risks related to e-cigarette use” and you will find—almost nothing. There are news stories filled with vague anecdotes and retracted studies that try to associate the harms of smoking with e-cigarettes. These are the characteristics of so many moral panics throughout history, not the rigorous scientific analysis we expect from public health experts.
I struggled to understand why such seemingly reputable institutions, most of them staffed by experts on tobacco science, would take a position so blatantly at odds with the growing scientific consensus on the benefits of vaping. The unsettling answer is politics.
After reviewing publicly available financial records (990 IRS forms, financial audits, and grants databases) from 2017 to present, the American Vapor Manufacturers, of which I am vice president, discovered that these organizations receive funding from several wealthy foundations to promote critical messaging about vaping. Bloomberg Philanthropies and the Robert Wood Johnson Foundation are two of the biggest donors.
I am not an unbiased observer in this debate, so it’s important to stress that academic researchers are also concerned about the role wealthy non-profits play in shaping tobacco policy. In a PLOS Medicine article published several years ago, scientists from Harvard and the University of California, San Francisco, made this point very clearly:
“ … [T]he Robert Wood Johnson Foundation has played a leading role in promoting anti-tobacco products and maintains Smoking Cessation Leadership Centers and programs, although its endowment is mainly invested in Johnson & Johnson, a leading manufacturer of cessation products, and some board members have been represented on both the Foundation’s and the company’s boards.”
The researchers went on to explain why the financial relationship between these philanthropies and the causes they support can be so problematic: “Such investments may counter these foundations’ purposes of promoting global health.”
Thank you for smoking
We are watching what happens when warnings about conflicts of interest aren’t heeded. Policymakers at the local, state and federal levels use misleading statements from these billionaire-backed organizations as justification to restrict or ban vaping products.
30 US states have enacted taxes on vaping products. Some jurisdictions, like California, have gone further and banned flavored nicotine liquid used in vaping devices. We see this dynamic at work even in the Food and Drug Administration (FDA). The agency’s leadership recently overruled its own scientists after they concluded that a menthol-flavored vape should be approved. FDA experts said the device would help adult smokers quit without tempting teenagers to try vaping; their bosses “concluded that all menthol-flavored [vapes] should be treated disfavorably, as a category.”
These policy decisions have serious public health consequences. As a team of experts explained in December 2022, such regulations lead “to increases in combustible tobacco product use.” You read that correctly. The most influential anti-smoking advocates in the world and the officials who listen to them support policies that encourage smoking.
In 2021, a team of more than 20 independent tobacco experts wrote an open letter to Michael Bloomberg urging him to reconsider his support for anti-vaping causes, emphasizing the harmful impact they have on public health. These researchers offered to meet with him and discuss evidence “that could prompt some strategic reflection on Bloomberg Philanthropies’ approach to tobacco control.” Bloomberg declined their invitation.
What about the children?
Critics will often retort that vaping appeals to children and, therefore, restricting or banning vape sales is entirely justified. But this allegation doesn’t hold up. Teen vaping has generally been very low since e-cigarettes hit the US market. Research has found that the flavored nicotine commonly used in vapes is unappealing to non-smoking teenagers.
There was a notable exception in 2018 when 1 in 5 high school students and 1 in 20 middle school students reported trying vaping at least once in the last 30 days. Since then, US teen vaping has declined precipitously. CDC survey data has shown that it dropped 29 percent between 2019 and 2020, then another 42 percent between 2020 and 2021. Today just 4.24 percent of high school students and 0.39 percent of all middle schoolers vape daily.
Everybody agrees that teenagers shouldn’t vape. However, we can achieve that goal by enforcing laws against selling nicotine to minors, the same way we prohibit underage alcohol sales. Wiping out the entire legal market for vaping products is as unnecessary as banning fruit-flavored vodka.
Conclusion
As a tobacco harm-reduction advocate, I believe every American has the right to lead a smoke-free life. Millions of us have achieved that goal by switching to vaping and millions more could join us. Unfortunately, that success is in jeopardy thanks to the same people whose publicly avowed mission is to end the epidemic that is tobacco use.
This effort is at odds with the latest science, which is reason enough to oppose it. More importantly, however, smoking kills nearly 500,000 Americans annually, and we now have a game-changing cessation tool that could prevent many of these deaths. Why would anybody in their right mind stand in the way?
Alli Boughner – RealClear Science – 2023-01-12.
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