My Response to Campaign for Tobacco-Free Kids' Article Published in The Hill

In a letter to the editor published in The Hill, I respond to an op-ed piece published a few days ago in The Hill by the Campaign for Tobacco-Free Kids. In that piece, the Campaign once again suggested that Big Tobacco is “peddl[ing] candy-flavored wares to kids.” It also argues that the current FDA e-cigarette deeming regulations are the best way to: “ensure that smokers have access to products that will actually benefit their health.”

In my letter, I take issue with the contention that the current FDA regulations are in any way helping to ensure that smokers have access to products that will benefit their health (namely, e-cigarettes) and that in fact, the regulations make it nearly impossible for e-cigarettes to enter or continue on the market. Instead, the regulations protect cigarette sales from competition by much safer tobacco-free vaping products.

The piece begins: “In his op-ed (“Congress, don’t help Big Tobacco peddle candy-flavored wares to kids,” March 26), Matthew Myers of the Campaign for Tobacco-Free Kids argues that the current FDA regulations regarding electronic cigarettes do not impede the ability of companies to put truly safer products on the market to compete with conventional tobacco cigarettes. But the opposite is true. By requiring every new product to submit burdensome and expensive applications, the regulations make it nearly impossible for companies to introduce new and safer vaping products into the market.”

You can read the rest of the letter, entitled “Why is the FDA favoring real cigarettes over fake ones?” here

NOTE: The letter mistakenly refers to the legislation as HR 1156, but the current bill number is HR 1136.

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IN MY VIEW: Campaign for Tobacco-Free Kids' Lying Has Got to Stop

In an action alert emailed today to its constituents, the Campaign for Tobacco-Free Kids insinuated that the tobacco companies are producing gummy worm electronic cigarettes. The title of the email is “Gummy worms,” and the headline of the action alert states that “tobacco companies” are “luring kids with candy-flavored e-cigarettes and cigars.”

As I’ve noted previously, this is simply not true. None of the tobacco companies is producing gummy worm-flavored electronic cigarettes.

While the Campaign for Tobacco-Free Kids has every right to fight for a ban on e-cigarette flavorings (a policy with which I vigorously disagree), it has no business lying to and deceiving its constituents in order to promote such a ban.

Telling the truth to its constituents would apparently not be glitzy enough for the Campaign. So instead, it has to lie by making the public think that Big Tobacco has sunk to the level of trying to get kids to use gummy worm-flavored nicotine products. This may be a catchy and eye-grabbing claim that succeeds in getting people riled up, opening up their pocket books, and eliciting donations, but it does so by misleading and deceiving them. That’s fundamentally dishonest and unethical, and I don’t believe a campaign like this has any place in public health.

Why is the truth not enough?

The Rest of the Story

Perhaps the reason that the truth is not enough is that the truth destroys the made-up story that the Campaign for Tobacco-Free Kids is trying to tell. Their story is that Big Tobacco is up to its old tricks, trying to seduce and addict kids to electronic cigarettes through outrageously blatant appeals to obvious youth-appealing flavors like gummy bear, gummy worm, and cotton candy. But unfortunately for the Campaign, that’s not the truth. The truth is that the largest cigarette company in the United States – Altria – produces its MarkTen XL Bold e-cigarettes in only two flavors: tobacco and menthol. And their original MarkTen e-cigarettes come in only four flavors: tobacco, menthol, fusion, and winter mint.

If Altria were truly interested in getting kids addicted to e-cigarettes, I hardly think that it would restrict itself to tobacco, menthol, fusion, and winter mint, when there are thousands of sweet-tasting, candy, fruit, and dessert flavors available that they could be marketing.

The truth just destroys the Campaign’s story. But apparently, the Campaign’s motto is “never let the truth get in the way of a great story.”

The real story is not a pretty one. The rest of the story is that the Campaign for Tobacco-Free Kids continues to incessantly deceive the public by falsely accusing tobacco companies of marketing gummy worm, gummy bear, and cotton candy electronic cigarettes to children.

Look – I have issued my fair share of accusations against the tobacco companies. I testified in about 10 cases against Big Tobacco, one of which resulted in a $145 billion verdict against the companies. But my testimony was always based on the facts. There were different ways to interpret those facts, but I would never lie or deceive the jury in order to try to make a point or embellish the case.

If we issue false accusations like this against the tobacco companies, then what reason is there for anyone to believe us when we complain about actions that they really have taken?

Perhaps this is why the actions of the Campaign for Tobacco-Free Kids are so disturbing to me. They tarnish the reputation of the entire tobacco control movement, including myself.

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UcanQuit2’s Smoking Gun

The military-focused website Ucanquit2.org is doing a fine impression of Col. Jessep from “A Few Good Men.” People, mostly military personnel and their families, who come to this website looking for accurate information about the risks of tobacco use, are treated as if they can’t handle the truth. UcanQuit2’s rigid philosophy is laid bare by the website’s strapline: “Quit Tobacco.” Contained in these two words is their absolutist position: All tobacco use is bad, and there is only the one option. There is no acknowledgment of tobacco harm reduction. Nary a hint that some forms of tobacco, like smokeless tobacco, are far less risky than smoking. Nor that a smoker who has switched exclusively to smokeless tobacco has eliminated the health risks of smoking in exchange for the dramatically lower risks of using smokeless tobacco.

UcanQuit2’s attitude is scarcely different from the hatchet-wielding saloon vandal, Carrie Nation. She thought alcohol was the problem, not the way it is consumed. UcanQuit2 thinks tobacco is the problem, not the way it is consumed. Make no mistake: UcanQuit2 is staking out an extremist position, and like all extremism, it tolerates no compromise about its singular goal, and selectively arrays only specific facts and claims to accomplish it. In other words, extremists with extreme goals must use extreme means to encourage others toward that extreme goal.

Over the past few weeks several people have taken advantage of UcanQuit2’s “live chat” feature to ask some basic questions of “tobacco cessation coaches” about tobacco use. The transcripts of these chats were forwarded to CASAA for review. David Sweanor, Brad Rodu, and Sally Satel have reported in more detail on their chat sessions here and here and here. From an inspection of these transcripts, two things became abundantly clear. 1) UcanQuit2 wants nothing short of everyone to quit tobacco in all its forms, and 2) UcanQuit2 will say anything, no matter how false or outrageous, to convince people to do so. What follows are key statements and exchanges that illustrate these two points. Tobacco cessation coaches’ statements and exchanges with visitors are in bold italic.

“Chewers are 50 times more likely than nonusers to get cancer of the cheek, gums, and inner surface of the lips.”

This hoary canard has been around since the 1980s. It’s based on a single study on a rare form of cancer found in a population of southern women, each of whom used a rare form of dry snuff, and had done so for over 50 years. This result has nothing to do whatsoever with the chewing tobacco and moist snuff that are by far the most common forms of smokeless tobacco in use today. Brad Rodu has completely debunked this myth here. Carl Phillips conducts a scientific autopsy of this idea here.

“Long-term [smokeless tobacco] users have a 50% greater risk of developing oral cancers than non-users.”

That this claim, along with the “50 times” claim above, appears on the same website and in the same chat transcripts is damning evidence that those at UcanQuit2 are not interested in citing scientific findings honestly. Apparently no one managed to spot that the first estimate is 100 times greater than the second. Which estimate is approximately correct? It turns out to be neither, as Brad Rodu explains.

“Oral tobacco contains at least 28 chemicals known to cause cancer (carcinogens). The most harmful of these are tobacco-specific nitrosamines, which are known to cause lung cancer.”

This sounds scary until you realize that nearly everything around us contains carcinogens at some measurable level. For example, coffee contains 21 carcinogens. That fact alone tells us nothing about the health risks of a particular product. What matters is the level of carcinogens present and the relationship of this level to causing disease. This claim, common to many anti-tobacco websites, simply glosses over this important follow-up analysis. If they hadn’t, they would have to report that there is no research clearly identifying any specific chemical (like nitrosamines) with a definitive link to any particular cancer (like lung cancer) in humans. UcanQuit2 is telling its visitors the intellectual equivalent that apples contain arsenic (they do), knowing the visitor will likely make a false assumption of significant risk from this out-of-context fact.   

“A: [from chewing tobacco] you can also get mouth cancer throat, and many others, yes you are still putting the toxins into your body.

Q: As bad as smoking?

A: Yes as bad and possibly worse.”

This is the full expression of UcanQuit2’s extremism writ large. If you are dogmatically against all tobacco use, then you have to claim all tobacco use poses high risks. In truth, there simply is no equivalence of risk between cigarette smoking and smokeless tobacco use. Smoking is approximately 100 times more risky. But to imply that smokeless tobacco use could possibly be worse than smoking is an egregious and dangerous lie that nudges people away from the far less risky option. It’s almost as if UcanQuit2 believes that if you cannot quit using tobacco, then they’d prefer you use the most dangerous form.

“Smokeless tobacco would be less likely [than smoking] to give you lung cancer.”

Given that the association between smokeless tobacco use and lung cancer is virtually zero, that would make eating grilled asparagus, drinking orange juice, or chewing gum also less likely to give you lung cancer compared to smoking. Mentioning smokeless tobacco in the same sentence with lung cancer, as if the risk is even measurable, is using a trivially true statement in an effort to mislead.

“Q: Do you mean that [Polonium 210; Uranium 235; Fiberglass and Sand] are added to dip and chew?

A: Yes they are.”

Finally, UcanQuit2 resorts to the absurd to sell their position. Polonium 210 and Uranium 235 are found throughout the earth, and finding them, in vanishingly small quantities, in smokeless tobacco is no surprise. The idea that manufacturers of smokeless tobacco gather and add these substances to products is simply laughable. Likewise the addition of fiberglass and sand, because, well, if one understood how smokeless tobacco works, it would be obvious that doing so serves no rational purpose.

UcanQuit2 is a fount of misleading, inflammatory, and outright false information when it comes to smokeless tobacco. It has few peers in its single-minded goal of convincing people to quit tobacco in all forms by any tactic necessary, no matter how dishonest. According to Tom Miller, the Attorney General of Iowa, if websites like UcanQuit2 were a business selling their information and advice, they would be guilty of consumer fraud.

It is quite unfortunate that service men and women, who put their lives on the line in foreign lands, should find their lives threatened here at home by ideologues pushing bad information to serve an absolutist goal to eradicate tobacco use. Our military personnel and their families deserve far better than this. They deserve to know the truth. Not only can they handle it; their lives depend on it.

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Anti-Vaping Advocates Support Indoor Vaping Bans Because We Don't Know if Secondhand Vaping is Harmful

In an interesting twist from the usual reasoning in public health, anti-vaping advocates are promoting the enactment of policies that ban vaping in public places not because secondhand vaping has been shown to have serious health hazards, but because it hasn’t been proven to be benign.

In an opinion piece published in Tobacco Control, Dr. Simon Chapman and colleagues support a ban on vaping in public places because we don’t know yet whether secondhand vaping is harmful. The authors write that: 
“those advocating for vaping to be allowed in smoke-free public places centre their case on gossamer-thin evidence that vaping emissions are all but benign and therefore pose negligible risks to others akin to inhaling steam from showers, kettles or saunas. This is likely to be baseless. Unlike vapourised water, electronic nicotine delivery system (ENDS) emissions comprise nicotine, carbonyls, metals, organic volatile compounds, besides particulate matter, and putative carcinogenic polycyclic aromatic hydrocarbon. … Importantly, the short time span since the advent of ENDS and the latency of candidate respiratory and cardiovascular diseases that may be caused or exacerbated by ambient exposure to ENDS emissions preclude definitive risk inference. Taking the current immature evidence as a proof of safety and using it to advocate for policy that allows ENDS indoors could prove reckless.”
The only known evidence of the hazards of secondhand vaping that the article is able to cite is that exhaled e-cigarette aerosol is “not harmless water vapor.” And the only evidence it presents showing that vaping can result in high levels of particulate exposure is from the measurement of particle concentrations at a “vapefest,” where literally hundreds of vapers are present in an enclosed location.
The Rest of the Story
In all the time that I spent lobbying for smoke-free bars and restaurants because of substantial evidence of life-threatening public health harm, little did I know that at a time in the future, we would be advocating for vape-free environments because a potential exposure was “not harmless.” Little did I know that we would be supporting bans on a behavior in private facilities (like restaurants) because we did not have definitive evidence that the behavior in question was benign.
I thought it was the other way around. I always thought that to justify interfering with individual rights and freedom as well as business owners’ autonomy, we had to demonstrate that there was a substantial public health hazard. These anti-vaping advocates suggest that it is the other way around. In order not to ban vaping, we have to prove that it is not harmful. In my view, this is antithetical to the justification for public health regulation. 
In order to justify societal policy that interferes with individual freedom and autonomy, we should be required to document – with reasonable evidence – that a significant public health hazard exists. We don’t just ban everything that may or may not have significant risks and wait until behaviors are proven to be benign before we allow them.
When I testified at public hearings in support of smoke-free bars and restaurants, opponents would often argue that I only wanted to ban smoking in these workplaces because I was annoyed by smoke and that it didn’t matter if secondhand smoke was actually known to be harmful. I countered this by explaining that in tobacco control, we respect individual rights and autonomy, including that of business owners, and that we would not call for a ban on smoking in these establishments in the absence of significant evidence that secondhand smoke exposure represents a substantial public health hazard.
What bothers me about this article, and about the campaign to ban vaping in public places generally, is that it essentially proves our opponents to be right. We aren’t basing our support for bans on vaping on the presence of substantial evidence of a public health hazard. Instead, we’re basing our support for these bans on the absence of substantial evidence that there is a public health hazard. If there were sufficient evidence to know that secondhand vaping is a significant public health hazard, this would be a no-brainer. So in essence, it is the lack of evidence of known health effects that is the basis of current campaigns.

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New York State Senator Uses "Alternative Facts" to Promote Ban on Flavored E-Cigarettes

A New York State senator – Brad Hoylman (D-Manhattan) – has introduced legislation to ban the sale of flavored electronic cigarettes in New York. To promote this ban, he argued that cigarette companies are seducing kids to vape by selling fruit punch, gummy bear, and cotton candy e-cigarettes: “Kids are attracted to the numerous flavors that the cigarette companies are selling, such as fruit punch, gummy bear, cotton candy.”

The Rest of the Story

Senator Hoylman’s position is based on “alternative facts,” or what prior to 2016 would have more simply been called a “lie.”

Not a single one of the tobacco companies is producing gummy bear, cotton candy, or fruit punch e-cigarettes.

Altria’s MarkTen e-cigarettes come in four flavors: classic (tobacco), menthol, fusion, and winter mint. Their MarkTen XL Bold e-cigarettes only come in two flavors: classic and menthol.

R.J. Reynolds Vapor Company’s Vuse e-cigarettes come in seven flavors: original, mint, melon, nectar, berry, chai, and crema.

Imperial Brands’ blu e-cigarettes come in 14 flavors: tobacco, menthol, vanilla, cherry, blueberry, peach schnapps, strawberry mint, Carolina bold, pina colada, mint chocolate, glacier mint, caramel cafe, gold leaf, and berry cobbler.

British American Tobacco’s Vype e-cigarettes come in 12 basic flavor types: tobacco, apple, master blend, vanilla, mint, wild berry, green snap, scarlet kick, indigo dive, dark cherry, oriental spice, and rich aniseed.

Thus, not a single one of the tobacco companies are producing gummy bear, cotton candy, or fruit punch e-cigarettes.

The cotton candy, gummy bear, and fruit punch flavors of e-liquids are being produced by independent companies that have nothing to do with Big Tobacco. However, that apparently does not make a good enough story to support this legislation. So instead of just telling the truth, the senator decided to lie and tell people that Big Tobacco is the culprit for marketing these flavors.

This is not just bad legislation because it is based on a lie. It is bad legislation because if enacted, it would have a devastating effect on the public’s health. Removing flavored e-cigarettes from the market is tantamount to a complete ban on e-cigarettes. There are literally millions of adults who use flavored e-cigarettes to stay off real cigarettes. Banning these products would result in tens of thousands of ex-smokers returning to smoking. It would also prevent quit attempts by many current smokers who are just not attracted by tobacco-flavored e-cigarettes. 

Any legislation so weak that you have to lie to support it is clearly not worth voting for. I hope the state Senate in New York sends this bill to a quick defeat.

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HR1136 – Co-sponsor Update as of 03.17.17

New co-sponsors from Kentucky, Maryland, Michigan, Missouri, Nebraska, Pennsylvania, Tennessee, and Virginia have been added to HR 1136.

For the updated list and an opportunity* to say “thank you,” please see our original post here.

*Please note that the thank you engagement is limited to people living in districts represented by co-sponsors. Address information for Representatives Cole and Bishop at the bottom of the original post if you would like to send a letter by mail.

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Campaign for Tobacco-Free Kids Admits that Its Secret Campaign Promoted Youth Cigarette Addiction

Through a shocking revelation, we learned last week that a major, national anti-tobacco organization ran a secret campaign to promote youth cigarette addiction.

The organization: The Campaign for Tobacco-Free Kids

The secret campaign: Federal lobbying against a ban on menthol-flavored cigarettes.

The admission: This campaign promoted youth cigarette addiction by protecting the cigarette companies’ ability to market the most popular flavored cigarette (menthol) to youth and the campaign worked: menthol cigarette use among youth increased significantly thanks to the lobbying efforts of the Campaign for Tobacco-Free Kids.

The reason I call this revelation shocking is that I find it scandalous that an organization which is supposedly dedicated to fighting youth addiction to cigarettes would secretly lobby for legislation that protects cigarette companies’ profits by blocking public health efforts to prohibit the companies’ ability to use flavored cigarettes to attract and addict kids to smoking.

And instead of admitting its mistake and apologizing, the Campaign for Tobacco-Free Kids is now bemoaning the devastating damage that was caused by menthol cigarettes without acknowledging that it was largely responsible for this damage because it lobbied against taking menthol cigarettes off the market.

The Rest of the Story

When Congress debated the Family Smoking Prevention and Tobacco Control Act, which was signed into law by President Obama in 2009, perhaps the most critical issue it considered was whether or not to curtail the cigarette companies’ ability to use menthol flavoring to attract and recruit kids to a lifetime of addiction to smoking.

The proposal on the table already banned non-menthol flavorings, but there was a problem: there were no non-menthol flavorings on the market. So while the proposal banned cherry, strawberry, banana, and pineapple cigarettes, there were no such products on the market. Candy-flavored cigarettes were not the problem. Menthol cigarettes were.

So the United States Senate debated whether to actually ban flavored cigarettes (i.e., menthol cigarettes) or whether to pretend to ban flavored cigarettes while exempting the only flavored cigarettes that were actually on the market (menthol cigarettes).

Understandably, a number of public health organizations came out strongly in favor of banning menthol cigarettes. But one organization – the Campaign for Tobacco-Free Kids – turned its back to the public’s health and to the children it was supposedly committed to protecting.

Instead of lobbying for the menthol ban, it lobbied against it. The Campaign went to war, not to protect youth from a lifetime of addiction, but to protect the cigarette companies’ ability to use flavored cigarettes to recruit and entice kids into a lifetime of addiction to smoking.

Last week, in a report entitled “The Flavor Trap,” the Campaign for Tobacco-Free Kids revealed that data from the National Youth Tobacco Surveys demonstrates that its lobbying efforts resulted in the increased addiction of youth to menthol cigarette smoking, acknowledging that the “use of menthol cigarettes, the only remaining flavored cigarettes, increased significantly after the ban.”

It is disingenuous for the Campaign to call menthol cigarettes “the only remaining flavored cigarettes” because menthol cigarettes were the only existing flavored cigarettes at the time the legislation was enacted. So yes, it is technically true that menthol cigarettes were the only remaining flavored cigarettes after the ban but they were the only remaining flavored cigarettes before the ban as well.

This admission – that the use of menthol cigarettes by kids increased significantly as a result of the legislation’s menthol exemption – is quite damning. It essentially acknowledges that it was the Campaign for Tobacco-Free Kids’ lobbying that was responsible for this rise in menthol cigarette use. Had this exemption not been granted, it is likely that youth cigarette smoking would have declined even more substantially.

What makes the report even more damning, however, is that the Campaign for Tobacco-Free Kids’ hides from the public the fact that it actively lobbied against a ban on menthol-flavored cigarettes. While it boasts about having banned lime, bubble gum, chocolate, and raspberry cigarettes – none of which were on the market to begin with – the Campaign fails to disclose its role in protecting menthol cigarettes.

The Campaign hides the fact that it chose to come down on the side of Big Tobacco rather than on the side of America’s youth.

Now – after the fact – the Campaign appears to be giving lip-service to the idea of extending the cigarette flavor ban to menthol. However, most of its attention is focused on banning flavored e-cigarettes – which are not addicted any nonsmoking youth- not on banning flavored real cigarettes, which the Campaign admits are addicting an increasing number of kids.

The rest of the story is that when it really mattered, the Campaign for Tobacco-Free Kids opted to protect the interests of Big Tobacco rather than to protect our nation’s youth from a lifetime of addiction to the most deadly products on the market.

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New York State Department of Health Urges Physicians to Discourage Patients from Quitting Unless They Use Big Pharma Products and Tells Vapers They Might as Well Go Back to Smoking

The New York State Department of Health has sent out a letter to medical professionals in the state, urging them to discourage patients from quitting smoking using e-cigarettes, even if they indicate unwillingness or lack of interest in nicotine replacement therapy or other smoking cessation drugs.

In the February 2017 letter, the state health commissioner writes:

“I encourage all health care providers to talk to their patients — young and old alike — about the dangers of e-cigarettes and to discourage their use. For patients who are already using traditional cigarettes or e-cigarettes, there are currently seven FDA-approved medications for smoking cessation, including five nicotine replacement therapies.”

Further, in a letter sent to VapeNY five days ago, the director of the state health department’s chronic disease prevention division castigates vapers by denying that switching from smoking to vaping has any public health value, thus telling vapers that they might as well return to cigarette smoking.

The director of the division writes:

“To date, the evidence on vapor products, electronic cigarettes and similar devices finds the products have no credible public health value in real world use…”.

The Rest of the Story

I could hardly believe my eyes when I saw these letters. In the first letter, the New York state health department actually urges physicians to discourage patients from quitting smoking unless they are prepared to use nicotine replacement therapy, Zyban, or Chantix. For patients who have no interest in using one of those three products (or have used them and failed in the past) and wish to try quitting by switching to vaping, the official recommendation from the state of New York is to discourage these patients from using e-cigarettes to quit. In other words, physicians should essentially discourage such smokers from making such a quit attempt, since the reality is that they are not interested in using medication.

This advice to physicians to discourage quit attempts using e-cigarettes is unqualified. It does not say: “Encourage smokers to try an FDA-approved medication first, and recommend e-cigarettes only if that fails.” It advises physicians to discourage e-cigarettes under all circumstances. Obviously, this includes the circumstance where the patient tells the physician that she has no interest in using Big Pharma products and instead, wants to try vaping.

This blanket recommendation is inappropriate and in my view, damaging. Essentially, smokers are being told that if they don’t want to quit the way the health commissioner thinks they should quit, then they shouldn’t even try. Clearly, this attitude from the state health department is going to discourage many quit attempts and therefore promote continued smoking by many.

The advice is particularly inappropriate because the scientific literature shows that smoking cessation medications only have a 10% success rate in the real world. Thus, 90% of smokers who take the health department’s advice are going to fail, and thus remain smokers.

The existing evidence suggests that electronic cigarettes are at least as effective as nicotine replacement therapy. And newer products currently on the market are almost certainly more effective than the nicotine patch, since the products tested in the existing clinical trials were first-generation products with very poor nicotine delivery. The delivery of nicotine by vaping devices has increased substantially since that time, meaning that these devices are almost certainly more effective than the early products. But even those early products performed equally to the nicotine patch in the clinical trial setting.

The Department of Health’s declaration that e-cigarettes have “no credible public health value” means that there must be no value in switching from smoking to vaping. The health department is essentially telling the millions of smokers in the United States who have done exactly that (quit smoking by switching to vaping), that they might as well return to smoking. After all, if vaping has no public health value, then why bother vaping? You might as well go back to smoking, and you haven’t lost anything.

The problem is that this is patently false. There is abundant evidence that vaping is much safer than smoking and that smokers who switch to vaping experience an immediate and dramatic improvement in their health, especially in respiratory symptoms and lung function. Several studies by Dr. Riccardo Polosa and his colleagues have demonstrated significant improvement in respiratory symptoms and objectively measured lung function (spirometry) among smokers who switched to electronic cigarettes. Positive effects on health were observed for patients with both asthma and COPD. And while the improvement was most dramatic for smokers who switched completely to vaping, many of the dual users who cut down substantially on the amount they smoked did experience health improvement. Dr. Polosa also found that smokers with hypertension who switched to e-cigarettes experienced a significant decrease in their blood pressure.

While we can argue about the potential long-term risks associated with vaping, it is simply not the case that e-cigarettes have no credible public health value in real world use. What do you call more than one million smokers quitting using e-cigarettes? If that doesn’t have public health value, then I don’t know what does. And that is a conservative estimate, since there are an estimated 2.5 million ex-smokers who currently vape. (While some of them may represent ex-smokers who picked up vaping, the vast majority almost certainly are smokers who switched to vaping.)

The New York State Department of Health is also being irresponsible in its direct communications to the public. In a press release issued just 2 days ago, it incorrectly claimed that e-cigarettes are a form of tobacco use. The truth is that e-cigarettes are not a form of tobacco use because they don’t actually contain any tobacco. They are no more a form of tobacco use than nicotine replacement therapy. We don’t say that using the nicotine patch is a form of tobacco use. Neither is vaping.

The department, in the same press release, claimed that e-cigarette use can be a gateway to nicotine addiction. There is no evidence to support this conclusion. Despite dramatic increases in youth e-cigarette use, the prevalence of nonsmoking youth who have become regular users of e-cigarettes (and thus potentially addicted) is miniscule. Thus, the current evidence is that e-cigarettes actually have a very low potential to serve as a gateway to nicotine addiction.

New York’s own data demonstrate that e-cigarettes are not serving as a gateway to smoking. Despite a doubling of e-cigarette use among youth between 2014 and 2016, youth smoking in New York in 2016 reached a historic low. Current smoking among youth in 2016 was only 4.3%.

In fact, while e-cigarette use among youth in New York state rose dramatically from 10.5% in 2014 to 20.6% in 2016, youth smoking plummeted from 7.3% to 4.3%. And if you go back to 2012, when youth e-cigarette use wasn’t even measured, the decline in youth smoking is from 11.9% to 4.3%. These data are simply not consistent with the hypothesis that e-cigarette use is a gateway to smoking among youth. If anything, it appears that e-cigarettes may be contributing to the further de-normalization of youth smoking. The emergence of a vaping culture appears to serve as an alternative to the smoking culture, not the other way around.

The rest of the story is that the New York Department of Health is spreading dangerous misinformation and irresponsible medical advice that has the potential to do public health damage. Hopefully, they will correct this misinformation and retract their misguided advice to physicians. They need to do this in order to prevent the unintended effect of their communications, which is to promote smoking by protecting it from competition by vaping products.

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