A British Lesson on Vaping for the CDC

Tom Frieden should listen to what English public health officials say about e-cigarettes.


Public Health England (PHE), a government agency, recently published a detailed report on electronic cigarettes that describes them as far less dangerous than the conventional kind and recommends them as a harm-reducing alternative. "Encouraging smokers who cannot or do not want to stop smoking to switch to EC [electronic cigarettes] could help reduce smoking-related disease, death and health inequalities," the report says. "Smokers who have tried other methods of quitting without success could be encouraged to try EC to stop smoking, and stop smoking services should support smokers using EC to quit by offering them behavioural support."

PHE's position should not be controversial. It is indisputable that vaping, which does not involve tobacco or combustion, is much safer than smoking, and it logically follows that smokers can dramatically reduce the health risks they face by switching. Yet public health agencies and anti-smoking organizations in the United States, unlike their counterparts in the U.K., are strangely reluctant to acknowledge these points, implausibly portraying e-cigarettes as a threat rather than an opportunity. The British example points the way to a calmer, more rational approach that is consistent with the public health goal of reducing the morbidity and mortality associated with smoking.

The PHE report, which was overseen by Peter Hajek, a professor of clinical psychology at the Wolfson Institute for Preventive Medicine, and Ann McNeill, a professor of psychiatry, psychology, and neuroscience at King's College London, is very clear on the relative hazards of smoking and vaping:

While vaping may not be 100% safe, most of the chemicals causing smoking-related disease are absent and the chemicals which are present pose limited danger. It has been previously estimated that EC [electronic cigarettes] are around 95% safer than smoking. This appears to remain a reasonable estimate.

The evidence concerning e-cigarettes' effectiveness in helping smokers quit is more limited but promising:

Recent studies support the Cochrane Review findings that EC can help people to quit smoking and reduce their cigarette consumption. There is also evidence that EC can encourage quitting or cigarette consumption reduction even among those not intending to quit or rejecting other support. It is not known whether current EC products are more or less effective than licensed stop-smoking medications, but they are much more popular, thereby providing an opportunity to expand the number of smokers stopping successfully.

The PHE report warns that misinformation about e-cigarettes, including sensational press coverage ofweak 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. Another 23 percent said they did not know.

The PHE report notes that American surveys have found a similar trend. In fact, public perceptions in the United States seem to be even more divorced from reality. According to a Reuters poll completed on June 4, just 35 percent of Americans understand that "e-smoking is healthier than traditional cigarettes." The rest, nearly two-thirds, either disagree with that statement or don't know.

"There is a need to publicise the current best estimate that using EC is around 95% safer than smoking," the PHE report concludes. In this country, however, public health agencies and anti-smoking groups seem determined to obfuscate that crucial point.

"The long-term impact of e-cigarette use on public health overall remains uncertain," says the U.S. Centers for Disease Control and Prevention (CDC), which calls e-cigarettes "tobacco products" even though they contain no tobacco. "When it comes to tobacco products," says CDC Director Tom Frieden, "we really have to assume they're dangerous until they're proven safe, rather than the other way around." Ron Chapman, director of the California Department of Public Health, calls e-cigarettes "a community health threat" and falsely claims "there is no scientific evidence that e-cigarettes help smokers successfully quit traditional cigarettes."

The advice from private organizations that are ostensibly interested in reducing smoking-related harm is generally not any more helpful or accurate. The American Cancer Society asks whether e-cigarettes are "safe," when the relevant question is whether they are less hazardous than conventional cigarettes, which they clearly are. "Because the American Cancer Society doesn't yet know whether e-cigarettes are safe and effective," it says, "we cannot recommend them to help people quit smoking."

The American Lung Association (ALA) says it's "a myth" that "e-cigarettes are safe" but does not address the relative hazards of smoking and vaping. The ALA also claims it's a "myth" that "e-cigarettes can help smokers quit," which is demonstrably false, as the PHE report shows. The ALA suggests that the continuing declines in smoking among American teenagers are "offset by the dramatic increase in use of e-cigarettes," which is scientifically absurd given vaping's clear health advantages over smoking.

American e-cigarette alarmists frequently argue that vaping is "renormalizing" smoking, luring nonsmokers into nicotine addiction, or serving as a "gateway" to smoking. The PHE report finds little or no evidence to support those claims:

Since EC were introduced to the market, smoking prevalence among adults and youth has declined. Hence there is no evidence to date that EC are renormalising smoking; instead it's possible that their presence has contributed to further declines in smoking, or denormalisation of smoking. The gateway theory is ill defined and we suggest its use be abandoned until it is clear how it can be tested in this field. Whilst never smokers are experimenting with EC, the vast majority of youth who regularly use EC are smokers. Regular EC use in youth is rare.

The trends and patterns of use are similar in the United States, where public health officials nevertheless continue to warn that vaping will somehow lead to more smoking. Frieden asserts, contrary to all the evidence so far, that "many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes." Frieden also bizarrely calls the decision to switch from smoking to vaping "a misconception," as if the choice itself were scientifically incorrect, on par with declaring the world flat or attributing someone's personality traits to the arrangement of stars in the night sky on his birthday.

Such misinformation can be lethal. "E-cigarettes are not completely risk free," says PHE official Kevin Fenton, "but when compared to smoking, evidence shows they carry just a fraction of the harm. The problem is people increasingly think they are at least as harmful, and this may be keeping millions of smokers from quitting." Although they claim to be interested in reducing smoking-related disease and death, e-cigarette alarmists like Frieden are actively undermining that goal.

This article originally appeared at Forbes.com.