The Food and Drug Administration (FDA) should abandon any efforts to inform the public that vaping is safer than smoking, says the American Lung Association (ALA).
Numerous public surveys show a consistent, widespread misperception that vaping nicotine is just as or more dangerous than smoking cigarettes. The problem is so extensive that correcting these false beliefs forms part of the FDA's Center for Tobacco Products (CTP) 5-year strategic plan.
Writing in the journal Addiction, Brian King, the head of CTP, stated: "Opportunities exist to educate adults who smoke cigarettes about the relative risks of tobacco products." To that end, among the five goals listed as part of CTP's plan is a commitment to inform the public that not all tobacco products are created equally, with cigarettes being the most dangerous and others, such as e-cigarettes, being far less harmful.
The pledge to provide accurate information about the risks of different nicotine products is long overdue and in line with the public health communications of peer countries such as Canada, New Zealand, and the U.K. (The U.K. even has vape shops in hospitals, and some smokers are offered free vapes to help them quit.)
But in their comments on CTP's strategic plan, the ALA, which proclaims its commitment to a world free of lung disease, demands the FDA "remove language from the description for this goal that references informing adults about the relative risk of tobacco products" and that "CTP should have no part in the industry's efforts to sustain addiction through the failed and flawed notion that adult smokers should switch to e-cigarettes."
Despite ALA's protestations, the idea that e-cigarettes are effective for smoking cessation is not a tobacco industry notion. According to the prestigious Cochrane Review, e-cigarettes are more effective than nicotine patches or gums in helping smokers quit. In essence, the ALA is asking the FDA to withhold accurate information from the public that could save lives. The recommendations sparked strong reactions from those who believe safer alternatives to cigarettes are a no-brainer from a public health perspective.
"This is highly ironic, given the extent to which the Lung Association and other tobacco control organizations went to punish the tobacco industry for lying to the public and hiding critical health information," writes Michael Siegel, a visiting professor at the Tufts University School of Medicine. "It is also unethical because it violates the public health code of ethics, which calls for honesty and transparency in public health communications. We do not hide critical health information from the public."
FDA Commissioner Robert Califf is adamant about the need to fight misinformation, calling it the most common cause of death in the United States, but has yet to address the wave of misinformation surrounding the risks of e-cigarettes. Speaking to Reason, Dave Dobbins, recently the chief operating officer of the Truth Initiative, the nation's largest anti-tobacco nonprofit who has since acted as consultant to the tobacco company Altria on harm reduction, fears that withholding truthful information from the public could further undermine the FDA's credibility. "I think that if you're a public health authority and you're caught not telling the truth, it will have long-term consequences that are with the next time people need information from you that's true and really important, they may not listen to you."
Dobbins believes the ALA has misread the strength of evidence around e-cigarettes rather than Siegel's stance that the nonprofit has taken an ideological position over a scientific one. "I disagree with their reading of the science, but I believe that's what motivates them, not a desire to suppress true speech more than just a very different interpretation of the science than many, many health authorities," Dobbins says.
Still, Dobbins, who stood shoulder to shoulder with the ALA on tobacco regulation for decades, believes they've called this issue wrong. If the FDA listens to the ALA, "it will prolong smoking as a behavior in the United States," he says. According to one estimate, if smoking was largely replaced by vaping, it could result in 6.6 million fewer premature deaths from from 2016 to 2100.
There is perhaps an underlying fear among many anti-tobacco groups that if the public knows how much safer e-cigarettes are than cigarettes, then many people who never would've used nicotine will start doing so. But "you don't get to live in a super virtuous world where nobody does anything," says Dobbins.
Besides, "in order to get people to comply with your vision of virtue, inevitably, you have to engage in coercion. And coercion has societal costs and health costs as well, and you have to take those into account."