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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.

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  • Fist of Etiquette||

    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.

    And what happens to public health agency budgets and anti-smoking organization revenue if people suddenly go off smoking to a healthier alternative? The PHE is going to position themselves right out of work.

  • Rockabilly||

    They could have a new campaign on the dangers of human farts, esp in confined places like the tube.

  • Werekoala||

    I switched to e-cig about 4 months ago (with an occasional real cigarette up until about the last few weeks - they've become quite nasty to me now) and couldn't be happier. Cheaper (I can vape for two weeks for the cost of two packs of cigarettes), the odor isn't "cigarette", just whatever flavor of fluid you're using (my preferred is called "Atomic Fireball - cinnamon), and even my non-smoking friends have no problem with me using the device in their homes. No more smoker's exile (at least on private property), no more smoke-scented clothing or breath, etc.

    Around the time I switched, I visited the doctor and he asked about smoking. Although I had already switched (but was still smoking a few a day) I told him hesitantly I was considering switching to e-cigs, fully expecting a "well, if you have to do SOMTHING, you weak-willed addict" speech, but instead he enthusiastically encouraged it. "Oh, that is SO much better for you, you're cutting out like 500 chemicals if you do." Considering the reflexive banning of e-cigs anywhere regular cigs are banned, I had expected a puritanical response as well. Needless to say, I was pleasantly surprised.

    So sure, might be better to quit all of it entirely, and switch to drinking distilled water and eating organic alfalfa flakes, but dammit, let me have some bit of "vice" and enjoyment out of life.

  • misanthropicjoy||

    "Although I had already switched (but was still smoking a few a day) I told him hesitantly I was considering switching to e-cigs, fully expecting a "well, if you have to do SOMTHING, you weak-willed addict" speech"

    I expected the same thing from my physician and she reacted in the same way yours did. Isn't it horrible that we have been conditioned to cringe away like a child who is expecting beating? And it is our own doctors we've come to expect it from?

    It's a shame that so many others in the pro-vaping community are also in this position and are not fighting back against the nannies who wish all of the citizenry to remain their children forever. Giving up vaping in public places is not the way that we should go. We are harming no one except other smokers who will thereafter view it as suspicious and not bother to examine them as an alternative to regular cigarettes.

  • C. S. P. Schofield||

    Over the years, I've lost a great deal of my awe of Doctors. The vast majority of them are glorified chancre mechanics, and that goes triple for the ones that involve themselves with "Public Health" initiatives.

  • Jam4Joy||

    I switched from smoking cigarettes to vaping. Then switched from vaping "tasty" flavored to the worst I could find. It took about 3 months, but it made me hate the feeling of a nicotine fix. I've been cigarette free (with the occasional slip, less than 5 total) for going on 2 years now.

    Before vaping, I'd tried everything to quit. I'd still be puff puffing away today without vaping.

  • Cap'n Krunch||

    It has nothing to do with risk at all. It's about ideology. Anything that even may be bad (or politically incorrect) must be discouraged and if possible made a criminal act.

  • C. S. P. Schofield||

    Bad isn't a criteria at all. Having serial encounters of unprotected anal sex with strangers is a LOT more unhealthy than smoking, and they're just fine with "The Gay Lifestyle".

  • C. S. P. Schofield||

    As I've said before, the anti-smoking campaign in the U.S. Isn't about health, amd hasn't been for a while. Not that the health risks of smoking aren't real, mind. But the Smart People expected the population to To As They Were Told, and stop smoking. And the smoking portion of the population went from about 60% before the Surgeon General's Report to slightly more than 20% .... and then stopped. The Smart People couldn't believe it! So through the 1970's they got more and more shrill, and sometime in the 1980's they completely stopped caring about facts and started the campaign of utter hogwash we see today.

    The entire "secondhand smoke" campaign is founded on bogus statistics that would embarass a Phrenologist. They assert that fewer people than ever are smoking, but I suspect (based on the number of ways that one is pressured) that the truth is fewer people than ever are replying honestly to surveys about it. When cigars suddenly enjoyed a renaissance, they suddenly went from "cigars are less dangerous than cigarettes" (thier position of some years) to "cigars are just as bad".

    The same thing happened to the Anti-Saloon League.

  • Rhywun||

    With a combination of draconian taxation and ban-boners, they got it down to around 15% in NYC. Last year it went up to 16% and Top. Men. are losing their shit over it. "We don't spend enough on those horror-commercials that are shown during every commercial break on every channel!!"

    You are right it is all signalling at this point.

  • C. S. P. Schofield||

    I haven't been in NYC for a while, but I just bet that the 15% figure really boiled down to "15% of the people who were willing to talk to us at all and didn't lie.".

  • Werekoala||

    I agree. We're fully in the grip of the "Anything I personally don't like is bad and must be stopped!' crowd at this point. I keep waiting for the day when we might shift from the passive types who give the whiny babies what they want just to shut them up to a more assertive, and individualist, mindset that tells them to shut up and go away if they don't like it, but the indoctrination is, unfortunately, finally bearing fruit.

  • sweettea71||

    The Feds need you to keep smoking the real thing so you keep sending them the tax dollars. The population control aspect is just a bonus.

  • C. S. P. Schofield||

    As population control, smoking is a bust. Statistically speaking, it takes about 20 years of smoking more than a pack a day for you to have a serious risk. Even if you started in the cradle, that's time enough to reproduce.

    No, the answer isn't subtle and clever. They are against vaping because "Waaaahn! they aren't doing as they're TOLD!!!!"

  • RealCrankyYankee||

    Right-O sweettea71! Tax dollars and govt agencies that oversee cigs don't want anyone to find a better alternative to ingesting nicotine (plus "DRUGZ ARE BAAAD!") And add to that, big tobacco companies have a big propaganda machine aimed at ECs so they can hang on to their cig consumers.

  • Hank Phillips||

    By Revelation the GOP came to believe e-cigs are a gateway to Satanic possession. Looters on "the other" side of the aisle simply want to ban them because they bring enjoyment and can possibly be kidnapped for bribes. This is not the sort of issue the LP can put in its platform--except maybe by way of reducing the threat of bankrupting the socialized medicine lately forced on us. Also, Paypal has taken time out from licking the blacking off of DEA and FATF boots to ban all payments for e-cigs. The outlook is not rosy.

  • Rhywun||

    Also, Paypal has taken time out from licking the blacking off of DEA and FATF boots to ban all payments for e-cigs.

    Jesus... really? See, it's all signalling.

  • Suicidy||

    E-cigs are in the GOP platform? Really? I kind of doubt that.

  • ace_m82||

    Don't let facts get in his way!

    (NOT a fan of the GOP.)

  • Suicidy||

    Where are you seeing this? I have seen nothing to indicate ANY position from the GOP where E-cigs are concerned.

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  • DenverJ||

    You know who else banned stuff and lied to the populace?

  • Babylonandon||

    People who see vaping as a real solution to smoking face a trifecta of seriously entrenched political interests.

    First, you have the nanny-state Nazi's who just want to play God with people. "Save being Gay or Vegan you should put nothing in your mouth ... because I said so".

    Second, certain government entities conspire with the tobacco companies and still rely on tobacco taxes to fill their coffers.

    Finally ... and probably the strongest and worst influence of all ... BIG PHARMA / BIG HEALTHCARE would lose BILLIONS they make for all their failed witch-doctor tobacco cessation products / programs AND treating smoking-related cancers. These guys have DEEP pockets and lots of lobbyists at both the Federal and State level working to encourage States to adopt anti-vaping laws and to get the FDA to declare vaping a health menace.

  • Devil's Candy||

    If E-cigarettes are so much better for you, then why doesn't ObamaCare cover them, hmm?! /sarc

  • Arthur45||

    I don't believethat vaping is 95% safer. I have to assume it is nearly 100% safer.
    Of course, all e-liquid is not the same, so nothing can be claimed without specifying which e-liquid you are reffering to. Basically e-liquid that I useis propylene glycol and water and cake falvoring. None of those ingreients have ever been deemed carcinagens.

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  • Puma Trainersfashionworld||

    The advice from private organizations that are ostensibly interested in reducing smoking-related harm is generally not any more helpful or accurate.

  • MichaelL||

    And, the tobacco companies and anti-smokers would have no reason to be against this, would they?!...(;-P The anti-s don't like it because it does not cause second hand smoke. So, they have no right to try to ban it. They want to ban it in bars, too! It is my medical opinion that the insane are now running the asylum!

  • Bill Adams||

    "It has been previously estimated that EC [electronic cigarettes] are around 95% safer than smoking. This appears to remain a reasonable estimate."

    Not really, since it's meaningless.

    Car X runs at 100 mph. Car Y runs "95% faster." So it runs at 195 mph. By this analogy, EC would be nearly, not quite, twice as safe as cigarettes. That isn't really very safe, when it comes to cancer, but it probably isn't what they mean.

    Object X's temperature is 100F. Object Y is "95% hotter." But you can't say it's 195F, because "hotter" isn't necessarily relative to the zero point of the Fahrenheit scale. This analogy is a little better, because "safer" is an even more relative a concept than "hotter."

    What they probably mean (I'm just guessing though, there's no logic to it) is that EC carry only a 5% probability of the health risks associated with cigarettes. (Though you'd have to break out the separate health risks for lung cancer, mouth cancer, throat cancer, emphysema, COPD, etc. to make even that meaningful.) But that's not what they're saying.

    I agree completely with the article, that EC are likely much much less dangerous to health than cigarettes, but this ain't the way to quantify it. If we're going to urge the FDA to tell the truth, give them a truer number to use.

  • Bill Adams||

    Okay, I wasted a lot of unnecessary space thinking this through for myself. I should have first scanned the Brit report for the numeral 95. Sure enough, they say "95% less harmful" (and back that up with meaningful statistics.) I can understand why you might think that since "less harmful" means "safer," you can substitute the latter in a statistic. But you would be wrong. Fortunately easy for you to fix, Jacob.

  • Bill Adams||

    Ah, crap. Just once I'd like to get it right the first time, though it would be great if you would let us edit.

    Continuing to do a search on 95%, I do find two instances of the goofy version of the statistic, including the one Jacob quoted verbatim.

    But the summary on the last page has it correctly. "95% less harmful" is correct, and means what they actually mean to say -- a reduction of quantifiable harm by 95%. "95% safer" would mean "nearly twice as safe" -- not what they mean to say at all.

    Still easily fixable, Jacob. Just quote from the last page, where they get it right.

  • Bill Adams||

    Christ on a crutch. No, it isn't the last page, it's in the foreword, page 5. That's why search saw it first, of course.

    Please let us edit comments.

  • smartin||

    Tom Frieden listens to the CDC Foundation who kick in big bucks to demonize tobacco and e cigs. The CDC Foundation has as members and partners all the groups who get money to lobby for bans, and who sell patches and gums and Chantix. The CDC Foundation claims to run over 250 CDC programs. The paid lobby groups include RWJF's Campaign For Tobacco Free Kids, the ACS, ALA, and guess who the big fat cat is who makes the most donations for lobbying for bans.... Michael, Pink Bloomers, Bloomberg! Yep. He's ruling the world now through the CDC Foundation.

  • smartin||

    I sure wish Reason would expose the Champagne Tower of Tobacco Control. I would but I don't have a news service.

  • premium e-liquid||

    I switched to tobacco e liquid, and haven't thought about going back to cigarettes. The best tobacco e liquid has made me quit smoking, and I breath so much better from it.

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