The Volokh Conspiracy
Mostly law professors | Sometimes contrarian | Often libertarian | Always independent
When Doctors Are the Source of Public Health Misinformation
Medical professionals are often unaware of the relevant research on the relative risks of tobacco products, and that can matter for public health.
Most Americans understand that smoking is harmful. It remains a leading cause of preventable death in the United States. A growing number of Americans do not understand that vaping and non-combustible tobacco products are far less risky. In a recent article, Jacob James Rich and I explored why this might be.
One source of public misunderstanding could be that doctors are often unaware of the extensive research concluding that vaping, while not risk-free, is substantially less risky than smoking (such that were all smokers to switch to vaping, tens of thousands--if not millions--of premature deaths could be averted). While reports by the National Academy of Sciences and Public Health UK (among others) have concluded that vaping exposes users to significantly lower contaminant levels and is likely to be substantially less harmful than smoking, one recent study found that 60 percent of doctors believe all forms of tobacco are equally harmful.
While some medical professionals are simply unaware of what can be said about the relative risks of smoking versus vaping, others seem intent on spreading disinformation. For instance, here's a TikTok by a cardiovascular surgeon claiming that vaping "is significantly worse than cigarette smoking." This is an outrageous and unfounded claim. Worse, insofar as this message is internalized by current smokers, it could discourage them from switching to less harmful sources of nicotine.
[Note: Even if this claim is based upon experience with EVALI victims, suggesting that EVALI is a consequence of vaping generally, when EVALI has been linked to black-market THC vaping fluids containing vitamin E acetate, is still quite irresponsible. There is no documented case of EVALI that has been linked to conventional vaping products.]
It is one thing to discourage vaping, as it is not risk-free (and there is limited evidence about its long term effects). It is quite another to suggest that vaping is equal or worse than smoking. The latter is misinformation--and the sort of misinformation that could cost lives.
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I wouldn’t call it “misinformation.” Do you expect all doctors to keep up with the risks of various forms of drugs and alcohol? They do have things to do like treat patients and enter endless coding for insurance companies.
Yes, it is quite literally their jobs and it's an essential part of their treatment of patients. But to the extent that they don't want to keep up with the risks of various products/behaviors/etc, they absolutely have an obligation to keep their traps shut.
Most translations of the Hippocratic Oath open with "first do no harm". Abusing your position of authority to pontificate beyond your expertise is harm.
I would expect any doctor who holds themselves out as an expert on public health to make sure that what they are saying is true.
For a libertarian blog, this place seems to blame other people all the time for their own dumb actions. Like saying vaping is as bad as smoking? So some people will I guess choose to smoke instead of vape and suddenly that’s their doctor’s fault? Give me a break.
Have you seen the gender affirming care regime and compared it to the desistence rates, add the suicidality post transition and, yeah, medical activists don't care about not doing harm.
There's only so much you can do, medically, to help people who belong to a group that a right-wing political movement have decided to persecute, mercilessly.
By definition, 'public health' is political.
Yes, because this is a simple, black-and-white, binary fact. Vaping has nothing to do with tobbacco except for the presence of nicotine, which itself has been extensively tested and is not inherently harmful except for a slight increase in blood pressure.
So yeah, as this is not some time-consuming, research-paper-reading endeavor. This involves the 5-second exercise of saying "Oh, I was wrong about that? Okay."
Well there is the water vapor, which can cause any metal parts to rust, but yes, you're right! and our brain and nerves actually have receptors for Nicotine, J-Hay wouldn't have put them there if he didn't want us to enjoy a nice Dominican every now and then.
Frank
He is a surgeon. He is not an expert on medical research or risk analysis. He is just a tiktokker with an opinion.
I thought TikTokkers with opinions were dangerous!
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Would you encourage your children to using vaping products? Would you be ambivalent?
This blog seems oddly vape-curious (if not vape-positive). Why?
If my children were to make the unfortunate and shortsighted choice to smoke cigarettes and were not inclined or unable to quit, I would indeed encourage vaping instead.
From my recollection, past articles on this blog -- like this one -- have tended to focus on the relative risk and presented vaping as the least-worst option.
Do you self-proclaimed "betters" find such pragmatism a tough concept?
No thoughts about young people who use vaping products but never smoked? My children have told me that is a substantial group.
Smokers are dumb. Vapers aren't much smarter.
People who promoted smoking were lousy people. People who promote vaping products are difficult to understand.
Objection; non-responsive.
Try forming a sentence without "promote" in it -- that seems to be clouding your thought process.
Life of Brian, given your hypothetical, that sounds like a wise choice for you and your family. You, however, are not advising from any but the point of view you mentioned—just the best solution to a bad situation which would have been better without the cigarettes or the vapes.
Anyone advising from the point of view of public health policy is at liberty to take a broader view, and has a duty to do so. What regulatory policy would best serve your family, or any family, given not only the premise of established addiction, but also the full range of other premises available? In that instance there is an obvious best solution—regulatory policy to wind down to zero all smoking/vaping addiction-based marketing.
That wind-down was on the way to accomplishment in the U.S., until the vaping alternative disrupted progress. Given that, there should be no moral or utilitarian confusion about policy recommendations. Government ill-serves its citizens if it leaves them exposed to any costly addiction-based marketing which experience has shown could have been avoided.
Of course the alcohol prohibition example must be reckoned with. But in that case, the facts and experience are different. Alcohol addicts are defined by an inextinguishable craving for what feels to them like a positive reward. By contrast, nicotine addicts almost universally come to regard themselves as slaves to a substance which delivers little except periodic punishment if its use is too long neglected.
That is apparently why such a large percentage of cigarette smokers proved capable to kick the habit. They grew weary of being punished. And thus, why the entire tobacco industry in the U.S. was on the way to extinction.
And it also explains why the attempt to prohibit alcohol addiction, which lacks a similar escape hatch for its addicts, failed. Consideration of long-term heath consequences can always be postponed. In the hear and now, punishments are best avoided. Rewards are best sought. The cases are not alike.
From the point of view of both public health, and your own hypothesis, a family like yours in the future would be better off without nicotine-based marketing to prey on and create addiction in the first place, especially among targeted young people whom the industry hopes to hook for life.
Thus utilitarian and moral arguments have limited scope. They do get traction in individual cases like yours, but the same arguments must be disposed of as ill founded in the more general case. Policy which best serves a family of established addicts cannot be alike with policy chosen to best serve a universal population of non-addicts.
The issues actually at stake thus can better be understood as a conflict over a few philosophical choices. First, is free rein for capitalist ideology worth a general sacrifice in personal welfare? Second, is libertarian ideology worth the same sacrifice, but reinterpreted in context of individualist choice? Third, is public health policy a power legitimately exercised by government? And fourth, on what basis and by whom should those choices and evaluations properly be made?
Adler's repeated threads on this topic are not wisely understood as forthright presentations concerning either morality or utility. They are instead attempts by an ideologist to reinforce the notion that ideologies he prefers should legitimately be chosen as the basis for government decisions. There is not much evident constitutional justification to support Adler's advocacy, despite its evident intent to influence government. But if it could be made customary and expected that government worked on Adler's preferred bases, other capitalist and libertarian undertakings Adler favors would also be better served. That service would come at a steep cost to general welfare.
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Or, producers or distributors of vaping products might have paid (indirectly or directly) for conservative advocacy.
I would prefer my children not use potentially addictive substances. Yet as I have said on this blog multiple times, if I had the choice between both of my children vaping, or one of them smoking, I would choose the former without any hesitation, and it's not close.
Vaping products have the potential to save lives. Deceiving people, particularly smokers, about the difference in risks costs lives. If saying so makes me "pro-vaping" (even though I don't vape), so be it.
You are not as dumb as the average smoker or vaper.
Vaping seems better than smoking. Vaping seems worse than abstaining. Increasing the number of smokers who vape (at least for a short period) and decreasing the number of abstainers who start to use vaping products seem natural, obvious, important public health goals.
People who attempt to cultivate use of vaping products among young nonsmokers are not admirable people. Those who do it for money are especially lousy people.
Most of the available evidence is consistent with the hypothesis that a relatively constant percentage of youth is going to engage in "disfavored" (or what we used to call "anti-social" behavior), but that which such behaviors they engage is more susceptible to policy interventions. So, for instance, study after study shows that when you make vaping products more expensive or less attractive as compared to cigarettes, fewer youth vape and MORE SMOKE. (The relevant research is summarized in this new working paper: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4586701) This may be a sucky trade-off, but that's the world we live in. Stopping youth from smoking is, to my mind, vastly more important than trying to stop them vaping, as smoking is (by most conventional estimates) likely 10-20 times more dangerous, and imposes greater harms on others.
It sounds like cigarettes should be more expensive (to recover the costs precipitated by smoking and to discourage smoking, including with respect to competition from vaping products) and that laws, enforcement actions, and public health programs designed to prevent minors from vaping should be strengthened.
Have you thought about taking a micro economics class. supply and demand curves. Understanding the subject for you would be a benefit
How would that persuade me that cigarette prices should not be increased (mostly by taxation) to (1) address the staggering costs of smoking by having smokers pay for more of the problems they cause and (2) reduce demand for a lousy (dangerous, exploitative, and with respect to minors unlawful) product?
Your boyfriend Barry Hussein Osama still smokes, calling his quitting a 'work in progress' and BTW, how many (Redacted)s do you have to (Redacted) at https://www.cor.pa.gov/Facilities/StatePrisons/Pages/Greene.aspx
for a pack of Newports?
Frank
Rev - your response makes a good impression - However, as I pointed out, understanding the supply and demand curves would provide you with a much better grasp of the consequences you promote.
Joe_dallas, what happens to demand for an optional, harmful product after public policy reduces supply to zero?
Your argument amounts only to a demand that government get out the way of constraint to prevent harm. That is an ideological choice, not a utilitarian argument, or a moral one.
And it is an especially unwise ideological choice. It risks dismantling the entire enterprise of government-run public health amelioration. That probably puts decades of personal life expectancy on the line for everyone.
Lathrop - At no time did I make any such claim or argument regarding the pros or cons, nor any comment on whether the government should be involved or not involved.
all I stated is that he should have a better understanding of the supply and demand curves. His comment showed both an ideological belief and no grasp of micro economics.
Though thanks for confirming you dont understand the supply and demand curves, basic micro economics either.
"Joe_dallas, what happens to demand for an optional, harmful product after public policy reduces supply to zero?"
That one is easy: the black market flourishes.
Absaroka 19 mins ago
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“Joe_dallas, what happens to demand for an optional, harmful product after public policy reduces supply to zero?”
That one is easy: the black market flourishes.
Concur- That is one of the basic concepts that is learned in the freshman level micro eco class.
"Vaping seems better than smoking. Vaping seems worse than abstaining. Increasing the number of smokers who vape (at least for a short period) and decreasing the number of abstainers who start to use vaping products seem natural, obvious, important public health goals."
The OP is about doctors spreading misinformation that exaggerates the dangers of vaping relative to smoking.
In this context, you're claiming that doctors should falsely exaggerate the dangers of vaping in order to achieve the policy goal of preventing young people who never smoked from taking up vaping, even if it results in increased deaths from smoking.
That's a terrible take that will rightly further undermine the public's confidence in health experts.
Well I have actually promoted addictive substances to my children, including delivery methods with higher concentrations.
But while addictive, caffeine delivery through tea, and coffee and the occasional triple espresso not only makes life easier to cope with it seems to promote mental, physical, and even economic well being.
In fact I'm high on coffee right now.
I also talked my son into vaping, rather than smoking 3-4 years ago, but I'm worried that state regulation of some products my push him back into smoking.
Your son sounds like a dope.
Have you tried persuading him to refrain from smoking and vaping?
I'd try persuading him to avoid disgraced Penn State Foo-Bawl Buggerers
This blog has made me grateful I am not autistic
You prefer being retarded? To each his own I guess.
It's the logical fallacy of "appeal to authority" or "argumentum ad verecundiam."
Just because a MD says something doesn't mean that you should believe it -- haven't we learned this with the COVID hysteria and the purported "vaccine"?
The average high school student with a smart phone has access to more medical knowledge than a Medical PROFESSOR had even 50 years ago, so only an idiot would believe something true merely because a MD said it was. Any rational person would ask "WHY???".
There are a lot of old-school MDs still out there, and they are quite dangerous because they aren't always right, nor are they able to keep up with ALL the latest research, no one could. It's why most insurance companies require a second opinion for surgery and why I have no use for any purported "expert" -- in anything -- who can't point me toward the rational for his/her/its opinion.
Argumentum ad verecundiam, it's a logical fallacy, and politicians such as Charlie Baker ought to have been called on it during Covid. I miss the Christmas Tree Shops -- an esoteric chain of stores that were driven out of business by Herr Baker decreeing that they weren't "essential" while Walmart was....
Well, it did cost Baker a third term -- he wouldn't have been re-nominated and enough of the Republican grassroots would have voted for Healey out of spite that she'd have won even if he'd run as an independent.
“I miss the Christmas Tree Shops — an esoteric chain of stores that were driven out of business by Herr Baker decreeing that they weren’t “essential” while Walmart was….“
I know this is going to shock everyone but this doesn’t appear to be accurate.
The last retail locations just closed this past august. They filed for bankruptcy protection in may 2023. While I don’t doubt Covid was tough for retail… laying it at the feet of “herr” baker is a bit much.
Plus you haven’t been spending any money there recently, by your own admission! Blame yourself for sagging sales!
First off, I don't recall EVER saying where I spend my money.
I'll grant that Best Buy & Beyond (also bankrupt) didn't do them any good and they did go a bit downhill after BB&B bought them circa 2003, but you don't honestly think that companies go bankrupt overnight, do you?
Yes, CTS cited "high inflation and recent interest rate hikes" as the immediate cause, but you can't shutter businesses for over a year without doing a lot of damage to even the healthiest of them.
“First off, I don’t recall EVER saying where I spend my money.”
Well, that’s true. You didn’t say you spent money there— you said you “miss them.”
What does that mean? You miss driving past the retail locations? You miss going inside and looking at all the pretty stuff but not buying anything? Do you think these kinds of buying (or not buying) habits have anything to do with the fate of CTS— setting aside the perfidy of Charlie Baker?
It’s also instructive that you bring up Bed Bath and Beyond (sic). What does the ultimate fate of that company tell you about the viability of CTS’s business model? Seems to me a lot of specialty brick and mortar chains are going out of business… could it be online retail has something to do with that?
Finally, you specifically blamed Covid lockdowns for putting CTS out of business despite the fact that they just declared bankruptcy what— 3+ years?— after retail lockdowns ended. You could have still shopped there as recently as august!
No, what this is is another demonstration of an Ed classic: make up facts to fit the story in your head. It’s how we end up with this and the “nobody knows how to do canning anymore” nonsense from yesterday.
While he may have the right of you regarding this chain, I often observed that the steps taken "to counter the virus" might as well have been DESIGNED to destroy small business competition to corporate retailers.
No proof, no argument, but it SEEMED that way to me. Might not have been deliberate, I suppose. Our corporate overlords might have ignored a nickel on the sidewalk (but...fiduciary duty! Pick it up!) and left it for a poor to acquire, but this magnanimity has not been elsewhere observed.
Wait, is it a day ending in 'y'?
It's "rationale", not "rational", but otherwise well-reasoned and well-stated.
(I had thought the Spelling Nazi had been beaten to death by years of online reading, but it still rears its' ugly head, usually when something is otherwise perfectly written.)
SO “Dr.” Ed2, when did you realize you didn’t have the Cranial Horsepower to become a “real” Doctor? Which was the second thing my future In-laws asked, after how a guy with an Irish last name was Jewish, if I was a “real” Doctor. Used to have a collection of photos of cracked chests, intraoperative craniotomy photos before cellphones let any idiot take a photo of anything, photo places sometimes wouldn’t give me copies if they were really bad, umm, ok, sometimes they weren’t medical photos.. To show A-holes who questioned my medical Boner-Fides. Oh yeah, don’t you realize by emphasizing that you’re “Dr” Ed, you’re just a less slightly annoying version of “Dr.” Jill Biden? and I’m only Dr. Drackman at work (OK, sometimes on the airplane, you know how many extra Delta Miles I’ve gotten for calling in a scrip for a Stew?) every where else it’s just “Frank” and I’m just a man, like you,
Frank
I’ve got a Joseph Ladapo holding on line 1
Are we blind to the "public health crisis" left in the wake of COVID-19.
In the opinions of many, public heath authorities issue decrees independent of any science. They have become a scourge on public health. Some examples cited by the critics are false or myths, but some are true. It is the public's privilege to set the bar for credibility as high as they wish.
Related is the overall crisis in science. Read the headlines saying that many or most scientific research papers published are phony.
Archibald Tuttle 3 hours ago
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Are we blind to the “public health crisis” left in the wake of COVID-19.
Related is the overall crisis in science. Read the headlines saying that many or most scientific research papers published are phony.
Adding to your comment regarding scientific research papers being phony. Its not so much that a high percentage are phony, its that many are overyhyped and surprisingly few people have either the elementary math skills to recognize bad data or bad statistical analysis or are simply willing to believe crap studies because the fit their political bias. pro mask studies, gas stove causing 12% of asthma cases, 98% positive transgender outcomes are just some of the examples of poor data quality studies that are touted by activists as the gold standard.
I'm probably the only M.D. (Mentally Deranged) regularly commenting here, and one of the shrinking few who still smoke (like Barry Hussein Osama, my quitting is a "Work in Progress") Started med school in 1984 when many of the cool Docs smoked, one Anatomy Professor smoked a pipe during lecture, and when we got to the Hospital 3rd year, you could smoke in the Doctor's Lounge, and in the break rooms in the ICU.
Down to a pack a month, and no longer need the Medical Marriage-a-Juan-a because my Glaucoma miraculously resolved when my practice started requiring random drug screens,
Frank 'need a cigarette'
You should quit frank. My old man just had surgery for lung cancer. No fun at all.
Not fun for the Surgeon or Gas Passer either, you have to use a double lumen endotracheal tube so you can deflate the lung the Sturgeon’s working on while still ventilating the opposite one, and it’s tricky, because the Surgeon and Gas Passer’s perspectives are opposite, often ends up being an Abbot and Costello routine,"Right Lung down!" “Left Lung down!,” “Right! Left Lung Down!” “No! Right Lung!” “Not the left lung?” “No!” “Third Base!”
Frank
Science can't operate if publishing dissident views is banned. The cure for bad speech on matters of opinion (which includes all health advice) is more speech.
I would feel differently if the doctor doing the speaking were actually selling harmful products or services for money, because then it would be fraud.
The real problem is the ongoing political battle between those who believe that harm reduction is the correct approach to major public health issues and those who cling to the belief that prohibitionism is the only valid approach to problems of substance use and abuse. Then of course there are turf battles between federal agencies whose mission is scientific (FDA, CDC) and agencies whose mission is law enforcement (DEA, ATF). Huge amounts of money, prestige, and political capital are on the table, and no one wants to be the first to propose serious compromises regardless of the relative safety of this or that and of the body counts that continue to rise. Jesus wept.
Seems everyone here is assuming vaping = nicotine. Vaping is a method, not a substance. Nicotine is not the only substance people are vaping these days. What about vaping THC, CBD, and mixed cannabinoids? Now I'm seeing ads for vaping melatonin, and vaping of vitamins has come to my attention. What about vaping flavors with no drug component? So you can't discuss vaping and assume it's all about nicotine.