Despite being on the U.S. market for more than a decade and a half, there is a lot of misinformation about e-cigarettes and nicotine and tobacco harm reduction.
A recent global survey of more than 15,000 doctors representing 11 different countries came to the alarming conclusion with 74 percent of participants “incorrectly [believing that] nicotine causes a range of illnesses from lung cancer to COPD.” More recently, ABC News (and other outlets) picked up on updated guidelines from various public health trade associations (including the American Heart Association (AHA) and the American College of Cardiology), claiming that doctors “increasingly discourage vaping amid mounting health concerns.”
In 2021, an estimated 10.4 million American adults 25 years or older were currently using e-cigarettes, with many of them having used the novel technology to quit smoking. Nearly a decade of research has found e-cigarettes to be significantly less harmful, yet the newest guidelines and doctor’s opinions are not based on science and are harming adult consumers.
The updated guidelines state “[a]lthough e-cigarettes increase the likelihood of successful smoking cessation compared with nicotine replacement therapy, because of the lack of long-term safety data … e-cigarettes are not recommended as a first-line therapy for smoking cessation.” While the authors of the report note identify at least 29 randomized control trials indicating efficacy in cessation, they ascertain that only five are “at a low risk of bias.” The guidelines again repeat to not recommend e-cigarettes a “first-line therapy for smoking cessation,” and urge that patients with chronic coronary disease who use e-cigarettes “be warned about risks of developing long-term dependence and encouraged to quit use of e-cigarettes promptly to avoid potential long-term risks.”
The ABC News article quotes the President of the American Psychiatric Association as remarking that “there are other very powerful, safe and FDA approved interventions.” The article then goes on to confuse readers – bringing up the 2019 spate of vaping-related lung injuries – the majority of with the Centers for Disease Control and Prevention attributed to illicit vapor products, often containing THC.
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The doctor’s survey is even more disappointing. According to the survey administers, more than two-thirds (77 percent) of doctors “mistakenly believe nicotine causes lung cancer.” Further, among American physicians, 70 percent “moderately” agreed nicotine was the source for “lung, bladder, and head/neck/gastric cancer.”
This misperception of nicotine’s role in causing cancer is nothing new.
A 2018 study examining a 2017 government health information survey of American adults found that 53 percent believed that nicotine is what caused most of the cancer related to smoking. A 2020 Rutgers-led survey of more than 1,000 physicians determined that 80 percent of respondents “believe it is the nicotine directly that causes cancer.” Recently, a 2022 study estimated that 61.2 percent of adults who smoke believe that nicotine causes cancer.
Interestingly, in some of these surveys, adults who used e-cigarettes were less likely to report a misperception about nicotine. The 2022 study found that adult smokers who had used e-cigarettes and/or smokeless tobacco “had significantly lower-than-average prevalence of the [nicotine] misperception.” The 2018 study reported that adults who smoked were more likely than e-cigarette users (52.5 percent to 14.6 percent) to believe nicotine was the cause of smoking-related cancer.
While addictive, nicotine is not what causes the most harm in combustible cigarettes and multiple entities have acknowledged that.
The International Agency for Research on Cancer (an intergovernmental agency of the World Health Organization) has reported that nicotine does not cause cancer. The U.S. Food and Drug Administration (FDA) has stated that nicotine “is not the primary cause of cancer and other chronic smoking-related diseases.” The U.S. Centers for Disease Control and Prevention point out that “nicotine medicines” do not cause cancer, lung disease, and that they are “much less likely to cause heart disease than continued smoking.”
Unfortunately, doctors associated with the AHA (which has received millions of dollars from anti-smoking and anti-vaping billionaire Michael Bloomberg to promote e-cigarette prohibition) continue claim there is not enough evidence to determine the long-term effects of e-cigarette use.
But there are long-term studies showing improved health outcomes among e-cigarette users.
A 2017 longitudinal study found that use of nicotine replacement therapy and/or e-cigarettes was “associated with substantially reduced levels of measured carcinogens and toxins relative to smoking only combustible cigarettes.” A 2020 longitudinal study of adults who smoked and had COPD found “significant and constant improvements in lung function” and COPD symptoms at a five-year follow-up.
Other liberal governments including the U.K. and New Zealand are actively encouraging adults who smoke to switch to e-cigarettes and other tobacco harm reduction products. The U.K. government is even handing out one million free e-cigarettes to promote switching.
Unfortunately, massive misinformation campaign in the U.S. is being largely driven by billionaire Michael Bloomberg who is funding anti-vaping organizations like the AHA, as well as the CDC Foundation, which monitors e-cigarette use. The vitriolic attack against less harmful alternatives to cigarettes has even stunted the FDA from being able to responsibly regulate an industry that has been active in the states since 2007. To date, the agency has approved only 29 e-cigarette products, while denying millions of others, many which were introduced (and sold) long before the so-called youth vaping epidemic.
American public health agencies, as well as physician-oriented associations, should be ashamed of themselves. The misinformation surrounding nicotine is harming the adults who smoke and American consumers and will keep the significantly harmful, cancer-causing combustible cigarette a commonality for the foreseeable future.
Lindsey Stroud is Director of the Taxpayers Protection Alliance’s Consumer Center.
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