• August 12, 2020

Muddy waters

Confusing claims about e-cigarettes may deter smokers from giving up their habit.

By George Gay

According to the liar paradox, if somebody says she is now speaking falsely, what she says is true if and only if it is false; but don’t take my word for it. The truth is that the truth is often a devilishly difficult thing to pin down, and, in fact, some people claim that we should not worry whether our beliefs are true or false as long as they work for us. Others go a step or two further and say that the truth can be ruinous to the ordering of the things of the world, and I’ve started to believe that some nicotine- control advocates see the world this way.

Why all the talk about truth? Well, there just seems to be a huge outbreak of interest in it at the moment. In September, the American Legacy Foundation, which described how in the past it had “waged a bold and historic battle with Big Tobacco,” reported that it had been renamed the Truth Initiative.

Also in September, the advertising watchdog Truth in Advertising was warning consumers “eager to try out e-cigarettes” that they needed to be “wary of the flood of questionable ad claims on the Internet.” A review it had carried out had apparently found that nearly two-thirds of sites made one or more of the following “problematic claims: vaping products are safer than tobacco, can be smoked anywhere, can help smokers quit, and are cheaper than traditional cigarettes.”

In my view, two of the “problematic claims”—the first and the third—are almost certainly truthful; one—the fourth—is probably truthful in more places than it is not; and the other, if you want to be pedantic, is not true because, for instance, you couldn’t use a vapor product while undergoing an MRI scan because there simply wouldn’t be room. So, again in my view, what this organization is saying isn’t untruthful—after all, what does it mean by “problematic”—but it is unhelpful because, in being vague, it sows confusion in the minds of people. It is the pursed-lips warning from the congenitally unadventurous: “You can never be too careful.”

In a press note, the watchdog’s executive director, Bonnie Patten, was quoted as saying that consumers needed to do their own independent research and not simply rely on the marketing claims made by companies on their websites. But I wonder what she means by this. Surely, she isn’t suggesting that consumers start out on a scientific quest that seems for the time being at least to have confounded the best brains at the U.S. Food and Drug Administration (FDA)? But if she merely means that consumers should head for the Internet, I can tell them what they will find: more confusion. And I’m not talking about the sorts of confusion that you might expect, where health lobbyists and pro-vapers trade dodgy factlets. This is confusion caused also by health experts who cannot agree among themselves.

For example: On Aug. 28, Action on Smoking & Health ASH issued a statement saying that it was “saddened to see The Lancet editorial today attacking Public Health England (PHE) for having ‘fallen short of its mission.’”

“To criticize Public Health England for quoting an estimate, contained in the expert review it commissioned, that e-cigarettes are 95 percent less harmful than tobacco on the basis that the methodology behind the estimate was weak is to miss the point,” the statement said. “To quote professor Michael Russell in the British Medical Journal in 1976, ‘People smoke for nicotine but they die from the tar.’ As the expert review concludes, e-cigarettes do not contain most of the toxic and carcinogenic constituents of smoke. Any they do contain are in very low doses, mostly far below safety limits for occupational exposure.”

ASH went on to say that it was concerned that, based on YouGov smoke-free Britain polls, a growing number of smokers were failing to understand the relative risks and might as a result be put off switching from smoking.

Justified concern

ASH seems right to be concerned. Stories about the decline in smokers switching to vaping and about vapers returning to smoking are not hard to find. And no doubt some of this decline can be attributed to stories in the media concentrating on the most sensationalist aspects of the findings of research that is later found to be totally misleading.

And what needs to be remembered here is that this isn’t just another academic spat. Six million people die prematurely each year because of smoking-related illnesses, we are told; so, having found another less risky product capable of substituting for cigarettes among smokers—the other being snus—it seems absurd that people with the power to influence public opinion should muddy the water.

This is not an argument against free speech or for stifling the pronouncements of people who have tested e-cigarettes using a method that fairly replicates the way in which vapers use them and found what are in the minds of the testers worrying results. Such people should come forward without delay. This is an argument against the sowing of confusion on the back of the results of poorly conducted research, and against the propagation of reports where the results are poorly presented.

Often, I have noticed, research results will be accompanied by meaningless phrases such as, “It is possible that these figures are underestimated,” as was the case in one recent report about worldwide deaths—estimated at more than 250,000—linked to smokeless tobacco use. “More than 250,000” suggests a possibly unlimited number within the confines of the number of smokeless-tobacco users, and even this unlimited number, according to the researchers, could be an underestimate. This is not providing information; it is spreading confusion. It is closer to marketing than to science, and clear water needs to be maintained between the two. When people see that the makers of Vimboom Plus claim that their product provides up to 90 percent of the daily requirement of vitamin C, they are aware that they are being cajoled into thinking the figure is close to 90 percent when it might, of course, be 0.0005 percent. But when “scientists” or “researchers” make claims, these are often accepted at face value by the general public.

This matters. Many smokers don’t need much of an excuse to stick with their habit. And it is not only because of the spread of confusing “information” that they are likely to do so. There is what I would call the worm technique, usually delivered to the brain through headlines. Here are a few I spotted during September: “More than half of kids exposed to e-cig marketing”; “Do e-cigarettes lead to cigarette smoking?”; “South Florida investigative report teens vaping dangerous drugs on the rise”; “School pupils exposed to e-cigarettes”; “Use of e-cigarettes to vaporize marijuana common among teens”; “Vaping poison put children at risk”; “Tobacco industry uses advertising to target youth with e-cigarettes”; “E-cigarettes still not banned on airlines”; and “Long-term effects of e-cigarettes still unknown.” I don’t have space here to go through these individually, but it is pretty obvious how these worms work. A lot of them appeal to the emotions through the exploitation of young people, others raise questions that the reader is expected to assume have only one correct answer, and others deliver assumptions: E-cigarettes still not banned on airlines.

Smokers—well those who take notice of such things—are subjected to all of these worms and are immersed in all of this confusion, but it has to be remembered that they see also a lot of positive stories about e-cigarettes and a lot of what I shall call, for want of a better term, “positive worms.” When I was looking at headlines, I saw at least as many vapor-product-positive headlines as negative ones. And there are beacons of reason out there. Whenever I’m getting to the point where the confusion is building up, I head for Michael Siegel’s blog, and I’m sure that a lot of vapers take shelter there.

Siegel is a professor in the Department of Community Health Sciences at the Boston University School of Public Health, and his only vested interests seem to be improving public health and telling the truth. Last month, he turned his attention to a decision by the FDA to order the removal from the U.S. market of four cigarettes, a decision that seemed to be based partly on the idea that the ingredient and delivery levels of cigarettes determined how detrimental they were to the public’s health—an idea that most of us thought got thrown out with the idea of “light” and “mild” cigarettes. “But even more preposterous than this is the fact that, while the FDA views some cigarettes as being safer, it does not view e-cigarettes as being safer than tobacco cigarettes,” Siegel wrote.

Given that there are these antidotes (there are a number of others out there besides Siegel) to all of the confusion and despite the fact that some smokers will clutch at straws to allow them to continue smoking, the question has to arise as to why a considerable number of smokers seem to be deterred from switching to vapor products. It seems to be the case that there must be other factors at work. One thing that strikes me is that, while smokers are being assailed with a considerable amount of negative publicity, some of the vapor products that they had started to use seem no longer to be available or seem now to have much lower profiles than they once did. Certainly, this is what I seem to have noticed in the U.K., and people in the U.S. tell me that this has happened also in their country. And advertising for some of these products has seemingly almost disappeared even though the products have been taken over by big companies with deep pockets.

I cannot help thinking that the atrophying of advertising for e-cigarettes is going to fertilize the negative perceptions planted in the minds of smokers and vapers by reports questioning whether e-cigarettes are less risky than are traditional cigarettes. I’m not advocating the use of “problematic” advertising for these products, but it has to be borne in mind that these are still new-ish products, and if people are going to have confidence in them, at the very least they’ve got to be seen to exist.