Vaping products are not associated with increased heart attack incidence among people without a history of smoking combustible cigarettes, according to a new study. Published in the American Journal of Preventive Medicine, researchers also concluded that three previous studies claiming a link between e-cigarettes and heart disease wrongly included those who previously smoked cigarettes or were using both vaping and combustible products. One paper even included participants who had heart attacks before they had ever vaped.
“Previous researchers confused their own models’ assumptions that these risks were independent with the idea that their analyses validated the presence of independent risks,” the researchers wrote. “There is no reliable evidence that e-cigarette use is associated with ever having had a myocardial infarction among never smokers.”
Authored by Michael Siegel, a community health sciences professor at Boston University, and University of California, Berkeley, business professor Clayton Critcher, analyzed data from 175,546 respondents to the annual National Health Interview Survey from 2014 to 2019. They found that daily e-cigarette use was only associated with higher heart attack incidence among people who were also currently smoking combustible cigarettes (duel users)—and that there was no evidence at all for increased risk among vapers who had never smoked combustible cigarettes.
Credit: NDABCREATIVITY
The researchers state that the initial study had drawn its conclusions about a perceived cause (vaping) and effect (heart attack) without factoring in a key variable (smoking). Critcher and Siegel acknowledge that a more thorough analysis of previous research would have noted that e-cigarettes are relatively new, limiting the ability to assess long-term health effects and make comparisons with combustible tobacco smoking, in an article with Filter. However, the findings of previous research that e-cigarette use in of itself causes heart attacks is fundamentally flawed.
A 2018 study, also published in the American Journal of Preventive Medicine, claimed that daily vapers increased their odds of heart attack. However, the study only included participants who used both e-cigarettes and combustible cigarettes—none who used e-cigarettes alone. Suspicious of that methodology, a different group of researchers published a reply, arguing the importance of examining the purported link among people who had never smoked combustible cigarettes. Authors of the original study then published a reply to that reply, arguing that such a distinction wasn’t necessary.
In the meantime, two (one, two) other papers were published based on the original paper’s claims, lending further harmful legitimacy to the idea of a link between e-cigs and heart attacks, according to Kevin Garcia writing for Filter.
The second of those two papers was coauthored by the former prominent tobacco harm reduction opponent Stanton Glantz. It was retracted in 2020 for basing its claim that vaping caused heart attacks on evidence that included heart attacks from before the participants had even started vaping. Three weeks after the American Heart Association’s journal retracted the vaping study, academics and health experts began pushing for another influential peer-reviewed medical journal to retract another Glantz study.
A new Yale University study shows that flavor bans cause an increase in underage smoking.
By Maria Verven
A new study by the Yale School of Public Health suggests that San Francisco’s ban on sales of flavored tobacco products may have substantially increased smoking among minors. When San Francisco voters approved a ban on the sale of flavored tobacco products, including menthol cigarettes and flavored e-liquids in 2018, public health groups prematurely celebrated another “win” in their battle to reduce teenage vaping.
Now advocates of the ban must come to terms with the fact that the flavor ban, and most likely similar flavor bans around the world, are inextricably tied to significant increases in teenage smoking rates. According to the study, the odds that high school students would start smoking conventional cigarettes doubled in San Francisco’s school district after the ban was put into effect when compared to districts that didn’t implement a flavor ban, even when adjusting for individual demographics and other tobacco policies.
A Threat to Public Health
Published in JAMA Pediatrics in May 2021, the sole author of the study, Abigail Friedman, associate professor in the Department of Health Policy and Management at the Yale School of Public Health, said the study is the first to assess how complete flavor bans affect youth smoking habits. “These findings suggest a need for caution,” she said. “Even if it is well-intentioned, a law that increases youth smoking poses a threat to public health.”
Before the ban was implemented, smoking rates in school districts in and around San Francisco were on the decline. Using data on over 95,000 youth from the Youth Risk Behavior Surveillance System’s 2011–2019 school district surveys, Friedman compared trends in smoking rates in San Francisco versus other districts. The findings revealed a glaringly large discrepancy after the flavor ban went into effect. In 2019, San Francisco’s smoking rates rose to more than twice the average of school districts without a flavor ban. In those districts, smoking rates among youth continued to fall.
E-cigarettes—and particularly those with flavors—have been the most popular tobacco product among U.S. youth since at least 2014. “Some kids who vape choose e-cigarettes over combustible tobacco products because of the flavors,” Friedman said. “For these individuals, banning flavors may remove their primary motivation for choosing vaping over smoking, pushing some of them back toward conventional cigarettes.”
Michael Siegel, professor in the Department of Community Health Sciences at Boston University School of Public Health, said society is at a critical juncture with regard to youth smoking. “It has plummeted to record lows and on top of that, a culture of vaping has completely replaced the culture of smoking,” he said. “The policies enacted in the next year could likely decide what happens next.”
Huge Policy Implications
Credit: JAMA Pediatrics
The results of the Yale study should have huge implications for other states and even other countries when deciding to ban flavored vapes. According to the National Conference of State Legislatures, five states—California, Massachusetts, New Jersey, New York and Rhode Island—have implemented laws banning flavored electronic nicotine-delivery systems (ENDS), and at least 310 localities have passed restrictions on menthol cigarettes and/or flavored tobacco products (including e-liquids), although these laws vary widely.
The U.S. Food and Drug Administration implemented a partial ban on the sale of flavored closed-system e-cigarette products in January 2020. The FDA ban exempts menthol and tobacco flavor as well as open tank vaping systems, which tend to be sold in vape shops where age restrictions are more often enforced.
Members of Congress have been pressuring acting FDA Commissioner Janet Woodcock to ban all flavored e-cigarettes, maintaining that flavors are attracting youth to ENDS products. Woodcock has not indicated whether the agency has plans to ban or otherwise limit the sale of flavored vapes, but a decision could be made this fall.
When asked to comment on the trend that youth use of cigarettes was declining while their use of ENDS products was on the rise, former FDA Commissioner Scott Gottlieb said the trends are not acceptable, even if they are moving in a more positive direction of reduced overall use of tobacco products. “Even if kids are using ENDS [products] instead of cigarettes—and that migration in part accounts for the decline in youth [combustible] cigarette use—that’s still not an acceptable trade,” he said.
Clive Bates, a tobacco harm reduction expert and former director of Action on Smoking and Health U.K., called this argument outrageous, adding that just because a regulatory agency believes young people should not smoke or vape does not mean that is how it plays out in the real world. “Public health is about dealing with the world as you find it—not giving instructions to people who are not listening, uninterested in your views and unimpressed by your authority,” said Bates. “But that doesn’t mean a regulator is absolved of responsibility for the consequences (good or bad) of its actions.”
Since Gottlieb essentially said that the FDA doesn’t care if vaping is helping to reduce smoking, Bates says the FDA is ignoring a big public health benefit that has been a goal of U.S. policy for decades. “The dangerous corollary is [that] the FDA doesn’t care if their anti-vaping measures increase smoking among adolescents. That’s what is so despicable about this lofty attitude—it’s an indifference to the group most at risk,” Bates said. “Yet the FDA doesn’t care if vaping works as an alternative to smoking for adolescents—and this is deeply unethical.”
Generally, regulators do not allow adolescent experimentation to bend adult society and legitimate choices out of shape, especially if these are beneficial to adults, according to Bates. “It should not be taken as a given that adult products that appeal to adolescents should be banned. For many, it is part of being a teenager to sample the forbidden fruits of adulthood,” Bates explains. “We don’t respond to youth experimentation by banning other potentially harmful adult products like alcohol or cannabis just because adolescents use them,” Bates said. “Though it has risen sharply, vaping is not out of the ordinary compared to the prevalence of other risk behaviors. But crucially, it does not actually pose much risk.”
Decisions That Kill
In June, Health Canada admitted in a regulatory impact statement that its intended flavor ban could lead to an increase in the smoking rate. David Sweanor, an industry expert and chair of the advisory board for the Centre for Health, Law, Policy and Ethics at the University of Ottawa, said that the Health Canada statement is basically saying Canadian regulators know they are going to do something that kills Canadians.
“Countries that simply allow alternatives, even without actively facilitating substitution, are seeing dramatic declines in cigarette sales,” Sweanor said, citing Japan, where cigarette sales over the past five years declined at a very rapid pace—far greater than declines in other countries, including the U.S. “I think the biggest constraint on progress is a lack of understanding of the magnitude of substitution effects. To dramatically reduce the use of lethal cigarettes, we need products that are less hazardous and evidence that consumers will switch to them in sufficient numbers to justify substitution as a policy intervention.”
Sweanor said efforts that show the extent of substitution effects are blocked by the absence of funding for such research, obstruction from the anti-vaping moralists and those pursuing a “tobacco-free world” agenda. He also believes that tobacco companies may be reluctant to release sales and consumer research data that would bolster policies designed to undermine their lucrative cigarette business. “Jurisdictions that allow viable alternatives to cigarettes, where such products are as accessible as cigarettes and consumers aren’t given misleading information on relative risks, will see far more rapid declines in smoking,” Sweanor said.
Friedman said the findings from her study strongly suggest that policymakers should be careful not to inadvertently push minors into using the more harmful product. When asked to suggest an alternative policy, she suggested that states consider restricting all tobacco product sales to adult-only (21-plus) retailers. “This would substantively reduce adolescents’ access to tobacco products at convenience stores and gas stations without increasing incentives to choose more lethal combustible products over noncombustible options like e-cigarettes,” she said.
Sweanor added that good policies are contagious and would be replicated. “I am confident that science and rationality combined with consumer advocacy will ultimately win,” he said. “Unfortunately, those opposing such policies can cause lengthy delays, which can result in a tragic and avoidable loss of life.”
Science, Reason and Humanism
Abigail Friedman, PhD
Seigel says that there is hope that the Yale study impacts future decisions regarding flavor bans; however, the mainstream anti-tobacco groups are not going to publicize the study because it goes against their preordained conclusions. “If flavor bans are widely adopted, I suspect that many youth who are experimenting with vaping will switch over to cigarette smoking and some will use THC vapes off the black market,” he said. “In contrast, with sensible policies that restrict e-cigarette availability to youth while allowing adult smokers to continue to access them, I think we could drive youth smoking pretty much into the ground—perhaps to a level from which it could never recover.”
Bates questioned how regulators and lawmakers alike could continue with confidence in implementing flavor bans after seeing the results of the Yale study. He added that he seriously questions whether legislators will admit that the ban was a bad idea and reverse course.
“It may put the brakes on some of the worst policy mistakes,” he said. “It’s what many of us have been saying should be expected from a flavor ban. But legislators hate to admit they were wrong, so it will probably lead to calls for tougher enforcement and anti-smoking campaigns rather than realizing that the whole idea is wrong.”
In jurisdictions where viable alternatives to combustible cigarettes are made available, data has shown that the rates of combustible cigarette smoking among youth and young adults is plummeting, according to Sweanor. “More importantly, we are seeing longer term cigarette smokers whose lives are truly on the line, substituting low-risk alternatives,” he said. “People’s response to research depends on motivations. There is a very long and frustrating history of reduced-risk alternatives to cigarettes being attacked by those on a moralist quest to rid the world of nicotine.”
Vaping products are attacked based on accusations about formaldehyde, popcorn lung, e-cigarette or vaping use-associated lung injury (EVALI), cognitive impairments and a seemingly endless list of other supposed hazards, Sweanor explained, adding that these arguments are ultimately shown to be meritless, but vaping opponents never admit to being wrong.
“Such behaviors are hallmarks of conspiracy theorists and those seeking to use the power of the state to impose their moral views on the behavior of others. But where lawmakers are open to science, reason and humanism, studies such as this … [Yale study] are very important,” said Sweanor. “Public health breakthroughs are possible when rational lawmakers get past the panics caused by the moralists. We are staring an historically significant public health breakthrough in the face. The sooner lawmakers recognize this, the sooner we can relegate cigarettes to history’s ashtray.”
The original “Vaping Vamp,” Maria Verven owns Verve Communications, a PR and marketing firm specializing in the vapor industry.
Policy experts weigh in on the vaping industry’s future under the Biden administration.
By Maria Verven
Within days of assuming office, U.S. President Joe Biden issued executive orders to respond to Covid-19, by far the biggest global health threat in over 100 years. It may be months or even years before anyone knows how the new administration and the U.S. Centers for Disease Control and Prevention (CDC) and its new director, Rochelle Walensky, will respond to another major health threat: the 480,000 annual deaths caused by combustible cigarettes.
Vapor Voice interviewed vapor industry leaders and legislative experts for their opinions on how the vapor industry might fare under the new administration. The panel includes:
Mark Anton, executive director, Smoke-Free Alternatives Trade Association (SFATA)
“Let’s get the junk science funded by big pharma and the tobacco Master Settlement Agreement out of the narrative of harm reduction. The federal government must be guided by the best science to ensure responsible decision-making.”
Gregory Conley, president, American Vaping Association (AVA)
“Legal nicotine vaping products are far less hazardous than smoking and serve a vital public health role in helping adult smokers quit.”
Michael Siegel, professor, Department of Community Health Sciences, Boston University School of Public Health
“Vaping is, for many smokers, a life-saving health decision. It is much safer than smoking and is literally saving the lives of smokers who would likely die if they weren’t able to stop smoking.”
David T. Sweanor, adjunct professor, advisory board chair, Centre for Health Law, Policy & Ethics, University of Ottawa
“It’s the smoke, stupid.”
Vapor Voice: What policy changes might the Biden administration make regarding vaping products?
Anton: During the Biden administration, SFATA is taking the lead in youth prevention with the creation of the Responsible Industry Network, which we presented to HHS and the FDA. This would allow adults to access flavors while protecting small businesses through the FDA’s PMTA (premarket tobacco product application) process.
Mark Anton / Credit: SFATA
Adults need access to products that help them transition away from combustible cigarettes, so unfavorable e-cig policies and flavor bans should not be on their agenda. Vaping is truly a good tool for tobacco harm reduction. The industry is made up of former smokers who strive to develop the best manufacturing practices without the FDA’s help. To protect against youth use, SFATA supports the enforcement of T21 [Tobacco 21], passed by Congress and signed by the president. Covid[-19] policies have prevented true enforcement.
Finally, the CDC should always give true assessments and release reports to the media and medical and public health journals. Last year, the CDC failed to give a full accounting of EVALI (vaping-related lung illnesses), when they should have made a declarative statement that vaping nicotine e-cigs was not the cause.
Conley: Sadly, there is no use answering this question as there’s no indication whatsoever that the Biden Administration will make favorable decisions with regard to vaping products. I would be thrilled to be wrong, but after a decade of fantasizing about smart policy and regulations and only getting the opposite, it’s time to stop dreaming and work within the broken system we have.
Siegel: Introduce legislation to ban the sale of tobacco products, including vaping products, with the exception of stores only open to [consumers] 21-plus that only sell these products. And direct health insurance companies to cover electronic cigarettes just as they cover other forms of nicotine-replacement therapy.
Encourage physicians to promote vaping for smokers who are unable to quit using other means. And direct the CDC, FDA and other national health agencies to endorse the use of vaping products for smoking cessation, especially when traditional medications do not work. Finally, discontinue the requirement for PMTAs for vaping products and, instead, directly regulate these products by forcing the FDA to promulgate safety regulations.
Sweanor: Follow the science on relative risk and communicate truthfully with the public. And empower those who use nicotine to have control over their health though ready access to a wide range of low-risk alternatives to cigarettes and risk proportionate regulation of the spectrum of products. Access to alternatives to cigarettes should be no less urgent a public health goal than access to Covid[-19] treatments and vaccines. Government policy should reflect this urgency.
What were the most egregious policies implemented during the Trump administration?
Anton: Clearly, CDC misinformation about EVALI, falsely accusing e-cigarettes and seeking to ban flavors without sufficient scientific evidence is high on the list of misguided policies. And despite all the research to the contrary, they created hysteria by calling e-cigarette use by minors an ‘epidemic’ when it was not. The true epidemic is 480,000 smokers dying every year from smoking combustible cigarettes.
Conley: [Former]President Trump created a wave of issues when he declared that flavored vaping products should be banned because they were killing people. He was undoubtedly being fed bad information from his advisors, but it was ridiculous coming from the supposed pro-business, anti-regulation POTUS. Even Trump’s biggest fans realized that one of his flaws was his inability to hire competent people who shared his worldview. Putting Alex Azar in as Secretary of Health and Human Services assured there would be no positive movement to reform vaping regulations at any of the agencies HHS oversees.
Greg Conley / Credit: AVA
Siegel: The ban on flavored e-cigarettes in pod systems and the requirement that companies must submit PMTAs to stay on the market both need to be reversed. There does need to be regulation of nicotine strengths, especially for nicotine salts, but getting rid of flavors isn’t going to solve the problem of youth vaping, and it is hurting many adult ex-smokers.
Sweanor: I think the biggest failure was the failure to remove the mounting barriers confronting less hazardous products such as e-cigarettes. After a steep decline in cigarette sales by substituting safer products, particularly vaping, cigarettes started making a comeback as the CDC and other agencies engaged in a massively misleading campaign against vaping.
Meanwhile, the FDA put vaping at a marketplace disadvantage compared to cigarettes. Research showed those most at risk were misinformed about the relative risks.
At the end of Biden’s term, what state do you think the vaping industry will be in?
Anton: The outlook is not very bright for the small vaping industry based on Biden’s cabinet selections; many have anti-vaping outlooks and ignore the multitude of studies in support of the harm reduction potential of vaping products. The focus has been on youth use even though it’s decreasing at record levels. Much of the vapor industry success or demise will hinge on the Biden administration’s willingness to look honestly at the science. Additionally, Congress has pushed to ban flavors despite the fact that flavors are an important tool for the average smoker to quit smoking.
Politics have clouded the potential of this industry’s ability to reduce harm in the U.S. regarding smoking combustible cigarettes. If the Biden administration follows this path, we will be worse off. But if they choose science and real life, it will be better. Much hinges on the role the FDA will play in issuing marketing authorizations.
Conley: Right now, most adult vapers can easily access tens of thousands of different vaping products in every flavor you can think of. While there will always be a gray market and internet sales, the legal market will never be as free as it is today.
Four years from now, there will still be a legal market for tobacco-derived nicotine vaping products authorized by the FDA. It may not be a great market, but it will exist. Companies with authorized products will do everything in their power to disrupt the gray market such as stand-alone devices, nicotine-free or tobacco-free nicotine e-liquids that many vapers rely on.
Siegel: It will probably be worse off. If the administration enforces the PMTA rules, many vaping products will be taken off the market. Big tobacco companies and a few large independent companies will dominate the market. The growth of the e-cigarette sector will wane. Many ex-smokers will return to smoking, and e-cigarettes will no longer serve as an off-ramp for as many smokers.
Dr. Michael Siegel
Sweanor: Ultimately, disruptive technology, science, rationality and human rights will win, and cigarettes will go the way of previous categories of unreasonably hazardous goods and services. The question of whether that happens within four years depends on the way politics unfolds and the emergence of leaders who see the opportunity and relentlessly pursue it.
Is limiting the level of nicotine a viable solution for users of conventional tobacco?
Conley: Bloomberg-funded prohibitionists and legislators who can’t differentiate between classes of vaping products are not going to be swayed by nicotine limits. Their goal is prohibition. When you give in to the prohibitionists, all you’re doing is guaranteeing they’ll be back next year to argue that we need flavor bans because nicotine limits didn’t work.
Siegel: Yes. Limiting nicotine in e-cigarettes will help reduce youth addiction to these products. There is also evidence that very low nicotine cigarettes can result in much lower levels of addiction in cigarette smokers.
Sweanor: No. It’s a replication of the disastrous Volstead Act that ushered in Prohibition, which forced beer and wine to have no more than a minimum level of alcohol.
David Sweanor
The total U.S. nicotine market is over $80 billion, and the cigarette market alone is over $60 billion, with tens of millions of consumers. The products are far more dependence-producing than alcoholic beverages. A prohibitionist policy is very unlikely to garner political acceptance and could rapidly lead to the sort of entrepreneurship and criminality long associated with other abstinence-only campaigns.
Many who are pushing for such a policy also oppose the wide availability of consumer-acceptable low-risk alternatives to cigarettes, demonstrating that this is a flawed moralistic strategy rather than a pragmatic public health one.
What chance do any of these proposed changes/solutions have at being implemented?
Anton: The previous FDA leadership has called the millions of smokers who have transitioned from combustible cigarettes to flavored vapor products ‘anecdotal evidence’ without investing any funds into research. The Biden administration and the new FDA leadership now has the opportunity to affect public health on a massive scale by investigating this hypothesis.
The U.K.’s National Health policy recommends that smokers who want to quit switch to vaping. They recognize vaping is safer than cigarettes. This is from the country that put warning labels on cigarette packs four years before the U.S. The Responsible Industry Network is a framework that will help prevent youth access, limit marketing to age-restricted stores and develop a pathway to prevent the loss of tens of thousands of small businesses. It brings together all the elements of the Tobacco Control Act (TCA)—protecting youth from smoking and tobacco use while assisting millions of adults who are trying to stop smoking.
While these are foundational items of the TCA and the FDA, politicians are missing the opportunity to help millions of current smokers because vaping is so politicized and youth use and access to vapor products has been blown out of proportion.
Siegel: The likelihood [that] these policies will be implemented is very low. I just don’t think the mainstream tobacco control and health organizations support the idea of harm reduction in tobacco control.
Sweanor: I have little ability to discern the likelihood of rational policies, in part because the current politics around nicotine seem to favor a War on Drugs mentality where the pursuit of total abstinence takes precedence over a public health orientation. Much will depend on Americans who use nicotine, a demographic Biden appears to care very much about.
The original “Vaping Vamp,” Maria Verven owns Verve Communications, a P.R. and marketing firm specializing in the vapor industry.
San Francisco’s proposed ban on vaping — inside your own apartment — is so anti-science, so counter to public health and so God awful stupid that I’m stunned Massachusetts didn’t do it first.
If you haven’t heard, the San Francisco Board of Supervisors voted 10-1 to ban smoking and vaping in apartments inside buildings with three or more units — unless you’re smoking or vaping pot, in which case it’s way cool and totally awesome, writes Michael Graham, whose editorial first appeared in the Boston Herald.
The alleged purpose of the ban is to protect your neighbors from the smoke you’re exhaling in your home. But as Dr. Michael Siegel of Boston University noted during a media conference call hosted by InsideSources Thursday, that claim fails two key points: If you’re banning “smoke,” how can you let people smoke pot? And why would you ban vaping, which doesn’t emit any smoke at all?
Michael Siegel
“San Francisco has taken an action which is not evidence-based,” Siegel said. “If I’m holding an electronic cigarette, there’s literally nothing coming out of that electronic cigarette,” Siegel said, “There is no ‘secondhand vapor.’”
Siegel is a nationally renowned anti-smoking advocate and expert on public health. He’s no fan of cigarettes, which is why he opposes bans on safer alternatives like vaping.
Combustible cigarettes are far more dangerous than their e-cig and vaping counterparts, the risk-comparison equivalent of a grizzly bear vs. a Gummi Bear.
But lifestyle-policing liberals in San Francisco and Boston don’t care. That’s why Gov. Baker and the Beacon Hill boneheads banned flavored vaping in 2019. The result? Lines at New Hampshire vape shops and more people turning to flavored cigarettes.
No problem — Massachusetts banned those, too, as of June 1, 2020. And what happened?
Massachusetts saw a 17% drop in cigarette sales year to year, says Ulrik Boesen of the Tax Foundation, who joined Dr. Siegel on the conference call. Good news, right?
“But in Rhode Island and New Hampshire their sales increased by 56%, Vermont’s by 21% and Maine by 30%. Significant increases in all the neighboring states simply because Massachusetts banned a popular product,” Boesen said.
“That means they did not achieve their public health goals, which was to get fewer people to smoke.”
Boesen’s the expert, but I have to disagree. The good-hearted, electric-car driving, NPR-listening liberals did achieve their goal. It just had nothing to do with public health.
No, their real goal is to make sure you smokers know they think you’re a bunch of losers.
Banning menthol smokes or vaping in your private apartment isn’t public health policy, it’s a punishment of the peons by the cultural elite.
“If the principle here is that nobody in an apartment should be exposed to harmful combusted products from an adjacent apartment, then there’s no justification for saying, ‘We’re banning tobacco, but not cannabis,’” Siegel said. And if there were, in fact, any principles at play, he’d be right. But this is pure classism, Commonwealth-style.
Which is why Massachusetts has made it easier to vape dangerous THC products than mango-flavored water vapor, and why San Francisco’s ban on “smoking” exempts the fog of marijuana fumes wafting from your bong.
Ban pot? No way, progressives answer. We smoke pot!
Dr. Siegel’s take on banning vaping in your home? “I think we should be doing the opposite. We should be encouraging smokers to switch to vaping, and we should encourage them to be vaping in their apartments rather than smoking, because the effects of secondhand smoke are substantial — especially if they’re living with children.”
He’s right, of course. But why “encourage” low-income, working class folks when “judging” them is so much more fun?
Any opinions expressed in the above article are solely the author’s and may not be the opinion of Vapor Voice or its parent, TMA.
Although it may have eclipsed our memories, COVID-19 is not the first disease outbreak that the Centers for Disease Control and Prevention has faced in the last three months.
It was as late as Feb. 25 — well after the first novel coronavirus case in the United States was reported — that CDC updated its numbers on what it called the EVALI (e-cigarette, or vaping-associated lung illness) outbreak. On that day, while COVID-19 was silently spreading throughout the country, CDC announced that this “e-cigarette”-related disease had caused 2,807 hospitalizations and claimed 68 lives. Little did we know at the time that these two events were profoundly connected.
Throughout its investigation of the first outbreak, CDC created public hysteria over the dangers of electronic cigarettes by attributing the outbreak to all vaping products, whether they contained nicotine or THC and whether they were purchased at a highly regulated vape shop or from a drug dealer on the street. The very name that CDC attached to the outbreak directly implicated electronic cigarettes, which are nicotine-delivery devices that are effective in helping adult smokers to quit smoking.
Following CDC’s lead, state health departments spread the word that using an e-cigarette to quit smoking could be life-threatening — so much so that seven states issued emergency bans on the sale of most or all electronic cigarettes.
Regulate, keep e-cigs away from youth
What the CDC failed to tell the public until nearly the end of the outbreak, and what many state health departments have still not publicly revealed, is that the lung illness outbreak was not caused by electronic cigarettes at all. Instead, it was caused by THC-containing vaping cartridges that were laden with a viscous oil — vitamin E acetate oil — that had begun to be used as a thickening agent in many black market THC vaping products shortly before the outbreak started.
Experts in the cannabis industry had the cause of the outbreak pretty much figured out by Aug. 30 and had definitively figured out the cause by Sept. 11. David Downs — the California bureau chief of Leafly.com — was almost single-handedly responsible for getting wholesale THC vape cartridge manufacturers (both licit and illicit) to stop using vitamin E acetate oil as a thickening agent. This not only led to the “eradication” of EVALI, but it has proven that e-cigarettes were never involved since the outbreak has ended but e-cigarettes continue to be sold in high volume and without any changes in their ingredients or manufacturing process.
Nevertheless, as late as Dec. 11, the Massachusetts Department of Public Health was still warning the public that: “We don’t understand what is causing these illnesses. From a public health point of view, we cannot recommend that anybody use vaping or e-cigarette products at this time.”
Sales data reported by PiperJaffray for the four weeks that ended Oct. 20 (when the Massachusetts emergency ban was in effect for 25 of the 28 days) and the four previous weeks (mostly before the ban went into effect) revealed that there was a substantial shift from vaping to smoking in the state. Nationally, there was very little difference in the rate of decline in cigarette sales between these two time periods from 2018 to 2019. The rate of decline decelerated by just 0.3 percentage points (from -7.8% to -7.5%). However, in Massachusetts, the rate of decline decelerated by a massive 5.7 percentage points (from -9.8 percent to -4.1 percent). This suggests that that many ex-smokers in Massachusetts who were reliant on e-cigarettes to stay smoke-free returned to smoking.
National data reported by Bloomberg News revealed the same pattern: the rate of decline in cigarette consumption slowed significantly because of the e-cigarette scare.
And the nation’s largest cigarette manufacturer — Altria — acknowledged in its 2019 annual report that: “Growth of the e-vapor product category and other innovative tobacco products has further contributed to reductions in cigarette consumption levels and cigarette industry sales volume and has adversely affected the growth rates of other tobacco products. Continued growth in these categories could have a material adverse impact on the business, results of operations, cash flows or financial position of Altria and its tobacco subsidiaries.”
What does this have to do with COVID-19?
It means that due to the zeal of CDC and other health agencies to condemn electronic cigarettes, cigarette smoking in the United States got a significant boost just before one of the most devastating respiratory disease outbreaks in our nation’s history. And there is strong evidence that smoking makes COVID-19 significantly worse.
Thus, the e-cigarette scare significantly worsened the health consequences of COVID-19, potentially resulting in more deaths than would have occurred if the CDC and state health agencies had simply told us the truth.
Dr. Michael Siegel is a professor in the Department of Community Health Sciences, Boston University School of Public Health, where he has conducted research on tobacco for 25 years. He wrote this for InsideSources.com.
