Saturday, May 30, 2020

Scary Stories About Vaping Aren't Helping Anyone

By Jacob Grier - May 30, 2020 at 06:00AM

Quit Vaping: Your Four-Step, 28-Day Program To Stop Smoking E-Cigarettes, by Brad Lamm, Penguin, 256 pages, $16

They say a lie will go 'round the world while truth is pulling its boots on, but today's debates over vaping may make you wonder if truth should even bother tying its laces. No matter how thoroughly they've been debunked, scare stories about the widespread lethality of e-cigarettes keep seizing the imaginations of journalists, politicians, and concerned parents.

The latest example is Quit Vaping, a new book by the Los Angeles–based "certified intervention specialist" Brad Lamm. Just looking at the front cover, you can see signs that Lamm's approach may be less than scientifically rigorous. There's the line boasting a foreword by Mehmet Oz, better known as Dr. Oz, a TV host notorious for promoting purportedly miraculous dietary supplements. Then there's the subtitle: Your Four-Step, 28-Day Program To Stop Smoking E-Cigarettes. No one "smokes" an e-cigarette—the absence of smoke is the whole point of the device—and this obvious misunderstanding foreshadows worse to come.

One shouldn't judge a book by its cover, but in this case the text lives up to expectations. The opening section, "Lies and Facts," offers a preponderance of the former. Initially I attempted to keep track of misleading statements and critical omissions by marking them with Post-its. By page 30, such a thicket had accumulated that I gave up. Adequately critiquing Lamm's selective reading of the scientific literature would be like trying to perform a live fact-check of a Trump campaign rally; the torrent of error is too much for any one person to handle. This section is a greatest hits collection of anti-vaping stories, recounting every possible danger and dismissing every possible benefit. In that sense, it provides a useful look at how coverage of the topic has become increasingly fear-based.

The moral panic over vaping is driven by two primary narratives: that e-cigarette use is an epidemic among teenagers and that the practice has deadly consequences. Worried parents are clearly a target audience for Lamm's book, and he does nothing to assuage their fears. He advises them to "know the signs" that their child may be a vape addict—signs including acne, secretiveness, irritability, and frequent snacking. As anyone who has known or been a teenager might attest, these are not exactly discriminating diagnostic criteria. And despite the endless press coverage of an adolescent Juul craze, sober analyses of the data generally conclude that most youth vaping is experimental, that habitual use among young people who have not tried tobacco is rare, and that rates of teen smoking are at their lowest levels in recorded history. There are a few genuine reasons for concern, but the kids are largely all right.

The fear that vapers are poisoning themselves en masse got a boost from a mysterious lung illness that emerged in summer 2019. Although it's clear now that contaminants in black market cannabis cartridges were the primary culprit, officials at the Centers for Disease Control and Prevention (CDC) were determined to blame nicotine e-cigarettes. Even the acronym the CDC gave to the disease—EVALI, short for "E-Cigarette or Vaping product use Associated Lung Injury"—prematurely implicated e-cigs. Anti-smoking groups latched onto the story, eager to prove at last that vapers who believed they'd found a safer way of consuming nicotine were deluding themselves.

Yet it was obvious even then that the true causes of the outbreak lay elsewhere. By early September, scientists had identified vitamin E acetate, a THC oil thickener, as a potentially dangerous additive, and by the end of that month the cannabis website Leafly had meticulously documented the ingredient's spread through the marijuana supply chain. In January 2020, the CDC finally acknowledged the overwhelming evidence and revised its guidance to focus on cannabis products.

Despite this, Lamm's book relies on tales of horrific pulmonary illness to portray nicotine vaping as dreadfully lethal—perhaps even more lethal than the smoking it was invented to replace. "Smoking kills people slowly, over many years," Lamm writes. "As we've seen, vaping can kill quickly, within months or a year." As further proof of this conjecture, he cites a couple of cases in which users were killed by exploding vape batteries. These are dramatic tales, but they underscore how rare it is to find instances of e-cigarettes killing their users; though he doesn't mention it, more than 300 Americans die every year in smoking-related fires.

Smoking is the most relevant comparison because smoking and vaping are substitutes for one another. More than 400,000 annual deaths are attributed to smoking in the United States; globally, the figure climbs to 7 million. All but the most ardently ideological opponents will acknowledge, when pressed, that vaping appears to be much safer than smoking. The Royal College of Physicians optimistically estimates that switching from smoking to vaping could reduce risk by 95 percent; another model, offered by David Levy of the Georgetown University Medical Center, predicts that widespread switching could prevent more than 6 million premature deaths in the United States.

Lamm breezily dismisses such benefits as "Big Vape lies." He ignores, among other studies, a randomized control trial published in The New England Journal of Medicine finding that vaping was twice as effective for helping people stop smoking as are pharmaceutical nicotine replacement therapies. He also ignores the stories of millions of ex-smokers who now puff vapor instead.

Lamm notes, accurately, that the Food and Drug Administration has not formally approved e-cigarettes as an aid to quitting smoking. He applies far less scrutiny to his own guidance on how to stop using e-cigarettes, which comprises the rest of Quit Vaping. He offers some reasonable advice, such as avoiding habits and social situations that one associates with vaping. The effectiveness of his "H2M" (for "hand-to-mouth") technique is more dubious. H2M calls for making a fist and breathing into it whenever the reader is struck by the urge to vape, thus satisfying oral fixation. Needless to say, no government agency has approved H2M as an effective means of quitting.

Some of Lamm's other tips are pure California woo: detoxing by avoiding "mucus-producing foods," eating an alkaline diet, chowing down on cruciferous vegetables, and sipping spicy ginger tea. Eating more veggies is rarely a bad idea, but there's a glaring inconsistency to dismissing the substantial body of evidence that favors vaping while preaching the healing powers of Brussels sprouts and oregano.

If Quit Vaping were an isolated example, it would be easy to ignore its Goopification of the vape debate. Regrettably, the conflation of tainted cannabis cartridges and nicotine e-cigarettes is endemic in other media. "After deaths, ban on flavored vapes to be passed by New York City," read a November headline in The New York Times; remarkably, and inexcusably, the article never so much as mentioned cannabis. A February cover story in New York magazine featured the dismissive headline, "Who thought sucking on a battery was a good idea?" Despite being nominally about the long-term risks of vaping nicotine, it devoted nearly half of its 6,000 words to EVALI, illicit marijuana dealers, and critically ill teenagers.

Such alarmist coverage has worsened misperceptions about vaping. A recent Morning Consult poll found that the percentage of American adults who believe e-cigarettes cause fatal lung illness rose by eight points between September 2019 and January 2020. Over the same period, the percentage correctly identifying THC vape liquids as the cause fell by six points. Compared to 2018, the percentage rating e-cigarettes "very harmful" rose 27 points, to 65 percent of the population.

This is a cruel disservice to cigarette smokers, many of whom could benefit from accurate information, access to lower-risk options, and the freedom to make their own decisions. Instead, e-cigarette bans are proliferating, sometimes to the point of involving police enforcement and the threat of jail time. Such excessive reactions illustrate how thoroughly Americans have lost their minds over e-cigarettes even as real cigarettes continue to kill more people every day than vaping has killed ever. The tragic story of EVALI has exposed more about the dangers of the drug war than it has about vaping; the moral panic over e-cigarettes reveals how stubbornly we insist on repeating its mistakes.


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