New York Times science reporter Sabrina Tavernise highlights the tendency of American public health officials to view e-cigarettes as a threat rather than an opportunity, even though vaping offers a much less dangerous alternative to smoking. “A growing number of scientists and policy makers say the relentless portrayal of e-cigarettes as a public health menace, however well intentioned, is a profound disservice to the 40 million American smokers who could benefit from the devices,” she writes.
Tavernise cites survey data indicating that the percentage of Americans who wrongly view e-cigarettes as no less hazardous than the conventional kind tripled between 2011 and 2015, from about 13 percent to nearly 40 percent. That misperception, encouraged by misleading and sometimes downright false statements from government officials and anti-smoking activists, surely discourages smokers from making a switch that could save their lives. “The unintended consequence is more lives are going to be lost,” one critic tells Tavernise, who contrasts the U.S. approach with the attitude of British public health officials, who see e-cigarettes as way to dramatically reduce smoking-related disease and death.
David Sweanor, a tobacco control specialist at the University of Ottawa, compares the enormous difference between the health hazards of smoking and the health hazards of vaping to “the relative risks of jumping out a fourth-story window versus taking the stairs.” Although the advantage of the the latter option is obvious, he tells Tavernise, American officials “are saying: ‘Look, these stairs, people could slip, they could get mugged. We just don’t know yet.’”
Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, tells Tavernise he is aware of smokers who say they quit with the help of e-cigarettes, “but the plural of anecdote is not data.” Mitch Zeller, who as director of the FDA Center for Tobacco Products is overseeing regulations that are expected to cripple the vaping industry, is similarly dismissive. In a recorded interview that was played at last month’s meeting of the Smoke-Free Alternatives Trade Association, Brad Rodu reports, Zeller said he is “absolutely aware of the anecdotal reports about individuals using e-cigarettes to help them quit, but we can’t make population-level policy on the basis of anecdotal reports,” because “FDA is required to use a population health standard.”
Rodu, a professor of medicine at the University of Louisville and a longtime tobacco harm reduction advocate, notes that we do have “population-level” data from surveys of current and former smokers. In the 2015 National Health Interview Survey, for instance, “2.5 million former smokers were current users of vapor products,” which suggests e-cigarettes are a pretty popular and effective way to quit smoking. “These 2.5 million former smokers are more than anecdotes,” Rodu writes. “They constitute population-level evidence.”
Likewise the survey data indicating that more than 6 million Europeans have quit smoking with the help of e-cigarettes, while more than 9 million have cut back. Tavernise notes that “surveys by Action on Smoking and Health, a British antismoking group, have found that half of Britain’s 2.8 million e-cigarette users no longer smoke real cigarettes.” She adds that another British study, published by the journal Addiction in 2014, found that “among people who are trying to quit smoking, e-cigarette users are 60 percent more likely to succeed than those who use over-the-counter nicotine therapies like gum and patches.”
Such observational evidence does not conclusively prove that e-cigarettes help smokers quit. Maybe the vapers who used to smoke would have quit anyway, and maybe the advantage over nicotine gum and patches has to do with the sort of people who choose e-cigarettes, as opposed to the e-cigarettes themselves. But controlled, randomized experiments, which are usually seen as offering stronger proof, have a weakness too, since they do not allow smokers to sort themselves according to the cigarette alternatives that appeal to them most. The variables for which such studies control, which include subjects’ tastes and preferences, may play an important role in the real world.
In any case, Frieden is simply wrong that “the plural of anecdote is not data.” When the anecdotes come in the form of responses to surveys with representative samples, they do qualify as data, and they should not be dismissed as irrelevant simply because they are not the same as data generated by clinical trials. When you combine these numbers with the evidence that vaping is much safer than smoking, you have a compelling case for promoting e-cigarettes as an alternative to the real thing.
Against that case, Frieden offers nothing but speculative concerns. “There are at least three negative things that might be happening,” he tells Tavernise: 1) People who never would have used tobacco may start vaping, 2) some of them may move on to smoking, and 3) smokers who otherwise would have quit completely will keep smoking once they have an alternative source of nicotine that can be used in more settings. But nonsmokers rarely become regular vapers, and there is little or no evidence that vaping is a “gateway” to smoking or that it deters smokers from quitting. Furthermore, vapers who reduce the number of cigarettes they consume but continue to smoke are still reducing the health risks they face. Although e-cigarette alarmists like Frieden and Zeller present themselves as more scientifically sophisticated than vaping enthusiasts, they are the ones who are grasping at straws.