Friday, August 08, 2014

Based on a Lie, Senator Durbin and Colleagues Want to Put Thousands of Vape Shops Out of Business

In a letter sent to the FDA Commissioner on August 1, Senator Dick Durbin (D-IL) and 12 Congressional colleagues demand an immediate ban on e-cigarette flavorings, based on what they purport is evidence that electronic cigarettes are a gateway to smoking.

They write: "What’s even more troubling is that these products serve as a gateway to traditional tobacco products.  A recent JAMA Pediatrics study found that middle and high-school students who used e-cigarettes were more likely to smoke traditional cigarettes and less likely to quit smoking." In support of this statement, they cite the Glantz and Dutra cross-sectional study of e-cigarette use and smoking among youth.

As I pointed out earlier this week, the truth is that this paper provides no evidence whatsoever that e-cigarette use is a gateway to smoking. Instead, it is entirely possible - and quite likely - that youths who use e-cigarettes are more likely to be heavier and more resistant smokers. I argued that by relying on this false evidence, the politicians are essentially lying to the American public. They are misrepresenting the scientific evidence, twisting it to try to support their pre-determined conclusion.

The Rest of the Story

Today, I reveal that to make matters worse, these politicians are not only lying about the scientific evidence, but they are using that lie to try to put thousands of vaping shops out of business. Specifically, the letter to the FDA calls for an immediate ban on e-cigarette flavorings. If such a ban is implemented, it will immediately put thousands of vaping shops out of business. In addition, it will eliminate the overwhelming majority of electronic cigarettes on the market. Such a regulation would essentially mean that there can be no variation in the ingredients of e-cigarette liquid. Every brand would be the same.

I think that if you are going to put thousands of people out of work, you ought to be doing it based on solid scientific evidence of the harm of their products. To do it based on a lie is inexcusable.

Wednesday, August 06, 2014

Wall Street Journal Op-Ed Debunks the E-Cigarette Gateway Myth

In an op-ed published today in the Wall Street Journal, I highlight the fact that many legislators and health organizations have demonized electronic cigarettes, largely on the basis of the erroneous conclusion that there is scientific evidence demonstrating that these products are a gateway to cigarette smoking among youth. The piece points out that there actually is no such scientific evidence and in fact, it presents evidence to the contrary.

As I point out in the piece, the CDC is partly responsible for the backlash against e-cigarettes because it publicly concluded that e-cigarettes are a gateway to smoking:

"Last September, in an interview with Medscape (a website for medical professionals), Thomas Frieden, director of the Centers for Disease Control and Prevention, said that "many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes." The same month he was quoted by the Associated Press as warning that e-cigarettes are "condemning many kids to struggling with a lifelong addiction to nicotine."

I then explain that the gateway hypothesis is actually unsupported by any scientific evidence and that there is some evidence which is inconsistent with the hypothesis.

I conclude as follows: "By promoting a message that flies in the face of the government's own statistics--which show a sharp decline in youth smoking concurrent with a dramatic increase in e-cigarette experimentation--some federal public health official appear to be trying to create a "gateway" narrative where none exists."

"The government has an obligation to carefully scrutinize any new consumer product that is presented as an alternative to smoking. But government agencies and public health officials have no business discouraging or disparaging e-cigarettes in the absence of any data that they are causing harm. This is especially the case when these products have so much potential to curb cigarette smoking, the public health scourge that still claims half a million lives a year."

Politicians Lie to the Public About the Scientific Evidence Regarding Whether E-Cigarettes are a Gateway to Smoking

In a press release issued Monday by 13 members of Congress, a group of politicians claimed that there is "more" evidence that electronic cigarettes are a gateway to smoking.

The press release was entitled: "Members of Congress: More and More Children Being Exposed To E-Cigarette Marketing Are Picking Up Habit; FDA Urged to Protect Children as More Evidence Shows E-cigarettes Serve as Gateway to Tobacco Products."

After claiming that there is now abundant scientific evidence that electronic cigarettes are a gateway to smoking, these politicians go on to urge the FDA to ban flavorings in e-cigarettes and to ban the online sale of these products.

The Rest of the Story

What is the new "evidence" that e-cigarettes are a gateway to smoking? According to the letter sent by these politicians to the FDA: "What’s even more troubling is that these products serve as a gateway to traditional tobacco products.  A recent JAMA Pediatrics study found that middle and high-school students who used e-cigarettes were more likely to smoke traditional cigarettes and less likely to quit smoking.[2]"

The reference which supports this assertion is a study by Dutra and Glantz which purports to provide data showing that electronic cigarettes are "aggravating the tobacco epidemic among youth."

The article reports the results of a cross-sectional sample of adolescents interviewed in 2011 and 2012 in the National Youth Tobacco Survey. Youths were asked to report their smoking status as well as their e-cigarette use, both any use and current use (at least once in the past month).

The study finds that e-cigarette use is associated with smoking status. In addition, e-cigarette use is associated with heavier smoking and with fewer periods of smoking abstinence.

The study concludes that "e-cigarette use is aggravating rather than ameliorating the tobacco epidemic among youths."

(See: Dutra LM, Glantz SA. Electronic cigarettes and conventional cigarette use: a cross-sectional study. Published online March 6, 2014. JAMA Pediatr. doi:10.1001/jamapediatrics.2013.5488.)

The authors of this study make one of the most cardinal errors in all of epidemiology. They ignore the principle that "correlation does not equal causation."

Here, they find a correlation between e-cigarette use and higher and more sustained levels of smoking. But because this is a cross-sectional study, they cannot determine which came first. In other words, what is the direction of the causal relationship? Does the e-cigarette use precede, and cause, the smoking? Or does the smoking precede, and cause, the e-cigarette use?

The problem is that in this cross-sectional study, there is no way to determine the direction of the observed relationship.

The authors admit this in the paper. They write: "This is a cross-sectional study, which only allows us to identify associations, not causal relationships."

Furthermore, later in the paper they reinforce this point more specifically, writing: "the cross-sectional nature of our study does not allow us to identify whether most youths are initiating smoking with conventional cigarettes and then moving on to (usually dual use of) e-cigarettes or vice versa...".

Thus, the authors readily acknowledge that it is impossible from this study to determine whether or not e-cigarettes lead to smoking or whether smoking leads to e-cigarette experimentation.

Nevertheless, this does not stop the authors from drawing a conclusion. They conclude, despite their acknowledged inability to draw such a conclusion, that: "e-cigarette use is aggravating rather than ameliorating the tobacco epidemic among youths."

In other words, despite acknowledging that they cannot tell from their study whether e-cigarette use precedes smoking or whether smoking precedes e-cigarette use, they nonetheless draw the conclusion that e-cigarette use precedes smoking.

The truth is that this paper provides no evidence whatsoever that e-cigarette use is a gateway to smoking. Instead, it is entirely possible - and quite likely - that youths who use e-cigarettes are more likely to be heavier and more resistant smokers.

By relying on this false evidence, the politicians are essentially lying to the American public. They are misrepresenting the scientific evidence, twisting it to try to support their pre-determined conclusion.

The rest of the story is that there simply is no evidence at the current time that electronic cigarettes are serving as a gateway to youth smoking. It may actually be the case that electronic cigarettes serve as an inhibitor of smoking initiation by getting a youth used to a flavorful experience, thus making it less likely - not more likely - that the youth will move on to the harsh taste of tobacco.

These politicians should stop lying to the American public in order to support their pre-determined agenda. Science, not politics, should guide public health policy in this nation.