Tobacco Researchers Challenge Misinformation on Nicotine E-cigarettes

A group of tobacco researchers has called on the US Centers for Disease Control and Prevention (CDC) and American surgeons to correct misinformation they shared about nicotine e-cigarettes in public health agencies.

The author has praised surgeon Vivek Murthy for his recent efforts to reduce the amount of misinformation surrounding health issues during the COVID pandemic but has cautioned both SG and CDC that these institutions are also actively promoting erroneous information regarding e-cigarettes. Specifically, the author references the CDC's incorrect information surrounding the 2019 lung injury outbreak known as "EVALI," and a 2016 report by the surgeon general regarding e-cigarette use among teenagers, which claimed that nicotine e-cigarettes were a gateway to teenage smoking.

The call was made in an editorial published today in the "Addiction" journal, co-authored by Michael Pesko, a health economist at Georgia State University, along with colleagues from Harvard Medical School, Pennsylvania State University, University of South Carolina School of Medicine, and University of Michigan. Tom Miller, Iowa's attorney general and former head of the Truth Initiative, is also a co-author.

The CDC will not abandon the misleading name "EVALI.

In the editorial, the author explains that the CDC used the name "EVALI" (e-cigarette or vaping product use-associated lung injury) to describe the 2019 lung injuries, and refused to change the name, which has resulted in ongoing misinformation in the media and scientific community about the cause of the situation.

During the outbreak of the pandemic, the CDC was the last public health agency to acknowledge that vitamin E acetate (which was being mixed with marijuana oil by black market sellers in order to save money) was the main cause, if not the sole cause, of injury. Additionally, the agency never fully ruled out nicotine e-cigarettes as having at least some responsibility for the outbreak. It is believed that Brian King, current director of the FDA's Center for Tobacco Products, created the name "EVALI." King was a staunch opponent of nicotine e-cigarettes at the time and is currently, and was at the time, an employee of the CDC's Office on Smoking and Health.

This product name has been linked to the deaths of 68 individuals and thousands of hospitalizations, due to the lack of warning from the country's primary public health agency regarding the risks of using unregulated THC pods. Many THC users continued to use the dangerous product because the Centers for Disease Control and Prevention intentionally avoided directly attributing their illness to vitamin E acetate, instead focusing on nicotine e-cigarettes as a potential cause. As a result, many nicotine e-cigarette users have reverted back to smoking traditional cigarettes.

The author argues that although the CDC's name includes "e-cigarettes," all evidence suggests that illegal tetrahydrocannabinol (THC) e-cigarettes contaminated with vitamin E acetate are the cause of the recent vaping illnesses, and no studies have found any chemicals in nicotine e-cigarettes as the cause. Vitamin E acetate is not soluble in nicotine vape oil and has never been detected in it.

Despite evidence, the Centers for Disease Control and Prevention continues to include "e-cigarettes" in the name EVALI. This naming has affected news reporting and fueled consumers' distorted beliefs about the risks of nicotine e-cigarettes.

In 2021, the same author formally requested that the CDC investigate changing the name "EVALI", removing "e-cigarette" from the name and adding "vitamin E acetate". The request was signed by an additional 68 experts, but was rejected by the Centers for Disease Control and Prevention.

Unprecedented Gateway to Smoking

When the Director of Health, in 2016, released a report titled "The Use of E-Cigarettes by Adolescents and Young Adults," it drew widespread attention from the country's newspapers and television news programs. However, as we noted at the time, few people were likely to bother reading the entire 298-page report, given that the SG's website offered a convenient shortcut.

The website of the Surgeon General still serves as an information resource regarding e-cigarettes and youth, and continues to mislead the public by implying that e-cigarettes are a known gateway for youth smoking. However, this is not accurate.

In an editorial, Pesko explained that "there is now a significant amount of evidence showing that the correlation between e-cigarettes and smoking is not a causal relationship, which has left the general public and healthcare professionals confused." Real-world data collected since the release of the SG report has emphasized the lack of causality. Even when youth e-cigarette use peaked in 2019, youth smoking rates were rapidly declining and continue to do so.

The author of the editorial describes how a "natural experiment" assesses how electronic cigarette restrictions implemented in certain places at specific times affect youth smoking, indicating an overall reduction in youth smoking due to the use of e-cigarettes. This natural experiment includes Pesko's own research on taxation, which showed that cigarettes and e-cigarette products are economic substitutes.

The 2016 Surgeon General's report did not take into account existing natural experiments that may have led its authors away from gateway claims. To this day, the SG website continues to ignore this evidence and claims that "there is no evidence to support the claim that e-cigarette use among young people may be protective against cigarette smoking.

A news release issued by co-author Cliff Douglas disputes misinformation from a website for surgeons indicating that the use of e-cigarettes leads young people to become smokers, which is not supported by evidence. "Despite a peak in teenage e-cigarette use in 2019, teenage smoking rates have recently reached an all-time low, below 2%," Douglas stated.

Will anyone pay attention?

Pesko and his colleagues wrote in an Addiction editorial that correlation does not imply causation. Public health officials, particularly the Surgeon General and the Centers for Disease Control and Prevention, must do a better job of explaining this difference to the public because public health advice should be based on reliable causal data and communicated clearly and appropriately to the general public.

The author pointed out that inaccurate information continues to be disseminated through news media, public health, and physician organizations, and is being used to advocate for "positive regulation of e-cigarettes, despite evidence suggesting this leads to increased use of combustible tobacco products." They wrote that correcting this misinformation is the "primary task of public health.

It should be a priority – an editorial itself should be a news story. However, it is doubtful whether it will catch the attention of health and science journalists. They did a great job last year by completely ignoring a more comprehensive paper that challenged misinformation about electronic cigarettes. The paper was written by 15 former chairs of the Nicotine and Tobacco Research Association.

Journalists and editors at major news outlets appear to be content with avoiding questioning of e-cigarette misinformation and falsehoods, when in fact they play a crucial role in disseminating such information. They often perpetuate dominant e-cigarette myths and provide oxygen for weak or selectively chosen supporting evidence to reinforce anti-e-cigarette orthodox views. The public's perception of e-cigarettes and other safer nicotine products cannot be altered until journalists begin to fully understand the harm caused by their passive, lazy, and dogmatic anti-e-cigarette advocacy.