CBS: Is a social panic over e-cigs ruining the "biggest public health opportunity" in a century?

Are we about to lose the war on cigarettes by winning a battle against vaping? “If we lose this opportunity” to get rid of cigarettes, David Abrams tells CBS News, “I think we will have blown the single biggest public health opportunity we’ve ever had in 120 years.” At issue is whether vaping is better for health than cigarettes, and how much better — a point on which British and American researchers strongly disagree:


“My research shows that e-cigarettes are significantly less harmful than cigarettes,” said Dr. Lion Shahab, an associate professor at University College London.

Public Health England describes e-cigarettes as “at least 95% less harmful” than tobacco cigarettes.

Dr. David Abrams, a professor at New York University, said that he thinks that’s a fair estimate. “Actually, I would go further,” he said. “I think there’s no evidence from looking at the cancer biomarkers, that it could be as high as 98% or 99% for cancer.”

Vaping isn’t harmless, Abrams notes, as nicotine is still addictive and has its own health-related concerns. Eliminating the tar and carbon monoxide of smoking, however, makes for a dramatic difference in health issues between the two. What’s more, the push to ban vaping will make it much more difficult to move current cigarette smokers to a much less harmful transition product. Abrams estimates that a ten year push to get cigarette smokers to e-cigs could save six to seven million lives a year.

Just how much less harmful e-cigs are is the core of the debate, however. CBS This Morning addressed the controversy in a second video report, as American researchers studying long-term vaping impacts think it might be nearly as bad — at least outside the lungs. Current animal-based research shows tendencies toward arterial changes that could lead to significant heart disease with decades of use, which will lead to excess preventable deaths as well:


But other American scientists, like West Virginia University School of Medicine associate professor Mark Olfert, are drawing very different conclusions.

“I would say it’s 95% harmful,” Olfert said, “because … in any single study that I’ve seen that’s looking at this in a meaningful way outside the lung, they’re finding damage and harm.” …

In a recent study, Olfert looked at eight months of exposure — the equivalent of 25 human years. What he found concerns him: The animals’ arteries stiffened almost as much as those exposed to cigarette smoke over the same time.

“Stiffer arteries means greater risk for stroke, for heart attack, atherosclerosis, aneurisms, any number of vascular effects,” Olfert said. “It’s extremely alarming, because it tells me that e-cigarettes simply are not gonna be safer than cigarettes.”

To some extent, the two camps seem to be talking past each other. Abrams and the British science establishment isn’t declaring vaping to be completely harmless and acknowledge that long-term risks have not yet been established. However, given the choice between the health impacts of cigarettes and e-cigs — which is the real and rational choice for current smokers — who wouldn’t choose to shed the lung-related health impacts? The outcomes Olfert highlight are present at the same levels or worse for cigarettes too, which remain on the market.


It’s the rash of acute illnesses and deaths that are driving concerns, which Abrams says is legitimate — but largely misdirected. The media coverage is driving a social panic about legitimate vaping when the deaths and injuries are related to home-brew vaping:

“I think all the evidence we’ve seen from the FDA and the CDC reports is that these cases are people who bought marijuana oils on the street made either illegally or in a sort of a street version like a dirty street drug,” he said.

“We haven’t seen a single case that a commercially made legitimate e-cigarette that smokers are using has caused any of these illnesses,” Abrams added. “And I would say for smokers they should not be scared by what they’re seeing and that e-cigarettes should still be used instead of cigarettes if they’ve already switched.”

It’s also being driven by the nature of the vaping industry, which largely consists of the same tobacco companies that spent decades being, ahem, less than honest about health impacts. They spent a long, long time micturating on our heads and calling it precipitation, and not only on health impacts but also youth marketing. That’s one of the concerns from US researchers — that vaping has been marketed not just to current smokers but also teens and young adults as a harmless experience. More recent restrictions have at least forced some changes to that approach, but it’s hard to criticize scientists for approaching the next generation of nicotine delivery devices with a very large amount of skepticism.


Still, that skepticism shouldn’t outweigh the science, especially if it can help wean smokers off cigarettes. Right now, it seems as though we’re poised to make the perfect the enemy of the good-enough-for-right-now.

Addendum: Kudos to CBS News for a very fair and balanced approach to this controversy, too. It’s not easy for news magazine shows to spend this much time and effort presenting all sides of an issue.

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