NEW YORK – Sure, it would be better if no one smoked any nicotine products. But the U.S. Centers for Disease Control and Prevention’s repetition of that message blurs important distinctions.
Whether they’re warning us about the risks of fat, salt, alcohol or electronic cigarettes, public health authorities tend to mislead — with the best of intentions! — by presenting a black-or-white oversimplification. They equate big risks, small risks and hypothetical risks under one umbrella as “unsafe.” In the case of electronic cigarettes, recently declared an “epidemic” and a “public health crisis,” the misleadingly dire message deprives people of information we need to balance potential risks against potential benefits.
Electronic cigarettes, or e-cigarettes, are devices that create a vapor people inhale, providing a nicotine fix without the tar that makes ordinary cigarettes so carcinogenic. The products became popular over the last decade, so it’s too early to know all the long-term risks, but they are very unlikely to be anywhere near as harmful as cigarettes. And that means people who switch from smoking to “vaping” may be prolonging their lives and the lives of people around them.
The same black-or-white thinking has shaped the message that no amount of alcohol is safe. That’s based partly on studies showing that a single drink a day is associated with a small increase in some cancers. But this could be put in a glass-half-full perspective, so to speak, emphasizing that even people who consume a drink every day have only marginally increased health risks.
How can lumping small and large risks together possibly help people make healthy choices? This seemed like a good question for Peter Sandman, an independent expert on risk communication. He told me that he considers the anti-vaping messages from the CDC to be dishonest and possibly harmful. “It’s almost inconceivable that anything that doesn’t involve burning is going to be anywhere near as dangerous as smoking,” he said.
While some experts have suggested that electronic cigarettes contain carcinogenic compounds, and that the nicotine itself, while not a cause of lung disease, might be harmful, Sandman said these are minor risks compared with smoking — which adds tar to the risks associated with nicotine and most of the other carcinogens.
To him, the most important question is how vaping influences the much more dangerous practice of smoking. Vaping should be considered dangerous if it functions as a gateway drug, leading more people to smoke. Likewise, he said, it should be considered beneficial if it acts as a substitute for smoking, giving people a safer alternative.
There is a public health approach known as harm reduction, which is often associated with safe injection site programs. Sure, it would be better if nobody injected drugs, but in our imperfect world, clean needles save lives. We don’t know yet whether electronic cigarettes also save lives this way, said Sandman, but we have to make policy with limited data. The public health community in the United Kingdom has embraced them, based on the estimate that they are 95 percent less harmful than smoking.
Much of the concern at the CDC focuses on the millions of teenagers who have experimented with e-cigarettes. Teens would be much better off not using any nicotine products, as they run a high risk of addiction, but Sandman argues that even the danger to teens has been exaggerated.
He pointed me to a blog post he wrote about a 2015 report by the CDC, and an accompanying news release, painting a bleak picture of a rapid rise in teen vaping over the previous few years. The report announced that “youth use of tobacco in any form is unsafe.” (The CDC refers to electronic cigarettes as a tobacco product because some of them derive their nicotine from tobacco.)
But the data showed an equally steep decrease in teen smoking, he wrote: “For sure teenage smoking is down. That’s wonderful news, made only a little less wonderful by the fact that teenage vaping is up.”
The false dichotomy between safe and unsafe practices showed up in the reaction to a series of columns for the New York Times, written by Joe Nocera. While some of his Times columns called out the misinterpretation of scientific data to try to vilify electronic cigarettes, others pointed to the potential good they could do by allowing nicotine addicts to get their drug a much safer way.
A critique in HealthNewsReview.org, which I usually find reasonable, makes the ridiculous contention that it’s illegitimate to have an opinion at all about whether vaping has an upside, because its dangers are not yet fully understood. The critic’s logic was that, because Nocera was “expressing opinions on matters of fact,” he “is not entitled to an opinion on whether e-cigs might save lives any more than he is entitled to an opinion on whether the sky is blue or the sun sets in the west.”
But that makes no sense. Of course people are entitled to opinions about how we should behave in the face of uncertain risks. We science journalists express or give voice to opinions on uncertain risks all the time — whether these concern pesticides, household chemicals, GMOs or probable consequences of global warming. Cutting off discussion of potential benefits of e-cigarettes might be politically correct, but it’s not rational.
Journalists, like public health officials, tend to err on the side of exaggeration over exoneration, but that’s not always in the best public interest. As Sandman points out, exaggerating the risks of vaping might seem harmless, but it’s harmful if it gives people the impression that it’s so dangerous they might as well smoke.
Science writer Faye Flam is a Bloomberg Opinion columnist.