VAPING SCIENCE: How Public Health Institutions Keep Reaching the Same Conclusion
As the sun rose in the offices of Washington D.C. on the 23rd of January, the National Academies of Sciences, Engineering and Medicine (NAS) was busy readying the release of a comprehensive report on the public health consequences of e-cigarettes. The study—commissioned by Congress—is a 600-page behemoth that takes aim at the controversial debate surrounding vape that is raging all over the planet, amid a flurry of misinformation both malicious and innocent in nature. The vape industry has been caught in a vicious flow of information, while FDA regulations—largely unguided by qualified scientific information—continue to threaten the future of an industry still very much in its infancy.
As public health organizations and the vape industry processed the release of the NAS’s Public Health Consequences of E-Cigarettes, scientists in the United Kingdom were authoring their own study out of Public Health England (PHE). The study, titled Evidence Review of E-Cigarettes and Heated Tobacco Products 2018 approaches many of the same questions as the NAS’s study, with the same goal of gaining a more rounded scientific understanding of the questions surrounding e-cigarettes and public health.
Historically, the posture of American and UK public health organizations has been in diametric opposition to one another on the issue of e-cigarettes. UK officials have traditionally been more bullish on the trend of e-cigarettes, seeing them as a viable alternative to traditional combustion tobacco products. American officials however, have traditionally been more bearish of the risks associated with long-term exposure to e-cigarettes. While it is difficult to point directly to any one cause of these attitudes, it is tough not to examine the pervasive spread of social media-fueled misinformation. This complicates the ability of the American public to get a clear picture of the facts surrounding what is and isn’t known to public health officials about vaping. However, we may have reached a turning point.
SCIENCE ACROSS THE POND
The research that has emerged from the NAS marks a seminal moment in the scientific understanding of vaping. Where previous speculation has dominated the health effects of vaping, the NAS’s study reached very similar conclusions to the PHE’s study. Chiefly that there’s no scientific evidence to support the notion that vaping is as harmful as traditional combustible tobacco. Naturally, given the early stages of this research the NAS was reluctant to make any definitive claims about the effects of e-cigarettes on public health, but this acknowledgement is a striking one coming from America’s premier public medical institution.
Of particular significance to this debate is that it further validates previous European Union and UK-based studies on the public health effects of e-cigarettes. The PHE’s study arriving a month later—and at the same conclusions as the NAS study—calls for a public reevaluation about how the public approaches vaping. This of course isn’t to say that the studies provide a definitive statement on the issue, as clearer scientific understanding is critical to the long-term evaluation of e-cigarettes. Regardless, a clearer picture has emerged of cross-continental public health agencies making discoveries that will help to delegitimize the stigma surrounding the vape industry.
This isn’t to say that the studies had universally positive comments about the industry. The NAS expressed deep concern about findings that suggest that vaping makes nicotine addiction more accessible to minors. The PHE study found similar results, but was unable to find any conclusive evidence to suggest that this was a pattern in the UK. Regardless of the severity of the issue, this still underscores the responsibility the vapor industry faces in preventing minors from trying vape products. The importance of proper ID programs on both online retail shops, as well as brick and mortar stores, cannot be understated. Furthermore, the necessity exists for public information campaigns to prevent kids from trying e-cigarettes and for companies to make compliant and responsible branding decisions that refrain from marketing that could potentially target minors. While the FDA has put rules in place to safeguard these issues, it is important for the vape industry to be proactive in preventing underage e-cigarette use as the industry is greeted with positive science-based news.
THE RIPPLE EFFECT
In early February, the American Cancer Society (ACS) was readying a press release in response to the NAS’s study. This press release would go on to make serious concessions in the shifting attitude toward the dangers of e-cigarettes among the nation’s healthcare research organizations. While not going so far as to endorse vaping, the press release conceded that e-cigarettes had the potential for a significant public health benefit if it could assist adults in converting away from traditional combusting tobacco. This important conclusion came from the ACS as it confirmed their own research into the vapor space.
As these studies reverberate through the healthcare industry, sending out a ripple effect of pro-vaping news worldwide, there exists an opportunity to correct the spread of misinformation that has plagued the vaping industry over the last five years. The peer-reviewed nature of these findings across multiple continents is starting to close the door on anti-vaping arguments.
This does not change the reality that vaping is neither healthy nor safe. The use of nicotine will never be safe, and vaping doesn’t change that. Individuals that try to advance any other argument are a clear and present danger to the integrity of the vaping industry. Bad actors that undermine the realities of the safety of nicotine also undermine the science that is determining the harm reduction potential of e-cigarettes. These same bad actors also risk ignoring future important data points for the industry regarding the long-term risks of vaping.
Utilizing responsible practices towards approaching science only helps the vapor industry. It allows companies, advocates and individuals to approach arguments regarding the realities surrounding vaping and its relationship with public health in an informed matter and authoritative posture. Any attempt to undermine the science will in turn undermine the confidence the public has in the vapor industry. Down that path lies the shared public perception that big tobacco cultivated over 50 years of constant attempts to misrepresent scientific data.
VAPING’S SILVER LINING
As the FDA considers their regulatory approach to e-cigarettes, the industry has waited with bated breath to see what the next regulatory decision will be. The inconsistent approach the FDA has taken has largely been a frustrating mystery to the vapor industry. Recent pivots have offered some evidence that the lack of scientific data has most likely guided the FDA’s decision-making process. As it turns out, public misconceptions and an unclear picture of the vaping industry may have contributed most heavily to the FDA’s confusing regulatory framework.
The wealth of new studies being published in the UK and US from respected public health organizations appears to be reshaping the FDA’s approach toward the regulation of e-cigarettes. FDA Commissioner Scott Gottlieb iterated this shift in 2017 when he expressed the FDA’s willingness to explore alternative nicotine delivery methods that could potentially be less harmful than combustible tobacco. The studies that have since been released form a compelling reason for the FDA to explore the value e-cigarettes have to public health and the FDA’s recent rulings on the iQOS device from Philip Morris seem to indicate this focus is primarily on e-cigarettes, rather than non-combustible tobacco. This hasn’t shifted the FDA’s 2022 deadline for Pre-Market Tobacco Authorization (PMTA), but four years is a significant amount of time for science to shift the FDA’s position and for the vapor industry to communicate the relevant scientific information to both the public and the FDA.
Despite the stressors that emerge from the regulatory space, this is an exciting time for the vapor industry. Vaping is primed to remain a potent force for harm reduction over the next four years, while maintaining its position as a viable, healthy market. The willingness of the vapor industry to work together to shift public opinion—and their ability to stick to scientific facts—will be one of the key factors in determining the ultimate staying power of e-cigarettes. This approach must go hand-in-hand with more aggressive self-regulatory efforts that will help to dissuade minors from vapor use. This means going beyond simple ID measures and working together as an industry to develop new approaches to combat the use of e-cigarettes by minors. If the vapor industry can come together under the banner of science, with a responsible approach to the products they sell, there exists a very real chance to see the vapor space survive long past the 2022 deadline.
It’s only a matter of how badly the vapor industry wants it.