Monday 17 January 2022

Dishonest arguments against vaping

It's 2022 and certain people are still arguing about e-cigarettes as if it's 2012. Even in 2012, we knew more about them than the European Respiratory Society (ERS) does today. In a head-to-head debate in the British Medical Journal, three members of the ERS take on Nicky Hopkinson, the chairman of Action on Smoking and Health, to discuss whether e-cigarettes should be available on prescription. 

It's a controversial question and there are reasonable arguments on both sides, but the medics from the ERS don't bother with reasonable arguments. Instead, they bluster and lie and act as if no research has been carried out since their organisation took an ideological position against vaping back in the day. Here's how they start off...

There is already enough nicotine addiction. 

That is a moral judgement and has nothing to do with health.

For decades, smoking rates in the UK have been declining, and few teenagers see themselves becoming smokers. This has been achieved without e-cigarettes, and the decline in smoking has not accelerated after the introduction of e-cigarettes.

This is a bare-faced lie. The smoking rate had barely moved in five years before e-cigarettes became popular in 2012. It then fell sharply. 
E-cigarettes as an aid to smoking cessation have not been endorsed by a single major respiratory or paediatric scientific society because their effectiveness in smoking cessation is unproved—and remarkably poorly studied.
The appeal to authority here is suspiciously narrow. There are not many respiratory societies and I wouldn't expect a 'paediatric scientific society' to have any particular expertise in this area. The authors neglect to mention the endorsement of e-cigarettes for smoking cessation by Public Health England, the Royal College of Physicians, Cancer Research UK, the French National Academy of Medicine and fifteen past presidents of the Society for Research on Nicotine and Tobacco, to name a few. 
As for being 'remarkably poorly studied', the authors are either dishonest or woefully uninformed. There have been many observational studies, a number of randomised controlled trials and several Cochrane reviews, all of which show that e-cigarettes work better than anything else, even for smokers who have no intention of quitting. This is tacitly acknowledged by the gormless authors in what follows...

In the most cited trial comparing e-cigarettes with medicinal nicotine products, e-cigarettes were found to be superior, showing a one year abstinence rate of 18%, compared with 10%. However, twice as many people in the “old fashioned” nicotine replacement groups were found to have quit nicotine completely, as people using e-cigarettes tend to continue vaping, whereas most people using medicinal nicotine products quit.

That's exactly what I did and it's just the way I like it, thanks. The important statistic is that nearly twice as many people quit smoking with e-cigarettes than without. Whether people continue vaping after quitting - or continue using nicotine gum, for that matter - is of trivial 'public health' interest.

There is also the phenomenon of “dual use”: smokers quit by using e-cigarettes and then restart smoking while they continue vaping. In the most cited trial, 40% of people assigned to e-cigarettes were still using them after a year, and more than half of these vapers were also smokers. 

This is the same randomised controlled trial mentioned in the previous paragraph and the authors are saying much the same thing in a different way. The fact remains that the smokers who were given e-cigarettes were 83% more likely to quit smoking. That is what should matter to a respiratory society.

(The University of Bath’s Tobacco Tactics group has noted that the tobacco industry loves dual use.)

Haha! Who cares what a Bloomberg-funded activist group thinks??

E-cigarettes are not “95% less harmful than cigarettes.” 

Indeed. It's probably closer to 99.9%.

This often quoted statement is indefensible because vaping has been associated with many cases of acute lung damage, events not seen in smokers.

You're not seriously going to blame the US's 2019 EVALI outbreak on e-cigarettes, are you? It has been proven beyond reasonable doubt that the lung damage was caused by the adulteration of black market THC cartridges. It had nothing to do with nicotine vaping.

Around 80% of these cases are related to cutting the liquids with cannabinoids—but 20% are not.

No. In around 80% of cases, the person admitted to consuming black market THC. The other 20% denied it because purchasing black market THC is illegal. 
Either that or normal e-cigarettes briefly produced exactly the same symptoms as EVALI among a handful of people in a few parts of the USA for a short period before the contaminated THC products disappeared from the market. Which seems more likely?

If the acute effects of vaping are worse than those of tobacco, how can anyone seriously state that the unknown long term effects are less harmful and expect to be believed?

What an insanely stupid thing to say. 

The whole article is equally idiotic. Read it here if you must. These chancers couldn't lie straight in bed.

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