Last week, I wrote a list called "7 Reasons E-Cigarettes Are Bad," which brought me a ton of backlash. Often, we hear that e-cigarettes are safe in comparison to smoking, so I set out to present a counter-narrative which scrutinized the health effects of e-cigarettes.
Hours after I posted the list, my Twitter account blew up. I was getting hundreds of Tweets that were attacking me and my piece. A quick scan of my critics revealed them to be mostly vapers, e-cig advocates, and others associated with the e-cigarette industry. It shouldn't be hard to see an obvious bias here.
Some went so far to accuse me of killing people. They felt my list was turning away smokers from life-saving e-cigarettes. I would even be harassed on Facebook by one of these e-cigarette fanatics, who thought it appropriate to lambast me in a profile picture comment around 3 a.m. in the morning.
And today, Jacob Sullum, a Senior Editor at Reason, picked up my story and wrote a list mockingly titled "4 Reasons This Article About E-Cigarettes Is Bad." I'm thrilled an award-winning journalist like Sullum took the time to write about my piece, so I feel obligated to write back.
"Start with the title: '7 Reasons E-Cigarettes Are Bad.' Compared to what? Since the relevant comparison is conventional cigarettes, which are indisputably much more dangerous, the title is an empty distraction. Holger continues to dodge the central issue in his introduction:"Sullum was on to something when he asked, "Compared to what?" Because...
"'Are e-cigarettes really any better than smoking a cigarette? Here are seven reasons e-cigarettes pose dangers to our health.'"
My article wasn't primarily concerned with comparing whether e-cigarettes are safer or more dangerous than cigarettes. My article presented health dangers of e-cigarettes. I never said that e-cigarettes were more harmful -- or equally harmful -- as cigarettes anywhere.
Of course, people are interested in this comparison, so I raised the question, "Are e-cigarettes really any better than smoking a cigarette?" A question to be mindful of, but a question which remains to be answered by scientific consensus. Sullum is right that I had no intention of answering this question. I don't have the answer because the jury is still out. It could potentially take decades of research before we know the long-term effects of e-cigarettes compared to smoking.
This is important, because most of my critics haven't gone so far to say e-cigarettes are safe. Instead, they criticize me on the grounds that e-cigarettes are safer than cigarettes.
"Holger is determined not to answer the question he poses, so he follows it with a non sequitur. Even if 'e-cigarettes pose dangers to our health,' of course, that does not mean they are just as hazardous as conventional cigarettes. In fact, as Public Health England (PHE) emphasizes in a recent report, they are something like 95 percent safer."To reiterate, my piece was not primarily invested in comparing whether e-cigarettes are safer than cigarettes, but rather if e-cigarettes have health issues. However, lots of people have been sending me this PHE report, and I think it's important to note The Guardian has reported the PHE is "under fire" due to a cited paper having funding connections to the tobacco industry (which owns the majority of multinational e-cigarette companies). Even so, the PHE report agrees with me that e-cigarettes are harmful. After all, even if e-cigarettes are "95% less harmful" than cigarettes, that doesn't mean they are safe.
"Holger avers that "e-cigarettes contain plenty of cancerous chemicals" and "their fair share of toxic chemicals," statements that are utterly uninformative in this context. How much, after all, is "plenty" or "their fair share"? As the PHE report notes, "most of the chemicals causing smoking-related disease are absent and the chemicals which are present pose limited danger" because they are typically present at very low levels."I would say the eight cancerous chemicals -- identified by the German Cancer Institute in 2013 -- would constitute more than a "few"chemicals, so I don't see why "plenty" isn't an acceptable descriptor. Additionally, even the PHE report admits that chemicals are present, albeit in "very low levels." Since e-cigarettes remain largely unregulated, these levels could fluctuate. Also, we don't yet know the long-term effects of inhaling these chemicals in "very low levels" over years of study.
"Holger is clearly wrong when he states that "e-cigarettes might create the equivalent of secondhand smoke."The German Cancer Institute and American Lung Association have both raised concerns about the detectable levels of carcinogens in exhaled e-cigarette vapor. So yes, e-cigarettes might create something like secondhand smoke. We'll have to wait and see the potential dangers of this vapor.
"Similarly, citing evidence of short-term changes in airway resistance during vaping, Holger warns that 'e-cigarettes have negative effects on lungs.' But as Siegel notes, these effects are far less serious than the respiratory damage caused by smoking, and smokers who switch to vaping 'experience an immediate improvement in their respiratory symptoms and lung function.'"In this point, I was concerned with pointing out that e-cigarettes have damaging effects on the lungs, whether or not the effects are as bad as cigarettes is irrelevant to the argument. Additionally, I noted a study by Indiana University, which showed even non-nicotine e-cigarette vapor destroys the endothelial cells of the lungs.
"Holger asserts that 'e-cigarettes are just as addictive as smoking tobacco,' based purely on the observation that they contain nicotine. But as Siegel notes, research indicates that vapers score lower than smokers on measures of dependence, possibly because e-cigarettes do not deliver nicotine as efficiently as the conventional kind. More to the point, addiction to cigarettes is a concern mainly because of the harm it causes, and vaping causes much less harm."Nicotine is clearly the main addictive substance in cigarettes and e-cigarettes. I think the logic is obvious that e-cigarettes are addictive under the same grounds. You can buy tobacco products with lower levels of nicotine as well, but that doesn't necessarily make them less addictive. Interestingly, tobacco products with lower levels of nicotine have been marketed by the tobacco industry, just like e-cigarettes are.
Also, I listed a study by the American University of Beirut and the Center for the Study of Tobacco Products which examined how e-cigarettes are equally addictive as tobacco, because they both rely on nicotine.
"Like CDC Director Tom Frieden, Holger warns that 'e-cigarettes could be a gateway into tobacco products for youth.' As the PHE report points out, it's not clear what that means. But assuming it means vaping leads to smoking among people who otherwise never would have tried tobacco, there is no evidence it is happening. To the contrary, smoking among teenagers continues to fall as vaping rises, as Holger implicitly concedes in the very same paragraph."The study from the University of Southern California found that teenagers who tried e-cigarettes were more likely to smoke tobacco. Of course, we could argue that these individuals would be experimental regardless, but e-cigarettes are still presenting more addictive options to youth.
"Like Ron Chapman, director of the California Department of Public Health, Holger claims 'e-cigarettes won't help you quit.' How can he possibly know that? Thousands of former smokers say otherwise, and the scientific evidence reviewed by PHE indicates that e-cigarettes 'can help people to quit smoking and reduce their cigarette consumption.'"Ron Chapman is right: There isn't sufficient evidence that shows e-cigarettes help you quit. Also, it raises alarms that e-cigarettes are marketed as smoking cessation devices when people clearly use e-cigarettes to continue their nicotine addiction in a way the industry deems safer. The PHE's examination is interesting, but there just isn't enough evidence to prove e-cigarettes are an effective way to quit smoking.
I'm pleased that my piece has helped spur the debate surrounding the safety of e-cigarettes -- that's exactly what I wanted. There are clearly strong views about e-cigarettes on both sides of the aisle, which is why the story about their effects on our health continues to develop. It should be interesting to see how safe e-cigarettes will really turn out to be.
UPDATE: An earlier version of this post stated The Guardian has reported the PHE is "under fire" due to funding connections to the tobacco industry. This statement was meant to articulate how the PHE report cites a paper that has funding connections to the tobacco industry. The statement has been corrected.
[Image via Flickr/Mike Mozart]