Why Doesn’t Everyone Agree on Vaping?

Anti-smoking charity Action on Smoking and Health recently called for journalists to be more careful with what they write about vaping but it seems like every article about electronic cigarettes always carries negative comments from supposed experts to balance out any positive ones. It’s no wonder smokers, vapers and the general public are confused, but if science is about finding the truth, why is there such disagreement?

The Politico, a politics focused newspaper, has carried several articles looking at “the toxic world” of ecig science. While some may say this is a bit of an exaggeration, long standing members of the vaping community and tobacco harm reduction advocates will attest that there have been many examples of where scientists and public health experts have decided to play the persona and not the ball.

It has been a two-way street for attacks, as Linda McAvan will attest. The former MEP oversaw the EU committee driving through the very first legislation on ecig products, producing reports from 2013. It was a time when few knew about vapes and little research had been conducted. What information was in the public domain was broadly positive, yet the risk averse politicians on the committee were more concerned about what might be found in the future. McAvan and her peers managed to upset doctors, scientists, advocates and vapers in equal measure by either going too far or not far enough with their plans for the Tobacco Products Directive – a piece of piece of legislation described by one harm reduction expert as “a gargantuan dog’s breakfast, a gluttonous feast of uncooked ideas unfit for human consumption”.
 
In hindsight, it is possible to see the reasons why politicians wished to be more cautious in their approach given the breadth of what everyone didn’t know at the time. But, as the years have rolled by the research papers began to appear in their tens, hundreds – then thousands. Back then the industry was almost entirely dominated by ex-smokers who had quit smoking with the help of vapes, but as the evidence began to build supporting the reduced harm aspect of the products the big companies and their lobbyists entered the arena.

Public health experts who had spent a career fighting the tobacco industry suddenly saw cigarette companies moving into the market with their versions of electronic cigarettes and worried that this was just another marketing ploy; after all, these were the same companies which once claimed smoking wasn’t linked to cancer despite having evidence to the contrary.
 
The entry of the tobacco industry immediately cemented a polarisation within the academic and public health communities. Independent minds saw vaping as a means to end the world’s addiction to smoking, others stuck to their belief that nothing this collection of businesses were involved with could ever be for the public good.
 
While small independent vape manufacturers had prided themselves on their self-regulation, following vapers calls to use the safest products and market themselves responsibly, the Johnny-come-latelies were more preoccupied with market share acquisition and engaged in some very dubious practices.

The trouble has been that politicians and public health agencies in most countries adopted a position based on concern and uncertainty. Professor John Britton told Politico: “You sort of paint yourself into a corner where if you say, at the outset, ‘I don’t like the look of this, let’s ban it,’ and then gradually evidence comes along, say, that banning it might not be quite a good idea, you’ve either got to have the courage to say, actually, ‘I’ve got the call wrong’ and change your position. Or you just hunker down. And the WHO has taken that approach.”

His comment goes part the way towards explaining what has gone wrong in research too. The small cohort of vocal public health specialists came out strongly against vaping in 2012/13 (despite one of them admitting that he knew absolutely nothing about it at the time). Two of them became embroiled in problems during some late night tired and emotional use of social media, then four of them published an incredible attack on one advocate in The Lancet in response to her article calling for reasoned discussion. Amazingly, considering everyone was ostensibly working to the same end of reducing tobacco-related cancers, battle lines had been firmly drawn.
 
This spilled over into the research community. The E-Cigarette Summit was set up as an annual event to discuss the latest findings looking at vaping and tobacco harm reduction. It was swift to exclude any researchers in receipt of funding from the tobacco industry. At the same time, independent researchers were speaking at The Global Forum for Nicotine, doing the same thing. But in 2021, the first event following the Covid outbreak, emails began popping up in academics’ inboxes threatening them with the removal of their research funding or their university posts if they continued to attend. It just so happens that those independent. researchers were all responsible for positive findings supporting ecigs as a tool to quit smoking.

Meanwhile, negative studies continue to pour out of the University of California, the Johns Hopkins Bloomberg School of Public Health and others. Wondering why these institutions are finding the opposite to independent researchers in the UK comes down to the nature and scale of the funding they receive to conduct their work. They are all beneficiaries of millions of dollars coming from the billionaire Michael Bloomberg – who has spent almost half a billion dollars on promoting banning all vapes and also happens to be the World Health Organization’s Global Ambassador for Noncommunicable Diseases…hence the WHO’s ongoing opposition to all e-cig products.

This then is why there is such disagreement and a highly polarised debate, it is not a clean consideration about scientific findings, but one influenced by personal outlooks, beliefs and morals – plus, to a not insignificant level, hurt feelings and perceived slights also play a part. Influential people who disagree with any form of nicotine use drive one side, pragmatists using evidence-based reasoning are on the other – and societies are caught in the middle, confused by the apparent lack of agreement on almost every point. And then the politicians (who are not scientists) who are responsible for forming policies are caught up in the maelstrom of argument, counterargument, and public opinion.
 
The UK has been very fortunate to date thanks to the way our universities support independent, high-quality research, and our successive Health Ministers have been excellent at tuning into it. The recent shift towards considering banning disposables shows how the current incumbent has moved from relying on science to embracing emotive arguments. Here’s hoping that this doesn’t stall the impact electronic cigarettes have had at reducing smoking numbers and prolonging lives.