E-cigarettes and the creation of ignorance

The American Heart Association (AHA), when discussing e cigarettes, warns that e cigarette use, “is a dangerous trend with real health risks”, and that, “e cigarettes should not be promoted as a safe alternative to smoking.”[1] Is this the case?

The AHA go on to list a number of, ‘dangers’ from e cigarette use. These include, under the sub-heading, “Many downsides. Few potential upsides,” the claim that e cigarettes are not effective as smoking cessation tools. It also supplies a link to, ‘proven methods to successfully quit smoking.’ [2]  I would not go there, it is just a glitzy version of the, ‘…is vaping safer than…’ page; indeed, repetition is a hallmark of ignorance production.

The messages we receive on this page are, first, “Ready to Quit Vaping? If you’ve realized needing your vape isn’t a great feeling and all your $ is going to pods, we’ve got you. Text HEART to 88709 to get free advice, tips and inspiration for quitting.”  [Of course, the AHA have already realised that, ‘the vape is a great feeling.’] They know full well, and we know, that it is a fabulous release from the chains of smoking. Why do you think that they want to ban flavours and restrict nicotine content? The comment is designed to influence those millions who have not already tried to use an e cigarette to try to stop smoking: who do not know how pleasurable and effective vaping is – it is saying to them, do not even bother trying vaping. What we are witnessing here is an important step in the creation of ignorance.

But why? Why on earth are the AHA trying to deceive and to deter people from trying a product which has been proven to be effective in helping smokers ease away from the habit of smoking and into stopping smoking completely? It makes no sense whatsoever for an organisation, whose stated aim is to help people away from the smoking habit, to advise them not to try the single most effective tool available in the history of smoking, to avoid it – not to even think about it.

But, the AHA deny that vaping is an effective measure.  They pour scorn on the idea that they work. Now, one could search for evidence in order to confirm things one way or another – The AHA could supply the evidence for the public to examine, but no! They simply use the deceptive argument that there is not enough evidence: there is no point in looking for evidence if it does not exist, is there? However, ’not enough,’ does not mean, ‘none.’ Evidence does exist; it is out there and there is more than enough, even at this place in time, and it should be more than convincing. [3] [4] [5] [6] [7]

But we should not be surprised, where in an early study (2012), looking at experienced users entitled: “User experience and/or device characteristics likely influence EC nicotine delivery and other effects. We read: “Systematic manipulation of these and other variables could elucidate conditions that produce intended effects.” [8]  This is important. As early as 2012 it had been observed that the type of device, nicotine, and importantly, ‘…other variables,’ could see the creation of more effective mechanisms in vaping as a substitute for cigarette smoking. So, there is evidence to say that vaping is more effective than, patches and gum, lozenges or quitting cold turkey, and we know how much the technology has evolved, yet the AHA advise the smoking public to avoid vaping and use NRT products instead: Thank goodness they are not reviewing motor vehicles! I fear they would be telling us that the Model T Ford has better build quality than a modern Ferrari – and is just as fast.

We have research, and we have real evidence as to the success of vaping This, real, evidence, is discounted by the AHA & Tobacco Control… it is anecdotal. It is thought to be irrelevant, but, in the face of only, ‘limited’ evidence – is it? Should it just be discounted out of hand?

The sheer scale of witness accounts bear testimony to the effectiveness of vaping as a substitute for smoking. Indeed, anecdotal evidence compliments the existing positive research. Have a look at one Facebook site. [9]  It belongs to, the US Consumer Advocates for Smoke Free alternatives Association (CASAA). Read a page, or two, or maybe all 1,255 pages. Look at what vapers are willing to tell the world about their experience – and each individual account must be accompanied with personal details to guarantee that these people are not creations of some spam account. [10]

But we do not have to justify the success of vaping just by looking at the testimonials from vapers… all we must do is apply some common sense as we look at the statements about vaping as put out by the AHA and others. [the term “common sense” has been used deliberately. It may be an anathema to some in the scientific community, but here it is used in context with the topic… agnotology [11] and vaping] All we have to do is witness the AHA and others scream and put out unjustifiable statements such as, ‘we do not have enough evidence.’ All we must do is ask ourselves, why do the AHA recommend second best products?

All we have to do is check the evidence they present to bolster their case and see the flaws inherent in these studies. Look to see if they have: “failed to carefully examine the literature for similar, prior research; failed to critically assess the prior literature;  failed to specify the inclusion and exclusion criteria for its subjects;  failed to determine and report the error of its measurement methods;  failed to specify the exact statistical assumptions made in the analysis; Failed to perform sample size analysis before the study begins; Failed to implement adequate bias control measures; Failed to vigorously recruit and retain subjects; Failed to have a detailed, written and vetted protocol; Failed to examine for normality of the data;  Failed to report missing data, dropped subjects and use of an intention to treat analysis; Failed to perform and report power calculations; Failed to point out the weaknesses of the study;   Failed to understand and use correct scientific language. [ Detail on each of these…] [12]

You will have noticed, of course, the complete and utter disregard for the use of proper scientific language here with my writing, and it is deliberate. Look at AHA and other organisations’ publications, particularly when they are being critical – sorry, that is just too formal – demonising vaping.

Seriously, the use of informal language should have no place in scientific discussion.

Informal language is the language of persuasion. It is the language we expect from, Dodgy Dick – better make that, Dave, down at the used car lot. Informal language is the language of emotion – how many, I wonder, felt irritation, or were mildly amused, at my previous comment? Childish innuendo!

Yet, the primary stakeholders in the smoking / vaping debate are smokers and vapers, and most of those people are not scientists, are not health experts. I number myself among this group. Then there is the general public whose attitudes are important to the regulators. The publics’ and often the regulators’ (as in politicians) only real access to the science behind vaping is through the media… but don’t the media get their information from the scientists?  Well, sometimes, and sometimes it comes from secondary sources such as the AHA.

So, what do the scientists say to the media – is it a formally worded version of their study? Is it accurate, but couched in simple terms not designed to elicit emotion? What does the media receive originating from, Dodgy Dave at the ‘honest’, used car lot? What do they read when Dodgy Dave contacts them?

As an example, one of the biggest scare stories about vaping was based on a study of vapour by David H. Peyton of Portland State University and published in the New England Journal of Medicine. It was a study that found high levels of formaldehyde in e cigarette vapour. Formaldehyde is a known carcinogen. But firstly, I wish only to look at the language used in the press release.[13] This is what the media pick up on and it is what the public swallow. [Note how I use the word, ‘swallow,’ instead of ‘read.’ Look at the connotation of being duped.]

One of the first comments that I noted was the comment by Prof. Peyton, “The popular ‘tank system’ e cigarettes allow users to really turn up the heat and deliver high amounts of vapor, or e cigarette smoke.” I find this very interesting. The professor calls the vapour, ‘smoke.’ Many people make this mistake, but look at what comes just before he does this. He calls the vapour, ‘vapour’, so he is fully aware it is not smoke. The intention, I believe, is to confound smoke with vapour. If it is not intentional then this ‘distinguished’ scientist is unaware of the difference between an aerosol and smoke: while smoke is an aerosol, not all aerosols are smoke. You need burning to produce smoke… oho! The good professor did know the difference – his research looked at burning, not the creation of vapour. We will come back to this.

Another point of interest is where we are told, “Formaldehyde is a known human carcinogen. It is a colourless, strong-smelling gas, commonly used as an adhesive in building materials such as particle board and in mortuaries as an embalming fluid. Formaldehyde is also used as an industrial fungicide, germicide and disinfectant.”

The researchers are not just turning up the heat on the vaping device being studied – they are ramping up the emotive heat. As if the media receiving this cannot do this for themselves. No, better to supply them with the juicy (irrelevant) content: ‘Strong smelling gas, mortuaries; embalming fluid; industrial fungicide’ – well I never!

And now for the study itself. We will begin with formaldehyde being strong smelling, it is, and it also has a very powerful taste. Burnt toast, black sausages left too long in the frying pan, the roast left forgotten in the oven, and if burnt black would you eat it? Of course not!

And the same holds true for formaldehyde in e cigarette vapour. As soon as it forms, the vaper can taste it. It is utterly disgusting. It is vile. This was demonstrated by Dr Konstantinos Farsalinos when he and his team replicated the original study. [14] The replication concluded, “The high levels of formaldehyde emissions that were reported in a previous study were caused by unrealistic use conditions that create the unpleasant taste of dry puffs to e cigarette users and are thus avoided.”  So how can the high levels found by Prof Peyton be accounted for…

The early experiment used an antiquated C4 coil. Even ‘the man in the street’ knew better than to take an antiquated coil, fit it to a modern variable voltage battery then ramp up the power – and they did not have to refer to research to acquire this knowledge. This, from a chat site re the C4 clearomiser. “Tbh I’d probably look at keeping the wattage below 10 on a CE4. They’re not really designed to handle a lot of wattage and going too high can ‘char’ the silicon cap over the coil. The top coil design means they can struggle with wicking too sometimes, particularly on high VG/high viscosity juices. Best to keep the wattage fairly low unless you’re fond of dry hits and the taste of overheated silicon.” And there you have it from two blokes discussing vaping gear – and not trying to justify a $3.4 million reward for using flawed science to demonstrate harm from vaping. [15] And, please note the vapers reluctance to, ‘really turn up the heat.’

The creation of formaldehyde is easy… keep breathing, however the creation of formaldehyde in e cigarette vapour (and creating a scare) is a little bit more complex.

1. Take an old fashioned, outdated tank system with a 2.1-ohm, capillary activated coil.
2. Match it up to a modern high powered, variable voltage / wattage vaporizer battery
3. Put it in a ‘puffing machine’ which does not replicate real usage.
4. Make sure that the puff regime creates heat by overlong draws on the device and tiny intervals in between.
5. If that does not produce the desired result, turn up the power, and again, and again, and again. Keep doing this till what you want to achieve is achieved.
6. Voila! We have more formaldehyde than is found in a cigarette.
7. Send the results with a suggested headline, and missing out all the above, to the media via a press release. [16] (This is a reference to my own writing)

Easy!

I would like to end this section with comment from Dr Farsalinos.

“The field of e cigarette research has an unusually high number of studies reporting “strange” (to say they least) results. A basic principle that should have been followed is that if the data do not make sense, don’t blame common sense but look at the data for possible mistakes. Still, many (if not most) of these studies are accompanied by press statements and widespread media campaigns. As a result, today, after so many years of research, the majority of smokers think that e cigarettes are equally or more harmful than smoking. It would be interesting to see how the journals and editors who publish these studies will react when the findings of their publications cannot be replicated.” [17]

Both before and after the ‘formaldehyde scare,’ sensational headlines have been produced and have swept the globe: ‘E cigarettes contain antifreeze; e cigarettes cause lipoid pneumonia; e cigarettes cause ‘popcorn lung; nicotine causes cancer…’  On and on and on. More and more garbage heaped into the pot of ignorance. And now the latest…

The THC scandal

This attack on nicotine vaping demonstrated and highlighted the bias held by the CDC about nicotine vaping (about e cigarettes). It demonstrates and highlights the efforts to which, what should be, trustworthy sources of information, are major contributors to the ignorance which exists in the public mind about vaping and vaping safety. Here, I will now define between nicotine vaping using an e cigarette, and cannabis vaping using a dab-pen or, I prefer the label, e-joint. Let us be absolutely clear. The e cigarette is used for vaping nicotine (or no nicotine) as an alternative to cigarette smoking – nothing else. Cannabis vaping uses devices which are not e cigarettes. There may be a variety of names but, e cigarette is not one of them. For the purpose of clarity, I will refer to cannabis vaping as use of the e joint.

In late summer 2019 an outbreak of serious lung conditions occurred in the USA. Soon it was revealed that people were dying. The CDC sprang into action – and got it all wrong.

The platform for this information disaster was personal and institutional bias, and very likely, a desire to influence the politicians. truth was a by-product that would only be used to ‘sweeten’ the lie; this was what was to be a blatant and deadly use of confounding to create ignorance; the propagators of culturally induced ignorance would be hard at work… again.

It started with warnings to avoid e cigarette use. On September 6^th headlines like the following issued a warning from the CDC, “Three people have died of a mysterious lung illness linked to vaping as cases skyrocket. CDC encourages people to stop vaping as investigation continues.” [18]  The term, ‘vaping’ is commonly attributed to e cigarette use. There is nothing to indicate it was anything other than nicotine vaping as the cause of the outbreak. This is despite the New York State Department of Health announcing that a chemical called vitamin E acetate had become, “a key focus,” and cannabis samples had been found to contain the substance. [19]  Despite the link to vitamin E acetate and illicit cannabis products, the CDC continued with warnings like, “While this investigation is ongoing, people should consider not using e-cigarette products.” [20]  Yet, these people were fully aware of the differences in e cigarette products. They stated, “On August 30, 2019, states were asked to submit data to CDC about lung illnesses associated with e-cigarette product use, as well as information about the types of e-cigarette products used.” Add to this that they recognised, “While many of the patients, but not all, reported recent use of THC-containing products, some reported using both THC- and nicotine-containing products. A smaller group reported using nicotine only.  [21] Surely the same emphasis and clarification should have been incorporated into the headings and warnings. Instead the CDC imply that there was some sort of doubt – justification for what they must have known was misinformation?

Others knew why, “a smaller group reported using nicotine only.”

Dr. Michael Siegel a Professor in the Department of Community Health Sciences, Boston University School of Public Health wrote as early as August 25th, 2019. He stated, “The advice from health agencies, including the CDC, to avoid using “e-cigarettes” is irresponsible. This is such a broad category of products that it doesn’t really give people any guidance whatsoever in terms of what to avoid. There are millions of people who are vaping nicotine-containing e-liquids and it would not be prudent for these millions of people to return to smoking in order to avoid the risk of this “unknown” and “mysterious” medical condition. Moreover, with such vague advice, no one is likely to change their behaviour because they are not being warned about any specific, identifiable risk.

The truth is that in every case so far in which a specific e-liquid has been identified  that product has been a THC-containing e-liquid, typically purchased off the street and often in open cartridges such that they could contain a contaminant or other drug. [22]

And it was not just Dr Siegel. Clive Bates former chief of Action on Smoking and Health UK. stated, that this is one of the, “darkest episodes in American public health … They have lost all their moorings with evidence and good practice.” [23]

The CDC were forced to come clean

The blizzard of complaints, and in the face of the facts demonstrated that THC vaping was 100% at fault. Nicotine vaping using e cigarettes was innocent and cannabis vaping using e joints was the culprit.

Yet!
Even now!

Just four days ago, [as I write Jan 8^th 2020] on the CDC website, we find a link to advice for physicians, , “ patients should be supported in their efforts to discontinue e-cigarette, or vaping, product use and should be educated that resuming use of e-cigarette, or vaping, products might result in recurrence of lung injury symptoms… Evidence-based strategies are recommended for the treatment of tobacco product use and dependence. For patients aged <18 years who use e-cigarette, or vaping, products, health care professionals can consider the use of interventions that have been shown to increase cigarette smoking cessation among adults, including behavioural interventions…” [24] 

Yes, the same document mentions cannabis vaping, but this is confounded, over and over again with reference to e cigarettes and tobacco use. This is advice on the outbreak of lung injury, no, not e cigarette use, but from illicit THC and e joint use. This confounding, this repetition and the refusal to change stance, and the language, even in the light of overwhelming evidence, are typical strategies used by those who wish to promote culturally induced ignorance.

Now a word about ‘common sense.’ Common sense relies on expert information. Common sense is “the ability to use good judgement in making decisions and to live in a reasonable and safe way.” [25] I repeat, judgements based on the findings of the experts.

How is it even possible to reach reasonable and safe conclusions about vaping when so much ‘expert’ advice is: so very badly flawed, skewed, twisted by bias and warped through personal and corporate interest? How can Joe Public be expected to crawl out of the primal soup that is misinformation and the deliberate creation of ignorance? How can thinking people ever evolve from, escape from, the clinging mud of this swamp?

Michelle Minton writing in, ‘fear Profiteers,’ [26] sums things up thus…

“Anti-smoking advocates often portray big tobacco companies as “merchants of doubt” that pour large sums money into efforts to obfuscate the evidence that their products are harmful to health, in order to keep making money. But the strategies employed by anti-tobacco activists to push for anti-vaping policies are not that different: using hyperbolic language in the media and misleading research to spread the patently false idea that vaping is as bad as or even worse than smoking.

There is nothing wrong with health groups accepting grants from industry, even from companies with a financial stake in their mission, with their advocating for regulatory changes they believe will benefit public health, or with utilizing the media to raise the profile of their issues or organizational clout. However, there is something wrong with health- focused groups using taxpayer funds to obscure facts, lobby government, collude with activists in government agencies, and create unwarranted public panic.

For public health regulation to do more good than harm, regulators need to base decisions on an objective analysis of sound research and a thorough examination of the potential unintended consequences of policy proposals. They should not make decisions based on assumptions, blind fear, or political pressure.”

Yes, money. But more than this. I think that the experts, like those mentioned, are as much victims of culturally induced ignorance as those they are trying to take down with them. Their bias is so strong that they feel justified in twisting facts to suit their agenda. Their bias is so strong they are blinded even when the science is clear.

The public cannot apply common sense to situations where the ‘experts,’ who are supposed to present the facts and unbiased interpretation of the facts, cannot see the facts, either for personal gain, or through the fact that they are, themselves, suffering badly from culturally, or deliberately induced ignorance.

That is an opinion not a fact… it is also common sense.