The mission statement of Johns Hopkins University’s Bloomberg School of Public Health reads: “Protecting Health, Saving Lives – Millions at a Time.” The idea that slogan conveys is that Johns Hopkins has such influence in worldwide public-health initiatives that the school—my alma mater—is responsible for keeping millions of people around the world safe from illness and injury through groundbreaking research and initiatives.
Admittedly, Johns Hopkins might not want to acknowledge me as one of their graduates. The Bloomberg School of Public Health is named for the man who, as mayor of New York, signed into law that cigarettes and e-cigarettes are essentially the same thing. On the other hand, I now advocate to anyone who will listen about the virtues of e-cigarettes. Indeed, I think e-cigarettes can accomplish the central goal of the Bloomberg School: to save lives, millions at a time.
This will come as no surprise to those of us who know how e-cigarettes compare to their combustible counterparts. With switching to e-cigarettes comes a quick end to the exposure of 7,000 toxins and carcinogens that accompany combustion. The remaining toxic ingredients that can be found in both products, such as formaldehyde, are found in much lower concentrations in e-cigarettes.
Concerns about diacetyl, a chemical that enhances the flavor profile of many e-liquids, are equally unfounded. Diacetyl also is present in higher concentrations in combustible cigarettes, so its lower concentration in e-cigarettes makes them inherently safer. Popcorn lung, which is linked to inhalation of these compounds, is exceedingly rare and also totally avoidable. More importantly, since the evolution of e-cigarettes, more and more nicotine liquids are completely free of these compounds. With the lower toxins and carcinogens that cause 14 cancers and other lung diseases, the population-level benefits for smokers who switch to e-cigarettes could be seen in as few as 10 years.
What’s the holdup on getting people to switch? Of course, some people just don’t want to switch and that is their decision to make.
More unsettling is the lack of clear communication regarding the safety of e-cigarettes. These muddled messages include unclear position statements from the Food and Drug Administration and not-so-subtle statements from the prior administration’s Office of the Surgeon General to fear-mongering on medical blogs and in the comments sections of vaping articles.
Roughly half of all Americans erroneously believe that e-cigarettes are just as, if not more, toxic and dangerous as combustibles. People with erroneous beliefs about the safety of e-cigarettes outnumber the equally ill-informed population of those with anti-vaxxing beliefs by five to one. Take a moment to think about how much damage has been done by refusing to vaccinate, and multiply that damage commensurately.
This could be changed though. Following an end to litigation and an agreement on timing with the U.S. Justice Department, the so-called “Big Tobacco” companies will be required to issue corrective statements on the effects of cigarettes, starting at the end of November. These statements will run in a variety of media outlets and cover five specific topics, including the adverse health effects of secondhand smoke, the addictive potential of cigarettes, the lack of health benefits from mild or light cigarettes and the manipulation of cigarettes to provide optimal nicotine delivery.
This moment also should offer an opportunity to provide clarity about reduced-risk products and set the record straight on the pros and cons of e-cigarettes. However, even if the DOJ allowed this to happen, who would believe it coming from Big Tobacco?
This message needs to be affirmed outside the echo chambers of e-cigarette advocates. Only if those of us inside the bubble can reach a broader audience of smokers and nonsmokers alike will we be able to have a direct impact on public health.
One place to start is to promote academic research so that it reaches a broad audience, not just those of us who live and breathe difficult-to-interpret public health studies. Today’s tidbit for the masses is a recently published report that estimates, by the end of this century, e-cigarettes could reduce cigarette deaths by 1.6 to 6.6 million people. Millions.
Image by Jon Bilous