I did a Twitter chat with the Campaign for Safer Alternatives on the typical objections raised to tobacco harm reduction. For those interested in the responses but who missed the live chat or got as confused as I did in trying to follow threaded answers, here is the chat as it unfolded over 15 questions with everything in the right order.
Contents
- Introduce yourself
- Does vaping create a gateway effect from vaping to smoking?
- Is vaping a trojan horse for the tobacco industry?
- Does vaping cause fluid build-up in the lungs?
- Does vaping cause ‘popcorn lung’?
- Do vaping flavours help adults quit smoking?
- What would be the outcome of a ban on flavours?
- Do flavours attract teens to vaping?
- Does teenage vaping justify banning vaping products?
- Did nicotine vaping cause the recent lung injury outbreak in the United States?
- What caused the US lung injury outbreak?
- Is there evidence that lung injuries were caused by black market THC vapes?
- Do regulated e-liquids contain toxic chemicals?
- What would bring more awareness about the value of THR?
- Does nicotine addiction cause a gateway effect?
1. Introduce yourself
. @Clive_Bates Thank you for making time to join us for a conversation debunking tobacco harm reduction. Kindly introduce yourself for those that may not be familiar with you #SaferAlternatives
— Campaign for Safer Alternatives (@GoingSmokefree) November 22, 2019
I have no conflicts with tobacco, vape or pharma industries
— Clive Bates (@Clive_Bates) November 22, 2019
2. Does vaping create a gateway effect from vaping to smoking?
.@Clive_Bates . Let’s delve right into it . Is vaping a gateway to smoking cigarettes? #SaferAlternatives
— Campaign for Safer Alternatives (@GoingSmokefree) November 22, 2019
Basically, no. All the evidence points the other way – that if there is a gateway effect it is an ‘exit’ from smoking for both adults and adolescents. However, it is a complicated issue, so we need to say more. #SaferAlternatives 1/ (thread)
— Clive Bates (@Clive_Bates) November 22, 2019
Easy to be misled: the same things that cause people to smoke (e.g. parents, disadvantage, mental health) also incline them to vape. So we often see smoking and vaping together, but the vaping does not *cause* the smoking. They have "common risk factors". #SaferAlternatives 2/
— Clive Bates (@Clive_Bates) November 22, 2019
The question always to ask is “what would have happened in the absence of vaping?”. If the person would have smoked anyway, then the vaping didn’t cause the smoking. #SaferAlternatives 3/
— Clive Bates (@Clive_Bates) November 22, 2019
Some scientists have loudly claimed to discover gateway effects, but they cannot overcome a basic problem – the common risk factors – and it is *never* possible to take all of these into account. @carlvphillips writes well on this: https://t.co/8BVFHTyfGr #SaferAlternatives 4/
— Clive Bates (@Clive_Bates) November 26, 2019
But what do we even mean by ‘gateway effect’? It is such a muddled term that PHE recommended not using it. #SaferAlternatives 5/
— Clive Bates (@Clive_Bates) November 22, 2019
For example, if one person somewhere in the world takes up smoking because they tried vaping is that enough to be a gateway effect? What if millions more went the other way? Again, @carlvphillips has a good piece on this: https://t.co/kcy1mPnWot #SaferAlternatives 6/
— Clive Bates (@Clive_Bates) November 22, 2019
More on the gateway effect:
— Clive Bates (@Clive_Bates) November 22, 2019
Me - how not to be duped: https://t.co/YJuFIk9eXQ
Carl V Phillips - an academic treatment: https://t.co/Y7L3gX9sLW #SaferAlternatives 7/7
3. Is vaping a trojan horse for the tobacco industry?
. @Clive_Bates are e-cigarettes being used as a Trojan horse – so the tobacco industry can keep people smoking? #SaferAlternatives
— Campaign for Safer Alternatives (@GoingSmokefree) November 22, 2019
It's a nonsense claim. It is *consumers* driving the move to vaping and other low risk products. If they can get what they like from cigarettes, but much lower risk of disease, less stigma, lower cost etc, they are going to switch. #SaferAlternatives 1/
— Clive Bates (@Clive_Bates) November 22, 2019
This is both an opportunity and a threat to the tobacco companies – they need to be in this market because they will lose customers to other vaping companies or the vaping businesses of rival tobacco companies. If they don’t make vaping work, they lose. #SaferAlternatives 2/
— Clive Bates (@Clive_Bates) November 22, 2019
No-one can explain how marketing vaping products “keeps people smoking”. If they make rubbish e-cigarettes, then their competitors will take market share from them. #SaferAlternatives 3/
— Clive Bates (@Clive_Bates) November 22, 2019
The only thing that will keep people smoking is excessive regulation, taxes or outright prohibition of vaping. That is being pushed by *public health* and WHO. But it is basically a protection of the cigarette trade from competition. #SaferAlternatives 4/
— Clive Bates (@Clive_Bates) November 22, 2019
David Sweanor wrote a great post on how tobacco control activists turn out to be “Big Tobacco’s Little Helpers” without them even realising it https://t.co/otQzxkPE1P #SaferAlternatives /5
— Clive Bates (@Clive_Bates) November 22, 2019
And I tried to imagine what goes on inside the mind of tobacco industry CEOs when they think about vaping and smoking. Pariahs, Predators or Players: the tobacco industry and the end of smoking > https://t.co/LbAyGIAp46 #SaferAlternatives 6/6
— Clive Bates (@Clive_Bates) November 22, 2019
4. Does vaping cause fluid build-up in the lungs?
. @Clive_Bates Does vaping cause a fluid buildup in the lungs? #SaferAlternatives
— Campaign for Safer Alternatives (@GoingSmokefree) November 22, 2019
No. Is someone saying this is a thing?
— Clive Bates (@Clive_Bates) November 22, 2019
There's a few tobacco control advocates that claim this
— Campaign for Safer Alternatives (@GoingSmokefree) November 22, 2019
No further comment. They are probably dishonestly trying to introduce fear confusion about the recent lung injury cases. But these are nothing to do with regular nicotine vaping. I am sure we will come back to these.
— Clive Bates (@Clive_Bates) November 26, 2019
5. Does vaping cause ‘popcorn lung’?
. @Clive_Bates What about popcorn lung? Do e-cigarettes cause popcorn lung? #SaferAlternatives
— Campaign for Safer Alternatives (@GoingSmokefree) November 22, 2019
No. It is a rare condition and no cases have been plausibly attributed to vaping (including the recent Canadian case). It was named after the disease developed in workers in a popcorn factory that were exposed to massive doses of diacetyl, which is used as a butter flavor. 1/
— Clive Bates (@Clive_Bates) November 22, 2019
Popcorn lung (or bronchiolitis obliterans) is similar in some ways to the lung injuries caused by black market THC vapes. So we can expect some confusion ahead – some of it deliberate. #SaferAlternatives 2/
— Clive Bates (@Clive_Bates) November 22, 2019
The exposure to diacetyl from cigarette smoking is much higher than from vaping. See @farsalinosK on this https://t.co/H6J8oKuSni
— Clive Bates (@Clive_Bates) November 22, 2019
And many vaping manufacturers have removed diacetyl just as precaution and to deal with this argument. #SaferAlternatives 3/3
Later tweets on the Canadian case
More unscrupulous anti-vaping activist-academics trying to prove vaping is harmful - this time it's a fake popcorn lung story from Canada. @mbsiegel has done the necessary takedown: https://t.co/ynLO0z1lUD 1/2
— Clive Bates (@Clive_Bates) November 22, 2019
Liars: the hospital initially claimed no THC use in a disingenuous effort to blame it on nicotine e-liquids:https://t.co/ms4SVzOdl7
— Clive Bates (@Clive_Bates) November 22, 2019
But the case report shows that the patient was a THC vaper:https://t.co/trK9tv8cJS
Note: you don't just "add THC to vaping liquid" 2/2 pic.twitter.com/axieEMt4jK
6. Do vaping flavours help adults quit smoking?
. @Clive_Bates Recently in the U.S, there have been calls to ban flavors .What role do e-juice flavors play in helping smokers make the switch? #SaferAlternatives
— Campaign for Safer Alternatives (@GoingSmokefree) November 22, 2019
Almost all vaping products are flavoured, including the tobacco ones. Flavours are critical in attracting smokers to vaping. To do that, the switch has to be a rewarding and pleasurable experience. See this study: https://t.co/qUt0y3xvAk
— Clive Bates (@Clive_Bates) November 22, 2019
1/ pic.twitter.com/7hujxfwT9f
Adults really do prefer non-tobacco flavours like fruit, candy and dessert. See this study fig 4 & 5https://t.co/YeqYqaTgp5
— Clive Bates (@Clive_Bates) November 22, 2019
2/2 pic.twitter.com/6XmxVEfMiW
It's being claimed that the flavored E-liquids are strategically targeted to kids or teens or entices teens into vaping. How do we address this situation?
— iUche (@jerrydree) November 22, 2019
If you take Juul, the most controversial product, its falvours are tobacco, menthol, mint, fruit, mango, creme and cucumber. All in very sedate packaging and branding. How that that be targeted at teens?
— Clive Bates (@Clive_Bates) November 22, 2019
When juul first appeared most of us joked how they were clearly going for the 'apple' look, it was so low-key looking. No way the packaging & style could be accused of being aimed at kids.
— Lorien (@CaeruleanSea) November 22, 2019
Totally for the kids..! pic.twitter.com/Vc52sMdRUQ
— Clive Bates (@Clive_Bates) November 22, 2019
7. What would be the outcome of a ban on flavours?
. @Clive_Bates About flavor bans, what would be the outcome of a ban on flavors? #SaferAlternatives
— Campaign for Safer Alternatives (@GoingSmokefree) November 22, 2019
Many people would go back to smoking - particularly those on a journey via dual use. 1/
— Clive Bates (@Clive_Bates) November 22, 2019
But there would be other responses: a black market, home mixing, back street trade, internet imports, trying other risky things. Regulators wrongly assume that when they ban something it disappears and everything else carries on as before. #SaferAlternatives 2/
— Clive Bates (@Clive_Bates) November 22, 2019
https://twitter.com/jetpack/status/1197864060555071494Though no-one likes to admit this, vaping is an important alternative for adolescents who would otherwise be smokers. So we can't rule out flavour bans cause more smoking among teens. #SaferAlternatives 3/3
— Clive Bates (@Clive_Bates) November 22, 2019
Something we pointed out was entirely possible years ago. It's not rocket science is it.
— Lorien (@CaeruleanSea) November 22, 2019
Yes - crap policies on vaping punted by tobacco control activists are FAR more likely to have an adverse and causal effect on smoking. They don't even understand how this might be possible - but *they* are gateway effect.
— Clive Bates (@Clive_Bates) November 22, 2019
8. Do flavours attract teens to vaping?
. @Clive_Bates Critics argue that flavors attract non-smoking teenagers to vaping .Do flavor descriptors attract teenage non-users? #SaferAlternatives
— Campaign for Safer Alternatives (@GoingSmokefree) November 22, 2019
At one level this is obvious – the products are just useless without flavours, to both adults and adolescents. It would be like pizzas without toppings – who wants that? #SaferAlternatives 1/
— Clive Bates (@Clive_Bates) November 22, 2019
However, when anti-vaping activists first raised this, their target was narrowly defined to particular flavour descriptors like Gummy Bear or Cotton Candy. Things that they thought appealed specifically to kids. #SaferAlternatives 2/
— Clive Bates (@Clive_Bates) November 22, 2019
This would be like banning, say, pizza toppings that contain pineapple, but it wouldn’t ruin the pizza experience for most people and close down all the pizzerias. Now they are basically trying to ruin the product completely #SaferAlternatives 3/
— Clive Bates (@Clive_Bates) November 22, 2019
It seems crazy to end up having only 'tobacco flavour' that is not banned - that's the experience and trigger that people are actually trying to get away from! #SaferAlternatives 4/4
— Clive Bates (@Clive_Bates) November 22, 2019
It's weird how the anti-vapers overlook the fact that access is the real issue. Why aren't we discussing limiting the availability of an adult product, rather than banning it? There's a solution that should be palatable for everyone.
— Todd Rhoades #WeVapeWeVote (@Todd_Rhoades) November 22, 2019
9. Does teenage vaping justify banning vaping products?
. @Clive_Bates Does teenage vaping justify banning vaping products? #SaferAlternatives
— Campaign for Safer Alternatives (@GoingSmokefree) November 22, 2019
No. We do not generally let adult society get bent out of shape by what adolescents do. We should recognise that they will try hard to do what adults do, and this is normal. We will never stop them completely, but we can help them avoid harm #SaferAlternatives 1/
— Clive Bates (@Clive_Bates) November 22, 2019
More kids drink alcohol than vape, and drinking can be more dangerous. But we aren’t making wine, beer and whiskey taste awful to prevent this. #SaferAlternatives 2/
— Clive Bates (@Clive_Bates) November 22, 2019
The right thing to do is to control (1) access (how easy to get hold of e-cigarettes) and (2) marketing (product names, advertising, packaging etc that appeals specifically to teens). #SaferAlternatives 3/
— Clive Bates (@Clive_Bates) November 22, 2019
But we also need to keep in mind that for many kids, particularly from disadvantaged backgrounds, that vaping may be an alternative to smoking and actually beneficial. No-one likes that argument but it is a genuine public health argument. #SaferAlternative 4/
— Clive Bates (@Clive_Bates) November 22, 2019
From US data, we know that most frequent youth vapers are also users of other tobacco products... so we need to be pretty confident that restriction on vaping wouldn't just trigger more teen smoking. (and we are not confident) 5/5
— Clive Bates (@Clive_Bates) November 22, 2019
10. Did nicotine vaping cause the recent lung injury outbreak in the United States?
. @Clive_Bates In the U.S, there have been numerous reports of severe lung problems—termed a “mystery lung illnesses”—allegedly caused by vaping. Did nicotine cause these illnesses? #SaferAlternatives
— Campaign for Safer Alternatives (@GoingSmokefree) November 22, 2019
No, not regular nicotine vaping. The recent serious lung injury issues have been caused vaping black market cannabis (THC) vapes that used a fatty (lipid) substance to cut and thicken the THC oil. This inflicted serious lung damage. #SaferAlternatives 1/
— Clive Bates (@Clive_Bates) November 22, 2019
These have *nothing* to do with the products sold for tobacco harm reduction as an alternative to cigarettes – around 50 million are using around the world without these problems. Sadly, unscrupulous public health professionals have tried to mix up the two. #SaferAlternatives 2/
— Clive Bates (@Clive_Bates) November 22, 2019
There are some in public health and tobacco control who will go to any lengths to stop the rise of vaping as an alternative to smoking – including misleading the public by confusing them about the cause of these lung injuries. It is deeply unethical. #SaferAlternatives 3/
— Clive Bates (@Clive_Bates) November 22, 2019
11. What caused the US lung injury outbreak?
. @Clive_Bates Was the delivery device or was it the substances that were vaped at the core of the outbreak? #SaferAlternatives
— Campaign for Safer Alternatives (@GoingSmokefree) November 22, 2019
The outbreak was caused by substances e.g. Vitamin E acetate added to the liquid, not the THC itself. These thickening agents serve no purpose in nicotine vapes and would not work anyway. #SaferAlternatives ½
— Clive Bates (@Clive_Bates) November 22, 2019
The chance of something else happening in nicotine vapes with the same symptoms, at the same time, in the same geography (US) is vanishingly small. @CDCTobaccoFree should have ruled out commercial nicotine vapes as a possible cause months ago. #SaferAlternatives 2/2
— Clive Bates (@Clive_Bates) November 22, 2019
12. Is there evidence that lung injuries were caused by black market THC vapes?
. @Clive_Bates Is there any research that shows the ‘outbreak’ of vaping related lung disease in the US was related to the use of unregulated cartridges containing tetrahydrocannabinol (THC)? #SaferAlternatives
— Campaign for Safer Alternatives (@GoingSmokefree) November 22, 2019
Yes. CDC has basically concluded this was the problem all along. https://t.co/ozoNqZXmDo
— Clive Bates (@Clive_Bates) November 22, 2019
To many of us, this was obvious from the end of July. But CDC has kept the doubt about nicotine vapes going for far too long. Deliberately and maliciously IMO. #saferAlternatives 1/1
13. Do regulated e-liquids contain toxic chemicals?
. @Clive_Bates Finally, do regulated e-liquids contain toxic chemicals? #SaferAlternatives
— Campaign for Safer Alternatives (@GoingSmokefree) November 22, 2019
Toxicity depends on dose – “the dose makes the poison”. Obviously, nicotine can be fatal if you take enough of it. There are sometimes hazardous chemicals in liquids but not at doses that would be toxic - i.e. causing a material harm. #SaferAlternatives 1/
— Clive Bates (@Clive_Bates) November 22, 2019
This has been a massive source of confusion in science - simply finding a hazardous agent in an e-liquid does not mean there is enough of it to have a harmful effect on the body or to overwhelm the body's defences. #SaferAlternatives 2/2
— Clive Bates (@Clive_Bates) November 22, 2019
14. What would bring more awareness about the value of THR?
What in your own view @Clive_Bates s would be the most viable approach to bringing about global or even so local awareness of THR as the way forward!? #SaferAlternatives
— Tobacco Harm Reduction Uganda 🇺🇬 (@ThrUganda) November 22, 2019
It really needs @WHO and @FCTCofficial to start being truthful and to recognise the value of THR in meeting its goals to reduce smoking and non-communicable diseases > se SDG 3.4, for example: https://t.co/qA1YdDAQC8
— Clive Bates (@Clive_Bates) November 22, 2019
Whether that is viable or not, I don't know... they show little sign of it
— Clive Bates (@Clive_Bates) November 22, 2019
15. Does nicotine addiction cause a gateway effect?
@Clive_Bates The "gateway theory" is backed by the claim that nicotine is addictive.
What is your opinion on the addictive properties of nicotine (alone, smoke free) for never-smokers?#SaferAlternatives— xavier limodin 🇫🇷 (@XLimodin) November 22, 2019
It depends on how it is delivered - it isn't an intrinsic property of the chemical itself.
— Clive Bates (@Clive_Bates) November 22, 2019
There are lots of reasons why someone who has never smoked would not transition from vaping to smoking... the nicotine 'hit' is just as strong if you want it to be. Plus smoking has many other unwelcome attributes - stigma, smell, mess and serious health effects.
— Clive Bates (@Clive_Bates) November 22, 2019
The language of addiction requires care... it usually means that there is some additional harm that goes with it. See my discussion here > https://t.co/DcPwZErBA9 #SaferAlternatives
— Clive Bates (@Clive_Bates) November 22, 2019
Great summary, Clive, thank you. Healthcare workers need to read this; as a trusted source of information I worry a lot about where *they’re* getting their information from
Thanks, Louise… some very big American players are now spreading bare-faced falsehoods about vaping. It’s as though AHA, ALA, AMA have gone all Trumpy with the truth.
I am just tired of all the nagging. Nine years vaping and felt like I did what they wanted but still getting nagged about vaping. Go to the dentist and get three of them in the room with me telling me the evils of vaping and how acidic it is on my teeth to the point of telling me cavities are showing up within weeks of being filled. Sitting in that chair with three people nagging me just takes me back to when I smoked and refused service due to tobacco smells on me. Can’t win for losing here and seems like the battle will go on until I pass away. (I am 62 right now)
I will never go back to smoking as when I switched to vaping I couldn’t even audio speak one sentence without coughing so hard it cracked my ribs. I am not getting sick over and over again with bronchitis and having to use three asthma puffers. My health is better so I really could do with a lot less nagging over my vaping.
Dear Kat – I absolutely sympathise. It must be so exhausting to have this amplified barrage of condemnation for basically doing exactly the right thing on your own initiative and at your own expense, taking personal responsibility for your own health without harming anyone else. Especially when the critics are wrong about almost everything about vaping.
You might like my evergreen blog post: Memo to public health grandees: vaping, vapers and you. It’s my most accessed blog.
And stick with it… it will make a big difference to quality of life over the coming decades.
Hi Clive and thanks for the reply back. I am not going to give up still as active online as I can be.
Is there some research or something for dental issues with vaping or to debunk it as I still have to go to the dentist and keep putting it off due to the nagging me over vaping. Maybe I will let people nag me when I am in my 90s but right now it just makes me very angry.