Health Risks of Vaping: Lessons From the Battle With Big Tobacco

ARCHIVAL (CNN, 9-16-15):
JAKE TAPPER: The number of teens, and even tweens who say they have tried e-cigarette has tripled.

ARCHIVAL (KRON, 6-12-20):
NEWS REPORT: 5.4 million in 2019.

KEN WARNER: You have essentially two different phenomenon occurring at the same time. On the one hand, you have an epidemic of use of e-cigarettes among kids.

ARCHIVAL (CNN, 9-16-15):
REPORTER: What kind do you smoke?
VAPER: Strawberry or mango, usually.

KEN WARNER: And then on the other hand, you have adult smokers who are succeeding in quitting smoking as a result of switching to vaping.

SPIKE BABAIAN: I’m using something that may be safer. I’m willing to take that chance.

ARCHIVAL (CONGRESSIONAL CAUCUS TO END THE YOUTH VAPING EPIDEMIC, REUTERS, 9-19-19):
SPEAKER AT PODIUM: We are in the midst of a national public health crisis.

KEN WARNER: This has set off a battle within the public health community, unlike anything that I’ve seen in the more than 40 years that I’ve been involved in this field.

NARRATION: That battle is over the science of e-cigarettes — just how safe or useful they really are — a battle that has taken on new relevance as scientists race to determine whether vaping may increase the effects of Covid-19. But to understand this moment you have to go back in time, to when the marketing of another product fueled a health crisis of its own.

ARCHIVAL (1967):
NARRATOR: We’ve told you the tale of our cigarette, of the Big Red Marlboro brand.

ARCHIVAL (1971):
LEE MARVIN: Hi, I’m Lee Marvin, just brushing up on my Judo and enjoying my favorite smoke, Pall Mal.

ARCHIVAL (1960):
FRED FLINTSTONE: Yeah, Barney, Winston’s taste good.

DAVID MICHAELS (EPIDEMIOLOGIST, GEORGE WASHINGTON UNIVERSITY, AUTHOR, “DOUBT IS THEIR PRODUCT”): When we look at what’s going on with e-cigarettes, the development of the science and look at that in relation to the marketing. You can’t understand it, unless you go back and look at the history of tobacco. That’s gotten us to where we are today.

ARCHIVAL (AD, STANFORD RESEARCH INTO THE IMPACT OF TOBACCO ADVERTISING):
NARRATOR: What cigarette do you smoke doctor? The brand named most was Camel! Yes folks, the pleasing mildness of a Camel is just as enjoyable to a doctor as it is to you or me.

NARRATION: Back in the 1950s, tobacco companies were a powerful industry. But increasingly research was showing their products were dangerous. They responded with so-called scientific studies of their own.

ARCHIVAL (AD, STANFORD RESEARCH INTO THE IMPACT OF TOBACCO ADVERTISING):
NARRATOR: A group of people smoked only Chesterfields in their normal amount, 10 to 40 a day. After a thorough examination the medical specialist stated that all participating subjects were not adversely affected in the six month period by smoking the cigarettes provided.

NARRATION: As the evidence grew linking cigarettes to a host of respiratory illnesses, tobacco executives went even further – attacking the science linking smoking and illness head on.

DAVID MICHAELS: What this executive said was, “Tobacco isn’t our product. Doubt is our product.” It’s the means of establishing a controversy. Because if you have a controversy around science and you have to debate the science, then you don’t have to debate the policy.

KEN WARNER (SENIOR SCIENTIFIC EDITOR, 1989 SURGEON GENERAL’S REPORT ON THE HEALTH CONSEQUENCES OF SMOKING): And one of the things they did was they established a tobacco research funding program that the companies contributed to. Which they said would be for unrestricted research on tobacco related issues.

ARCHIVAL (THE TOBACCO INSTITUTE, CITIZEN MEDIA FOR WE THE PEOPLE, 1968):
NARRATOR: Did you know that after years of research there is no scientific proof that cigarette smoking causes human disease. We believe that only through research can we end the guesswork and controversy about smoking and health. And replace them with facts.

KEN WARNER: They funded large numbers of research projects. Many of which had absolutely nothing to do with smoking.

DAVID MICHAELS: There was a publication that went out with any sort of article about some other cause of lung cancer. One of the ones I have a little picture on my desk, bald men less likely to get lung cancer. You know, anything that, that wasn’t cigarettes that caused lung cancer was what the tobacco industry would emphasize.

NARRATION: And even after the 1964 Surgeon General’s report declared that smoking caused cancer, that strategy of denial continued.

ARCHIVAL (CBS, 1964)
HOWARD CULLMAN (PRESIDENT, TOBACCO MERCHANTS ASSOCIATION): I don’t believe that most people who smoke get lung cancer. If there are bad elements, and if they are found, they will be removed, but at this point we do not know.

ARCHIVAL (UCSF, 1979)
ANCHOR: The tobacco industry says there is no, repeat no conclusive evidence that smoking causes cancer or heart disease.

ARCHIVAL (UCSF, 1979)
WALKER MERRYMAN (EXECUTIVE, TOBACCO INSTITUTE): There is no demonstration of a cause and effect relationship. We are taking about an area of scientific uncertainty.

ARCHIVAL (1994):
WILLIAM CAMPBELL (PRESIDENT AND CEO, PHILIP MORRIS USA): We don’t know what causes cancer in general right now. We may find out some relationship, which has yet to be proven.

DAVID MICHAELS: Even thought it was obvious, there was no debate over these subjects they would say, “I don’t think so,” or “I just don’t know.” But they had more than 50 years of unfettered sales, because of this campaign.

NARRATION: Then, in 2007, a new product hit the American marketplace — the e-cigarette.

ARCHIVAL (BLU ECigs AD, 2013):
JENNY MCCARTHY: I get to have a Blu without the guilt because there’s only vapor, no tobacco smoke. That means no ash, no odor.

ARCHIVAL (THE LATE SHOW, 2012):
KATHERINE HEIGL: It’s a fun addiction.

NARRATION: Like tobacco companies before them, e-cigarette makers pitched the idea that their products were fun — and safe — to a new generation.

DAVID MICHAELS: The Camel cigarette campaign, in some ways, is a classic. But it was nothing compared to what Juul was able to do through a new technology, and social media marketing. They figured out exactly how to reach teenagers, how to reach middle schoolers. And there was no question, those products were marketed to kids. And it worked.

ARCHIVAL (YOUTUBE):
VAPER: I’ve got the Juul. Actually I don’t know if vaping’s cool yet. I think it’s on the cusp.

NARRATION: But there’s a problem with the marketing of e-cigarettes as a cool and consequence-free social experience – nobody knows exactly how dangerous vaping really is – even though the products have been on the market, largely unregulated, for more than a decade.

ILONA JASPERS (DIRECTOR, CENTER FOR ENVIRONMENTAL MEDICINE, ASTHMA & LUNG BIOLOGY, UNIVERSITY OF NORTH CAROLINA): The regulations should have been done before we actually see health effects, not sort of chasing something afterwards. We’re now basically trying to fix something, putting the genie back into the bottle. There are a lot of unknowns in e-cigarette and, and those, sort of, health effects. We have to establish that they are safe and we haven’t done that yet.

NARRATION: University of North Carolina toxicologist Ilona Jaspers has been researching these effects for almost a decade. And what she’s seen so far concerns her.

ILONA JASPERS: The lung is not equipped to possibly, sort of, detoxify some of these chemicals. It’s designed to take up air and exhale CO2. If something is safe to ingest, that doesn’t mean that it is safe to inhale.

NARRATION: Nicotine is a big concern. As with cigarette smoking, vaping pulls nicotine into the lungs, where it is absorbed into the bloodstream and enters the brain. The nicotine “kick” is caused when the body reacts.

Adrenaline is released — raising the heart rate, increasing blood pressure and constrIcting blood vessels — while the brain’s pleasure center is activated by a flood of dopamine.

Some e-cigarette makers heighten this effect by chemically rejiggering the nicotine to make it gentler on the throat — that means users can take in more nicotine, more quickly.

ILONA JASPERS: There’s known health effects of nicotine. There’s also more and more data coming out now that once you are addicted to nicotine through e-cigarettes, you’re much more likely to actually switch to conventional cigarettes and we all know what that does. What’s really concerning to me is that the success that we’ve been able to achieve by reducing smoking has now been neutralized by this new generation of nicotine addicted kids.

ARCHIVAL (YOUTUBE):
VAPER: Like how far can you go with nicotine before it’s dangerous?

NARRATION: But instead of being open to these scientific concerns, critics say the e-cigarette industry has approached the problem in the same way the tobacco companies did — they’ve gone on the offensive.

ILONA JASPERS: My work has been attacked on Twitter multiple times by, you know, certain people that are very very passionate about vaping.

ARCHIVAL (VAPING RALLY):
CROWD: We vape, we vote!

ILONA JASPERS: They are very, very politicized. They’re very organized now. We shouldn’t make this a political issue. In the end, science and scientific facts, and research observations, need to drive our opinions.

NARRATION: Tobacco companies are now heavily involved in e-cigarettes. For instance, cigarette maker Altria, formerly known as Philip Morris Companies, holds a major stake in Juul. And the connections between the two industries run deep.

Scientific consultants who once helped cigarette companies question the dangers of secondhand smoke now help raise doubts about scientific studies that show harm from vaping. And other research became the basis for one of the biggest e-cigarette talking points.

ARCHIVAL (CNBC, 9-27-19):
TONY ABBOUD: E-cigarettes are at least 95 percent safer than combustible cigarettes.

DAVID MICHAELS: That’s not based on anything we understand, because we don’t know the risk from e-cigarettes. We haven’t followed people for 30 years who smoke e-cigarettes. We simply don’t know, and we can’t know.

NARRATION: The similarities between cigarette and vaping companies don’t stop there.

SAMIR SONEJI (ASSOCIATE PROFESSOR OF HEALTH BEHAVIOR, UNIVERSITY OF NORTH CAROLINA): Juul has established a research institute. It has sent out solicitations for partnerships and also cold calling and cold e‑mailing individuals for working in their laboratories, for working in their research.

ILONA JASPERS: And it’s not just Juul, it’s other companies as well. They’re obviously trying to legitimize their research by getting people like myself to do research on their products.

SAMIR SONEJI: Ostensibly that research is unbiased, but they select the studies. And so, if a study looks like it will likely have a favorable conclusion, that seems to be a study that they would likely pick for receiving a million dollar check. The concern is exactly the same kinds of illegitimate debate that delayed tobacco regulation could very well be happening again.

NARRATION: On the flip side, many public health experts are intrigued by e-cigarettes, because there is some compelling evidence that these products can help smokers kick the cigarette habit.

DR. MICHAEL SIEGEL (PROFESSOR OF PUBLIC HEALTH, BOSTON UNIVERSITY): There’s strong evidence that these products are helping people quit. And the amount of reduced morbidity and mortality that’s going to come from that is, is astronomical.

KEN WARNER: I do not believe that vaping is, is the magic bullet. I do think it can be part of the arsenal of weapons against smoking.

NARRATION: Millions of Americans have died of smoking related illnesses. And this epidemic of preventable deaths continues today.

MICHAEL SIEGEL: When I got involved in this in the 1980’s, there were approximately 55 million smokers in the US. There are still 35 million people who are smoking. Smoking is still the number one cause of preventable death, that hasn’t changed.

SPIKE BABAIAN (INSIDE VAPENY): What kinds of flavors do you like?
CUSTOMER: I like, kinda, desert flavors. I’m more of a desert. SPIKE BABAIAN: Ok, let’s go to these babies. So we have snickerdoodle cookie, which is like a taste.

SPIKE BABAIAN (OWNER, VAPENY, BOARD MEMBER, NEW YORK STATE VAPOR ASSOCIATION): I smoked for 19 ½ years, 30 to 40 cigarettes a day. Tried using the patch. Tried using the nicotine gum, I tried toothpicks. I tried candy. I said, “Well, maybe if I’m eating candy I won’t smoke.” And I got 14 cavities in one year. I know that if I don’t use this, I’m smoking cigarettes again. I don’t want that to happen.

KEN WARNER The vaping industry has done itself an enormous disservice basically trying to sell vaping as a young adult, sexy, sociable kind of experience. If they meant what they said from the beginning, that they wanted to obsolete the cigarette, they would have been advertising their vaping products to middle aged and older adult smokers.

NARRATION: Juul denies it intentionally marketed its e-cigarettes to kids. But lawsuits have multiplied even as teen vaping rates have recently declined.

Meanwhile, regulators are now beginning to review reams of data, much of it provided by the industry, to decide whether these products should remain on the market. This has made being able to trust the science behind e-cigarettes more important than ever before.

DAVID MICHAELS: Everybody is watching the development of scientific knowledge around e-cigarettes every carefully, because we’ve been burned by tobacco. If you want to say there’s uncertainty in the science, you can always find someone to say that. And if you can pay a lot of money, you can find someone who will say it really well. That’s the tobacco playbook. And it works.

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