Experts Take Aim at Vaping Industry's Tobacco-Like Tactics

Ingrid Hein

September 23, 2019

MADRID — Investigators who receive funding from e-cigarette companies will be denied the right to present their research if a new by-law is passed at the upcoming European Respiratory Society (ERS) 2019 International Congress.

The edict echoes a similar vote from 2000 that restricted researchers who received funding from tobacco companies.

"We are concerned our colleagues will be used," said Jørgen Vestbo, DMSc, from the University of Manchester in the United Kingdom, who will cochair a session on e-cigarettes and heated tobacco.

"Researchers may get lab support to do research that is obviously beneficial to the vaping industry, and makes it look more credible," Vestbo explained. The approach harkens back to the 1960s and 70s, when big tobacco companies funded scientific research that suggested smoking was not as harmful to human health as it is now known to be.

Vestbo said he worries that marketing and industry-funded science will prevail, as it did with big tobacco, especially because e-cigarettes are seen as a harm-reduction tool.

We are concerned our colleagues will be used.

This line of thinking can be dangerous, he said. "We should not be blinded to the fact that a huge amount of the vaping industry has ties to the tobacco industry."

Vestbo told Medscape Medical News that he is confident that the new by-law will pass: "I don't expect anyone will challenge this."

Two sessions — one on vaping-induced lung disease and another on advocacy for e-cigarette policies — have been added to the agenda just days before the start of the meeting.

When it comes to e-cigarettes, "we have a lot to discuss," Vestbo said.

A task-force report on electronic nicotine delivery, recently issued by the ERS tobacco control committee (Eur Respir J. 2019;53:1801151), does not recommend population-based harm-reduction strategies for tobacco cessation. In fact, it states that there is "no evidence that e-cigarettes are safer than tobacco in the long term."

But the science on the harm e-cigarettes can cause to humans is still not clear.

And the smoking-cessation aspect of e-cigarettes pits scientists and clinicians against one another, even though they are all "on the same side," said Filippos Filippidis, MD, PhD, from Imperial College London, who will discuss novel tobacco and nicotine products during the session that Vestbo will cochair.

Long-term Effects

A long-time smoker might switch to e-cigarettes because it's "better" for him, Filippidis explained, but his 16-year-old child might have a hard time understanding "that this may be a solution for a person who cannot quit, but it's a terrible choice for a 16-year-old who doesn't smoke."

Although "we are on the same side" of the issue, "we are polarized," he said. "I am sad to see that the tobacco-control community — many members of which have dedicated their lives to combating tobacco and saving people's lives — is now divided on the topic of e-cigarettes."

We are polarized.

Recent news reports about hospitalizations and deaths in young people caused by vaping have raised the alarm in the respiratory community. "We have been following the news closely and we want to put the precautionary principle to work," Vestbo said.

"We don't know the long-term effects," he pointed out. "We were bad enough at fighting one inhalation epidemic, why would we be any better at another?"

Discussion of a recent preliminary report of 53 hospitalizations in the United States — which suggests that tetrahydrocannabinol products used in e-cigarette devices could have caused a cluster of illnesses that "represents an emerging clinical syndrome or syndromes" (N Engl J Med. Published online September 6, 2019) — will likely be at the center of the lunchtime presentation and panel session on vaping-induced lung disease that was just added to the program.

"We need to understand what to tell doctors to better identify when someone is in the ER because vaping caused the illness," Vestbo said.

Numerous hospitalizations related to vaping have been reported in the United States, but there is no evidence of a surge in vaping-related hospitalizations in Europe. This could be because medical data is recorded separately in each European country and policies are diverse, he explained.

"In some places, you can still smoke in restaurants," Vestbo said. "The UK is probably the most e-cigarette-friendly country in Europe, saying it's a way to quit smoking and that it's bound to be safer than real cigarettes."

In the United Kingdom, vaping products are approved by the Medicines and Healthcare Products Regulatory Agency and vaping is supported as a smoking-cessation aid.

We need to send out a signal with regulation, said Vestbo. "The longer politicians wait to come out with restrictions, the longer the e-cigarette industry has to convince people it is safe and a good way to stop smoking."

Vaping Bans

Last week, India banned e-cigarettes from entering the country — a bold policy move for a country with 106 million cigarette smokers.

In the United States, flavored e-cigarettes — popular with teenagers — are being banned in many jurisdictions.

Young Americans are taking up e-cigarettes at a high rate. In high-school students, vaping rates increased from 11.7% in 2017 to 20.8% in 2018 (MMWR Morb Mortal Wkly Rep. 2018;67:1276-1277). In contrast, 2.8% of adults were users of e-cigarette in 2017 (MMWR Morb Mortal Wkly Rep. 2018;67:1225-1232).

At the end of the day, e-cigarettes can help you stop smoking cigarettes, but they are also keeping you addicted to nicotine, Filippidis said. He pointed to a study comparing e-cigarettes with nicotine-replacement patches for smoking cessation. At 1 year, participants in the e-cigarette group were more likely than those in the patch group to be still using their cessation aid (N Engl J Med. 2019;380:629-637).

"I fear that people who stop smoking by using e-cigarettes will just have mixed consumption," he said. "We can't promote this for harm reduction. We already have other smoking-cessation methods that we know work."

European Respiratory Society 2019 International Congress.

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