British newspapers were filled Monday with scare headlines about e-cigarettes, all based on a June letter in the Journal of the American College of Cardiology from a group of Greek researchers. The letter described an unpublished study that found that vaping caused “stiffness of the aorta.”
The letter was recently used by Stanton Glantz to do some freelance fear-mongering, claiming (of course) that this is yet more evidence that vaping is unsafe. “One of the many ways that smoking damages the cardiovascular system is by stiffening major blood vessels,” wrote Glantz.
“How stiff the aorta (the big vessel leading directly out of the heart) is can be measured by how fast the pressure wave moves down the aorta, the pulse wave moving faster when the aorta is stiffer. Following use of an e-cigarette for just five minutes, the pulse wave velocity increased by about 40% as much as smoking a conventional cigarettes and about 80% after 30 minutes of use.”
Does a stiff aorta cause heart disease?
Dr. Michael Siegel wrote a funny blog about Glantz and his trumpeting of the letter, reminding us that many things besides nicotine cause the aorta and other blood vessels to stiffen. Caffeine, exercise, and fear can all have a similar effect on the aorta to nicotine’s.
“Sadly for my students, taking an exam has also been shown to increase aortic stiffness, just like smoking,” Siegel wrote. “However no one would argue that the cardiovascular effects of taking an exam are as bad as smoking. Hopefully none of my students has read Dr. Glantz’s post because I can just see them trying to get out of my next exam by claiming that it will cause aortic stiffness and their doctor has advised them against any exposures that have adverse cardiovascular effects.”
The cardiovascular problems that often beset smokers after years of inhaling cigarette smoke aren’t caused solely by nicotine. They’re caused by inhaling smoke. Cigarette smoke contains an array of chemicals, created by combusting plant material, that wreaks havoc on the heart and blood vessels. A lifetime of inhaling cigarette smoke can’t be compared to vaping, which has no combustion products at all. And a temporary stiffening of the aorta doesn’t cause heart disease.
That should have been the end of this ridiculous story. It’s true that nicotine stiffens the aorta, as do lots of other things. People like Glantz, who want to believe the worst about vaping, read every study in the worst possible light. Responsible scientists understand that every vaping effect similar to one of the many that smoking causes is not evidence that the long-term harm is equivalent. “Where nicotine is used separately from tobacco smoke, for example in the form of NRT or smokeless tobacco, there is no significant elevated disease risk,” wrote Clive Bates.
An expert is born
Then the lead author, University of Athens Medical School professor Charalambos Viachopoulos spoke about it at the European Society of Cardiology Congress in Rome. And all hell broke loose.
Dr. Viachopoulos knows very well that caffeine has similar effects, since the infamous letter he wrote to the cardiology journal references a study that shows just that — and it was written by Dr. Viachopoulos! But that didn’t stop him from making a lot of inflammatory comments designed exactly to be picked up by sensationalist newspapers.
He said he wouldn’t recommend smokers switch to vaping, and he even attacked Public Health England for its evidence-based stance on e-cigarettes. “I think the UK has rushed into adopting this method,” said Dr. Viachopoulos. Just what the world needs, another instant e-cigarette expert.
The papers gleefully reported every word, apparently deciding that any random doctor’s self-serving scientific trolling is a match for the opinions of Public Health England and the Royal College of Physicians. Oh, you have a 200-page comprehensive review of all the scientific literature on the subject? The hell with that, here’s a guy no one’s ever heard of and he says you’re all wrong!
What did it look like in the British press?
- <a href="http://www.mirror.co.uk/science/e-cigarettes-bad-you-smoking-8731169“>E-cigarettes are as bad for you as SMOKING, a new study has claimed
- <a href="http://www.telegraph.co.uk/news/2016/08/29/vaping-as-bad-for-your-heart-as-smoking-cigarettes-study-finds/“>Vaping as bad for your heart as smoking cigarettes, study finds
- <a href="http://www.dailymail.co.uk/health/article-3763932/E-cigarettes-bad-heart-tobacco-Nicotine-vapour-damages-blood-vessels-raises-risk-disease.html“>E-cigarettes are ‘as bad for the heart as tobacco’: Nicotine vapour damages blood vessels and raises risk of disease
None of the articles were quite as bad as the headlines, but the issue is that a day of banner headlines like this can never be offset by education from vaping groups, or even determined pro-vaping public health organizations. The ugly fact is that many people just see the headline, and look no further. How many smokers decided to pass on vaping because of these headlines? How many will die prematurely because of this doctor’s cynical self-promotion?
Vapers and supporters of vaping were outraged, of course. This is an old routine. British vapers and advocates have worked very hard to make progress, convincing doubtful public health groups to sign on to support e-cigarettes as a harm reduction strategy, and moving public opinion inch by inch. Then, just when they think the situation might be improving, along comes a story like this that knocks their efforts back two steps.
Clive Bates wrote a blog tearing this story apart piece by piece. He didn’t spare the British press, but really turned up his contempt for the scientist responsible for the stories.
What’s wrong with just reporting the results? He went a lot further than reporting results. In making these claims to the media, Professor Vlachopoulos highlighted an entirely predictable and already-understood effect. His team calibrated the experiment so that the effect would be roughly the same in smokers and vapers. They then went on to falsely attribute a cardiovascular disease risk to this commonplace effect of stimulants. He then implicitly claimed that this effect was sufficient to equate vaping cardiovascular risk to smoking cardiovascular risk. The authors carefully avoided noting any of the established literature on nicotine cardiovascular risk, including the recent paper that addresses this question explicitly in the context of e-cigarettes. Vlachopoulos then took this exercise in reckless ignorance into the media, which duly obliged with massively unscientific scare stories without the slightest critical push back.
I am pretty sure he will not face any reckoning or accountability or even the mildest rebuke from his peers, who will simply not see it as their responsibility or care insufficiently about the consequences, or who are too timid to engage. On the contrary, his media ‘success’ will be high-fived by his colleagues, institution, funders, his wretched ‘learned society’ and the conference organisers/sponsors – thus ensuring it happens again and keeps happening. It’s not as if this is an isolated incident within tobacco policy or elsewhere in public health.
Dr. Viachopoulos deserved every word. One problem is the smokers who’ll now keep smoking. “Through his cavalier negligence, he has protected the cigarette trade, promoted smoking and probably caused more cases of death and disease,” wrote Bates.
But another problem is that no one knows who to trust. Regular people are not going to search the scientific literature on aortic stiffness and discover the facts. They might not even read the whole story. The headlines alone probably did the trick.
Cigarette makers can’t advertise in the British papers anymore, or on TV billboards. Why would they need to? The newspapers do it for free.