National Academies Vape Report: Just What the FDA Needed

A new report on the health effects of e-cigarettes from the National Academies of Sciences, Engineering, and Medicine says that vaping is likely to be far less harmful than smoking, and that it might help adult smokers quit cigarettes.

The report is not the usual lopsided review of risks, but neither is it a ringing endorsement of vaping as an alternative to smoking. Its conclusions are eerily in line with what the FDA will need to carry out the mission of its current leadership.

"The bottom line for the American public is that the main conclusions of this report are consistent with those reached by respected organizations like the Royal College of Physicians and Public Health England,” said American Vaping Association president Gregory Conley in a statement to Vaping360. “The committee's findings also fall in line with FDA Director Scott Gottlieb's nicotine strategy, a key element of which involves adult smokers switching to lower risk products.

“In the wake of this report,” he added, “it is more apparent than ever that true leadership is needed in public health to ensure that adult smokers have access to truthful information about the benefits of switching to smoke-free products."

The National Academies of Sciences, Engineering, and Medicine (NASEM) are, according to their website, “private, nonprofit institutions that provide expert advice on some of the most pressing challenges facing the nation and the world. Our work helps shape sound policies, inform public opinion, and advance the pursuit of science, engineering, and medicine.”

The National Academy of Sciences was chartered by Congress during the Civil War. The other academies came later, in 1964 (Engineering) and 1970 (Medicine, originally called the Institute of Medicine). The National Research Council (chartered in 1916), produces the academies’ reports, and is governed jointly by the three academies.

“Much of the research on e-cigarettes suffers from methodological flaws and many important areas have not yet been researched,” says the NASEM report intro — and they’re right.

“Nonetheless, the committee found sufficient literature to suggest that, while there are risks associated with e-cigarettes, compared with combustible tobacco cigarettes, e-cigarettes contain fewer toxicants; can deliver nicotine in a manner similar to combustible tobacco cigarettes; show significantly less biological activity in a number of in vitro, animal, and human systems; and might be useful as a cessation aid in smokers who use e-cigarettes exclusively.”

The report, sponsored by the FDA, appears to walk a stick-straight path through the evidence base without drawing overly broad conclusions. Until they get to the children. Then they suddenly embrace research that is thought by many to be poorly constructed and biased — like the gateway papers authored by some of the same people who are members of the committee that prepared the report.

Why, by the way, would the National Academies choose as committee members researchers who have already demonstrated a clear anti-vaping bent? And why are there no members from the world of vaping and smoking research that are generally positive about low-risk smoking alternatives? If we must suffer two well-known gateway theory purveyors arguing their own well-known positions, why no Ray Niaura, Ken Warner, Amy Fairchild, or Danny Giovenco to balance the committee’s discussions?

As for the complaint that the research on vaping is sparse, that is certainly the fault of the FDA and the National Institutes of Health (NIH). Those agencies have spent hundreds of millions of dollars funding inconsequential research designed to generate frightening headlines, rather than answering important questions. Now they wonder where the science is.

University of Michigan professor Richard Miech was also a co-author of that review — which included his own gateway study that concluded vaping is a “one-way bridge” to smoking. Dr. Michael Siegel dug into Miech’s research and discovered that the one-way bridge was built on evidence of just four teenagers moving from an e-cigarette one year (possibly as little as one puff) to smoking the next. Four!

Miech is also a NASEM committee member.

“However, youth who begin with e-cigarettes are more likely to transition to combustible tobacco cigarette use and become smokers who may be at risk to suffer the known health burdens of combustible tobacco cigarettes,” says the report. But there is no research showing conclusively that vaping causes a significant number of teens to move to smoking...right?

Adam Leventhal, a University of Southern California psychologist, has authored or co-authored no less than seven of the studies used by the NASEM committee — the same committee he sits on — to draw a clear gateway conclusion.

Leventhal was a co-author of an infamous systematic review of gateway studies, in which a group of gateway authors analyzed their own pro-gateway research and discovered — shockeroo! — a gateway. And that review is one of the sources for this report’s conclusion that vaping leads to smoking among teens.

A mutation in the gene pool

The bottom line is that the NASEM review is just what the FDA was hoping for. It acknowledges the undeniable view that vaping is an improvement for smokers, but kowtows to the prevailing American public health position that e-cigs might just be a trick to ensnare a new generation of naive kids with demon nicotine.

For smokers, vaping must be primarily a cessation product. For children, vaping must be made unattractive. See, those are ideas the FDA can work with: eliminate flavors, restrict marketing, and make the products more NRT-like. The march toward 2022 continues.

“Some product characteristics may pose much greater health risks with little potential benefit and be viable candidates for restrictive product standards,” they write in the conclusion. “For example, if evidence were to identify certain flavor additives that increased toxicity and appeal to youth, but did not enhance appeal or efficacy as a smoking cessation aid, the development of product standards to prohibit the use of such additives would likely have net improvement on the health of the population.”

Viewing vaping as a cessation aid is popular among lots of “pro-vaping” public health folks. But vaping isn’t NRT. It’s something new: a replacement for cigarettes, a mutation in the gene pool of smoking evolution, and the biggest threat the 100-year-old cigarette market has ever faced.

At first glance, this is 600 pages of Dragnet science. “Just the facts, ma’am,” over and over and over again. The authors seem to carefully avoid taking a stand, and by being so deliberately middle-of-the-road, they miss the revolutionary potential of vaping to upend the entire tobacco market.

But who wants that?