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Joe Nocera’s contentious e-cigarette crusade

We’re very pleased to feature the following guest post by Paul Raeburn, a journalist and blogger whose writing has appeared in The New York Times Magazine, Discover, Scientific American, and other leading outlets. He’s also the author of five books, including the forthcoming The Game Theorist’s Guide To Parenting: How the Science of Strategic Thinking Can Help You Deal with the Toughest Negotiators You Know–Your Kids (2016). He tweets as @praeburn.

We’re very pleased to feature the following guest post by Paul Raeburn, a journalist and blogger whose writing has appeared in The New York Times Magazine, Discover, Scientific American, and other leading outlets. He’s also the author of five books, including the forthcoming The Game Theorist’s Guide To Parenting: How the Science of Strategic Thinking Can Help You Deal with the Toughest Negotiators You Know–Your Kids (2016). He tweets as @praeburn.

On Nov. 3, Joe Nocera bid farewell to his job as an Op-Ed columnist at The New York Times with what he called “a few last opinions.” One of those opinions was this: “There is no doubt [e-cigarettes] could save lives if adult smokers could be encouraged to make the switch.”

Nocera (who is moving to the sports pages at the Times) wrote about e-cigs in a series of eight columns stretching from December, 2013 to October 17th of this year. In those columns, he argued strenuously that the public health community should embrace the e-cigarette to help stop smoking. “It has the same look and feel as the lethal product…but the ingredients that kill people are absent,” he wrote in that first column in 2013. And his stance has never wavered.

At first glance, Nocera’s position seems obvious: If smokers switch to a safer substitute to satisfy their nicotine craving, fewer will die from smoking. The problem is that this isn’t a matter of opinion. We need the facts: Will e-cigs cut the death rate from lung cancer and heart disease? Nocera is certain the answer is yes, but the truth is that we just don’t know.

The findings so far on the risks and benefits of e-cigs are preliminary, but they raise the possibility that e-cigs might not help smokers quit. There is also evidence that nicotine is harmful to health, even without the other ingredients in tobacco. And preliminary data suggests e-cigs might encourage kids to smoke, a development that could outweigh any advantages for adults, if true. The net result could be that e-cigs lead to more deaths, not fewer.

None of this research is conclusive. But more studies will be done, and the implications of e-cigs for the public health may soon become clear. And that underscores the main problem with Nocera’s reporting: He is expressing opinions on matters of fact. He is not entitled to an opinion on whether e-cigs might save lives any more than he is entitled to an opinion on whether the sky is blue or the sun sets in the west. The research will give us the answers. Until then, opinions on policies are fair game, but not opinions on matters of fact.

E-cigarettes–which can resemble conventional cigarettes or ball-point pens–use a battery-powered heating coil to vaporize liquid nicotine and other additives so they can be inhaled. E-cigs give users a quick nicotine fix without the carcinogens in cigarette smoke.

It’s possible that they will help millions of smokers give up Marlboros. Or maybe they won’t. Or smokers might choose to use both–cigarettes at work, and in the evening, a cocktail with a pomegranate e-cigarette (a flavor offered by e-cig maker NJOY).

“The Nocera fantasy is that the only thing that happens is smokers switch to e-cigarettes, and a bunch of them quit smoking cigarettes,” says Stanton Glantz, a professor of medicine at the University of California, San Francisco, and a leading tobacco researcher and activist. But that’s not the whole story.

According to the Campaign for Tobacco-Free Kids, existing research on the use of e-cigarettes as an aid to quitting “provides mixed results.” Smoking an e-cigarette is less harmful than smoking a conventional cigarette, so substituting an e-cig for a Marlboro is a good step. But “e-cigarettes could ultimately reduce the number of smokers who would otherwise quit if smokers continue to use them in addition to, and not instead of, regular cigarettes.” And light and intermittent smokers are at greater risk for heart disease and lung cancer than non-smokers.

Again, the research is not conclusive–but it challenges Nocera’s certainty about the benefits of e-cigs. The value of e-cigs is not a matter of opinion.

The situation with kids is likewise disturbing, Glantz says. “We know that youth use of e-cigarettes is exploding. That’s well documented,” he says. And preliminary evidence suggests that “a substantial fraction of kids using e-cigs likely would never have picked up a cigarette.” (Researchers can predict with reasonable accuracy which kids are likely to start smoking, considering such factors as whether a best friend smokes.)

In a response to Nocera’s Oct. 17 column, Matthew L. Myers, the president of the Campaign for Tobacco-Free Kids, wrote that e-cigs must be “marketed so they do not re-glamorize smoking among young people…The concern about youth is serious. In 2014, over a quarter of a million youths who had never smoked a cigarette had used e-cigarettes.” Will e-cigs encourage those young people to smoke conventional cigarettes? We don’t know. But we should know before hailing e-cigarettes as a public-health bonanza.

Additionally, although the nicotine vapor from e-cigs has fewer carcinogens than tobacco smoke, it is far from safe. Nocera has written repeatedly, including in his farewell column, that smokers “smoke for nicotine, but they die from the tar.” The implication is that nicotine is relatively safe. But it isn’t.

In addition to nicotine vapor, e-cigs produce formaldehyde, acetaldehyde, acrolein, volatile organic compounds such as toluene, tobacco-specific nitrosamines, and metals like nickel and lead, according to the Campaign for Tobacco-Free Kids. It acknowledges that the levels of these toxins are lower than what’s found in cigarette smoke, but e-cigs still carry health risks.

Finally, while e-cig makers deny they are targeting children, e-cigs “often contain flavorings including fruit and candy flavorings that are not permitted in regular cigarettes,” according to the Campaign for Tobacco-Free Kids. It said that in January, 2014, researchers had identified 7,700 e-cigarette flavors available online. That’s not proof that e-cig makers are targeting kids; far from it. But it does, once again, poke holes in Nocera’s certainty that e-cigs are good for the public health.

The point is that what’s needed here are controlled studies–not reporters’ opinions. Nocera is not the only columnist or commentator who has made the mistake of confusing opinions and facts. Anyone who professes not to “believe” in climate change or evolution is doing the same thing. Climate change can be measured; it’s not a question of belief. Nor is evolution.

Reporters covering medical stories should keep this in mind. It’s fine to speculate, and it’s fine for op-ed columnists to have strong opinions. But it’s not appropriate for columnists to let opinions substitute for facts, just because the facts happen to be murky.

In a lengthy email, Nocera explained his interest in e-cigs. “I don’t smoke, and never have,” he wrote. Two of his grown children smoke, he wrote, and “I dearly want them to quit.” For him, e-cigarettes are the kind of long sought “harm reduction” that can reduce illness and death in smokers even if they are unable to quit.

“There are very few voices in the mainstream media that support the harm reduction potential of e-cigarettes–which is one reason I’ve stayed at it,” he wrote. “I think it is such a huge potential life-saver that I want to shout it from the rafters. I don’t feel apologetic about that.”

Nocera also addressed a question regarding his wife’s affiliation with the tobacco maker Philip Morris. From 2002-2008, according to her LinkedIn profile, she was director of external communications for Altria, the parent company of Philip Morris USA, which launched an e-cigarette brand last year. “She has never had a thing to do with e-cigarettes,” he wrote. “I came by my opinion honestly and honorably.”

This isn’t the first crusade Nocera has mounted. He has written multiple columns critical of the National Collegiate Athletic Association, and from mid-2013 until the middle of 2014 he published The Gun Report, an attempt to tally all of the gun deaths in the country. It’s strong reporting from a respected journalist.

He should use the same care when opining on e-cigs. Reducing smoking-related cancer and heart-disease deaths is a campaign worthy of Nocera’s tenacity. But a more skeptical and careful approach to the risks and benefits of e-cigarettes would serve him well in that campaign.

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