“If you tell a big enough lie and tell it frequently enough, it will be believed.”—Adolf Hitler (1889-1945)
My eldest daughter, 1st Lt. Susan Buckenmaier (fifth generation military in my family), recently completed a Master of Public Health (MPH) at the University of Maryland. One of her final tasks in this program was a research paper on an emerging public health issue. I had mentioned to Susan that I was thinking about an editorial on the emerging health problem with e-cigarettes and the vaping trend, and Susan was pleased to inform me that her final research effort was on that very topic (great minds think alike). While my daughters no longer allow me to edit their scholarly efforts (apparently I am too harsh a critic), I was very pleased to see Susan’s final manuscript, and I have drawn heavily from her efforts for this editorial.
Admittedly, I was somewhat hesitant to use a quote from perhaps the most evil persona in modern history, but even the most dastardly can stumble on truth. Hitler was a master at lies and worked in the medium like Rembrandt worked in paint. The tapestry of lies and misinformation that Hitler and his henchmen wove around the German people enslaved a nation and plunged the world into a war that cost millions of innocent lives.
While it is fitting to despise the man for the epic suffering he wrought on humanity, it is important not to forget the lessons this history can teach. Hitler schooled humanity on the power of big lies told frequently enough to manipulate public opinion and understanding. Perhaps the modern day equivalent of this process is the “alternative facts” concept popularized by some with political or financial motivations.
A modern healthcare example, but perhaps no less threatening to human life, has been the culture of lies and misinformation perpetuated by the tobacco industry on the American public concerning the safety of tobacco products. The risks of smoking are now well known, and the damaging effects of cigarettes on human health indisputable. Sadly, as with the lies perpetrated by Nazi Germany, too many lives have been sacrificed to the deceptions of the tobacco industry. Why this harsh and rather unpleasant narrative? There is a new threat on the horizon, and new fabrications are being generated that support company financial goals at the expense of public health and safety.
E-cigarettes are an emerging trend in smoking, called vaping, and are often marketed as a safer alternative to traditional cigarettes. The term vaping refers to the mechanics of these products that vaporize water (smoke) containing nicotine, various flavors and numerous other chemicals. The devices are also used to inhale tetrahydrocannabinol (THC) in place of nicotine for marijuana smokers. The diversity of e-cigarette devices is phenomenal, ranging from pipes to cigarette facsimiles, and use has exploded in the United States as traditional tobacco use has steadily declined.
Young people, in particular, appear to be taking up vaping at an alarming rate, and e-cigarettes are now the most common way youth abuse tobacco. The e-cigarette industry understands this market potential and advertising, often directed at youth, has increased from $6.4 million in 2011 to $115 million in 2014 according to the national Centers for Disease Control and Prevention (CDC). The internet is rife with claims that e-cigarettes are a considerably safer alternative to traditional tobacco smoking and even a method to quit the habit of smoking.
Superficially, this statement is hard to discount, since so little is actually known about the compounds ingested with vaping and their short and long-term effects. E-cigarettes require a power source that energizes a heating element to produce the vapor, allowing the nicotine and other flavors to be inhaled. It is known that many popular vaping products include nicotine, marijuana, ultrafine particles, chemical flavoring (e.g. diacetyl), volatile organic compounds (VOCs) and a mixture of heavy metals. When heated, the various flavor chemicals used in e-cigarettes break down into myriad chemical compounds with unknown effects on human health. Certainly more is known about the unhealthy effects of both nicotine and THC on young people who are still developing mentally and physically.
From my perspective, the “health benefits” of e-cigarettes over traditional smoking is akin to the safety benefits of playing Russian roulette with a revolver that contains only one bullet (vaping) as opposed to the revolver containing three bullets (tobacco smoking). Although the odds of a successful outcome are indisputable with the first revolver, playing the game with either revolver involves unacceptable consequences. I understand this analogy is a gross oversimplification of the issues associated with e-cigarettes and the youth of this country, but there are times when gross oversimplification is indicated because one is gambling with the collective health of the country and its future leaders.
Far too little is understood about the impact of vaping on humans to make any claims of safety. As federal medicine providers, we cannot afford, for our patient’s sake, to ignore the lessons of history as we digest the claims of the e-cigarette industry concerning the improved safety profile of their products. These claims seem suspiciously similar to tobacco industry lies concerning cigarettes that ensnared generations of Americans a few decades ago. Lung cancer is the primary cancer in men and women which is snap-linked to the misinformation campaign of big tobacco.
What consequences will arise for the next generation from the marketing tall tales of the vaping industry? The power of lies to negatively impact society has been a reverberating theme throughout human history. For this reason, we cannot passively accept claims of safety from the e-cigarette industry, particularly since these claims appear to be directed at the most vulnerable segment of our society, our impressionable youth.
The modern corollary to the wisdom of Confucius would be Albert Einstein’s quote, “The more I learn, the more I realize how much I don’t know.” For me, one of the greatest attractions during my 30-plus years in the medical profession is the humbling impact this career has on personal perceptions of what I perceive to “know.”
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