Few things are more damaging to public health than convincing people that reliable evidence cannot be trusted. That is precisely what appears to be happening with vaping.
The BBC recently reported (online and on broadcast media) on the latest Cochrane review of electronic cigarettes for smoking cessation. Cochrane is widely regarded as the gold standard for systematic evidence reviews. The review examined 80 studies involving almost 30,000 people and found that smokers who want to quit are more likely to succeed if they use nicotine e-cigarettes than if they use nicotine replacement therapy such as patches or gum. It also found no evidence of an increased risk of serious harm from using e-cigarettes to quit smoking. This should have been a straightforward public health story.
Instead, the reaction on social media was extraordinary. The comments repeated almost every piece of misinformation about vaping that has been doing the rounds in the media, and more. People claimed nicotine is more addictive than smoking. They claimed vaping causes lung cancer. They claimed the research was funded by the tobacco industry. They claimed researchers were ignoring future diseases. They demanded that the products should be banned.
This should alarm anyone who cares about public health. One could argue that such people are simply ignorant, but they have been given very good reasons to be so.
For years, tobacco control organisations have promoted messages about nicotine and vaping that have confused people and muddled the debate. The public has repeatedly been told that vaping is dangerous without explaining that the overwhelming health damage caused by smoking comes from combustion.
Moreover, the UK Government is proposing measures that will make safer nicotine products look increasingly like cigarettes. Its current consultation proposes restrictions on the packaging, appearance and retail display of vaping and nicotine products. Vapes and nicotine products could face plain packaging, restrictions on branding and imagery, abolition of many flavours, controls on device appearance and a ban on displays.
Treat vaping like smoking and eventually people will believe that vaping is the same as smoking.
The Government is simultaneously proposing policies that make safer nicotine products appear the same as cigarettes while public health organisations wonder why the public does not understand the difference between them.
Even organisations that acknowledge that vaping is substantially less harmful than smoking have often conveyed the message quietly, while allowing louder and more alarming claims to dominate the media.
Action on Smoking and Health (ASH) has documented the extent to which the public misunderstands the relative risks of vaping and smoking. Yet, mentioning the problem in passing is not enough. If the objective really is to prevent the disease and premature death caused by smoking, publicly correcting these misconceptions should be an urgent public health priority.
This is why a respected scientific organisation publishes a major evidence review, a world-renowned broadcaster reports it, the evidence is consistent with previous Cochrane reviews, yet large sections of the public simply reject it.
This distortion threatens the entire public health enterprise. If public health authorities repeatedly make claims that are exaggerated and are ideological and based on their own prejudices, they should not be surprised when people believe this misinformation and ignore accurate science.
The public health movement should be loudly distinguishing nicotine from smoking. It should explain the differences between combustible tobacco and non-combustible nicotine products to the public. It must correct demonstrably false claims, even when those corrections are politically inconvenient.
Most importantly, it must ensure that scientific evidence leads the debate rather than allowing conjecture, a distaste for industry, and outright falsehoods to drive public opinion to the extremes of ignorance.
The tobacco control industry talks constantly about an endgame in which smoking disappears. Yet its relentless campaign against nicotine alternatives is creating an entirely different endgame, one in which nobody believes what scientific organisations say anymore.
Cochrane has done its job. Researchers have done theirs. The BBC has, on this occasion, reported the evidence accurately. Now the public health establishment needs to do its job. It needs to start telling the truth clearly, consistently and without ideological qualifications.
It may already be too late to recover all the trust that has been lost. The public appears increasingly willing to dismiss evidence that conflicts with existing beliefs, even when that evidence comes from one of the world's most respected scientific review organisations.
If people reject reliable evidence because they have been conditioned to distrust it, the ultimate casualty will not be the tobacco industry, it will be public health. In which case, everyone loses.
Martin Cullip is International Fellow at The Taxpayers Protection Alliance's Consumer Center and is based in South London, UK.
