Vaping: Does the American Lung Association Have a Financial Conflict of Interest?

I bought my first electronic cigarette (e-cigarette, e-cig) in 2012. After a month of smoking and using an e-cig (vaping), I finished off my last pack of Camels and gave up tobacco forever. There are thousands of Americans who have followed that same path to a smoke-free life.

If you ask the American Lung Association (ALA), though, my vaping compatriots and I must not exist, because the anti-tobacco group says e-cigarettes don't help smokers quit. As Fox Business reported on December 5:

While the e-cigarette industry tells smokers falsely that switching to their products is safer and can help them quit, the American Lung Association is urging the U.S. Food and Drug Administration, which regulates nicotine-vaping products, to ‘crack down’ on these false quit-smoking claims,' the group said.

While it's true the e-cigarette industry encourages smokers to drop their deadly habit in favor of vaping, so do many independent medical experts who've seriously considered the evidence—which indeed shows that e-cigarettes are safe, effective smoking cessation devices.

If anyone is advancing “false quit-smoking claims,” it's the ALA and its allies in the tobacco control industry. Let's examine the association's case against e-cigarettes to see how it stands up to the data.

The association warned smokers that the FDA has not found any e-cigarette to be a safe and effective tool for ending an addiction.

If that's the case, the FDA doesn't know how to use a search engine. Thirty seconds on Google turned up this 2018 article published in the British Medical Journal, which noted that more than 50 percent of e-cigarette users in the UK are ex-smokers. The authors concluded from this and other statistics that “the limited evidence available suggests e-cigarettes containing nicotine may help people stop smoking.” A 2016 systematic review of the available evidence on e-cigarette use likewise reported that the devices appear to aid smoking cessation efforts:

One particularly large survey reported 81% complete smoking substitution with a median time of e-cigarette use of 10 months. Furthermore, a longitudinal study of e-cigarette use reported that daily users of e-cigarettes were 6 times as likely as nonusers/triers to report quitting. The results of …. the first prospective 12-month randomized controlled trial, suggest that e-cigarettes help combustible tobacco smokers reduce or abstain from use.

There's more clinical and epidemiological data we could cite, but it's clear from the personal testimonies (submitted voluntarily and without compensation) and peer-reviewed research that e-cigarettes help many smokers quit. Even more critical studies find that e-cigarettes are “at least as effective as nicotine patches. E-cigarettes are also more attractive than patches to many smokers ….” according to a 2013 article published in The Lancet. Interestingly, the ALA endorses nicotine patches as “safe and effective” for smoking cessation, so it's unclear why the association would discourage use of an equally (and probably more) effective option in e-cigarettes.

Fox Business also reported, “The association warned smokers that research has shown the devices contain dangerous metals and toxic chemicals ….” Little needs to be said here since ACSH has debunked this claim dozens of times: e-cigarettes contain these “dangerous metals and toxic chemicals” in far lower quantities than traditional cigarettes, which is why multiple studies have found that vaping is roughly 95 percent safer than smoking.

The American Lung Association could do a lot of good by following the science and endorsing e-cigarettes for smoking cessation, as the American Cancer Society and* several other influential research organizations have. The fact that the ALA hasn't is frustrating and difficult to explain, though Boston University public health expert Michael Siegel has offered one plausible explanation:

It appears that the American Lung Association is only prepared to acknowledge that a person has quit smoking if that person quits the way the ALA wants them to quit: using FDA-approved medications produced by Big Pharma companies with which the ALA has a financial relationship ….”

*Update on 9-Dec-2019 @ 9:04 pm PT: The American Cancer Society has rescinded their endorsement of e-cigarettes.