Past and present commissioners of the Food and Drug Administration recently announced an initiative to engage partners to help combat public health misinformation. Explaining the rationale for this move, current FDA Commissioner Robert Califf stated, “I actually believe that misinformation is the leading cause of death right now in the U.S.,” saying that “people are making bad choices driven by the information that they get.”
Encouraging words that the FDA needs to take to heart when presenting information about vaping.
This is not the first time Califf has expressed dissatisfaction with poor public health messaging. In September, he condemned the “growing spread of rumors, misinformation and disinformation about science, medicine and the FDA.”
He rightly identified that “the distortions and half-truths of misinformation and disinformation pose enormous dangers to the effectiveness of science and to public health itself.” He vowed to make “combating misinformation one of (his) priorities” on social media.
While it is admirable of the FDA to try to tackle misinformation that can adversely affect individual public health choices, it would be helpful if Califf could first address the FDA’s own misinformation when it comes to reduced-risk alternatives to combustible tobacco, including vaping.
The FDA website carries youth vaping prevention posters claiming that “nicotine can rewire a teen’s brain to crave more nicotine and can create addiction,” despite analysis of the national youth tobacco surveys from academics noting that “frequent use and signs of e-cigarette dependence remained rare in students who had only ever used e-cigarettes and never any other tobacco product.”
The FDA also regularly warns that “using nicotine as a teen may have enduring impacts on attention, learning and memory” but fails to mention that the science they cite for this claim was only performed on rats, which are widely regarded not to be an accurate proxy for assessing effects on humans.
By far, the most egregious misinformation peddled by the FDA was its handling of the lung injury outbreak in 2019 and its keenness to make propaganda capital out of an issue that resulted in dozens of deaths. The event was categorized as E-cigarette or Vaping Acute Lung Injury (EVALI), as both agencies instantly pointed the finger at all e-cigarette products, namely nicotine-containing, despite there being no outbreak of lung injuries related to nicotine vaping anywhere else in the world.
It was evident in August 2019 that the problem was specific to illicit black market THC pods, but the FDA and the Centers for Disease Control and Prevention persisted in labeling “EVALI” as a nicotine vaping problem, the very definition of misinformation that Califf seeks to eradicate.
Califf describes misinformation as “the leading cause of death right now in the U.S.” In the case of EVALI, it is quite possible that misinformation presented by the FDA itself deterred smoking adults from taking up far safer vaping products and caused many to continue using lethal illicit products.
Partly due to the FDA’s prevailing negativity about vaping, multiple studies have found that consumers, policymakers and doctors are misinformed about the role nicotine plays in smoking-related harm, so much so that only a pitiful 2.6 percent of the American public correctly believe that vaping is “much less harmful” than smoking cigarettes, according to the National Cancer Institute HINTS survey.
It has also had a chilling effect on advice given by physicians to people who smoke. A study published by researchers at Rutgers University in 2022 discussed the effect of misinformation on physicians and found that more than 60 percent of doctors surveyed incorrectly believed that vaping products are just as harmful as cigarettes and, as a result, they are less likely to recommend vaping as an alternative for adults who smoke.
It is correct that the FDA should be looking for help to curb misinformation. Misrepresentation of science is rife in many areas. Nowhere is this truer than in the tobacco and nicotine policy, partly down to a political reluctance of federal agencies like the FDA to inform Americans properly of the potential that lower-risk nicotine products can provide to reduce smoking.
Many people will continue to smoke because of being poorly informed of the relative risks between combustible tobacco and less harmful nicotine products. As part of the FDA’s campaign, Commissioner Califf should also make it an FDA priority to correct public misunderstanding of safer alternatives to smoking.
