It started with a “sign bunny,” a simple social media meme with the outline of a rabbit holding up a placard that reads, “VAPING ISN’T A SAFE REPLACEMENT FOR CIGARETTES.”
The tweet, posted nearly a week ago by New Jersey Department of Health Commissioner Dr. Shereef Elnahal and pinned to the top of his Twitter account, called into question the vape industry’s suggestion that e-cigarettes are a safe way to quit or reduce tobacco use. The post collected more than 1,200 likes and hundreds of re-tweets and comments.
| VAPING ISN’T |
| A SAFE |
| REPLACEMENT |
| FOR CIGARETTES |
| ＿＿＿＿＿＿＿＿＿ |
— Shereef Elnahal, MD (@ShereefElnahal) May 24, 2019
“There was much more support for the bunny than opposition,” Elnahal said Wednesday in a phone interview.
But advocates for vapes — electronic devices that heat a nicotine-infused oil to create a vapor that is inhaled — note that these e-cigarettes don’t deliver the same cancer-causing tar that makes traditional smokes so deadly and can allow people to curb their addiction. They believe vapes should be considered alongside other nicotine treatment options like patches and gums.
Industry leaders fire back
So Elnahal’s tweet got the attention of vape shops and industry leaders who fired back online, insisting e-cigarettes were saving lives. Greg Conley, head of the American Vaping Association, an industry-funded group focused on public policy issues, said Elnahal’s comments mislead smokers as to the options available to help them quit.
“This is a public health issue,” Conley said by telephone. “Where is his empathy?”
Smoking rates in the Garden State have declined in recent years — less than 14 percent of adults and around 12 percent of high school students now light up — and remain below the national average. But the use of vapes has exploded in the state; the DOH found more than one in five New Jersey high school students tried or used e-cigarettes during the 2016-2017 school year, and it has fought back with new, targeted efforts.
Nationwide, vaping soared 77 percent among high school students in 2018, making it the most popular tobacco product for this group. While sometimes used to ingest marijuana-infused products, the devices are more commonly used for nicotine delivery, often in flavored oils designed to appeal to young people. Building on regulations initiated in 2016, the U.S. Food and Drug Administration launched a campaign in September to reduce vape use among youngsters, with education and new enforcement actions related to under-age sales. Lawmakers in New Jersey are also seeking to curb their use among minors.
A 2016 landmark study in England led the Royal College of Surgeons to endorse the devices as a better option than traditional cigarettes, in part because they don’t contain the same potentially deadly tar. The U.S. Centers for Disease Control and Prevention notes e-cigarettes have a potential to benefit adult smokers but are not safe for kids through high school, pregnant women or current non-smokers — those not already addicted to nicotine.
In addition to nicotine, vape oils contain heavy metals, volatile organic compounds and cancer-causing agents, the federal Centers note, and more research is needed for the devices to be considered safe. Moreover, the FDA has not approved e-cigarettes use as a treatment for nicotine addiction, something Elnahal points out online.
Tar or nicotine
Another U.K. study published in February in the New England Journal of Medicine suggests vapes may help smokers quit cigarettes but not without other impacts. The research, which involved nearly 900 tobacco users, showed that people given e-cigarettes and counseling for three months were nearly twice as likely (18 percent to 10 percent) to still be abstaining from cigarettes after a year as those who received nicotine gum or patches and counseling for the same three-month period.
But of those who abstained, 80 percent of the vape group were still using the smokeless device at the end of the year, compared with 9 percent of those who quit with patches or gum. The former smokers in the e-cigarette group may no longer be inhaling tar, but most were still ingesting nicotine.
“That speaks to the value of the FDA-approved nicotine replacement therapies over nicotine vaping — the real goal of quitting,” Elnahal explained. It also underscores why vape makers have not sought federal approval as a smoking cessation method, he said.
As Conley sees it, the health commissioner is missing an opportunity to help some smokers, particularly those who have failed with other treatments. He said the public has been misled to believe vaping is “just as bad” as cigarette smoking and that nicotine is the primary danger, not the tar and other additives in traditional tobacco products.
“Perhaps he would say preventing dependence and addiction takes precedence over preventing death and disease,” Conley said Wednesday.
‘…shameless child marketing’
Their Twitter exchange grew more heated through the holiday weekend. Elnahal blamed Conley for “shameless child marketing” and twisting the truth about vapes, while getting paid by the industry. He also posted updates, referring to studies that show e-cigarettes are not always effective quitting aides, and highlighting the toxins involved, in between tweets on other topics, like maternal care and medicinal marijuana.
Responding, Conley called Elnahal a “loser,” questioned his appointment by Gov. Phil Murphy and wondered how he could advocate for harm-reduction benefits like clean needles for heroin addicts but not support vapes as an alternative to cigarettes. (Elnahal said needles are a proven strategy, without other dangers and that this claim can’t be made for vapes.) Other posters chimed in, questioning the commissioner’s education, suggesting he was looking to keep people smoking, and claiming he had made a “giant ass” of himself in the debate.
Conley said he has worked in other states for nearly nine years on these issues, but “He’s the first health commissioner to come at me like that.”
Elnahal, who has strong support from Gov. Phil Murphy, showed no sign of letting up and was still adding to the online conversation Wednesday afternoon.