World No Tobacco Day is on 31 May 2019. Just in time for that auspicious occasion, a coven of anti-tobacco activists published a “right of reply” article attacking a column on e-cigarettes, or vaping, which I wrote two weeks ago.

In that column, I argued that the World Health Organisation ought to promote vaping, because heavily restricting their sale and use would do more harm than good. In particular, I claimed that e-cigarettes were less harmful than tobacco cigarettes, posed no significant threat to bystanders, did not act as a gateway to smoking tobacco, and did not renormalise smoking.

I am not sure why the activists merit a “right of reply” since they were not named in my column. I certainly do, however, since their article contains very serious allegations that call into question my honesty and integrity as a journalist. It cannot go unanswered.

The group, Savera Kalideen, Leslie London, Catherine Egbe, Peter Delobelle and Ishaaq Datay, claim to be members of something called the Tobacco Control Advocacy Alliance. I’d post a link to a relevant website, but there is no mention of it on the entire internet, according to multiple search engines.

They also claim to represent, presumably individually, the National Council Against Smoking, University of Cape Town (UCT), University of Western Cape, South African Medical Research Council and the Chronic Disease Initiative for Africa. Their article was republished on the UCT website.

With such grand affiliations, one might expect that their arguments – against me and against e-cigarettes – would be persuasive. They are not, however.

The article is “appalling”, in the words of a health journalist of my acquaintance: “They give no evidence to support why they say e-cigarettes are potentially as dangerous as cigarettes. They don’t deal with harm reduction. They quote op-eds and position statements as evidence. (It’s not.) They cherry pick. Shocker.”

Before we get to their own claims, let’s deal with their accusations against me. They allege that my claims are unsupported. This is true only in a narrow, technical sense.

I always include links to my sources. Unfortunately, the links to my sources went missing during publication in this case. I have been given assurances that they will be restored. (Ed’s note: Links Restored)

This does not, however, mean that the papers to which I refer do not exist, that there is no evidence supporting my claims, or that my claims are incorrect, as they allege.

A list of my scientific sources makes it abundantly clear that their accusations against me are baseless, and that their own primary claims are contradicted by the evidence.

Let’s start with McRobbie (2014), a review of the scientific literature which concludes that vaping helps smokers to quit, helps heavy smokers to reduce their cigarette consumption, and is not associated with significant adverse events. An update by Hartmann-Boyce et al. in 2016 came to the same conclusions.

In the British Medical Journal (BMJ), Beard (2016) concludes that e-cigarettes are positively correlated with the success of quit attempts.

Shahab (2017), funded by Cancer Research UK and published in the Annals of Internal Medicine, finds “substantially reduced levels of measured carcinogens and toxins” in vapers, compared to smokers.

In the BMJ’s Journal of Tobacco Control, Stephens (2017) concludes that under ordinary circumstances, e-cigarette vapour has less than 1% of the carcinogenic potency of cigarette smoke. It is notable that this claim is stronger than the position of Public Health England (PHE), which is that vaping is 95% less risky than smoking. The authors dispute the PHE position, but since it is not necessary to my arguments, I won’t argue the point.

Bauld (2017) shows that most e-cigarette experimentation does not turn into regular use, and levels of regular use in young people who have never smoked remain very low.

In the New England Journal of Medicine, Hajek (2019) finds that e-cigarette users are almost twice as likely (18%) to quit successfully as people who used traditional nicotine-replacement therapy (9.9%).

We go back to the Journal of Tobacco Control for Hallingberg (2019), which concludes that e-cigarettes are not associated with a renormalisation of smoking, even during a period of rapid, unregulated growth in the sale and use of e-cigarettes, and that fears of a resurgence of tobacco smoking among teenagers as a result of vaping are unfounded.

All my claims are supported by the academic literature, of which one might expect academics who claim to specialise in the field to be aware. To accuse me of “deliberate misinformation” is therefore malicious and false.

These sources also directly contradict the claims they make themselves, for which they, incidentally, provide almost no evidence whatsoever.

They say there is “considerable evidence” that e-cigarettes have “introduced new toxic hazards” and “accentuated the problems associated with nicotine as a toxic agent”, but they don’t actually cite any. The latter is far-fetched. The former is plausible, but no discussion of toxic hazard is complete without also mentioning the degree of risk. There’s toxic hazard in your shower gel. There’s toxic hazard everywhere. This claim is misleading, and in any case, unsubstantiated.

They say that I claimed e-cigarettes were designed to help smokers stop and that this claim is inaccurate. But I made no such claim. I never said for what purpose they were designed. I merely cited scientific evidence that they do help some smokers quit, and are twice as good at it than conventional therapies.

They make the unsubstantiated claim that “e-cigarettes have emerged to maintain the industry’s market share” because fewer people are using tobacco. This is patently false. The tobacco industry had nothing to do with the invention and development of e-cigarettes.

They were invented by Herbert A Gilbert in 1963, who had no association with the tobacco industry and whose only goal was to create a healthier alternative to smoking. His invention was never commercialised.

The modern e-cigarette was patented in 2007 by Hon Lik, a pharmacist in the Chinese Traditional Medicine tradition, who was inspired by his own smoking addiction and his father’s death of lung cancer to develop a safer alternative to tobacco products. They were developed by multiple independent producers, and for years were dismissed by tobacco companies as a fad.

Only recently have tobacco companies shown any interest in e-cigarettes. And so what if they do? I’m all for tobacco companies selling things that do less harm than tobacco products and actually help people to quit smoking. My argument is about public health, not an emotional vendetta against the tobacco industry.

It should also be noted that the biggest lobbyist for regulating e-cigarettes as tobacco products – as South Africa proposes to do – was the tobacco industry. The other big lobbyist was the pharmaceutical industry, which wanted them regulated as pharmaceutical products. Both wanted that regulation because it would hamstring their competition. It is ironic that an anti-tobacco group is lobbying for the same policies as the tobacco industry lobbied for itself.

One of the only two scientific studies our activists bother to cite is one that I also cited, namely Hajek (2019). They choose to highlight the finding that 80% of ex-smokers who quit using e-cigarettes were still using them a year later, compared to 9% of former smokers who used conventional nicotine-replacement therapy (NRT). This, they cite in support of their argument against e-cigarettes.

What they neglect to mention is the headline conclusion from that study: that the one-year success rate for e-cigarette users was 18%, compared to 9.9% for NRT users. Ignoring the primary conclusion of a study because it contradicts their view is, to use their phrase, “deliberate misinformation”.

If they want to mention secondary conclusions, they should also point out that although e-cigarette users reported a little more throat and mouth irritation than NRT users (which stands to reason), they also reported a little less nausea, as well as less coughing and phlegm production. Based on those results, I’d choose e-cigarettes over NRT any day, even if I’m still vaping a year later.

The only other academic study they cite is in support of the claim that “e-cigarettes create new health risks”. It found that daily e-cigarette users (but not former users, or occasional users), had 1.79 times the risk of heart attacks than those who smoked neither tobacco nor e-cigarettes. What they neglect to mention is that this risk was much lower than that in cigarette smokers (including former and occasional smokers), which had 2.72 times the baseline risk. The study, therefore, does not support their claim of “new health risks”. On the contrary, it supports the view that e-cigarettes pose less risk than tobacco products.

They quote a random paediatrician, who says there is increasing but unspecified evidence “showing that both nicotine and the aerosols from these products result in harm such as pulmonary inflammation, impaired immunity and reduced lung function”.

Why this guy has any standing to say so is beyond me. In any case, all he is saying is that there is some risk. Nobody – not even e-cigarette manufacturers – denies this. What the good doctor does not say is how big the risk is, compared to the risk of smoking cigarettes. Therefore, he does not contradict anything I wrote in my column in support of e-cigarettes.

“Studies have also shown that young people are increasingly progressing to smoke cigarettes after trying out electronic cigarettes,” our intrepid activists parrot. “Global evidence suggests e-cigarettes are a gateway to the use of other tobacco products, especially among adolescents.”

They don’t cite any of this supposed evidence, and the actual evidence I cited directly contradicts these claims.

The activists’ primary claims – that e-cigarettes pose a substantial risk of harm compared with tobacco products, are not useful as quitting aids, and encourage young people to smoke tobacco – are exposed as misleading propaganda under even the most cursory scrutiny.

Instead, the scientific evidence supports my allegedly “unsupported and incorrect” claims. Their accusation that I spread “deliberate misinformation” is false, and therefore defamatory.

Far-reaching restrictions on the sale and advertising of e-cigarettes in the face of this mounting evidence would be against the interests of public health. Advocating such restrictions, as the mysterious Tobacco Control Advocacy Alliance does, is in my view deeply immoral. But then, what would one expect from propagandists who aren’t afraid to stoop to defamation? DM