Conflict of Interest

From time to time, people ask me if electronic cigarettes, in particular vaping, is bad for the health.

Since I have attended a number of international seminars on e-cigs, I believe that I am in a position to say that it depends.

If you ask me if vape juices that are being sold in your friendly neighborhood store (one store in Cubao sells mobile SIMs, cellphone chargers, and vape juices) are safe, my answer would be I do not know. After all, the containers for these vape juices do not tell you what the ingredients are.

But in other countries like those in Europe, vaping is safe and a good alternative to traditional cigarettes. Regulations in many countries in Europe are strict when it comes to what ingredients one can use. They even regulate the size of the vaping device and the amount of the liquid that can be placed in it so that it will not be toxic in case ingested by children.

That is why it is unfair and misleading for the World Health Organization (WHO) to say that e-cigarette use could cause lung damage.

The WHO initially published a Q&A on its website last Jan.  20 and e-mailed it to journalists in several countries. According to Dr. Vinayak Prasad who leads the WHO tobacco control program, the original Q&A was meant to inform the public about e-cigarettes in following of the outbreak of vaping-related serious lung disease cases in the US last year. It claimed that there is growing evidence to show that e-cigarette use could cause lung damage.

Vaping advocates later criticized the Q&A as particularly malign and accused the WHO of misrepresenting the science about vaping risks by exaggerating claims about the harm caused by e-cigarettes. WHO revised the Q&A last Jan.  29, perhaps an attempt to soften its claims against e-cigarettes, but did not e-mail the updated Q&A to journalists.

Prasad insists that WHO did not revise the Q&A because of the criticisms, but because there were people asking more questions [and] we said we would explain it.

The truth, according to experts, is that the outbreak has nothing to do with e-cigarettes at all. The US Centers for Disease Control and Prevention (CDC) has identified vitamin E acetate oil in refillable e-cigarette products as the culprit. It’s important to note that e-cigarettes containing nicotine are more tightly regulated in the United Kingdom than in the US. THC and vitamin E acetate oil are not permitted in e-cigarettes in the UK, where to date no vaping-related cases like in the US have been reported.

Clive Bates, former chief of the UK charity Action on Smoking and Health (ASH) and a strong advocate of e-cigarettes as a smoking cessation tool, in his blog described the WHO’s attempt to imply that e-cigarettes and combustible cigarettes pose similar health risks as deeply unethical.

He pointed out that WHO employs a series of half-truths and non-sequiturs that confuse relative and absolute risk and ‘safe’ and ‘much safer’, with the seeming aim “to confuse the reader about the comparison of smoking-vaping risks.”

Bates explained that there is little evidence that vaping emissions are or are likely to be a cause of serious harm, and certainly, nothing comparable to cigarettes, pointing out that a product that has five percent of the risk of smoking is five times the risk of a product with one percent of the risk. But for all practical purposes, it is the 95 to 99 percent reduction compared to cigarettes that matters for policymakers and consumers.

The Q&A claims that e-cigarette emissions typically contain nicotine and other toxic substances that are harmful to both users and those exposed to the vapors secondhand. But according to Bates, this conveys a basic misunderstanding of nicotine because it is not the nicotine that causes serious harm, but the smoke produced by combustible cigarettes.

The Q&A also noted that young people who use e-cigarettes are more likely to use conventional cigarettes. This, Bates said, is true but highly misleading, explaining that e-cigarette use does not lead to cigarette smoking.

Bates said that far more likely is that those same influences that incline young people to smoke also incline them to use e-cigarettes. These factors might include genetics, family circumstances, mental health, school environment, delinquency, and risk-taking behavior, among others.

He said that e-cigarettes are more likely to be beneficial to the young people who use them because vaping may be diverting them away from smoking.

According to Public Health England (PHE), the evidence does not support the concern that e-cigarettes are a route into smoking among young people, noting that youth smoking rates in the UK continue to decline, regular use is rare and is almost entirely confined to those who have smoked.

Experts attribute this to how the UK government has embraced a harm reduction approach with good effect, while also effectively regulating access to vaping products in order to protect the youth.

Some sectors have pointed out that the WHO Framework Convention on Tobacco Control (FCTC) is an evidence-based treaty that reaffirms the right of all people to the highest standard of health, while the Conference of the Parties (COP) is a biennial gathering of all the tobacco control delegates from signatory countries to discuss and decide on action plans with regards to the treaty. The funding for the activities of the WHO, specifically the FCTC, comes from member-countries/signatories, the World Bank and private donations which is not unusual given that the WHO is a non-governmental organization.

But one author noted that what is unusual is the lack of transparency on the private donations and whether or not these funding sources have any undue influence on the workings of the WHO FCTC in its decision-making process. Nancy Loucas, in an article in the Aotearoa Vape Community - NZ Vape Advocacy website, looked at the WHO FCTC budget for 2020-2021 and found a possible conflict of interest since of the $22 million WHO FCTC budget, $10 million was contributed by private funders who are anti-vape.

Bates said WHO ignores a giant conflict of interest embedded in its operations and that WHO’s work in this field is also built on a conflict of interest that should be a source of real concern to those involved in WHO governance.

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