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Formaldehyde Flap Fallout

For harm reductionists, there may be a positive takeaway from the recent formaldehyde flap. Although the general public may continue to be unduly swayed by vape-bashing headlines, an increasing number of well-positioned voices in government and science are starting to notice how little the emperor is wearing. And major press organs are more and more frequently publishing their comments.

A number of prominent news sources have published articles criticizing the flawed study that came out in the New England Journal of Medicine last week. They have noted all the flaws that were reported early on by Godshall, Bates, Farsalinos, Conley, Sullum, Siegel, and your humble servant: the study was conducted under unrealistic conditions, using machines not people, and reported on behaviors that would never take place in real life; they calculated risk from one substance (formaldehyde produced by vaping at unrealistically high temperatures) but presented a finding that compared it with the risk from a multi-toxicant substance (cigarette smoke); and they ignored the difference between the toxicant and a “releasing agent” which they assumed, with no evidence, could be expected to have the same effect.

It was bad science, and this time people noticed. Important people. Reuters quoted Professor Neal Benowitz (UCSF), a prominent nicotine scientist, who “questioned the legitimacy of comparing the effect of formaldehyde delivered in a cigarette to that delivered via hemiacetal [the 'releasing agent'], in droplet form, in an e-cigarette. The effect on organs could be entirely different, [Benowitz] said.” The Reuters article also noted the unrealistic voltage level, which would produce a terrible taste and would never be used by a real vaper, and also the fact that the study ignored the difference between the risk from one substance and the risk from 70 thousand substances. The Reuters journalist concludes with a quote from Schroeder Institute head Dr. David Abrams to the effect that the study is likely to be taken out of context “in the worst possible way”. The institute Abrams heads is a prominent think tank on tobacco policy. Abrams went on to note that the actual findings of the NEJM study show that in normative vaping, "there are non-detectable levels of formaldehyde ... which means people can use them to help them quit smoking lethal cigarettes."

An article in Time Magazine noted that the NEJM-published study found substances “slightly different from regular formaldehyde” (those pesky hemacetyls), and went on to say that “scientists don’t yet know if formaldehyde-releasing agents carry the same risk as pure formaldehyde.” Everything after that is prefaced with “if” and the paragraph ends with the comment that “the observation wasn’t confirmed.” In other words, Time notes that the reported danger was a hypothesis based on an unsupported assumption of equivalence.

In an op-ed piece in the New York Times, Joe Nocera notes that “Every dollop of news suggesting that vaping is bad for your health, much of which has been overblown, is irrationally embraced by anti-tobacco activists.” Nocera goes on to report that “close to a third of the people who had abandoned e-cigarettes and returned to smoking did so because they were worried about the health effects of vaping....”

Nocera put in a call to David Peyton, one of the authors of the “letter” published in NEJM. Peyton disavowed the vape-bashing conclusion common in the press. “It is exceedingly frustrating to me that we are being associated with saying that e-cigarettes are more dangerous than cigarettes. That is a fact not in evidence,” said the researcher, according to Nocera in the Times.

Yesterday, the newly appointed Surgeon General of the US, Harvard med school prof Vivek Murthy, said that officials are “in desperate need of clarity” in the debate over e-cigs. “"There've been theories and ideas around the fact that e-cigarettes may be helpful from a harm reduction perspective in helping people who are already on cigarettes (that) have had trouble quitting actually get off cigarettes," Murthy said. "If the data indeed bears that out, then I think we should absolutely embrace that and use e-cigarettes in targeted ways."

Another bit of evidence that the tide is turning.