The rise of a vibrant market for e-cigarettes has been a blessing for many smokers. After many failed attempts to quit, e-cigarettes provide an exciting new means for smokers to reduce their exposure to the harmful aspects of combustible cigarettes or even break their life-threatening smoking habit entirely.
Although research on e-cigarettes has yet to definitively calculate the precise long-term risk associated with vaping, reputable scientific institutions are increasingly coming to the same conclusion—e-cigarettes are vastly safer than smoking, help smokers quit, and are a net positive for public health. Despite this, public perception of e-cigarette safety has declined, while demands for stricter regulation—even bans on certain e-cigarettes—have only intensified.
That the public perception of e-cigarettes diverts so radically from the actual evidence raises the question: Why? This paper makes the case that the confusion is the intended result of an orchestrated disinformation campaign led by individuals and groups that ought to be among the most supportive of lower-risk tobacco alternatives—anti-smoking health advocates.
Instead of recognizing the historic opportunity e-cigarettes represent to displace traditional smoking, powerful charities like the American Cancer Society and the Campaign for Tobacco-Free Kids, state and federal health agencies, and some academics have condemned the proliferation of vaping products. Their influence on public opinion and public policy stems largely from their image as credible, apolitical entities motivated purely by an interest in protecting public health. As their approach to e-cigarettes demonstrates, this perception is inaccurate.
In addition to their public health goals, health agencies’ and health charities’ activities are also driven by a need to defend and expand the financial resources they need to pursue their respective missions. Whereas for-profit businesses raise funds by competing for consumer dollars, non-profits—and to a certain extent, health departments—compete for charitable donations and sometimes government funding. The two basic strategies health charities and agencies employ to court funding are to: 1) raise the perceived need to address the health problem on which they focus; and 2) promote their organization’s comparative effectiveness in addressing said health problem.
This approach to fundraising is generally uncontroversial in the non-profit arena, where organizations compete intensely in an environment where both attention and charitable dollars are limited. However, when an organization is part of a government agency or endorsed by government agencies, its efforts to raise awareness of an issue and its own clout can incentivize activities that clash with sound public health policy.
Furthermore, using e-cigarettes as a case study, this paper demonstrates how this negative effect is magnified when health charities, federal health agencies, and state health departments are financially co-dependent. Though perceived as independent health charities, many of the nation’s most well-respected health non-profits are, in effect, arms of federal health agencies. Groups like the American Cancer Society (ACS) receive money from agencies, like the National Cancer Institute within the National Institutes of Health. As such, it is in ACS’ interest to support or even lobby on behalf of the National Cancer Institute as it seeks to sustain or increase the funding allocated to it in the federal budget.
In turn, health agencies like the National Cancer Institute have an incentive to boost the reputation of their supporting health charities like ACS. Not only can these charities provide strong support during budget discussions, by echoing or even executing the Institute’s efforts throughout the year, they can make the Institute appear more effective and therefore more worthy of budget allocation.
A similar process takes place at the state level, where state and local health departments “partner” with respected health charities like ACS, the American Heart Association, and the American Lung Association. The health departments divert funding to the charities, while the charities do what health departments cannot—lobby state and local governments.
These health charity-government agency alliances have proven so effective and lucrative that it has given rise to a vast, nationwide network of groups that includes government bodies at the local, state, federal and international level; charities; grassroots organizations; universities; and even scientists. While seemingly independent from one another, these entities are in fact deeply financially interwoven.
In the case of e-cigarettes, this interconnected network of health groups and advocates has helped fuel public fears about tobacco alternatives. To the general public, these disparate groups appear to have reached the same conclusion about the health effects of e-cigarettes independently of one another.
Anti-smoking activists have reason to be skeptical about nicotine products advertised as intended to “reduce harm.” But, unlike the tobacco in- industry’s previous efforts to promote safer cigarettes to sustain profits from smoking, e-cigarettes appear to be genuinely harm-reducing. At present, the evidence increasingly indicates that e-cigarettes not only carry significantly less risk than combustible smoking, but also help people to quit smoking and do not attract non-smoking individuals to nicotine use. In fact, smoking among both adolescents and adults is currently lower than it has ever been.
Health agencies should communicate this information in an unbiased way that allows consumers to make informed choices about the relative risk of using e-cigarettes versus smoking. Instead, health agencies, charities, health advocates, and the media have promoted the unfounded notion that e-cigarettes are as harmful as—or more harmful than—combustible cigarettes.
This campaign to restrict or ban e-cigarettes does a huge disservice to public health, decreasing the likelihood that smokers will utilize these devices as a means of quitting their deadly habit. Though concerns over e-cigarettes’ long-term effects are reasonable, that is not the impetus behind the anti-e-cigarette movement. Rather, as this paper demonstrates, it is the consequence of those groups and individuals vested with the power and funding of the government seemingly prioritizing their organizational interests over public health.