In August, the FDA announced that its “Real Cost” campaign, a series of over-the-top messages designed to manipulate teenagers, would be expanded from traditional tobacco products to include attacks on vaping. This is expected to launch within the next few months. The messages are likely to further interfere with tobacco harm reduction efforts.
For those not familiar, the campaign consists mainly of a series of television ads, targeting viewers of South Park and similar programs, which show grisly “disease porn” images and make false or misleading claims about risks. In one [warning: disturbing images] a young smokeless tobacco user is shown a vision of his future self with a unrealistically grotesque depiction of oral cancer. It explicitly asserts – despite the lack of scientific support for the claim – that dipping causes oral cancer. In another, a clerk selling a pack of cigarettes demands that the customer pay not just the purchase price, but the “real cost,” in this case pulling out one of his teeth. The voiceover asserts that “a pack of smokes cost[s you] your teeth.”
As disturbing as it is for the government to lie and to target kids with images worthy of slasher movies, the subtleties are arguably just as bad. Most notably, the statements and images are designed to make viewers equate a small increase in far-future risk with an imminent certainty. Decades of smoking may cause an increase of a few percentage points in the risk of tooth loss. But that ad implies that the twenty-something smoker will lose his tooth, with certainty, immediately. That smokeless tobacco ad which misleadingly suggests oral cancer looks like a transformation into a zombie, also suggests it occurs at about age 30. Even if someone cherrypicked the evidence to suggest there is some such risk, they would have to concede that there is no hint of it appearing before about age 60.
Naturally, the FDA claims that these ads are effective at stopping product use. However the only basis for this is a report by their own staffers and contractors. They did not even try to publish it in one of the “peer reviewed” anti-tobacco journals that will print almost anything that tobacco controllers write (it appeared in a government newsletter). The methodology, as with the methodology for most evaluations of anti-tobacco efforts, is a joke. If anti-tobacco campaigns were as successful as claimed in these evaluations (which are almost always done by the same people who did the campaigns), all tobacco use would already have been eliminated. There is no reason to believe that any teenager who has not already been convinced by anti-tobacco messaging finds the “Real Cost” ads anything but silly.
But imagine that the messages are effective. Effective anti-smoking messaging does improve teenagers’ health prospects, whatever broadcasting blatant propaganda might do to the credibility of the government and real public health efforts. The spillover effect on adults, who are also exposed to the propaganda, has similar implications. Effective anti-smokeless-tobacco messaging has basically zero effect on health unless it encourages would-be dippers to smoke instead, in which case the effects are very negative. Fortunately such effects are mitigated by cultural divisions that reduce the substitutability of one for the other. The spillover effect on adults is probably minimal, since the use of smokeless tobacco for harm reduction in the US tends to be limited to highly-informed consumers who are not going to be affected by the FDA’s lies.
Anti-vaping messages, however, could be a very different story.
The FDA faces an interesting dilemma in trying to incorporate anti-vaping messages into this style of propaganda. The existing messages base their disinformation on a germ of truth (there is a small risk of eventual tooth loss from smoking) or on a widely-believed falsehood (most people have been tricked into believing smokeless tobacco causes oral cancer). It seems unlikely that they are going to try to trying to create a disease porn ad based on the claim that vaping exposes you to dangerous levels of carbonyl compounds (which, by the way, it does not, unless you enjoy dry puffs).
The real “real cost” of vaping is just the purchase price. There is no evidence that there are any health impacts. But the “Real Cost” campaign is not about reality.
It seems likely that the attacks on vaping will focus mostly on nicotine, in keeping with the FDA’s war on nicotine. The teenage target audience will be told that that a few puffs on an e-cigarette will render them lifetime slaves to “evil industry’s” machinations, and will permanently damage their brains. It seems quite likely that the voiceovers or closing memes will also suggest, or even state, that vaping might be as harmful as smoking. They will probably also use the standard chemophobia playbook, making claims about vapor containing scary-sounding chemicals, without mentioning that the quantities are far below harmful levels.
The impacts of this could be terrible for people’s health. Unlike with smokeless tobacco, which anyone naive enough to believe this propaganda already (incorrectly) believes is harmful, many teenage vapers are sensibly substituting vaping for smoking. Lots of teenagers harmlessly try vaping, but a large portion of those who regularly vape are would-be smokers. If they are convinced that they might as well smoke, some will smoke instead.
The spillover effect on adults is even worse. Adults, and indeed most teenagers, have established views about cigarettes and smokeless tobacco. These views, whether accurate or not, are extremely difficult to change. But views about vaping are still malleable. If the FDA produces convincing anti-vaping propaganda, adult smokers who see it might never consider switching to vaping. Some vapers who are still smoking or are on the fence might be convinced to switch back. In addition, a large portion of the population have vague negative views of vaping, making them easy targets for the FDA’s propaganda. They will tend to believe any false claims and thus feel more empowered to try to talk their friends out of switching from smoking.
The FDA claims that it recognizes the differences in risks across product categories. But the “Real Cost” campaign’s attacks on smokeless tobacco show this is just cheap talk. When this propaganda campaign takes aim at vaping, it will presumably continue to make blatantly indefensible claims. Cigarette and smokeless tobacco manufacturers are too timid to file lawsuits or otherwise challenge such claims, and there are no effective consumer advocates for those products in the US. But vapor product manufacturers and advocates could position themselves to challenge the claims when they appear.