Harvard’s School of Public Health and the New York Times op-ed page have storied histories. Both were once highly respectable institutions. But a recent op-ed on the Times op-ed page by Joseph G. Allen, an assistant professor at the Harvard school, demonstrates how far both have fallen. The piece is astonishingly bad, reading like an article in a medical office pamphlet, written in 2014 by an intern at a local public health agency who just completed her undergraduate in sociology. Were it not for its prominence, it would not be worth the effort to critique. The piece strings together antiquated falsehoods that most serious anti-vaping activists — no matter how dishonest — are too embarrassed to highlight anymore. Apparently the New York Times decided its series of attacks on vaping called for airing the views of junior activists who are willing to associate themselves with the old lies.
The article begins:
Recently, there has been a shift away from calling e-cigarettes “e-cigs.” In public health circles, people now tend to call them by what they do: deliver nicotine to the inhaler. Thus, the term Electronic Nicotine Delivery Systems, ENDS for short, has come into vogue.
In addition to being a bizarre lede — more “stream of consciousness blogger” than “paper of record” — only the first sentence is correct. The shift, however, is toward using phrases like “vapor products.” People in real public health circles seldom use “ENDS,” and normal people (e.g., most New York Times readers) have never heard it. The term was concocted — not recently, but rather about four years ago — by tobacco controllers as an inaccurate and unethical effort to denigrate the vaper community, treating them as an enemy or as mere objects of study rather than as a culture with the right to use their own words to describe their own lives.
Allen proceeds to bicker about the term because vapor contains chemicals other than nicotine. Apparently this public health professor is unfamiliar with the standard phrase “delivery system,” which refers to drugs that are intentionally being delivered even though other chemicals are always present. The term “ENDS” is imprecise and inappropriate, but calling vapor products (or cigarettes, or Nicorette) a “nicotine delivery system” is accurate.
Continuing his misunderstanding of the phrase, Allen refers to vapor products as “Electronic Formaldehyde Delivery Systems.” The following paragraph must be read to appreciate just how bad this piece is:
Do manufacturers intentionally put formaldehyde in e-cigs? No, they don’t. But there’s some fundamental chemistry happening that can generate formaldehyde. E-cigs often use propylene glycol or glycerol to help transport nicotine and flavors and to create the big vapor cloud. We’ve known for a long time that when we heat these so-called carrier fluids they can transform into formaldehyde.
When referring to liquids as “fluids” barely makes the top ten for bad turns of phrase in a single short paragraph, it is difficult to know where to even start editing. How is “fundamental chemistry” different from chemistry? Vapor products always use PG or glycerine, which are carrier liquids, not “so-called.” They do not to “help” transport the other ingredients, but are the method to transport (and otherwise carry) them. As for the size of the vapor cloud, that is up to the consumer.
These are the words of someone who has not spent even a day reading knowledgeable writing about vaping. Yet he presumes to offer advice to the world on the topic.
The goal of this word salad is, of course, tricking readers into worrying about formaldehyde. Allen employs standard chemophobia techniques here, never explaining that formaldehyde, like many other small molecules, is produced by metabolic processes and so is coursing through our bodies all the time and exhaled in our breath. He tries to portray it as some exotic rare toxin like polonium 210, something that is potentially harmful in any quantity and is shocking to find. It is, in fact, found basically anywhere organic chemicals are present.
The dishonesty increases dramatically when Allen cites the thoroughly debunked letter from Portland State University, in which the researchers overheated e-liquid to produce high levels of formaldehyde. He cites one of the many debunkings of that and similar bad lab work, so he is apparently aware that the results represent overheated dry-puff production that no one would continue to vape. Given the overall lack of understanding of the topic Allen demonstrates, however, it is impossible to tell whether he genuinely does not understand the science or whether he is intentionally lying about it.
Allen tries to trick his readers by pretending that there are not numerous other debunkings of the overheated e-liquid results, including a recently published replication study. He cites only one early response and then suggests that it must be wrong because there were subsequent publications that either merely detected some formaldehyde (inevitable) or again overheated the e-liquid to produce unrealistic quantities. This same trick could be used in support of any junk claim. Consider: “Andrew Wakefield showed that vaccines cause a high risk for autism. Yes, there was this one immediate response claiming his methods were faulty. But it must have been wrong because here are some subsequent papers that repeat his conclusion.”
What is worse, Allen never actually responds to the (correct) substance of the debunking of the dry-puff results. Instead he merely notes that the authors of the single rebuttal he chose to cite had received some industry funding. He libelously refers to them as “hired guns.” Yet he does not even manage to get this ad hominem attack right: He never actually says this means that one critique (let alone the countless others) is wrong. Allen finishes his nonsense about formaldehyde with a misleading comparison of the concentration in vapor to limits set for workplace air, limits that are based on breathing nothing but that air all day.
Allen goes on to recite the “popcorn lung” trope, about the diacetyl in e-liquid causing bronchiolitis obliterans. The dishonesty of this claim is trivially obvious: Not only has there never been a single case of that disease blamed on vaping, but there has never been a case blamed on smoking despite cigarette smoke containing many times the concentration of diacetyl in vapor. This simple observation is sufficient. It is probably too much to hope that a professor of public health would understand the following: Since the reported cases have been people exposed to high levels of the cocktail of chemicals in popcorn flavoring, not just diacetyl, there is no reason to believe that any plausible level of diacetyl exposure alone is sufficient to cause the disease.
Allen concludes his survey of debunked 2014 anti-vaping claims with the gateway claim. As previously analyzed, the claim that vaping causes would-be nonsmokers to start smoking (at any nontrivial rate) is a complete fabrication. There is no good reason to believe it would even happen and literally none of the evidence cited as supporting the claim does any such thing. You might expect Allen to use the modern version of this lie, focusing on studies that report associations (thanks to uncontrolled confounding, causation in the opposite direction, and cooking the statistics). Instead he based the claim entirely on a single statistic from one state-level study, that 22 percent of eighth-grade smokers tried vaping before smoking. It is one thing to see a tobacco controller engage in the ad hominem fallacy — it both invalid and deplorable, but it is their go-to substitute for having real arguments and can be written off as a verbal tic. But to apparently not even understand that post hoc ergo propter hoc is a fallacy is mind boggling.
The failure to use the more sophisticated junk arguments for the gateway claim suggests that Allen is not only unfamiliar with the real science in this area, but also with the junk science pushed by tobacco control. It is truly a mystery why he thought he was qualified to write about this topic.
Allen then claims, in an apparent attempt to suggest his article really was written in 2014, “many states now restrict e-cig sales for those under 18.” (Of course, the FDA deeming of vapor products resulted in a nationwide ban on sales to minors. Even before that, the proper statement would have been “almost all states” rather than “many.”) He asserts “e-cigs are being marketed toward this age group,” though at least he concedes that this is merely “my opinion.” Meaningless personal opinion is the only basis for that assertion whenever it is made, so perhaps the concession is the one real contribution to knowledge in the entire piece.
He concludes, presumably thinking it clever, with:
And if the public health community really thinks we need a new name for these devices, a more fair one would be “Electronic Nicotine/Formaldehyde/Diacetyl Delivery Systems” — though not even that would reflect the full list of harmful components. I suggest we stick with “e-cigs.”
The “public health” community (not the real public health community) does not hesitate to denigrate the public and their choices. But it seems likely even they would find this to be stupid. In any case, few people who have anything useful to say about the topic are sticking with “e-cigs.”
Allen is either unfamiliar with the evidence and with how to engage in proper scientific inference, is extremely dim, is intentionally lying, or is some combination of the three. The Harvard School of Public Health has been a bit of an embarrassment to the real Harvard for a couple of decades, having become more “public health” than Harvard, but this takes it to a new level. The piece is incorrect and amateurish from start to finish. It is a testament to the New York Times’ desire to attack vaping that they would publish this. It is a testament to how low HSPH has sunk that it professors publish work that is well below the quality of the average term paper written by the students across the Charles River.