Juul Pod Mod and a Cigarette

Nicotine, Obesity, and Moral Panic

A new study in the New England Journal of Medicine is stirring up a complex mixture of feelings with some objective data about vaping. The study shows that e-cigarettes are 83 percent more effective than nicotine replacement products for helping people quit smoking. In the U.K., the reaction is positive. In the U.S., the reaction is tinged by moral panic. “Are we going to renormalize nicotine addiction?”

A funny thing this is. We see the reverse situation on the subject of obesity. In the UK, we hear much more fear about “normalizing obesity.”

A Lesser Evil?

Professor Peter Hajek in London led the study. “We know that there are millions of smokers out there who successfully stopped smoking by switching to vaping,” he says. He goes on to say that nicotine itself is not a big issue for public health:

It would be very similar to drinking coffee. You have a lot of people who have to have their cup of coffee every day. They do it because there’s stimulant drug in it, and it’s very similar to using pure nicotine without the toxins, which actually kill people. So from our point of view, on this side of the pond, this [vaping] is not a public health issue any more.

However, the Puritans on this side of the Atlantic will have none of that. In an editorial alongside this study, Belinda Borrelli and George O’Connor wrote that e-cigarettes should be a “last resort” for people who fail all other methods for quitting.

Bias Against “An Easy Way Out”

Does this sound familiar? Sure, vaping is far safer than smoking cigarettes. And it’s nearly twice as effective for quitting altogether. But don’t try it until you’ve failed in every other way.

As a matter of fact, this is very consistent with stigma for people seeking obesity care. Unless you lose weight with diet and exercise, according to the prevailing bias, you are a failure. In that case, you might want to try obesity meds or bariatric surgery. The bias falsely labels surgery as “the easy way out.”

This is no way to deal with two serious health threats. And it’s certainly no way to respect or care for a patient, a loved one, or a neighbor.

Click here for the vaping study, here for the editorial, and here for a second editorial. For further reporting on this study, click here. Finally, you can find perspective on the bias against smokers and vaping here.

Juul Pod Mod and a Cigarette, photograph © Vaping360 / flickr

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January 31, 2019

8 Responses to “Nicotine, Obesity, and Moral Panic”

  1. January 31, 2019 at 4:02 pm, David Sweanor said:

    Well said. There is a constant tension between those pursuing rational, pragmatic efforts to improve health and those who have a moralistic mindset. I have encountered this on the cigarette smoking issue all my career. For far too many people attracted to such work, the battle is best understood as a Medieval fight against sin. Sinners need to repent, do penance or face perdition. They must show they feel terrible about what they have been doing and seek redemption through some challenging ordeal, or terrible things will ultimately befall them. Giving them as easy out does not fit the moralistic mindset any better than a sinner required to do a 30-mile pilgrimage being allowed to do it on horseback, or being cut some slack on the number of Commandments to be followed along the way.

    • January 31, 2019 at 4:09 pm, Ted said:

      Thank you, David, for your continued good work in this field.

  2. January 31, 2019 at 6:57 pm, Michael said:

    Opposition to the easy way out goes beyond health or religion. Didn’t the same aversion cause some guy to get stuck in negotiations about a wall recently?

  3. February 01, 2019 at 1:00 am, mike said:

    The sinner mentality and moral panic is definitely a good point.

    However, what I have heard a lot (i guess in online articles by some experts) and in casual conversation is that if you smoke, definitely vaping is way better. Bet vaping is way worse than not smoking at all…especially when the teenager nicotine usage is double (24-12% or something like that now). I don’t believe that is fear mongering. Am I wrong in beleiving this research / experts that say nicotine usage is damaging compared to using neither vaping or smoking? That nuance I believe is important…or do you disagree? thanks in advance, love the blog

    • February 01, 2019 at 4:02 am, Ted said:

      Nicotine is not such a good thing for a young brain. And smoking tobacco is far worse still. For adults, the comparison to caffeine above is fair, in my opinion.

  4. February 01, 2019 at 12:00 pm, David Sweanor said:

    Risk to youth is something to consider on any issue. But people attempting to end any policy discussion by simply screaming ‘What about the children??!!’ is a telltale sign of a moralistic agenda – be it on nicotine, anti-vaxxing, fluoride, sex education, drug harm reduction, etcetera. Any concerns should be part of a cost-benefit analysis. We should rationally assess the actual risk. In virtually all cases the moralists have exaggerated or simply fabricated the stated risks to youth. Remember, they are battling ‘sin’, so such tactics are standard. Then we need to weigh the upside (say, addressing the global total of seven million annual deaths due to an outrageously and unnecessarily lethal way people are getting nicotine). Policies can rationally reduce risks of unintended consequences while maximizing gains. We just need to focus on practices based on the Enlightenment rather than the Inquisition.

  5. February 01, 2019 at 12:29 pm, Jacques Le Houezec said:

    Unfortunately, nicotine is seen as the evil even by smokers. Nicotine is my subject of research for more than 35 years now, and I can attest that it has many positive effects (https://nicotinepolicy.net/blogs/guest-blogs/32-jacques-le-houezec/88-the-positive-effects-of-nicotine). Nicotine is a psychostimulant, pretty similar to caffeine in terms of effects. Outside of combustion with tobacco (the worst way to use it), it causes no negative effects on health. Being against nicotine use is a moralistic position, not base on any evidence of toxicity. If you smoked dry letuce, you would get the same toxic substances as smoking tobacco (tar, carbon monoxide, oxidant gazes, particulate matters…), but no nicotine. In Scandinavia, snus (an oral form of tobacco) is used for many century. In the 70′ snus started to be used by smokers to quit smoking. The result is that Sweden for example has a daily rate of smoking of 5%, and it is the country in the world with the lower rate of chest cancer and head and neck cancers. This is just because most Swedes have switched to a non combustible form of tobacco.
    Vaping is much much safer than smoking, and there are good chances that we’ll never succeed to find some negative effects about it. In real life (e.g. in vape shops) vaping is more effective than in the study by Hajek et al., because that study was done as a clinical trail, limiting the options available (different devices and liquids), and done a few years ago with second generation devices. Third generation devices are more effective in delivering nicotine, and so more effective to help smokers quit smoking.
    And by the way, since you are mentioning obesity, it could well be that in the future vaping could be use for this purpose (see: https://www.ncbi.nlm.nih.gov/pubmed/27798086). The abstract of this paper written by knowledgeable researchers reads like this:
    Obesity is set to overtake tobacco smoking in many countries as the primary cause of several high-cost diseases. Tobacco smoking mitigates weight gain through nicotine’s effect on the brain and metabolism. Smoking, however, is associated with many illnesses and premature death and appropriately has been discouraged leading to declining prevalence rates. This article explores the emerging perception that vaping electronic cigarettes with nicotine and flavors could deliver similar appetite and weight control effects as smoking. The potential to reduce risks associated with excess weight deserves exploration. An initial research agenda is suggested.
    And finally, the panic about youth vaping in the US is totally out of measure. Smoking in teens has never been so low in many countries, including in the US, and this trend was accelerated when vaping became popular. We are living an historic era with vaping, for the first time in history, we may get rid of tobacco smoking, which is a fantastic Public Health news!

  6. February 01, 2019 at 9:07 pm, Joe Gitchell said:

    This is a very good array of perspectives and observations – particularly for those who like to feed their curiosity!!

    For a tour de force survey of broad tobacco control and public health issues, this just published piece in The Conversation by UMich’s Prof Ken Warner cannot be beat.


    Thanks, Ted!