The AMA’s misleading narrative on vaping harms public health

The debate over vaping and e-cigarettes remains mired in fearmongering, and the American Medical Association (AMA) is a key contributor to the problem. On May 30, the AMA published an interview with Dr. Bilal Shahid Bangash titled “What Doctors Wish Patients Knew About E-Cigarettes,” authored by Sara Berg. While the AMA’s stated goal may be to inform, its messaging strays far from scientific accuracy, prioritizing misleading narratives over evidence-based harm reduction.

Berg’s piece cleverly presents technically true claims that lack critical context, creating a distorted picture of e-cigarettes’ role in public health. This obscuration ignores the reality that e-cigarettes are a vital tool for adult smokers seeking to quit traditional combustible cigarettes. Consider some specific claims from the AMA’s interview to highlight the gaps between their narrative and the evidence:

Claim 1: “E-cigarettes, once marketed as a safer alternative to smoking, have found a stronghold among teens and adults alike.”

This opening statement implies that e-cigarettes are no longer considered a safer alternative to smoking, but it stops short of making that claim explicitly—it’s a subtle inference designed to mislead. The truth is, e-cigarettes are still widely recognized as safer than smoking. Back in 2015, Public Health England published a landmark review that concluded e-cigarettes are approximately 95% less harmful than combustible cigarettes. Recently, King’s College London reaffirmed this observation, arguing that “vaping products rather than smoking leads to a substantial reduction in exposure to toxicants that promote cancer, lung disease and cardiovascular disease.” By omitting this context, the AMA avoids an outright lie while ignoring inconvenient facts.

The claim of a “stronghold among teens and adults alike” is equally misleading. First, youth nicotine use is at an all-time low, as evidenced by the 2024 National Youth Tobacco Survey (NYTS), which reported a decline in e-cigarette use among high school students from 10% in 2023 to 7.8% in 2024. Second, while e-cigarette use among adults has risen, overall adult nicotine use has remained stable since 2017, according to a CDC review of the National Health Interview Survey (NHIS). Meanwhile, cigarette smoking among adults fell to a record low of 11% in 2024, which suggests that adult smokers are switching to e-cigarettes without a significant increase in new nicotine users—a public health victory the AMA fails to acknowledge.

Claim 2: “While vape use went down between 2023 and 2024, for the 11th year in a row, e-cigarettes have been the most commonly used tobacco product among middle- and high-school students…”

The AMA highlights the decline in youth vaping between 2023 and 2024 but omits the broader trend: youth e-cigarette use has dropped nearly every year since 2019. By focusing on e-cigarettes as the “most commonly used tobacco product” among youth, the AMA distracts from the fact that overall youth nicotine use is at a historic low. The 2024 NYTS reported that only 10.1% of high school and 5.9% of middle school students currently used any tobacco products in 2024, a significant decline from previous years that should be celebrated. Indeed, current cigarette smoking among many youth demographics, such as black high school students, is now so low that it’s statistically indistinguishable from zero.

Claim 3: “Vaping not shown to help you quit… No e-cigarettes or vapes have been found to be safe and effective by the Food and Drug Administration (FDA) in helping smokers quit…”

It’s true that the FDA has not approved any e-cigarette as a safe and effective smoking cessation tool—but this is a regulatory failure, not a reflection of the science. The science is clear: E-cigarettes do help smokers quit. An ongoing review by Cochrane Library that was updated this year found that nicotine e-cigarettes are much more effective than all of the traditional nicotine replacement therapies that are FDA-approved, like patches or gums. Such observations motivated a 2024 editorial in The New England Journal of Medicine, which urged the medical community to “add e-cigarettes to the smoking-cessation toolkit,” highlighting the overwhelming scientific evidence that they can save lives.

The burdensome regulations that the FDA has arbitrarily produced have made it nearly impossible for e-cigarette manufacturers to make cessation claims, as none have yet to successfully navigate the process. The FDA has barely approved any e-cigarettes to be legally sold (PMTA), and none to be advertised as modified risk products (MRTP). This regulatory framework prevents e-cigarette manufacturers from disclosing truthful information about their products, which prevents smokers from knowing that they can switch to a less harmful alternative—a consequence the AMA fails to address. Some legal scholars and I argue that these laws violate free speech protections under the First Amendment.

Claim 4: “Using any other tobacco product or any other product that contains nicotine is not actually quitting.”

Dr. Bangash’s assertion that vaping isn’t “quitting” because it involves nicotine misses the point of harm reduction. The goal of switching to e-cigarettes isn’t necessarily to end nicotine use but to reduce health risks. While long-term data on e-cigarette use is still emerging, early studies are promising. A 2017 study in the Annals of Internal Medicine found that former smokers who switched to e-cigarettes had significantly lower levels of carcinogens in their saliva and urine compared to current smokers. And a 2018 study published by the AMA itself noted that within a year of switching to e-cigarettes, former smokers’ blood carcinogen levels were nearly indistinguishable from those of never-smokers.

The benefits are particularly striking for vulnerable populations, such as pregnant women. Smoking during pregnancy is well-known to cause adverse outcomes like low birth weight and miscarriage. However, a 2019 presentation published by the American Journal of Obstetrics & Gynecology found that babies born to mothers who exclusively used e-cigarettes during pregnancy were nearly indistinguishable in health outcomes from those born to nonsmokers. Leading publications, including The Lancet’s EClinicalMedicine, have replicated these results multiple times. By dismissing vaping as “not quitting,” the AMA overlooks significant harm-reduction benefits for both adults and children.

A call for nuance and honesty

Perhaps most troubling is the AMA’s failure to encourage adult smokers to switch to vaping. In 2023, the CDC reported that 24.3 million U.S. adults still smoked combustible cigarettes, contributing to approximately 447,000 smoking-related deaths that year. Such circumstances have motivated The New England Journal of Medicine to issue an editorial calling on clinicians to recommend e-cigarettes to smokers in appropriate situations, emphasizing the potential to save lives through harm reduction. Yet the AMA’s focus on youth vaping—despite declining rates—overshadows this urgent need, perpetuating a narrative of fear rather than opportunity.

The AMA should be a beacon of scientific integrity, not a purveyor of misleading narratives. Instead of obscuring reality, the AMA should foster a nuanced discussion about the competing interests of promoting e-cigarette use among adult smokers while minimizing youth exposure to nicotine. E-cigarettes are not risk-free, but they are a proven tool for reducing the harm caused by smoking—a fact supported by decades of research. By ignoring this reality, the AMA undermines public health and misses a critical opportunity to save lives.

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