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Prop E Win in San Francisco Would Be Loss for Public Health

“Big Tobacco” is pouring millions into a campaign to maintain their ability to keep selling harmful products that target children. At least, that’s the narrative most news outlets have sold about Proposition E, a measure on the city’s June 5th ballot, which would ban the sale of flavors, including menthol, for tobacco products, including e-cigarettes.

The David and Goliath story is compelling, but don’t be fooled. The other side, comprised of hundreds of anti-tobacco activists is just—if not more—powerful than big tobacco companies. These groups have an advantage by cloaking their support of Prop E under the guise of “public health” and the support of factions in government and the university system, along with the industries that compete with e-cigarettes (e.g. big pharma). They also have vast financial resources, including taxpayer money, which they can spend without reporting it as “lobbying.”

In June 2017, the San Francisco Board of Supervisors voted unanimously to ban the sale of flavored tobacco products in the city, including menthol cigarettes, flavored cigars, and flavored e-cigarettes and e-liquid. To nobody’s surprise, companies that make and sell these products, such as R.J. Reynolds along with small vape shops and retailers, led a petition drive against the decision, forcing a voter referendum on the issue.

Opponents of the ban have reportedly spent around $11.5 million on a “no to prop E” campaign. The other side, anti-smoking groups like the Campaign for Tobacco-Free Kids, the American Heart Association, the American Lung Association, and the American Cancer Society, raised considerably less money for the “yes no prop E” campaign; just a few million dollars, most of which has come from former New York City mayor, Michael Bloomberg.

But this financial math ignores the money anti-smoking turned anti-vaping activists have dedicated to this fight. For example, on April 24th the California Department of Health launched its Flavors Hook Kids advertising campaign, aimed at combating “the tobacco industry’s latest strategies aimed at getting youth hooked on nicotine.” The marketing blitz is part of CDPH’s $75 million anti-vaping campaign, which has been running non-stop TV ads since January 2018. A campaign paid for by taxpayer money.

CDPH will assert that this is merely an educational effort and not political activism (which would be illegal.) But it’s hard to believe these commercial won’t influence voters when they sandwich images of sweet-faced infants noshing on strawberries and cereal next to video of an obviously underage boy vaping a “pebbles donuts” flavored e-cigarette. “It’s like donuts and cereal...no burn or anything, this is so good” the pre-teen effuses. It’s unclear if the boy in this particular was one of those recruited by CDPH to vape on camera for money or if his lines were scripted by CDPH.

The timing of the vote is auspicious for anti-vaping groups, as it comes on the heels of a sudden outbreak of media panic about one particular device, the Juul, which looks a little like a thumb drive. Though anti-tobacco groups insist the media frenzy over the Juul is an organic response to rising Juul use in high schools and middle schools, there is compounding evidence that it was part of a calculated and concerted effort by anti-tobacco activists.

In January 2018 the Campaign for Tobacco-Free Kids issued a press release about the threat the Juul poses to teens (a release that has been reissued several times since). It contained some notable phrasing, like the hypothesis that Juul is popular among teens because of its “sleek and discreet design” which “looks quite similar to a USB flash drive...[and] can be charged in the USB port of a computer,” and for its kid-friendly flavors like “cool mint...and fruit medley.” The release also focused on one of the Juul’s flavors: crème brûlée. Though the Juul website spells this flavor as creme brulee (with no accents), the CFTFK document spelled it as “crème brulee.”

That odd spelling of crème brûlée has shown up in hundreds of news stories, releases from other anti-tobacco groups, state departments of health like Washington and North Carolina, notices made by county and city officials, like the Chicago health commissioner, and even letters written by members of Congress, such as Rep. Frank Pallone (D-NJ) and Sen. Chuck Schumer (D-NY).

Despite their tax status as nonprofits and their veil of concern for public health, these groups have a financial interest in targeting e-cigarettes and ignoring the evidence about their benefit to public health. For most, their major source of funding (apart from taxpayer-funded grants) are the hundreds of millions of dollars pharmaceutical companies like Johnson & Johnson (through the Robert Wood Johnson Foundation) and Pfizer (through the Pfizer Foundation) dole out to tobacco harm-reduction groups each year. It should come as a shock to nobody that these companies manufacture and market the world’s leading smoking-cessation products and benefit enormously by any harm to products, like e-cigarettes, that compete with them.

Of course, anti-tobacco groups rarely mention their ties to big pharma or how the policies they advocate benefits their donors who, with less competition, can sell greater quantities of nicotine replacement products at higher prices. Instead, organizations like the Campaign for Tobacco-Free Kids—which the Robert Wood Johnson Foundation created—couch their anti-vaping activism as a heroic fight between advocates and big evil tobacco.  “Tobacco companies have a long history of developing and marketing flavored tobacco products as ‘starter’ products that attract kids,” Matt Myers, president of the Campaign for Tobacco-Free Kids, told reporters. It’s all about protecting kids from trying e-cigarettes and becoming addicted to nicotine, which Myers’s organization recently wrote “threatens to undermine decades of progress in reducing youth tobacco use.” 

But, all the scary headlines about the “epidemic” of teen vaping ignore the fact that teen vaping has declined. Among high schoolers, reported use of e-cigarettes plummeted an impressive 30 percent between 2015 and 2016. On top of that, habitual use of e-cigarettes among teens was never all that common to begin with. Even the height of vaping popularity in 2015, just two percent of high schoolers reported using e-cigarettes on a daily basis. Only eight percent reported vaping three or more times in the last month. Furthermore, despite fears that this experimentation will lead to nicotine addiction, researchers found that vast majority of teens who do vape, vape nicotine free e-cigarettes.

More importantly, evidence abounds that the rise of e-cigarettes has not stopped the decline in youth smoking which is at its lowest rates ever. In fact, vaping might be responsible for the sharper drops in teen tobacco use.

Kids, it seems, are neither targeted nor very interested in vaping, despite what anti-vaping activists claim. However, adult smokers increasingly rely on these devices as a safer means of consuming nicotine. While likely not risk-free, recent analyses estimate that vaping has just 1 percent of the cancer risk that traditional combustible cigarettes carry. And flavor seems to be an essential element in keeping people from returning to cigarettes. As a 2013 study found, the number of flavors a vaper used was independently associated with smoking cessation.

With issues like drug use and sexual health, California has generally been at the forefront of harm-reduction policies (like needle exchanges and safe sex education) and rejected an abstinence-only approach. Yet, when it comes to nicotine consumption, they is actually the approach anti-tobacco crusaders are now asking San Franciscans to embrace. They are using the specter of big tobacco targeting children to convince voters to institute stricter regulations that will make e-cigarettes harder to get, more expensive, and less attractive than actual cigarettes. If they succeed, it will be a major victory for activists, their big pharma benefactors, and big tobacco. The biggest losers will be current and former smokers and good public health policy.