A study published last year found that if you lie to people on Twitter, some of them will believe you. The researchers showed 2,400 smokers some tweets about vaping, most of which were categorically untrue, and found that those who were exposed to misinformation were more likely to have a poorer understanding of the risks of e-cigarettes than those who were exposed to accurate information.

So far, so unsurprising. What was remarkable was the level of ignorance displayed by nearly everyone, regardless of what tweets they were shown. Of the people who were told that vaping is as harmful or more harmful than smoking, only 29 per cent believed that e-cigarettes contain fewer toxins than cigarettes. This is a pitifully low figure, but even amongst the people who were told that vaping is “completely harmless”, the figure was only 43 per cent. (In case it is not obvious — and apparently it isn’t — e-cigarettes contain far fewer toxins than cigarettes.)

No matter what messages they were shown, more than 60 per cent of the participants wrongly believed that e-cigarettes contain tar, and the vast majority of them believed that vaping causes “popcorn lung”. Even amongst those who were told that vaping is completely harmless, 88 per cent thought that e-cigarettes cause popcorn lung.

British smokers were less ignorant than Americans, but they were still deeply confused. At the start of the study, only 11 per cent of the British smokers correctly believed that vaping doesn’t cause popcorn lung (compared with a pitiful 6 per cent of American smokers), and only 46 per cent of them understood that e-cigarettes don’t contain tar (amongst the Americans it was just 27 per cent). They would have been better off getting their opinions from a coin toss.

People are woefully misinformed about the risks of vaping

This has to be one of the greatest public health failures of all time. Every indicator shows that people are not only woefully misinformed about the risks of vaping, but that their ignorance has got worse over time. This is true of smokers and nonsmokers alike in any country you choose to name. In England, the proportion of smokers who wrongly believe that vaping is as dangerous or more dangerous than smoking rose from 36 per cent in 2014 to 53 per cent in 2020. England is one of the few countries where public health agencies make an effort to tell people the truth. In the USA, where they don’t, the proportion of people who correctly believe that vaping is much less harmful than smoking fell to just 2.6 per cent in 2020. Pathetically, ten times as many Americans think vaping is more harmful.

Given the proven benefits of e-cigarettes in smoking cessation, this is nothing short of a scandal. It is all the more shameful for being the consequence of nonsense spouted by people claiming to act in the name of public health. Despite having been repeatedly debunked, the popcorn lung myth continues to be propagated by everyone from the Campaign for Tobacco-Free Kids to the American Lung Association. Although nine out of ten people apparently believe it, I doubt one in a hundred people even know what popcorn lung is. The medical term is bronchiolitis obliterans, but it got its nickname when some workers in a popcorn factory in Missouri developed the disease as a result of inhaling a flavouring called diacetyl. Diacetyl was once used as a flavouring in some vapes, although not since 2016 when the EU banned it. There has never been a recorded case of popcorn lung among vapers anywhere. The doses are far too small. Cigarettes contain hundreds of times more diacetyl than an e-cigarette ever would, and there have never been cases of popcorn lung among smokers either. 

In Australia, which has completely lost its mind about vaping, some scientists recently suggested — without a shred of evidence — that Polonium-210 is in e-cigarettes. In case anyone had forgotten that this was the chemical used to kill ex-KGB officer Alexander Litvinenko in 2006, one of them eagerly told the press that Polonium-2010 is “a weapon of espionage. The Russians have used it as a poison”.

This endless drip-drip of lies and innuendo inevitably has an effect on public opinion. You might expect doctors to be more scientifically literate but, on this issue at least, they are more ignorant than the man on the street. In Britain, 40 per cent of smokers wrongly believe that nicotine causes cancer. According to a survey conducted last year, that figure rises to 60 per cent among British doctors. Again, the British are more knowledgeable than people in most other countries. In the USA, 67 per cent of doctors think nicotine causes cancer. In India the figure is 88 per cent, and in Indonesia it is a staggering 97 per cent. 

It is tempting to believe that a public information campaign laying out the facts would move popular perceptions closer to reality. It certainly wouldn’t do any harm, but most people believe what they want to believe and only accept evidence that aligns with their priors. Everybody knows that the media are more interested in bad news than good news, but this seems to apply to people in general. The authors of the aforementioned Twitter study found that telling people that e-cigarettes are more dangerous than they are has more effect on risk perceptions, than telling people that e-cigarettes are less dangerous than they are. Not all lies are equal. They concluded, “Negative information is more memorable and compelling than positive information and is assigned a greater weight in belief formation.” Perhaps we are just hard-wired to believe the worst.