by Carl V Phillips

The story of the week in the vaping space has been an outbreak of lung diseases cases, with at least one death, that has apparently resulted from a bad batch (or, perhaps, due to wild coincidence, two simultaneous bad batches) of vapeable synthetic cannabinoids. Of course, this has nothing to do with what we call vaping, other than sharing approximately the same delivery system. As I mentioned in my last post, the reason there was a bad batch is because the Drug War causes these drugs to be produced without regulation of any sort (including producers’ need to maintain a good reputation, which is really the most important form of regulation). The reason synthetic cannabinoids even exist in a world that grows perfectly good cannabis is also the Drug War.

Again, nothing to do with vaping, except in a cautionary sense: If the march toward banning most nicotine vape products continues, this might happen in our sector too.

Anti-vaping activists have been aggressively using these events to attack vaping (proper nicotine vaping, that is — I will stop including that clarification now). Of course they have. They are not exactly known for sticking to legitimate criticisms. This has included the U.S. CDC and FDA, as well as others who obviously know this is disinformation. There is no better evidence of the fact that they care only about the propaganda value, rather than the bad outcomes, than:

But that brings up the interesting question: Why is this successful? That is, why do news reporters, politicians, and other clickbait artists freak out about vaped poison when they are blasé about smoked (or injected, or snorted, or swallowed) poison? Whether a particular author is among those who were tricked by the anti-vaping activists, or whether they knew better but just wanted the clickbait, this remains a good question.

The answer, I believe, can be found in the work on cognitive biases about risks, mostly from the 1970s and early 1980s. Search under Tversky, Kahneman, and Slovic to learn more. Researchers, led by those three, compiled lists of characteristics of a risk that systematically make people irrationally worried (or, conversely, irrationally comfortable) with the risk. For example, people fear flying more that driving, even though flying is much safer, because: (a) they are in control of the car and not the plane (as if they are a better at driving than a professional pilot is at flying), (b) airplanes are a mysterious technology while cars are not (never mind that anyone who really understands how cars function, and the physics of why they are dangerous, probably generally understands airplanes), and (c) they have driven a lot more, without dying from it, so are confident they are at less risk than average when driving (never mind that they do not have nearly enough data to have updated their priors that way — i.e., even a bad driver with double the average risk is extremely unlikely to die from a few decades of driving).

[Aside: It is a frequent source of amusement for me when someone stumbles across this work on cognitive biases or its current iterations (which, as far as I can tell, have really added nothing useful to the original work), and breathlessly reports its implications for current policies. Um, yeah. We kinda already knew that 35 years ago.]

When I taught this material, I collected a few of the items in the Slovic-Tversky-Kahneman lists into what I called spookiness bias. People are irrationally afraid of risks that involve novelty, magical (to their understanding) technology, invisibility, and in general things that they cannot translate into the everyday physical world they understand. There is also often some element of imagining some evil supervillain behind the exposure. The mystery of flying in an airplane is an example of magical technology to most people. So are irrational fears of nuclear power (which is also invisible and brought to us by “big energy”) and pesticide residues (also invisible, and is ~chemicals~, and is inflicted by big evil chemical companies). Similarly, cancer is spooky (mysterious invisible biological action) while deaths from falls are largely ignored and little is done to prevent them.

The behavior is uneven: For a while, cellular phones were a target of similar irrational fears, but then they became non-novel and much beloved and so the fears went away, even though they remained a magical source of invisible radiation. It is difficult to guess whether a technology is going to provoke spookiness bias. Claims to the contrary seem to just be ex post just-so stories.

Vaping should not be a victim of spookiness bias. Nicotine is not novel or mysterious. Smoking is normal and common, after all. There are thousands of OTC and prescription medicines that deliver droplets of drugs into the mouth, lungs, or nose. But anti-vaping activists have cleverly managed to slip vaping into the spookiness bias space. Well, that probably gives their bumbling machinations too much credit: They just attacked in every way they could, as they always do, regardless of the truth-value of what they were saying, and it so happened that this was a point of vulnerability they stumbled upon.

So, as noted in the tweet, smoking a bad batch is ho-hum deaths of no-good druggies. But vaping a bad batch! Well, that is spooky!

The particular points of this bumbling that seem to have landed include: tricking people into believing the nicotine content of vapes is fundamentally different from cigarettes, listing spooky-sound chemicals that are detectable in vapor, talking about mysterious “particulate matter”, and constantly implying there is something novel about this exposure even though there has been in the neighborhood of a hundred million person-years of cumulative exposure. These are all spookiness factors. Never mind that (real) particles and all of those chemicals are present in cigarette smoke, mostly at concentrations that are orders of magnitude greater. People are comfortable with cigarettes (and smoked bad batches) and medical inhalers, so they are post-spooky like mobile phones. But vaping has been carved out from them.

For those who lack the knowledge of our history, and so think there is anything new under the sun: This is exactly what tobacco controllers did with smokeless tobacco (snus) in the 1990s, in order to discourage smokers from switching. The anti-THR activists associated snus with oral cancer (never mind that the evidence shows it does not cause measurable risk), which seemed like a novel scary risk. Of course, it is not novel. Smoking (though not snusing) causes a substantial increase in oral cancer risk. They also discussed spooky sounding chemicals (tobacco-specific nitrosamines, etc.) only in the context of snus. As with vaping, particular diseases and chemicals were “reserved” for attacking the smoke-free alternative, even though they are more part of the smoking exposure.

Again, I am not giving credit for this being their clever plan from the start. Tobacco controllers just happen to have not bothered to emphasize those aspects of the smoking exposure. They thus created the opportunity to pretend these were something novel about the low-risk alternative, a reason to stick with the normal — and thus non-spooky — option of smoking.

One of the burning questions of the week is, “Why are people blaming the delivery system for a (sadly) commonplace illicit drug poisoning incident?” The answer is that they have been tricked into believing the delivery system is spooky, despite it really being unremarkable. Fighting back on the specific claims in this case is worthwhile, of course. But that is just a skirmish, and the real battle is about overcoming the spookiness perception that is associated with vaping.

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Original author: Carl V Phillips