The AMA’s Vaping Narrative: A Disservice to Public Health and Smokers Seeking Alternatives?
The ongoing debate surrounding vaping and e-cigarettes in the United States is frequently clouded by fear-based messaging, and critics argue that the American Medical Association (AMA), a leading voice in healthcare, is a significant contributor to this problem. A recent AMA publication, an interview with Dr. Bilal Shahid Bangash titled “What Doctors Wish Patients Knew About E-Cigarettes,” authored by Sara Berg and published on May 30th, has reignited concerns that the organization is prioritizing a misleading narrative over evidence-based tobacco harm reduction. While the AMA’s stated intention may be to inform the public, its approach often seems to obscure the potential of e-cigarettes as a vital tool for adult smokers aiming to quit deadly combustible cigarettes.
The piece employs a strategy of presenting technically true claims that, when stripped of critical context, paint a distorted picture of e-cigarettes’ role in public health. This selective presentation ignores the reality that for millions of adult smokers, vaping represents a significantly less harmful way to consume nicotine. Let’s examine some specific claims from the AMA’s interview to highlight the discrepancies between their narrative and the broader scientific 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 subtly implies that e-cigarettes are no longer considered a safer alternative to smoking, without explicitly stating so. This is a misleading inference. The overwhelming scientific consensus remains that vaping is significantly less harmful than smoking. As far back as 2015, Public Health England published a landmark review concluding that e-cigarettes are approximately 95% less harmful than combustible cigarettes. More recently, a King’s College London review in 2022 reaffirmed this, stating 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 crucial context, the AMA avoids an outright falsehood while sidestepping inconvenient facts that support harm reduction.
The assertion of a “stronghold among teens and adults alike” is also problematic. Firstly, regarding youth, nicotine use is actually at a remarkable low. The 2024 National Youth Tobacco Survey (NYTS) reported a further decline in e-cigarette use among U.S. high school students, falling from 10% in 2023 to just 7.8% in 2024. This continues a significant downward trend since the peak in 2019. Secondly, while e-cigarette use among adults has indeed risen, a CDC review of the National Health Interview Survey (NHIS) indicated that overall adult nicotine use (from all products) has remained relatively stable since 2017. Concurrently, adult cigarette smoking fell to a record low of 11% in 2024. This strongly suggests that many adult smokers are successfully switching to e-cigarettes without a significant net increase in new nicotine users among adults – a positive public health outcome that the AMA’s framing fails to acknowledge or celebrate.
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…”
Here, the AMA acknowledges the recent decline in youth vaping but immediately pivots to emphasize that e-cigarettes are the “most commonly used tobacco product” among youth. This framing, while technically accurate because the FDA classifies e-cigarettes as tobacco products, distracts from the more significant public health story: overall youth nicotine and tobacco use is at historic lows. The 2024 NYTS reported that only 10.1% of high school students and 5.9% of middle school students currently used *any* tobacco products in 2024. This represents a substantial decline from previous years and should be the primary focus. Indeed, current cigarette smoking among many youth demographics, such as Black high school students, is now so low it is statistically indistinguishable from zero – a remarkable achievement in public health that often gets overshadowed by the focus on vaping.
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 is true that the FDA has not *approved* any e-cigarette as a smoking cessation therapy in the same way it approves pharmaceutical drugs. However, this is largely a reflection of regulatory pathways and the immense burden of proof required for a therapeutic claim, not a definitive statement on their effectiveness for individual smokers. The scientific evidence strongly indicates that e-cigarettes *do* help smokers quit. An ongoing Cochrane Library review, updated in 2024, consistently finds with high certainty that nicotine e-cigarettes are more effective in helping people stop smoking than traditional nicotine replacement therapies (NRTs) like patches or gum, which *are* FDA-approved. Such compelling evidence 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 data that they can save lives by helping smokers switch.
The FDA’s burdensome Premarket Tobacco Product Application (PMTA) process has made it nearly impossible for e-cigarette manufacturers, especially smaller ones, to make explicit cessation claims or even get many products authorized for legal sale, let alone as modified risk tobacco products (MRTPs). This regulatory framework, as argued by legal scholars and industry analysts like Clive Bates, effectively prevents manufacturers from communicating truthful information about the reduced-harm potential of their products to adult smokers – a serious consequence the AMA fails to address.
Claim 4: “Using Any Other Tobacco Product or Any Other Product That Contains Nicotine is Not Actually Quitting.”
Dr. Bangash’s assertion in the AMA piece that vaping isn’t “quitting” because it involves nicotine fundamentally misses the core principle of tobacco harm reduction. For many adult smokers who have tried and failed to quit nicotine altogether, the primary goal of switching to e-cigarettes is not necessarily immediate nicotine abstinence, but a drastic reduction in exposure to the thousands of harmful toxins produced by burning tobacco. This shift significantly lowers health risks.
While long-term data on e-cigarette use is still accumulating, early and medium-term studies are promising. A 2017 study in the Annals of Internal Medicine found that former smokers who switched exclusively to e-cigarettes had significantly lower levels of measured carcinogens and toxins in their bodies compared to current smokers. A 2018 study published by the AMA’s own journal, JAMA Network Open, noted that within a year of switching to e-cigarettes, former smokers’ levels of certain tobacco-specific carcinogens were nearly indistinguishable from those of never-smokers.
The benefits are particularly striking for vulnerable populations. Smoking during pregnancy is known to cause severe adverse outcomes. However, research, including a 2019 presentation published by the American Journal of Obstetrics & Gynecology and replicated in journals like The Lancet’s EClinicalMedicine, has found that babies born to mothers who exclusively used e-cigarettes during pregnancy had health outcomes (like birth weight) nearly indistinguishable from those born to non-smokers, and significantly better than those born to mothers who continued to smoke cigarettes. By dismissing vaping as “not quitting,” the AMA overlooks these profound harm reduction benefits.
A Call for Nuance, Honesty, and a Focus on Saving Smokers’ Lives
Perhaps the most troubling aspect of the AMA’s recent messaging is its failure to actively encourage adult smokers, who cannot or will not quit nicotine, to switch to significantly less harmful vaping products. In 2023, the CDC reported that 24.3 million U.S. adults still smoked combustible cigarettes, contributing to approximately 447,000 preventable smoking-related deaths that year. These staggering numbers underscore the urgent need for effective harm reduction strategies.
The New England Journal of Medicine’s call for clinicians to recommend e-cigarettes to smokers in appropriate situations emphasizes the life-saving potential of this approach. Yet, the AMA’s disproportionate focus on youth vaping – despite consistently declining rates – overshadows this critical opportunity, perpetuating a narrative dominated by fear rather than a balanced assessment of risks and benefits.
The AMA holds a position of significant trust and authority. It should be a beacon of scientific integrity and nuanced public health communication. Instead of obscuring the reality of tobacco harm reduction, the AMA has an ethical obligation to foster an honest discussion that acknowledges the competing interests of promoting e-cigarette use among adult smokers as a means to quit deadly cigarettes, while simultaneously working diligently to minimize youth exposure to and uptake of all nicotine products. E-cigarettes are not risk-free, but they are a proven, substantially less harmful alternative for adult smokers – a fact supported by extensive research. By continuing to downplay or ignore this reality, the AMA undermines public health and misses a critical opportunity to save countless lives.
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