The Real Cost

Here at HandCheck, it can sometimes feel like it’s “all FDA news all the time”, but that’s only partly true. We actually have a lot of enemies, some of them even more powerful than the federal regulatory agency which most often finds itself in our crosshairs. The federal government itself, for instance, is no great friend of the vaping industry, nor are our old friends “Parents Against Vaping E-Cigarettes”.


But yeah, today we’re going to be talking about the FDA yet again. Why? Their long-running “The Real Cost” campaign which, although it’s had some decent impact over the years, has lately turned into a propaganda outlet for the worst people on the subject of vaping.


Truth or DARE?


You see, it all began with the “truth®” campaign, which was launched by the American Legacy Foundation in 2000. They received funding from the ominously named Master Settlement Agreement with the stipulation that they would discourage tobacco use among young people. The truth® campaign quickly gained notoriety for their graphic use of imagery and pulling back the curtain on the tobacco industry and their nefarious marketing practices. While all of this is quite public knowledge now, i.e. Big Tobacco markets to kids, cigarettes cause lung cancer, this kind of candor was groundbreaking at the time and led to plaudits from pundits and parents alike.


More importantly, perhaps, was the fact that the truth® campaign seemed to be effective. Scientific studies conducted around this time showed a dose-response relationship between exposure to truth® materials and underage smoking. The more kids saw these ads, they less likely they were to pick up smoking. It was around this time that government officials began to take notice. The idea of shocking children with terrifying images and warnings naturally appealed to the government, and the concept took hold.


Smaller campaigns were launched in states like Florida and Massachusetts, garnering similar results to the truth® campaign, albeit on a local scale. In Florida, they were able to decrease smoking by a whopping 5% (although this statistic doesn’t specify whether it’s underage smoking or smoking, in general) and Massachusetts reported a more vague “slowing of progression to established smoking within the first 4 years”. I’m not even sure entirely what that means, but apparently, it’s evidence of their success.


These test studies also demonstrated to government observers that the funding and scale of these campaigns was significant. In order for the campaigns to have any kind of efficacy, they must be broad and pervasive enough to reach their targets many, many times over a significant time period. If not, the ads would not be effective. Sounds an awful lot like some of the more insidious “brainwashing” or “subliminal messaging” techniques we’ve been warned against. Apparently, employing these tactics towards a healthy end is a different story. “Acceptable brainwashing”, perhaps.


Truth, But on Steroids


With the evidence and relative success of the truth® campaign, the Center for Tobacco Products (CTP) began to formulate a plan of attack. While the truth® campaign only ran for a period of a few years, the CTP had their eyes on a long-term, consistently funded campaign which would presumably continue until nicotine didn’t exist anymore. This is where “The Real Cost” campaign comes in – and the CTP really didn’t hold back.


Using all the evidence and experience gained from the truth® campaign, the CTP was able to put together an intensive cadre of teams working both internally and externally to craft The Real Cost from the ground up. Team members included experts in marketing, research, campaign development, implementation, and outcome evaluation. Basically, ever crank, quack, and snake oil salesman you’ve ever met, all in one place working together to create a propaganda campaign which would run in perpetuity.


With this A-Team of pseudo-scientists now assembled, CTP launched full steam into market research, best practices, exploratory research, and evidence summaries. They dove deep into the psychology of their “target audience” (i.e. young people), making sure to rigorously test every message they intended to use. They measured their ideas and concepts to ensure maximum penetration and impact. Once they had perfectly honed their blades, they made sure to craft a campaign which would be goal oriented. That is, the entire campaign was set up to be measured. As the campaign went on, they would be looking to measure changes in knowledge, attitudes, beliefs, and behaviors.


During this time, the CTP identified three basic pillars for their new assault. These pillars would form the basis for their messaging, as they were determined to be most effective at breaking through to young people. These concepts were:

  • Loss of Control & Addiction – The premise here is basically explaining to teenagers that, while smoking might seem cool or sexy or whatever, one day they’ll be unable to regulate their own use of the product. “Addiction” is a scary concept to young people, as is anything that interferes with their autonomy, hence this became the first pillar of the new campaign.
  • Dangerous Chemicals – While everybody today can seemingly list half the products in cigarettes off the top of their head, this wasn’t always the case. Explaining to teenager that tobacco smoke contained dangerous chemicals is an effective method, particularly if it could be tied to something they already knew as dangerous. For example, pointing out that ammonia, a household cleaner, could be found in cigarette smoke scares teenagers. This same tactic has since been applied in far more duplicitous and nefarious ways.
  • Health Consequences – Similar to both of the above categories, drawing a direct line from smoking to things like cancer, lung disease, and cosmetic damage created a tangible sense of danger. Even though most teenagers knew that smoking probably wasn’t great for them, it’s always effective to name the specific threat posed by a substance.


Once all these pillars were firmly in place, leaders of the CTP, the FDA, and the HHS all worked together in order to push the final project. Since its implementation, government agencies report having prevented “nearly 350,000 U.S. youths aged 11-18 years from initiating smoking from February 2014 to March 2016”. While these figures are obviously sheer projection, there’s no doubt that a campaign of this scale and magnitude had some kind of positive impact, although not likely on par with the agencies’ own self-congratulatory estimation. After all, they had to justify having spent a billion dollars on this thing; it couldn’t very well be measured a failure if the people at the top were to keep their jobs.


The Power of Fear, Stigma, and Shock Tactics


For those who haven’t completely succumbed to governmental bootlicking, the tactics outlined above may seem shocking and intensely invasive. Even assuming the best of possible intentions, government agencies basically created a comprehensive psychological profile of an entire generation of Americans. Using this information, they handcrafted a propaganda campaign designed to alter their behavior. Was this same information passed along to the DOJ or defense contractors? There’s no way to tell, but the implications are concerning to say the least.


But I digress – the “Real Cost” campaign was grotesque enough in its own right, without getting borderline conspiratorial about the whole thing. As the world turns, however, the Real Cost campaign set its sights on the newest threat in the nicotine world – vaping. During their campaign against cigarettes, it was all too easy to throw out shocking images. Everyone remembers the lady who had to speak through a hole in her neck, or the revolting images of aging smokers and their blackened lungs. But how can they replicate this kind of fearmongering with vaping? After all, there is no hard connection between vaping and any kind of visually striking health condition. There’s no connection, yet, of course, but it’s not for a lack of trying. In just the past few months, the FDA and their friends in the media have tried their hardest to connect vaping with “mysterious lung issues”, something called “wet lung”, and seizures.


And the lack of scientific evidence hasn’t completely stopped this ad campaign from tying vapes to health diseases. In fact, in their zeal to go after vaping like they did cigarettes, they have even stooped to outright lying. In the earliest days of the Real Cost attacking vaping, they claimed that “all vaping liquid contains carcinogens” or exaggerated the impact of nicotine on a developing brain. After all, the pillars of the Real Cost campaign had already been set out. If they couldn’t stoke fear about Health Consequences and Dangerous Chemicals, they only had Addiction left. Addiction, on its own, just isn’t scary enough. And so the lies continued.


New Face, Same Fear Tactics


More recently, the Real Cost campaign has shifted gears slightly, in a “more bees with honey” type approach. Now their ads include a millennial “street magician” doing tricks for young people and turning vapes into traditional cigarettes before their very eyes. As the punch line to this illusion, the magician, Julius Dein, says, “It’s not magic. It’s statistics.” – another outright lie from the Real Cost campaign.


When it comes to striking fear into teenagers about vaping, the Real Cost campaign relies upon teenagers not looking too hard into the data they provide. Each of their “studies” and “data points” are carefully cherry-picked and phrased in a particular way, especially when it comes to the drug nicotine. Most people have an inherently negative association with the word “nicotine”. Historically, it’s always been connected with cigarettes and the health consequences and myriad dangers associated with them. On its own, however, nicotine is an extremely mild drug which essentially mimics caffeine.


Like caffeine, nicotine has a stimulant effect on the body. People also develop a tolerance for nicotine, as they do with caffeine, which can lead to increased usage, and even withdrawals and cravings. It should be striking, then, that the Real Cost campaign makes such a huge deal about the impact of nicotine on “developing brains”. Physicians claim that caffeine has almost an identical impact, yet there is no outcry against coffee or soda. At least not in any meaningful way.


Instead, the Real Cost highlights that nicotine causes irritability, attention deficit, and headaches – the exact same issues caused by caffeine. Interesting that my old high school has a Starbucks directly across the street. Caffeine isn’t an 18+ drug and almost nobody seems concerned about the prevalence of teenagers walking around high schools with Starbucks in their hands. But, according to the alleged “concerns” regarding vapes, these coffee cups are interfering with the wellbeing of teenagers in almost the exact same ways. While hypocrisy is certainly not the “gotcha” it once was, it’s worth noting.


In any case, while these new ads have a more friendly, even funny, tone to them, it’s the same tactics of fear-mongering and exaggeration they used to good effect during their assault on cigarettes. This lack of distinction between nicotine and cigarettes comes in stark contrast to the tone taken in other civilized countries. In England, for instance, the Royal Society for Public Health released a statement in 2015 specifically differentiating the health impacts of nicotine and tobacco.


This statement also highlights the importance of vaping as a cessation tool, a claim which is flat-out illegal to make in America. “Getting people onto nicotine rather than using tobacco would make a big difference to the public’s health… this would move us on from having a serious and costly public health issue from smoking-related disease to instead address the issue of addiction to a substance which in and of itself is not too dissimilar to caffeine addiction.”


The Real Cost of the “Real Cost” Campaign


And that’s the whole ballgame, really. With tobacco and traditional cigarettes, you have a gigantic bundle of potential health hazards, most of which rank fairly high on the scale. With nicotine itself, you have an addiction on par with caffeine. In England, this distinction is fairly clear, but not so in the U.S.A. Why? This is the real cost of the “Real Cost” campaign: a terrified populace with a remarkably tainted view of anything associated with tobacco, including, of course, nicotine.


In America, the Real Cost campaign has been drilled into people’s brains since childhood. For many adult Americans, the health hazards of cigarettes cannot be distinguished from nicotine. As such, cigarettes, cigars, vaping, and even marijuana all fall into a similar category. The Real Cost campaign has cast a shadow of suspicion which stretches far beyond the initial target of their propaganda to include just about anything that’s inhaled and produces a cloud of any kind.


While this campaign could possibly be believed to have begun in good faith, it has far outlived both its usefulness and its “good faith” origins> according to Lynn T. Kozlowski, professor of community health and health behavior at the University of Buffalo, “[these ads] are more like propaganda than the transmission of evidence-based health information. If a manufacturer were to make as preposterous a claim based on a small increase in confounded probabilities – that vaping in effect becomes smoking at that’s the ‘statistics’ – it would be considered a deceptive ad” – and rightly so!


This, in effect, is a big part of the problem. The government-funded ad campaign is held to entirely different standards than the industry it relentlessly assaults. The vaping industry is effectively hamstrung by myriad legal bindings which prevent it from striking back or setting the record straight. For instance, we mentioned above that the vaping industry is legally prohibited from claiming that their product could help smokers quit. While there are countless studies supporting exactly this fact, they can’t claim it in advertisement or print, rendering them helpless to defend themselves against the completely opposite and unsupported claim being pushed in these ads.


Gateways – The Oldest Myth in the Propaganda Handbook


Slippery slope arguments and gateway drug myths have long been disproven in academic circles, but this sort of rigor is not demanded of the “Real Cost” campaign. Many of the arguments being used in the modern vaping discourse have long been used in the war on drugs, just like the DARE campaign outlined above alongside the truth® campaign. It wasn’t true then, and it’s not true now.


People who sought to ban marijuana during its heyday in the 70s and 80s often claimed that people who picked up marijuana were just a couple hits away from switching to the “hard stuff”. If they could only prevent people from smoking marijuana, they’d be able to effectively prevent addiction to drugs like heroin, benzodiazepines, and amphetamines. This, of course, proved to be utter nonsense, but it’s still an argument made all the time.


While it was stupid to use this argument against marijuana, it’s causing real damage today as it’s used against vaping. The argument that vaping is merely a steppingstone to combustible cigarettes confuses the facts to the point where harm-reduction practices are being rendered impossible. To put it simply, vaping has been proven the most effective cessation aid for smokers. Millions of smokers worldwide have successfully moderated their cigarette use or quit entirely through the use of vaping products.

In America, however, we’re teaching the youth the inverse. Instead of viewing e-cigarettes as a possible means to escape tobacco addiction, countless young people will learn exactly the opposite lesson, potentially discouraging them from ever seeking a way out from cigarettes should they find themselves addicted.


Additionally, the Real Cost campaign includes essentially no information on harm reduction or comparative-harm studies. For instance, these ads may point out real health risks posed by vaping, but they’re almost never laid out side-by-side with the health risks of cigarettes. Medical professionals constantly stress the importance of comparative studies, as relaying the “risks” of vaping on their own is scientifically insignificant. That is, vaping is far less dangerous than cigarettes are, and this is medically significant. That e-cigarettes aren’t perfectly healthy is not significant, for the simple fact that they can help people avoid a far more dangerous medical situation. This is the essence of harm-reduction, and it’s proven to be easily the most effective way to deal with addicitons of all kidns.


For instance, in many countries hit by opiate epidemics, health officials pivoted to harm-reduction models. In these systems, addiction is de-criminalized, addicts are provided with safe injection sites and needle exchanges, and options like Suboxone and methadone maintenance are expanded. While switching from heroin to methadone is not an ideal or flawless long-term solution, the benefit is massive in comparison. Likewise, switching from cigarettes to e-cigarettes is a massive start, although the ideal would be to quit nicotine altogether. 


The Road Ahead


While we’re all hounded incessantly about the “kids in Wisconsin” and the looming dangers of “vaping-related lung issues” which is rapidly spreading beyond Wisconsin, it’s time to take a hard look at where this road is leading. This campaign of misinformation, fearmongering, and media blitzing is pointing towards one endpoint: banning e-cigarettes.

While we’re still probably a long way off from this disastrous final solution, the entire conversation should be framed in exactly those terms. As we’ve already seen from local bans and various types of crackdowns throughout the country, vaping is becoming dangerous. That is, scarcity and illegality have given rise to black markets of street vapes which are every bit as dangerous as drugs purchased from the same sources. Nobody who’s paying any attention believes for a second that regulated, store-bought vapes are any danger to the general populace in the hands of knowledgeable vapers. But we all know that buying unregulated and illegal substances on the street carries a massive risk.

That’s the future we’re providing for smokers, kids, and vapers alike. A world in which vapes are increasingly difficult to get a hold of or outright illegal will leave only one alternative. And the alternative has already shown itself to be dangerous, if not lethal. Advocates of vaping need to take up this argument and march it directly up to Capitol Hill before vaping is driven extinct by well-meaning anti-vapers and the more nefariously funded “Real Cost” campaign. The clock is running out.