The issue of electronic cigarettes is a complex one and there is plenty of room for - and in fact a need for - vigorous discussion and debate on both sides of the issue. However, what I don't believe there is room for is tobacco control scientists and government agency leaders making up scientific evidence to support pre-determined positions. Science, not ideology, should be guiding the complex decisions that need to be made regarding the handling of the electronic cigarette issue.
Unfortunately, it appears that last week two prominent public health and tobacco control figures fabricated scientific evidence to bolster their opposition to electronic cigarettes.
1. CDC Director Dr. Thomas Frieden Stated that Many Youths Have Started Smoking Because of Electronic Cigarettes
In an interview with Medscape, CDC Director Dr. Thomas Frieden stated that many youth have become cigarette smokers because they experimented with electronic cigarettes, which then led to their smoking initiation.
Specifically, Dr. Frieden stated:
"What we are doing first is tracking, and we are seeing some very
concerning trends. Use of e-cigarettes in youth doubled just in the past
year, and many kids are starting out with e-cigarettes and then going
on to smoke conventional cigarettes."
The Rest of the Story - #1
Dr. Frieden shares two pieces of data from the CDC's tracking of electronic cigarette use among youth. First, he reports that the use of e-cigarettes in youth doubled in the past year. This statement is true, as the CDC survey did in fact show a doubling of experimentation with electronic cigarettes among youth.
The second piece of data from the survey that Dr. Frieden shares is that many of the youth smokers in the survey started as pure electronic cigarette users and that the electronic cigarette use ultimately led to their initiation of cigarette smoking.
This statement, sadly, appears to be a fabrication. The CDC survey did not show that many youth smokers actually started with e-cigarettes. In fact, the survey did not even assess that question. It measured the prevalence of smoking and electronic cigarette use among youth, but it was a cross-sectional survey and it did not track youth over time to determine their vaping and smoking patterns. Moreover, it did not collect complete smoking and vaping histories from the youth so that it could answer this question.
In other words, Dr. Frieden apparently just fabricated this evidence and presented it as being a result of the CDC's surveillance of youth e-cigarette use.
If you examine the methodology and questionnaire for the National Youth Tobacco Survey, you'll note that:
1) It is a cross-sectional survey, so it did not examine the trajectory of smoking initiation in relation to electronic cigarette use; and
2) The questionnaire only assessed ever use and past 30 day use of conventional and electronic cigarettes and it did not ascertain the longitudinal history of smoking initiation in relation to experimentation with electronic cigarettes.
Thus, in contrast to Dr. Frieden's statement, the survey provides no evidence that "many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes."
Moreover, I am aware of no other scientific evidence that many youth who started out with e-cigarettes then initiated smoking.
Unfortunately, the rest of the story is that this piece of scientific evidence appears to have been fabricated to support the CDC's opposition to electronic cigarettes.
Here, I am not criticizing the CDC for its position on electronic cigarettes (that is a separate issue), but instead, I am criticizing the apparent fabrication of scientific evidence to support that position. If the evidence does not support the CDC's assertions, then the agency should not make up evidence to support those assertions. Perhaps it should instead re-think those assertions.
I believe that one of the core ethical principles of public health is honesty and transparency. Here, it appears that the CDC is being neither honest nor transparent.
2. Anti-Smoking Researcher Dr. Stan Glantz Stated that Electronic Cigarettes Present 10% to 20% of the Risk of Tobacco Cigarettes
In an article on electronic cigarettes in TIME magazine, Dr. Glantz is quoted as asserting that electronic cigarettes pose 10% to 20% of the risk of tobacco cigarettes, and therefore, since the risks of cigarette smoking are enormous, electronic cigarette use is a major health risk.
Specifically, Dr. Glantz is quoted as stating:
"The studies that the e-cigarette people point out, claiming that these things are harmless, are really, really, really crappy. It is probably about 10% to 20% of what a cigarette puts out, so looked at that way, they are really nice. On the other hand, if you look at absolute levels of risk, they are pretty bad, because a cigarette is just ridiculously toxic and ridiculously polluting. ... If you say an electronic cigarette is only 10% to 20% less polluting than a massive forest fire, that's not so good."
The Rest of the Story - #2
Here, Dr. Glantz has essentially fabricated scientific evidence that doesn't exist. He asserts that electronic cigarettes pose 10% to 20% of the risk of conventional cigarettes. However, no such evidence exists. Basically, he is just making this up.
If you examine the constituents in electronic cigarette vapor compared to tobacco smoke, Dr. Glantz' assertion holds no water. Cigarette smoke contains between 10,000 and 100,000 chemicals, including more than 60 known human carcinogens. Electronic cigarette vapor contains about 15 chemicals, of which only about five are of any significant health concern, and the levels of those five chemicals in electronic cigarettes are comparable to those in nicotine replacement products like the nicotine inhaler, nicotine gum, or nicotine patch.
I have argued that there are a few potential health risks associated with vaping, including long-term respiratory health effects of propylene glycol, carcinogenic effects of formaldehyde, and cardiovascular and reproductive health effects of nicotine. However, so far there is no actual scientific evidence that electronic cigarettes are causing any significant health harm to users. To assert that the risk is 10% to 20% of that of cigarettes is not only absurd, but it is just a fabrication.
If what Dr. Glantz is asserting is true, then if used over many years at the same prevalence as cigarettes, electronic cigarettes would eventually cause between 40,000 and 80,000 deaths per year. Obviously, that's a fabrication as there is no current evidence that vaping poses any significant mortality risk. What specific diseases does Dr. Glantz assert that e-cigarettes cause and what specific chemicals cause those diseases?
I would readily acknowledge that we don't have enough scientific evidence to precisely quantify the absolute risk levels associated with vaping. But that's quite the point. By asserting that the risk is 10% to 20% of that of cigarette smoking, Dr. Glantz is essentially just making up a risk estimate, without any scientific justification, support, or evidence.
Once again, the rest of the story is that another prominent tobacco control scientist appears to be fabricating scientific evidence to support a pre-determined position against electronic cigarettes. There is no room for tobacco control scientists and government agency leaders to make up
scientific evidence to support pre-determined positions. Again, science, not
ideology, should be guiding the complex decisions that need to be made
regarding the handling of the electronic cigarette issue.