- The Centers for Disease Control and Prevention (CDC);
- Dr. Stan Glantz; and
- Dr. Michael Fiore
The CDC was first to the punch, with its director misrepresenting cross-sectional CDC survey data as conclusive evidence that electronic cigarettes are a gateway to smoking. Specifically, CDC Director Dr. Thomas 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."
In addition, Dr. Frieden was quoted as stating that electronic cigarettes are "condemning many kids to struggling with a lifelong addiction to nicotine."
The Office on Smoking and Health (where I used to work) vigorously supported these statements and failed to offer any public corrections. Nor am I aware of any other CDC corrections or retractions of these claims.
More recently, Dr. Stan Glantz began disseminating the conclusion that e-cigarettes are a gateway to smoking. In an article published in USA Today, he stated definitively that electronic cigarettes are a gateway to smoking. He was quoted as stating: "There's no question that e-cigarettes are a gateway to smoking."
And even more recently, Dr. Michael Fiore rang in the new year with a public statement that electronic cigarettes can lead youth to a lifetime addiction to nicotine. He was quoted as stating: "One of the biggest concerns about e-cigarettes is that they will serve as a gateway drug to lifelong nicotine dependence and all of the harms we know result from cigarette smoking. We know that the adolescent brain is very sensitive to nicotine. Use of e-cigarettes, with its exposure to nicotine, puts these adolescents at risk of lifelong nicotine addiction."
The Rest of the Story
As I have repeatedly pointed out, there is absolutely no existing evidence that electronic cigarettes are a gateway to smoking among youth or that electronic cigarette experimentation is leading youth to a lifetime of addiction to nicotine. In fact, the only evidence to date suggests that among U.S. youth, electronic cigarettes are not a gateway to smoking and e-cigarette experimentation does not appear to lead to regular (greater than weekly) use, much less to a lifetime of addiction.
President John F. Kennedy once said: "The great enemy of truth is not the lie--deliberate, contrived, and dishonest--but the myth--persistent, persuasive, and unrealistic." Here indeed, the repeated statements of the CDC and a number of prominent anti-smoking researchers have effectively created a myth, one that has become persistent and persuasive, even though it lacks evidence. And as a result, the media and in turn, policymakers, are accepting this myth as truth and making poor policy decisions because of it.
Interestingly, what President Kennedy went on to say in that 1962 speech relates perfectly to the manner in which the anti-smoking movement is dealing with the scientific question of whether e-cigarettes are a gateway to smoking.
Kennedy went on to say: "Too often we hold fast to the cliches of our forebears. We subject all facts to a prefabricated set of interpretations. We enjoy the comfort of opinion without the discomfort of thought."
This is precisely what is occurring in the tobacco control movement. We are holding fast to the cliches of the fast (i.e., the knowledge that smokeless tobacco can act as a gateway to cigarette use). We are subjecting all evidence to a prefabricated set of interpretations. Even cross-sectional evidence is being interpreted as showing that youth are starting with e-cigarettes and then progressing to active smoking. The CDC and some anti-smoking researchers are enjoying the comfort of expressing their conclusions about the gateway hypothesis without having to actually "think" (i.e., to actually analyze and interpret the scientific evidence that bears directly on this question).
I will close as President Kennedy did: "The stereotypes I have been discussing distract our attention and divide our effort. These stereotypes do our Nation a disservice, not just because they are exhausted and irrelevant, but above all because they are misleading--because they stand in the way of the solution of hard and complicated facts. It is not new that past debates should obscure present realities. But the damage of such a false dialogue is greater today than ever before... ."