Friday, April 15, 2016

CDC Continues to Lie and Deceive the Public about Youth Tobacco Use

The Centers for Disease Control and Prevention (CDC) is a critical source of health information on most public health issues, but sadly, it is no longer a trustworthy source of information about youth tobacco use. The agency has been consumed by an obsessive vendetta against electronic cigarettes, which has blinded it to the severe problem of youth smoking and distorted its vision away from the protection of the public's health and towards the articulation of an ideology that shows a complete disregard for the health of our nation's youth.

The CDC's lack of honesty, transparency, and integrity when it comes to the issue of youth tobacco use was further demonstrated yesterday by its public claim that youth tobacco use has remained unchanged since 2011, despite the fact that its own report - also released yesterday - revealed that smoking among high school youth declined from 15.8% to 9.3% during the period 2011-2015, smokeless tobacco use decreased from 7.9% to 6.0%, cigar use declined from 11.6% to 8.6%, pipe tobacco use declined from 4.0% to 1.0%, and bidi use dropped from 2.0% to 0.6%.

With declines in all of these categories of tobacco use, how is it possible for the CDC to claim that the use of tobacco has actually stayed the same from 2011 to 2015?

Very easy. You just lie.

And that's exactly what the CDC did.

Rather than acknowledge the truth - which is that despite a dramatic increase in experimentation with vaping among youth over the past 5 years, smoking rates and the use of other forms of tobacco (other than hookah) has declined substantially, the CDC has distorted the truth by falsely telling the public that e-cigarettes contain tobacco and that when kids vape they are using tobacco. Through this deceptive and fraudulent manipulation, the agency is now able to tell the public that youth use of tobacco has stayed the same.

The Rest of the Story

The CDC's claim is categorically false. Youth use of tobacco has not stayed the same since 2011; it has dramatically declined.

To use tobacco, a youth would have to use one of the following products:
  • cigarettes or cigarillos;
  • smokeless tobacco;
  • pipe tobacco;
  • cigars;
  • bidis; or 
  • hookah.
Youth who are vaping are undeniably not using tobacco, since e-cigarettes and vaping products do not contain tobacco.

Since the overall use of the six types of tobacco by youth has declined substantially since 2011, it is simply untrue for the CDC to claim that the use of tobacco by youth has stayed the same, which is exactly what it told the public:

"No decline in overall youth tobacco use since 2011."
---Centers for Disease Control and Prevention; April 14, 2016.

"Overall tobacco use by middle and high school students has not changed since 2011...".
---Centers for Disease Control and Prevention; April 14, 2016.

The fact that for a technical legal reason (a strange definition of the term "tobacco products" in the Family Smoking Prevention and Tobacco Control Act of 2009), the FDA's Center for Tobacco Products is regulating (any day now) e-cigarettes as a "tobacco product" does not miraculously mean that tobacco magically appears in vaping products out of thin air.  Despite what the CDC says, there is no process that observes the laws of physics which can instantly teleport tobacco into an electronic cigarette liquid or cartridge that didn't have tobacco in it when it left the manufacturing plant.

While the CDC would be deceiving the public even if it stated that youth use of "tobacco products" has remained the same, the agency is going far beyond that. It is actually claiming that the use of "tobacco" itself among youth has stayed the same. This is categorically false.

Even if the CDC argued that the use of "nicotine-containing" products among youth has remained the same since 2011, it would still be deceiving the public. According to data from the Monitoring the Future study, the majority of electronic cigarettes being used by youth do not contain any nicotine. However, the CDC is claiming - incorrectly - that all e-cigarettes used by youth contain nicotine. The Monitoring the Future findings suggest the most youth who are using e-cigarettes are sticking to the use of e-liquids that just contain flavorings, but without nicotine.

The CDC claim that "one in four high school students use tobacco" is, quite fortunately, not true. It is not even true that one in four high school students uses nicotine. What is true is that one in four high school students uses either tobacco or electronic cigarettes.

It does not seem that the CDC's claim is simply the result of a careless mistake. It has all the trappings of a deliberate attempt to deceive the public into thinking that the public health gains associated with the dramatic decline in smoking have been completely offset by the increasing rates of experimentation with electronic cigarettes.

By essentially equating the use of cigarettes (which contain tobacco) with the use of e-cigarettes (which do not), the CDC is not only undermining the public's appreciation of the severe hazards of smoking (thus taking up a role that the tobacco industry used to play), but it is also revealing that the agency actually doesn't care whether youth use real cigarettes or fake ones. They're just lumping them together: both products that kill hundreds of thousands of people, including about half of the youth who use them over many years, and products which have not been demonstrated to have any substantial health risks, and about which the worst the CDC can say is that "they are not harmless water vapor." Neither is coffee.

Apparently, to the CDC, if a youth uses an electronic cigarette, it is just as bad as that youth using a real tobacco cigarette. This shows a reckless disregard for the health of our nation's youth. Parents should be absolutely thrilled if their kids are using fake cigarettes instead of real ones. That smoking rates have declined in the presence of huge increases in e-cigarette use is a major public health victory. If all cigarette use among youth was replaced by e-cigarette experimentation, it would be a public health miracle that would save literally millions of future lives. But the CDC appears to have less interest in saving lives than it does in demonizing e-cigarettes simply because they are not just harmless water vapor.

To be clear, none of this means that we should not ban the sale of e-cigarettes to minors, discourage kids from using vaping products, regulate the marketing of e-cigarettes to youth, and educate kids about the potential health risks and the not clearly defined potential long-term risks associated with vaping. But we can do all of the above things without lying to kids. We can do all of these things without deceiving the public into thinking that electronic cigarettes contain tobacco when they do not.

In fact, by not being straightforward with our nation's youth by explaining the differences between cigarettes and e-cigarettes, the difference between the vast majority of vaping products that do not contain tobacco and the few which do (such as products like the Pax vaporizer), and the differences between vaping liquids and cartridges which contain nicotine and those which do not, the CDC is squandering an opportunity to actually make a difference by reducing the risks associated with vaping among youth and reducing the risk of addiction to these products.

For six years, the CDC has been scaring youth about the health effects of e-cigarette use, yet its campaign is not working: as the CDC itself documents, e-cigarette use continues to skyrocket. Clearly, this approach is not working. Telling the kids the truth would be the first step towards an effective strategy to confront the problem. Furthermore, such an approach would not have the adverse effect of undoing years of public education about the severe health hazards caused by smoking.

For those who think I am exaggerating when I opine that the public has less appreciation of the severe hazards of smoking than in the past, consider the scientific evidence: less than half of the public understands that smoking is more harmful than vaping, and the percentage of the public who think that smoking is no more harmful than vaping is increasing.

There are two things that the CDC has never told youth, and never told the American public either?

a. that electronic cigarettes do not contain tobacco; and
b. that electronic cigarettes are not as hazardous as tobacco cigarettes;

It is completely unnecessary, and quite damaging as well as dishonest and non-transparent, to hide this critical information from the public, and from youth. The CDC is treating youth like ignorant babies who have to have every decision made for them. Our nation's youth are actually more likely to take steps to protect themselves if they can make the decision for themselves by being fully informed about the facts. Sweeping, exaggerated, and deceptive propaganda has never worked as an approach to improving adolescent health.

Most importantly, honesty and transparency are important cornerstones in the ethical code of public health. By eschewing these principles for the sake of trying to use scare tactics, the CDC is not only violating this code, but it is risking losing the public's trust and undermining its own credibility. That would be a disaster. If people realize that the CDC is lying to them about the contents of electronic cigarettes, then the public may not trust the agency about other issues as well, and that could have disastrous outcomes.

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