Cambridge Public Health Department Follows the CDC's Lead, Claims that Electronic Cigarettes are a Gateway to a Lifetime of Tobacco Use

Following the lead set by CDC in telling the public that electronic cigarettes are a gateway to tobacco cigarette smoking, the Cambridge (Massachusetts) Public Health Department has proclaimed that e-cigarettes "are powerfully addictive and often serve as a 'gateway' to a lifelong tobacco habit."

In a memorandum to the City Manager, the Cambridge Public Health Department writes as follows:

"The manner in which tobacco companies have targeted younger groups also poses a long-term concern, as many younger individuals may not understand that e-cigarettes are powerfully addictive and often serve as a 'gateway' to a lifelong tobacco habit."

The memorandum recommends that the city tobacco ordinance be amended to ban the sale of electronic cigarettes to minors.

The Rest of the Story

I completely agree with this policy recommendation. However, I don't believe it was necessary to rely upon a false or unsupported statement to support this recommendation.

There is, in fact, no evidence that electronic cigarettes serve as a gateway to a lifelong tobacco habit. In fact, there is not even any evidence that electronic cigarettes serve as a gateway to a short-lived tobacco habit. The only study to examine this hypothesis found that electronic cigarettes are not currently serving as a gateway to cigarette smoking among young people.

Although more research needs to be done, it is safe to say that at the present time, the evidence suggests that electronic cigarettes are not a major gateway to smoking initiation among youth. At the very least, however, it is undeniable that there is no evidence to support the assertion that electronic cigarettes are leading to smoking among youth, much less a lifelong addiction to tobacco.

The larger part of this story is the question of how the public health department came to believe that electronic cigarettes are a gateway to a lifetime of smoking.

It is possible, and in fact, likely, that this local health department was simply reiterating material that was spewed out by the CDC in a widely circulated Associated Press story, which appeared in numerous newspapers and on television station sites, Dr. Frieden was quoted as stating that electronic cigarettes are "condemning many kids to struggling with a lifelong addiction to nicotine." These articles also state that Dr. Frieden suggested the CDC survey data indicate that many kids experiment with e-cigarettes and then go on to smoke cigarettes.

It is certainly curious that the Cambridge Public Health Department's language mirrors that of Dr. Frieden.

According to the AP story: "health officials worry e-cigarettes could re-ignite teen cigarette use. They point to a finding in the study that 20 percent of middle school e-cigarette users had never tried conventional cigarettes. When the same question was asked of high school students, only 7 percent had never tried regular smokes. That suggests many kids experiment with the electronic devices and move on to cigarettes by high school, said CDC Director Dr. Tom Frieden. "In effect, this is condemning many kids to struggling with a lifelong addiction to nicotine," he said."

Fortunately, in the same article, there is an opposing quote from Dr. Kurt Ribisl from the University of North Carolina who pointed out that the survey results "don't prove that e-cigarettes are a gateway to smoking cigarettes." However, the CDC's point had already been made.

A quick Google search shows at least 52 different media outlets that disseminated this information, including the quote indicating that electronic cigarettes are "condemning many kids to struggling with a lifelong addiction to nicotine."

At a recent TMA conference on electronic cigarettes, a CDC official defended Dr. Frieden's statement on the grounds that: (1) It was merely a "slip of the tongue"; and (2) it was inconsequential because very few people saw it.

Apparently, this slip of the tongue, which was disseminated nationwide through more than 50 media outlets, will have no impact on local public health organizations. However, based on today's rest of the story, it appears that this unsupported statement may in fact be leading local public health practitioners to further disseminate this misleading information.

Fortunately, in this case, the misleading information is not supporting a damaging public health policy. However, in other cases, it might well result in a policy that could harm the public's health.

In at least one other case, public health practitioners were explicit in noting that their hypotheses regarding electronic cigarettes and a lifelong addiction to smoking came directly from the CDC. In their op-ed piece published in the Spring Grove (MN) Herald, Shelton (CT) Herald, Los Angeles Daily News, and perhaps other local newspapers, writers from the American Lung Association tell us that: "We share the CDC's concern that children who begin by using e-cigarettes may be condemned to a lifelong addiction to nicotine and cigarettes."

Words matter, and the words spoken by the CDC matter even more than those of most health organizations. Many state and local health groups, like the Cambridge Public Health Department, look to the CDC for guidance on health science and policy issues. This is why it is particularly important for the CDC to get it right and not to disseminate false statements that mislead the public.

An associate professor of Pediatrics at the Ohio State University goes so far as to claim that: "a lifelong addiction to nicotine can start with one e-cigarette." We know that this professor relies heavily upon the CDC for his information because earlier in his article he cites the CDC's report on electronic cigarette use among youth. (By the way, he goes on to state: "Even if you assume that e-cigarettes are “cleaner” than tobacco, they still deliver a potent drug that can lead to lifelong dependence in many teenagers").

Meanwhile, the CDC's deceptive statements live on.

Just last week, a full eight weeks after the CDC's original statements, they are still being disseminated nationally through the media. An article on electronic cigarettes in Spry, dated November 21, reads: "According to a recent CDC report, the number of high school students who tried e-cigarettes rose from 4.7% in 2011 to 10% in 2012. In the report, CDC officials expressed concern about the potential for abuse and addiction inherent in e-cigarettes. “The increased use of e-cigarettes by teens is deeply troubling,” said CDC Director Tom Frieden, M.D., M.P.H. “Nicotine is a highly addictive drug. Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes.”"

I believe that it is now the CDC's responsibility to correct its previous statements and to make it clear to state and local public health practitioners that there is no evidence that electronic cigarettes are serving as a gateway to cigarette smoking among young people.

CDC Lying About Financial Conflicts of Interest and Failing to Disclose Big Pharma Funding When It Releases Statements About E-Cigarettes

The Centers for Disease Control and Prevention (CDC) makes a multitude of recommendations regarding the prevention and treatment of a variety of diseases and adverse health conditions. Many of these recommendations involve the promotion of specific pharmaceutical products, such as antibiotics, vaccines, or smoking cessation drugs.

For this reason, it would seem important that the CDC remain independent of any corporate influence and that the agency not accept funding from corporations, especially from Big Pharma.

In fact, the CDC claims to have no financial interests or other relationships with any manufacturers of commercial products that are involved in its recommendations. The CDC claims that it does not accept any commercial support.

For example, on the web page for a smoking cessation tutorial funded by CDC, the following disclaimer is provided:

"CDC, our planners, and our content experts wish to disclose they have no financial interests or other relationships with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters with the exception of: Dr. Neal Benowitz. He wishes to disclose that he was a member of the Pfizer Inc. advisory board and a paid consultant for GlaxoSmithKline. Dr. Nancy Rigotti. She wishes to disclose that she was a member of the Pfizer Inc. scientific advisory board, receives royalties for chapter on smoking cessation from UpToDate, Inc., and a research grant was awarded to Massachusetts General Hospital (not to Dr. Rigotti) from Nabi Biopharmaceuticals."

Thus, CDC is claiming that the agency receives no funding from any companies.

This disclaimer appears widely in virtually all of the course content provided by the agency.

For example, in its course on the tetanus/diphtheria/pertussis vaccine, the CDC states:

"CDC, our planners, and our content experts wish to disclose they have no financial interests or other relationships with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters. ... CDC does not accept commercial support."

As I have revealed on this blog, the CDC has made numerous (false) public statements about electronic cigarettes, including the claim that they are a gateway to youth smoking and a source of lifetime addiction for kids who experiment with them. In none of these statements has the CDC disclosed any financial conflicts of interest. This would certainly lead the public to believe that CDC has no financial relationship with Big Pharma, as this would represent a conflict of interest. The pharmaceutical companies' profits are seriously threatened by electronic cigarettes, as these products represent an alternative to smoking cessation drugs, including the nicotine patch, nicotine gum, nicotine inhaler, Chantix, Zyban, and others.

The Rest of the Story

The rest of the story, quite simply and sadly, is that the CDC is lying. Not only about electronic cigarettes being a gateway to smoking and a source of lifetime addiction for kids, but also about its having no financial interests or other relationships with the manufacturers of commercial products.

The truth is that CDC has multiple partnerships with corporations and that it receives a great deal of funding from multiple companies. And these companies include Big Pharma.

According to its fiscal year 2014 report, the CDC Foundation, which provides financial support for CDC programs, received funding from multiple pharmaceutical companies, including:

• Bristol-Myers Squibb;
• Jansenn Therapeutics;
• Johnson & Johnson;
• Kadman Pharmaceuticals;
• Lupin Pharmaceuticals;
• Merck;
• Novo Nordisk;
• Onyx Pharmaceuticals;
• Pfizer;
• Sanofi-Aventis; and
• Vertex Pharmaceuticals.

The CDC Foundation readily admits that its purpose is to forge relationships between CDC and private companies and to raise money to support CDC's work. The CDC partners with at least one funding partner (i.e., company) to implement public health programs. In the CDC Foundation's own words:

"Established by Congress as an independent, nonprofit organization, the CDC Foundation connects the Centers for Disease Control and Prevention (CDC) with private-sector organizations and individuals to build public health programs that make our world healthier and safer. Since 1995, the CDC Foundation has provided $450 million to support CDC's work, launched more than 750 programs around the world and built a network of individuals and organizations committed to supporting CDC and public health. Each CDC Foundation program involves a talented team of experts at CDC and at least one outside funding partner. Sometimes, a program begins with a CDC scientist who has a great idea and wants to collaborate with an outside partner to make it happen. At other times, organizations in the private sector recognize that they can better accomplish their own public health goals by working with CDC through the CDC Foundation."

According to an article in The BMJ, the CDC Foundation received $12 million from corporations in 2014 and the CDC itself received $16 million from sources including individuals, philanthropic organizations, and corporations. Moreover, the CDC receives some funding directly from the CDC Foundation.

According to the article:

"Despite the agency’s disclaimer, the CDC does receive millions of dollars in industry gifts and funding, both directly and indirectly, and several recent CDC actions and recommendations have raised questions about the science it cites, the clinical guidelines it promotes, and the money it is taking. Marcia Angell, former editor in chief of the New England Journal of Medicine, told The BMJ, “The CDC has enormous credibility among physicians, in no small part because the agency is generally thought to be free of industry bias. Financial dealings with biopharmaceutical companies threaten that reputation.”"

According to the article, CDC director Dr. Thomas Frieden "did not respond to a question about the disclaimer." However, he apparently did acknowledge that the agency's funding from corporations does present conflicts of interest, stating: "When possible conflicts of interest arise, we take a hard, close look to ensure that proper policies and guideline are followed before accepting outside donations."

In other words, Dr. Frieden has essentially admitted that the CDC is lying in its disclaimer.

If the CDC is lying so readily about its funding from and partnerships with private corporations then perhaps it is not surprising that the CDC is also lying about electronic cigarettes being a gateway to smoking and condemning millions of kids to a lifetime of addiction. The agency's funding from pharmaceutical companies that stand to lose severely if electronic cigarettes are promoted creates a clear conflict of interest that CDC has failed to disclose.

This story is particularly troubling because CDC is the nation's leading public health agency and the public relies on its credibility to make decisions and formulate policies that literally affect life and death. That the CDC's recommendations may be tainted by corporate conflicts of interest is inexcusable. That the CDC is hiding these conflicts is reprehensible. And that the CDC is lying about having these financial relationships in the first place is a tragedy because it threatens the basic credibility of the agency, which in turn, threatens the agency's ability to protect and promote the public's health.

An Inconsequential Slip of the Tongue? CDC Director is Quoted in Many Media Outlets as Stating that Youth Electronic Cigarette Experimentation Leads to Lifelong Addiction

Several weeks ago, I reported that 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."

I argued that: "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."

Last week, I presented these facts at the TMA conference on electronic cigarettes. A CDC official defended Dr. Frieden's statement on three grounds:

First, it was merely a "slip of the tongue."

Second, it was inconsequential because very few people saw it.

Third, it is only one minor sentence out of a much longer and more detailed presentation  of the survey results.

The Rest of the Story

It is difficult to see how this could merely be a slip of the tongue because it appears to be a pretty well thought-out statement that depicts a complex sequence of events. I have a hard time seeing how a statement that youth are starting with e-cigarettes and then going on to smoke tobacco cigarettes is merely a slip of the tongue. The CDC survey did not address this issue and it seems hard to believe that adding this as a conclusion of the CDC study simply "slipped out."

Moreover, this was a live interview, not a reporter editing together sound bites. So if it had been a slip of the tongue, Dr. Frieden could easily and immediately have corrected it. Once it "slipped out," he could easily have just corrected the statement and explained that the survey actually did not find that electronic cigarettes are serving as a gateway to smoking and that it didn't actually assess that question.

Furthermore, even if we assume that it was a slip of the tongue and that the mistake wasn't noticed at the time, it could have been corrected afterwards, once the video and transcript were published online. I have no doubt that Medscape would post a corrective statement.

The argument that this is inconsequential because very few people saw the statement is refuted by data on the popularity of the Medscape web site. According to Alexa, which monitors the popularity of web sites, Medscape is among the top 2,000 most viewed web sites in the United States. It appears that even in its early years, Medscape had over 1,000,000 members, "far exceeding the reach of any medical journal in history and most consumer publications."

Moreover, the idea that the CDC would downplay a factual misstatement because the media outlet is inconsequential doesn't hit me right (and seems to be somewhat of an insult to Medscape).

The third argument - that this is just one minor sentence somehow taken out of a larger context - ignores the way in which public health advocates and policy makers are influenced by the media. A single conclusion by a prominent health official in the media is enough to influence the knowledge, conclusions, and positions of health organizations and policy makers for years. For example, the FDA's misleading insinuation back in 2009 that electronic cigarettes contain "anti-freeze" is still widely quoted by public health groups and policy makers to this day, and it has undoubtedly influenced public policy on this issue.

Words matter, especially when they come from the head of such a distinguished and respected organization like the CDC.

Moreover, the CDC statement is not taken out of context or extracted as a minor sentence from a larger presentation of the study results. In fact, I included the entire quotation of Dr. Frieden's comments regarding the conclusion of the CDC survey. The entirety of his presentation of the study results in the interview was as follows: "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." I don't see how or why we should simply ignore that statement and pretend that it doesn't exist (especially when the statement is still on the web site, still being viewed by readers, and hasn't been corrected).

But that's not the whole rest of the story.

The rest of the story is that CDC has in at least two other media interviews presented the gateway hypothesis as a definitive conclusion of its survey.

First, in a widely circulated Associated Press story, which appeared in numerous newspapers and on television station sites, Dr. Frieden was quoted as stating that electronic cigarettes are "condemning many kids to struggling with a lifelong addiction to nicotine." These articles also state that Dr. Frieden suggested the CDC survey data indicate that many kids experiment with e-cigarettes and then go on to smoke cigarettes.

According to the AP story: "But health officials worry e-cigarettes could re-ignite teen cigarette use. They point to a finding in the study that 20 percent of middle school e-cigarette users had never tried conventional cigarettes. When the same question was asked of high school students, only 7 percent had never tried regular smokes. That suggests many kids experiment with the electronic devices and move on to cigarettes by high school, said CDC Director Dr. Tom Frieden. "In effect, this is condemning many kids to struggling with a lifelong addiction to nicotine," he said."

Fortunately, Mike Stobbe also included in his article an opposing quote from Dr. Kurt Ribisl from the University of North Carolina who pointed out that the survey results "don't prove that e-cigarettes are a gateway to smoking cigarettes."

A quick Google search shows at least 52 different media outlets that disseminated this information. Was this statement, that e-cigarettes are condemning kids to a lifetime of addiction, also just a slip of the tongue? And is it also inconsequential? Is this just another minor public statement that is being taken out of context?

Second, in a CNN interview, Dr. Frieden concluded that while the reported benefits of electronic cigarettes -- aiding smoking cessation -- are merely "possible," the speculated and undocumented potential harms -- such as hooking kids to smoking -- are "definite":

"I think what we can say basically is they might or might not be able to help you quit, but there are definite harms that they can cause. And those definite harms are in different environments. So, if they get kids hooked on nicotine, that's a really bad thing. If they get a smoker who would have quit smoking to continue smoking, that's a bad thing. If they get a smoker who stopped mo smoking and going back to nicotine addiction and then smoking, that's a bad thing. And if they re-glamorize the act of smoking, that's a bad thing. So, we have possible benefits and definite harms."

Here, it is hard to imagine that this is merely a slip of the tongue. Dr. Frieden appears to go out of his way to emphasize that the potential benefits of electronic cigarettes are just speculative, but that the potential harms are definite. In other words, we don't have scientific evidence to support the conclusion that e-cigarettes can help people quit smoking, but we do have evidence that they contribute to increased smoking.

Taken together, I simply don't see any support for the argument that these statements are all just slips of the tongue that are inconsequential because very few people are seeing them and that they are minor statements that have been inappropriately extracted out of context.

Instead, it appears to me that the CDC's intention was to infer to the public that there is now scientific evidence that electronic cigarettes are causing societal harm by helping to hook youth on nicotine and push them into a lifetime of smoking. In fact, I think CDC did a great job of making this point and I don't see how it would have been accomplished any better had there actually been a study documenting that a substantial proportion of nonsmoking youth are becoming addicted to nicotine and then progressing to cigarette smoking.

New CDC Report on E-Cigarettes Shatters Gateway Myth, Suggests Shift from Hazardous Smoking to Much Safer Vaping among Youth

A new CDC report released moments ago and published in tomorrow's MMWR (Morbidity and Mortality Weekly Report) presents new data from the 2014 National Youth Tobacco Survey which show a tripling of past 30-day ("current") e-cigarette use from 2013 to 2014 among both high school and middle school students.

(See: Arrazola RA et al. Tobacco use among middle and high school students -- United States, 2011-2014. MMWR, Vol. 64, No. 14, April 17, 2015.)

The report shows a dramatic and statistically significant increase in current use of e-cigarettes among both high school and middle school students over the period 2011-2014. The actual data are as follows:

Current (past 30-day) E-Cigarette Use 

High school students
2011: 1.5%
2012: 2.8%
2013: 4.5%
2014: 13.4%

Middle school students
2011: 0.6%
2012: 1.1%
2013: 1.1%
2014: 3.9%

In a press release issued by CDC, the director of the FDA's Center for Tobacco Products stated: "In today’s rapidly evolving tobacco marketplace, the surge in youth use of novel products like e-cigarettes forces us to confront the reality that the progress we have made in reducing youth cigarette smoking rates is being threatened."

The Rest of the Story

The CDC, FDA, and anti-smoking groups are only telling one aspect of the story. There is indeed a "rest" of the story, and here it is:
What the CDC fails to mention in its report is that these new data pretty much shatter the gateway myth that the CDC has been disseminating over the past two years.

The CDC has been telling the public that its data from the National Youth Tobacco Survey provides evidence that e-cigarettes are a gateway to cigarette smoking among youth. Remember that the CDC misrepresented cross-sectional CDC survey data as conclusive evidence that electronic cigarettes are a gateway to smoking. Specifically, CDC Director Dr. Thomas Frieden stated, in response to the 2011-2012 increase in youth e-cigarette use: "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."

However, today's CDC report reveals that something very different appears to be occurring. It appears that rather than serving as a gateway toward cigarette smoking, e-cigarettes may actually be acting as a diversion away from cigarettes. Perhaps the most important finding of the new report is that despite the dramatic increase in e-cigarette use among youth, the prevalence of smoking among youth has fallen dramatically during the same time period.

Among high school students, while current use of e-cigarettes increased from 1.5% in 2011 to 13.4% in 2014, current use of real cigarettes declined from 15.8% to 9.2%. Moreover, the prevalence of overall tobacco use among youth has remained steady during this time period, both among high school and middle school students.

These data do not support, and in fact, help to refute the CDC's assertions that e-cigarettes are a gateway to cigarette smoking among youth. These new data are simply not consistent with such a conclusion. Moreover, the data suggest the opposite. The data suggest that overall tobacco use among youth is not changing, but the form of that use is shifting dramatically: away from combustible cigarettes and towards non-tobacco-containing and much safer electronic cigarettes.

This is actually a good thing. While we of course do not want the reduction in smoking among youth to be "offset" by increases in the use of safer products, such as e-cigarettes, because we would prefer that youth not use any form of nicotine, the reality is that the observed shift away from real tobacco cigarettes and towards the fake cigarettes is actually a positive phenomenon in terms of improving the public's health. This shift is going to result in a great reduction in disease and death down the road, because vaping is far safer than smoking.

The truth is that the increase in e-cigarette use is not "offsetting" the decline in cigarette smoking because a large component of the increase in non-cigarette tobacco products is a dramatic rise in hookah use, which among high school students increased from 4.1% in 2011 to 9.4% in 2014.

The rest of the story, then, is that what the CDC data show, but the CDC fails to acknowledge, is that overall use of tobacco among youth is stable, but the form of that use is shifting from the most hazardous type of nicotine-delivering product (real tobacco cigarettes) to less hazardous products (especially electronic cigarettes). There is no question that we need to redouble our efforts to discourage youth from all forms of tobacco and that our goal should be to reduce all tobacco use, not just cigarette use. However, that goal does not justify misrepresenting the scientific data as indicating that the rise in e-cigarette use is troubling because it is going to lead to eventual smoking addiction.

The rest of the story is that the opposite phenomenon appears to be occurring. The advent of this novel product (e-cigarettes) actually appears to be diverting youth who are at high risk of smoking away from tobacco cigarettes and towards e-cigarettes. In essence, e-cigarettes are a gateway product, but they are a gateway away from, rather than towards cigarette smoking.

2014 Anti-Smoking Myth of the Year Award Goes to CDC, Dr. Stan Glantz, and Dr. Michael Fiore

The Rest of the Story is pleased to announce the recipients of the 2014 Anti-Smoking Myth of the Year Award. This year's award goes to:

• The Centers for Disease Control and Prevention (CDC);
• Dr. Stan Glantz; and
• Dr. Michael Fiore

for publicly spreading the myths that electronic cigarettes have been found to be a gateway to smoking among youth and that electronic cigarette experimentation leads to a lifelong addition to nicotine.

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... ."

CDC's False Statements About E-Cigs are Still Doing Damage; Agency Needs to Retract Statements Immediately

Although it has been a year and a half since the CDC disseminated to the public inaccurate information about electronic cigarettes being a gateway to smoking among youth, this false propaganda is still doing damage.

It was in fall 2013 that CDC made the following statements regarding electronic cigarettes being a gateway to smoking:

1. The CDC misrepresented cross-sectional CDC survey data as conclusive evidence that electronic cigarettes are a gateway to smoking. Specifically, CDC Director Dr. Thomas Frieden stated: "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." 

2. In addition, Dr. Frieden was quoted as stating that electronic cigarettes are "condemning many kids to struggling with a lifelong addiction to nicotine and conventional cigarettes."

This past Sunday, in an article in the Newburyport Daily News, the CDC was again quoted as concluding that electronic cigarettes are a gateway to youth smoking.

According to the article: "While supporters say e-cigarettes are a less dangerous alternative to cigarettes, health officials said they worry the devices could spur teen cigarette use, possibly undermining decades of work to reduce smoking rates. At least 10 percent of high school students say they tried e-cigarettes in 2012, up from 4.7 percent in 2011, according to a National Youth Tobacco Survey by the US Centers for Disease Control and Prevention. “The increased use of e-cigarettes by teens is deeply troubling,” CDC director Thomas Frieden said in a recent statement. “Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes.”"

Even a brief search of the internet reveals that this statement continues to be relied upon by anti-smoking groups throughout the country in pressing the case that e-cigarettes are a gateway to youth smoking. The quote is even featured in an argumentative writing assignment for 9th graders at the Moore public schools in
Oklahoma.

The Rest of the Story

I can certainly understand if the CDC made a mistake. I do it all the time. Anyone can misspeak or say something in an interview that is not correct. The important thing is that you correct the error, especially if it will have a major effect on public policy.

But here we are a year and a half after the original statements and the CDC has failed to make any attempt to retract or correct these statements. They even have the original press release up with no note of any correction.

Given this failure to correct what is obviously a completely unsupported statement and one which appears to be false, one has to at this point infer that the deception of the public is intentional.

I call on the CDC to immediately retract these statements before any further damage is done. Failing to do so will only solidify my conclusion that the agency is intentionally misleading the public to promote its anti-e-cigarette agenda.

First Study to Examine E-Cigarette Gateway Hypothesis Can Find Only One Nonsmoker Who Initiated with E-Cigs and Went on to Smoke

In the first study to examine the hypothesis that electronic cigarettes are a gateway for youth to become addicted to cigarettes, Dr. Ted Wagener from the University of Oklahoma Health Sciences Center reports being able to find only one young person who initiated nicotine use with e-cigarettes and then went on to smoke cigarettes, out of a sample of 1,300 college students.

The study has not yet been published, but it was presented Tuesday at the annual meeting of the American Association for Cancer Research in Washington, D.C.

According to Brenda Goodman's HealthDay article summarizing the study: "E-cigarettes don't appear to entice teens to try smoking tobacco, a new study says. ... Last month, the U.S. Centers for Disease Control and Prevention warned that "vaping," or inhaling the nicotine vapors from e-cigarettes, might be a dangerous new fad that could set teens up for smoking. In just one year, the number of kids in grades six through 12 who said they'd ever tried an e-cigarette more than doubled, rising from 3.3 percent to 6.8 percent. Among the 2.1 percent who said they were current e-cigarette users, more than three-quarters said they also smoked regular cigarettes. Given that overlap, many health experts worried that e-cigarettes might be acting like a gateway drug, sucking kids more deeply into nicotine addiction, and law officials urged the U.S. Food and Drug Administration to regulate e-cigarettes as tobacco products."

"The new study suggests that may not be the case. Researchers surveyed 1,300 college students about their tobacco and nicotine use. The average age of study participants was 19. "We asked what the first tobacco product they ever tried was and what their current tobacco use looked like," said researcher Theodore Wagener, an assistant professor of general and community pediatrics at the University of Oklahoma Health Sciences Center, in Oklahoma City. Overall, 43 students said their first nicotine product was an e-cigarette. Of that group, only one person said they went on to smoke regular cigarettes. And the vast majority who started with e-cigarettes said they weren't currently using any nicotine or tobacco."

"It didn't seem as though it really proved to be a gateway to anything," said Wagener, who presented his findings at a meeting of the American Association for Cancer Research, in National Harbor, Md."

The Rest of the Story

This study provides preliminary evidence that electronic cigarettes are not currently serving as a major gateway to cigarette smoking. Of course, more studies of this nature, as well as longitudinal studies, are necessary to firmly answer this question. And importantly, this only reflects the current situation and things can change at any time. It is important that we remain vigilant and closely monitor youth electronic cigarette use over time.

I should also make it clear that in no way am I arguing that sales and marketing restrictions are not needed. In fact, I am hoping that the FDA will promulgate regulations that do strictly regulate the sale and marketing of electronic cigarettes to youth.

What this evidence does highlight is how unfortunate it was that CDC Director Dr. Thomas Frieden disseminated to the public a conclusion about this research question, telling the public that we already know the answer and that electronic cigarettes are a gateway to tobacco addiction. Dr. Frieden stated that: "many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes."

Unfortunately, this premature speculation (or conclusion, as the above statement does not seem to be speculative) led to widespread media dissemination to the public of the news that electronic cigarettes are a gateway to tobacco addiction. These articles are already having an effect on policy makers throughout the country.

In a Forbes magazine online column today, Jacob Sullum explains how many tobacco control advocates, including Dr. Frieden, "jumped all over CDC survey data indicating that the percentage of teenagers who have tried e-cigarettes doubled (from 3.3 percent to 6.8 percent) between 2011 and 2012." Sullum writes: "'Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes,' CDC Director Tom Frieden worried. But the survey data [the CDC data] provided no evidence that e-cigarettes are a gateway to the conventional kind, and a new study [the Wagener study] casts further doubt on that hypothesis."

The issue of whether electronic cigarettes serve as a gateway to youth tobacco addiction is a very serious one. It should not be taken lightly. If these products lead to increased cigarette smoking among youth then this harm would offset the benefits of enhanced smoking cessation and electronic cigarettes would no longer have net public health benefits. So this is a crucial research question.

But I emphasize that it is a "question." It does a disservice to the public to draw pre-determined conclusions, as Dr. Frieden did in telling the public that we already have the answer: kids are starting out with e-cigarettes and going on to smoke conventional cigarettes.

Our public policies must be science-based. But when one draws pre-determined conclusions, rather than rely on the scientific evidence, this does not lead to evidence-based policies. My fear is that because of a strong pre-existing ideology against electronic cigarettes because they simulate the physical actions of smoking, tobacco control groups are drawing conclusions based on ideology rather than on science.

CDC is Running a Dishonest Campaign Against E-Cigarettes Which is Re-Normalizing Smoking

Almost the Entire Tobacco Control Movement is Helping to Spread CDC's Deception

In an ironic twist of devastating proportions, the Centers for Disease Control and Prevention (CDC) is running an enormous, dishonest campaign against electronic cigarettes that is being spread by almost the entire tobacco control movement and which is serving to re-normalize smoking and undermine decades of progress in educating the public about the hazards of cigarette smoking.

The CDC's campaign involves lying, dishonesty, and massive deception:

Lying

The CDC has been telling the public that its data from the National Youth Tobacco Survey provides evidence that e-cigarettes are a gateway to cigarette smoking among youth. The CDC misrepresented cross-sectional CDC survey data as conclusive evidence that electronic cigarettes are a gateway to smoking. Specifically, CDC Director Dr. Thomas Frieden stated, in response to the 2011-2012 increase in youth e-cigarette use: "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."

However, the CDC surveys do not provide any evidence that e-cigarette use is a gateway to smoking. If anything, they suggest the opposite: experimentation with e-cigarettes appears to be diverting kids away from smoking and contributing to the dramatic, accelerated decline in youth smoking that is contemporaneous with the more than tripling in youth e-cigarette use.

The surveys are cross-sectional and cannot determine whether youth are starting with e-cigarettes and progressing to smoking or whether dual users of e-cigarettes are smokers who subsequently starting using e-cigarettes. But this hasn't stopped CDC from drawing a conclusion, apparently a pre-determined one.

Moreover, the CDC surveys do not provide any evidence that e-cigarettes are condemning youth to a lifelong addiction to nicotine. In fact, what the current evidence suggests is that e-cigarettes are not particularly addictive. Despite the widespread use of these devices, very few youths have been found to be using e-cigarettes regularly, in a pattern that suggests nicotine addiction.

The surveys do not inquire about regular use of e-cigarettes, and thus they are not able to determine whether even a single youth has become addicted to vaping. But again, this hasn't stopped the CDC from disseminating what appears to be a pre-determined conclusion. 

I maintain that the CDC has intentionally failed to ask kids how often they use e-cigarettes because if they find out that most e-cigarette use is only occasional (as suggested by evidence from several studies), it would destroy the myth that e-cigarettes are a major gateway to long-term or lifelong nicotine addiction.

Dishonesty

The CDC is being dishonest with the public by classifying electronic cigarettes as tobacco products and by repeatedly referring to e-cigarettes as a form of tobacco use. Electronic cigarettes are not tobacco products, as understood by the public, because they do not contain any tobacco. Vaping is not a form of tobacco use.

E-cigarettes are tobacco products in only one sense: from purely a legal perspective, these products meet the definition of "tobacco product" under the Family Smoking Prevention and Tobacco Control Act because they contain nicotine, which is derived from tobacco and they are not marketed as drugs or devices. Were the very same product marketing as a drug or device, it would no longer be considered a tobacco product.

By dishonestly classifying e-cigarettes as tobacco products and by telling the public that e-cigarette use is a form of tobacco use, the CDC is deceiving perhaps millions of people into believing that electronic cigarettes contain tobacco. This is simply not true. I believe that it is both dishonest and unethical for CDC to repeatedly refer to e-cigarettes as a form of tobacco use and to classify e-cigarettes as tobacco products because this is dishonest, massively deceives the public, and completely undermines the public's appreciation of how severely toxic real cigarettes are. By essentially equating smoking and vaping, CDC is undermining its own campaign to highlight the severe dangers of smoking.

The CDC is also being dishonest with the public by failing to find out whether youth who are using e-cigarettes are using them regularly or only occasionally, such as in social situations. The CDC has only been able to report on the percentage of kids who have used e-cigarettes in the past month. However, these could easily be kids who picked up an e-cigarette to try it once and will never use one again. These could also be kids who use e-cigarettes only in social situations and so they may vape once a week or less. This would hardly constitute addiction.

The CDC is being particularly dishonest because it has failed to ask youth how often they use e-cigarettes. Moreover, the CDC is hoodwinking the public by not acknowledging that it has failed to document a single youth who is addicted to vaping.

Deception

The CDC is deceiving the public by implying that youth who use e-cigarettes are going to experience brain damage from the inhaled nicotine. The CDC is repeatedly scaring the public into believing that the pattern of e-cigarette use we are observing among youth is likely to cause brain damage. The CDC is repeatedly emphasizing that "nicotine can cause serious damage to the developing brains of teens."

This is very deceptive because it is unlikely that the sporadic exposure to the low levels of nicotine delivered by e-cigarettes is sufficient to cause serious brain damage. There is absolutely no evidence to support this contention. Moreover, the evidence that nicotine causes brain damage is based largely on animal studies and it is not clear whether one can extrapolate from animal models to humans. Furthermore, the few human studies that suggest possible neurological consequences from nicotine inhalation involve smokers, whose nicotine exposure is much higher and more frequent than that of the typical teenage e-cigarette experimenter. The observed decrease in pre-frontal cortex activity was highly correlated with the level of nicotine addiction.

The Rest of the Story

These lies, dishonesty, and deception have been widely incorporated as part of the tobacco control movement's mantra and are being spread like wildfire by virtually all major tobacco control organizations and policy makers who purport to be concerned about the long-term health of our nation's youth. Here is just a small sample of examples:

The chair of the New Jersey Breathes coalition stated: "This [the increase in e-cigarette use] could introduce a whole generation to cigarettes that may have not otherwise smoked." 

The American Heart Association stated: "We cannot stand by [while e-cigarette use increases] while more and more youth put themselves at risk for heart disease, stroke or even an early death."

Senator Dick Durbin (D-IL) stated: "While the FDA continues to drag its feet on finalizing commonsense regulations to protect children and teenagers from the dangers of e-cigarettes, the number of young people getting hooked on this potentially deadly habit is growing exponentially."

Senator Richard Blumenthal (D-CT) stated: "As a gateway to nicotine addiction, e-cigarettes are a burgeoning market and public health menace."

The Campaign for Tobacco-Free Kids stated: "We cannot allow the tobacco industry to keep addicting kids and create another epidemic with a new generation of tobacco products."

The Campaign for Tobacco-Free Kids also stated: "the explosion of e-cigarette use among kids means these products are being taken up in record numbers with totally unknown long-term consequences that could potentially undermine all the progress we’ve made."

The FDA stated: "In today’s rapidly evolving tobacco marketplace, the surge in youth use of novel products, like e-cigarettes, forces us to confront the reality that the progress we have made in reducing youth cigarette smoking rates is being threatened."

The Massachusetts Medical Association stated: "We’re running the risk of creating a whole new generation of smokers which will undo 50 years of public health efforts in smoking-reduction."

It is clear that almost the entire tobacco control movement has fallen for the CDC's lies and dishonesty about electronic cigarettes hook, line, and sinker. These groups are now helping to widely disseminate this inaccurate information to the public. I don't recall any previous tobacco-related public information campaign as dishonest and deceptive as this one since the tobacco industry itself battled to undermine the public's appreciation of the health hazards of smoking.

In fact, the truth appears to be the exact opposite of what these groups are telling the public. Electronic cigarettes are not creating a whole new generation of smokers. Instead, they appear to be diverting smokers and potential smokers away from tobacco cigarettes and toward the fake ones, which are orders of magnitude safer. And by equating the health hazards of smoking with those of vaping, these groups are the ones who are actually guilty of undermining 50 years of public health efforts in smoking reduction.

Not only is the CDC undermining our progress in reducing smoking by suggesting that non-tobacco-containing, non-combusted e-cigarettes are just as bad as tobacco cigarettes, but it is also undermining progress by completely diverting attention away from the problem of youth smoking (which is the real problem that is causing disease and death) to the problem of e-cigarette experimentation (for which there is presently no evidence that existing patterns of use will cause disease and death).

In fact, the CDC failed to even celebrate the finding that youth smoking has reached its lowest level in decades and that the decline in youth smoking accelerated from 2013 to 2014. Instead, all the CDC wanted to talk about was how horrible it is that youth are experimenting with e-cigarettes, how this is going to lead to nicotine addiction and serious brain damage, and how it is going to reverse progress in reducing youth smoking (via a rather strange mechanism, since the dramatic rise in youth vaping was associated with an acceleration in the decline in youth smoking).

Joe Nocera, in his New York Times column, astutely points out this strange behavior for an agency that is supposed to be focused on preventing disease and death. He writes:

"equating smoking cigarettes with inhaling e-cigarettes, as the C.D.C. is doing in its messaging around teen tobacco use, is a huge disservice to public health. On the scale of potential harms, e-cigarettes aren’t even in the same ballpark as combustible cigarettes. They have the potential to save millions of lives if smokers could be convinced to switch—which is what the C.D.C. ought to be stressing. Jack Henningfield, a tobacco expert at Pinney Associates, told me that while youths should be discouraged from using nicotine, “putting electronic products in the same basket as cigarettes is not truthful, credible or helpful.” Invariably, teens do things they shouldn’t; that’s part of growing up. For decades, smoking cigarettes has been one of those things. The fact that they are doing less of it than ever before is not a cause for dismay. It is a cause for celebration."

CDC Again Lies to Public in Attempt to Demonize Electronic Cigarettes

Last November, I reported that CDC was lying to the public by telling us that an agency survey had found that electronic cigarettes are a gateway to smoking. Specifically, I noted that CDC director Dr. Thomas Frieden stated at that time: "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." However, the CDC was a cross-sectional one and it didn't track e-cigarette users over time to see whether they went on to smoke conventional cigarettes. Thus, Dr. Frieden was lying to the public.

The Rest of the Story issued a call for a corrective statement by CDC to clarify this error, but none was forthcoming.

Instead, in response, a CDC official defended Dr. Frieden by suggesting that the statement was just an inconsequential slip of the tongue.

Today, I reveal that CDC has again lied to the public, which suggests that its dishonesty is not just an inconsequential slip, but a pattern of dishonest behavior intended to demonize electronic cigarettes.

The Rest of the Story

In an article published last week in the Los Angeles Times, CDC director Dr. Thomas Frieden was quoted as stating:

"The challenge that the FDA has is that they will be challenged by the tobacco industry, as they have been at every step of the way. [The FDA] tried to regulate e-cigarettes earlier, and they lost to the tobacco industry. … So the FDA has to balance moving quickly with moving in a way that’s going to be able to survive the tobacco industry’s highly paid legal challenge."

Assuming that this is an accurate quote from Dr. Frieden, the CDC is lying. It is not true that the FDA lost a lawsuit to the tobacco industry when it tried to regulate e-cigarettes earlier. The lawsuit it lost was filed by two electronic cigarette companies, neither of which were owned by Big Tobacco. In fact, at the time of that lawsuit, the tobacco companies were not even in the business of selling e-cigarettes. All e-cigarette companies at that time were independent of Big Tobacco.

Clearly, this statement by the CDC is intended to imply that Big Tobacco has been fighting the FDA's attempts to first ban and now regulate the product. This is false. In fact, the tobacco companies were not involved in the earlier lawsuit and since entering the market, they have strongly supported the FDA's regulation of electronic cigarettes.

In fact, it is unlikely that the tobacco companies will challenge the deeming regulations. These companies stand to gain the most by the regulations, which make it much more difficult, if not impossible, for the non-tobacco-related electronic cigarette companies (especially the smaller ones) to survive. If the deeming regulations are challenged, that challenge is more likely to come from the smaller manufacturers, not the tobacco companies. And any such challenge would not be from "highly paid" sources, but from companies that cannot independently afford such a challenge. They would have to pool resources to have any chance of affording such a challenge, which makes me believe that any serious challenge to the regulations is unlikely.

If this statement was misquoted by the Times, then the CDC should have immediately corrected it. Since I do not see any correction (as of the time of the writing of this post), I have to assume that the statement is correct.

As I remarked last week, I do not begrudge the CDC for holding a different position than I do on the e-cigarette issue. However, the agency crosses the line when it lies to the public in order to support its position. Dishonesty has no place on the agenda of a federal public health agency, especially one that is as highly reputed as the CDC.

CDC Continues to Spread Unsupported Propaganda and Misinformation About Electronic Cigarettes

In an article published early this week in the Los Angeles Times, CDC director Dr. Thomas Frieden issues a blistering attack on electronic cigarettes. In the article, he compares the damage and destruction caused by tobacco cigarettes with e-cigarettes, suggesting that another generation of our kids is going to become addicted to smoking because of e-cigarettes. He argues that the electronic cigarette industry is harming "hundreds of thousands of children."

Dr. Frieden is quoted as stating that: "E-cigarettes are a tobacco product."

In addition, Dr. Frieden insinuates that electronic cigarettes are a gateway to smoking, are impeding smokers from quitting, are causing ex-smokers to return to smoking, and deterring smokers who want to quit from quitting.

He states: “If they get another generation of kids more hooked on nicotine and more likely to smoke cigarettes, that’s more harm than good. If they get smokers who would have quit to keep smoking instead of quitting, more harm than good. If they get ex-smokers who have been off nicotine to go back on nicotine and then back to cigarettes, more harm than good. If they get people who want to quit smoking and would have taken medicines to think e-cigarettes are going to help, but they don’t, more harm than good."

Furthermore, the reporter interpreted Dr. Frieden as asserting that "e-cigarettes are as dangerous as tobacco cigarettes."

The Rest of the Story

The rest of the story is simple: the CDC is spreading unsupported propaganda and misinformation to the public as part of an unscientific and unwarranted attack on electronic cigarettes. Sadly, this attack on electronic cigarettes is doing a huge favor to Big Tobacco because it is going to deter smokers who would otherwise have quit or cut down using e-cigarettes from doing so and it may well cause many ex-smokers who quit via electronic cigarettes to return to cigarette smoking.

I do not begrudge the CDC for holding a different position than I do regarding electronic cigarettes. However, I find it abhorrent that the CDC is supporting this position by disseminating false and misleading information that is completely unsupported by scientific evidence. Our nation's leading public health agency should not be acting in this way.

There is absolutely no evidence that electronic cigarettes are a gateway to smoking. There is no evidence that vaping is impeding smoking cessation or that it is causing former smokers to return to smoking. In fact, the existing evidence suggests that the opposite is true: it appears that electronic cigarettes are increasing quitting attempts and enhancing smoking cessation without serving as a gateway to youth smoking.

There is no evidence that the e-cigarette industry is harming hundreds of thousands of children. Most of the youth who have used e-cigarettes are those who were already users of tobacco products, so it is entirely possible that the use of e-cigarettes among these children actually decreased their tobacco use. Moreover, the assertion that e-cigarettes are a gateway to smoking is inconsistent with actual data on trends in youth smoking rates. Furthermore, the assertion that e-cigarettes are impeding smoking cessation is inconsistent with data on cigarette consumption trends.

That the CDC has apparently drawn pre-determined conclusions about these questions is both inappropriate and unfortunate. And it is not only unscientific but it precludes the agency from making evidence-based decisions or recommendations.

Even claiming that electronic cigarettes are tobacco products is disingenuous because these products do not contain tobacco. It is true that electronic cigarettes are being regulated as "tobacco products," but they are not tobacco products in the ordinary usage of this term. Calling them tobacco products will mislead the public into thinking that electronic cigarettes contain tobacco. This is of course not true.

While as I said, I do not begrudge the CDC for holding this position on e-cigarettes, the fact that it is resorting to fabricating evidence in support of its position suggests that its position is untenable. If your position is strong, you should be able to support it with actual facts and scientific evidence. When all you can do to support your position is to produce false and misleading propaganda, then it's pretty clear you don't have a leg to stand on.

CDC and Glantz Misinformation Campaigns on Electronic Cigarettes are Working: Media Disseminating False Conclusions to Public

In recent weeks, I have exposed a repeated series of false or misleading statements being made by health and anti-smoking agencies, organizations, and advocates who are opposed to electronic cigarettes. The two most problematic aspects of this misinformation campaign are:

1. The CDC's propaganda regarding electronic cigarettes being a gateway to a lifetime of smoking addiction, despite the absence of any evidence to support this contention; and

2. Stan Glantz's propaganda that electronic cigarettes are a pathway to smoking addiction among youth, despite the fact that his study was a cross-sectional one and could not determine whether even a single youth started using electronic cigarettes and then progressed to established smoking.

A CDC official with whom I have been corresponding did not deny that the statement made by CDC regarding electronic cigarettes being a gateway to smoking addiction was misleading; however, he did downplay its significance, arguing that no one is paying attention to that statement.

Putting aside, for the time being, the attitude that it is acceptable for a federal agency to disseminate misinformation as long as no one pays attention, let's address the argument that no one is paying attention.

The Rest of the Story

Today, I present recent two newspaper headlines which make it clear that the two sets of propaganda outlined above - that from the CDC and that from Stan Glantz - are not merely being lost in the clutter, but instead, are resulting in widely read media stories that disseminate false conclusions to the public.

1. The CDC Propaganda Campaign

According to a New York Times article from last week, opponents of electronic cigarettes are arguing that electronic cigarettes are a gateway to smoking addiction among teenagers. The article states: "Opponents of e-cigarettes also argue that they are a gateway to conventional cigarettes, particularly for teenagers."

And who is the electronic cigarette opponent that the New York Times believes is arguing that these products are a gateway to cigarette addiction? It is the CDC.

According to the article: "The Centers for Disease Control and Prevention has found that the percentage of middle- and high-school students who use electronic cigarettes more than doubled from 2011 to 2012. In a statement with that report, Dr. Thomas R. Frieden, the C.D.C. director, said teenagers who used e-cigarettes could become addicted to nicotine and go on to smoke regular cigarettes."

Fortunately, the article does include a statement from the president of NJoy which makes it clear that there is no evidence to back up the CDC's assertion: "But Mr. Weiss, the NJoy executive, said: “There is no scientific data to support the argument that e-cigarettes are a gateway to smoking. On the contrary, there is a significant amount of research that indicates e-cigarettes can be a novel approach for moving smokers away from tobacco cigarettes.”"

However, it the CDC's word against NJoy's, and I believe most readers are going to trust the information they are getting from the CDC.

In this case, that information is untruthful, since there is no evidence that youth are becoming addicted to smoking from experimentation with electronic cigarettes. In fact, the only study to directly examine this hypothesis failed to find any evidence that this phenomenon is occurring.

Sadly, the CDC's informational campaign regarding electronic cigarettes is one of misinformation and deception.

2. The Glantz Propaganda Campaign

The headline of a Voice of America article last week reads: "Teens' E-Cigarette Use Promotes Heavy Tobacco Use."

According to this article: "According to the first-ever study on the use of electronic cigarettes, or e-cigarettes, by young people, researchers have found that the devices, marketed as an alternative to real cigarettes, appear to fuel heavy smoking among youth. ... Glantz said that while there is evidence electronic cigarettes help a small percentage of adult smokers stop, the same is not true for adolescents, who he says are being bombarded with appealing ads. “They are being marketed with flavors, with images of sex and independence, and also marketed with the claim they will help you quit smoking and, in fact, the kids who are trying to quit smoking were more likely to be using e-cigarettes. But, as I said before, [they are] much less likely to actually quit,” said Glantz."

Think about how damaging this headline is. Clearly, it is disseminating the conclusion that electronic cigarette use leads to heavy smoking among teenagers. If true, this would negate the tremendous smoking cessation benefits of electronic cigarettes for current smokers. Therefore, this conclusion has immense policy implications.

Disturbingly, the conclusion is false. There is no evidence to support the conclusion that electronic cigarettes are causing youth to smoke heavily. As I explained last week, Glantz's study was cross-sectional. The association between electronic cigarette use and heavy smoking could just as easily be explained by the hypothesis that youths who smoke heavily are more interested in electronic cigarettes, perhaps because they may be interested in quitting or cutting down on their tobacco use.

To be clear, this is not the reporter's fault. She is simply repeating what Dr. Glantz concluded in the propaganda material that he sent out to the media. Remember that in a statement accompanying his new study, Glantz proclaimed that electronic cigarettes are "a new route to smoking addiction for adolescents." He also represented his data as showing that: "kids who use e-cigs are less likely to have stopped smoking." And he wrote that: "Use of e-cigarettes is associated with heavier use of conventional cigarettes, which raises the likelihood that actual use of e-cigarettes may increase harm by creating a new pathway for youth to become addicted to nicotine and by reducing the odds that an adolescent will stop smoking conventional cigarettes."

In other words, this news article is a precise reflection of the Glantz propaganda campaign. Sadly, that campaign, like that of the CDC on the same issue, is one of misinformation and deception.

Without Any Evidence, CDC Continues to Claim that E-Cigarettes are a Gateway to Youth Smoking

CDC Also Continues to Lie About E-Cigarettes Being Tobacco Products

Back in 2013, the CDC began to wage a campaign of deception about electronic cigarettes, claiming that e-cigarettes were a gateway to smoking despite the lack of any evidence to support that contention, lying about e-cigarettes containing tobacco, and falsely claiming that Big Tobacco fought the FDA's efforts to regulate e-cigarettes.

Despite plenty of opportunity to correct these false statements, the CDC failed to do so. My hope was that things would change in 2016.

However, as today's story reveals, things have not changed, and instead, the CDC has brought its public deception about e-cigarettes to a new level.

While there is still absolutely no evidence that e-cigarettes are a gateway to smoking, since 2013 there has been accumulating evidence that e-cigarettes are not leading youth to start smoking. In fact, if anything, the evidence suggests the opposite: it appears that e-cigarettes are diverting youth away from smoking. Nevertheless, the CDC began 2016 by once again claiming that e-cigarettes are a gateway to smoking.

According to a Fox News story published moments ago, CDC director Dr. Thomas Frieden stated: "People need to understand that e-cigarettes are tobacco products. They contain nicotine. They’re addictive. And they may well result in changes in the adolescent brain and increase the chances that a kid will smoke regular cigarettes and have to deal with all of the suffering and disability and cost that that causes for a lifetime."

It is highly deceptive, if not an outright lie, to claim that e-cigarettes are tobacco products. After all, e-cigarettes do not contain any tobacco. None whatsoever! Clearly, the public is going to interpret the CDC's statement as meaning that e-cigarettes, like real cigarettes, contain tobacco. This is not true, so the CDC is deceiving and confusing the public with this false and misleading claim.

According to the CDC's logic (e-cigarettes are a tobacco product because they contain nicotine), eggplants are also a tobacco product. They contain approximately 100 nanograms of nicotine per gram. By that token, potatoes, tomatoes, and cauliflower are also tobacco products.

There is no evidence that electronic cigarettes are resulting in youth addiction to nicotine, nor is there any evidence that experimentation with e-cigarettes increases "the chances that a kid will smoke regular cigarettes and have to deal with all of the suffering and disability and cost that causes for a lifetime." In fact, it is more plausible that kids who experiment with e-cigarettes are actually less likely to start smoking regular cigarettes and therefore less likely to deal with all of the suffering and disability that smoking causes for a lifetime.

It is not even true that all the e-cigarettes used by youth do contain nicotine. In a recent survey, the majority of youth who use e-cigarettes reported using non-nicotine-containing products. Across all grades, more than 60% of youth who used e-cigarettes in the past month reported using a product with just flavoring (without nicotine). Among high school seniors, only 22.2% reported using a nicotine product. Nearly two-thirds (65.4%) of youth past-month e-cigarette users reported using a non-nicotine, flavored product. Thus, the CDC does not even have evidence to support its contention that the e-cigarettes that kids are using are primarily nicotine-containing products. 

This is not science. This is not the type of evidence-based statements that one would expect from the nation's leading public health agency. It is essentially little more than fear-mongering and an attempt to demonize a product that, for some reason, the CDC doesn't like.

Of course, I agree with the CDC that youth should not use e-cigarettes. But it is not OK to just make up evidence to support your position. To state that the CDC is being hyperbolic when it claims that e-cigarette experimentation among youth is going to condemn them to a lifetime of suffering and disability is an understatement. Hyperbolic implies an exaggeration. But here, it may well be that precisely the opposite is true. So this is not hyperbole. It is fabrication.

The Rest of the Story

I had hoped that 2016 would bring an improvement in the debate over electronic cigarettes by ending the misrepresentation of scientific evidence and the deception of the public regarding the truth about e-cigarettes. But in just the first few days of the year, we see that tobacco researchers and the nation's lead public health agency continue to mislead the public with false or deceptive claims about these products. It appears that there is a pre-existing distaste for electronic cigarettes and that vaping opponents are going to continue to lie to or deceive the public in order to promote their a priori agenda, which is - inadvertently - to protect cigarettes from a potential threat from a much safer alternative product that hundreds of thousands of smokers are using to try to quit.

March E-Cigarette Madness: CDC Wins National Championship for Worst E-Cigarette Lie

The national championship for worst e-cigarette lie was held between CDC and the California Department of Health Services.

Here are the relevant statements (lies) of each finalist organization:

California Department of Health Services: The California Department of Health Services (CDHS), under a grant funded by the Centers for Disease Control and Prevention (CDC), produced a brochure entitled "Protect Your Family from E-Cigarettes: The Facts You Need to Know," which claimed that: (1) "E-cigarettes are just as addictive as regular cigarettes" and (2) "Studies show that e-cigarettes do not help people quit smoking cigarettes."

CDC: The CDC misrepresented cross-sectional CDC survey data as conclusive evidence that electronic cigarettes are a gateway to smoking. Specifically, CDC Director Dr. Thomas Frieden stated: "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."

While it was a closely contested match, the CDC pulled out the victory because the damage caused by its lies are likely to be much greater than those of the California state health department. Some of the lies from the state health department are so blatant that no one will actually believe them. However, the CDC's lies about e-cigarettes being a gateway to smoking have been widely accepted and repeated by local health departments and policy makers and are already serving as the basis for some local policies. Moreover, the CDC's lies are potentially devastating to the e-cigarette industry because if these statements were true, then it would be difficult, if not impossible, to show that e-cigarettes will have a net benefit for the public's health, and therefore, no e-cigarette pre-market applications could be approved. The effect of CDC's lies, if they are accepted as truth, could therefore be the complete destruction of the e-cigarette market. That would have a severe detrimental effect on the public's health, and it brought the CDC the championship trophy.

THE NATIONAL CHAMPION for Worst E-Cigarette Lie:

Centers for Disease Control and Prevention (CDC)

CDC's Lies to the Public Called Out in Forbes Magazine and Reason Online

In a commentary that appears both at Forbes.com and Reason.com, Jacob Sullum, senior editor at Reason magazine calls out the CDC for lying to the public about electronic cigarettes.

Sullum takes issues with the fact that the CDC classifies electronic cigarettes as tobacco products. But they are not tobacco products, as they contain no tobacco. As Sullum points out:

"e-cigarettes do not burn and contain no tobacco, which is why they are so much safer than traditional cigarettes. It is more than a little misleading to classify them as tobacco products."

"Yet that is what the CDC does. When it claims "there was no decline in overall tobacco use between 2011 and 2014," it is counting e-cigarettes as tobacco products. That makes as much sense as counting nicotine gum or patches (which also contain nicotine derived from tobacco) as tobacco products. This is no mere word game, because it is not true that "there was no decline in overall tobacco use between 2011 and 2014." The CDC is lying to us."

Sullum also points out that the American Lung Association is lying to the public by claiming that the dramatic decline in youth smoking is being offset by the increase in e-cigarette use. This is blatantly false from a public health perspective and also requires an additional lie: once again, that e-cigarettes are tobacco products. Sullum writes:

"Similarly, the American Lung Association suggests that the decline in smoking is "offset by the dramatic increase in use of e-cigarettes," which is scientifically absurd given the clear health advantages of vaping. This is not simply a matter of emphasis or opinion. In terms of health effects, it cannot possibly be true that the increase in e-cigarette use offsets the decline in smoking."

Finally, Sullum points out that the CDC is also lying about e-cigarettes serving as a gateway to cigarette smoking among youth:

"For years anti-smoking activists and public health officials have tried to justify their irrational hatred of electronic cigarettes by arguing that vaping leads to smoking, especially among impressionable young people who otherwise would never touch tobacco. But that is not happening. To the contrary, vaping and smoking rates among teenagers are moving in opposite directions. Rather than admit they were wrong to claim that e-cigarettes are a “gateway” to the conventional kind, opponents of vaping have escalated their prevarications by implying, in defiance of all scientific evidence, that there is no important difference between the two kinds of nicotine delivery devices."

The Rest of the Story

It is gratifying to see that the CDC's lies are being called out to the public. While the agency itself has done nothing to retract or correct the misinformation it has been disseminating, it is my hope that the revelation to the public that CDC is not being truthful will force the agency to respond.

I also think that it is only a matter of time before a Congressmember or a Congressional oversight committee files a formal inquiry to the CDC, which would also force the agency to respond and explain to the legislative branch why a public health agency is lying to and seriously misleading the public.

It is quite clear at this point that the CDC's statements are not simply mistakes or oversights. The deception is intentional, and it is part of a deliberate campaign to pull the wool over the eyes of the public. The CDC wants the public to think that e-cigarettes contain tobacco to help prevent people froom believing (quite correctly) that vaping is safer than smoking.

The CDC also wants the public to believe (quite incorrectly) that e-cigarette experimentation is leading to smoking addiction among youth. Only such a dramatic piece of misinformation could offset the clear public health benefits that vaping has provided to smokers. One way to alter the true cost-benefit mix is to lie about there being no benefits and at the same time, lie about there being severe costs.

With regards to the electronic cigarette issue, the CDC has long since left the realm of practicing public health. It has also left the realm of scientific rigor and of ethical public health practice.

In another Forbes column, Sally Satel, resident scholar at the American Enterprise Institute, also calls out the CDC for its lying. She also calls for Congressional hearings to force CDC to explain why it is running a campaign to deceive the American public. Satel writes:

"It is shameful that the CDC, the nation’s leading institute of public health, doesn’t acknowledge the value of e-cigarettes as a substitute for cancer-causing cigarettes. In an ad campaign launched three weeks ago, Dr. Frieden, a longtime critic of vaping, went so far as to warn that e-cigarettes do not help people quit and even lead to collapsed lungs. These claims are patently false but they are part of a larger anti-e-cigarette agenda that simply keeps smokers puffing on deadly cigarettes – after all, why switch if vaping is as bad as smoking? ... Director Frieden is playing fast and loose with public trust. It is time he defended his misleading rhetoric about e-cigarettes to members of the oversight subcommittee of the House Energy and Commerce Committee. His latest alarmist stance about vaping corrupting the youth of America is belied by his agency’s own data which tell a different, more encouraging story: e-cigs are not leading to smoking and may well be a diversion from it."

March E-Cigarette Madness: Regional Results for Worst E-Cigarette Lie

Today, I reveal the brackets and the regional finalists for the 2015 Rest of the Story Worst E-Cigarette Lie Championship. Those who have been following the Rest of the Story recently will recognize that there were a huge number of eligible contestants and that the work of the selection committee was difficult. The semifinalists and finalists will be revealed over the coming days. Criteria for selection included: (1) the extent of the misinformation provided to the public about e-cigarettes; and (2) the amount of probable damage to the public's health resulting by the misinformation.


WEST REGIONAL

University of California, San Francisco (UCSF) vs. California Department of Public Health

UCSF: In an article published in USA Today, Dr. Stanton Glantz 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."

California Department of Health Services: The California Department of Health Services (CDHS), under a grant funded by the Centers for Disease Control and Prevention (CDC), produced a brochure entitled "Protect Your Family from E-Cigarettes: The Facts You Need to Know," which claimed that: (1) "E-cigarettes are just as addictive as regular cigarettes" and (2) "Studies show that e-cigarettes do not help people quit smoking cigarettes."

SOUTH REGIONAL

Centers for Disease Control and Prevention (CDC) vs. Greenville (SC) Health System

CDC: The CDC misrepresented cross-sectional CDC survey data as conclusive evidence that electronic cigarettes are a gateway to smoking. Specifically, CDC Director Dr. Thomas Frieden stated: "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."

Greenville Health System: On the Greenville Health System blog, a respiratory therapist wrote: "I strongly oppose the use of e-cigarettes. It is unregulated and could potentially be more dangerous than a regular cigarette." Clearly, this claim that cigarette smoking might be healthier than vaping is a lie.


MIDWEST REGIONAL 

Mayo Clinic vs. University of Kentucky (Tobacco-Free UK)

Mayo Clinic: The Mayo Clinic stated that: "with nicotine inhalers you receive only nicotine." Even the arch-enemy of electronic cigarettes - Dr. Stanton Glantz - has acknowledged that nicotine inhalers deliver to users the following chemicals: Formaldehyde; Acetaldehyde; o-methylbenzene; Cadmium; Nickel; and Lead. In fact, I have shown that nicotine inhalers actually deliver higher amounts of six carcinogens than electronic cigarettes. The Mayo Clinic also stated that: "No studies have been done to examine the safety of e-cigarettes." However, there have been many studies that examined the safety of electronic cigarettes.

University of Kentucky Tobacco-Free Task Force: Tobacco-Free UK at the University of Kentucky warned the campus community that electronic cigarettes cause cancer. The text of its poster stated that "it causes cancer." The Tobacco-Free UK organization appears to be a UK Tobacco-Free Task Force, which is headed up by Ellen Hahn, a professor who has made misleading claims about electronic cigarettes.

EAST REGIONAL

Food and Drug Administration (FDA) vs. American Lung Association (ALA)

FDA: The FDA stated, in its proposed deeming regulations: "Many consumers believe that e-cigarettes are "safe" tobacco products or are "safer" than cigarettes. FDA has not made such a determination and conclusive research is not available." That the FDA is not sure whether smoking is any more hazardous than vaping does not say a lot for the agency's scientific standards.

ALA: A CNN Opinion page featured an op-ed on electronic cigarettes from Harold Wimmer, the president and CEO of the American Lung Association. In the piece, Wimmer argued that Big Tobacco companies are using electronic cigarettes to create "new nicotine addicts" and that they are enticing youth with flavors such as bubble gum and cotton candy. According to the American Lung Association piece: "Big Tobacco desperately needs new nicotine addicts and is up to its old tricks to make sure it gets them. E-cigarettes are being aggressively marketed to children with flavors like Bazooka Bubble Gum, Cap'n Crunch and Cotton Candy. Joe Camel was killed in the 1990s, but cartoon characters are back promoting e-cigarettes." However, none of the three tobacco companies which market electronic cigarettes in the U.S. are selling electronic cigarettes with bubble gum, cap'n crunch, or cotton candy flavors. In fact, the disposable electronic cigarettes being sold by Big Tobacco companies (i.e., the ones most likely to be purchased by youth) are available solely in classic tobacco or menthol flavors.

THE WINNERS

West Regional: California Department of Health Services defeats UCSF

Since Dr. Glantz is recognized as an arch-enemy of electronic cigarettes, his lie about e-cigarettes being a gateway to smoking is less likely to cause damage. However, the California Department of Health Services, as a large and respected state health department, is likely to be causing public health damage with its false assertions that e-cigarettes are as addictive as tobacco cigarettes and that e-cigarettes do not help people quit smoking.

South Regional: CDC defeats Greenville Health System

The CDC simply carries too much weight. Its false claim that e-cigarettes are a gateway to smoking was picked up by media outlets throughout the country and is influencing state and local public health policy and causing substantial public health damage.

Midwest Regional: Mayo Clinic defeats University of Kentucky Tobacco-Free Task Force

The Mayo Clinic carries tremendous weight and thus its public misinformation about e-cigarettes is more damaging to the public's health.

East Regional:  FDA defeats American Lung Association

The FDA has perhaps the most influence on the electronic cigarette issue of any governmental organization. It defeated the ALA because its false and misleading pronouncements about electronic cigarettes have caused enormous public health damage.

SEMIFINAL MATCHUPS

1. California Department of Health Services vs. Mayo Clinic

2. CDC vs. FDA