Monday, November 25, 2013

Analysis of CDC Statement on Relative Harms of Electronic Cigarettes vs. Smoking: Is Deception Intentional, or Merely a Mistake?

I have previously criticized a CDC statement for implying that electronic cigarettes may be no more harmful than tobacco cigarettes. I quoted the statement as follows: "There is insufficient evidence to determine whether ... electronic cigarettes ... reduce individual ... health risks." "

I have been criticized for not including the full quote, and for not providing the context. So let's now look at the full quote in context.

On the bottom of its web page on low-yield cigarettes, CDC includes a statement about the relative harms of electronic cigarettes compared to smoking. The statement, in full, reads as follows:

"There is insufficient evidence to determine whether novel tobacco products (e.g., electronic cigarettes) reduce individual and population health risks."

In a previous post, I criticized this statement because while I do not think it is unreasonable to question whether electronic cigarettes reduce population health risks, I think it is very clear that electronic cigarettes reduce individual risks. In other words, smokers who switch to electronic cigarettes are reducing their health risks, as these products are much safer than tobacco cigarettes.

Thus, I believe this statement is misleading because it suggests that electronic cigarettes do not reduce either population or individual health risks.

My critique was questioned by an official from CDC, who defended the statement. His argument was that since the sentence says individual AND population health risks, it is accurate, because there is not sufficient evidence to determine if electronic cigarettes reduce BOTH individual and population health risks. But he acknowledged that CDC's position is that a smoker who switches to electronic cigarettes (exclusively) is reducing his or her health risks.

Thus, CDC's position appears to be that while electronic cigarettes can reduce individual health risks, they have not been shown to reduce population health risks.

Instead of stating this, the CDC chose to state that electronic cigarettes have not been shown to reduce BOTH individual and population health risks.

The Rest of the Story

For the sake of argument, let's stipulate that electronic cigarettes do not reduce population health risks, but they can reduce individual health risks. This seems to be consistent with what CDC claims its position is.

Now, it strikes me as rather deceptive (and disingenuous) to inform the public that electronic cigarettes do not reduce individual AND population health risks, when you know that e-cigarettes reduce individual health risks. Why combine both in the same sentence? Why not just state: "While electronic cigarettes can reduce individual health risks, it is not known whether they reduce population health risks."

Perhaps an analogy may help explain this.

Suppose you read the following statement:

"Michael Siegel is not a nice guy and a national hero."

I suppose one could put forth the argument that this statement is technically true. While Michael Siegel is arguably a nice guy, he is most definitely not a national hero.

But this misses the point. Why combine both in the same sentence, unless one's intent is to put into people's mind that Michael Siegel is not a nice guy? (Yes, I realize that we have to stipulate that Michael Siegel is a nice guy for the sake of argument, rather than rely on scientific evidence.)

To further illustrate this point, let's turn the CDC's statement around. What they are essentially asserting is the following:

"There is insufficient evidence to determine whether cigarettes increase individual and population health risks (compared to electronic cigarettes)."

Technically, this statement may be true because while cigarettes most certainly increase individual health risks, it's not yet clear whether they increase BOTH individual AND population health risks compared to electronic cigarettes.

But do you see how deceptive that statement is?

If a tobacco company were to make that precise statement, anti-smoking groups would certainly attack them. (No - I will not issue another satirical tobacco company press release to make that point; I think we can all accept it is true.)

So if the statement would be very deceptive coming from a tobacco company, how is it not equally deceptive coming from a public health agency?

The final point I want to address is whether this deception is intentional, or simply a careless mistake?

I think I was able to trace the origin of the statement. It comes, word for word, from the 2010 Surgeon General's report. With one exception. The 2010 Surgeon General's report made this statement with regards to tobacco products, meaning products that actually contained tobacco. For example, smokeless tobacco products like Premier, Eclipse, and Accord. But the current statement adds, in parentheses, "e.g., electronic cigarettes."

The statement actually cites the 2010 Surgeon General's report, as if it backs up the assertion that electronic cigarettes do not reduce individual and population risks. But the 2010 report doesn't even mention electronic cigarettes. Is it not deceptive, therefore, to cite a reference that doesn't support the statement being made? Doesn't that make it appear to readers that the Surgeon General's report actually mentioned the topic of electronic cigarettes?
It is just difficult for me to believe that the statement from the Surgeon General's report was "accidentally" revised to include electronic cigarettes. How can that addition be a simple accident, or careless mistake? 

If a cigarette company made the same statement ("There is insufficient evidence to determine whether cigarettes increase individual and population health risks"), would we reasonably conclude that it was just a careless mistake?

Furthermore, one has to consider this in the context of the statements that Dr. Frieden made about electronic cigarettes being a gateway to youth smoking. It appears to me that CDC is presenting the information to the public with a strong bias. I'm not criticizing this bias, per se, but simply pointing out that the bias appears to be intentional. CDC appears to have a clear position that it wants to articulate to the public.

This could all be corrected and put to an end if CDC simply made a clarification statement to the public, clearly asserting that electronic cigarettes are much safer than tobacco cigarettes, and that there is no current evidence that e-cigarettes are a gateway to smoking. But CDC makes neither of those statements. In fact, I can’t find a single place where CDC has informed the public of the truth: that e-cigarettes are much safer than tobacco cigarettes. How am I left to conclude that this glaring omission is anything but intentional?

But maybe I’m wrong. I keep waiting to be wrong. But every day I wake up, and there’s no correction from CDC. No statement about how electronic cigarettes are safer than tobacco cigarettes.

Believe me, I want nothing more than to find out that this has all been due a simple mistake and that the true intent of the CDC is to impartially provide all of the facts about electronic cigarettes and their relative harms compared to tobacco cigarettes.

Now I go back to the CDC's MMWR article about electronic cigarettes. Could I perchance be wrong? Maybe that article mentions that electronic cigarettes are safer than tobacco cigarettes.

No, it doesn't. It does mention that "Potentially harmful constituents ... have been documented in some e-cigarette cartridges, including irritants, genotoxins, and animal carcinogens," but it mentions nothing about these products being orders of magnitude safer than tobacco cigarettes. One would think that this would be one of the critical background points made in such an article. Again, this could be a simple omission, but taken in the entire context of the CDC's communications about electronic cigarettes, it is difficult to reach such a conclusion.

I continue to hope that I'm wrong.  I guess I’ll just keep waiting.

UPDATE (November 25th, 5:30 pm): The CDC official has assured me that they will be revising the statement by deleting the words "electronic cigarettes" from the sentence. I applaud the CDC for taking the time and effort to correct the statement and for demonstrating a concern for making sure that its communications are not misleading. I am hopeful that this is the first step forward to greater honesty and accuracy in communications from tobacco control organizations. Hopefully, the FDA will be the next to correct its web site.

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