Friday, May 16, 2014

In Senate Testimony, CDC Lies in Order to Obscure the Issues Surrounding Electronic Cigarettes

In 1994, so many of us in the tobacco control movement, including myself, castigated the chief executive officers of the tobacco companies who testified before Congress that nicotine is not addictive. In fact, some of us went so far as to suggest that these executives should be prosecuted for perjury.

Clearly, those of us in tobacco control believe it is essential that testimony before Congress be accurate, honest, truthful, transparent, and not at all misleading.

Unfortunately, CDC's testimony yesterday before the Senate Health, Education, Labor, and Pensions Committee fell way short of that mark.

Specifically, in describing the benefits of switching from tobacco cigarettes to electronic cigarettes, the CDC called such benefits "hypothetical," thus casting doubt on whether such benefits actually exist.

The CDC stated: "It is not fair to our children to ask them to pay a price for that for a hypothetical benefit for adult smokers." [emphasis is mine]

The Rest of the Story

In characterizing the benefits of switching to electronic cigarettes as merely "hypothetical," the CDC has misled the Senate and the American public about the clear science on this issue. There is no question that vaping is much safer than smoking. There is therefore no question that smokers who quit smoking by switching to electronic cigarettes are improving their health. In addition, there is clear evidence that smokers who become dual users are also improving their health. Just this week, a study demonstrated that dual users experience substantial improvements in their asthma symptoms. Moreover, there is abundant clinical evidence, both anecdotal and published, that smokers who switch to electronic cigarettes experience substantial improvement in their respiratory health.

Ironically, the truth is actually the opposite of what the CDC suggests. The benefits of switching to electronic cigarettes for adult smokers are quite clear. In contrast, the harms to youth of trying electronic cigarettes are hypothetical because there is no evidence that e-cigarette use leads to cigarette smoking among adolescents. In fact, the present evidence suggests that e-cigarettes may be serving as a partial deterrent to real cigarette use, as the overwhelming proportion of youth regular e-cigarette users are adolescents who have previously experimented with tobacco products and are therefore at high risk of becoming addicted smokers.

There is an abundance of information about electronic cigarette use that we do not know. However, there is one thing that is clear: electronic cigarettes are much safer than the real ones, and smokers who switch to e-cigarettes or even who cut down substantially on their cigarette use by taking up vaping are greatly improving their health. In other words, the benefits of electronic cigarettes for adult smokers are not hypothetical, but well established.

Why would the CDC deceive Congress and the public in this way? Why misrepresent the nature of the scientific evidence on this issue? Why throw dirt in the face of every vaper who has quit smoking and is proud of himself or herself for having improved their health and perhaps saved their life? Why give ex-smokers throughout the country pause about their switch to vaping and perhaps cause them to return to smoking because of doubt over whether they are experiencing any health benefits?

If the benefits of a switch from smoking to vaping are only "hypothetical," then why should vapers continue to vape? Why not just return to cigarette smoking, since there is no proven benefit to their vaping?

The CDC's misinformation to Congress is therefore not only deceptive, but potentially harmful and destructive as well. It certainly undermines the public's well-established appreciation of the severe hazards of cigarette smoking. If there are no known benefits to smokers of switching to electronic cigarettes, then it appears that smoking isn't as bad as we thought. 

The rest of the story is that the tobacco executives are not the only ones who have pulled the wool over the eyes of Congress and the public. Sadly, the CDC has added itself to that shameful category.

Am I equating the lies of the tobacco executives with that of the CDC? Of course not. The nature of the deception was very different and so was the motivation beyond the deception (the tobacco companies lied for profit; the CDC is lying because of an apparent underlying ideology, although its ultimate intentions are good ones). However, misinformation is misinformation and if we are going to attack the tobacco companies for deceiving Congress, then we cannot stand by and allow public health groups to mislead Congress without being willing to also criticize them. In fact, public health should be beyond reproach in providing accurate and scientifically supported information to Congress and the public.


This may be the most difficult blog post I have ever written. I was deeply saddened to see the CDC completely obscure the critical issues surrounding electronic cigarette use by arguing that the harms being done to adolescents are definite, while the benefits to adult smokers as being merely hypothetical. In fact, it is exactly the opposite.

In contrast, I thought Mitch Zeller presented a well-balanced and evidence-based perspective.

I hope my readers understand how difficult it is for me to see this. It literally pains me to see, especially since I once worked at CDC, in the Office on Smoking and Health, and have a very deep attachment to that office.

However, I also can’t stand the idea of a public health agency deceiving the Congress and that has to take precedence over my deep affections for the office that I love.

Second Addendum

I want to emphasize that this position of the CDC's - that the benefits of e-cigarettes are hypothetical but the harms are real - is not new. Dr. Frieden has been saying this for some time and the CDC testimony yesterday merely reflected this long-standing (but wrong) summary of the scientific evidence.

For example, 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."

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