Monday, April 20, 2015

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:


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.


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.


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."

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