December 19th, 2016
Fear-based lies are the foundation of most reports on drug use published by US government agencies sworn to protect the health and well-being of the public. And so it is with this month’s Surgeon General’s report, “E-Cigarette Use Among Youth and Young Adults.”
The entire report is based on a whopper of a lie. It is told first in the foreword by Dr. Thomas R. Frieden, the director of the Centers for Disease Control and Prevention, and then in the preface by Surgeon General Dr. Vivek H. Murthy himself.
Frieden states: “Tobacco use among youth and young adults in any form, including e-cigarettes, is not safe…E-cigarettes are tobacco products that deliver nicotine.”
Murthy says: “These products [e-cigarettes] are now the most commonly used form of tobacco among youth in the United States, surpassing conventional tobacco products, including cigarettes, cigars, chewing tobacco, and hookahs.”
E-cigarettes are not tobacco products: They contain zero tobacco. To describe e-cigarettes as a tobacco product is profoundly deceitful. And this factual misrepresentation to scare smokers into not using them is quite deliberate.
How do leading tobacco-control physicians get away with characterizing e-cigs as tobacco products? In 2009 Congress passed the Tobacco Control Act. The legislation defines the term “tobacco product,” in part, as any product “made or derived from tobacco.” Because the nicotine in e-cigarettes is derived from tobacco plants and not other sources like eggplants, tomatoes or potatoes, electronic cigarettes are considered a “tobacco product.”
This is absurd. Who do they think they are kidding? Nicotine doesn’t kill almost half a million Americans every year; combustible tobacco leaves do.
Interestingly though, nicotine gums, inhalers, lozenges and patches are never described as tobacco products. Guess where that nicotine hails from? I contacted GlaxoSmithKline (GSK) the makers of Nicorette gum and Nicoderm patches. A customer service representative told me that the nicotine in GSK products is derived from tobacco leaves.
Perhaps it should come as no surprise that representatives of government health agencies lie about drugs. Think about the falsehoods they peddled for decades about marijuana: It causes brain damage; it is a gateway to “harder” drugs; it causes amotivational syndrome, lung cancer and crime.
All those pernicious lies have been debunked, but why should we suppose that the government should kick its habit of deception and fear mongering around drugs? Government agencies, steeped in drug-war hysteria, need to identify and amplify new demons to stay relevant. Never mind that the American people have long paid a heavy price, in freedom, social and racial justice and public health.
The first problem with the Surgeon General’s report is its conceptual framework. Murthy and the contributing authors and editors believe—incredibly, after all we have learned from decades of failed policy—that a tobacco- and nicotine-free world where all adolescents “just say no” is possible. The bulk of interventions and policy approaches are still directed at that unobtainable goal.
Earth to Surgeon General Murthy: Drugs are here to stay and young people will continue to experiment with a range of substances, legal and illegal. Drug experimentation is normal, and the vast majority of young people do not become addicted. The report doesn’t mention this vital fact and instead exaggerates the risk of nicotine addiction.
For those who do become addicted to nicotine, the reality is that most get un-addicted. Millions of people in the US have stopped smoking. Non-punitive public health measures and cultural shifts in how smoking is perceived have produced in a dramatic drop in smoking rates, including in youth. The recently released “Monitoring the Future 2016” survey showed that the percentages of eighth-, 10th-, and 12th-graders who reported smoking cigarettes during the previous month fell again. Cigarette smoking is no longer sexy or cool—it is a highly stigmatized behavior, and young people understand this. The health risks that are associated with smoking tobacco have been drilled into generations of youth.
The second conceptual problem is that it fails to frame the use of e-cigarettes as harm reduction. To the great detriment of public health, US policy still sees a harm reduction approach to drug use as the third rail, despite a mountain of evidence worldwide that harm reduction interventions decrease morbidity and mortality. (Another of Surgeon General Murthy’s reports, “Facing Addiction in America,” is an example of this.)
If the latest report put vaping risks into context with the risks of smoking tobacco, its only possible conclusion would be that vaping dramatically reduces harm—by 95 percent, according to the Royal College of Physicians in England. No one is saying that electronic cigarettes are 100 percent safe, but they are safer by orders of magnitude in comparison to the combusted and inhaled tobacco use in which 15 percent of Americans engage.
Data show that one of the main reasons young people use e-cigarettes is because of the “low perceived harm compared to other tobacco products,” and the simultaneous increase in vaping and decrease in tobacco smoking among young people should be impossible to ignore. It appears that youth are a whole lot smarter than the Surgeon General and his ghostwriters believe.
The report confesses that some public health scientists have highlighted “the potential for alternative nicotine products to serve as a substitute for conventional cigarettes and thus a harm reduction tool.” The Surgeon General concludes that “current evidence is insufficient to reject” the position that e-cigarettes reduce harm, but by burying this single most important fact about e-cigarettes, that is effectively what his one-sided report does. Not one advantage of switching to vaping is discussed. Instead, Dr. Murthy ominously calls the increase in e-cigarette use among youth and young adults a “major public health concern,” and says that “young people are being harmed by these products.”
Yet the report never explains why e-cigarettes are a major public health threat or how adolescents are being hurt by them. Currently, there is no evidence of adverse health effects of e-cigarettes with the exception of the potential of batteries to explode—a problem that the Federal Drug Administration (FDA) should take seriously but does not. The Federal Emergency Management Agency found that most explosions occurred during charging.
Numerous myths about e-cigarettes are recycled in the report. A tired and time-tested one is that vaping is a “gateway.” Somehow, if youth vape, they will progress to smoking cigarettes. It doesn’t make sense: E-cig use is up 900 percent and smoking tobacco continues to fall. Vaping is a gateway—but only out of smoking.
“Whenever you see a young person vaping, you have to ask what they would have been doing in the absence of e-cigarettes,” said Clive Bates, former director of Action on Smoking and Health (ASH) and a leading proponent of vaping. ”If they would otherwise have been smoking, you are looking at a win for public health.”
Another myth is that e-cigarette companies promote flavored products, in particular fruit flavors, to get adolescents hooked. Hold up: Grown-ups like fruit-flavored products. Many adult smokers who switch to e-cigs—and they up make up the vast majority of the market—report that they enjoy fruit-flavored e-cigs; for some, they help prevent a return to tobacco.
Again, the method of ingestion seems to affect how this kind of thing is perceived. Where is the concern for flavored nicotine gum? Nicorette is available in “fruit chill,” mint and “cinnamon surge.”
Vodka, meanwhile, comes in a variety of flavors from apple to chocolate to pomegranate to whipped cream (I know; I’ve tried them all). Yet outcry over supposed nefarious plots to appeal to adolescents is largely confined to a drug (nicotine) that is far safer than alcohol.
Read more from The Influence:
The Surgeon General is so desperate to smear e-cigs that he even mixes a dash of “reefer madness” into his report. One of its major conclusions is that “e-cigarette products can be used as a delivery system for cannabinoids and potentially for other illicit drugs.”
Maybe. But young people have been smoking cannabis since long before the electronic cigarette was imagined.
The adolescents surveyed for the report gave a number of intelligent and honest reasons for their e-cig use besides liking the flavors and sheer curiosity: “to help me quit smoking,” “to cut down on smoking,” “it doesn’t smell bad,” “to relax or relieve tension,” “because of boredom—nothing else to do,” “it is healthier than regular cigarettes” and “to not disturb other people with smoke.”
Public health professionals should pay particular attention to young people who say they use nicotine to relax and to relieve tension and boredom. Adolescence is typically a stressful, anxiety-inducing stage of life and nicotine has fast-acting, calming effects. The Surgeon General’s report should have included recommendations aimed at alleviating the sources of stress and boredom so many youth and young adults experience.
There are racial disparities in adolescent e-cigarette use. According to the report: “Among youth—older students, Hispanics, and Whites are more likely to use e-cigarettes than younger students and Blacks. Among young adults—males, Hispanics, Whites, and those with lower levels of education are more likely to use e-cigarettes than females, Blacks, and those with higher levels of education.”
This means black youth who smoke tobacco—one of the greatest killers of black people—have less access to and knowledge of a proven, life-saving product. This resource is being under-utilized among this population, and Surgeon General Murthy’s messaging is helping to perpetuate this.
The Surgeon General’s report also supports the highly problematic FDA ban on selling e-cigarettes to minors. One study found that access to e-cigs reduced smoking among minors and that “banning electronic cigarette sales to minors counteracts 70 percent of the downward pre-trend in teen cigarette smoking for a given two-year period.” Another study documented the same trend. Given the devastating health consequences of smoking, bans on minors purchasing e-cigs should be carefully studied and reevaluated.
That a report from the Surgeon General’s office on the use of electronic cigarettes ignored the largest demographic of users—adults—is astounding. They are the parents of the children Dr. Murthy wants to keep healthy and happy. But they will be neither if their moms and dads die from smoking-related illnesses—or if their own health is damaged by their parents’ second-hand tobacco smoke.
The Surgeon General, the FDA and most of the contributors to the report want to severely restrict access to electronic cigarettes for adults. They stubbornly refuse to recognize the benefits of vaping and continue to deny, in the face of mounting evidence, accepted in other countries, that e-cigarettes have helped millions of adults to quit or cut down on cigarettes.
You can’t profess to care about “the children” and not be in favor of helping their parents to stay alive. You just can’t.
Helen Redmond has written for Al Jazeera, AlterNet, Harpers and the Socialist Worker. She is a Licensed Clinical Social Worker and adjunct faculty member at the Silver School of Social Work at New York University. She is a documentary filmmaker and is currently working on a documentary about methadone: Methadone Manifesto. Her last piece for The Influence was: “Prejudice Kills: People Who Need Lifesaving Methadone Continue to Be Degraded and Blocked.”