US Surgeon General: World’s Most Dangerous Man?

Having only had a few hours notice that the US Surgeon General would be releasing his “first” report on the subject of e-cigarettes, it should come as no surprise how quickly the news has spread that “e-cigs are bad mmmkay”. Clive Bates eloquently put together three separate posts, two before the report and one after. Each delving deep into the minutiae of the US position on e-cigarettes.

The major issue with the release of this report is how easily it will be taken as gospel by a number of tobacco controllers and public health busybodies. Already Simon Chapman has gleefully tweeted:

Which doesn’t link to the report, but rather his mate Stanton Glantz’ analysis of it – which needless to say, is full of self-indulgence (seeing as Glantz was in fact a reviewer of the report) – and claiming that a total of 150 “experts” reviewed it. Actually the number of actual reviewers was only sixty-four, including two from the Campaign for Tobacco-Free Kids. There were seven report editors, seven contributing editors, twenty-three contributing authors, and twenty-six “other” contributors. Adding editors, authors and contributors together is only 127.

I thought being a “scientist” meant you could math? If you add the seven other acknowledgements, it’s only 134. Still far short of the “Reviewed by 150 experts” figure. Still, this isn’t a Simon Chapman bashing session, for once.

The opening statements included in the report from Sylvia Burwell, Thomas Frieden and the Surgeon General himself naturally reflect the tone of the report and it is, quite frankly, the worst piece of drivel I’ve had the misfortune to read.

Comments such as:

“We have more to do to help protect Americans from the dangers of tobacco and nicotine, especially
our youth. As cigarette smoking among those under 18 has fallen, the use of other nicotine
products, including e-cigarettes, has taken a drastic leap. All of this is creating a new generation of
Americans who are at risk of nicotine addiction” — Sylvia Burwell


“E-cigarettes are tobacco products that deliver nicotine. Nicotine is a highly addictive substance,
and many of today’s youth who are using e-cigarettes could become tomorrow’s cigarette smokers.
Nicotine exposure can also harm brain development in ways that may affect the health and mental
health of our kids” — Thomas Frieden

Commentary from two individuals that are hardly objective when it comes to e-cigarettes specifically, and harm reduction generally.

“Although we continue to learn more about e-cigarettes with each passing day, we currently know
enough to take action to protect our nation’s young people from being harmed by these products.”

–Surgeon General

If you truly care about the young people of the nation then you’d spend more time researching how to make these products better instead of wasting taxpayer cash on scaring the public into believing that e-cigs are just as harmful (or more harmful) than combustible tobacco. But then, this is a deliberate crusade against a disruptive technology that can have a major beneficial impact for millions of people.

As noted by Dr Christopher Russell:

“On pages 10-11, the USSG writes: “There are diverging opinions about the potential public health impact of these new products. 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 (Henningfeld et al. 2003; Abrams 2014).”

And then on page 184, the USSG adds: “Correspondingly, e-cigarettes have been proposed by some as a harm-reduction strategy and as a tool for smoking cessation, but the data to date do not support e-cigarettes for harm reduction or cessation (Siegel et al. 2011; Abrams 2014).

Three things disappoint me about this:

1) Thats it – these are the only two mentions in the entire 251 page report that allude to e-cigarettes as having potential to reduce smokers’ risk for developing smoking-related disease and premature mortality.

2) The USSG does not acknowledge, or even call for more research to determine whether, as the World Health Organisation concluded two months ago, that if the great majority of tobacco smokers who are unwilling or unable to switch without delay to alternative sources of nicotine with lower health risks, this would represent a significant public health achievement.

3) As this group well knows, the Royal College of Physicians published a comprehensive report earlier this year in which the evidence of potential harm to young people attributable to e-cigarette use (as either an active or passive consumer of vapour) was specifically addressed, as was the potential for e-cigarettes to reduce or increase risk for smoking initiation among young people. The RCP report arrived at very different, but rightfully tentative conclusions about the potential for e-cigarettes to cause and reduce harm to you young people. The USSG, however, makes not a single mention of even the existence of this comprehensive report by his UK counterparts. The USSG cites two studies (Henningfield, Abrams) that highlight the potential for e-cigarettes to reduce harm. Just two. Two studies of the now hundreds of empirical, theoretical and policy studies that are published and publicly available to the USSG. If this ommission was deliberate, this would be highly disrespectful to all the pioneering work and discussion that has taken place around tobacco harm reduction in the United Kingdom since 2007. If for some inexplicable reason, the USSG did not feel the RCP report contained any argument or data that were relevant to issues faced by U.S. Public Health services, then I would suggest this is either disingenuous or highly troubling that the USSG believes the RCP and reports cannot in any meaningful way inform a regulatory approach that would be appropriate for the protection and improvement of the health of America’s young people.”

–Dr Christopher Russell

It is clear from the report that there is an emphasis on the harms (potential or otherwise) of e-cigarettes rather than the benefits that can be gained.

“E-cigarette use has increased considerably in recent years, growing an astounding 900% among high

school students from 2011 to 2015.”

The thing is, this “astounding increase” doesn’t have any context. This is, plain and simple, a sound-bite for the media to pick up and echo.

Data from the CDC shows that, yes while e-cigarette use has risen other actual tobacco product use has fallen. But showing information like this alongside combustible tobacco simply reinforces the ideal that e-cigarettes are a tobacco product. Whether you agree with that sentiment is beside the point, it adds to the misconception that the products are bad – after all, the US spends an awful lot of taxpayer dollars telling anyone and everyone that tobacco is a bad thing. (hint: it’s an enjoyable, legal product)

The US also likes to admonish anyone that uses any of the products shown in the graph as “hopelessly addicted” but data from the Monitoring the Future Survey belies that claim:

Experimentation is by far the most common reason why teens use e-cigarettes with tiny number claiming they are “addicted”. If nicotine is such an addictive chemical as is widely (and incorrectly) believed then surely that tiny 0.8-1.3 figure would be much larger? There is already solid data on nicotine within NRT that can, if used correctly, handily debunk such a myth. Some NRT users do indeed continue long past the end of their “course” and those figures are likely to be around the same level – 0.8 – 1.3%.

Meanwhile, the headlines generated in response to this report are only going to further skew public perceptions of the product – look for the next survey data point when the public are asked how harmful they think e-cigarettes are, guarantee there’ll be a jump in “as harmful” and “more harmful”. Which, of course, is the whole point of this exercise isn’t it?

Nowhere in the report is there any understanding of why people choose to vape, nor why they choose to smoke. It is grossly underestimating consumer forces and the market in general. But of course, the US don’t like e-cigarettes. They have a comfy number with the MSA and the various “public health” bodies (yes CfTFK I’m looking at you) that a disruptive product to that arrangement is immediately and irreversibly seen as a “public health threat”.

The only threat to the health of the US public right now is from those out to “save” it.

This now means that the UK is truly isolated in its view on e-cigarettes. Does that mean that our establishment will cave in to the mounting pressure from the US and the WHO?

Time will tell.