The vast difference in governmental perceptions of e-cigarettes in Britain versus the United States is alluded to but not fully fleshed out in a New England Journal of Medicine commentary by Sharon Green and colleagues at Columbia University’s Mailman School of Public Health (here).
Green describes Britain’s scientific and rational approach by highlighting Public Health England’s report (described by me here) and other key developments, like the Royal College of Physicians’ 2007 analysis that challenged governments to consider “...that smokers smoke predominantly for nicotine, that nicotine itself is not especially hazardous, and that if nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved.”
Green should have referenced a 2002 RCP report, which, as I stated in congressional testimony one year later (here), underscored that smokeless products are up to “1,000 less hazardous than smoking” and established tobacco harm reduction as a viable public health strategy.
While Green notes that “England and the United States have now staked out very different positions” on e-cigarettes, her description of the American government’s inimical approach is inadequate. She refers without citation only to a CDC conference “on e-cigarettes in which all five speakers focused on the possible health risks…None acknowledged a potential role for e-cigarettes in reducing the tobacco burden …Given the tight focus on potential risks to children and nonsmokers, e-cigarettes were out of the question.”
That is correct, but the CDC has done much worse. Green could have cited numerous misleading agency reports and publications, as I have done in this blog:
- A publication authored by Dr. Brian King, who suggested that increased use of e-cigs among former smokers might be due to relapse among people who were previously abstinent (here)
- Reports and press releases about children’s use of e-cigs that distort and misrepresent federal survey data to cast e-cigs as gateways to smoking (here, here and here)
- A published study that redefined youths who were “probably not” intending to smoke as those who intended to smoke (here)
- A report and press release claiming, “There is no conclusive scientific evidence that e-cigarettes promote successful long-term quitting,” while CDC director Tom Frieden claimed without evidence that “Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes” (here)
- A joint press release with the FDA asserting, “the progress we have made in reducing youth cigarette smoking rates is being threatened…” by “the surge in youth use of novel products like e-cigarettes” (here)
- A report bashing e-cigarette flavors that was replete with technical discrepancies (here)
One wonders if Green’s omission of specific evidence of the government’s tobacco prohibition campaign is due to a reluctance among American academics to criticize the main source of university research funding (discussed here). In contrast, two respected tobacco researchers just published (here) convincing evidence that the CDC has kept “in quarantine” data on the risk differentials of smokeless tobacco vs. cigarettes – a choice likely based on the CDC’s reluctance to reveal that smokeless tobacco-related deaths are near zero.