Surgeons General Say the Darndest Things About Tobacco

Acting U.S. Surgeon General Boris Lushniak recently tweeted, “@OxfordWords #Vape may be #WOTY but the increase in never-smoking youth using e-cigs is a not a trivial story.”  The tweet referred to the Oxford English Dictionary’s having designated “vape” as the word of the year, and reflected a CDC report claiming that e-cigarette use among children had increased in 2013.  The prevalence of e-cig use among youth who had never smoked was 0.3%. 

Tobacco use by youth is never trivial, but in taking an extreme position, Dr. Lushniak was acting in the tradition of previous surgeons general.

In December 1992, Surgeon General Antonia Novello announced: “The majority of our experts predict an oral cancer epidemic beginning two or three decades from now if the current trends in spit tobacco use continue.” (here).  That was shocking news for many, including this oral cancer expert.  As an oral pathologist for 15 years at Emory University and the University of Alabama at Birmingham – deep in smokeless tobacco country – I had made microscopic diagnoses in hundreds of oral cancer cases (almost all smoker/drinkers), and I had assisted in the treatment of hundreds more.  Over time, I had become increasingly bothered by the disconnect between the dogma I taught my medical and dental students (that smokeless tobacco was a death sentence for oral cancer) and what I had experienced in practice (that smokeless tobacco was almost never listed as a behavior on the pathology request forms, the rare exception being powdered dry snuff).

Dr. Novello’s announcement was the catalyst for my research, which led to my first journal articles in 1994 (here and here), and my book, “For Smokers Only”, in 1995.  (An updated version with a new chapter on e-cigarettes is now available in print and as an audiobook here).   

I testified at a 2003 Congressional hearing on tobacco harm reduction (available here), at which Surgeon General Richard Carmona also testified. (Dr. Carmona is today an NJOY director and chair of its scientific advisory committee.)  In that hearing Dr. Carmona said, “there is no significant evidence that suggests smokeless tobacco is a safer alternative to cigarettes.”  I subsequently noted in a Washington Times editorial (here) that the surgeon general had ignored decades of published research and the findings of Britain’s esteemed Royal College of Physicians.

Dr. Carmona so blundered in supporting a ban on all tobacco products that Bush administration officials had to backtrack.  “This is not the policy of the administration,” White House spokesman Scott McClellan said, adding that Dr. Carmona’s comments reflected his views alone.

The surgeon general occupies one of the most trusted positions in American medicine. The individual holding that post should speak the truth about safer cigarette substitutes, today and always.