Friday, January 31, 2020

The Surgeon General’s Bogus Report on Smoking Cessation

The U.S. Surgeon General’s new 700-page report on smoking cessation includes a foreword by former CDC director Robert Redfield that succinctly describes the government’s tobacco prohibition objective: “we remain committed to…end the tobacco use epidemic and provide all Americans with the opportunity to live tobacco-free.”

The report’s “major conclusion” with respect to e-cigarettes is that “there is presently inadequate evidence to conclude that e-cigarettes, in general, increase smoking cessation.” 

This is the standard position of prohibitionists.  They state with absolute certainty that vapor injures cells, animals and people; and it causes addiction, teen epidemics and a host of other nasty problems.  But with respect to positive impact like smoking cessation, well, there’s just not enough evidence.  Federal authorities minimize as mere “anecdotes” the millions of cases of former smokers who have quit via vaping.

Far more difficult to ignore are the many well-conducted clinical trials published in prestigious medical journals.  For example, Hajek et al. published the results of a British trial in the New England Journal of Medicine, reporting that e-cigarette users are more likely to quit smoking than smokers using nicotine medicines (Relative risk = 1.83; 95% confidence interval [CI], 1.30 to 2.58).  Commenting on this research, the Surgeon General emphasized largely vaporous caveats.  The UK, he said, is different than the U.S.  More research needs to be done, he argued, and most importantly, “80% of participants in the e-cigarette group were using e-cigarettes at 52 weeks follow-up [versus] the [nicotine medicine] group.”  In other words, the Surgeon General was more impressed with the 4 subjects (out of 44) who achieved complete abstinence than the 63 (of 79) who were vaping, but NOT SMOKING, at one year.

The Surgeon General also shortchanged epidemiologic evidence published by me in 2017.  I found population-level proof in an FDA survey that e-cigarettes are not only popular, they are the only aid more likely to make one a former smoker (i.e., a successful quitter) than quitting cold-turkey.

While, to his credit, the Surgeon General cited my study twice in his report, he never mentioned my main finding.

The Surgeon General’s bogus claim of “inadequate evidence … that e-cigarettes … increase smoking cessation” and his failure to stem smokers’ deaths by encouraging switching to vaping are a disservice to the cause of public health.

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