U.S. Military’s Misbegotten Message to Troops: Cigarettes Are Safer Than Vape Products

With regard to tobacco products, the U.S. Department of Defense isn’t serving the health interests of those who serve.

As I have documented many times (here, here, here and here), in pursuing a tobacco-free fighting force, DOD has grossly misinformed American service members about the relative safety of smokeless tobacco and e-cigarettes. 

David Sweanor recently posted the photo at left from an Army and Air Force Exchange Service store. 

Even worse is this Military Times article from September 24,

about the removal of vaping products from Army, Air Force and Navy exchanges by October 1, owing to “the outbreak of mysterious vaping-related lung injuries.” 

Actually, that mystery has been solved.  CDC Principle Deputy Director Dr. Anne Schuchat said on October 25, “The vast majority of patients with [lung injuries] including those who died…, had a history of use of e-cigarette, or vaping, products that contained THC.”

DOD removed products that we now know did not kill 34 Americans who were instead vaping contaminated marijuana liquids, yet DOD continues to sell cigarettes, which have, in fact, killed 380,000 Americans so far this year.

In this case, military intelligence is an attribute of our proud troops, but not of their health officers or administrators.  The Military Times notes:

“Vaping now appears to be more common in the military than smoking regular cigarettes, according to results of the most recent Defense Department Health-Related Behaviors Survey of Active-Duty Service Members. The results of that survey, conducted in 2015, showed 11.1 percent of troops said they were daily e-cigarette users, compared to 7.4 percent who said they smoked cigarettes daily.  In the junior enlisted ranks, nearly 20 percent said they were current e-cigarette smokers.”

The troops have made the switch to vastly safer smoke-free tobacco at far higher rates of use than are seen in the general U.S. population. 

So far, the Marine Corps, which at 16% has the highest prevalence of vaping among the military branches, continues to permit the sale of vaping products, signalling semper fidelis to harm reduction. 

The Army, Air Force and Navy exchanges should immediately reverse their egregious decision and return e-cigarettes and vaping products to their shelves.

Educating Air Force Generals About Tobacco Use & Risks

The Military Health System and the Defense Health Agency last November published a grossly misleading article on their website titled, “Quit the spit: Smokeless tobacco no better than lit” (archived article here).  After I educated Air Force officials, the article was removed.  Here is the story. 

The piece wrongly asserted that smokeless tobacco (ST) use is equally harmful as smoking:

“…putting in a dip or a chew can cause as much harm as lighting up cigarettes... ‘A lot of the effects smoking has on the body – causing blood vessels to narrow raising blood pressure and causing several cancers – are the same for smokeless tobacco,’ said Air Force Col. Thomas Moore, a preventive medicine doctor and in charge of health promotions for the Air Force Medical Support Agency... ‘You’re really not gaining anything by giving up cigarettes just to put in a load of chew,’ said Moore.” (emphasis added)

In a November 18 email I advised Colonel Moore of the article’s numerous errors:

“These passages send the clear, unmistakable and completely false message to military personnel that smokeless tobacco use is just as dangerous as smoking.  Numerous scientific studies published over the past twenty years provide indisputable evidence that smokeless tobacco use is vastly safer than smoking.  For example, a 2002 report by the British Royal College of Physicians (here), one of the world’s oldest and most prestigious medical societies, stated ‘As a way of using nicotine, the consumption of non-combustible [smokeless] tobacco is on the order of 10-1,000 times less hazardous than smoking, depending on the product.’

“Your just-as-dangerous message may be considered a breach of medical ethics.  A 2004 study (here) authored by a panel of international tobacco research and policy experts concluded: ‘…[smokeless] products pose a substantially lower risk to the user than do conventional cigarettes.  This finding raises ethical questions concerning whether it is inappropriate and misleading for government officials or public health experts to characterize smokeless tobacco products as comparably dangerous with cigarette smoking.’

“Members of our armed forces put their lives on the line every day.  The Military Health System and the Defense Health Agency should show them respect by giving them truthful information about tobacco use.  There is a lot at stake.  In another 2007 report (here) the Royal College concluded ‘...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.’

“I urge you to promptly retract the article or issue a substantial revision to reflect the indisputable evidence that smokeless tobacco use is vastly safer than smoking.  Please let me know if I can provide any additional information to facilitate this action.  I appreciate your prompt response to my request.”

In the absence of a response, I sent a similar email to U.S. Air Force Surgeon General Mark Ediger.  This generated a reply from Major General Roosevelt Allen, Jr., Director of Medical Operations & Research in the Office of the Surgeon General.  He wrote that I was “correct in stating that current scientific evidence clearly delineates different levels of health risk associated with the various forms of tobacco use,” and he promised “to see if it is possible to post a clarification of the article on the Health.mil site.”

At General Allen’s request, I supplied a portfolio of published medical articles on ST and tobacco harm reduction. 

Sometime in February, the offending article was removed from the military website.  It is evident that senior Air Force health officials recognized that the Defense Health Agency’s article was indefensible, given the vast difference in risks involved in smoking and ST use.  I am hopeful that this awareness will translate into a rational tobacco policy at the Department of Defense and beyond.

Department of Defense Anti-Smokeless Campaign Is “50” Shades Darker

February is a popular month for tobacco prohibitionists to attack smokeless tobacco (ST).  A year ago, this blog refuted seven false claims (here) from county health departments.  This year, the U.S. Department of Defense (DOD) escalated the attack.

Thanks to David Sweanor of the University of Ottawa Centre for Health Law, Policy & Ethics, we became aware of an outrageous DOD website called UCanQuit.  Sweanor, who has a long history of fighting cigarette company malfeasance, coauthored a commentary last month labeling an FDA ST misinformation campaign unethical (here). 

The DOD site prompts users to engage in chat sessions to obtain quitting advice.  The apparently scripted responses from human agents are filled with false information, such as these from Sweanor’s session:

“Chewers are 50 times more likely than nonusers to get cancer of the cheek, gums, and inner surface of the lips… long-term users have a 50% greater risk of developing oral cancers than non-users.”

A “50 times” risk is a boldface lie (here), as the proven risk is nearly nil (here).  While the American Cancer Society in 2010 told the Wall Street Journal that it would no longer use the 50 number (here), DOD perpetuates that falsehood, even as it makes a contradictory misstatement about a 50% increased risk.

DOD chats are numbingly focused on ST nicotine levels.  In Sweanor’s 12-minute session, the subject came up 16 times: “[ST users] are hooked on nicotine, a highly addictive drug… [ST] products deliver substantial doses of nicotine along with powerful cancer-causing chemicals… nicotine from [ST] is absorbed through the mouth… nicotine obtained from smokeless tobacco is comparable to that of cigarettes… One can of snuff gives you as much nicotine as 60 cigarettes. Nicotine gives you the ‘buzz’ but is highly addictive… [ST] contains MORE nicotine than cigarettes! Using snuff or chewing tobacco may give you three to four times as much nicotine as from smoking a cigarette. And the nicotine stays in the bloodstream longer. Use two cans a week and you'll get the same amount of nicotine as smoking a pack and a half a day…”

When Sweanor inquired, “any difference in relative risks? Is using snus safer than smoking cigarettes for someone addicted to nicotine?”, the response was only more of the same: “one can of snuff gives you as much nicotine as 60 cigarettes…Smokeless tobacco contains MORE nicotine than cigarettes! Using snuff or chewing tobacco may give you three to four times as much nicotine as from smoking a cigarette. And the nicotine stays in the bloodstream longer. Use two cans a week and you'll get the same amount of nicotine as smoking a pack and a half a day.”

Other experts subsequently visited the DOD site to engage in chats, with similar results.  My 12-minute session yielded 14 nicotine mentions, plus one particularly bizarre exchange.

This list appeared suddenly and without context: “1. Cadmium: used in car batteries 2. Formaldehyde: embalming fluid 3. Lead: a poison 4. Nicotine: an addictive drug 5. N-Nitrosamines: cancer-causing chemical 6. Polonium 210: nuclear waste 7. Acetaldehyde: irritant 8. Hydrazine: toxic chemical 9. Benzopyrene: cancer-causing chemical 10. Uranium 235: used in nuclear weapons 11. Sodium: salt, can cause high blood pressure 12. Sugar: can cause cavities 13. Fiberglass and Sand: abrasive”

The implication was that these are deadly constituents of ST.  I have previously noted that such lists are meaningless, as everything we consume contains trace amounts of contaminants (here).  Chew and dip are no exceptions, but the contaminants at trace levels pose zero risks (here).

Because tobacco prohibitionists often imply that such trace contaminants are added to ST, I asked my chat correspondent: “I don't understand the answer starting with cadmium. Do you mean that those things are added to dip and chew?”

Chat operator:  “Yes they are.”

I asked: “How do dip and chew makers get access to uranium?”
 Chat operator: “I have no idea.”

Finally, an honest answer.
  
DOD has gone to the dark side with their taxpayer-funded, unfactual, anti-smokeless website. It should be taken down.