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] 9%...in 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.

The Surgeon General’s Misguided Report on E-Cigarettes

Teen smoking declined to record-low levels in 2016, according to the latest University of Michigan annual Monitoring the Future Study, which examines youth tobacco, alcohol and drug use (data tables here).  The figure at left shows the percentage of high school seniors using alcohol, marijuana, cigarettes and e-cigarettes in the past 30 days over the period 1990-2016.

Cigarette smoking among high school seniors plummeted from 19.2% in 2010 to 10.5% this year.  That is, the smoking rate was cut almost in half after e-cigarettes became readily available.  E-cigarette use also dropped over the past two years. 

Days ago, U.S. Surgeon General Vivek Murthy issued a report asserting that e-cigarette use among youth is “a major public health concern.”  The report recycles dire warnings about vaping that have been issued by FDA tobacco director Mitch Zeller and CDC director Tom Frieden, despite the lack of evidence of significant health risks associated with e-cigarettes.

The report is ostensibly a full review of scientific literature relevant to e-cigarettes and smoking among youth.  But as Case Western University law professor Jonathan Adler pointed out in the Washington Post (here), “there are now several studies that look at the effect of restricting teen access to vaping products showing that such measures increase teen smoking (including among pregnant women). I’ll say that again: Reducing youth access to e-cigarettes appears to increase youth smoking rates…Despite their relevance, these studies are completely ignored by the surgeon general. They’re not even listed in the report’s references.” 

Those studies were discussed in this blog (here and here).  Their omission in the Surgeon General’s report is inexcusable.

Why does the government focus on youth as it wars against e-cigarettes?  These products are responsible for virtually no health problems and certainly no deaths among youth and young adults.  In contrast, the MTF survey documents that alcohol is by far youth’s drug of choice.  In 2016, one-third of high school seniors had an alcoholic drink in the past 30 days, and one in five had been drunk, despite laws against underage sales and consumption. 

Young Americans die from alcohol consumption and abuse.  From 2007 to 2014, CDC data (here) shows that accidental alcohol poisoning killed 930 people age 15-24 years.  And alcohol also contributes to traffic fatalities.  With the exception of the elderly, this age group (15-24 years) suffers the highest death rates due to auto accidents.  Comprising just 14% of the U.S. population, this young cohort accounts for 25% of auto deaths (1,544 in 2014).

The Surgeon General’s report is the latest in a series of misleading and unsupported tobacco diatribes (here and here).  The public would be better served if government committed its limited resources based on the relative impact of a substance on children’s health.  Tobacco products should not be ignored, but Dr. Murthy’s report wrongly damns a safer and satisfying product that is currently helping 2.5 million former smokers (here) become or remain smoke-free.