US Surgeon General sounds alarm on e-cigarettes, teens; but report shows gross misunderstanding of entire subject

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The U.S. surgeon general in a report released on Thursday (December 8, 2016) called for action to reduce the use of e-cigarettes among young people, noting they have overtaken cigarettes to become the most commonly used tobacco products among this group.

@Surgeon_General calls for action to reduce the use of #ecigs among young people Click To Tweet

Vivek Murthy, the country’s top doctor, in the first Surgeon General’s report on e-cigarettes use among youths, said young people were more vulnerable to the negative consequences of nicotine exposure than adults and should be protected, says Reuters.

“We know a great deal about what works to effectively prevent tobacco use among young people,” the report said. “Now we must apply these strategies to e-cigarettes.”

The report recommends that e-cigarettes be incorporated into existing smoke-free policies to prevent youth from accessing e-cigarettes. Such policies include imposing price and tax policies that discourage use.

The report drew a swift and angry response from those who argue that e-cigarettes may have the potential to help smokers quit, thereby lowering the overall burden of death and disease caused by conventional cigarettes.

“The long tradition of scientifically rigorous messages and reports from the U.S. surgeon general appears to have ended,” the public policy group R Street said in a statement. “The report focuses on youth experimentation and completely omits the opportunities for harm reduction these devices offer for adult smokers,” of which there are some 40 million.

The report states that there is no evidence to support claims e-cigarettes help people quit smoking. It concedes, however, that neither is there proof young people who begin vaping move on to smoking traditional cigarettes.

“More studies are needed to elucidate the nature of any true causal relationship between e-cigarette and combustible tobacco product use,” it said.

Statistics from the Centers for Disease Control and Prevention (CDC) show that as e-cigarette use has risen among young people, smoking rates have gone down. Between 2011 and 2015, use of e-cigarettes among U.S. middle school students rose to 5.3% from 0.6%, according to the CDC.

Use of combustible cigarettes among U.S. middle school students fell to 2.3% from 4.3% over the same period. E-cigarette use among high school students rose to 16% in 2015 from 1.5% in 2011. Over the same period, 9.3% of high school students reported smoking traditional cigarettes compared with 15.8% in 2011.

Even so, because research related to e-cigarettes is so new, the report said, a “precautionary principle” should be employed to help prevent e-cigarette use among young people:

“This principle supports intervention to avoid possible health risks when the potential risks remain uncertain and have been, as yet, partially defined.”

The report comes as the overall smoking rate in the United States fell in 2015 to a record low of 15%. Public health experts fear those gains could be lost if young people become addicted to nicotine via e-cigarettes and progress to using more damaging conventional cigarettes.

E-cigarette advocates say it is entirely possible that the products contributed to the decline in smoking. Reynolds American Inc., Altria Group Inc. and Fontem Ventures, a subsidiary of Imperial Brands PLC, are among the leading manufacturers of the devices.

Their use has grown quickly in the past decade, with U.S. sales expected to reach $4.1 billion in 2016, according to Wells Fargo Securities. However, use of vapor devices among the population as a whole has stalled in the United States as more Americans question their safety, according to an online Reuters/Ipsos poll released in May.

Marlboro maker Philip Morris International Inc. last week filed its first U.S. application to market an electronic tobacco product with a claim that it is less harmful than cigarettes. The device, called iQOS, contains real tobacco which is heated but not burned.

Steve’s Take:

Like Jacob Sullum, one of Forbes’ brightest and most articulate contributors, I also am a conscientious objector on this particular subject. Our Surgeon General, Dr. Vivek Murthy, apparently doesn’t have a lot left to do on his remaining calendar because this latest report about e-cigarettes misses the mark in so many ways as to make an opening response to it almost impossible.

But first, some recent history about smoking, in general.

In 1962, two years before then U.S. Surgeon General Luther Terry released his famous report on the health hazards of smoking, the Royal College of Physicians (RCP) covered the same subject in a report that went further than Terry’s, linking cigarettes to cardiovascular disease as well as lung cancer and chronic bronchitis.

Back in April, the RCP issued another landmark report that should have inspired imitation in the United States, endorsing e-cigarettes as a harm-reducing alternative to the combustible, tobacco-containing kind, says Forbes.

“Large-scale substitution of e-cigarettes, or other non-tobacco nicotine products, for tobacco smoking has the potential to prevent almost all the harm from smoking in society,” the RCP said. “Promoting e-cigarettes…and other non-tobacco nicotine products as widely as possible, as a substitute for smoking, is therefore likely to generate significant health gains in the UK.”

Then the RCP report carefully addresses the concerns raised by critics of vaping.

“E-cigarette vapor contains a far less extensive range of toxins, and those present are typically at much lower levels, than in tobacco smoke,” the report notes. “In normal conditions of use, toxin levels in inhaled e-cigarette vapor are probably well below prescribed threshold limit values for occupational exposure, in which case significant long-term harm is unlikely. Some harm from sustained exposure to low levels of toxins over many years may yet emerge, but the magnitude of these risks relative to those of sustained tobacco smoking is likely to be small.”

The RCP report concludes that,

“Although it is not possible to quantify the long-term health risks associated with e-cigarettes precisely, the available data suggest that they are unlikely to exceed 5% of those associated with smoked tobacco products, and may well be substantially lower than this figure.”

Similarly, a 2015 report from Public Health England said, “it has been previously estimated that [electronic cigarettes] are around 95% safer than smoking,” which “appears to remain a reasonable estimate.”

Given this huge difference in risk, I agree with Sullum it is completely irresponsible for government officials and medical authorities to discourage smokers from switching to vaping by implying (or stating outright) that tobacco-free, noncombustible e-cigarettes are just as dangerous as the real thing.

The RCP argues that appropriate safety regulations could further reduce the hazards posed by e-cigarettes. But it warns that if regulation:

“makes e-cigarettes less easily accessible, less palatable or acceptable, more expensive, less consumer friendly or pharmacologically less effective, or inhibits innovation and development of new and improved products, then it causes harm by perpetuating smoking.”

That’s a pretty strong endorsement of the need for safety regulations. And the same conclusion should but hasn’t occurred in the United States, where public health officials tend to view e-cigarettes with fear rather than hope.

Yes, the Hippocratic Oath emphasizes, “firstly, do no harm.” But above all, the RCP report goes to lengths to champion the much greater need to actively promote the accessibility of e-cigarettes as a primary public health objective.

Alright, I’ve been holding back some news reported earlier in the week–in case you weren’t aware of it–that further disparages the Surgeon General’s report. And it’s incredibly good news, though mentioned only in passing in the Reuters report, so hang on to your hats.

For the first time since record keeping began 50 years ago, the number of Americans who smoke cigarettes has dropped below 40 million. The CDC reports that between 2005 and 2015, the percent of cigarette smokers declined to 15% from 21%, says The New York Times. That’s a plunge of 29%!

There were significant reductions in smoking across all ages, races and ethnicities, socioeconomic levels and regions of the country. In 2005, there were 45.1 million smokers in the country. By 2015 there were 36.5 million. Sixteen percent of men and 14% of women smoked in 2015, down from 24% and 17% in 2005.

Smoking declined most sharply in the youngest age groups. But 13% of 18- to 24-year-olds, 18% of 25- to 44-year-olds, 17% of 45- to 64-year-olds, and 9% of those over 65 were still smoking.

There was almost no difference between the percentage of non-Hispanic whites and non-Hispanic blacks who smoked–around 16.5%–and 10% of Hispanics smoked cigarettes. Medicaid recipients are one of the few groups in which smoking has slightly increased.

“We’ve made commendable progress toward reducing smoking, the leading cause of death in this country,” said Brian A. King (pdf), a deputy director in the office of smoking and health at the CDC. “But there’s still work to do,” he added. “If we’re going to make a difference, we need to implement what we know works: price increases, mass media attention and prevention services.”

Even as a conscientious objector, I would argue that included in “prevention services” are e-cigs.

But what do “people on the street” say about e-cigs and the smoking controversy?

I was surprised by my complete ignorance of what ordinary people believe and what’s reported in the media when I canvassed several of my adult children, the youngest among whom is a 21-year-old male. Here’s a summary of what they say about vaping at an early age:

“Kids are after the flavor and the smoke of an e-cigarette–not the nicotine. It’s the “juice”–the flavored liquid of which there are thousands, like coffee, fruit punch, mint, even apple pie, to name just a few. Countless combos. And some people make their own juice.”

“It’s really about blowing the clouds; sure, you can get juice with all different concentrations of nicotine from zero to 0.1%, which could be one puff on a cigarette. However, the nicotine isn’t really why people most people are vaping. But to people trying to quit cigarettes, it’s about smoking something, anything–it’s an oral fixation to them.”

“Smokers use it as an alternative in order to quit. They get more interested in the flavors, until they no longer need cigarettes.”

“There are even competitions where the prizes can be $10,000 to blow the biggest cloud in a certain amount of time.”

Thus, among our youth, it’s not just the nicotine that’s the draw. It’s the smoke, the tricks and the varieties of the juice. It gives kids a cool way to practice “smoking;” to get good at it.

Then there’s the economics. Vaping is much cheaper than cigarettes. An average pack of cigarettes is now $7-$9 with the new laws, and in California and New York, for example, with the additional tax, a pack of American Spirits costs $10-$12. For a single pack!

Now let’s look at the current market prices of e-liquids and regular tobacco cigarettes. A 10ml bottle of juice usually costs $6.99, so a pack of tobacco cigarettes is around $1.40 in ecig vapor, says VaporHQ. A 15ml bottle that sells for $9.99 equals $1.33 per pack.

What’s my final take? Our Surgeon General says e-cigarettes “are not safe for our youth.” He warns use of e-cigarettes by American teens “has the potential to create a whole new generation of kids who are addicted to nicotine.”

He casts “vaping” as an emerging public health threat for young people and has said more research is needed into the effects of e-cigarettes but added that they aren’t harmless and too many teens are using them.

Well, neither is hours on their cell phones and Facebook, nor drinking and eating Coke products, nor surfing.

Europe is way out in front of us on this. They know that the more you clamp down on youth, saying something lame like vaping is dangerous, without any further elaboration, the more likely they are to rebel and try it.

If anyone thinks that our youth here in the US will be dissuaded from vaping by the Surgeon General’s report, I predict it will only convince them that our government agencies and we parents don’t know what’s really going on in their world if we support it. Kind of like when we were in their shoes.

Steve's Take: #ecigs are a part of the solution to reducing #tobaccosmoking, not the problem Click To Tweet

And with rates of smoking tobacco cigarettes dropping precipitously, I’m reminded of the old saying, “If it ain’t broke, don’t fix it.”  Let’s not mess with a good thing. E-cigs are a part of the solution, not the problem, to quitting or not initially taking up tobacco smoking, especially among our youth.

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