Scientists Slam US Surgeon General's Attitude Towards E-Cigarettes

If you've heard of the US surgeon generals report on e-cigarettes, you're probably aware that it is far from positive.

The report:

• painted a picture of an e-cigarette epidemic amongst youth smokers
• ignored rapidly falling smoking rates amongst youth since e-cigs became popular
• used data from smoking studies to reach conclusions on nicotine in vapour
• ignored the potential health benefits of e-cigs

The report also outraged a group of scientists and anti-smoking campaigners, Professor Polosa of the University of Catania, Dr Russell from the Centre for Substance Use Research, Dr Nitzkin, Chair of the Tobacco Control Task Force of the American Association of Public Health Physicians, and Professor Konstantinos, research fellow at the Onassis Cardiac Surgery Center in Athens, Greece.

This lead them to the unusual step of releasing a paper analysing the report - with some shocking conclusions.

We caught up with Riccardo Polosa to learn more...

You, along with other scientists, released a paper criticising the US Surgeon General’s 2016 report on e-cigarettes. That’s a serious step to take, and obviously you must have had some huge concerns about the report.

What, in your opinion, are the biggest problems with the Surgeon General’s report, and what spurred you and the co-authors to take this step?

We were surprised to find that data used in the 2016 SG Report has been totally misinterpreted suggesting exaggerated health risks of ECs [e-cigarettes] and an apparent epidemic of these products among US youth.

The Report draws conclusions on ECs use among US youth, when in fact most of the data cited is irrelevant because it refers to studies in adults and to the risk of nicotine in the tobacco smoke. Last but not least, this Report does not consider the actual or potential impact of ECs on the population as a whole.

The possibility that ECs could have a favourable population impact by diverting potential smokers to these less addictive and less hazardous products and by inducing smokers to switch are dismissed out of hand as seemingly unlikely and without sound scientific justification. In our opinion, the Report was so misleading and so evidence-baseless that it demanded critical appraisal. My colleagues and myself felt that taking this step was the right thing to do.

In your report you’ve highlighted some huge errors, such as over emphasising the toxicity of propylene glycol and vegetable glycerine, misrepresenting data to exaggerate the impact of vaping on US youth smoking rates and neglecting the positive impact vaping can have on public health.

Do you think these errors were accidental or deliberate? What do you think motivated the Surgeon General to include an attack on electronic cigarettes?

It is hard to say. Until now, SG Reports have been always so impartial and taken as authoritative that it seems unreal that the incorrect interpretation of the data was accidental. For reasons I do not quite understand, the US health establishment is particularly anti-ECs. No one wants to fault the Surgeon General for wanting to protect America’s youth from using tobacco products, but the suggestion that ECs pose a grave public health crisis is far from reality.

What damage has the Surgeon General’s report caused?

The Report failed to acknowledge that these products are a much less harmful alternative to cigarettes and that the current data does not show them to be a threat for young people. This is a very important health issue.

Leading people to believe that ECs are a big danger for their health has serious unintended consequences; many smokers in the US and around the world will not switch to a much less harmful alternative to combustible cigarettes just because of the general panic fuelled by respected health authorities.

In the UK we’ve seen a much more supportive attitude towards electronic cigarettes. What do you think accounts for the difference in attitudes we have seen until now from US regulatory authorities?

It seems obvious that US public health authorities are doing everything in their power to demean and discourage people from using alternative options to conventional cigarettes. To make things even worse, the latest FDA regulations, if eventually implemented, will eliminate most, if not all vapor products from the market, leaving only the pharmaceutical alternatives, which many smokers have tried and abandoned as unsatisfying and ineffective.

The rapidly expanding popularity of ECs is a threat to the interests of both the tobacco and pharmaceutical industry. Most importantly, the large revenues generated by tobacco excise taxes are much needed by national governments to run their countries and to sponsor their anti-tobacco policies. These are particularly important factors in the US, probably much more than in the UK.

What do you hope to achieve with this paper?

This is a great question! We sincerely hope that regulators and health authorities in the US and all over the world will objectively consider this document as a basis for an open dialogue on Tobacco Harm Reduction.

ECs are part of a tobacco harm reduction strategy that can be integrated into the currently existing Tobacco Control Policies with the goal of accelerating the decline in smoking prevalence and to reduce and prevent tobacco-related disease. Maybe this is too ambitious…. Alternatively, we simply hope that future Reports of the SG on the topic of ECs will provide a more accurate reflection of the available research.

How can vapers, and supporters of tobacco harm reduction, help to get your message across?

Vapers should continue doing what they do best – give smokers advice on how to properly embrace a vaping lifestyle in order to quit tobacco smoking. That is the best way to prove we are doing the right thing. The vaping community should be proud of this role in “public health”.

Supporters of tobacco harm reduction should keep engaging with researchers, doctors, nurses, politicians, health authorities and the community to get the message across. They should be, however, very careful in scrutinising “bad” from “good” science.

Thank you to Riccardo Polosa for once again taking the time to answer our questions! You can read more about Professor Polosa's research into vaping here.

Research mentioned in this post

Polosa R. et al, A critique of the US Surgeon General’s conclusions regarding e-cigarette use among youth and young adults in the United States of America, Harm Reduction Journal, Aug 2017 https://doi.org/10.1186/s12954-017-0187-5