CDC director misleads Medscape

by Elaine Keller

Centers for Disease Control and Prevention (CDC) Director Thomas R. Frieden, MD, MPH, sat down with Medscape during the recent National Health Research Forum in Washington, DC, to mislead the public about electronic cigarettes. http://www.medscape.com/viewarticle/811616  The following includes some of his comments and my corrections of the lies.

Medscape: There is a growing health concern about the electronic cigarette and how it is being marketed to consumers… What is the CDC doing to address this concern?

Dr. Frieden:  “What we are doing first is tracking…and we are seeing some very concerning trends.”

This is a misleading non sequitur and only the first half of the statement is true.  CDC has done no apparent research on marketing.  They are doing some tracking, but only about usage, not the reasons for usage.  And their data suggest nothing that is “very concerning”.

The CDC tracking he refers to seems to consist of their National Youth Tobacco Survey.  It asked youth whether they have ever tried an e-cigarette and whether they used an e-cigarette during the 30 days preceding the survey, even if only once. In addition, they asked youth whether they smoke conventional cigarettes. In order to make the numbers for trying e-cigarettes seem high, they intentionally avoided comparing them to the (much higher) numbers for youth smoking.  They also claimed there is a causal connection between e-cigarette experimentation and initiation of smoking, as well as claims that non-cigarette flavors are particularly appealing to youth, but they did not collect any data that addresses those claims at all — they just made them up.

Here is what the CDC is not reporting about e-cigarette use (some of which they do not know because they did not ask, and some of which they do know but avoided reporting):

  • How many students use e-cigarettes regularly or daily?
  • Among students who currently use e-cigarettes, how many are also smokers, or are former smokers who switched to e-cigarettes?
  • Among students who have ever tried e-cigarettes, how many prefer candy or fruit flavors, or even use them at all (let alone were attracted due to those flavors)?
  • How students are obtaining e-cigarettes?  Which merchants are refusing to sell to them and which are not?  Are the products they are using the ones that are actively advertised?

Dr. Frieden:  Use of e-cigarettes in youth doubled just in the past year…

Misleading! The only statistic that doubled was “ever use” which is really ever tried.  This category will inevitably increase for a novel product, even if there is no significant regular usage. If one student tries a puff, he is forever in that category, and if a second student tries a puff the next year, the statistic would double. This number grew from 3.3 percent in 2011 to 6.8 percent in 2012. However, the percent of youth in grades 6 through 12 who used an e-cigarette (even so much as one time) during the 30 days preceding the survey was only 2.1 percent.

Dr. Frieden:  “…and many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes.”

False. The CDC collected no data that would support this allegation.  Perhaps more important still, even if someone tried an e-cigarette and went on to smoke does not mean that the e-cigarette caused the smoking. Most people — quite possibly everyone — who follows that pattern would have started smoking anyway.  There is no reason to believe that e-cigarette use would make smoking more appealing, since we know that it generally makes smoking less appealing.  The whole reason e-cigarettes exist is to make smoking less appealing!

Assessing whether use of one product causes the use of another (rather than just precedes it) is quite difficult, which makes it easy for people like the CDC to lie for political reasons.  If it is true — if anyone is honestly interested in the answer, rather than just wanting to lie about it — we will know once e-cigarette use becomes so popular that we see an increase in smoking.  Past 30-day smoking rates have been steadily declining for youth between ages 12 and 17, dropping from 8.7 percent for males and 9.3 percent for females in 2009 to 6.3 and 6.8 percent, respectively, in 2012 (source).  Likewise, smoking initiation rates dropped from 6.2 percent for males and 6.3 percent for females in 2009 to 4.7 percent and 4.8 percent, respectively, by 2012.  If youth e-cigarette use is causing more smoking (rather than further reducing it, as it does with adults), this trend will reverse.  It seems impossible that this will happen.

Dr. Frieden: “Nicotine can be a very addictive drug, so we want to make sure that e-cigarettes don’t lead to another generation of kids becoming addicted.”

There is no basis for this claim.  There are strong arguments that nicotine (as opposed to cigarettes) is not addictive, and certainly no evidence to the contrary.  (See the previous post by CVP, for more on this topic.)

Though we do not know what he means by “addiction” we can guess at it and propose some real analysis that CDC seems oblivious to. They need to assess how many of the possible “addicts” (daily use might be a necessary condition for addiction, but it is not sufficient) were already regular smokers. Telling us that 9.3 percent of those who tried an e-cigarette (that may or may not have contained nicotine and perhaps tried only one time) were non-smokers provides no information at all about e-cigarette addiction. One way to get some notion of whether nicotine via e-cigarettes is addictive would be to track the number of never-smokers who became regular, daily users of e-cigarettes that contain nicotine. The CDC has not researched daily use or even whether the e-cigarettes being used by youth contain nicotine.

Dr. Frieden:  “In addition, if smokers want to quit, we know that there are FDA-approved medications that can double or triple their likelihood of succeeding.”

Been there, done that. The majority of adult smokers who turn to e-cigarettes have already tried FDA-approved medications more than once. One advantage of e-cigarettes is that the nicotine dose can be tailored to keep withdrawal symptoms under control.  Also, the only medicines that help more than a miniscule fraction of smokers (the case with NRTs) have major bad side effects.  I would be very interested in Frieden’s basis for claiming that these are better than e-cigarettes.

Dr. Frieden:  “Also, we need to make sure that people who have quit smoking don’t get hooked back on nicotine by starting up with e-cigarettes and then go on to smoking conventional cigarettes.”

Not likely. Many former smokers struggle with strong urges to smoke for years after quitting. Not having a satisfying substitute is the major risk for relapse. E-cigarettes with nicotine help prevent relapsing to conventional cigarettes. There are no reports of people who had quit smoking taking up e-cigarette use and then returning smoking conventional cigarettes.

It is bad enough that people who are paid anti-THR liars make claims like this.  But Frieden works for the U.S. government, and so has a legal obligation to tell the truth.  His moral obligation to tell the truth is also stronger since when he makes statements that contradict the facts, it will likely affect policy and thus hurt the public.

[For more on Frieden's lying, see also this post by Michael Siegel.]

11 responses to “CDC director misleads Medscape

  1. This is the truly most outrageous lie in my opinion: “Dr. Frieden: “…and many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes.”

    I have **NEVER** seen even a **HINT** of any data **ANYWHERE** that would support such an assertion. If he had said “some kids” he could at least claim that somewhere in the world there must be two or three “kids” that would fit the claim, but to say “many”? Frieden should be challenged directly on this statement in EVERY interview he EVER does on e-cigs in the future until he either produces sound evidence for it or retracts it. Indeed, I’d say the e-cig people might have solid grounds for a lawsuit against him on the statement for injuring their business interests with a bald-faced lie. (I’m assuming here of course that he has no data… but I think that’s a pretty safe assumption or else Elaine would have known and I would have known.)

    – MJM

  2. Oliver kershaw

    Dr. Frieden appears to be lobbying on this issue on federal time. Correct me if I’m wrong, but is this not quite illegal?

    • Carl V Phillips

      He can probably get away with the advocacy, based on the claim that it is part of his job. Maybe not though — I’m not sure. However what is clearly a violation of the law is the government promulgating lies. A legal foundation had some success on this topic, almost ten years ago, forcing NIH et al. to remove some of their lies about smokeless tobacco from their websites.

      It could probably also be done in this case, but it really requires a legal foundation, which CASAA cannot be. Anyone out there?

  3. Pingback: CDC director misleads Medscape | vapeforlife

  4. Advocating for or against federal regulations is NOT legally considered lobbying, which is why foundations (e.g. Legacy, RWJF) and federal and state government agencies can lawfully spend money advocating for or against federal regulations, but cannot lawfully spend money to lobby elected officials for or against federal or state legislation.

  5. I suppose this can be considered another case of fear mongering when the facts do not support this. This seems obvious from statements that appoved medications having 2 or 3 times higher chance of sucess. Which in reality means 7-10% success rate. So, those lucky enough to be in the 7-10% group are fine. The rest should do what? Keep smoking???

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  7. Pingback: E-cigarettes: The Jury is Out…But It Shouldn’t Be on Extending the NYC Smoke-Free Air Act to Their Use | The Flying Vapor

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  9. Pingback: CDC Director Misleads Medscape | The Spinfuel Network

  10. Other than this website, I can’t find anybody who dares to challenge these lies (and that’s exactly what they are). This guy feels free to promulgate whatever fictions promote his twisted agenda, knowing that they will not be questioned and, instead, will be widely repeated in the media, in state, federal and local hearings, at school board meetings and elsewhere. This makes me alternatively very sad and angry and I feel powerless to do anything about it.

    It would be one thing if he were spreading harmless lies about, say, football statistics or what brands of bluejeans teens prefer, but these lies are calculated to demonize products which have not been shown to cause significant adverse effects and which are saving many lives.

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