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Fantasy-based policymaking at the CDC

The director of the Centers for Disease Control and Prevention gave the Los Angeles Times a list of 5 reasons he hates e-cigarettes. There are no surprises: it is the usual list of fantasies given by e-cig opponents for making anti-vaping policy decisions. For some reason, the Times chose to put it on the "Science" page, despite a complete lack of evidence for the fantasies in the list.

Dr. Thomas Frieden, Director of the Atlanta-based health agency, gives us a list of "if's".  The "gateway effect" is the first fantasy he lists. "If they get another generation of kids more hooked on nicotine and more likely to smoke cigarettes, that’s more harm than good," he says. No contest – if vaping were to do that, it would certainly be bad. But there's no evidence that it does, no matter how often opponents cite this fantasy as proven fact. Surely Dr. Frieden knows that smoking among youth declined during the very period when e-cig use was rising in the same group. His agency reported the rise in vaping with horrified rhetoric, but never mentions the simultaneous drop in smoking in the same breath.

The next three fantasies are related. Vaping might discourage smokers from quitting, and corollary to this, they might encourage successful quitters to return to nicotine through vaping and then go back to smoking cigarettes (why?), and they might discourage people from using approved medical quit methods. No evidence is presented for these scenarios. One of the subtexts here is about "dual use". What does it mean to "quit smoking"? Any puffs taken on a vaporizer are puffs that are not on a cigarette, and some people wean themselves away gradually. Some continue to have an occasional cigarette while vaping most of the time. These people are insignificant to hardliners. According to hard-line anti-vaping enthusiasts like Frieden and Stanton Glantz of the University of California/San Francisco, anyone who ever smokes a cigarette after "quitting" is just as much of a smoker as someone currently puffing down 2 packs a day. They opine that there is no difference in the health danger posed by one cigarette a day and that posed by 40. Many of the vapers Frieden would say are "discouraged from quitting" are in fact gradually reducing their smoking, but the hardliners' statistics admit of no gray areas. Regarding the 2nd corollary, that vaping might discourage approved medical methods of quitting, wouldn't it make more sense to assume that vaping is preferred to, say, the patch, because it works better? (Marginally better, but nonetheless better, according to a New Zealand study.)

Frieden concedes that “stick to stick, they’re almost certainly less toxic than cigarettes" (re: "almost" -- yes, and drinking cola, while not healthy, is "almost certainly" less harmful than drinking laundry bleach – I don't have scientific statistics, but still I'd be willing to bet on it), and that they have helped some people quit. Frieden pooh-poohs this as "anecdotal", saying that "the plural of anecdote is not data." What about many thousands of anecdotes? At what point does a number become a statistic? Only when it's produced by a CDC-funded study? Numbers are numbers – saying otherwise is just mumbo-jumbo.

There's another inaccuracy in the picture Frieden presents. He opines that "the FDA has been challenged by the tobacco industry... at every step of the way.... [The FDA] “tried to regulate e-cigarettes earlier, and they lost to the tobacco industry." Every step? The tobacco industry? Simply not true. The tobacco industry didn't become involved in e-cigarettes until 2012, with Lorillard's purchase of Blu. Frieden is thinking of the court's decision in FDA v. Sottera, a ruling passed down in 2010. The companies involved were vaping industry companies, not Big Tobacco. E-cigs may be deemed a tobacco product since last Thursday, but they were not so deemed in 2010; it was as a health product that the FDA was trying to regulate them. It was not the tobacco industry that the FDA lost to in 2010.

Frieden's 5th reason for hating e-cigarettes is that they might re-glamorize smoking. Look again. What's being hailed as glamorous these days is not smoking but vaping: mods, personal vaporizers, vape pens, tank systems – the less it looks like a cigarette the more glamorous it looks these days!

There is a place for fantasy. Lewis Carroll's Queen of Hearts believed in believing six impossible things before breakfast. Even in the formulation of public policy, fantasy might not be necessarily harmful – imagining international conflicts or world markets might prompt us to make military or trade policy. But a policy decision to restrict a product that is saving lives, admittedly (see above) saving lives, on the basis of unsubstantiated fantasies, is unworthy of a great scientific institution.

Thank goodness the FDA seems poised to listen to realities before making its decisions.