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Siegel to Frieden: No Data for Gateway

Michael Siegel of Boston University's School of Public Health chides the chief of his former workplace, the Centers for Disease Control, Thomas Frieden, for making unjustified claims that e-cigarettes have been demonstrated to lead to smoking on the part of children and adults. Siegel, a noted harm reductionist in the field of nicotine science, has long maintained that the potential benefits of e-cigarettes far outweigh any possible harms, and that the product should be allowed to compete unrestricted with tobacco cigarettes in the marketplace.

Opponents of vaping products, among whom Frieden stands out as one of the most prominent and one of the most vociferous, have long maintained that electronic cigarettes will inevitably entice non-smokers, particularly young people, to take up cigarette smoking. Frieden has been a particularly outspoken proponent of this theory, stating it often as an unquestionable fact in several top-ranked public forums. Many have faulted him for taking this indefensible stance, among them this column. Siegel's voice is a powerful one, pointing out that the allegation has no support in the rapidly emerging data. The appearance of his op-ed piece in a publication as prestigious as the Wall Street Journal is truly a landmark.

"Many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes," said Frieden in September 2013 in an interview with Medscape, a website aimed at physicians. The Associated Press quoted him as saying that e-cigarettes are "condemning many kids to struggling with a lifelong addiction to nicotine."

Siegel calls this idea a "myth". By and large, non-smokers don't vape, Siegel points out, and "of the few nonsmoking youths who do experiment with e-cigarettes, there is currently no evidence that they subsequently progress to cigarette smoking." A study conducted by Dr. Ted Wagener at the University of Oklahoma Health Sciences Center, and reported at a conference in October 2013, found a single college student introduced to nicotine through e-cigs who went on to become a cigarette smoker.

Two months ago, in June 2014, Dr. Constantine Vardavas of the Harvard School of Public Health, reported on a study of the smoking and vaping habits of over 26 thousand Europeans, a study that found 1% of non-smokers had tried vaping products.

In the autumn of 2013, Frieden's prestigious organization published, with much fretful ringing of hands, the statistic that e-cig use had doubled among youngsters, and this finding was widely reported in the press, along with statements by Frieden and others that this certainly meant that they would soon turn to smoking. Meanwhile, another CDC study reported a continued precipitous drop in teen smoking at the same time. This study was almost completely ignored by the press. Data from Britain display the same concatenation of figures.

Siegel's conclusion is an understatement, letting Frieden's fibs off the hook quite easily: "By promoting a message that flies in the face of the government's own statistics—which show a sharp decline in youth smoking concurrent with a dramatic increase in e-cigarette experimentation—some federal public-health officials appear to be trying to create a "gateway" narrative where none exists."

You can say that again!