Surgeon General Undermines Harm Reduction by Pushing Anti-Vaping Policies and Propaganda

In the name of fighting "the epidemic of youth e-cigarette use," Jerome Adams wants to raise prices and ban indoor vaping.


PS3 / Patricia Schlein / WENN / Newscom

Today Surgeon General Jerome Adams issued an advisory that urges state and local governments to fight "the epidemic of youth e-cigarette use" by "implementing price policies" and banning indoor vaping. Those measures directly attack products that even Adams concedes "have the potential to reduce risk for current smokers" in the name of preventing underage vaping, which itself may be driving down tobacco-related morbidity and mortality.

While raising the price of e-cigarettes may deter teenagers from buying these products (which they are not legally allowed to do in any case), it will have a similar effect on adult smokers interested in making a switch that could save their lives. One major advantage of e-cigarettes, in addition to a dramatic reduction in risk, is that they cost substantially less per dose than the combustible kind. A Juul pod, which sells for about $4, is roughly equivalent to a pack of cigarettes, which can cost as much as $10.45, depending on the state. The "price policies" Adams is advocating would undermine that advantage.

Another selling point of e-cigarettes is that they can be used in many settings where smoking is prohibited. Adams wants to eliminate that advantage as well, based on the dubious premise that e-cigarettes "can potentially expose" bystanders to "harmful substances" such as "heavy metals" and "volatile organic compounds." These "harmful substances," even when they can be detected in e-cigarette aerosol, are typically present at very low levels, which is one reason vaping is so much less hazardous than smoking.

A recent analysis of the aerosol generated by eight Juul pod flavors, commissioned by Juul Labs, looked for 22 potentially harmful constituents. In every case, the substance either was not detected or the level was too low to quantify. "Even breathing e-cigarette aerosol that someone else has exhaled poses potential health risks," Adams' office warns. The implication is that bystanders are endangered by minute quantities of chemicals that probably pose no measurable risk to vapers themselves. Since Adams frames bans on indoor vaping as a way to discourage underage consumption, it's clear that his real goal is not to protect bystanders from imaginary risks but to make e-cigarette use less convenient, which is bound to have an impact on adult vapers who would otherwise be smoking.

The same can be said of Adams' fearmongering about the dangers that e-cigarettes pose to vapers. As is typical of public health officials, he obscures the health advantages of e-cigarettes by erroneously describing them as "tobacco products," even though they do not contain tobacco. He links to an FDA "fact sheet" that claims the "e-cigarette use surge" led to an "uptick in overall tobacco use" by teenagers, as if vaping and smoking are interchangeable from a public health perspective.

The reality is that the "epidemic" of adolescent vaping has coincided with the lowest levels of smoking by high school seniors ever recorded in government-sponsored surveys. A recent analysis in the journal Tobacco Control, based on data from five national surveys, found that downward trends in smoking by teenagers and young adults accelerated as e-cigarette use in those groups took off. That correlation strongly suggests that young people who would otherwise be smoking are vaping instead, which represents a huge improvement in terms of health risks.

The Surgeon General's Office advises parents whose kids ask about the relative hazards of vaping and smoking to dodge the question. "Aren't e-cigarettes safer than conventional cigarettes?" a hypothetical child asks. "It's still risky," Mom or Dad is supposed to respond, while mentioning nicotine's potential impact on developing brains and noting that "some e-cigarette batteries have even exploded and hurt people." In other words, the surgeon general wants parents to obscure the enormous difference between the dangers of vaping and the dangers of smoking.

"Vaping can expose the user's lungs to harmful chemicals like formaldehyde, diacetyl, and acrolein, as well as toxic metal particles like nickel, tin, and lead," says an FDA lesson plan that Adams recommends. Again, that is highly misleading, judging from chemical analyses of the aerosol produced by the leading brand.

While these warnings are ostensibly aimed at scaring teenagers away from e-cigarettes, they have an impact on adults as well. The share of American adults who incorrectly believe that vaping is just as hazardous as smoking is already on the rise, thanks in no small part to overwrought, misleading, and sometimes flat-out inaccurate warnings from activists and public health officials. In one survey, the share of adults who incorrectly said vaping is as harmful as or more harmful than smoking tripled between 2012 and 2015, from 13 percent to 40 percent. The surgeon general's propaganda can only encourage that trend, making it less likely that smokers will switch to vaping and more likely that those who have switched will resume smoking.

This is the second advisory Adams has issued, USA Today notes. The first "urged people to carry the overdose antidote naloxone" as a way of preventing opioid-related deaths. In that case, Adams was promoting harm reduction. Now he is actively undermining it.