US Surgeon General's #NoEcigs4Kids Report Ignores Data And Misleads Public

From CASAA;

Today, the US Surgeon General released a report on youth use of vapor products and the potential risks to young people from vaping. Although we agree that youth use of nicotine should be discouraged, interventions should be balanced by the need to honestly inform adult smokers of safer alternatives to cigarettes. CASAA is disappointed that Dr. Murthy has chosen politics over achieving genuine public health goals.

Sadly, the Surgeon General is missing an opportunity to highlight the potential public health gains for all smokers of switching to low-risk, smoke-free alternatives to smoking. At no point in the 238-page report does the Surgeon General compare the speculative risks of vapor products with the known risks of smoking. Predictably, the report conflates the two distinctly different products and encourages parents to misinform their children that vaping is just as harmful as smoking.
In the report, the Surgeon General devotes a lot of space to suggesting that youth use of vapor products carries dire risks and is rising at an alarming rate. The report even goes as far as implying that vaping is a precursor to not only smoking but drug and alcohol abuse as well. Although the highlights of the report state these concerns practically as fact, the report itself admits that the scientific literature does not support these conclusions.
Perhaps most concerning are the policy recommendations that the Surgeon General is making under the guise of protecting young people. Enacting or raising taxes, including vaping in indoor clean air laws, and raising the minimum legal purchase age (Tobacco 21) are all policies that restrict adult access to safer vapor products. It is understandable that we want to protect young people from risky behaviors, but to do so at the expense of adult awareness and access to life-saving products is unacceptable.
Experts from around the world are offering reaction to the Surgeon General’s report. We are including their statements as well as other recent observations on youth use of nicotine below. Their perspective is sadly absent from not only the Surgeon General’s report but from other sources that are informing US tobacco policies.
Clive Bates

• “Bad science, poor insights and likely to do harm – rapid reaction to the Surgeon General’s terrible e-cigarette report”  http://www.clivebates.com/?p=4593
• “Five questions to put to the US Surgeon General on e-cigarette science” http://www.clivebates.com/?p=4574
• “The critic’s guide to bad vaping science” http://www.clivebates.com/?p=4567

Attorney General Tom Miller (D-IA)http://clivebates.com/documents/Miller-AmericaNeedsEngland.pdf

• “[U]nder American consumer protection law you can’t imply something that is false. In America, kid use of e-cigarettes is high—16%–but overwhelmingly experimental. Sixteen percent of kids used e-cigs at least once in the last 30 days but only 1% are daily users. The original announcement is 16% once in the last 30 days. But then people say that kid use is 16%. People then tend to assume that 16% is regular use. Where people cross the consumer protection line is when they make alarmist statements using the 16%. At that point there is an implied claim that the 16% use is something other than overwhelming experimental use.”
• “Now there is a very legitimate concern about e-cigarettes, and that’s kids – particularly ecigarettes being a gateway to the combustibles that will kill in a way that we’ve all seen and been very concerned about. Let’s look at all the facts and numbers. Again, for better or for worse, I am a numbers person. There’s enormously large and troubling experimental use of e-cigarettes by kids. Overall, once in the last 30-day use, has been in a range of 13 to 16 percent for a couple of years. A significant number. But, it’s overwhelmingly experimental. And, the reason I say that is that the kid-use of e-cigarettes on a daily basis is 1 percent. The kid-use of e-cigarettes on a 20-to-29 day basis out of 30 is 1 percent. So, for regular use or semi-regular use you have 2 percent, for experimental use you have 14 percent. So that’s the first thing to really recognize. And you really shouldn’t talk about one figure without talking about the other, because to say that there are 16 percent of kids who use e-cigarettes really is misleading because so much of that is experimental. And to say that only 2 percent use it regularly or semi-regularly without recognizing the experimental use is deceptive as well.”
• “Ken Warner did a recent study using the Monitoring the Future data and came up with what I think is very informative on the whole gateway issue and that is that for kids that haven’t tried or used combustibles, the possibility of that group of kids to get to a daily or semi-daily user of e-cigarettes – not combustibles but e-cigarettes – the chance is one in 140 kids.”
• “My conclusion, based on what we reasonably know today, is that for kids, e-cigarettes are a gateway to nowhere. This is extremely important in balancing health risks and benefits of e-cigarettes.“
• “We have the situation where millions of lives could be saved but smokers don’t know that e-cigarettes are significantly, dramatically less harmful. What do we do about that in America? The best thing to start with would be for us to be like England, where not only public health, English Public Health, but also ASH, the tobacco control community, and the physicians, the Royal College of Physicians have all, in a united way, taken the position that e-cigarettes are dramatically less harmful. They say at least 95 percent less harmful. And adult smokers that cannot quit, or are unwilling to quit, should switch to e-cigarettes. We need that in America. We need the federal government to take that position, we need the tobacco control community to take that position, and we need physicians to take that position.”

Christopher Russell PhD., Centre for Substance Use Research“The USSG does not acknowledge, or even call for more research to determine whether, as the World Health Organisation concluded two months ago, if the great majority of tobacco smokers who are unwilling or unable to switch without delay to alternative sources of nicotine with lower health risks, this would represent a significant public health achievement.”
https://www.facebook.com/groups/casaamembers/permalink/1160330510671461/
American Vaping Association (AVA)“AVA Comments on Surgeon General Report
REPORT DRAWS CRITICISM FOR MAKING ‘RECKLESS’ CONCLUSIONS”
“This is just another politically-motivated attack on an industry that is helping people quit smoking. Discussion of the risks and benefits of vapor products should center on the science, not moralizing platitudes. The Surgeon General has failed the American people by releasing such a biased report.”
http://vaping.org/press-release/ava-comments-surgeon-general-report/
Prof Peter Hajek, Director of the Tobacco Dependence Research Unit at Queen Mary University of London (QMUL)“The UK Royal College of Physicians published its ground-breaking report Smoking and Health in 1962. The US Surgeon General Report followed two years later and replicated the findings and recommendations. Things are very different this time. The RCP report on e-cigarettes published earlier this year identified vaping as a great public health opportunity. The new US report on e-cigarette use among youths portrays vaping as a threat to public health. Which one is right?

“The new US report’s conclusions do not tally with what the actual data show. It is simply not true that e-cigarettes are a tobacco product or that vaping lures children to smoking or that it creates dependence in non-smokers. The prevalence of smoking among young people is at all time low and regular use of nicotine containing e-cigarettes among never-smokers is extremely rare. On-going vigilance is needed, but so far, e-cigarettes have acted as a gateway away from smoking, for adults and adolescents alike.  The report also ignores the huge benefits of vaping for adult smokers who are switching from deadly smoking to much less risky vaping in large numbers.

“The worst part of the report is its policy recommendations. They may be well meant, but no consideration is given to their likely unintended consequences. Limiting smokers’ access to the much less risky option of vaping is likely to contribute to keeping smokers smoking and smoking-related disease and death going at the current rate.”
http://www.sciencemediacentre.org/expert-reaction-to-us-surgeon-generals-report-on-e-cigarettes-and-young-people/
Prof Linda Bauld, Professor of Health Policy at the University of Stirling and Co-Chair of the Smoking in Pregnancy Challenge Group, a multi-agency group set up to support action to reduce smoking in pregnancy“This report mentions the issue of e-cigarette use in pregnancy, stating that nicotine delivered by e-cigarettes can affect fetal and post-natal development including causing sudden infant deaths (SIDS) and obesity in children.

“This is a fundamental misunderstanding of the evidence and leaps from studies in mice and rats to what might happen in humans. We know Nicotine Replacement Therapy is safe – a recent study from the University of Nottingham found no adverse impact on the children of mothers who used it in pregnancy and followed up these infants until they were two years old. The evidence on sudden infant deaths primarily relates to the tobacco smoking in pregnancy which is hugely harmful and is one of the main causes of SIDS. To conflate this with e-cigarettes is inaccurate.

“The priority must be to support pregnant women to stop smoking both for the sake of their own health and that of their child. While we need more research on e-cigarettes, pregnant women who find it difficult to stop smoking should not be discouraged from using them. This is the position and current advice in the UK endorsed by a range of organisations. Clinicians and others could be concerned by this report from the USA and be more hesitant about discussing Nicotine Replacement Therapy and e-cigarettes with pregnant women who smoke as a result. That would be harmful to maternal and child health and must be avoided.”
http://www.sciencemediacentre.org/expert-reaction-to-us-surgeon-generals-report-on-e-cigarettes-and-young-people/
ASH-UK“Deborah Arnott, Chief Executive of ASH commented:  ‘ASH is puzzled by the level of concern being expressed about e-cigarettes by the Surgeon-General. In the US as in the UK, young people are experimenting with e-cigarettes but vaping has not been associated with an increase in smoking, a point which is not made sufficiently clear in the report.

While nicotine is not completely harmless, it is smoking that is lethal.  In the UK we have a regulatory system that restricts advertising and controls sales to young people. There is no evidence of significant regular use by non-smoking children and, as in the US, smoking rates are going down, not up.’”

http://ash.org.uk/media-and-news/press-releases-media-and-news/ash-comment-on-us-surgeon-generals-report-on-e-cigarette-use-among-youth/
National Center for Public Policy Research“Impending Announcement by U.S. Surgeon General Vivek H. Murthy on E-Cigarettes Draws Statement by Jeff Stier of the National Center for Public Policy Research”
“The Surgeon General would have been wise to adopt the clear approach used by the Royal College of Physicians in its landmark report last year, by saying, ‘It’s very simple: adult cigarette smokers who switch to e-cigarettes dramatically reduce their risk, by using ‘nicotine without smoke.'”
http://www.nationalcenter.org/PR-E-Cigarettes-Surgeon_General_120816.html
Jacob Sullum, Reason“Surgeon General Launches E-Cigarette Scare Campaign That Will Harm Public Health”
Vivek Murthy’s concerns about adolescent vaping is overwrought, and his propaganda is pernicious.
“This is propaganda masquerading as science, which has already warped public perceptions of the hazards posed by e-cigarettes. … Such efforts to scare people away from e-cigarettes are positively pernicious and potentially lethal to the extent that they deter smokers from making a switch that could save their lives.”
http://reason.com/blog/2016/12/08/surgeon-general-launches-e-cigarette-sca