My regular readers and anyone expert in tobacco harm reduction (THR) will know that former U.S. Surgeon General Richard Carmona, who now works for the major e-cigarette company NJOY, is arguably the worst anti-THR liar in history. His “worst” rating comes from a combination of how blatant the lies were and how much influence they had on the world. The low point was the disinformation he presented in 2003 Congressional hearings on THR, claiming that smokeless tobacco is as harmful as cigarettes. This was used in basically every anti-THR lie campaign for years. This preeminence faded when anti-THR lying shifted some focus from smokeless tobacco to e-cigarettes, but the quotes are still aggressively used in many anti-THR efforts.
He could have told the truth, to the great benefit of the public’s health, or at least stayed silent if he genuinely did not know the truth, but instead he chose to lie (about what he knew and/or by claiming he had sufficient expertise to offer an opinion) and thus massively set back the progress of THR. While switching to smokeless tobacco was never hugely popular in the USA, it was far from rare. The modest decline in smoking prevalence in the 2000s pretty much matched the increase in smokeless use, and switching was a usually-successful method for quitting smoking. But its potential was strangled. Carmona probably killed tens of thousands smokers with his lies. He has never issued a correction, let alone apologized for the harm that he has done.
As part of NJOY’s publicity efforts, Carmona recently gave an interview to Science magazine (paywalled, but Snowdon was kind enough to reprint it for the masses). Sadly, health reporters — even those at Science, who are better than average — are not good at asking probing questions, even when they know they are talking to flacks. So I have suggested some follow-up questions. To make it easy when Carmona posts a comment here to reply (haha), I have made them multiple choice. The italicized material are selected bits of the original interview where a follow-up was desperately needed (for the rest of it, follow the Snowdon link). My questions are identified as “F.U.” to follow the format of the original (that is for “follow-up” — what else could it mean?).
Note to pre-answer a couple of inevitable follow-up questions for me:
1. Of course I believe that people should be allowed to change their mind, correct past mistakes, and start making positive contributions, and should be praised for doing so. And, yes, it is a good thing that Carmona is now partially on the right side of the issue (partially because someone is not truly a supporter of THR if he is just flogging one product and not embracing the entire concept in all its variations). But trying to memory-hole past mistakes without so much as an admission of error, let alone an apology, is not acceptable. It is not as if his 2003 statements were a random blog post by a 25-year-old kid that his 36-year-old future self should be allowed to quietly forget — it was Congressional testimony by a supposed expert. In politics and personal dealings, apologies are considered necessary. In science, it is explicit statements of correction or even retractions. In some religions it is confession. In 12-step programs it is making amends (which is confession+apology+more). This is not a radical expectation.
2. No, I do not think it is better tactics to just embrace Carmona and quietly forget about the harm he caused because he is now doing and saying some things that are good for the cause. That is the strategy of tobacco control — to embrace anyone and any claim that seems to be supporting their cause — and this makes them fundamentally unethical, to say nothing of frequently self-contradictory. It also tends to perpetuate anti-scientific beliefs and frequently backfires (until Carmona mans-up and corrects his previous disinformation, it is not difficult to imagine settings in which a follow-up question could cause enormous damage to THR all over again).
3. No I am not trying to pick on NJOY this week (or ever). NJOY is doing great work. But their statements and actions make for interesting analysis. The smaller e-cigarette companies and their various trade groups say and do enough incorrect, damaging, or downright nutty things that I could write about that full time, but they just do not matter that much, unlike NJOY. The established tobacco companies tend to keep tighter control on communications (e.g., they tend to be more subtle when they hire a former tobacco controller), so there is less to say about them, though I certainly criticize them when they make anti-consumer moves. (Note that exceptions to this are some of Lorillard/Blu’s nuttier moves, which I do comment on, such as using Jenny McCarthy as a spokesman — remarkably parallel to using Carmona in many ways — or calling for a twitter bombing of a member of Congress.)
So, on to the interview questions:
Q: How can you be sure [e-cigarettes are] safe?
R.C.: As research priorities, we’re asking about cons from long-term nicotine use, and we’re examining the different components in side-stream vapor to make sure they’re not unsafe. So far we don’t see any problems. And we’re also looking into long-term efficacy: How many people who use e-cigarettes quit and for how long? We just have to craft the right questions and then report back to the public.
F.U.: Isn’t it the case that the evidence that smokeless tobacco was low risk was, in 2003 when you claimed there was no such evidence, far stronger than the current evidence that e-cigarettes are low risk? Wasn’t there overwhelming affirmative evidence there are no major problems, in contrast with your mere “so far we don’t see any problems”? And, indeed, isn’t the main reason we can be confident that e-cigarettes are low risk the fact that we know smokeless tobacco is low risk?
- You are right, and I would hereby like to apologize for misleading people about smokeless tobacco in 2003. I have learned a lot since then and realize that what I said then caused a lot of damage.
- In 2003 I was being paid to claim that smokeless tobacco was high risk. Now I am being paid to claim that e-cigarettes are low risk. So I don’t see any problem.
- Other __________
Q: E-cigarettes are touted as a way to stop tobacco smoking. But would you advocate that people who do that successfully then also try to wean themselves off e-cigarettes?
R.C.: Yes, but the urgency isn’t as great because people who use them aren’t inhaling large amounts of carcinogens and cardiovascular disease–causing agents.
F.U.: Are you aware that basically everything is a carcinogen or cardiovascular-disease-causing agent in the right quantities and situations, so claims like this are scientific nonsense that are used to trick people into believing all sorts of falsehoods?
- Yes, and I use lines like this because they are a good way to trick people into believing a claim is scientific.
- No, they do not teach things like that in medical school, and despite presenting myself as a scientific expert for decades, I never took the time to learn the science.
- Other ____________
Q: Won’t e-cigarettes just lead to more people getting hooked on nicotine?
R.C.: That same question came up decades ago when nicotine gum, patches, and sprays came on the market. People said they would create new nicotine addicts and that never happened. But e-cigarettes are a different kind of nicotine delivery device, so they raise unanswered questions that we’re looking into.
F.U.: Are you aware that roughly half of all NRT sold is to long-term users, most of whom are practicing THR but some of whom never smoked? Are you aware that using the term “addicts” to describe (any) tobacco product users is derogatory and highly misleading, but even setting that aside, clearly seldom applies to uses of tobacco other than smoking cigarettes?
- No.
Q: On what basis do you think e-cigarettes can help people quit smoking?
R.C.: There is evidence that gums, patches, and sprays work, but they don’t work well enough. And early evidence suggests that because e-cigarettes reinforce the physical movement of smoking, they can enhance tobacco cessation, but we don’t have all the information yet. We have to continue doing the research and publishing data to demonstrate that they’re helpful.
F.U.: How does the evidence about the effectiveness of e-cigarettes compare to the evidence — from 2003 or currently — that smokeless tobacco use is quite effective at replacing smoking, and indeed as of now has replaced far more smoking than have e-cigarettes?
- It is basically the same evidence. We have observed a lot of people replacing smoking with each of these product categories, and the evidence is clear that it makes people happier to replace smoking rather than just quitting.
- I would like to repeat my apology for playing a role in slowing the replacement of smoking with smokeless tobacco, and thus dooming thousands more people to die from smoking.
- Both of the above.
- Other __________
Q: How would you respond to [tobacco control industry] critics who say you shouldn’t be doing this?
R.C.: ….
F.U.: How would you respond to critics who say you have no intellectual or moral authority to do this — and indeed, see your role as some kind of sick joke — until you recant about smokeless tobacco?
- __________________
We await your reply.
EP-ology 