[This article was updated on March 13 to reflect breaking news.]
On March 13, the Senate Health, Education, Labor, and Pensions Committee was due to hold a confirmation hearing on Dr. David Weldon, President Donald Trump’s nominee for director of the Centers for Disease Control and Prevention (CDC). Then it was reported that the Trump administration had withdrawn Weldon’s nomination, hours before the scheduled hearing.
Weldon—whose deeply discouraging record included claiming a debunked link between vaccines and autism, and opposition to medical marijuana access—would have faced many challenges, as will whoever is eventually confirmed. A proposed $1.8 billion cut to the CDC’s budget is one of them. Another is the agency’s shameful history of misinformation around tobacco and nicotine, which continues to this day. Weldon’s personal stance on nicotine was unknown.
A week prior to the scheduled hearing, on March 6, the CDC published its latest Morbidity and Mortality Weekly Report, titled “Notes From the Field: Tobacco Product Use Among Adults.”
The CDC perpetuates a situation where most people wrongly believe safer nicotine products are as harmful as cigarettes, and many make their personal choices accordingly.
It misleads the public in a now-routine way by failing to distinguish between smoking and not smoking. By categorizing all nonmedical nicotine products as “tobacco products”—and neglecting to mention that items such as vapes and nicotine pouches do not contain tobacco—the agency creates confusion about their relative risks.
As a result, people are led to believe that nicotine and combustible tobacco are synonymous and equally harmful. This point is emphasized when the report states, “tobacco use is the leading cause of preventable death in the United States,” omitting a crucial detail: Smoking tobacco is the leading cause.
The CDC acknowledges in the report that cigarette smoking has declined significantly. Yet, instead of celebrating this public health victory, the agency casts it as a problem.
“While current cigarette smoking has decreased to the lowest level in 60 years, current tobacco product use among adults has not changed since 2017,” it states—as if reduced use of products that kill is somehow negated by increased use of products that don’t.
“You’ve got to be kidding me,” as Professor Michael Siegel responded on his blog.
By ignoring the steep continuum of risk among nonmedical nicotine products, the CDC perpetuates a situation where most people in the United States wrongly believe that vapes and other safer nicotine products are as harmful as cigarettes, and many make their personal choices accordingly.
While consumers understand “e-cigarette” to mean a nicotine vape, the CDC continues to use that term for a vape containing any substance.
This is far from the first time the CDC has presented data in a way that misleads the public and failed to communicate which nicotine products are more harmful than others. It can lead to moral panic, fuel clickbait headlines, and provide ammunition to those pushing policies that would deny adults access to products that help them quit smoking.
Previously, the CDC declined to update its terminology when it became evident that its communications were unclear to the public. While consumers understand “e-cigarette” to mean a nicotine vape, the CDC continues to use that term for a vape containing any substance.
In 2021, 2022 and ever since, dozens of internationally renowned tobacco control experts have told the CDC that “EVALI”—”E-cigarette or Vaping product Associated Lung Injury”—is a misleading name for harms that were not caused by vaping nicotine. The CDC has refused to adopt a term that would better educate the public.
In 2019, when the spate of lung injuries first hit the US, the CDC had immediately blamed nicotine vapes, and delayed acknowledging that the real culprit—Vitamin E acetate in adulterated THC vaping products—played any role.
Even the CDC’s web page about “E-Cigarettes (Vapes),” which supports harm reduction more than most of its materials, continues to send mixed messages. It bluntly claims that “E-cigarettes should not be used by youth, young adults, or women who are pregnant.”
“E-cigarettes may have the potential to benefit adults who smoke and are not pregnant if they are used as a complete substitute for smoked tobacco products,” it adds. “However, no e-cigarette has been approved by the FDA as a smoking cessation aid.”
The CDC often recommends other approaches to smoking cessation that have not been approved by the FDA. Examples include bird-watching, playing cards and building snowmen.
The implicit assumptions include that no young adults smoke, and that vaping during pregnancy is as harmful as smoking. The United Kingdom’s National Health Service states: “If using an e-cigarette helps you to stop smoking, it is much safer for you and your baby than continuing to smoke.”
Also interesting is the fact that the CDC often recommends other approaches to smoking cessation that have not been approved by the FDA. Examples include bird-watching, playing cards, building snowmen, “dad jokes” promoting another stimulant, writing yourself notes, taking up a hobby, and switching to friendship bracelets.
Yet, there doesn’t appear to be a single CDC tweet that suggests switching to vapes, nicotine pouches, snus or heated tobacco products—effective options associated with large-scale smoking cessation in the US and overseas.
While the CDC does continue to educate the public on the harms of smoking, its communications give the impression that it doesn’t take the challenge of quitting seriously. How else would you explain such unhelpful cessation suggestions? Is this the type of thing we’d recommend to people trying to overcome addictions to alcohol, gambling or opioids?
With each change in CDC leadership, hopes may flicker that the misinformation will end and the truth will lead to drastic improvements in public health. Yet over the years, multiple changes at the White House, the FDA and the CDC have failed to maximize the acceleration of the end of death by smoking. The barriers, it would seem, run deeper.
“Make America Healthy Again” is a supposed goal of the current administration. Without a decisive change of direction at the country’s leading health agency around the country’s leading cause of preventable death, “Keep America Smoking” will be the more honest slogan.
Photograph by Raed Mansour via Flickr/Creative Commons 2.0
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