Earlier this year, Dr. Robert Califf, commissioner of the United States Food and Drug Administration (FDA), emerged as a vocal advocate against misinformation in the public health domain.
A commitment to combating the real problem of health rumors and falsehoods is commendable. But Califf’s recent statements regarding tobacco harm reduction reveal a concerning level of misinformation of his own—and the distinct whiff of hypocrisy.
In January, the FDA announced an initiative designed to address public health misinformation. Explaining the rationale, Califf stated, “I actually believe that misinformation is the leading cause of death right now in the US.”
He added that “people are making bad choices driven by the information that they get.”
In May, Dr. Califf doubled down on this, declaring: “The distortions and half-truths of misinformation and disinformation pose enormous dangers to the effectiveness of science and to public health itself, through the negative impact it has on individual behavior.”
“That’s why I’ve made combating misinformation one of my priorities,” he promised.
A statement doesn’t have to be an outright lie to be a costly distortion.
Yet on November 2, he tweeted, “Use of tobacco products in any form—including e-cigarettes—is unsafe, especially among youth.”
A statement doesn’t have to be an outright lie to be a costly distortion. Calling vapes “unsafe” is only true if you apply a standard of safety far higher than we apply to other life activities or consumption choices.
Oversimplifying a complex issue, Califf ignored a large body of evidence that alternative nicotine products are exponentially safer than combustible tobacco—a distinction that is surely the key public health point, when the cigarettes that these products can replace kill nearly half a million Americans each year.
Numerous studies have demonstrated that switching from cigarettes to vapes or other reduced-risk products substantially reduces a person’s health risks. By sidelining these findings in favor of a simple recommendation not to use nicotine products in any circumstances, Califf contradicts the principles of harm reduction and contributes to the perpetuation of misinformation.
Califf obscured realities once more, this time expressing alarm about “millions of teenagers getting addicted to nicotine through vaping.”
Youth vaping, which Califf and his FDA colleagues continually emphasize, is a subject of debate regarding the extent, or presence, of net harms at a population level. What is not debatable is that any vaping harms do not come remotely close to those of smoking.
Califf obscured this reality once more on November 8, this time expressing alarm about “millions of teenagers getting addicted to nicotine through vaping.”
The same tweet also warned of smoking-related deaths. But rather than point out how millions of people have quit smoking thanks to vapes, Califf chose to make youth use his sole vaping point. Again, it’s a distortion of public health priorities.
Califf’s depiction is also directly misleading. According to the Centers for Disease Control and Prevention (CDC), “current use” of vapes among US middle and high school students stood at 2.13 million in 2023, a big decline on the previous year. Yet most of this “current use” was occasional; well under a third of that 2.13 million total (29.9 percent of high school students who vape) reported the daily use that could even potentially qualify as addiction—not “millions.”
What’s more, modern definitions of addiction or substance use disorder rely significantly on the presence of serious life harms—harms largely absent with most teen vaping.
A more helpful approach would be nuanced enough to recognize that harm reduction strategies can be tailored to different age groups. It would balance legitimate concerns around youth access with the top priority of providing accurate information to people who smoke—including on harm reduction tools shown to be effective for smoking cessation.
In the fight against misinformation that Commissioner Califf ostensibly champions, it is crucial for public officials to lead by example.
By communicating an unequivocal stance against both combustible tobacco and harm reduction alternatives, Califf risks contributing, however inadvertently, to the burden of smoking-related illnesses.
Frustratingly, Califf has the platform to promote harm reduction as a valid strategy for adults who smoke, in a way that could meaningfully swell the numbers of those who benefit. His FDA role does not preclude this, when agency colleagues at least grudgingly admit that tobacco harm reduction has a role to play.
Califf’s failure to take this opportunity, along with the FDA’s refusal to properly regulate a wide array of vaping products to be made available to people who smoke, undermines public health goals. Talking down, or even ignoring, the benefits of harm reduction hampers the prospects of millions of people who smoke taking steps to improve their health.
In the fight against misinformation that Commissioner Califf ostensibly champions, it is crucial for public officials to lead by example. They have a duty to provide accurate, evidence-based and proportionate information to the public. Califf’s ill-conceived comments on tobacco harm reduction fail that test.
Photograph of Dr. Califf in 2020 by Christopher Michel via Wikimedia Commons/Creative Commons 2.0