The Rest of the Story
Essentially, the entire premise of the report is a lie. The report repeatedly informs the public that vaping is a “form of tobacco use” and that electronic cigarettes are a “form of tobacco.” This repeated statement could not be further from the truth. Vaping is not a form of tobacco use. Electronic cigarettes are not a form of tobacco. The truth is that electronic cigarettes do not contain tobacco. A person who vapes (but does not smoke) is not a user of tobacco. Such a person is not using any form of tobacco. A nonsmoking vaper is in fact “smoke-free” and “tobacco-free.”
The Surgeon General’s repeated statements are an insult to the intelligence of the public. They apparently assume that the public is so stupid that we need to be lied to in order to appreciate the fact that vaping may be associated with some health risks. Rather than tell the truth and inform us that while e-cigarettes do not contain or burn tobacco, the constituents in the e-liquids can still degrade into chemicals that potentially could carry some risks with long-term use, the report dishonestly informs us that e-cigarettes apparently contain tobacco and represent a form of tobacco use.
If anyone actually believes the report, it is going to do a lot of public health damage. Vapers reading the report will be encouraged to return to smoking. After all, if e-cigarettes are just another form of tobacco use and if tobacco use in any form is dangerous, then why bother to remain off cigarettes? You might as well return to smoking tobacco cigarettes. Fortunately, most vapers are far more educated than the Surgeon General apparently is about the basic facts regarding vaping and the differences between vaping and smoking.
You don’t have to get very far in the report before you are lied to. In the preface itself, the report states: “These products [e-cigarettes] are now the most commonly used form of tobacco among youth in the United States, surpassing conventional tobacco products, including cigarettes, cigars, chewing tobacco, and hookahs.” What the report does not tell the public is that while cigarettes, cigars, chewing tobacco, and hookahs are a form of tobacco use because they contain tobacco, e-cigarettes are distinct from all these others because they do not contain tobacco. Perhaps the Surgeon General’s office needs a reminder lesson of “Which one of these things is not like the other?”
Also in the preface, the report recommends strategies to “discourage tobacco use in any form, including e-cigarettes” and emphasizes the need to prevent “tobacco use in any form.” Again, this is massively deceptive, as vaping is not a form of tobacco use.
In fact, not only does the report imply that e-cigarettes contain tobacco, but it never informs the public that e-cigarettes do not contain tobacco. Even in the chapter purporting to provide a detailed “background” to the issue of e-cigarettes, the Surgeon General does not inform readers that unlike cigarettes, e-cigarettes do not contain tobacco. And even in the section which goes into detail on what an e-cigarette is, there is no mention of the fact that e-cigarettes do not contain tobacco, and thus are distinct from every other "tobacco product" on the market.
Let's be clear. If the Surgeon General is going to state that vaping is a form of tobacco use, then so is using nicotine replacement therapy. And if the Surgeon General is serious in stating that "any form of tobacco use" is dangerous, then why isn't he warning people who are using nicotine gum and nicotine patches?
Obviously, it would be terribly misleading and deceptive to tell the public that the nicotine patch is a form of tobacco use. It would be lying to tell the public that people who use the nicotine patch are tobacco users. But the nicotine in a nicotine patch is derived from the same tobacco as is the nicotine in e-cigarettes. The Surgeon General would not make such a statement because it would deceive smokers into thinking that NRT is just another form of tobacco use. The Surgeon General would then have to acknowledge that ex-smokers who are still using NRT are not "tobacco-free." They are still tobacco users, and tobacco use in any form is dangerous.
How is it any less of a lie, then, to tell the public that vaping is a form of tobacco use?
What is so disturbing about the report is that while it spends an inordinate amount of time attacking the tobacco industry for historically misleading the public about the relative risks of different types of tobacco products (e.g., "light cigarettes"), the report itself then goes on to deceive the public about the relative risks of different forms of nicotine-containing products: namely, tobacco-free products and products that actually do contain tobacco.
If the Surgeon General does not recognize the substantial difference between a product that is killing more than 400,000 people a year and a product that is simply "not harmless," then we have a huge problem in our federal public health approach.
And if we are not able to communicate the vastly different risks associated with a product that is killing more than 400,000 people a year and a product that is simply "not harmless," then we have a huge problem in our risk communication ability.