In a triumph of wishful thinking over data, former Surgeon General Richard Carmona joins e-cig board of directors

I am among the many public health professionals who were shocked to hear that former Surgeon General Richard Carmona joined the board of directors of e-cigarette company NJOY.  

Echoing justifications physicians gave for working with the conventional cigarette companies decades ago, Carmona told the Associated Press, “I’m probably going to be [the company’s] biggest critic. … I still look at my job as being a doctor of the people, and I’m going to look at the science. … If we can find a viable alternative that gave us harm reduction as people are withdrawing from nicotine, I’m happy to engage in that science and see if we can do that.”

The problem with this statement is that the e-cigarette industry is already aggressively promoting their products as safer alternatives to conventional cigarettes that can be used to help quit smoking.

In fact, the one and only longitudinal study published to date (from Canada, US, UK and Australia) conducted during 2010 and 2011 found that, although 85.1% of e-cigarette users reported using e-cigarettes as a cessation ad, there was no difference in successful quitting of conventional cigarettes between e-cigarette users and nonusers (P=0.516, which is not even close to statistical significance).

Equally important, there are very high levels of "dual use," where people smoke e-cigarettes and conventional cigarettes at the same time.  one US study found that 84% of e-cigarette users were dual users and another found 55%.  It may well be that e-cigarettes have the effect of keeping people smoking conventional cigarettes.

And, while not as polluting as conventional cigarettes, e-cigarettes pollute the air with acetic acid, acetone, isoprene, formaldehyde and acetaldehyde, averaging around 20% of what the conventional cigarette put into the air, that innocent bystanders are forced to breathe.

Dr. Carmona should reconsider and drop off the board.




My first question here would be, Is Carmona being paid for this role, and if so, how much?

We could proceed with the rest of the 'conflict' issues from there. 

I wonder if somebody he respects might ask him to disclose this publicly?

Steve Heilig

San Francisco Medical Society

oh please

NJOY wants Carmona to evaluate the science? Oh please.

If NJOY wanted advice on the science, there are literally thousands of scientists qualified to do this. NJOY didn't hire them. It hired Carmona. It hired his name. It hired his Surgeon General cred. It hired the image of health.

And likewise, NJOY hired Carmona to be its biggest critic? Yeah, right. That's just what happened. Oh wait; NJOY bought PR. It bought an impressive sounding name for its board. Anything else is a fairy story.

The tobacco industry loves to hire names that have creds in science and health. NJOY is just following suit. When the industry hires them, the usual outcome over the short term is industry cred goes up and the name's cred goes down. Long term, industry cred goes back down, but the name's cred never recovers. As Mike Wallace put it, "no, that's fame has a 15 minute half-life. Infamy lasts a little longer".

Jon Krueger



I disagree. Dr. Carmona is correct to focus on science and no this us not the same as doctors endorsing low tar cigs. E- cigs should be regulated as medical devices for the delivery if nicotine. Hopefully that is what NJOY will do. So I'm willing to see what happens and make my judgement based on actions.
As to dual use the study you cite is one where recruitment only involved smokers. We see as much or more dual use among nicotine gum users. The evidence on dual use leading to longer term smoking of conventional cigarettes or eventually to cessation is lacking. I agree the claimof the efficacy if e- cigs for cessation is weak, and needs to be developed to either refute or confirm the claims.
Hopefully Dr. Carmona can ensure that NJOY does the kinds of studies needed to ensure the safety of the products and validating of the marketing claims.

The cited studies do document genuine dual use

Mike (presumably Mike Cummings) is correct that the multicountry longitudinal study (the ITC study) is only of smokers, so all e-cig users are, by design, dual users.  The reason I cited this study is because it fails to find even a suggestion that e-cig use is associated with quitting conventional cigarettes.  It is the other two studies, which surveyed the general population, not just smokers, that demonstrate high levels of dual use.  How long will Dr. Carmona be kept on the NJOY board if he decides that these are general patterns? And in the meantime, he is serving a huge PR benefit for the company and will likely help them attract and maintain more nicotine addicts.