Adams wrote: “Just spoke w a teacher at my daughters school. Just learned her 18yr old is addicted to e-cigs. Started years ago w exposure & sporadic use at school. Now affecting her mood, sleep, memory. As mom & teacher, she begged me to address what she deems an epidemic of youth initiation.”
Bates responded: “With respect, this language sounds weird and unreal. And in any case, why are anecdotes drawn from your own privileged background of any relevance at all? You have to see it from the perspective of the adolescent who would be smoking instead.”
The Surgeon General appeared to take umbrage: “why do you assume anything about my background?”
It was clear to any other reader that Bates was referring to him speaking and writing from his position as the Surgeon General, and that he was lending more credence to this fictional story than he ever would to an anecdote coming from a vaper. Adams was writing from and about a privileged class position – one where those greatest at risk of a lifetime of tobacco addiction are the poorest in society.
Clive retorted what most were thinking: “In case it wasn’t clear, I think you invented or embellished this exchange. Ordinary people do not speak that way.”
And so, despite claiming, “I’m an advocate who wants to hear from folks on the topic,” it appears that Adams’ willingness to hold dialogue comes with unpublished caveats. Moreover, he claimed to have met with vapers but refused to supply POTV with the names of any consumer or nicotine advocacy body, stating that he felt this reporter was an “anonymous … bot”.
The US Surgeon General blocked Clive Bates for questioning his unsourced tale. One of the leading figures in the harm reduction debate in the United States stuck his fingers in his ears and, despite many calling for him to reverse this decision, is refusing to engage one of the world’s foremost experts in harm reduction.
Consequently, Bates has published his explanation, describing what he sees is wrong with Adams’ “inauthentic” statements.
“The most serious problem is that the Surgeon General and teacher do not know what the 18-year old would have been doing in the absence of e-cigarettes - they don't know the counterfactual. The 18-year old could well have been a smoker and it is possible that vaping has diverted him or her from that,” writes Clive. “If it began 'years ago' before the Juul fad and in the early years of vaping, then the 18-year old was likely predisposed to tobacco or nicotine use. Regular vaping is strongly associated with a propensity to smoke.”
Bates continues: “The Surgeon General and teacher also do not know what happens next or over the life course. Teen vaping behaviour is only a material health problem if it leads to many years or decades of smoking. Given the middle-class background, quitting is likely and there isn't likely to be much risk. The U.S. Surgeon General, the nation's top doctor, tweets a diagnosis from a teacher. Vaping, we learn, is ‘affecting mood, sleep and memory’. These are not normal symptoms of vaping. Nicotine generally improves cognitive performance.”
It is incredible that Adams would accept and repeat this invented diagnosis from a teacher. As a trained anaesthetist he ought to be conversant with what nicotine actually does to the body.
“In the rush to attribute symptoms to vaping, the U.S. Surgeon General and the mother may be missing something else going on in this young person's life (stress, depression?) and vaping may be a response to it, not the cause.”
“Why does the U.S. Surgeon General not reflect on the direction of causation, if any? The U.S. Surgeon General determines that this young person is an "18yo addict" - a stigmatizing diagnosis-by-hearsay. But how many teachers at this school have 18 year-olds? What has U.S. Surgeon General done to protect her identity and privacy?”
Something doesn’t smell right about Adams’ version of events, and Clive knows it. He “repeats the teacher's claim that she deems it ‘an epidemic of youth initiation’. It is odd language again - strangely using the same words as FDA officials? But 'epidemic' is a strong term and you would use that guardedly and only the basis of population statistics.”
Clive points out other inconsistencies with Adams’ version of events, and the way the language used replicates that coming from the Centres for Disease Control and the Food and Drug Administration – not the words and phrases any normal teacher would use.
“Which means the ideas of the teacher that the U.S. Surgeon General uncritically repeats here may do more harm than good. Not that there is any sign at all that he has weighed up the possibility of unintended consequences. He's a doctor, so he is (excessively) confident in his own gut feel.”
“When the United States more than ever needs level-headed and science-based advice on public health, it is disappointing to see the top of the profession, the US Surgeon General engaged in anecdote and hearsay with no critical analysis. Please do better Jerome Adams.”