Among the direst casualties of the COVID-19 pandemic is Americans’ trust in public health authorities. According to a Pew Research poll, prior to the pandemic more than three-quarters of adults rated “public health officials – such as those at the Centers for Disease Control and Prevention” as doing an excellent or good job. Now just a little over half rate them so highly. Among some groups, it’s far lower. As new CDC Director Mandy Cohen has acknowledged, “Trust is easily broken and, as folks know, trust takes time to rebuild.”
For citizens to trust the public health establishment, they must have confidence that these institutions are guided by science, free of political or social agendas. Yet on countless issues – even the most critical to public health – federal health agencies appear to be failing this challenge.
Take the significant public health issue of youth tobacco use. CDC’s annual National Youth Tobacco Survey (NYTS) is a key input for informing federal regulators’ tobacco-related policy agenda. The voluntary survey is administered to middle and high school students through their schools “to provide national data on long-term, intermediate, and short-term indicators key to the design, implementation, and evaluation of comprehensive tobacco prevention and control programs.” Why then, did the 2023 survey ask kids if they are transgender? How does it further tobacco regulation to know kids’ sexual orientation, or if they’ve felt discriminated against because of their race?
Furthermore, the CDC may be offering inappropriate financial incentives to underage NYTS participants, potentially influencing the integrity and accuracy of responses. Because “[t]obacco research studies with adolescents report that recruiting smokers to participate is substantially more difficult than recruiting nonsmokers,” the CDC said, “we propose to offer a $50 incentive to boost participation in the cognitive interviews among youth.”
Given that eventual Food and Drug Administration (FDA) regulation of tobacco products is driven by NYTS results, the ethical and methodological implications of paying kids to say they smoke are far reaching.
Like the CDC’s questionable approach on the NYTS, the FDA’s Center for Tobacco Products (CTP) has used its mandate to reduce youth tobacco use in ways even the courts have found incompatible with sound science. For instance, in July a federal judge struck down the FDA’s attempted regulation of premium cigars because of the agency’s misrepresentation of data on the prevalence of youth cigar smoking.
Now the FDA is preparing to finalize a ban on menthol products even as evidence mounts that such bans can increase cigarette sales and use, building much of its case on reducing youth tobacco addiction.
A Yale School of Public Health study partly funded by the FDA found that banning menthol e-cigarettes increased the sale of regular cigarettes and that 71 percent of the increased cigarette sales were non-menthol, “suggesting that restrictions on menthol cigarettes would not substantially reduce sales.”
Concerned the ban “would simply create a black market for these products,” Congressional investigators cited real world state experiments: After California’s 2022 ban, “a study found that roughly one in five cigarettes smoked were menthols even six months later, of which 27.6 percent were imported.” Clearly, illicit smugglers (read: China and Mexican drug cartels) will fill the void created by a ban.
Ironically, the scientific integrity issues plaguing the administration’s proposed ban may be overshadowed by social justice concerns. Al Sharpton’s National Action Network has come out against the proposed rule, saying the ban targets “black adult smokers” and could lead to incidents like Eric Garner’s death while police were arresting him for selling “loose, untaxed cigarettes.”
Is the FDA staffed by anti-tobacco zealots who ignore studies they themselves funded? Or are special interests helping drive the agency’s crusade? CTP is 100 percent funded by user fees. Yet user fees are a black box of accountability. Protect the Public’s Trust has been forced to sue the agency for information about how the CTP – as well as its sister agencies at the FDA focused on other important health issues like women’s health –spends these fees.
If the public can’t rely on public health authorities to make decisions based on sound science for the most serious and high-profile issues, what confidence can it have in the countless other decisions and advice it renders every day? Americans need to be able to trust the actions and pronouncements of public health authorities. For that to happen, sound science can’t be substituted for the sake of advancing a special interest agenda.
Michael Chamberlain is Director of Protect the Public’s Trust a watchdog group that aims to restore trust in American public servants by ensuring fair enforcement of rules, regardless of politics or policy perspectives, and by educating the public on officials' self-dealing, conflicts of interest, and improper behavior.
