CASAA's Letter to University of Kentucky Regarding Ellen Hahn

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President Eli Capilouto

Office of the President
101 Main Building
University of Kentucky
Lexington, KY 40506-0032
Fax: (859) 257-1760
pres@email.uky.edu

Attorney General Jack Conway
Office of the Attorney General
700 Capitol Avenue, Suite 118
Frankfort, Kentucky 40601
attorney.general@ag.ky.gov

20 August 2012

Dear President Capilouto and Attorney General Conway:

We are writing to call upon the University of Kentucky (the “University”) and the government of
the State of Kentucky to investigate and take appropriate remedial actions in response to the
recent actions of your employee, Ellen J. Hahn. Details about what Hahn has done, as well as
our role in this matter and other points follow this cover letter.

To summarize: Hahn is employed in a research faculty-type position at the College of Nursing at
the University. She has a history of using her position at the University to engage in political
activism that is outside of, and often contrary to, her job description, and to publicly make
scientific claims that are both false and beyond her area of professional expertise. Most recently
she attempted to incite a private party (a local conference hotel) into a breach of contract for a
legal commercial activity (a meeting of “vapers,” aficionados of electronic cigarettes) for the
purpose of preventing the free assembly of those to whom she is politically opposed. In so
doing, she (a) explicitly represented herself as speaking for University and implied that she
spoke for the state government, (b) offered inaccurate and threatening legal advice, and (c) made
false and otherwise misleading scientific claims.

In pursuit of a personal activist agenda, Hahn abused the good name of the University to
tortiously intimidate a merchant into breaching a legal contract, while pretending to be a concerned 
expert offering honest advice. Moreover, this incident is merely the most obvious in a

series of violations of University rules and the public trust that she has committed in the name of
the University, including research misconduct and popular dissemination of junk science.

We ask that you take the following actions, and expect that following an investigation that you
will agree that they are appropriate (more details appear at the end of the continuation pages):
  • Issue an apology for the manipulation and disinformation to everyone who suffered as a
    result of her tortious incitement to breach the contract.
  • Investigate the allegation that she has repeatedly made false and misleading scientific
    claims, and report your results of that investigation.
  • Remove the content from Hahn’s Center from the uky.edu website until the substantial
    portion of it that is activist junk science can be identified and excised.

Sincerely,
Carl V. Phillips, Scientific Director (cphillips@casaa.org)
Elaine Keller, President (ekeller@casaa.org)
Consumer Advocates for Smoke-free Alternatives Association (CASAA)
8094 Rolling Rd, #200
Springfield, VA 22153
Phone: (202) 241-9117
______________________________________________________________________________

Background
We represent CASAA, a consumer advocacy membership group that supports the public health
goal of tobacco harm reduction (“THR”), the effort to promote smoking cessation by
encouraging smokers to replace cigarettes with low-risk smoke-free forms of nicotine, including
the nicotine inhaler devices known as “electronic cigarettes” or “e-cigarettes.” These are
typically estimated to be approximately 99% less harmful than smoking for the user, and
completely eliminate bystanders’ exposure to environmental tobacco smoke. Our group’s role is
focused on trying to ensure that low-risk substitutes for cigarettes remain legal and available and
that consumers are accurately informed about them. Despite the scientific evidence that makes
clear that quitting smoking by switching to smoke-free nicotine products has approximately the
same benefits as quitting nicotine entirely (any difference between the two options is too small to
detect), there is fierce political opposition to THR.1

Hahn, due to personal and perhaps financial motives of her own, has been an aggressive political
activist against the availability of e-cigarettes, a position that seems blatantly contrary to her
official university role as Director of the Kentucky Center for Smoke-free Policy (emphasis
added). She is part of an activist political faction which takes an extremist view of tobacco and
nicotine use, ignoring the science and aggressively condemning low-risk products,2 even though
– in keeping with the name of her Center – it is only smoking that causes any measurable disease
risk and is the source of environmental effects.

We are very concerned about such activism because it effectively dissuades smokers from
switching to low-risk alternatives. Put another way, activism like Hahn’s encourages smokers to
continue to smoke. We recognize that you, President Capilouto, have scientific expertise in
public health, health economics, and even in THR specifically, and so you probably can
immediately see the basis of our concern.

We understand that there is room for policy debates about THR, in academia and in society as a
whole, and there are open scientific questions about the details of THR (though there is no
question that THR is possible and has proven effective in helping huge numbers of people avoid
smoking). But it is never ethical to disseminate disinformation for purposes of manipulating
these debates and misinforming smokers about their cessation options. We have, on multiple
occasions, had to respond to the disinformation Hahn disseminates as part of her activism, in

both the academic and popular press. She has responded to our presentations of accurate
scientific information by trying to vilify our organization with further disinformation, as she has
also done with individual persons. For example, in attempting to discredit those who she
disagrees with, she has circulated claims that Brad Rodu, a respected senior professor at another
Kentucky university whose research demonstrates and pursues the benefits of THR, is an officer
of a major tobacco company, as well as claims that one of our board members (a practicing
attorney) is a liquor distributor who makes money from selling tobacco.

The mission of the Center she directs is “to provide rural and urban communities across
Kentucky with science-based strategies for advancing smoke-free policies on the local level and
educating citizens and policymakers about the importance of smoke-free environments”
(emphasis added).3 Thus it appears that her anti-e-cigarette activism is not merely outside of that
mission, but flatly opposes that mission: Every smoker who switches to smoke-free alternatives
contributes to making the environment more smoke-free (as well as protecting himself from the
health effects of smoking). Moreover, her efforts to promulgate scientific disinformation not
only violates basic ethical and University rules, but also the mission of her Center. We realize
that a director of a private advocacy organization might legally choose to ignore the
organization’s stated mission and seize control of it to pursue a different agenda. But it seems
unlikely that a university employee whose job it is to direct an academic Center has the authority
to ignore the stated mission of that Center, especially when explicitly claiming to be acting on
behalf of the institution. This in itself is a violation of the public trust, and might represent a
violation of her obligations as an employee.

We suspect that you are already familiar with some of this, because we know that many outraged
individuals who have benefited from THR have written to the University, and possibly the state
government, to protest Hahn’s personal activist campaign that is being carried out under your
auspices. You may have even seen some of the extensive discussions about this in the
blogosphere which are painting an increasingly unflattering portrait of your institution. As an
organization, we have not previously sought an institutional response because we respect the
right of American citizens (when acting as individuals) to engage in free speech, even if it is
misleading and harmful to the public’s health, and we realize it is difficult to claim that a
University employee has gone beyond speech that is protected by academic freedom.

Nevertheless, it appears to us that Hahn frequently crosses the line of the protected academic
space that allows University employees to engage in speech within the bounds of their expertise
in appropriate forums. In addition to her false statements about individual persons, she has
actively pushed scientific disinformation into the popular press while implying she was speaking
on behalf of the University, an act that seems to be contrary to her professional and employment
obligations. Her Center has published similar disinformation at the uky.edu website. Despite
this, we would probably have never asked the University to intervene over such behavior so long
as it did not involve explicit incitement. No matter how misleading someone’s claims and no
matter how damaging the results might be for public health, such an intervention poses dangers
for academia, and it creates a burden for the administration to become sufficiently expert to
judge that particular claims are indeed junk science. Moreover, we recognize that more often
than not, such requests for institutional intervention are carried out by rich and powerful special
interests who are attempting to censor honest and legitimate research, and those attacks create a
burden for a university. Since one of us has personally been the victim of such a campaign, we
would have hesitated to call for such action even though Hahn’s is one of the rare cases in which
such an effort would be legitimate.

Hahn’s letter
However, these reasons for hesitation do not extend to Hahn’s recent private communication that
was explicitly intended to mislead a Kentucky merchant to break a perfectly legal private
contract, and thereby attempt to prevent the free assembly of a class of people who Hahn seeks to
discriminate against. Specifically, a gathering of e-cigarette aficionados and businesspeople was
planned and scheduled at the Best Western Lexington Conference Center Hotel for August 4,
2012. This conference, like many such gatherings that take place across the country every
month, was a combination of trade show (merchants demonstrating and selling their products),
social gathering, and modest fundraiser for the organizers. It was also an educational and
political rallying point for people with an interest in fighting the anti-THR policies that Hahn and
her political allies support. Indeed, because part of the mission of this gathering was to educate
about e-cigarettes, the organizer invited Hahn – before he became aware of her attempts to shut
down the conference – to attend and perhaps hear the many stories from former smokers who felt
like they were destined to die from smoking until they discovered e-cigarettes and quit smoking
by switching to them.

Obviously, being able to use e-cigarettes was an inherent part of that gathering, and doing so in a
hotel is perfectly legal in Lexington and almost everywhere else in the country. Because ecigarettes
do not produce smoke or any similar environmental exposure, and so the expert
consensus is that they pose no apparent threat to bystanders, they are – quite sensibly – not
affected by the smoke-free air laws instituted by Lexington-Fayette County or the State of
Kentucky. The organizer of the conference, when contracting with the hotel, had made clear
what the gathering was, what e-cigarettes were, and that almost all attendees would be using ecigarettes
in the meeting and around the hotel. Indeed, he even used an e-cigarette throughout
the hotel while meeting with the manager to arrange the contract. Since there are no local legal
restrictions or hotel rules that would prevent e-cigarette use in this manner, this required no
special arrangement, but the organizer nevertheless made clear that this was the plan and
received an explicit agreement from the hotel manager that this was fine.

Approximately one month before the event, Hahn wrote an extremely misleading letter to the
hotel manager (which is attached as Appendix A), attempting to persuade her to forbid ecigarette
use at this event. Hahn was undoubtedly aware that forbidding e-cigarette use at an ecigarette
gathering would have the same effect as forbidding some other legal and necessary
activity, like talking: While it would not literally be the unilateral cancellation of the event by
the hotel, it would be equivalent, since the event would no longer be functional and most
everyone would choose to cancel their plans to attend. Despite the fact that Hahn is usually
aggressively publicity-seeking and that she launched a local media blitz attempting to vilify ecigarettes
at the same time, she wrote this letter in secret. Fortunately, the hotel management
shared Hahn’s letter with the event organizer, who in turn contacted us and so it was possible to
respond to her disinformation and to partially – but not fully – mitigate the damage done by the
breach of contract that she intentionally incited.

The manager believed that Hahn was telling her that allowing e-cigarette use would be a
violation of indoor smoking prohibitions and was threatening that the University would be
displeased and might retaliate if the event occurred (see below for more details). The manager
was planning to yield to all of Hahn’s demands and thus completely breach the contract. She
informed the event organizer of this approximately one week before the day the conference was
scheduled. She avoided attempts by the organizer to discuss the matter, later admitting that she
did so because she felt like she had been put in an impossible position, until the organizer was
able to confront her by making an unannounced in-person visit to the hotel. As a result of these
events, the organizer experienced substantial distress and was forced to spend several personal
days trying to salvage the event.

Eventually the event organizer was able to assert some of the terms of his contract and arrange
for the manager to speak to a government official who confirmed that – in accordance with the
organizer’s original information and contrary to Hahn’s message – that there was no legal
prohibition. Because of this, attendees were allowed to use e-cigarettes in the meeting room.
However, Hahn’s efforts did cause the hotel management to partially breach their contract,
declaring that e-cigarette use would not be allowed elsewhere and that e-cigarette users must stay
in smoking rooms, even though they are nonsmokers (and, indeed are ex-smokers who are
particularly motivated to stay away from smoke). The actions taken by the hotel manager were
in no way based on law or hotel policy, and clearly resulted only from Hahn’s actions.

The event took place as scheduled. Participants were told that they could not use e-cigarettes in
parts of the hotel where it was allowed before the event, creating an inconvenience for them.
Several of the attendees expressed distress about being forced to stay in smoking rooms.

Representing herself as an official spokesperson
Hahn wrote her letter on College of Nursing letterhead and signed it, “Ellen J. Hahn, PhD, RN,
FAAN; Director, Kentucky Center for Smoke-free Policy; UK College of Nursing” and included
her University physical and email addresses. Her first sentence was, “I am writing on behalf of
the Kentucky Center for Smoke-free Policy (KCSP) at the University of Kentucky College of
Nursing” (emphasis added). The footer on her continuation pages included further references to
the University and the uky.edu website, which clearly sent the message “this is an official
statement of this institution.” She offered no caveats whatsoever about the content being her
own views and not those of the College of Nursing of the University itself. She failed to
communicate to the recipient that she is a political activist in this area and was acting on her own
motives. She did not point out that her actions ran contrary to the stated mission of her smokefree
Center.

The University rules say, “Individuals writing or speaking publicly in a professional or expert
capacity may identify themselves by their relationship with the University, but if so identified
then in all instances where the individual might give even the appearance of speaking on behalf
of the University, care must be taken to emphasize that any views expressed are their own and
are not representative of the University of Kentucky.”Not only did Hahn not take such care to
avoid the inevitable perception in this case, but she deliberately chose language that
communicated that she was speaking officially for the institution.

Because of this, the hotel manager interpreted the letter as an official communication from the
University, as any reasonable reader would do. When the event organizer was able to confront
the manager about the content of the letter, the manager indicated she felt compelled to accept
the claims in the letter and to do what was demanded of her because she could not afford to
offend the University, which is her business’s major client. She took the reasonable position, in
responding to the organizer, that though he might be right when he pointed out that the claims in
the letter were false, she would not be able to learn enough to be able to judge that. Thus, she
had no chance but to accept the assertions that, in her mind, were being made by the University.

In sum, Hahn’s representation of herself as speaking for the institution caused the manager to
believe that the claims in the letter were backed by the University and fear that the University
would retaliate against her business if she did not do as Hahn demanded. Anyone reading
Hahn’s letter will recognize that a reasonable person would quite likely come to that conclusion.

We realize, of course, that academics generally communicate in forums and in ways where the
audience would never interpret their statements as being representative of their university, let
alone the government that the university is a component of. Thus, caveats that the views are
their own are not offered, and would seem rather absurd. But it is difficult to imagine a case
where such caveats are more necessary: The communication was made by a political activist
who happens to be on the University staff but was pursuing her own political agenda. It was
made to a non-academic who could not be assumed to know that academics virtually never speak
officially for their University, and who could be easily intimidated by Hahn’s institutional
identification alone. The need for the caveat is especially strong given that the focus of the
communication is to urge a specific action that has serious legal consequences. But instead of
offering the required caveat or even identifying herself as an activist, Hahn actively tried to
create the perception of official communication.

Any subtle distinction about her explicit claim being that she was speaking on behalf of a unit of
the University – apparently illegitimate even in itself – and not the University per se, would
clearly be lost on her audience. Recall that her letter was to the manager of a hotel property and
needs to be interpreted in terms of what would be communicated to that audience, and not based
on the knowledge of someone highly familiar with academia. Also recall the mission statement
of that Center that she claims to be speaking on behalf of, and how that mission is not advanced
by this bit of personal activism.

Moreover, because the University is part of the government of the State and in particular because
the name of Hahn’s Center reads, to the average person, as the name of an official agency of the
state, her letter also tended to imply that she was speaking as an official of the State itself. She
wrote nothing that would tend to correct that likely perception.

Incorrect legal advice

Hahn twice claimed to the hotel manager that forbidding e-cigarette use in the hotel would be
“consistent with your smoke-free policy”. But since e-cigarettes do not produce smoke, this is
patently false. Nevertheless, it is easy to see why these statements created fear on the part of the
hotel manager that she had entered into a contract in violation of hotel policies and also smokefree
laws, and thus served as a personal threat. Indeed, the manager believed that Hahn was
telling her that allowing e-cigarette use would be illegal and was only dissuaded from this
interpretation after a conversation was arranged with a local government official. We note that
Hahn did not address or even copy her letter to the hotel chain’s legal office or senior
management, individuals who could have confidently denied the accuracy of her claims, but
wrote only to a local manager who would likely fear for her job and possibly even criminal
sanctions as a result of Hahn’s official-sounding claims.

Hahn’s Center at the University, which she explicitly claimed to be representing, defines “100%
smoke-free” to mean, “Municipalities with ordinances or regulations that include all workplaces
(workplaces include both public and private non-hospitality workplaces, including, but not
limited to, offices, factories, and warehouses), that do not allow smoking in attached bars or
separately ventilated rooms and do not include workplace size exemptions” (emphasis added).6
It is thus apparent that (a) Hahn presumably understands that “smoke-free” refers to prohibiting
smoke and smoking, not prohibiting smoke-free alternatives to smoking, and so knew she was
offering misleading legal advice, and (b) she is making claims that directly conflict with the
policy of her Center.

Hahn also asserted, with no further elaboration, that “e-cigarettes are tobacco products.” This
claim is obviously false in a scientific or practical sense: E-cigarettes contain medical-grade
nicotine which is a highly-processed derivative of the tobacco plant, but about 99.99% of an ecigarette
is not even a derivative of the tobacco plant. From a practical perspective, Hahn’s
claim is no more accurate than saying that a car is a corn product. Thus, her statement can only
be interpreted as making a legal claim about how e-cigarettes are regulated. The average person
would interpret Hahn to be asserting that rules that apply to tobacco cigarettes, like indoor
smoking prohibitions, also apply to e-cigarettes. This is especially likely since Hahn’s phrase
continued, “e-cigarettes are tobacco products that emit harmful substances” and was immediately
preceded by a statement about the hotel’s prohibition against smoking in public areas. There is
simply no other apparent purpose for her claim that e-cigarettes are a tobacco product other than
to make an implicit legal claim.

Inaccurate scientific claims
Hahn’s violations of university policy are clear in the above observations alone. However, her
false representation of herself and the law would likely not have been sufficient to incite the
breach of contract absent Hahn’s false and otherwise misleading scientific claims. Without this
disinformation, the inaccurate legal claims would have rung hollow and the hotel manager might
not have believed that the University cared enough about the matter to threaten her business over
it. Moreover, Hahn’s dissemination of this disinformation in the letter, written in her official
capacity, represents misconduct in and of itself, as does her dissemination of similar information
in the popular media.

Responses to Hahn’s many false and otherwise misleading scientific claims in her letter requires
many pages, because it always takes tens or hundreds of times as many words to debunk a junk
science claim as it takes to make the claim. We have identified and addressed some of them in
Appendix B (and we would be happy to provide you with further analysis of these points and
others, including specific evidence about Hahn’s various falsehoods, to whatever extent might be
useful). To summarize, Hahn’s letter was written in a way as to imply it was an unbiased expert
scientific review of the information on the topic. But she was actually using scientific-sounding
claims in an effort to mislead, as she has in her other writings. She consistently misrepresented
the science as well as basic principles of scientific inquiry and knowledge.

Hahn might respond to this charge by claiming genuine ignorance – and in a few places she does
appear to be strangely ignorant of simple points in a field where she claims expertise, since she
makes blatantly false and easily debunked statements. But for ignorance to be her entire excuse,
she would have to claim her ignorance includes not knowing: common chemicals that occur
everywhere are not hazards; speculative statements made by authors in commentaries do not
constitute scientific evidence; even for chemicals that are hazardous in high concentrations,
barely-detectable trace amounts are not hazardous, or as the saying goes, “the dose makes the
poison”; citing a source as if it supported a claim that is exactly contrary to what the source
claimed is not appropriate; and individual, out-of-context factoids do not represent the body of
scientific knowledge on a point, and thus honest scientific claims cannot be made based on
choosing a favorite bit of evidence and pretending there is no other relevant knowledge. If she
claims that she was not lying, but rather was suffering from this broad and deep ignorance, then
perhaps the University’s investigation should focus on her representation of herself as a scientific
expert who is qualified to work at your University.

While a claim of scientific illiteracy is a theoretical defense, our analysis in the Appendix shows
that Hahn’s disinformation is actually carefully crafted to mislead readers while minimizing the
need to make flatly false statements. Such skillful misleading does not occur by accident or from
honest ignorance. It is indicative of someone who knows that an honest assessment of the
information does not support her main claims, but skillfully takes advantage of how people can
be manipulated with scientific-sounding language. The University’s definition of research
misconduct includes “deliberate misrepresentation in proposing, conducting, reporting, or
reviewing research,”7 and it is quite clear that Hahn is in violation of this in her letter and in
similar content she has published, as detailed in Appendix B.8

Some of the entries in Appendix B identify out-and-out false claims she made. But the majority
of her claims have the characteristics, (a) they are technically true in some sense, (b) but they
have no scientific significance (specifically, no relevance to the health claims she is making),
however (c) they are presented in a way that gives the impression to a non-expert reader (and
potentially even a trusting expert reader) that they are scientifically significant and support the
author’s thesis. When we observe this combination of characteristics, it is clear evidence that the
author is not trying to educate and is not concerned, but is merely using scientific-sounding
claims to support a political agenda. It is easy to recognize when someone has made an incorrect
scientific assessment due to half-understanding the material – those of us who have been
teachers, or who read what news reporters write about our fields of expertise, are quite familiar
with this pattern. It is a pattern that is not found in Hahn’s writing, which instead uses the
carefully crafted tactics that are the common tools of junk scientists and others who want to
provoke unjustified fear of an exposure.9

Hahn’s core claim in her letter is that allowing e-cigarette use would endanger the health of hotel
workers and guests to a degree that should not be allowed. This claim, which was explicitly
intended to incite a breach of contract, is not based on scientific evidence. While she has
presented some misleading and ominous-sounding information, the fact is that those who have
analyzed the environmental effects of e-cigarette use (including the very researchers that she
cites) have concluded that there is no basis for expecting any health effect on bystanders. The
only claims to the contrary consist of mere speculation by anti-e-cigarette activists like Hahn
herself.

It is a defensible scientific position to assert, “I believe that we will find that these products are
much more harmful than the current science shows.” It might even be protected academic
speech to write in a journal “banning e-cigarettes will improve public health” even though that is
rather obviously false. But Hahn did not offer statements of prediction or belief, but rather
declared false and speculative claims to accepted facts. She did not do this in an academic
context, where the audience would have the ability to recognize her falsehoods or dispute her
claims, or where strong claims might be considered a harmless part of the debate. Rather, she
made the false assertions in a context where the audience was powerless, ignorant, and likely to
be intimidated, and did so for the purpose of inciting a particular action, specifically a breach of
contract.

Academic freedom offers Hahn no defense in this case. Had the scientific content of her letter
been professional, accurate, and a balanced presentation of what the evidence says, rather than
being a clear attempt to mislead a layperson reader with scientific-sounding claims, Hahn might
be able to assert that she was engaged in legitimate scientific communication and was inviting
the hotel manager to make her own informed decision based on the knowledge. That is, under
that hypothetical (and setting aside her legal claims and the implicit threat of University
sanctions), Hahn might be able to argue that she was not trying to trick the merchant into
breaching a legal contract, even though she was attempting to persuade her to do so. But
because so many of Hahn’s claims were incorrect and outlandishly misleading, the only possible
interpretation is that she was not trying to educate or communicate honestly but was trying to
manipulate the behavior of the recipient, using every tool available short of physical force, to
cause a specific action, namely the breach of contract.

Request for action
In light of this statement of complaint, we request that the University convene an investigation of
this matter and suggest that perhaps the State of Kentucky might also want to conduct its own
investigation. We believe it very unlikely that you will be pleased with what such investigations
find, and we are convinced that you will take steps to put an end to this junk-science-based
activism that is being done in name of your University and State.

In addition to the obvious implications of such an investigation, we ask that:
  • Upon concluding that Hahn engaged in various forms of misconduct in the matter of her
    letter (and given how overwhelming the case against her is, we have no doubt that this
    will be the conclusion), you issue an apology for the manipulation and disinformation –
    officially on behalf of the University and ideally from Hahn herself – to everyone who
    suffered as a result of her actions, including the hotel manager, the hotel company, the
    organizer of the Lexington vaper event, and the attendees at that event. In addition,
    explicitly inform the hotel branch and hotel chain that neither the University nor any unit
    thereof is trying to pressure it into adopting a particular policy about allowing e-cigarette
    use, and will not base any purchasing decisions on such policies. (Should you request,
    we will assist in you arranging for the relevant parties to waive any further claims in
    exchange for the apology.)
  • Explicitly investigate and take appropriate remedial action regarding Hahn’s false and
    misleading scientific claims, and not just address the easier aspects of the matter. We
    realize the much simpler case that Hahn committed a tort and violated the terms of her
    employment can be found in her representation of her political activism as an official
    University action, her legal claims, and her incitement of a merchant to breach a legal
    contract. But we believe that the University owes the larger community a response to the
    ultimately more important matter of Hahn’s dissemination of false claims and research
    misconduct (particularly including the allegations of her suppression of data), and the
    resulting damage this has caused for public health.
  • Remove the content from Hahn’s Center from the uky.edu website until the substantial
    portion of it that is activist junk science can be identified and excised. We believe you
    will find that these statements violate the University prohibition against misrepresenting
    research, and perhaps other University rules.
In the interest of clear and open communication, we want you to know that our plan is to
publicize this complaint and whatever response we receive. We believe that countering harmful
extremist activism like Hahn’s is crucial for public health and thus do not intend to be quiet or
subtle. However, we would be happy to delay such communication for a reasonable period,
upon request, in order to incorporate any response from you. Moreover, we will respect any
explicit request to keep the contents of any reply from you confidential.
We have already taken steps to prepare for a civil action, naming Hahn and all other relevant
parties, and bundling in other actions she has taken, should it become necessary. While we
cannot respond to all the people making absurd legal and scientific claims about THR and
making libelous statements about its proponents, we feel that we are obliged to intervene in a
case like this, where an activist claims to be speaking for a respected major institution. We
would very much like to avoid going down the path of litigation, however, and would much
prefer that the institution take the lead on this matter. We are confident that a thorough
investigation will result in appropriate remediation.
_____________________________________________________________________________________
1 The details about why there is opposition to this promising public health strategy are not relevant to the present
matter, but we would be happy to explain the apparent reasons, as well as provide any other clarifications you might
want.
2 The exceptions to this blanket condemnation by Hahn and other anti-THR activists is that they do not condemn the
products made by the pharmaceutical companies, products which are similar to and directly compete against the
more consumer-friendly products like e-cigarettes. The active support by Hahn, and others in her political faction,
for these products while they aggressively attack equivalent non-pharmaceutical products is generally attributed to
the lavish funding the pharmaceutical companies provide them, though there are compelling alternative theories.
Other prominent commentators [e.g., http://tobaccoanalysis.blogspot.com/2012/07/kentucky-center-for-smoke-freepolicy.
html] have suggested that Hahn is motivated by a financial conflict of interest due to personal payments from
the pharmaceutical industry. While we believe that such funding usually follows upon, rather than causes,
someone's political activism, we know that there are rules about appropriate disclosure, and there are widespread
claims that she may have violated them. This information is probably useful background for anyone investigating
this matter, but Hahn’s political motives, whatever they are, do not constitute part of this complaint; we note that
others have formed the opinion that she has violated rules about financial disclosure, but have not ourselves formed
an opinion.
 
3 From the Center homepage, at www.mc.uky.edu/TobaccoPolicy/KCSP/ or www.kcsp.uky.edu/ 
4 This is especially ironic since in her letter (see in particular the claims about nicotine in Appendix B) Hahn invokes
claims about the supposed hazards of being in a space where someone has left a residue from cigarette smoking
(trying to incorrectly suggest they apply to e-cigarettes). These claims are quite dubious, but are common in the
anti-smoking activist community and Hahn apparently believes them. Thus, based on her own beliefs, she was
causing a risk exposure for the conference attendees. 
5 University of Kentucky Office of Legal Counsel, UK Ethical Principles and Code of Conduct,
http://www.uky.edu/Legal/ethicscode.htm, copyright 2007, last updated 1/15/10. 
6 Percent of the Kentucky Population Covered by 100% Smoke‐free Workplace Laws or Regulations, Updated June
1, 2012, PDF available via www.mc.uky.edu 
7 Quoted from www.research.uky.edu/ori/misconduct.htm
8 In addition, there are credible public claims that Hahn has engaged in other research misconduct, particularly
suppression of data that would have undermined her preferred conclusions when publishing her research. We do not
want to distract from the focus of this letter by going into detail, but we ask that the investigation of her conduct
include a review of these allegations. 
9 Perhaps the classic illustration of the tactic of tricking laypeople with scary statements about chemicals was a
school science projects (which has been replicated probably thousands of times) in which the student wrote a “fact
sheet” about the scary properties of “dihydrogen monoxide” (water) and asked laypeople to sign a petition calling
for its ban. With remarkably few words changed, Hahn’s letter can be converted into an anti-dihydrogen-monoxide
broadside; many of the exact statements she makes about e-cigarettes are also true of water. We would be happy to
point you to such a rewriting of Hahn’s letter that illustrates how it is a perfect example of the tactic. 
________________________________________________________________________________________

A‐1

Appendix A – Hahn’s letter

A‐2

A‐3

B‐1
Appendix B – Debunking of false and otherwise misleading scientific claims in Ellen J.
Hahn’s July 11, 2012 letter

The following is a response to some (not all) of the inaccurate claims and intentional
implications of Ellen J. Hahn’s letter of 4 August 2012. It is necessarily much longer than the
letter itself because the nature of junk science (and a huge advantage for those who traffic in junk
science in general) is that making a false claim can be done in one sentence or less, while
debunking it using honest scientific analysis often cannot be done in less than a page.

The significance of this pattern of false and otherwise misleading statements is twofold: (1) She
is intentionally making great effort to cause her audience to believe something that she knows
cannot be supported honestly, so is misrepresenting the available information. (2) It is an
indication that Hahn knows she does not have any genuine or honest evidence available to
support her point, or else she would have included that. We contend that this pattern of
technically true but clearly misleading statements is the worst sort of scientific
misrepresentation, because unlike with cases of simple false statements which can result from
ignorance, it is implausible that the author did not know she was lying (i.e., trying to cause
people to believe something she knew to not be true).

We realize that some readers might be tricked by Hahn’s apparently scientific presentation and
find themselves thinking, “but most of these claims are footnoted to some source”. In response
to that, it is important to realize two things: First, some of the claims are factually true, and the
narrowly-interpreted out-of-context factual claim is indeed supported by the source. But the
information is presented in a way that is intentionally designed to mislead the reader about its
implications. Indeed, sometimes the implication flatly contradicts what the source says (see the
“acetone” point for an example).

Second, when an author presents a statement as fact, without caveats, she is asserting that the
statement is true and she is capable of judging that. The mere observation that one person wrote
a particular statement sometime in history obviously does not make that statement true, as
anyone – scientist or otherwise – knows. An author always has the option of presenting a
sourced statement with an explicit caveat that one previous author “claimed” a particular
statement (and, where appropriate, this should include more explicit caveats like, “however,
there is no evidence to support this claim” or “many observers believe the evidence better
supports the opposite claim”). A caveat can communicate “someone else claims this, but I do
not assert it to be true based on my own expertise”, and the lack of such caveat says the opposite:
“I assert this is true and have sufficient expertise to make such a judgment.” The presence or
absence of a citation does not change the fact that the author is making such an assertion; rather,
it is a statement along the lines of, “by the way, this cited publication is either my basis for my
belief or a source for learning more about it”. Thus, it is proper to analyze the statements as they
appear in the document, and judge Hahn based on their content, regardless of what previous
authors might have written. In particular, quoting someone’s false statement, when there is
ample information that shows that the statement is false, does not excuse an author who claims
expertise in a matter for making the false claim.

For any of the points presented here, we would be happy to provide, upon request, expanded
analysis or a catalog of the evidence that supports the honest scientific conclusions.

Hahn’s Claim: “e-cigarettes...emit harmful substances in the vapor”
The truth: The natural language interpretation of Hahn’s statement, which she presents in the
context of her warning about risks to bystanders, is that the exposure from being near someone
using an e-cigarette is believed (based on evidence) to be harmful. This is false. Existing
evidence suggests that there is no environmental hazard. It would be true, though of no practical
consequence, to claim “the vapor contains substances that are known to be harmful in sufficient
concentrations”, but even that would be clearly misleading unless the clarification was added
“but the concentrations found in the vapor are orders of magnitude less than the harmful levels”.

This is probably the most significant – in the sense of the importance of the claim – of Hahn’s
claims that are false but could be defended as technically true based on a tortured interpretation
of the statement. The examples below provide much clearer examples of how she is
intentionally using this tactic.

Hahn’s Claim: e-cigarettes are a “largely untested product” and “Very few brands have been
tested (and some of those tests were funded by the e-cigarette companies).”

The truth: Hahn’s implication is that there are major significant knowledge gaps, while the truth
is that there is solid scientific knowledge about what e-cigarettes produce and what the health
effects of those exposures are. A tortured literal interpretation could be seen to be technically
true: of all the possible tests that could be done – say, what happens if you microwave an ecigarette,
or try to use it in zero-gravity? – few have been done.

There is sufficient testing to be sure that high-quality properly-functioning e-cigarettes do what
they are supposed to do. Testing by brand is an absurd way to look at the challenge, since
brands do not correspond to important product differences. This is like saying “we cannot be
sure that fruit is healthy since most brands of fruit have not been tested”.

Regarding funding, who else is going to do the research? And who should be responsible for
paying for it, if not the companies? We expect pharmaceutical companies to pay for research on
their own products, after all, and almost all such research is indeed paid for by the companies.
However, in contrast to much pharmaceutical research (e.g., on the smoking cessation products
that she recommends), the industry-funded research on e-cigarettes has been done by
independent researchers who do not depend on the e-cigarette industry and could never expect
substantial funding from it, and thus could not be enticed into making inaccurate claims.

Moreover, there has been research that was not funded by industry, though very little of it
because Hahn’s political faction has effectively blocked independent funding on THR. Indeed,
the disingenuousness of Hahn’s claim is perhaps even more important than its falsehood. THR
advocates are always interested in learning more about e-cigarettes, but Hahn has never
suggested or supported any useful research, and has contributed to making it less likely to
happen. The innuendo about funding source is particularly disingenuous given Hahn’s financial
relationships with producers of similar competing products.

Hahn’s implicit claim: The information that follows the header “What are e-cigarettes?” actually
provides accurate and useful information needed to understand them.

The truth: She starts with the bullet, “Battery operated devices that use a heating element to
vaporize nicotine and other substances”. This is basically accurate, though she works hard to not
mention that the main “other substance” is propylene glycol (PG), and indeed this is most of the
liquid and vapor. This is significant because in the main body of her letter and shortly after this
“What are...” section in the continuation pages, she goes on to try to mislead the reader about PG
(see next point for details). This glaring omission from the description of e-cigarettes seems to
be intentional, so that she could trick readers into believing that PG is some dangerous
contaminant.

The next bullet describes the activation of e-cigarettes, in which she leads with “lights the LED
light in the e-cigarette tip”. While it matters little whether an e-cigarette has such a light, it is
very odd that she apparently does not know that many of them do not (and for others it is not at
the tip), and that she chose to lead her description of the workings with a health-irrelevant
decorative feature. The rest of her description in this bullet is also accurate for some e-cigarettes,
but not all of them, but she presents it as if it were universally true. This may be a matter of
genuine lack of expertise, since the error seems to serve no rhetorical purpose.

Hahn’s claim: There is “no known human testing” of propylene glycol (PG) and “a major
chemical company warns [propylene glycol] should not be inhaled”

The truth: As noted above, nowhere in her entire letter and its attachment does Hahn explain that
PG is the biologically inconsequential primary ingredient in the vapor in current-technology ecigarettes.
If she did, she would not be able to portray it as if it were some scary chemical and a
dangerous unintended exposure. This ostentatious omission alone makes clear that Hahn is
seeking to confuse her readers rather than inform them.

She does not mention PG is used much the same way as the carrier for drugs in various inhaler
medical devices (e.g., asthma medicine), devices which have been extensively tested. PG is
generally recognized as safe as a food additive and is widely used as a source of thick visible
vapor for recreational purposes (the “fog” that is often used in dance clubs or theatrical
presentations). Indeed, PG vapor has even been used as a disinfectant in hospitals. These uses –
along with years of people using of e-cigarettes themselves – have produced extensive scientific
information about the effects of the exposure (which is to say, has shown the lack of any
observable effects). Thus, the “no known human testing” claim is patently false.

Hahn communicates to the reader that PG is harmful, but the very references she cites about it
support the opposite conclusion. One reports, “Results: Biochemistry and histopathology
findings demonstrated that under the conditions tested, deionized water, 10% ethanol, and 30%
propylene glycol were tolerated in a qualitatively similar way presenting limited cellular
reaction” (her reference 11). The other reports, “There was no apparent tissue toxicity of the
lung, liver and kidney in these studies” (her reference 12).

The chemical company claim has absolutely no real significance, though it obviously sounds
scary to a layperson. This rhetoric seems to trace to a single warning label on an industrial-grade
propylene glycol (PG) product, although there are undoubtedly other examples. Industrial
chemicals typically have warnings against human consumption and other exposures, even when
the chemicals are sometimes food ingredients when prepared in food-grade conditions.

Industrial-grade containers of ethanol and citric acid also have warning labels that say “do not
ingest”; this obviously does not mean that a mimosa is inherently dangerous to ingest, and
anyone who claimed otherwise either is clueless about health or is trying to lie. As Hahn no
doubt knows, warning labels can be found, that if over-interpreted and taken out of context, warn
against most any proper use of every manufactured chemical. Hahn does not explain any of this,
but rather tries to imply that a manufacturer of the grade of PG found in e-cigarettes has stated,
as a matter of general policy, that it should not be inhaled. But, of course, no such claim would
be made since PG is considered safe to inhale in many circumstances.

There is simply no charitable interpretation available for Hahn’s use of this misleading scary
claim that has no legitimate information value for the audience.

Hahn’s claim: “Finally, nicotine is also found in the vapor. Nicotine creates a sticky residue that
reacts with a normal substance in the air to form cancer-causing agents that off-gas [sic] into the
indoor air and cling to carpets, drapes, and other surfaces”, and later in the table, “Nicotine from
vapor or cartridge spills can react with an element in the air releasing strong carcinogens, which
can be inhaled, absorbed through the skin, or taken in by mouth”

The truth: The total amount of nicotine used by a typical e-cigarette user in an entire day has a
volume that is in the order of 1/10th of a single drop of water. Almost all of that is absorbed by
the user, with only a tiny fraction exhaled into the environment. The idea that this could create
enough nicotine residue to be considered “sticky” is absurd.

It is technically true that some nicotine molecules in the environment will undergo chemical
reactions into known carcinogens. The same can be said for basically any complex molecule and
many simple molecules. Hahn is trying to mislead her audience into believing that this occurs to
a degree that it creates a measurable health risk, a claim which is not supported by any evidence.
Indeed, the two references she claims support this contention consist of one lab study that used
an extremely high concentration cigarette smoke residue and still found barely measurable levels
of the results of these chemical reactions (reference 7) and a non-research advocacy commentary
which included a discussion of residue from cigarette smoke and also included a separate and
unrelated discussed of e-cigarettes, which contained absolutely no evidence in support of Hahn’s
claim (reference 8).

The available evidence does not let us really even guess at the total quantity of these “cancercausing
agents” that might be created by e-cigarette vapor in the environment (which means that
there is no evidence that supports Hahn’s message that this phenomenon represents a health
hazard). But to try to put the magnitude in perspective, based on the one laboratory study of
cigarette smoke that she does cite, it seems likely that the total quantity of the carcinogens in
question created via this phenomenon from someone using e-cigarettes for her entire life would
be less than is found a single puff from a cigarette (and moreover, most of what was created
would remain harmlessly in the environment). But Hahn is clearly trying to mislead the reader
into thinking that this is a proven significant hazard.

Hahn’s Claim: “Cartridge may contain up to 500 mg of nicotine (approx. 10 time lethal dose).”

The truth:
 This claim illustrates the willingness of Hahn to make any claim that she thinks might
support her point, without being concerned with whether it is remotely plausible. For even the
high-nicotine e-cigarette solutions, 500 mg would require about a shot glass worth of liquid.
Anyone familiar with e-cigarettes and units of measure could figure this out with a few
moments’ thought. A e-cigarette that is of roughly the form of an actual cigarette (e.g., the one
Hahn shows in the graphic on the same page), with a cartridge that is typically smaller than a
cigarette filter, is obviously far too small to hold anywhere close to that much. It is possible for a
hobbyist to make a novelty “mod” that holds that much liquid, and this has been done, but this
has no relevance for the normal products.

Hahn’s Claim: “Difficult to refill cartridges without getting liquid on hands.”

The truth: Many of the first-generation refillable products had this problem, but today most ecigarettes
sold are either non-refillable, so there is no such problem, or refillable devices are
much higher quality and so also do not have this problem. This claim is like warning that gas
stoves are a danger because people get burned when they light the burner with a match – long out
of date, as anyone who knows the topic already knows. So either Hahn is intentionally citing
out-of-date information or she knows so little about e-cigarettes that she has no business
commenting on them.

This claim, when combined with the “500 mg” claim that appears immediately before, is clearly
intended to communicate that the very physical existence of e-cigarettes, apart from their
intended use, creates an accidental exposure and overdose risk. Missing is the accurate
information that after millions of people have used e-cigarettes for years, there has not been a
single publicly reported case of an overdose that required medical attention.

Hahn’s Claim: Acetone, cresol, xylene, and styrene are found in the vapor and “Volatile organic
compounds can cause negative health effects”

The truth: The source to which she traces this claim, as well as the next two claims assessed
below is an extremely exacting analysis that looked for contaminants down to minimally
detectable levels; it concluded that the traces found were at levels that did not pose a health
hazard to the e-cigarette user. The orders-of-magnitude lower level of exposure experienced by
bystanders – the people that Hahn is claiming are being put at risk – are obviously even less
consequential.

As anyone familiar with health science knows, thanks to modern detection methods that can find
even a few molecules of a contaminant, almost everything can be shown to contain traces of
chemicals that in much higher concentrations create a health hazard. Many laypeople do not
understand this, however, and thus claims of “finding chemicals” are a common deceptive
practice of activists who seek to mislead people into fearing fake environmental hazards.

The author of the cited analysis explicitly reported that the levels of these contaminants were at
levels below those determined to be harmful, and well below the minimum risk levels accepted
by the US Public Health Service and OSHA. It is believed that many of the barely-detectable
contaminants were outgassing from the device’s tiny electronics, in much the same way they
outgas from a computer, lamp, or other electrical device, though larger devices will produce
quite a lot more.

Most important, notice the exact wording of the quoted phrase. The average reader will perceive
her claim to be “these volatile organic compounds, as found in the vapor, can cause negative
health effects”. But a more careful examination reveals that the author is trying to trick the
reader into this perception, while the actual claim is a generic statement about unspecified VOCs
and unspecified quantities. Compare the juxtaposition of these accurate statements: “Ellen J.
Hahn has been found to be a H.sapien. H.sapiens have caused 100 million deaths from genocide
over the last century.” This is a clear example of someone who apparently knows that it would
be false to say that these trace contaminants pose a health risk, but has nevertheless chosen to
communicate exactly that message.

Indeed, the entire table in which this appears is clearly designed to be misleading. It is
completely absurd to present a lay audience with a list of “chemicals” (a word that basically
means “stuff”, but that has connotations that scare lay readers) that combines the main two
ingredients of e-cigarette liquid, a list of barely-detectable trace contaminants that can be found
in most everything in the biosphere, and one non-trace (though still well below harmful levels)
contaminant that was once detected in one apparently badly-manufactured product. But if that
list is going to be presented, it should contain relevant information, like the quantities and how
they compare to the quantities that are believed to be harmful. Informing the reader is clearly not
the goal of this table.

Hahn’s Claim: “Ethyl alcohol” and acetaldehyde are found in the vapor, and again “Volatile
organic compounds can cause negative health effects”

The truth: Notice the reprise of the generic statement about VOCs, again presented so that the
average reader inevitably thinks the claim is being made about these particular exposures. In this
case, though, it refers to two common chemicals that are present in many foods in quantities that
far exceed those found in e-cigarettes, and released by cooking and evaporation.

Most people know that ethyl alcohol (unlike nicotine, contrary to Hahn’s claim that has already
been addressed) is intentionally consumed in shot-glass sized quantities, so the microgram
quantities that contaminate e-cigarette vapor are obviously not a real issue. However, the
layperson that is the target of this communication might not recognize the particular term she
chose, and definitely would not know that the exposure was completely inconsequential. Since
this would have been easy to clarify and improve the reader’s understanding, it is clear that
helping readers understand the truth was not the goal.

If Hahn really believed what she was claiming – that inhaling barely-measurable quantities of
ethanol and acetaldehyde is harmful – she would be campaigning to shut down the bars and open
kitchens in hotels. Instead, she voiced this concern only in the context of trying to discriminate
against and prevent the free assembly of her political opponents.

Hahn’s Claim: Formaldehyde is found in the “cartridge” (by which she presumably means the
liquid) and vapor and it is a “Cancer causing agent”.

The truth: As with the above two claims, the source to which she cites this claim reported that
there is no health concern. Again, that reassurance is based on the exposure of the e-cigarette
user herself, with the environmental exposure being much more trivial. Formaldehyde is cited as
one of the hazards from environmental tobacco smoke, but the nontrivial quantity that is released
via combustion has no relevance to e-cigarettes, for which it is only a trivial trace contaminant.
On the other hand, the pressed wood products that are common in, say, hotels, do produce a
nontrivial exposure to formaldehyde. Again, Hahn obviously does not really believe that these
exposures are dangerous enough to warrant asking a hotel to change its practices – except in the
one case where that change would block the freedom of assembly of her political opponents.

Hahn’s Claim: Beta nicotyrine, a “Cancer causing agent derived from nicotine”, is found in the
vapor and liquid.

The truth: The FDA study she cited this to found quantities in the parts per billion range, and did
not suggest it posed any risk. Indeed, it noted that the concentration was below what the FDA
allows for the Nicotrol inhaler. At the end of the document, Hahn explicitly recommends the use
of a category of products that includes the Nicotrol inhaler.

Hahn’s Claim: “Five minutes of e-cigarette use has lung effects similar to tobacco smoking.”

The truth: A scientist will immediately notice that the statement is pseudo-scientific, with a
specific unit in the former part of the comparison but no unit in the latter (how much tobacco
smoking?). The experiment that the statement cites to found that a few particular detectable
acute effects that result from smoking, which may or may not have any health implications in
themselves, can be produced by vaping. Using the logic that goes from that study result to
Hahn’s statement, it is also true to say that breathing has lung effects similar to tobacco smoking.

Of course, most readers will interpret this statement as saying that e-cigarette use causes as much
harm to the lungs as smoking, and the author, of course, knows this. A plethora of evidence
shows that claim is false.

Hahn’s Claim: “Using e-cigarettes in smoke-free areas may cause others to think smoking is
allowed, creating enforcement problems.”

The truth: This is an example of Hahn reporting a speculative hypothesis as if it were fact. She
cites this claim to a two-year-old advocacy piece that speculates about the possibility. However,
e-cigarettes have been widely used for years, and we are aware of only a single report (from
England) of an “enforcement problem” – a smoker who tried to escape a fine by claiming he was
actually using an e-cigarette. Obviously this does not represent a serious concern.

Indeed, even the speculation about the possibility seems quite ludicrous in the American context
(the document cited is from a European organization). Who would seriously think that a smoker
in Lexington in 2012, or most anywhere in the United States, would not be aware that indoor
smoking is banned almost everywhere (and smokers are well aware of the few places where this
is not the case) and would ignore that – as well as the lack of ashtrays – and light up upon seeing
an e-cigarette in use. If he did, he would quickly be told to extinguish it, with no harm beyond
mild passing embarrassment – hardly an “enforcement problem”.

Hahn’s misleading description of the e-cigarette device may be designed, in part, to try to
support this claim, with its emphasis on cigarette-shaped devices and the LED light. What she
fails to mention is that to the extent that e-cigarettes have lights on the tip, consumers and
producers tend to favor green, blue, or other colors that ostentatiously display that the device is
not a cigarette. Moreover, long-term and more knowledgeable e-cigarette users (i.e., the
population that would dominate the vapers meeting in question) tend to use devices whose shape
and size are radically different from that of a cigarette. An observer would be no more likely to
believe that smoking was allowed than if they saw someone chewing on a pen, let alone someone
engaging in the perfectly legal act of holding an unlit cigarette in anticipation of going outside to
smoke.

Hahn’s Claim: “Marketers claim that e-cigarettes can be used where smoking is prohibited.”

The truth: Actually, that is the truth – that is, the “claim” is the truth. E-cigarettes, because they
are a smoke-free alternative, are not affected by the vast majority of anti-smoking rules
(including those of Lexington, Kentucky, and Best Western hotels). Of course, Hahn is
presenting this in a way that is meant to imply that the claim is false and somehow nefarious, and
that anyone making it should not be trusted. Compare: “Ellen J. Hahn claims that she is an
employee in good standing of the University of Kentucky.”

Various irrelevant claims
Hahn’s letter also contains various claims that have absolutely no bearing on whether a hotel
should act to prohibit exposure to e-cigarettes. Most of them are policy advocacy opinions and
devoid of useful information. Inclusion of these in her communication was clearly meant to
generally vilify e-cigarettes and manipulate the audience, not to produce an informed decision
about health risks. But apart from that general observation, analysis of some of a few of the
specifics is useful for presenting a complete picture of Hahn’s misleading letter.

Hahn’s claim: “E-cigarettes are not a proven cessation aid and could derail true cessation
attempts”

The truth: This claim is interesting primarily because it is so obviously false that it illustrates the
profound disregard for science by the author. If even a single person is known to have stopped
smoking by switching to e-cigarettes, then this statement is false, and there are thousands of
published testimonials of individuals reporting exactly that experience.

A more nuanced statement might not be so patently false. For example, “smokers who try to
switch to e-cigarettes seldom succeed” or “e-cigarettes are inferior to the cessation aids
mentioned below” or “there is no systematic research that helps us to estimate the rate at which
e-cigarettes succeed as a cessation aid”. It turns out that all of these claims are also false, but at
least they do not represent a profound disregard for simple and easily-observed facts.

In addition to the evidence from individual reporting, there is a growing body of systematically
gathered evidence that e-cigarettes are very effective for smoking cessation and produce the
benefits we expect from cessation. The first such study results were first published (by one of
us) almost three years ago, before Hahn became an activist in this arena, so she cannot claim that
her knowledge is just a bit out of date. Several population surveys as well as evidence from
clinical testing show that e-cigarette users are largely made of up former smokers who report
they would still be smoking without e-cigarettes, as well as studies that show those who switch
to e-cigarettes experience effectively the same health improvements as those who quit nicotine
entirely.

It may be that Hahn is trying to play more word games, treating the word “cessation” as meaning
nicotine cessation, while the common (and only important, from a health perspective)
interpretation would be smoking cessation. The whole point of switching to e-cigarettes is to
achieve the benefits of smoking cessation while avoiding the possibly prohibitive costs of
nicotine cessation. (Though there also turns out to be evidence that suggests that smokers using
e-cigarettes as part of a path to complete nicotine cessation find them quite effective for that too.)

Hahn’s reference to “true” cessation attempts is just cheap rhetoric. There is nothing more or
less “true” about a particular method for smoking cessation – any motivated attempt to quit
smoking is equally “true”, whatever tools are being used. Ironically, later in the document Hahn
recommends the use of “nicotine replacement regulated by the FDA” (i.e., gums, patches, oral
sprays). But the evidence consistently shows that these products are almost completely
ineffective. Moreover, the extra months of smoking that result from these failed attempts, even
if switching or other cessation soon follows, pose more of a health risk than a lifetime of using a
low-risk smoke-free product like e-cigarettes. If “true” is to mean anything, it seems like it best
describes use of methods that are often successful rather that those that almost always fail.

But Hahn’s honesty in making these claims does not even depend on the relative effectiveness of
cessation methods. If Hahn actually believes that the cessation methods she advocates are better,
it is perfectly acceptable for her to argue that point using accurate information. But it is clearly
dishonest for her to communicate to a lay audience that it is settled fact that e-cigarettes are not
useful for cessation and to state that there is no evidence contrary to that opinion.

Hahn’s Claim: “Dual use of cigarettes and e-cigarettes will not result in public health benefits.”

The truth: While it is true that anyone who continues to smoke for even part of their nicotine
consumption will face greater health risks than someone who stops smoking, Hahn’s statement is
false for several reasons.

First, if someone reduces their smoking by using e-cigarettes, it will provide a health benefit,
though not as much as if they switched completely. Second, there is clear scientific evidence
that a large portion of smokers who switch to low-risk alternatives go through a period of dual
use; thus, some dual use is part of the process by which e-cigarettes provide public health
benefits.

Third, it appears that the basis for a claim like this (based on versions that appear elsewhere) is
that if many smokers who might have otherwise quit smoking instead choose to continue to
smoke as part of a dual use pattern because e-cigarettes are available, then it could perhaps be
that the net public health effects are negative, though that is extremely unlikely. But notice how
much more conditional and nuanced that statement is than what Hahn asserted. Even with the
caveats, such a claim amounts to a speculative hypothesis that would need to be substantiated by
empirical evidence, that dual use results in no net public health benefit (the existing evidence
shows that it is pretty clearly wrong, by the way). Hahn has taken a complicated hypothetical
possibility that would need to be supported by evidence and stated it not as hypothesis or even
prediction, but as established fact, a clear violation of honest scientific analysis.

Finally, it is worth noting how disingenuous this is. Someone who genuinely worried that there
was a common pattern of dual use that was having a net negative public health effect would be
seeking ways to persuade the dual users to switch away from smoking entirely. Simply taking
away their e-cigarettes will quite likely result in most of the dual users resuming exclusive
smoking.

Hahn’s Claim: “Some e-cigarettes are marketed as ‘green’ and ‘healthy’ which may encourage
youth to experiment and become addicted.”

The truth: This is a variation on one of the favorite unsubstantiated claim of anti-THR activists,
though a rather odd variation on the theme, and not just because it is illegal to market an ecigarettes
as healthy in the US. It is a very strange speculation that these would be the claims
that attracted youth (who would ever believe that a battery operated device, especially a
disposable one, is green?) Indeed it is pure speculation; it is cited to a source that is a purely
speculative opinion piece – in other words, the inclusion of a citation is meant to merely give the
illusion of support for the statement. The reality is that approximately all use of e-cigarettes is
by former smokers, and there is little or no appeal to children.

Hahn’s Claim: “the commercials claim” that e-cigarettes produce water vapor

The truth: There are a few vendors who have mistakenly described the vapor from e-cigarettes as
water vapor. But Hahn’s statement implies that this is the common practice, which it is not, and
that “the commercials” (as opposed to authoritative scientific sources like CASAA and online
discussion forums) are the main source of available information. Moreover, the claim “is like
water vapor” is actually much more accurate, from a practical standpoint, than her claims: A
claim that e-cigarettes produce water vapor, while technically false, helps the audience
understand that the vapor is very different from smoke, and that the health risk from the vapor is
similarly low to that from water vapor. This contrasts with many of Hahn’s claims that, while
technically true, are designed to cause the audience to believe the false claim that the vapor is
highly hazardous.

Hahn’s Claim: “E-cigarettes are marketed online with testimonials from people trying to quit,
despite the fact that e-cigarettes are not scientifically proven or FDA-approved cessation aids.”

The truth: Once again, this is half true, but Hahn uses even the true claims to communicate
falsehoods. For obvious reasons, the testimonials are most often from people who successfully
quit smoking using e-cigarettes, not the ones who are trying. This is perfectly reasonable factual
communication on the part of the marketers, given that e-cigarettes are scientifically proven to
help some people quit (flatly contrary to Hahn’s claim). The intended message is that this
marketing is somehow misleading or improper, but it is that message itself which is misleading.

As for the claim about FDA approval, this is a common bit of misdirection by anti-THR activists.
Switching to low-risk alternatives is one of the most important smoking cessation methods in the
US today. Studies that try to compare the relative effectiveness of smoking cessation tools
suggest that nothing has a higher success rate than THR; it appears that the only option
responsible for more successful cessation attempts (because it is tried most often) is quitting
without the use of any drug, product, or device – an option that is also not approved by the FDA.