The Public Health Case for Electronic Cigarettes

Earlier this month, a federal appeals court blocked the Food and Drug Administration's attempt to ban electronic cigarettes, battery-powered devices that simulate smoking by generating vapor from a propylene glycol solution containing nicotine. An article in the December 9 Journal of Public Health Policy explains why, legal issues aside, the FDA should not be trying to ban this product if its aim is to reduce tobacco-related harm. Boston University public health professor Michael Siegel and Zachary Cahn, a graduate student in political science at U.C.-Berkeley, review the evidence concerning the relative hazards of e-cigarettes and conventional cigarettes as well as the former's potential as a replacement for the latter. "A preponderance of the available evidence shows [e-cigarettes] to be much safer than tobacco cigarettes and comparable in toxicity to conventional nicotine replacement products," they write. Furthermore, because e-cigarettes more closely simulate the experience of smoking than nicotine gum, patches, or inhalers do, they may be more effective in helping smokers quit. Siegel and Cahn note that effectiveness may not hinge on nicotine delivery:

Taken together, this evidence suggests that electronic cigarettes are capable of reducing cigarette craving, but that the effect is not due exclusively to nicotine. Bullen et al observe that "the reduction in desire to smoke in the first 10 min[utes] of [electronic cigarette] use appears to be independent of nicotine absorption."...The sizable craving reduction achieved by the "placebo"—a nicotine-free electronic cigarette—demonstrates the ability of physical stimuli to suppress cravings independently. Many studies have established the ability of denicotinized cigarettes to provide craving relief. Barrett found that denicotinized cigarettes reduce cravings more than a nicotinized inhaler, supporting Buchhalter et al's conclusion that although some withdrawal symptoms can be treated effectively with NRT [nicotine replacement therapy], others, such as intense cravings, respond better to smoking-related stimuli.

Perhaps because of these very same "smoking-related stimuli," public health officials and anti-smoking groups have been irrationally hostile to e-cigarettes, demanding that they be removed from the market. Siegel and Cahn challenge these critics to act on their own professed principles, including the injunction to "do no harm," by supporting e-cigarettes as a harm-reducing alternative to smoking:

Thus far, none of the more than 10 000 chemicals present in tobacco smoke, including over 40 known carcinogens, has been shown to be present in the cartridges or vapor of electronic cigarettes in anything greater than trace quantities. No one has reported adverse effects, although this product has been on the market for more than 3 years....

The evidence reviewed in this article suggests that electronic cigarettes are a much safer alternative to tobacco cigarettes. They are likely to improve upon the efficacy of traditional pharmacotherapy for smoking cessation....

By definition, enacting a ban will harm current users, unless the evidence suggests that the harms outweigh the benefits for those already using the product. The burden of proof is on the regulatory agency to demonstrate that the product is unreasonably dangerous for its intended use....

Unless the evidence suggests that vaping does not yield the anticipated reduction in harm to the user, enacting an electronic cigarette prohibition will do harm to hundreds of thousands of vapers already using electronic cigarettes in place of tobacco ones—a clear violation of nonmaleficence.

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  • ||

    But the children! its obviously a gateway to real smoking.

    How do kids manage to grow up anyway. No wonder they are all such fucking miracles!

  • James||

    I call Bull Sh*t on this post!

  • Cyto||

    You jest, but apparently this is a real concern to the nannies out there. Apparently right-wing talkshow guy Limbaugh is using the e-ciggies and was asked not to e-light up at a restaurant because "it might be seen by the children". So no, your joke isn't a joke.

  • Matrix||

    Why do they coddle children so much? It's getting ridiculous that we think that children cannot handle seeing grown-ups doing grown-up vices (ie, drinking or smoking) without immediately going out and trying to do the same. I saw some adults do stupid shit as a kid, and did not have the compulsion to do the same.

    Kids probably know a lot more than their parents think they know, and they are a lot worse than their parents think they are. Seriously, maybe it's the parents who need to grow up and not the kids!

  • Robert||

    They still make toy razors and toy cars.

  • Ska||

    Vaping blueberry cheesecake right now. At my desk. And it's awesome.

  • prolefeed||

    It's such a no-brainer allowing e-cigs, so morally reprehensible to ban them and cause tens or hundreds of thousands of preventable deaths, that I'm surprised there isn't a hue and cry to hold the monstrous banning policymakers accountable for those deaths by firing their sorry asses.

  • ||

    Lemme get this straight. You want civil servants ant their politically appointed bosses held responsible for doing their jobs.

    That's a good one.

  • Joe_D||

    Not to be pedantic, but did you accidentally omit the word "squad" after "deaths by firing..."? I realize that the grammar is awkward with that word added, but the sentence makes so much more sense with it.

  • Prohibition Kills||

    The FDA, protecting your children, because you can't.

  • ||

    Siegel and Cahn challenge these critics to act on their own professed principles, including the injunction to "do no harm," by supporting e-cigarettes as a harm-reducing alternative to smoking:

    How are they supposed to wield their power and control arbitrarily then?

  • ||

    Pat Robertson in favor of cannabis decriminalization?

    http://gawker.com/5716175/pat-.....iminalized

    (gawker link, I know)

    "It got to be a big deal in campaigns: 'He's tough on crime,' and 'lock 'em up!'" the Christian Coalition founder said. "That's the way these guys ran and, uh, they got elected. But, that wasn't the answer."

    His co-host added that the success of religious-run dormitories for drug and alcohol cessation therapy present an "opportunity" for faith-based communities to lead the way on drug law reforms.

    "We're locking up people that have taken a couple puffs of marijuana and next thing you know they've got 10 years with mandatory sentences," Robertson continued. "These judges just say, they throw up their hands and say nothing we can do with these mandatory sentences. We've got to take a look at what we're considering crimes and that's one of 'em.

    "I'm ... I'm not exactly for the use of drugs, don't get me wrong, but I just believe that criminalizing marijuana, criminalizing the possession of a few ounces of pot, that kinda thing it's just, it's costing us a fortune and it's ruining young people. Young people go into prisons, they go in as youths and come out as hardened criminals. That's not a good thing."
  • ||

    It sounds like one of his kids just got popped.

  • ||

    They don't even bother trying to offer honest excuses for the shit they pull these days. I've got news for the brazen bureaucrats, their days are numbered.

  • ||

    Unfortunately, with our current electorate, that number is fairly large.

  • ||

    The number can not be conveniently expressed without using exponential notation.

  • Rick||

    I used one of these to help me quit. It was the only thing that worked for me, a 25 year 2 pack a day+ smoker.

    The tobacco lobby and control freaks need to stay the heck out of it. I can't even list my used e-cig on eBay because they are scared of the repecussions.

  • Tobacco Industry||

    Hey, we paid for protection. Remember that 'settlement'?

  • ¢||

    so morally reprehensible to ban them and cause tens or hundreds of thousands of preventable deaths, that I'm surprised there isn't a hue and cry

    Surprised?

    J. Random Voter enjoys participating, at least vicariously, in the making-dead of people she hates. (The average person is a woman.) It's, like, the causa prima of representative government.

    The American People™ have been successfully conditioned, of late, to hate smokers—as such, whether they actually smoke or not. If smokers are allowed to get what they need harmlessly—to hide from the horrific deaths they deserve—they're cheating.

  • Um||

    You couldn't be more dead on. You should write for the Colbert Report.

  • The Liberals||

    There goes Sullum again, shilling for Big Electronic Cigarette.

  • Robert||

    Could be worse: Big Electric Cat.

  • Tim||

    Cool, Adrian Belew reference.

  • SIV||

    I'm surprised we don't have E-cig spammers showing up.

  • SIV||

    Can States ban electronic cigarettes? The product is diminishing their "take" from the master settlement agreement.
    There is some "real harm" for ya.

  • Andrew Cuomo||

    I'm on it; I'll let you know.

  • P B||

    "Earlier this month, a federal appeals court blocked the Food and Drug Administration's attempt to ban electronic cigarettes ..."
    Like that will slow them down, see FCC.

  • Gaunilo||

    They of course cannot be 100% sure that the e-cigs won't cause any harm. So they reflexively want to ban them.

    Best parallel I can think of is when they wouldn't let some of the oil skimmers work on the Gulf oil spill because the water that emerged from the filtering had more oil per millions than the regs allowed. The fact that they would have removed thousands of gallons of oil per day didn't matter. They discharged oily water into the (even oilier) water, and therefore were polluting the ocean.

  • Gaunilo||

    They of course cannot be 100% sure that the e-cigs won't cause any harm. So they reflexively want to ban them.

    Best parallel I can think of is when they wouldn't let some of the oil skimmers work on the Gulf oil spill because the water that emerged from the filtering had more oil per millions than the regs allowed. The fact that they would have removed thousands of gallons of oil per day didn't matter. They discharged oily water into the (even oilier) water, and therefore were polluting the ocean.

  • ||

    Here in WA state, King County just banned the use of e-cigs. in places where real cigs. are forbidden.

    Here's their rationale:

    "By returning smoking to the public eye, public e-cigarette use threatens to undermine the social norming impact" of the smoking ban, testified Scott Neal, manager of the tobacco prevention program for Public Health -- Seattle & King County."

    They don't even try to pretend that this is about "health" anymore.

    http://www.seattlepi.com/local.....source=rss

  • Rhywun||

    I'd love to resurrect the candy cigarette industry, market them as a "smoking cessation tool", and watch their heads explode trying to compute that.

  • Rhywun||

    Incidentally, that has got to be one of most puke-inducing instances of nanny-babble ever. "Social norming"? "Public eye"...?! God damn, how creepy.

  • Robert||

    Taken together, this evidence suggests that electronic cigarettes are capable of reducing cigarette craving, but that the effect is not due exclusively to nicotine. Bullen et al observe that "the reduction in desire to smoke in the first 10 min[utes] of [electronic cigarette] use appears to be independent of nicotine absorption."...The sizable craving reduction achieved by the "placebo"—a nicotine-free electronic cigarette—demonstrates the ability of physical stimuli to suppress cravings independently. Many studies have established the ability of denicotinized cigarettes to provide craving relief. Barrett found that denicotinized cigarettes reduce cravings more than a nicotinized inhaler, supporting Buchhalter et al's conclusion that although some withdrawal symptoms can be treated effectively with NRT [nicotine replacement therapy], others, such as intense cravings, respond better to smoking-related stimuli.


    That there's the real dynamite here.

  • Robert||

    Sheesh, nobody else reacting to how unimportant nicotine is in maintaining the smoking habit?

  • sevo||

    If the argument (and resulting restrictions) against smoking tobacco had anything to do with health, there would have been screams to develop healthier alternatives, sort of like the efforts around AIDS.
    It doesn't; it's nothing other than puritans hoping no one enjoys anything and the weenies who wouldn't touch a smoke for fear they'd die instantly.
    I hope they die of tofu-poisoning.

  • Robert||

    I never thought of that comparison, good insight. Some promoted safer homo sex, others wanted to switch homos to hetero sex; but nobody just wanted people to stop having sex, period.

  • Robert||

    By "having", I meant "enjoying".

  • ||

    Tar bad.
    Nicotine good.
    E-cigarettes excellent.

    Mayor Bloomberg very unhappy.

  • rhea||

    “Smoking is bad for your health!” High tax for cigarettes and a visual representation for smokers and non-smokers alike, has been in debate for a long, long time…
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  • Rick H.||

    Note to Reason webmaster: This ^^ is spam.

  • pmains||

    You'll have to put that in words understandable by squirrels. (Note to squirrels. This ^^ guy is a nut.)

  • John R. Polito||

    While the e-cig makes tremendous harm reduction sense, the marketing hype and lies of some companies are as bad as anything seen from tobacco companies. The FDA needs to stop fighting the e-cig and issue sensible manufacturing, quality control, and marketing regulations.

    If heroin were legal would we allow it to be marketed and sold in front of children? An explosion of new nicotine delivery products, including snus, if we're concerned about rising youth nicotine dependency rates, we'd be wise to consider laws and ordinances which deny youth the right to enter any nicotine product sales location. Is it really too much to ask store owners need to decide whether they want to market what most consider the most addictive chemcial of all, or have children and teens as customers?

  • Jimmy||

    If "addiction" is so horrible, why are kids allowed to buy coffee and lottery tickets? Why is it so easy for an adult to buy liquor? As King County has finally admitted - and I think we'll see lots more of it - the real issue is the "image" of smoking. If nicotine had always come in a cup, we wouldn't even be having this conversation.

  • pmains||

    I get it. John R. Politico. Very amusing character.

    In all seriousness, I find the e-cig people endearing. Sometimes annoying, but it also takes me back to the old-West days of snake oil salesman. Sure, their patent medicines would make you go blind. Really brought home the lesson of personal responsibility and caveat emptor, though.

  • ||

    No, that's his real name...he's a rabid anti-smoker! Google is your friend.

  • ||

    It's obvious that the FDA, in their puritanical crusade against smoking, is willing to let untold numbers of people die rather than allow a safer* alternative to tobacco because it looks like smoking.

    *Preponderance of evidence my ass. Does anyone at the FDA want to bet that E-cigarettes are as harmful as the tobacco variety?

    I'm giving 100-1 odds.

  • ||

    They are not interested in harm reduction, they are intrested in imposing their morals on others. Smoking or even pretending to is wrong. That's why they push for bans on candy cigarettes. We can't have kids pretending to smoke can we? It's nannyism.

  • ||

    You can buy a toy gun and a kid can run around pretending to shoot people. But pretending to smoke is bad.

  • ||

    And I am aware some people have a big problem with toy guns.

  • omg||

    It almost sounds like liberal moral crusaders have some sort of alternative agenda or something.

  • ||

    I've been using an electronic cigarette exclusively for over 3 months. After smoking 1+ pack a day for 20+ years. I'm very thankful that this technology exists.

    Back the fuck off, bureaucrats! This shit works. And you're damn right I'm trading one habit for another. But this new habit doesn't require me to lose my breath standing up, cough up a lung every morning, or force me to face an early demise. Nor does it demand I pay homage to Federal and State entities with every purchase I make - that's the real crux, isn't it?

  • ||

    10,000 chemicals present in tobacco smoke? Gee, I wouldn't have thought it was over 9700. Go figure.

  • Rock Action ||

    Somebody ought to light up a cigarette, blow it in their face, and show them what unelected authority with lack of respect for autonomy is all about.

  • Rock Action ||

    *a lack of

    That was a bit like slamming the door on one's way out and forgetting the keys.

  • ||

    Electronic cigarettes are just another industry with a vested interest in lies and scientific fraud.

    http://www.smokershistory.com

  • I Love E-Cigarettes||

    How you like them apples, FDA? N screw King County. It's ridiculous. If you see someone steal some candy from a grocery store, does that mean you are going to steal one too? NO! It's your responsibility to know and practice the law. It's not mine as an e-cigarette smoker.

  • TDot||

    I find my e-cig mimics the feeling of smoking pretty, and I can smoke indoors without any problems. If you're on the fence about buying one, I suggest taking a look at some reviews in order to see which device is best suited for you. Some models have longer battery life while others produce more vapor.

    I recommend http://e-cigcentral.net as their reviews seem pretty honest and unbiased.

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