Public Health

Inhale Your Vapor If You've Got It

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The Colorado Springs Gazette reports that at least two companies are selling electronic nicotine inhalers shaped like cigars, cigarettes, and pipes as tobacco substitutes. The manufacturers aim to avoid FDA regulation by marketing the devices not as a quitting aids (or, as the FDA would see it, treatments for the disease of nicotine addiction) or as safer (and therefore disease-ameliorating) alternatives to cigarettes but as a way to get your nicotine fix when you're not allowed to smoke. The article quotes one anti-smoking activist, Bill Godshall of Smokefree Pennsylvania, who welcomes the inhalers, and another, Alan Blum, director of the University of Alabama Center for the Study of Tobacco and Society, who sounds ambivalent. But both are mavericks within the anti-smoking movement: Godshall also favors smokeless tobacco as a harm-reducing alternative to cigarettes, and Blum at one point was sympathetic to that idea.

I predict most anti-smoking activists will be outraged by these products. First, they will argue (as they do with respect to smokeless tobacco) that the inhalers give smokers a way to endure smoke-free environments more comfortably and therefore blunt the effectiveness of smoking bans as a way of encouraging smokers to quit. That's probably true, but from a "public health" point of view you'd have to weigh the people who continue to smoke because of these products who otherwise would have quit against the smokers who switch mostly or entirely to the inhalers, thereby dramatically reducing their intake of toxins and carcinogens. Second, many, if not most, anti-smoking activists are uncomfortable with the idea of continuing to use nicotine indefinitely, regardless of the health consequences, because they view drug addiction as inherently bad. In their view, complete abstinence is the only acceptable alternative. Again, from a "public health" perspective, which seeks to minimize morbidity and mortality, this stance is highly questionable, since it could well result in more disease, not less.

From a libertarian perspective, of course, the issue is easy: Let manufacturers sell whatever tobacco or nicotine products they choose, as long as they're honest, and let consumers make their own tradeoffs between risk and pleasure, regardless of the impact on collective measures of health. That's not likely to be the way this shakes out, of course. I suspect the manufacturers of nicotine gum and patches, who not only had to get pre-market approval for their products but waited years before they were allowed to sell them over the counter instead of only by prescription, will be irked by the competition from non-FDA-regulated nicotine inhalers. All of these companies are selling essentially the same thing, however they choose to describe it, and it's quite common for people to use patches and gum as long-term cigarette substitutes, as opposed to "cures" for nicotine addiction. It seems like the artificial regulatory distinctions among different nicotine products can't last. Then again, our drug laws are riddled with such inconsistencies.