California Declares E-Cigarettes a 'Community Health Threat'

The state's Department of Public Health sees no upside to a product that can save smokers' lives.



This week the California Department of Public Health (CDPH) declared electronic cigarettes "a community health threat" in a report that crosses the line between hyperbolic scaremongering and outright lying. The report includes the same lame claims that people who hate vaping for subrational reasons tend to offer when they try to justify their gut reactions to products that offend them mainly because they look too much like the real thing. There is the purported epidemic of poisonings involving children whose parents fail to keep e-cigarette fluid out of reach, the absurd insistence that candy or fruit flavors must be aimed at children because they could not possibly appeal to adults, the worry that vaping will encourage teenagers to smoke by making it seem cool again or by getting them hooked on nicotine (even though smoking among teenagers has reached record lows as experimentation with e-cigarettes has risen dramatically), and the warning that e-cigarette vapor, despite very low levels of just a few problematic substances, may pose a threat to bystanders because no one has conclusively proven that it doesn't. Generally speaking, these claims amount to unsubstantiated speculation or an alarmist spin on actual facts. But at least one crucial statement in the report is simply false: "There is no scientific evidence that e-cigarettes help smokers successfully quit traditional cigarettes."

It would be fair to say there is not a lot of scientific evidence that e-cigarettes are effective in helping smokers quit (although the testimony of former smokers surely should count for something). But there is some evidence. For instance, a randomized trial reported in The Lancet two years ago found that the six-month quit rate for e-cigarette users was 7.3 percent, compared to 5.8 percent for subjects who used nicotine patches. A survey reported last year in the journal Addiction, by comparison, found that people who try to quit smoking with the aid of electronic cigarettes are twice as likely to succeed as people who use nicotine replacement products such as gum or patches.

The differences between the results of these two studies probably have a lot to do with self-selection in the latter, which can be viewed as methodological problem but also more accurately reflects what happens in the real world. If e-cigarettes are especially effective for certain types of smokers, a randomized study would not show that. It also seems likely that randomized trials involving newer models of e-cigarettes and vaporizers, which deliver nicotine more effectively, would show higher quit rates (although even the Lancet study found e-cigarettes were more effective than nicotine patches). In any case, when CDPH Director Ron Chapman says there is no evidence that e-cigarettes help people quit smoking, he is just making shit up.

The reason that's important, of course, is that vaping, because it does not involve tobacco or combustion, is much less hazardous than smoking. So if e-cigarettes help even a small share of smokers quit, the benefits in terms of reduced tobacco-related disease and death could be huge. Chapman is desperate not to acknowledge that potential, because it implies that what he identifies as a public health threat could in fact be a public health boon. Given the ongoing debate among anti-smoking activists and public health specialists about the benefits of e-cigarettes, his completely one-sided approach is dishonest and reckless. His message to smokers, supposedly grounded in science, is that there is no point to trying e-cigarettes, since they won't help you quit and are nearly as bad as conventional cigarettes anyway. This is the sort of bad advice that puts lives at risk.