Anyone with a modicum of knowledge regarding public health will agree that the most important, devastating, and preventable threat to human health we face is cigarettes. Smokers trying to quit have an extremely difficult time: Less than 10 percent succeed without help, and the various FDA-approved products are of little help, if any. Over the past few years, a new technology has been taken up by millions seeking an escape from deadly smoke: electronic cigarettes (e-cigs, also known as ENDS, electronic nicotine-delivery systems).
Many experts in tobacco control believe e-cigs present the best hope of improving the unacceptably low rate of successful quitting among addicted smokers. Yet, in a perverse inversion of public-health policy, these devices face relentless opposition — and not from Big Tobacco, whose interests seemingly are most threatened by the switch from cigarettes to e-cigarettes. Rather, it is the official public-health agencies, such as the CDC and the FDA, and the big health nonprofits, such as the American Cancer Society and the American Lung Association, that are fighting this public-health miracle. Even worse, they are using tactics akin to the deceptions and manipulations we recall from the cigarette makers of the 20th century. One of their more egregious tactics is simply redefining the words “tobacco” and “smoke” to include e-cigs, which are linked to neither. The question is: Why? One thing is certain: Their antipathy is not based on science or the good of public health.
Our nation is home to over 40 million smokers, among whom about 480,000 die from their habit each year. Over half of the 40 million will die prematurely because of cigarette smoke. While the percentage of American adults who smoke has been in gradual decline since the groundbreaking 1964 surgeon general’s report, the total number has hardly changed.
Most smokers desire to quit, understandably, but the addiction to smoking is extremely powerful, largely (though not solely) because of nicotine’s power. Unfortunately, it is often believed by smokers, and even by some doctors, that it’s the nicotine that is toxic and lethal. This is a dangerous myth. It is a proven aphorism that “Smokers smoke for the nicotine — but they die from the smoke.” But it’s not only the nicotine that is addictive: There are many psychoactive chemicals in smoke; these, along with the behavioral rituals and the nicotine, are what wrap the addicted smoker in a death grip.
E-cigarettes provide not only a sufficiently potent dose of nicotine to satisfy a smoker’s craving (unlike the ineffective patches and gums), but also the comforting rituals of inhaling and exhaling a smoke-like mist, which is actually composed almost entirely of water. They use a battery to vaporize water and nicotine, which the user (called a “vaper”) inhales, along with vegetable glycerin and/or propylene glycol and flavoring. They often have a cigarette-like LED tip that glows red — or some other color if preferred — but without tobacco, without combustion, without smoke. The ingredients are generally recognized as safe by regulatory agencies, and have been in common use for decades — although no long-term health studies have been done on their safety in inhalational use. Such studies are being done, even now.
Sales of e-cigarettes have doubled in each of the past few years, to the extent that a recent survey found that an astounding one-fifth of smokers had tried them: millions of smokers, now ex-smoking vapers. At the same time, cigarette sales have shown a historic decline in this same period (a reliable analyst predicts that e-cig sales may well overtake cigarette sales within a decade — if regulators and health nonprofits get out of the way). While “gold standard” studies showing the markedly reduced health risk from e-cigs haven’t yet been completed, simple common sense would tell us that inhaling their ingredients, as compared to inhaling the thousands of chemicals from tobacco combustion (the smoke), is highly likely to be less harmful.
Despite the complete absence of any evidence or even report of harm from vaping, a bizarre trend seems to be sweeping the land, wherein towns, cities, and states are enacting measures to ban, restrict, or tax e-cigs as if they were actually cigarettes. The rationales for such misguided, harmful regulation vary from locale to locale, politician to politician. But the fount of all these measures is unquestionably the federal agencies charged with the custodianship of our public health. The FDA initially tried to bar e-cigs from even entering the country in 2009, but it was slapped down by a federal judge who accurately pointed out that nothing in the new law that gave tobacco oversight to the agency addressed e-cigs. Perhaps out of spite, the FDA has continued to warn smokers not to even try vaping as a cessation method. The FDA’s partner in such malfeasance, the CDC, has stooped to manipulating youth tobacco-survey data to promote the anti-e-cig agenda, loudly alerting concerned parents that e-cig use among teens had doubled between 2011 and 2012. The head of the CDC, Tom Frieden, conveniently neglected to note that almost all the young people who had experimented with e-cigs were previously tobacco users. Even more revelatory, the official announcement lacked the key datum that during this ostensible epidemic of teen nicotine addiction, smoking rates among teens fell significantly, even more than they had fallen over the previous few years.
Other excuses for attacking e-cigs range from “We just don’t know what will happen to vapers over the next five or ten years” to “We don’t know what’s in them.” But we surely do know what will happen to many smokers over the next decade if they don’t quit, and we surely do know what’s in e-cigs: Their vapor has been extensively analyzed in objective academic labs, and nothing of concern to health has been detected — as would be expected, based on their chemical constituents. Concerns about attracting and addicting young people to nicotine via e-cigs have not been supported by valid evidence, despite a nearly hysterical response by the media to an outrageously deceptive “study” published last week by the formerly esteemed JAMA Pediatrics.
These days, when one reads about “regulating” e-cigs, the real goal is usually to regulate them right off the market. Responsible scientists and the outnumbered members of “the tobacco-control movement” who espouse reasonable regulation also want this groundbreaking technology regulated: Age limits for sales and marketing; good manufacturing practices, as with any consumer product; accurate ingredient labeling; childproof packaging — these should all be mandatory. More stringent regulation is neither necessary nor desirable.
The unanswered question is this: Why do all these “public health” groups and agencies abdicate their responsibilities in favor of deceiving smokers about the facts regarding e-cigarettes? Can the leaders of these health bodies be so ignorant? Or are there darker forces at work: Are the CDC and the FDA, perhaps, concerned more with abetting the collection of cigarette taxes than with saving smokers? Does the impressively generous funding support from Big Pharma to the nonprofit “health” groups generate influence, either overtly or more subtly? I cannot say. A particularly galling irony is that almost all the pompous hype calling for ever-tighter restrictions and even outright bans emanates from the “liberal” Democratic camp, which has over the years been sympathetic to other forms of harm reduction, such as condoms for HIV positives and clean needles for addicts. But it’s “nicotine abstinence only” for smokers: Quit or die, they say.
The World Health Organization predicts that 1 billion lives will be lost to cigarettes this century, if current trends go unchanged. Everyone concerned with tobacco and health has been on tenterhooks since last November, awaiting the FDA’s long-overdue ruling on how it plans to regulate e-cigarettes. The agency has the power to be flexible and maintain the current vibrant, innovative market — or it could “deem” e-cigs to be tobacco products, effectively banning them, which would be a catastrophe. One thing is certain: This misguided, harmful crusade against e-cigarettes is clearly detrimental to America’s public health. While long-term randomized clinical trials are desirable, the matter is too urgent and important to require these lengthy and expensive studies prior to market approval. In fact, those who demand a priori evidence before approval should be made aware that the effects of this type of regulation would be doubly destructive: Smokers would lose access for years to their best hope of quitting, and Big Tobacco will be the sole survivor after years of trials prove what we can plainly see now. E-cigarettes have the potential to save millions of lives, and those who would impede smokers’ access to them — or to truthful information about them — are, in fact, killing smokers.
— Gilbert Ross, M.D., is medical director of the American Council on Science and Health.