[ed. John Tierney looks at e-cigarettes and the forces shaping both sides of the debate.]
by John Tierney, NY Times {excerpt}
The controversy is part of a long-running philosophical debate about public health policy, but with an odd role reversal. In the past, conservatives have leaned toward “abstinence only” policies for dealing with problems like teenage pregnancy and heroin addiction, while liberals have been open to “harm reduction” strategies like encouraging birth control and dispensing methadone.
When it comes to nicotine, though, the abstinence forces tend to be more liberal, including Democratic officials at the state and national level who have been trying to stop the sale of e-cigarettes and ban their use in smoke-free places. They’ve argued that smokers who want an alternative source of nicotine should use only thoroughly tested products like Nicorette gum and prescription patches — and use them only briefly, as a way to get off nicotine altogether.
The Food and Drug Administration tried to stop the sale of e-cigarettes by treating them as a “drug delivery device” that could not be marketed until its safety and efficacy could be demonstrated in clinical trials. The agency was backed by the American Cancer Society, the American Heart Association, Action on Smoking and Health, and the Center for Tobacco-Free Kids.
The prohibitionists lost that battle last year, when the F.D.A. was overruled in court, but they’ve continued the fight by publicizing the supposed perils of e-cigarettes. They argue that the devices, like smokeless tobacco, reduce the incentive for people to quit nicotine and could also be a “gateway” for young people and nonsmokers to become nicotine addicts. And they cite an F.D.A. warning that several chemicals in the vapor of e-cigarettes may be “harmful” and “toxic.” But the agency has never presented evidence that the trace amounts actually cause any harm, and it has neglected to mention that similar traces of these chemicals have been found in other F.D.A.-approved products, including nicotine patches and gum. The agency’s methodology and warnings have been lambasted in scientific journals by Dr. Polosa and other researchers, including Brad Rodu, a professor of medicine at the University of Louisville in Kentucky.
Writing in Harm Reduction Journal this year, Dr. Rodu concludes that the F.D.A.’s results “are highly unlikely to have any possible significance to users” because it detected chemicals at “about one million times lower concentrations than are conceivably related to human health.” His conclusion is shared by Michael Siegel, a professor at the Boston University School of Public Health.
“It boggles my mind why there is a bias against e-cigarettes among antismoking groups,” Dr. Siegel said. He added that it made no sense to fret about hypothetical risks from minuscule levels of several chemicals in e-cigarettes when the alternative is known to be deadly: cigarettes containing thousands of chemicals, including dozens of carcinogens and hundreds of toxins.
Both sides in the debate agree that e-cigarettes should be studied more thoroughly and subjected to tighter regulation, including quality-control standards and a ban on sales to minors. But the harm-reduction side, which includes the American Association of Public Health Physicians and the American Council on Science and Health, sees no reason to prevent adults from using e-cigarettes. In Britain, the Royal College of Physicians has denounced “irrational and immoral” regulations inhibiting the introduction of safer nicotine-delivery devices.
“Nicotine itself is not especially hazardous,” the British medical society concluded in 2007. “If nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved.”
The number of Americans trying e-cigarettes quadrupled from 2009 to 2010, according to the Centers for Disease Control. Its survey last year found that 1.2 percent of adults, or close to three million people, reported using them in the previous month.
Read more:
illustration: Viktor Koen
by John Tierney, NY Times {excerpt}
The controversy is part of a long-running philosophical debate about public health policy, but with an odd role reversal. In the past, conservatives have leaned toward “abstinence only” policies for dealing with problems like teenage pregnancy and heroin addiction, while liberals have been open to “harm reduction” strategies like encouraging birth control and dispensing methadone.
When it comes to nicotine, though, the abstinence forces tend to be more liberal, including Democratic officials at the state and national level who have been trying to stop the sale of e-cigarettes and ban their use in smoke-free places. They’ve argued that smokers who want an alternative source of nicotine should use only thoroughly tested products like Nicorette gum and prescription patches — and use them only briefly, as a way to get off nicotine altogether. The Food and Drug Administration tried to stop the sale of e-cigarettes by treating them as a “drug delivery device” that could not be marketed until its safety and efficacy could be demonstrated in clinical trials. The agency was backed by the American Cancer Society, the American Heart Association, Action on Smoking and Health, and the Center for Tobacco-Free Kids.
The prohibitionists lost that battle last year, when the F.D.A. was overruled in court, but they’ve continued the fight by publicizing the supposed perils of e-cigarettes. They argue that the devices, like smokeless tobacco, reduce the incentive for people to quit nicotine and could also be a “gateway” for young people and nonsmokers to become nicotine addicts. And they cite an F.D.A. warning that several chemicals in the vapor of e-cigarettes may be “harmful” and “toxic.” But the agency has never presented evidence that the trace amounts actually cause any harm, and it has neglected to mention that similar traces of these chemicals have been found in other F.D.A.-approved products, including nicotine patches and gum. The agency’s methodology and warnings have been lambasted in scientific journals by Dr. Polosa and other researchers, including Brad Rodu, a professor of medicine at the University of Louisville in Kentucky.
Writing in Harm Reduction Journal this year, Dr. Rodu concludes that the F.D.A.’s results “are highly unlikely to have any possible significance to users” because it detected chemicals at “about one million times lower concentrations than are conceivably related to human health.” His conclusion is shared by Michael Siegel, a professor at the Boston University School of Public Health.
“It boggles my mind why there is a bias against e-cigarettes among antismoking groups,” Dr. Siegel said. He added that it made no sense to fret about hypothetical risks from minuscule levels of several chemicals in e-cigarettes when the alternative is known to be deadly: cigarettes containing thousands of chemicals, including dozens of carcinogens and hundreds of toxins.
Both sides in the debate agree that e-cigarettes should be studied more thoroughly and subjected to tighter regulation, including quality-control standards and a ban on sales to minors. But the harm-reduction side, which includes the American Association of Public Health Physicians and the American Council on Science and Health, sees no reason to prevent adults from using e-cigarettes. In Britain, the Royal College of Physicians has denounced “irrational and immoral” regulations inhibiting the introduction of safer nicotine-delivery devices.
“Nicotine itself is not especially hazardous,” the British medical society concluded in 2007. “If nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved.”
The number of Americans trying e-cigarettes quadrupled from 2009 to 2010, according to the Centers for Disease Control. Its survey last year found that 1.2 percent of adults, or close to three million people, reported using them in the previous month.
Read more:
illustration: Viktor Koen
