E-cigarette legislation
The American Council on Science and Health (ACSH), a public health education and consumer advocacy nonprofit devoted throughout our 35 year history to the promotion of sound science in public health policy, urges the Oklahoma Legislature to promote the benefits of e-cigarettes as a method of Tobacco Harm Reduction (THR) in helping smokers quit.
Our own research on this subject1 published in a peer-reviewed academic journal, as well as many other studies and epidemiological data, support our assertion that the methodologies comprising THR the substitution of low-risk tobacco and nicotine-delivery products for lethal cigarettes have significant potential benefits in terms of reducing the tragic toll of cigarette smoking by supplying addicted smokers with the substance they crave nicotine but at a much reduced cost in terms of adverse health effects.
While we are in full agreement that no form of tobacco use is entirely "safe," that nicotine is highly addictive, and that therefore all recreational tobacco use should be discouraged, it is still necessary to acknowledge the fact that there are 44 million addicted adult smokers in our nation about 20% of the adult population. Further, while almost three-quarters wish to quit, and half of those do indeed attempt to quit each year, only one in ten (or fewer) succeed. Rarely, smokers quit without cessation aid cold turkey but the FDA-approved methods aimed at increasing quit rates (nicotine patches, Zyban, Chantix, etc.) have had an abysmal "success" rate around 15% or less at one year. Yet, these are the only methods accepted by our public health authorities, who in a perverse distortion of evidence-based public health policy, actively discourage consideration of newer, low-risk alternative cessation aids that have shown promise in helping addicted smokers quit. Perhaps the most significant of the facts that the stick with the FDA-approved methods adherents blithely ignore is that every year, over half a million Americans die of diseases caused by cigarette smoke, while 8 million others suffer smoking induced chronic diseases.
Those who support the concept of tobacco harm reduction, including ACSH, urge you to rely on the readily available scientific and empirical evidence to recommend policies promoting THR and e-cigarettes, which is this:
- The benefits from electronic cigarettes for Oklahoma's public health are supported by a growing mountain of scientific and empirical evidence, which over the past five years consistently indicates that e-cigarettes:
- are approximately 99% less hazardous than cigarettes
- are consumed almost exclusively (i.e. > 99%) by smokers and former smokers who quit by switching to e-cigs
- have helped several million smokers quit and/or sharply reduce cigarette consumption
- have contributed to the historic declines in sales of cigarettes over the past two years
The most important piece of supporting evidence for the use of e-cigarettes to help smokers quit is this:
While many smokers, the public, and even many physicians, believe that nicotine is a toxic component of cigarette smoke, in fact the toxic chemicals reside amongst the thousands of other chemicals in the tar and the gas phase. The nicotine is the primary (but not the sole) addictive agent smokers smoke for the nicotine, but they die from the smoke.
Furthermore, studies have indicated that levels of the contaminants that e-cigarette users are exposed to are far below any levels that would pose a health risk. And, the exhaled vapor poses no risk to bystanders. One such study was conducted by researchers led by Dr. Maciej L. Goniewicz2 of the Roswell Park Cancer Institute in Buffalo, N.Y. This group conducted a comprehensive analysis of the vapor from a dozen brands of electronic cigarettes under a controlled setting. They found that while e-cigarette vapors contained some toxic substances, the levels of toxicants were nine to 450 times lower than cigarette smoke. The other study, conducted by Professor Igor Burstyn3 of the School of Public Health of Drexel University s Department of Environmental and Occupational Health, reviewed 9,000 observations about the chemistry of the vapor and the liquid in e-cigarettes, and determined that the levels of contaminants e-cigarette users are exposed to are insignificant, far below levels that would pose any health risk.
Furthermore, Professor Burstyn and colleagues concluded that there is no health risk to bystanders. This negates the need for legislation that would ban e-cigarettes in places where smoking is banned since this legislation is based on concern for potential risk to bystanders.
Some who, for various reasons oppose the use of e-cigarettes to help smokers quit cite a recent CDC teen survey of tobacco use, generating the fear. The results, when interpreted correctly, show that the number of teens actually using e-cigarettes more than once a month is tiny.
The fear that experimentation with e-cigarettes among young people will be a gateway to tobacco cigarettes is in fact baseless, and is actually contradicted by the full CDC survey. According to CDC data4 and a host of other studies conducted in the USA and Great Britain5,6, cigarette use and overall tobacco use decreased between 2011 and 2012, as e-cigarette use increased.
If needless restrictions, bans, or taxation out-of-proportion to risk are enacted presenting obstacles for desperate smokers trying to quit electronic cigarettes will become black market items or sold by Big Tobacco companies, eager to snap up the currently vibrant small businesses in the e-cigarette stream of commerce.
Those who oppose ecigs call for regulation, by which they mean regulate them off the market and into the waiting embrace of Big Tobacco. Our response: Regulate electronic cigarettes, by all means! Age restrictions on sales and marketing, ingredient labels, good manufacturing practices, childproof packaging all need to be mandated. But making e-cigs inaccessible to desperate smokers by needless or inappropriate restrictions will send smokers this message: Keep on smoking.
Banning indoor vaping will also be counterproductive and communicate the message that addicted smokers should keep on smoking. E-cigarette vapor is not smoke, there is actually no combustion, and relegating ex-smoking vapers out into the street with smokers is exactly the wrong way to help them remain smoke-free.
The World Health Organization predicts one-billion prematurely dead from cigarettes this century if current trends continue. That must not be allowed to happen. While some agenda-driven opponents of e-cigarettes warn: We just don t know what might happen with e-cigarettes, we at The American Council on Science and Health respond, We surely do know what will happen with the real ones: almost a half-million dead American smokers, each year."
Thank you for your consideration.
Elizabeth M. Whelan, Sc.D., M.P.H., President, ACSH
Gilbert L. Ross, M.D., Medical Director, ACSH
References:
- http://acsh.org/2012/02/helping-smokers-quit-the-science-behind-tobacco-harm-reduction/
- Goniewicz: http://tobaccocontrol.bmj.com/content/early/2013/03/05/tobaccocontrol-2012-050859.abstract
- Burstyn: http://publichealth.drexel.edu/~/media/Files/publichealth/ms08.pdf
- Centers for Disease Control and Prevention, 2013, National Youth Tobacco Survey 2012 <http://www.cdc.gov/tobacco/data_statistics/surveys/nyts/> (Accessed 17Jan2014).
- Johnston LO PM, Bachman J, Schulenberg J, 2013, 18/Dec, Teen Smoking Continues to Decline in 2013, in Monitoring the Future <http://www.monitoringthefuture.org/data/13data.html#2013data-cigs <http://www.monitoringthefuture.org/data/13data.html
- Mitka M. CDC: Use of emerging tobacco products increasing among US youths. JAMA 2014 8/Jan;311(2):124.
Links to ACSH s own publications on tobacco harm reduction and most recently, nicotine.
http://acsh.org/2012/02/helping-smokers-quit-the-science-behind-tobacco-harm-reduction/
http://acsh.org/2014/01/effects-nicotine-human-health/
Supporting Studies:
The emerging phenomenon of electronic cigarettes.
Caponnetto P, Campagna D, Papale G, Russo C, Polosa R.
http://www.ncbi.nlm.nih.gov/pubmed/22283580
Tobacco, nicotine and harm reduction.
Le Houezec J, McNeill A, Britton J.
http://www.ncbi.nlm.nih.gov/pubmed/21375611
Contrasting snus and NRT as methods to quit smoking. an observational study
Janne Scheffels1, Karl E Lund, and Ann McNeill
http://www.harmreductionjournal.com/content/9/1/10
Recent op-ed s by ACSH s Dr. Gilbert Ross
The Parliament: http://www.theparliament.com/latest-news/article/newsarticle/pm-blog-gilbert-ross-ecigarettes/#.UswzY2RDuYj
American: http://www.american.com/archive/2013/november/smoking-kills-and-so-might-e-cigarette-regulation
NPR: http://acsh.org/2013/10/dr-gilbert-ross-on-npr-cleveland/
Spectator: http://spectator.org/articles/34413/deadly-crusade-against-e-cigarettes
Can e-cigarettes help you give up smoking? (Interviews of Mike Siegel and ACSH's Gil Ross b staff writer Lori Newman), Lifescript Healthy Living for Women, 2/3/2013