February 23, 2014

Stanton A. Glantz, PhD

The difference between the ecigarette optimists and pessimists

Today (Feb 23, 2014), the New York Times ran a front page story on the debate going on inside the health community about e-cigarettes.  Earlier this week The Guardian in the UK ran a similar story.
Leaving aside paid shills for the e-cigarette companies like former Surgeon General Rich Carmona, a careful reading of these news stories reveals that the thing that defines the difference between the optimists and pessimists in whether they focus on what might happen or what is happening with e-cigarettes.
The optimists are careful to condition their statements with a lot of caveats that, taken together, envision an environment in which the FDA is heavily regulating cigarettes to make  them less addictive (by, say, ratcheting down nicotine) or by making them harder to smoke (by, say, manning menthol, added sugars, or ammonia). 
While such a world is not impossible, the Obama Administration has not even let the FDA ban menthol and  the issue of warning labels has dropped off the public regulatory agenda all together (other than some research).  Even the e-cigarette deeming rule remains stalled at the OMB for months.  And, if it includes the silly "consumer surplus" discount that the FDA did for warning labels, it will doom any meaningful regulation of e-cigarettes (which, at best is years away because of the inevitable lawsuits).   The fact that the Obama Administration has been sitting on a proposed Department of Transportation rule to keep e-cigarettes of airplanes also shows an unwillingness to do anything meaningful.
Us pessimists remain open to the possibility, however remote, that this situation will change.  But, in the meantime, we focus on what is actually happening in the real world:

  • The vast majority of e-cigarette users are continuing to smoke cigarettes.  This so-called "dual use" is projected in all the investment analysts' reports and is exactly what one would expect as cigarette companies take over the e-cigarette business.
  • There is explosive growth in e-cigarette use, with many kids initiating nicotine addiction with e-cigarettes.
  • While many people swear that e-cigs helped them quit smoking, what the population-level data shows is that e-cigarette use is associated with less not more quitting.
  • Marketing is back on TV and radio and product placement in movies and TV is going wild.

The science around these issues is accumulating rapidly and, as I told  the NY Times, I think that there will be a consensus on these points in the next year or so. 
The real question is whether, while the scientists deliberate and information creeps through the peer review process into academic publications, the cigarette companies will be able to solidify the market and get a lot of legislation protecting their interests in place, particularly at the state level.
Fortunately, the American Cancer Society has been working hard to fight bad legislation (masquerading as youth protections) in many states.  And, in positive moves, as we saw with clean indoor air in the 1980s, local governments are joining the issue by integrating e-cigarettes into clean indoor air laws and restrictions on cigarette sales. 



As many readers on this blog will appreciate, history gives good reason for pessimism, though supporters of unregulated e-cigs leave that out of the picture and/or show confidence that this time the situation is somehow different.  
I posted the comment below to the NYTimes, which has nearly disappeared under the weight of personal stories of e-cigs being a rescuing force.  (Which may well be truly perceived, but only represents a part of the picture.)
Two online posters replied directly to my NYT comment that we should not view this new industry as if it were independent from Big Tobacco.  But at least one piece of direct evidence belies this -- here in Hawai'i, the most visible spokesperson for e-cig retailing who repeatedly presents in the manner of just-a-local-independent-business-owner-trying-to-get-by, has concluded his recent submissions of http://www.capitol.hawaii.gov/Session2014/Testimony/SB2495_TESTIMONY_HTH... in the state legislature with a written invitation for any questions to be sent to his business' "representative", who is also one of Altria's principal lobbyists in the state.  If that isn't a slip, (and it probably isn't), it's a not-so-subtle note to legislators of the fact that e-cig retailing and Big Tobacco are on the same page here.
In any case, it seems easy to predict that the e-cig industry will be entirely subsumed into Big Tobacco within a very short time.
Mark Levin
(The text of my post to NYTimes follows below.  It's online http://www.nytimes.com/2014/02/23/health/a-hot-debate-over-e-cigarettes-....)
I'm a pessimist here.
In the 50's, the tobacco industry fooled the world with filtered cigarettes. These weren't safer, though millions died having been led to believe they were. Meanwhile tobacco smoke pollution brought down those around them too.
In the 70's, the industry scammed us by marketing light and mild cigarettes. Once again, not safer but a great boost to keep people addicted, and paying for it with wallets and lives. Secondhand death and disease also continued.
Finally, in recent decades, lawmakers around the the globe began stepping forward to right these wrongs. Though work is incomplete, government leaders have taken important steps forward with nearly universal agreement on the Framework Convention on Tobacco Control (FCTC).
Here we go again. New addictive devices are pitched to be a safer use. These will boost the industry by keeping folk addicted and as dual users, while luring our youth. But with this industry's deadly track record, in what right mind should we trust public health to nicotine aerosols inside unregulated vapors?&nbsp;
If there is therapeutic merit, let sellers prove that following food and drug laws. But they haven't and I expect they can't. In the meanwhile, let's be smart and safe -- setting all the legal structures for these to be the same as for incendiary tobacco products.&nbsp;
And the first point is easiest: no vaping where there's no smoking. Even if this is fine for users, let's leave everyone else out of it.

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