Cigarette smoking takes the lives of more Americans than any other health problem. Our annual toll — about 440,000, amongst our 45 million smokers — is an unbelievable tragedy, more so for being at least potentially preventable. Unfortunately, the smoking habit is devilishly hard to break: cold turkey success rates hover around 5 percent, and the FDA-approved products raise that “success” rate to 15 or 20 percent. The WHO predicts that the global toll will be one billion lost this century — IF current trends continue.
But is this the shadow of what will be … or what may be? A game-changing technology appeared on the western scene a few years ago, but it may well be a public health miracle: electronic cigarettes (ecigs). Millions of smokers have switched to “vaping” — inhaling vapor produced from ecigs, which involves no combustion, no tobacco, and no smoke. Many ecigs resemble cigarettes, and deliver an effective dose of nicotine suspended in water vapor and glycerin or propylene glycol, plus flavorings. Inhalation yields a comforting a LED tip glow, to further the mimicry of the real cancer sticks.
Published studies (as well as common sense) indicate that the trace levels of chemicals in ecig vapor are not a threat to bystanders’ health. And despite what many falsely believe (even many doctors), nicotine is neither toxic nor carcinogenic, although inhaling the nicotine in smoke (along with its thousands of other chemicals) make cigarette addiction extremely hard to break. Although fully three-quarters of smokers want to quit, and a majority tries each year, few succeed, and eventually half of all smokers will die prematurely from their habit. Something must be done to ameliorate this intolerable situation.
Given even the possibility that ecigs are a possible solution to this preventable catastrophe, one would think that devotees of improving public health would be jumping with joy, encouraging desperate smokers to give it a try. Yet for reasons of their own — some clear, some opaque — the overall response has been a perverse, monolithic refusal to even consider the potential benefits. Instead, federal and state agencies and “public health” nonprofits have unleashed a relentless campaign of misinformation and distortion worthy of the 20th century Big Tobacco conspirators. Their stated rationales include alleged concern for long-term, hypothetical risks, and fear of kids being seduced into lifelong nicotine addiction. The CDC, FDA, the American Cancer, Heart and Lung Associations (among many others) have closed ranks to disparage ecigs and warn smokers not to even try these potential lifesavers. Meanwhile, the actual statistics — obfuscated by the CDC and the FDA — show ecigs being a gateway indeed, but out of cigarette addiction, rather than the reverse. And the “toxic chemicals” posted on their websites actually show lower levels than are found in the approved nicotine replacement patches.
All these “leaders” seem to be trying to solve a problem that does not exist — the “harms” of ecigs — while willfully blind to the actual problem: the vast toll of smoking-related disease and death.
Lawmakers have bent over backwards to intentionally conflate ecigs with “cigarettes,” and vapor with smoke. When I recently testified at a public hearing of the New York City Council, I had to restrain myself when I heard Bloomberg’s Commissioner of Health Tom Farley pompously assert that he had no idea what was in ecig vapor, and that their resemblance to cigarettes might cause confusion in restaurants. (A colleague asked him, “Shall we then also ban water because it looks like vodka?”) Shortly thereafter, NYC banned almost all public use of ecigs based on the “Smoke-Free Air Act” — even though there’s no smoke!
It may be too late for New York, but for the rest of us, there is still time to turn aside from such unscientific, perverse measures, the effects of which will be to kill smokers. Opponents say, “We have no proof that ecigs help smokers quit.” But millions of smokers have become vapers, after trying and failing with the approved products.
In years to come, I predict that those who have distorted and manipulated data to impede the facts from being truthfully communicated to smokers and their families will be held to account, as happened to the cigarette makers in the 1990s. The tobacco merchants were trying to enhance their bottom line, an unacceptable goal given the devastation their deceptions wreaked. But how to account for similar behavior amongst our federal and state agencies? Should those in charge at the CDC, the FDA, and the public health nonprofits not be held to a much higher standard of ethical behavior? I wonder how they manage to live with their deceptions, which are so destructive.
Even now, all of us involved in public health and smoking issues await — with a combination of eagerness and dread — the rules promulgated by the FDA, which will lay the groundwork for e-cigarette regulation for years to come. With flexibility and creativity on the part of the agency, the e-cig marketplace will remain vibrant and innovative, helping millions of smokers escape cigarette’s deadly clutches. With 20th-century perspective and old-school dogma (not to mention influences of a baser nature, like self-interested donors), electronic cigarettes will become black market items or sold by Big Tobacco barons.
Those who oppose ecigs call for “regulation,” by which they mean regulate them off the market and into the eager arms of Big Tobacco. My response: regulate ecigs, by all means! Age restrictions on sales and marketing, ingredient labels, good manufacturing practices all need to be mandated. But making ecigs inaccessible to desperate smokers by inane or corrupt restrictions will send smokers this message: Keep on smoking. Hyper-precautious officialdom says, “We just don’t know what might happen with e-cigarettes.” But we surely do know what happens with the real ones: over 400,000 dead American smokers, each year.
