In two separate op-ed articles published during the past week, anti-smoking advocates are misleading the public about the scientific evidence regarding the safety of electronic cigarettes, while at the same time encouraging many ex-smokers to return to cigarette smoking.
In an op-ed in the Tacoma News Tribune, Tacoma-Pierce County health director Dr. Anthony Chen advises smokers not to use electronic cigarettes because "FDA analysis of e-cigarettes found their vapor contains nicotine and other harmful chemicals known to be toxic and cancer-causing." He writes that "it is bad policy to allow the public to be exposed to harmful chemicals such as nicotine and nitrosamines."
In an op-ed in the Lexington Herald-Leader, professors Ellen Hahn and Carol Riker also advise smokers not to use electronic cigarettes to quit smoking, asserting that electronic cigarette companies "oppose smoke-free policies" and accusing them of "attacking public-health professionals." Moreover, the authors argue that electronic cigarettes "emit secondhand vapor that includes nicotine and may include other potentially harmful chemicals." They also argue that electronic cigarette use "is an uncontrolled experiment conducted by those whose primary interest is to profit from addiction, which causes early, painful death."
The Rest of the Story
Both op-eds are grossly distorting the actual scientific evidence and misleading the public.
Chen asserts that the FDA analysis of electronic cigarettes found that their vapor contains cancer-causing chemicals (i.e., tobacco specific nitrosamines). However, what he doesn't reveal is that only trace levels were found, that these levels are comparable to those in the nicotine patch or nicotine gum, and that these levels are orders of magnitude lower than those found in cigarettes. Thus, what the FDA analysis actually shows is that in terms of carcinogenicity, electronic cigarettes are much safer than tobacco cigarettes.
Chen also asserts that it is bad public policy to allow the public to be exposed to nicotine and nitrosamines. What he is conveniently hiding from the public, however, is that his health department allows the public to be exposed to nicotine and nitrosamines every day. By allowing the sale of nicotine patches and nicotine gum, Chen is allowing perhaps thousands of Tacoma-Pierce County residents to be exposed to nicotine and nitrosamines. It is well-established that NRT products contain nicotine and nitrosamines. In fact, nitrosamines are easily detectable in the saliva of nicotine gum users. By not mentioning this, Chen is further misleading the public.
Hahn and Riker assert, first, that the electronic cigarette companies oppose smoke-free policies. This is untrue. The electronic cigarette companies have never opposed smoke-free policies. They have merely asked that their products, which do not produce tobacco smoke, not be included in such policies.
Hahn and Riker assert, second, that the electronic cigarette companies are attacking public health professionals. I am not aware of any such attacks, although these companies are correcting misinformation being disseminated by public health professionals, like Hahn and Riker.
Hahn and Riker assert, third, that electronic cigarettes emit vapor that contains nicotine and possibly other toxic chemicals. However, there is no evidence to support this claim. No studies have documented that the emitted vapor from the electronic cigarette contains any appreciable quantity of nicotine and no studies have documented that the emitted vapor contains any other toxic chemical in appreciable amounts. Because nicotine is effectively absorbed in the mouth and lungs, it is highly unlikely that the emitted vapor from electronic cigarettes contains anything other than trace amounts of nicotine.
Finally, Hahn and Riker assert that e-cigarette makers' primary motive is to profit from addiction and that this addiction to nicotine causes a slow, painful death. If the e-cigarette makers' primary motive was to profit from addiction, then why are they making and marketing zero-nicotine cartridges and why are they encouraging their customers to gradually wean themselves down from 16 mg to 12 mg to 8 mg to 4 mg to zero nicotine? The truth is that many of the electronic cigarette companies have a sincere interest in helping to save lives but providing an alternative to the dismal NRT products currently on the market, which fail in the overwhelming majority of smokers who try them.
That nicotine addiction alone causes a slow and painful death is not clear. There is no evidence, for example, that the use of NRT for a prolonged period of time increases the risk of cancer or heart disease. In contrast, there is massive evidence that the continued use of cigarettes increases the risk of cancer, heart disease, and lung disease. Rather than causing death, electronic cigarettes are preventing a the long, painful death of which Hahn and Riker speak by helping smokers to get off the tobacco cigarettes.
By encouraging ex-smokers who have successfully quit smoking by using e-cigarettes to stop using these products - which is invariably going to lead them to return to cigarette smoking - these anti-smoking advocates are doing a disservice to the public, I believe. The companies that truly benefit from this advice are the tobacco companies, because they are the ones who stand to gain from public health practitioners' efforts to discourage the use of electronic cigarettes. Doing so will only increase sales of the real ones.