Although the draft regulation mentions only a ban on the sale of electronic cigarettes to minors, a letter from the Director of Public Health to tobacco sellers refers to an outright "ban on the sale of e-cigarettes." A knowledgeable source told the Rest of the Story that the Board is indeed considering a ban on the sale of electronic cigarettes, not only to minors but to adults as well.
The rationale for the Board's proposed ban on the sale of electronic cigarettes is not clear, since there is nothing in the preamble of the draft regulation that mentions electronic cigarettes or why they pose a danger to the public's health.
The Rest of the Story
I believe that enactment of this regulation would be a serious mistake. There is strong evidence that electronic cigarettes are much safer than tobacco cigarettes. These products contain no tobacco and do not involve combustion. Multiple studies have confirmed that there are only a few chemicals present beyond the nicotine, and so far, only trace or low levels of potentially concerning constituents have been detected - levels which are much lower than in real cigarettes. Users of these products generally report an immediate and dramatic reduction in respiratory symptoms. Moreover, there is strong evidence that electronic cigarettes can be effective in smoking cessation and that they may actually be more effective than traditional nicotine replacement products such as nicotine patches, gum, or lozenges.
So why would the Board of Health want to ban the sale of these products?
There is a legitimate concern about the potential for youth to get their hands on these products, and that concern warrants the regulation of the sale of electronic cigarettes to minors. But why ban the sale of this smoking cessation aid to adult smokers who are trying to quit?
It makes no sense, from a public health perspective, to ban a product which is almost uniformly used by smokers in an effort to quit smoking or significantly reduce the amount of cigarette consumption, while at the same time, to sanction the sale of the real thing: deadly cigarettes. What the Board of Health would be saying, if it enacts this regulation, is that they would rather have smokers continue to smoke cigarettes than quit smoking with the aid of a much safer alternative product.
If the West Springfield Board of Health were truly committed to protecting the health of its residents from the dangers of cigarette smoking, it would address the problem head on by simply banning the sale of cigarettes. Why ban the non-tobacco cigarettes that have not been shown to be hazardous and which are helping thousands of smokers get off cigarettes, while leaving the real ones on the market to continue to kill West Springfield residents?
I have published extensively on this topic, co-authoring studies which review the safety and effectiveness of electronic cigarettes, demonstrate the widespread use of electronic cigarettes to quit smoking, and discuss the reasons why electronic cigarettes are essential as a harm reduction strategy in tobacco control. These articles, as well as multiple commentaries on this blog, address each of the concerns expressed by the FDA about these products and show that the agency has not presented an objective picture of the relative safety and efficacy of electronic cigarettes.
Briefly, my research with Zachary Cahn was the first to comprehensively review the scientific evidence about the safety and effectiveness of electronic cigarettes and was published in the Journal of Public Health Policy. After reviewing 16 laboratory studies of the constituents of electronic cigarettes, we conclude that electronic cigarettes are much safer than the real ones and therefore show tremendous promise in the fight against tobacco-related morbidity and mortality. Banning these products from the market would benefit the tobacco companies at the expense of the public’s health.
The FDA and major anti-smoking groups keep saying that we don’t know anything about what is in electronic cigarettes. The truth is, we know a lot more about what is in electronic cigarettes than regular cigarettes. Our review shows that carcinogen levels in electronic cigarettes are up to 1,000 times lower than in tobacco cigarettes. No other constituents have been detected at levels that are of significant health concern. Thus, using electronic cigarettes (also called vaping) appears to be much safer than smoking. Taking these products off the market would force thousands of vapers to return to cigarette smoking. Why would the FDA and the anti-smoking groups want to take an action that is going to seriously harm the public’s health? The only ones who would be protected by a ban on e-cigarettes are the tobacco companies, as these new products represent the first real threat to their profits in decades.
Regarding the relative safety of electronic cigarettes, the study concludes that “few, if any, chemicals at levels detected in electronic cigarettes raise serious health concerns. Although the existing research does not warrant a conclusion that electronic cigarettes are safe in absolute terms and further clinical studies are needed to comprehensively assess the safety of electronic cigarettes, a preponderance of the available evidence shows them to be much safer than tobacco cigarettes and comparable in toxicity to conventional nicotine replacement products.”
The study also reviews preliminary evidence that electronic cigarettes can be effective in suppressing the urge to smoke, largely because they simulate the act of smoking a real cigarette. The fact that bothers the anti-smoking groups the most – that vaping looks like smoking – is precisely the fact which appears to make e-cigarettes an effective tool for smoking cessation.
Regarding the effectiveness of electronic cigarettes for smoking cessation, the study concludes as follows: “Although more research is needed before we will know how effective electronic cigarettes are at achieving smoking abstinence, there is now sufficient evidence to conclude that these products are at least capable of suppressing the urge to smoke.” There is also reason to believe that they offer an advantage over traditional nicotine delivery devices, the study argues, because smoking-related stimuli alone have been found capable of suppressing tobacco abstinence symptoms for long periods of time.
The article concludes: "The evidence reviewed in this article suggests that electronic cigarettes are a much safer alternative to tobacco cigarettes. They are likely to improve upon the efficacy of traditional pharmacotherapy for smoking cessation." While more research is needed, the article concludes that electronic cigarettes show promise as a harm reduction strategy and that removing them from the market would substantially harm the public’s health.
I hope that the West Springfield Board of Health will consider this research and these arguments before it makes a decision that I believe will harm, rather than protect, the public's health.