As I noted yesterday, one of the most central tenets of medicine and public health is "to do no harm." Research out of the Center for Survey Research at the University of Massachusetts Boston suggests that policy makers and anti-smoking groups which are supporting bans on e-cigarette flavors - such as one proposed in New York City - would be violating this principle, causing tragic consequences by promoting smoking to a significant proportion of the population.
Monday, I discussed a study, just published online ahead of print in the journal Nicotine & Tobacco Research,
which reports the results of a population-based survey of smokers
after two years to determine whether e-cigarette use was associated
with higher or lower rates of smoking cessation. The study found that
intensive electronic cigarettes users at baseline were six times more
likely to quit smoking after a two-year follow-up period compared to
intermittent or non-users.
However, the survey included a very useful question for all smokers who
had tried, intermittently used, or intensively used electronic
cigarettes but discontinued e-cigarette use for some reason and returned
to smoking. Specifically, these smokers were asked to name the most
important reasons why they returned to cigarette smoking.
The number one reason given by smokers for stopping electronic cigarette use was the taste of the product. More than one-third (35.0%) of
triers reported that taste was a major factor in their discontinuation of vaping.
Very few intensive users and only a small number of intermittent users listed taste as an important consideration in discontinuing vaping. This suggests that taste is a critical aspect of the vaping experience which largely explains whether a smoker will progress to more intensive and perhaps more advanced use of these products, which are associated with a higher likelihood of smoking cessation.
The Rest of the Story
What does this mean?
It means that if electronic cigarette flavors are banned, the percentage of smokers who progress to regular e-cigarette use will plummet. Moreover, the benefits of e-cigarettes in terms of promoting smoking cessation will be largely negated. Worst of all, thousands of smokers who would otherwise have been likely to reduce their cigarette consumption or perhaps quit with e-cigarettes will instead return to cigarette smoking or never give e-cigarettes the light of day.
Simply, it would be a public health tragedy that would cost countless lives.
It would, of course, also be a huge boon for combustible cigarette profits.
Proponents of these flavoring ban proposals have failed to present a cost-benefit analysis demonstrating that these enormous costs of basically decimating the e-cigarette market would be offset by a reduction in harm to youth who are picking up e-cigarettes because of the flavor and suffering serious health consequences (presumably as a result of initiating smoking). In fact, the current evidence base does not suggest that the use of flavored e-cigarettes is causing any net harm. If anything, it appears that youth e-cigarette use might be associated with some amount of smoking reduction among youth smokers.
It is critical that before policy makers, whether in New York City or at the FDA, take the draconian step of banning electronic cigarette flavors, they demonstrate that such a measure's public health benefits would outweigh its harms. The current evidence demonstrates that the opposite is the case. There would be very little public health benefit at the expense of tragic consequences to ex-smokers, who would return to smoking in huge numbers, and to current smokers, who would continue to smoke combustible cigarettes rather than make a potentially successful quit or reduction attempt using e-cigarettes.
Disclosure: I have not received any funding or compensation from
the tobacco, electronic cigarette, or pharmaceutical industries.
However, I am seeking funding from several electronic cigarette
companies to conduct a behavioral study on the effects of electronic
cigarettes on smoking behavior.