In one of the most ironic twists in my 30-year career in tobacco control, the anti-smoking movement is doing more to harm the public's health than to protect it with respect to its position and actions on electronic cigarettes. What started as an exponentially increasing trend of dramatically rising quit attempts, successful quitting, and substantial cutting down due to e-cigarettes has now plateaued and may even be starting to decline, thanks to the inane actions of anti-smoking groups, which have successfully scared the public about e-cigarettes, so much so that they have convinced huge numbers of smokers that vaping is just as hazardous as smoking. The end result? A huge increase in the number of smokers compared to what we would have seen in the absence of the misleading and sometimes dishonest public health campaign against electronic cigarettes.
When electronic cigarettes first came onto the U.S market in about 2007, I, too, was skeptical. I assumed, incorrectly, that this was a new tobacco industry ploy to hook smokers, under the guise of being a safer product. I thought it was the low-tar scam all over again. However, I was willing to change my mind in response to scientific evidence, and as I learned more about the product, talked to many vapers, conducted initial research, and reviewed the burgeoning body of research on the topic, I came to realize that this was not a repeated of past tobacco industry ploys. In fact, until 2012, the tobacco industry had nothing to do with the promotion or sale of electronic cigarettes. Instead, these were bona fide products whose companies' value proposition was that they wanted to make combustible cigarettes obsolete. The entrance of Big Tobacco into the e-cigarette market has changed things, but not enough to challenge the basic ideas that electronic cigarettes are a threat to continued success of combustible tobacco products and that the greater shift in nicotine use from cigarettes to e-cigarettes, the greater the degree of improvement in the public's health.
Many anti-smoking advocates rightly pointed out that we must consider and weigh the costs and benefits of e-cigarettes. However, over the past three years, adequate research has been conducted to indicate that while the benefits of electronic cigarettes are immense, there are very few known costs. These products are not acting as a gateway to smoking among youth, they are not particularly addictive among youth, and they may even be serving as a deterrent to youth who might otherwise become addicted to cigarette smoking. Nor are these products enticing ex-smokers to return to nicotine use and then back to cigarette smoking. And finally, there is no evidence that e-cigarettes are hindering the quitting process for smokers who - if not for e-cigarettes - would have quit completely.
So we are left with a situation where the existing evidence all points in the direction that e-cigarettes are indeed a gateway. They are a one-way gateway away from combustible cigarettes and toward a much safer alternative product that is literally saving thousands of lives.
Are electronic cigarettes safe? Of course not. If they were absolutely safe, this wouldn't be a debate. By definition, harm reduction involves an alternative product that is much safer, but not safe in absolute terms. But e-cigarettes don't need to be absolutely safe. They need to be orders of magnitude safer than cigarettes, and it appears that they most likely are.
There are legitimate concerns about electronic cigarettes that need to be addressed. But none of the anti-smoking groups are actually working toward such ends. What is needed is simple: the FDA should set uniform safety standards for all e-cigarettes and vaping products. These standards should include things like leafproof containers, childproof packaging, no sale or marketing to minors, adequate warning labels and instructions to keep away from infants and children, battery safety, quality control standards for nicotine labeling and for production of e-liquids, modest regulation of flavorings (such as a ban on diacetyl), and regulation of the coil temperature to prevent overheating of the e-liquid.
Instead of working toward these much-needed regulations, which go far to allow the benefits of e-cigarettes to unfold while minimizing the risks, the anti-smoking movement has instead been demonizing these products, using a widespread campaign of cherry picking, misrepresenting scientific evidence, deception and sometimes outright lying. The campaign was worked. Huge numbers of smokers have been convinced (wrongly) that vaping is actually no safer than smoking. This has resulted in large numbers of smokers eschewing the opportunity to quit smoking using e-cigarettes and instead, remaining stuck on tobacco cigarettes.
It has been a tremendous lost opportunity for public health. I can only hope that the insanity ends soon, so that the promise of vaping technology - or something like it - will not be wasted. This has the potential to be one of the greatest anti-smoking developments in my lifetime. I hate to see it go down the tubes because of immovable ideology. And I especially hate to see it go down the tubes because anti-smoking groups are misleading and lying to the public.