Here is my point-by-point response to several of the statements made in the press release issued by City Attorney Herrera announcing the introduction of legislation to ban the sale of all electronic cigarettes in the city of San Francisco:
"City Attorney Dennis Herrera and
Supervisor Shamann Walton today announced joint steps to curb the epidemic of
youth e-cigarette use, which has erased more than a decade’s worth of progress
in reducing youth tobacco consumption."
The “epidemic” of youth e-cigarette use has not “erased”
progress in reducing youth tobacco consumption. The gains in reducing youth
smoking prevalence are very real and will translate into millions of lives
saved down the road. The problem of vaping has nothing to do with tobacco use
because e-liquids do not contain any tobacco. Youth who vape are not tobacco
users. They are vapers. So youth e-cigarette use has not undermined gains in
reducing smoking. It is a separate problem that, while serious, is far less of
a hazard to the public’s health than the epidemic of youth smoking.
"San Francisco has never been
afraid to lead,” Herrera said, “and we’re certainly not afraid to do so when the health and lives of our children are at stake."
San Francisco is apparently afraid to lead because
they are willing to take the politically expedient step of requiring safety
testing for e-cigarettes, but they are not willing to place the same
requirement on real cigarettes. In fact, tobacco cigarettes have already had
their safety testing and they failed miserably. If San Francisco wants to lead,
then why isn’t it taking cigarettes off the shelves?
"Banning vaping products that
target young people and push them towards addiction to nicotine and tobacco is
the only way to ensure the safety of our youth."
Let’s stipulate that. But
if that’s true, then certainly banning tobacco products (i.e., cigarettes and
smokeless tobacco) that target young people and push them towards addiction to
nicotine and tobacco is also the “only” way to ensure the safety of our youth.
"San Francisco, along with the
City of Chicago and the City of New York, sent a letter to the FDA this morning demanding that
the FDA do its job and immediately conduct the required public health review of
e-cigarettes that, by law, was supposed to happen before these products were on the market."
The law does not require the FDA
to conduct a public health review of e-cigarettes. What it requires is that
manufacturers who want their products to remain on the market must submit a
pre-market tobacco application to the agency for approval. This review was not
supposed to happen before the products were on the market. They were already on
the market in 2014 when the FDA issued its regulations. The FDA delayed the
deadline for these applications because not doing so would have resulted in the
elimination of vaping products, forcing millions of ex-smokers back to smoking
and removing a huge competitor to cigarettes. It would have been a huge gift
for cigarette companies. So it’s a good thing that the FDA did not enforce its
original August 2016 deadline.
"In coordination with the City
Attorney’s Office, Supervisor Walton is introducing groundbreaking legislation at the Board of
Supervisors today that would prohibit the sale in San Francisco of any
e-cigarette that has not undergone FDA review."
This is not
ground-breaking. What would have been ground-breaking is if the city introduced
legislation to ban all tobacco
products that have not been reviewed by the FDA and found to be reasonably
safe. Surely, cigarettes would have been on this list.
"This is not an outright ban on
e-cigarettes. It’s a prohibition against any e-cigarettes that haven’t been reviewed by the FDA
to confirm that they are appropriate for the protection of public health."
It is essentially an outright ban
on e-cigarettes because the city knows full well that there isn’t a single
e-cigarette that has gone through the pre-market approval process (since that
deadline was extended until 2021). But the more important question is why the
Board of Supervisors believe that e-cigarettes should only be sold if they are
shown to be appropriate for the public health, while they are allowing
cigarettes to be sold even though we know for certain that they are not “appropriate for the public’s
"The FDA has simply failed to do
its job in unprecedented fashion,” Herrera said. “These are prudent steps to ensure that we
know the health and safety implications of products being sold here. If the FDA hasn’t reviewed
it, it shouldn’t be on store shelves in San Francisco."
If they really mean what they say, then certainly, cigarettes should be on store shelves in San
Francisco. You can’t take as a serious public health effort a proposal that e-cigarettes
should be taken off of store shelves in San Francisco because we’re not certain
of their health implications, yet it’s perfectly fine to let cigarettes remain
on store shelves in San Francisco despite the fact that they have dismally
failed their “safety review.” There is simply no public health justification for
banning e-cigarettes but not real cigarettes.
"Tobacco use is the leading cause
of preventable disease and death in the United States. Tobacco kills
more than 480,000 people a year
in this country. That’s more than AIDS, alcohol, car accidents,
illegal drugs, murders and
Exactly! Yet vaping products
are not responsible for a single one of those 480,000 deaths. And so the city
of San Francisco’s response to 480,000 deaths from cigarettes is: Let’s ban the
fake cigarettes and let the real ones, which are causing 480,000 deaths a year,
to stay on the shelves.
"These companies may hide behind
the veneer of harm reduction, but let’s be clear: their product is addiction."
Veneer of harm reduction? There is
overwhelming evidence that vaping is much safer than smoking. It is convenient
to ignore this scientific evidence because it doesn’t make for as good of a
story. But public health needs to be guided by science and evidence, not by