Monday, January 24, 2011

New York State Assembly Health Committee Has Chance to Save Thousands of Lives on Tuesday Afternoon

Members of the Health Committee of the New York State Assembly have a unique opportunity to save thousands of lives tomorrow when they decide whether to allow ex-smokers to remain ex-smokers by continuing to keep themselves off tobacco cigarettes with the use of electronic cigarettes.

To be very clear, passage of Assembly Bill A01468 would force thousands of ex-smokers in New York State to return to cigarette smoking by taking electronic cigarettes off the market in the state. In addition, it would prevent current smokers who want to quit from successfully quitting smoking using the most effective method currently available - vaping - thus causing immense damage to the public's health.

The bill's justification claims that electronic cigarettes contain diethylene glycol - an ingredient in anti-freeze - and carcinogens and therefore must be removed from the market because there is no evidence that they are any safer than regular cigarettes. However, this justification is factually inaccurate on both counts.

First, although diethylene glycol was detected more than 18 months ago in one cartridge of one brand of electronic cigarettes, there is no evidence that it is present in any of the more than 100 other brands of electronic cigarettes on the market. Multiple companies have had their products tested for diethylene glycol and none of the samples have turned up positive. It appears that the presence of diethylene glycol was an isolated anomaly caused by one company's errant use of a non-pharmaceutical grade of propylene glycol. Readers should note that pharmaceutical grade propylene glycol does not contain any appreciable quantities of diethylene glycol.

Second, the bill's justification ignores the fact that the levels of carcinogens found in electronic cigarettes were only trace levels - comparable to those present in nicotine patches and nicotine gum. In fact, the relevant finding from the FDA's testing was that the level of tobacco-specific nitrosamines in electronic cigarettes was more than 1000 times lower than that present in Marlboro, the most commonly smoked cigarette in New York State. Thus, there is no scientific doubt that switching from tobacco cigarettes to electronic cigarettes will substantially reduce a smoker's risk of developing cancer.

Why would the New York State Assembly want to take away from both current smokers and ex-smokers the choice to use a product that is demonstrably much safer than cigarettes and which also appears to be far more effective than nicotine replacement therapy in reducing both the craving and desire to smoke?

The majority of smokers who have switched to electronic cigarettes report an immediate and dramatic improvement in their health. If this bill passes, these largely ex-smokers will be forced to return to cigarette smoking and these health gains will be decimated.

There are few public policies that, if enacted, will almost certainly result in an increase in morbidity and mortality. Assembly Bill A01468 is, unfortunately, one of them.

It is certainly reasonable to prohibit the sale of electronic cigarettes to minors. But New York Assembly members have a unique opportunity to save lives on Tuesday by voting to delete section 2 of the bill, which bans the sale of electronic cigarettes to adults, and retain section 1, which merely prohibits the sale of this product to minors.

The Rest of the Story

A new study I co-authored which was published online ahead of print last month in the Journal of Public Health Policy was the first to comprehensively review the scientific evidence about the safety and effectiveness of electronic cigarettes (see: Cahn Z, Siegel M. Electronic cigarettes as a harm reduction strategy for tobacco control: A step forward or a repeat of past mistakes? Journal of Public Health Policy; 9 December 2010; doi:10.1057/jphp.2010.41).

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. Nevertheless, the FDA and several states are threatening to ban them from the market, an action that 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.

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