A
front-page story in yesterday’s New York
Times notes the divide within the anti-smoking movement
on the merits of electronic cigarettes, as exemplified by the split
between Boston University public health professor Michael Siegel
and his former mentor, Stanton Glantz, director of the University
of California at San Francisco’s Center for Tobacco Control
Research and Education. The Siegel camp sees e-cigarettes, which
deliver nicotine without tobacco or smoke, as a promising harm
reduction tool, while the Glantz camp sees them as a public health
menace. Because health reporter Sabrina Tavernise accurately
summarizes the arguments of both sides, it is hard to see how a
fair-minded reader could end up agreeing with Glantz. Here are the
two main arguments against e-cigarettes:
E-cigarettes will lure teenagers into smoking.
Since avoiding that smelly, dirty, and dangerous habit is the main
motivation for vaping, this fear seems implausible. Furthermore,
there is
no evidence that e-cigarettes are serving as a gateway to the
conventional kind. In fact, the recent increase in vaping among
teenagers has been
accompanied by a continued decline in smoking.
Vaping will discourage smokers from quitting by giving
them a way to get their nicotine fix when they can’t light
up. Again, there is no evidence that is actually
happening, and the same objection could be raised against nicotine
gum, lozenges, or patches.
As Tavernise notes, the “public health” debate about
e-cigarettes “comes down to a simple question: Will e-cigarettes
cause more or fewer people to smoke?” The testimonials of vapers
tell us that e-cigarettes are a viable alternative for many people
who would otherwise continue sucking smoke into their lungs. We
know those people actually exist. The same cannot be said of
smokers who never would have started or who would have quit but for
e-cigarettes. Those vaping-enabled smokers may exist only in the
imaginations of Glantz and his allies. So if your concern is the
net impact on tobacco-related morbidity and mortality, the existing
evidence strongly favors e-cigarettes.
Regardless of how that collectivist calculus comes out, the
indisputable safety advantages of e-cigarettes would be enough to
recommend them as an option for individual smokers. Unlike some of
her colleagues, who in the past have implied
that the relative hazards of smoking and vaping are a matter of
scientific dispute, Tavernise understands the significance of
eliminating tobacco and its combustion products:
Public health experts like to say that people smoke for the
nicotine but die from the tar. And the reason e-cigarettes have
caused such a stir is that they take the deadly tar out of the
equation while offering the nicotine fix and the sensation of
smoking. For all that is unknown about the new devices—they have
been on the American market for only seven years—most researchers
agree that puffing on one is far less harmful than smoking a
traditional cigarette.
None of the e-cigarette critics quoted by Tavernise disputes
that point, and it is hard to imagine how anyone reasonably could
(although that does not stop some activists from trying).
But the huge difference in risk between vaping and smoking is not
enough for Thomas Frieden, director of the U.S. Centers for Disease
Control and Prevention. “I think the precautionary principle—better
safe than sorry—rules here,” he tells the Times. In what
sense is it “safe” to prevent smokers from buying a product that
could literally save their lives? If the Food and Drug
Administration, which is supposed to start regulating e-cigarettes
soon, takes its cue from Frieden, the result could be more
smoking-related disease and death instead of less. “If we make it
too hard for this experiment to continue,” says Siegel, “we’ve
wasted an opportunity that could eventually save millions of
lives.”
Frieden has been known to simply make stuff up in his campaign
against vaping,
claiming without any evidence that “many kids are starting out
with e-cigarettes and then going on to smoke conventional
cigarettes.” That he is now resorting to the precautionary
principle—which my colleague Ron Bailey aptly sums
up as “never do anything for the first time”—says a lot about
the weakness of the case against e-cigarettes, which is essentially
an emotional reaction against a product that
looks too much like a long-reviled symbol of evil. “Part of the
furniture for us is that the tobacco industry is evil and
everything they do has to be opposed,” University of Nottingham
epidemiologist John Britton tells the Times. “But one
doesn’t want that to get in the way of public health.”
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