Fierce debates dominate D.C.’s first E-Cigarette Summit

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If you imagined an e-cigarette conference full of policymakers at a Marriott in Washington would be a tame event, you would be wrong. I suppose I shouldn’t be surprised that e-cigarettes could a polarizing topic, but I will not soon forget the cheers and boos in the crowd as people stood up to state their opinions and present their research at the first E-Cigarette Summit here in Washington.

A running theme of this conference came down to the existential question: are you a skeptic or are you an enthusiast? Are e-cigarettes addictive products designed to hook teenagers or should they be marketed to current smokers as a quitting tool?

It’s important to understand that e-cigarettes are much safer than combustible cigarettes. Every panelist—including professors, physicians, economists and industry folks—agreed with reports that e-cigarettes are at least 95 percent safer than traditional cigarettes. What is not so easily understood is how best to use e-cigarettes to promote a healthier society.

We’ve seen debates like this before. Will needle-exchange sites keep injection users free from infectious disease or will they tacitly encourage people to try heroin? Does condom distribution in high schools prevent teen pregnancy or lead to a breakdown of morals? There are valid points in support of either argument, but whichever way we as a society land will have long-lasting effects.

The truth is there are a lot of specific questions that need to be answered before people will feel comfortable with novel devices. When it comes to e-cigarettes, there needs to be a balance between consumer protection, trust and the application of science, so that sound policy can best direct public health goals. Some of the discussions at this forum centered on questions for which we don’t yet have definitive answers:

  • Does a standalone nicotine product at the concentrations found in e-cigarettes (with the absence of other chemicals that are present in tobacco) produce changes in the brain consistent with addiction?
  • What environmental or product factors are predictors of successful transition from combustibles to e-cigarettes?

As we move forward in our research and advocacy endeavors, the answers to these questions will help shape both tobacco and e-cigarette policy and will form a foundation for U.S. harm-reduction policy.

Some of the more contentious issues created even more forceful debates. While e-cigarettes are effective smoking-cessation tools, physicians are reluctant to recommend them over medications, gum or the patch. Although teen smoking rates are at historic lows, the rise in experimentation of e-cigarettes is concerning (it is noteworthy that daily use of e-cigarettes among teens is 2 percent). While it is unethical to perpetuate the myth that e-cigarettes are nearly as harmful as traditional cigarettes, some suggest there might be an ethical dilemma in marketing e-cigarettes to recreational users.

It is fair to say that more information is better to avoid hooking a new generation on cigarettes, but it is more important to use the tools we have now to encourage smokers to switch to safer products. We cannot forget that, just today, more than 1,300 people will die from smoking in the United States alone. Getting people to stop smoking combustible cigarettes should be our No. 1 priority and there is now a product to make that happen.


Image by LezinAV

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  • Rusty Rogers

    I finally was able to quit smoking after 53 on 5/19/13. From day one of using an e-cig a friend had given me I was able to resist ever having another cigarette. I had tried everything else available for years to no avail. I for one am very grateful for the e-cig industry!

  • Nate

    “Are e-cigarettes addictive products designed to hook teenagers or should they be marketed to current smokers as a quitting tool?”

    This is a totally false dichotomy. They’re recreational products that should be freely available to any grown adult who wishes to purchase and use them. It isn’t anyone’s damn business what the reason is.

    And people who enjoy smoking cigarettes and have no inclination to quit should be left the hell alone.

    • I totally agree.

      Ecigs may be used like NRTs, but they primarily are a recreational consumer product.

      I was one of the sizeable minority who had no intention to quit anything. I tried vaping just out of curiosity. And switched. Simply for the improved pleasure. Not for health reasons, not even because of the money.

      Details of “My Story” in my blog (via Disqus profile)

  • We do have some data to answer the first question: Does nicotine in concentrations found in e-liquid cause addiction? That answer is no. We have FDA approved gum in 4mg per piece strengths and there does not appear to be an addiction element (addiction defined not as dependence but habitual use without regard to consequences).

    We have some solid clues to answer the second question: What flavors predict successful transition? Surveys of vapers demonstrate that the variety of flavors in the fruit and bakery goods appear to be the most prevalent by those who have switched successfully. Better survey design, to capture any shifting preferences as switching happens could fill in the blanks. An RCT would not be able to control for flavor preference enough – and what we’ve seen in the RCT’s for current NRT products demonstrates a poor correlation to real-world results.

    One of the larger problems is the amount of propaganda that has been generated to the public that equates smoking and vaping as being equal. Clearly they are not, based on the science. But overcoming the reluctance to recommend by health professionals not only needs good data on transition success and health outcome, but the need to overcome the false equivalence created by the media. The UK has successfully overcome that (they were very opposed at first too) through clear messaging on the risk and reasons e-cigarettes are valuable. For that to take place in the US the ideological interest groups must first recognize, as PHE and RCP did, that the evidence is there to reduce health costs in both dollars and lives sufficient to accept a small percentage of unintended non-smoker initiation. Once this information gets out, and e-cigarettes are no longer ‘forbidden fruit’ but market targeted to smokers a great deal of their appeal to youth would be lost (no longer a cool adult behavior) which could drive the 2% figure even lower.

  • The wording of “E-cigarette: an evidence update. A report commissioned by Public Health England” that said that “best estimates show e-cigarette are 95% less harmful to your health than normal cigarettes” is flimsy, and their “95%” statistic turns out to be a mere optimistic guess, not a real percentage based on mathematics using data or measurements.

    • castello

      What percentage would you want it to be for you to be convinced? The anti nicotine/tobacco zealots have been looking for any reason to tax or ban them for 10 years and they have found nothing. Smokers are dying while listening to the vaping naysayers. http://www.nhs.uk/news/2017/02February/Pages/Long-term-vaping-far-safer-than-smoking-says-landmark-study.aspx

    • Nate

      No, the 95% nonsense is a worst-case scenario because the RCP (no, it was not Public Health England; good job quoting an idiotic error-filled misinterpretation of the source) wanted to hedge their bets. If you’d actually read the quote on which you’re commenting, you’d know it also contains their concession that vaping can not at this time be shown to have caused any meaningful harm to anyone.

  • AregularMom

    I highly recommend ecigs as a replacement for cigarettes. I have tried every way from Sunday trying to quit. The ecig has made it almost easy! And that is after smoking for 47 years! I thank the person that gave me the initiative to try this route through their Facebook post. I’m going down each month by 1 in the amount of nicotine. Eventually, I will be ecig free too! What a wonderful and totally unexpected dream come true!

    • Nate

      If you enjoy vaping and nicotine, and they are doing you no harm, there is no reason to strive for cessation, aside from the bizarre ascetic self-denial that lunatic tobacco controllers expect of you.

    • Keep up the good work, because nicotine is not only addictive but also a dangerous neurotoxin, even when not inhaled as smoke from burning tobacco leaves: (reported by KSDK)…said Mark Clifton, the owner of No Smoke Shop in St. Louis…
      “Nicotine poisoning is a real thing” … “Symptoms would be headaches, vomiting and it can get even more dangerous than that.” More dangerous as in fatal. Children have been killed by drinking nicotine e-liquid. Even when it feels like fun nicotine is damaging arteries.

      • melawyth

        There was a challenge last month with a cash prize from anyone who could produce a study showing that nicotine is addictive. No one could find one. Do you know why? Because nicotine, away from all the chemicals in cigarettes, is not particularly addictive.
        One child was killed because he drank liquid nicotine (not e-liquid), and I believe there was a suicide a couple of years ago by injecting pure nicotine (not e-liquid). This was tragic, but it was caused by careless parents or by deliberate decision, not by vaping.
        I’ll hand it to you Carl — you do try hard. Too bad you merely scratch the surface of analysis and come up with the equivalent of old wives’ tales.

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