The New York State Senate is owed a debt of gratitude from all New Yorkers who care about public health. It managed to remove Gov. Andrew Cuomo’s proposed $0.10 per-milliliter tax on e-cigarette liquid from the new state budget, along with a provision that would ban vaping anywhere smoking currently is prohibited.

Unfortunately, I have no doubt these same proposals will return next year, unless the medical community and politicians come to understand that e-cigarettes and traditional cigarettes are not, from a public-health standpoint, equally harmful. In fact, they’re not even close. The level of misinformation on this topic is epitomized by a recent New York Times editorial which advocated for tighter restrictions for e-cigarettes by the U.S. Food and Drug Administration. If these rules were implemented, by July 2018 it effectively would be impossible to purchase e-cigarettes legally.

E-cigarettes are not altogether safe and no one would make such a claim. But they are significantly safer—as much as 95 percent safer—than combustible products. In fact, they are so much safer that the United Kingdom now actively promotes adoption of e-cigarettes as an alternative to help adults quit smoking. With new research finding they are more effective than nicotine patches, it is no exaggeration to say they are becoming a standard tool in smoking cessation. More than half of American physicians now report advising their adult patients to switch to e-cigarettes to quit smoking. In practice, the recently defeated proposals to raise taxes on e-cigarettes or place undue restrictions on their public use would instead establish perverse disincentives for smokers ever to quit.

While young people who already smoke are indeed likely to try e-cigarettes, a recent report was widely misinterpreted (including by state Health Commissioner Dr. Howard Zucker) as showing that e-cigarette use leads to smoking. Analysis of the research suggests instead that a rising rate of vaping by youths is actually a causal factor in why cigarette smoking by youth is at its lowest level ever. From a public-health perspective, those findings should be considered a tremendous net positive.

Zucker seemed to suggest that users of e-cigarettes go back to smoking. I am sure that was not the statement he intended to make. Large-scale studies in Europe show that more than 1 million smokers have quit using e-cigarettes, and many more have reduced their inhalation of combusted smoke. To prevent a quit attempt with e-cigarettes is to doom smokers to more rapid progression of their tobacco-related disease.

The discussion about e-cigarettes is timely, as tobacco-control efforts in New York continue to underperform. New York State has more than 2 million smokers. Despite the highest state tobacco tax rate in the country, the prevalence of adult smoking is 15.2 percent, or 12th highest in the nation. The American Lung Association gives New York an F grade on tobacco prevention and control program funding and a D for access to smoking-cessation services. Annual health care costs in New York directly caused by smoking hover at $10 billion, with smoking-caused productivity costs at $7 billion.

If e-cigarette use has doubled in New York, and if e-cigarettes are leading young people to smoke, why is youth smoking in the state at its lowest point ever?

Clearly, something is not working out.

If we all agree that smoking is an important driver for illness, death, and health care costs in New York, and that smoking cessation can be effective, cost-effective, and one of the few interventions actually to lower health-care costs, then why not look closely at having providers recommend e-cigarettes as a harm-reduction tool?

Cuomo, Dr. Zucker and even The New York Times have been pulled into a contentious national discussion on vaping, and taken a strong position against e-cigarettes. Fortunately, common sense appears to have prevailed in the state Senate, which recently rejected new taxes on e-cigarettes. In view of the controversies and the need for continued improvement in the state’s performance on tobacco control, why not convene a panel to review the evidence and set meaningful policies that address the needs of all New Yorkers?

Image by a katz

Featured Publications