In April of this year, two members of the Washington, DC city council introduced a bill to forbid the use of electronic cigarettes, devices that deliver nicotine via vapor, in all the places covered by the District’s existing smoking ban. “It is smoking, is an inhalant, and it’s similar to smoking,” council member Yvette Alexander told the Washington Post. “We don’t know what the ill effects of this are, and it’s still a bother to some people.”
“Similar to smoking” and “a bother.” Time was public officials and anti-smoking activists offered evidence of harm before imposing new restrictions on personal behavior. Advocates for bans on actual smoking in bars and restaurants made their case with studies indicating that long-term exposure to secondhand tobacco smoke was harmful to the health of hospitality workers. They sometimes went overboard with the alleged dangers, but at least they were trying. Today’s effort to extend bans to e-cigarettes is based on little more than the fact that they sort of look like the real thing.
“This is no ordinary product because it encourages mimicking and could promote taking up smoking,” France’s Health Minister Marisol Touraine said at a press conference last month announcing her intention to apply the country’s ban to e-cigarettes. Scott Neal, manager of the tobacco prevention program for Public Health in King County, Washington, offered a similar reason for implementing the same policy in Seattle. “By returning smoking to the public eye, public e-cigarette use threatens to undermine the social norming impact” of the ban, he told the Post-Intelligencer.
As if in proof of Marx’s dictum that history repeats itself first as tragedy, then as farce, it appears inevitable that the fight over smoking bans will be re-argued. Italy may soon follow France’s lead. New Jersey became the first US state to extend its ban to e-cigs in 2010. Bills in California and Connecticut would do the same. Boston, Seattle, and several other American cities have already done so.
If e-cigarettes are to be included in smoking bans, then the vapor they produce should be demonstrably harmful to bystanders. So far there is little reason to think it is. A study published in May evaluated the toxicity of twenty-one brands of e-cigarettes. Twenty of them showed no signs of causing cell damage, and the only one that did so was nonetheless far less toxic than cigarette smoke.
Opponents of e-cigarettes seize on trace amounts of metals or carcinogenic nitrosamines that have been detected in the products. They neglect to mention that similarly trace amounts have been detected in smoking cessation devices like nicotine gums, patches, and inhalers already approved by the FDA. The level of carcinogens in cigarettes is a thousand times higher. Greater transparency and consistency in the production of e-cigarettes is desirable, but they are demonized far out of proportion to any reasonable expectation of harm.
Perhaps the nadir of this fear-mongering came from Dr. Lowell Dale, medical director of the Mayo Clinic’s Tobacco Quitline, who warned journalist Eli Lake that the propylene glycol used in many brands of e-cigarettes is “similar to antifreeze.” Actually the FDA classifies the chemical as “generally recognized as safe” and it’s in common use in food and drug products. It may cause irritation in some people, and the long-term consequences of repeated inhalation by e-cigarette users is certainly worthy of study. But irritation is a far cry from the lung cancer and heart disease that supposedly justified banning smoking in private businesses, and not remotely comparable to the result of consuming antifreeze intended for cars.
The smoking ban battle is just the beginning, however. The bigger question is whether e-cigarettes will remain on the market at all. The Food and Drug Administration has already tried and failed to ban them once. Though the products are currently free of FDA regulation so long as they do not make therapeutic claims, the agency has indicated that it plans to extend its authority to additional tobacco products, with e-cigarettes considered by many to be a likely candidate for inclusion.
Since no one seriously disputes that using e-cigarettes is far safer than habitually inhaling cigarette smoke, allowing them to compete should be a no-brainer. Unfortunately, the law allows the FDA to ban new tobacco products even when they are irrefutably safer than what is already for sale. The agency evaluates applications based not only on the risk to individual users, but also on how they impact smoking cessation and initiation in the population as a whole. If the FDA decides that these effects outweigh the health benefits, it could ban e-cigarettes not because they are dangerous, but rather in spite of their safety.
It’s worth considering who would benefit from taking e-cigarettes off the market. The first answer is big tobacco companies; an analyst for Morgan Stanley projects that e-cigarettes may displace 1.5 billion cigarettes in 2013. Recognizing the trend, the large tobacco companies are finally joining more than 100 smaller firms in the marketing of e-cigarettes.
Also facing competition are pharmaceutical companies that produce smoking cessation products. While helpful to some, these therapies are an inadequate solution for most smokers. A growing body of evidence and anecdotal success suggests that e-cigarettes may be a more effective alternative.
There is reason to be concerned about the influence these companies have on the e-cigarette debate. As reported by Michael Siegel, a professor in the Department of Health Sciences at Boston University and advocate for harm reduction strategies, groups that have opposed e-cigarettes—these include the American Cancer Society, American Lung Association, and Campaign for Tobacco-Free Kids—accepted contributions of nearly $3 million in 2011 and 2012 from Pfizer, producer of the smoking cessation drug Chantix.
The recently appointed director of the FDA’s Center for Tobacco Products, Mitch Zeller, comes to the job directly from consulting for GlaxoSmithKline on its nicotine replacement products—the same pharmaceuticals threatened by potentially more effective e-cigarettes. This conflict of interest at the highest level of leadership calls into question the agency’s ability to regulate e-cigarettes impartially.
Not long before assuming his new post, Zeller contributed an essay to a special issue of the academic journal Tobacco Control devoted to “endgame” strategies that could finally eliminate tobacco use. Though details are scarce in Zeller’s proposal, what comes through is a technocratic belief that benign regulators hold “enormous promise” advancing that objective by manipulating nicotine levels across the product spectrum. Nicotine could be sharply reduced in combustible tobacco, forcing smokers to take up safer forms of delivery regardless of their own preferences.
Smoking is, in this view, a purely medical problem. Practically mechanical. Simply a matter of having the right people pulling the right levers.
The e-cigarette may find a home in this approach, but it also threatens it at a fundamental level. This, more than the interest of pharmaceutical companies, is why the device receives so much opposition despite so little evidence of danger: The e-cigarette is an unwelcome reminder that nicotine can be enjoyable and that consenting adults can consume it without undue risk. For an anti-smoking movement that has been taken over by a rigid abstinence-only ideology, that simply will not do.
Those who take seriously the prospect of an endgame should remind themselves of just how resilient the demand for tobacco truly is. Historically, smokers and tobacconists have faced enormous import duties and kingly scorn in England, imprisonment in Switzerland and Japan, the death penalty in China, nostril-slitting, flogging, castration, and Siberian exile in Russia, beheading in the Ottoman Empire, and the pouring of molten lead down one’s throat in Persia. In the early twentieth century, American prohibitionists succeeded in banning the sale of cigarettes in fifteen states. And in the past decade, despite all the tax hikes, smoking bans, and stigmatization, the smoking rate in the US has budged merely a few points. Talk of an endgame won by regulation is a little premature.
There is a better way. Innovations in manufacturing, distribution, and advertising are what brought about the cigarette’s domination, and innovation is what can finally end it. In a competitive market many users will choose mostly harmless vapor, some will continue to use patches and gums, others will stick to cigarettes and smokeless tobacco, and still others will prefer more flavorful cigars and pipes. Though falling short of the smokefree America desired by many, this would result in massive improvements in health and happiness. But only if consumers have the choice—a choice that today’s anti-smoking movement is determined to take away.