At Large

The Deadly Crusade Against E-Cigarettes

Experts meeting in Seoul this week want to ban a sure-fire way to prevent death from smoking.

By 11.15.12

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Today is "The Great American Smokeout" -- an appropriate day to take a moment to spare a thought for the 44 million Americans in the grip of a deadly addiction. Over half of all smokers tried to quit last year, and an estimated 443,000 died from cigarette-related illness.

Public health officials made great strides in reducing the prevalence of smoking, beginning with the groundbreaking Surgeon General's report in 1964. Back in the 1970s, 2 out of every 5 adults puffed: now about 1 in 5 do -- but what's left seems to be a coterie of hardcore addicts for whom the officially approved methods of smoking cessation just don't work. Figures released by the Centers for Disease Control and Prevention last week reveal the sad truth: The U.S. made no progress toward reducing smoking rates in 2011, and has made very little since 2005.

When it comes to smoking cessation, public health officials are out of ideas -- and it shows. Delegates from more than 140 countries that are party to the World Health Organization's anti-tobacco treaty, the Framework Convention on Tobacco Control (FCTC), are meeting in Seoul, South Korea, this week, and high on their agenda is banning or further restricting the best hope for slowing this catastrophe: harm reduction through electronic cigarettes and smokeless tobacco products.

As for the innovative new devices, known as e-cigarettes to their users, WHO director-general Dr. Margaret Chan told the delegates, "[I]ndustry is seeping through the cracks." But it's not that e-cigarettes are actually harmful, mind you -- they're not. It's just that they resemble actual cigarettes, so public health officials fear that the use of e-cigarettes may impede their efforts to "de-normalize" smoking."

It's worth a moment to understand what we're talking about here. Electronic cigarettes work by giving addicted smokers the nicotine they crave, without the toxic smoke. They supply "vapers" a variable amount of nicotine in a watery vapor and produce a red glow at the tip when puffed upon. That similarity -- especially the nicotine, the highly addictive substance smokers crave -- is what is best about e-cigarettes. The nicotine "hit" they supply matches, more or less, that of inhaling cigarette smoke, as do the behavioral mannerisms of holding the thing as though it was their familiar "friend," and killer: the lethal cigarette.

But that's where the similarity ends. There are no products of combustion to be inhaled hundreds of times a day, and hence no tobacco toxins. Nicotine is not a health threat, per se: its danger lies in its potent addictive power. "Vapers" get the satisfying drug but none of the tarry smoke. That's why many smokers who switch to e-cigarettes succeed in staying smoke-free, while those who try to quit using the FDA-approved methods so often fail. (The little-known fact, rarely discussed by "public health" gurus, is that the patches, gums and drugs they recommend as "safe and effective" are all-too-often neither).

E-cigarettes and smokeless tobacco products should be seen as two variants of a method called harm reduction -- providing smokers with nicotine but without the toxic smoke. The message to desperate addicted smokers from the neo-prohibitionists who are gathered in Korea to try to ban these reduced-harm products can roughly be translated as "quit, or die."

Lethally addictive cigarettes remain available on every street corner in Seoul and Atlanta while authorities denounce e-cigarettes as though the harmless sticks were Satan's emissaries. (In fact, the product is already banned in Canada, Australia, and New Zealand.) And while, as of today, e-cigarettes remain available in the hyper-precautionary European Union, a new Tobacco Products Directive is expected this year to call for a ban (while tightening the existing proscription on the nearly-harmless type of Swedish smokeless, snus). Such measures would leave addicted smokers with no effective means to help them quit.

The irrationality of these "public health" arguments puts into stark relief the blind-spot of the prohibitionist zealots: They fail to acknowledge the inconvenient fact that the millions of smokers in Europe and America (not to mention the billion or so worldwide) are not going to suddenly accept being regulated off their nicotine. The millions who have succeeded in quitting thanks to e-cigarettes and reduced risk tobacco products will not kick their habit and become nicotine-abstinent if these products are prohibited. No -- they will revert to the widely available, deadliest source: cigarettes.

Prohibiting the safest form of nicotine delivery will increase, not stem, the calamity of cigarette-related death. Truly informing smokers about reduced-risk nicotine products, such as e-cigarettes and smokeless tobacco, and increasing access to these products is the best way we have to save millions of lives.

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About the Author

Gilbert Ross M.D., is executive and medical director of the American Council on Science and Health.