The E-Cigarette Barn Door Is Open
The health of America's 42 million smokers, whose lives will be cut short an average of ten years by their continued use of combusted cigarettes, is being held hostage by government inaction.
Public-health officials agree that e-cigarettes have a role in reducing the burden of illness; while e-cigarettes are not safe, they are a much less harmful way of delivering the nicotine to which smokers are dependent. They can help smokers quit — even, sometimes, smokers who didn't take them up with that intention. Failing that, they reduce the harm of continued nicotine consumption.
Both the Food and Drug Administration and the Centers for Disease Control know this, yet have done precious little to address the new technology — either to encourage smokers to switch, or even to regulate e-cigarettes in a serious and reasonable manner. They have been preoccupied by their war on nicotine, regardless of the source.
Television ad campaigns against smoking are a prime example of how federal agencies approach the subject. While these advertisements are effective, especially with young people, they leave millions who could be helped to quit smoking untreated.
These agencies express concern that positive messages about e-cigarettes could encourage young people to try them. This is a reasonable worry. But although some young people have taken up e-cigarettes in recent years, this is largely due to an absence of regulation — while some states have banned sales to minors, many have not yet formally taken action.
Better regulations could address this concern, but that does not seem to be a priority for policymakers. The government has spent the last five years, for example, developing protocols to evaluate and regulate the safety of e-cigarettes. The draft guidelines are so onerous that it would take several years and millions of dollars for any e-cigarette product to be approved. And after many years of reports of children being poisoned after accessing their parents' nicotine, it was only this year that Congress passed legislation requiring that e-cigarettes and the devices used to refill them be made childproof.
Fortunately, smokers who want to reduce their risk of tobacco-related disease are not waiting. Reuters reports that 10 percent of adults now use electronic cigarettes. One prominent health activist has attributed the recent decline in cigarette smoking, which has reached a new low of 15.3 percent, to this increased use of e-cigarettes. Two recent surveys of physicians find that half report their smoking patients ask about e-cigarettes; one in three doctors recommend them for harm reduction or cessation.
Progress on controlling smoking has been more substantial in the United Kingdom. In 2015, Public Health England published a systematic review of the available literature on the health and safety implications of electronic cigarettes, concluding their use is about 95 percent safer than smoking. The authors recommend that smokers who have tried other methods of quitting without success be encouraged to switch to e-cigarettes. In addition to helping with cessation, switching could reduce smoking-related disease, death, and health inequalities. The report added that there is no evidence so far that e-cigarettes act as a route to smoking for children or non-smokers.
These conclusions were based on several well-designed studies that show e-cigarettes to be as effective as nicotine patches as a cessation tool. In addition, one in seven e-cigarette users reduce their daily cigarette consumption by 50 percent or more.
England's National Health Service now dispenses select electronic cigarettes as part of routine smoking-cessation interventions. A 2015 article published in Addiction Research and Therapy describes how adding e-cigarettes has increased the program's appeal, cost-effectiveness, and efficacy.
Here in the U.S., the FDA and CDC's concerns about the impact of e-cigarettes on young people certainly is appropriate, but that does not excuse the agencies' failure to promote evidence-based interventions for adult smokers.
Edward Anselm is medical director of Health Republic Insurance of New Jersey and a senior fellow of the R Street Institute.