International experts in tobacco control are urging United States regulators to keep an open mind about regulating the use of e-cigarettes and other vaporized nicotine products and not just think about them as a gateway to tobacco use.
In a paper published in the journal Addiction, the experts propose a framework for evaluating the public health impact of e-cigarettes and other vaporized nicotine products (VPNs), and they bring together much of the evidence available on these products.
The paper follows an announcement by the Food and Drug Administration (FDA) that the agency is proposing to extend its tobacco authority to cover “additional products that meet the legal definition of a tobacco product, such as e-cigarettes.”
Electronic cigarettes, also known as e-cigarettes, are battery-operated devices that contain addictive nicotine, flavor and other chemicals and convert them into an aerosol that is inhaled by the user.
Lead author of the new study, David T. Levy, professor of oncology at the Lombardi Comprehensive Cancer Center at Georgetown University Medical Center in Washington, DC, says:
“We’re concerned the FDA, which has asserted its right to regulate e-cigarettes, will focus solely on the possibility that e-cigarettes and other vapor nicotine products might act as gateway to cigarette use.”
“We believe that the discussion to date has been slanted against e-cigarettes, which is unfortunate,” says Prof. Levy, “because the big picture tells us that these products appear to be used mostly by people who already are or who are likely to become cigarette smokers.”
He and his colleagues suggest that, on balance, the benefit e-cigarettes bring – in terms of reduced tobacco smoking and bringing down tobacco-related deaths – outweigh their potential harms.
Rates of tobacco smoking in the U.S. peaked in the 1960s, after which, because of tobacco control policies, they gradually came down. But the authors note that tobacco smoking is still a big killer. The Surgeon General’s Report for 2014 states:
“Death and disease from tobacco use in the United States is overwhelmingly caused by cigarettes and other burned tobacco products. Rapid elimination of their use will dramatically reduce this public health burden.”
Levy and colleagues argue that e-cigarettes
There is also evidence, says Prof. Levy, in countries where smoking rates are still high and smokers want to quit, that e-cigarettes can improve public health by offering an alternative to cigarette use.
Research from England, Canada and the U.S. also shows that cigarette use has fallen more in the last 2 years than in the 4-5 years before that, and the drop coincides with an increase in e-cigarette use.
The authors acknowledge that while e-cigarettes can be a gateway to smoking, much of the evidence shows they also help stop tobacco smoking.
They also anticipate that their paper will fuel the ongoing debate about whether e-cigarettes help or undermine tobacco control efforts.
According to the FDA, e-cigarettes have not been fully studied, so we currently do not know what risks they pose, how much nicotine or other chemicals are inhaled during use, or whether there are any benefits associated with their use.
The federal agency also maintains that we do not know whether e-cigarettes may lead young people to try other tobacco products, such as conventional cigarettes.
Prof. Levy and colleagues note that they do not wish to encourage young people to take up e-cigarettes who would never have taken up smoking. But surely, they argue, the main purpose of tobacco control should be to discourage people from taking up smoking and helping smokers quit – “even if that means switching for some time to e-cigarettes rather than quitting all nicotine use.”
On a final note, the authors warn that while heavy regulation and taxation of e-cigarettes could be a way to stop young people from taking them up, it could also reduce the potential benefits these products bring to other areas of public health, as Prof. Levy concludes:
“Increasing e-cigarette prices by taxing them the same way as cigarettes will discourage youth VNP use, but also discourage use by smokers, especially those of lower socioeconomic status, who are trying to quit.”