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Novel Nicotine Delivery Systems and Public Health: The Rise of the "E-Cigarette" -- Cobb et al. 100 (12): 2340 -- American Journal of Public Health
Editorial
Novel Nicotine Delivery Systems and Public Health: The Rise of the "E-Cigarette"
December 2010, Vol 100, No. 12 | American Journal of Public Health 2340-2342
Nathan K. Cobb, MD, M. Justin Byron, MHS, David B. Abrams, PhD and Peter G. Shields, MD
Introduction
Inhalation of smoke from burning tobacco remains the most deadly risky behavior in the United States. For years, corporations have sought alternative methods to administer nicotine to the brain without the harms of combustion while retaining the immediate rewarding aspects of cigarettes that make them so profitable, pleasurable, and addictive. The latest attempt at reduced harm products is a heterogeneous collection of battery-driven inhalers termed by the World Health Organization (WHO) as electronic nicotine delivery systems (ENDS)1 or more popularly as electronic cigarettes or e-cigarettes. These devices pose significant challenges to the public health community because their distribution and use has become widespread in the United States while simultaneously evading most regulatory structures. Ultimately, these devices force a close consideration of how the health and regulatory system evaluates claims of safety and harm reduction in a dynamic, consumer driven environment to ensure the broad protection of public health...
The ENDS tested so far have demonstrated poor quality control; toxic contaminants, albeit at low levels; misrepresentation of the nicotine delivered; and insufficient evidence of overall public health benefit. Ongoing, rigorous safety testing is needed, including determining real-world use patterns and further laboratory testing across device constructions to determine actual systemic nicotine delivery and exposure to harmful constituents. We recognize a manufacturer's desire to market their product and advocates who say ENDS are logically safer than cigarettes. However, to allow their unregulated sale on presumption is not protecting public health. ENDS should be removed from the market and permitted back only if and when it has been demonstrated that they are safe, that their benefits outweigh their harms to overall public health, and that a comprehensive regulatory structure has been established under an appropriate FDA division. It is possible that ENDS-like devices will eventually provide safer alternatives to smoking that do not increase uptake among youths, that foster cessation, and that are less harmful or addictive than cigarettes. Until then, health and safety claims based on assumptions are unacceptable.
Note that authors Cobb, Byron and Abrams work for the American Legacy Foundation, which has previously urged the FDA to ban e-cigarettes (until they are proven safe and effective by the FDA as smoking cessation aids).
Cobbs e-mail address is ncobb@legacyforhealth.org
Editorial
Novel Nicotine Delivery Systems and Public Health: The Rise of the "E-Cigarette"
December 2010, Vol 100, No. 12 | American Journal of Public Health 2340-2342
Nathan K. Cobb, MD, M. Justin Byron, MHS, David B. Abrams, PhD and Peter G. Shields, MD
Introduction
Inhalation of smoke from burning tobacco remains the most deadly risky behavior in the United States. For years, corporations have sought alternative methods to administer nicotine to the brain without the harms of combustion while retaining the immediate rewarding aspects of cigarettes that make them so profitable, pleasurable, and addictive. The latest attempt at reduced harm products is a heterogeneous collection of battery-driven inhalers termed by the World Health Organization (WHO) as electronic nicotine delivery systems (ENDS)1 or more popularly as electronic cigarettes or e-cigarettes. These devices pose significant challenges to the public health community because their distribution and use has become widespread in the United States while simultaneously evading most regulatory structures. Ultimately, these devices force a close consideration of how the health and regulatory system evaluates claims of safety and harm reduction in a dynamic, consumer driven environment to ensure the broad protection of public health...
The ENDS tested so far have demonstrated poor quality control; toxic contaminants, albeit at low levels; misrepresentation of the nicotine delivered; and insufficient evidence of overall public health benefit. Ongoing, rigorous safety testing is needed, including determining real-world use patterns and further laboratory testing across device constructions to determine actual systemic nicotine delivery and exposure to harmful constituents. We recognize a manufacturer's desire to market their product and advocates who say ENDS are logically safer than cigarettes. However, to allow their unregulated sale on presumption is not protecting public health. ENDS should be removed from the market and permitted back only if and when it has been demonstrated that they are safe, that their benefits outweigh their harms to overall public health, and that a comprehensive regulatory structure has been established under an appropriate FDA division. It is possible that ENDS-like devices will eventually provide safer alternatives to smoking that do not increase uptake among youths, that foster cessation, and that are less harmful or addictive than cigarettes. Until then, health and safety claims based on assumptions are unacceptable.
Note that authors Cobb, Byron and Abrams work for the American Legacy Foundation, which has previously urged the FDA to ban e-cigarettes (until they are proven safe and effective by the FDA as smoking cessation aids).
Cobbs e-mail address is ncobb@legacyforhealth.org
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