Here is the letter the American Association of Public Health Physicians sent to Indianapolis / Merion County Council members.
On October 26th, the council voted 13-14 on the proposed legislation, with 2 abstentions and 2 absenters.
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From: Joel Nitzkin
To:
Sent: Saturday, November 28, 2009 7:01 AM
Subject: Re: e-cigarettes
Dear At-large Members of the Marion County Council:
This note is to urge your deletion of any reference to e-cigarettes in the proposed expansion of your smoking ban.
Banning smoking in public places and workplaces is an effective measure to both protect non-smokers and reduce exposure to tobacco-related toxic substances in cigarette smoke. Including e-cigarettes in this ban, however, will do more harm than good.
From a public health perspective, the most promising option we have to rapidly and substantially reduce tobacco-related illness and death in American society is to honestly communicate the fact that there are now smokeless tobacco products and other nicotine delivery products on the market that carry near-zero risk of cancer, heart or lung disease. Enabling and empowering current smokers to switch to such products could safe the lives of 4 million of the 8 million current adult smokers who will otherwise die of a smoking-related illness over the next 20 years. We believe that e-cigarettes will soon prove to be one of these zero-risk products. We also believe that this public health benefit can be secured without increasing the numbers of children and teens initiating nicotine use.
I, and the organization I represent (AAPHP) have no financial or other relationship with any manufacturer or vendor of E-cigarettes or any other tobacco product or nicotine delivery product. This communication is based on our best judgment of the steps we, as an American society, should take if we are to achieve the most rapid and most substantial reduction in tobacco-related illness and death.
From our perspective, use of E-cigarettes should be encouraged as a substitute for conventional cigarettes for cigarette smokers who are unable or unwilling to quit, but are sincerely interested in reducing their risk of tobacco-related illness.
The carrier for the nicotine is ethylene glycol, not the diethylene glycol found in automobile antifreeze. Ethylene glycol is the substance used by theater fog machines. It has been extensively tested and found to be safe.
Your inclusion of e-cigarettes in the proposed smoking ban appears to be a direct response to the July FDA press conference on electronic cigarettes. This press conference included substantial inaccurate information and failed to mention that the carcinogens found in the E-cigarette liquid were the same carcinogens found in FDA approved nicotine replacement products and in the same concentrations. The new leadership of the FDA tobacco program have been advised of these inaccuracies and is now considering their response, There has been no further action against E-cigarettes (that we are aware of). FDA has not formally asserted regulatory authority over these products. Since there is not yet a formal regulatory program for E-cigarettes, those E-cigarette manufacturers who would like to submit their products for FDA review have been unable to do so. Some have, however, submitted their products to independent laboratories and published the resu lts on their respective web sites.
Even without FDA oversight, a number of the E-cigarette manufactures and vendors have voluntarily adopted a policy of no sales to minors.
E-cigarettes have been in use in the United States for more than three years. There are currently hundreds of thousands of users. There are no reports of adverse effects, and many reports of success in totally quitting conventional cigarettes, and feeling better as a result.
The tobacco problem, from a public health perspective, can be summarized as follows:
1. Conventional cigarettes kill about 440,000 Americans each year -- about 400,000 smokers and about 40,000 non-smokers killed from environmental tobacco smoke.
2. Conventional cigarettes are, by a very wide margin, the most hazardous of nicotine delivery products, in terms of illness and death rates, and property damage.
3. The death rate from conventional cigarettes is at least 50 times more than the death rate from smokeless tobacco products. There are some smokeless products that have been well studied over a number of years that carry no measurable risk of any form of cancer or any other serious illness. While E-cigarettes are too new to have undergone such studies, everything we know about them suggests that they, too, will pose little or no risk of cancer, heart or lung disease or other cause of death.
4. Nicotine addiction is extremely powerful. Once acquired, it is very hard to break.
5. The success rates from pharmaceutical nicotine replacement treatment (NRT) products are dismal. While the quit rates are about 40% at 12 weeks, the rates are about 7% at 6 months and only 5% one year post treatment. These product appear to be effective only if used on a long term basis. Even this is unsatisfactory to most current smokers because they are very expensive and do not deliver a level of nicotine satisfaction equal to that of cigarettes. In this context, E-cigarettes appear to both effective and satisfactory to large numbers of smokers as a means to maintain their nicotine addiction while eliminating exposure to the high concentrations of dangerous chemicals in tobacco smoke.
6. E-cigarettes pose no fire hazard, and, as far as we can tell, no risk to others who may be in the same indoor space. Please keep in mind that the vast majority of indoor air pollution from conventional cigarettes is from sidestream smoke -- the smoke that curls off the end of the cigarette when no one is puffing on it. E-cigarettes have no sidestream vapor.
7. There is no evidence that E-cigarettes may be any more attractive to children and teens than conventional cigarettes.
From our perspective, E-cigarettes should be considered a smokeless tobacco product (vapor is not smoke) and should not be prohibited in areas where smoking is prohibited.
To learn more about how we reached these conclusions, and the scientific evidence that backs up these conclusions, please see the "Tobacco Issues" page on our
Tobaccolegfeb07 web site. The papers of most interest to you will probably be our Harm Reduction Resolution and White Paper, and the paper on the Myth of the Safe Cigarette.
Please feel free to contact me by phone or e-mail if you would like yet additional information on this topic.
Joel L. Nitzkin, MD, MPH, DPA
Chair AAPHP Tobacco Control Task Force
(AAPHP = American Association of Public Health Physicians)
c/o JLN, MD Associates LLC
4939 Chestnut Street
New Orleans, LA 70115-2941
Phone: 504 899 7893 or 800 598 2561
Cell phone 504 606 7043
Fax: 504 899 7557
Skypename jlnitzkin
jln-md@mindspring.com
Tobaccolegfeb07
