Here is the executive summary with my thoughts on each part:
EXECUTIVE SUMMARY
E-cigarettes are evolving rapidly and being marketed like cigarettes were in the 1950s and
1960s
Yeah, so?
o Marketing is back on television and radio
Yeah, so? Is it bad that e-cigs (that have helped many people quit analogs) are being advertised? The last time I checked, Chantix, nicotine patches and nicotine gum were routinely advertised on T.V., radio, print and the Internet.
o Aggressive placement in convenience stores (next to candy) and in other stores (next
to medications)
It's the old "save the children" argument. Whenever someone uses the "children" or the "terrorists" excuse, you usually know they are pushing an agenda. Bush and Obama use "the terrorists" to erode our civil liberties (NSA spying, warrantless wiretaps, etc.) and a lot of people with other agendas (banning firearms, banning fast food, banning soda, banning e-cigs) typically break out the "save the children" argument. After all, what kind of upstanding citizen could be for the terrorists or against the children?!
Youth are rapidly adopting e-cigarettes
Evidence? Everyone I have seen in my area smoking an e-cig is almost certainly an adult. None of the B&M stores where I live allow children inside. Granted, this is anecdotal, but I have yet to see any studies that prove widespread adoption among youth. Are youth using e-cigs? Most certainly. Is it on the level of those that use traditional tobacco? The jury is still out. Would it be better if they bought e-cigs instead of a pack of Marlboros? Most definitely.
o E-cigarettes contain candy flavors (e.g., cherry, chocolate, turkish delight)
Yeah, so? Are we supposed to be forced to NOT enjoy our e-cigs?
o High levels of dual use
Again it's anecdotal, but I was a 2 pack a day smoker for 15 years. I have not touched one cigarette since the day I bought my e-cig kit. There are thousands of such stories as mine floating around by people who are now e-cig users.
o Youth who use e-cigarettes are heavier (not lighter) smokers
Perhaps some of these youth will give up tobacco cigs and adopt e-cigs as a replacement. Is this ideal? No. Is it better than smoking Marlboros? Yes.
o The temporal and causal relationships between e-cigarette use and smoking have not
been determined
So we are using the argument that e-cigs are a "gateway" to analogs? This is laughable.
E-cigarettes have not been proven to help people quit smoking
Perhaps there are no good long-term studies, but the anecdotal evidence and surveys point in the other direction, and rather strongly.
o Longitudinal population studies show that e-cigarette use is associated with a lower
odds of quitting
I doubt this, but we'll see.
o The randomized trial comparing e-cigarettes to nicotine patch shows that in the
context of low level behavioral support, the quit rate for those using e-cigarettes is
low and similar to those using a nicotine patch
Again, extremely doubtful. There needs to be more studies on bigger populations and having those people utilize better equipment (i.e. higher powered devices and not convenience store e-cigs).
There is a high level of dual use of e-cigarettes and conventional cigarettes among adults
Some people do continue to smoke. A lot of people who still smoke have cut down their traditional cigarette use dramatically. Many people quit smoking entirely. Even if there is some dual use, are the people who have quit smoking completely because of e-cigs to be "punished?" Are we to scare away other smokers who could benefit (even if only a fraction of them succeed?).
The hope that e-cigarettes will reduce harm by delivering "clean" nicotine will not be
realized in continuing dual users
Yeah, but what about the many former smokers who are not dual users? Are they to be left out in the cold?
E-cigarettes deliver lower levels of toxins than conventional cigarettes, but they still deliver
some toxins
What toxins? Of course there are a lot of variables (quality control of juice, where it's made, who makes it, what ingredients are used, etc.) I have seen a few papers written on the chemical composition of e-liquid and in every case the level of toxins when compared to a traditional cigarette aren't even remotely close. Indeed, in most cases, the level of "toxins" are well within the EPA standards for safe ingestion. Nicotine by itself is very little of a risk (outside of large quantities ingested quickly). PG and VG are not short term risks (long-term is still an open question). Flavorings are a more interesting question and there needs to be more research on what sorts of flavors carry the least risk for inhalation.
E-cigarettes pollute the air less than conventional cigarettes, but they pollute the air
o They do not just emit "harmless water vapor"
Yes, they pollute the air with propelyne glycol and glycerin vapor -- two of the most benign dilutants known to mankind. Both have been studied extensively for
decades and both are considered GRAS by the FDA. PG is used in IV drips, in medications as a dilutant (i.e. benzodiazepines), as well as in asthma inhalers. Indeed, the FDA approved nicotine inhaler uses PG as the dilutant. Glycerine is used in many household skin care products. Of course, there is some question as to the long-term effects of inhalation of both of these compounds, which is where more research money needs to go.
People passively exposed to e-cigarettes aerosol absorb nicotine (measured as cotinine), with
one study showing levels comparable to passive smokers
Which study? I have seen studies that come to the opposite conclusion (the nicotine level in the air was almost immeasurable).
There is little research on direct health effects
o One study shows short-term pulmonary effects
A much disputed study with questionable clinical significance. Other studies have shown that the cytotoxicity of e-liquid is almost nil (depending on the liquid tested). Again, it is an open question as to what the long-term effects are, but can we not agree it is almost certainly much less of a risk than long-term tobacco smoking?
o Evidence of cytotoxicity in animal and human in vitro test systems
Perhaps you should read the actual paper. The cytotoxicity was extremely low (and it varied depending on the liquid tested, which brings us back to quality control and standards which need to be established).
While the original e-cigarette companies were competing with conventional cigarette
companies, all the major cigarette companies are now in the e-cigarette business
E-cigarette companies are using the same political and public relations strategies as cigarette
companies (most notably organizing users, similar to how the cigarette companies organized
smokers)
I am an e-cig proponent and have never been "organized" by any corporation, nor has any other advocate I know. It's an insult to every e-cig user to suggest that somehow we are too stupid to make up our own minds about the issue.
E-cigarette policy making in many countries is dominated by assumptions about their use
(utility as a smoking cessation aid or for harm reduction) that are not supported by the
evidence available to date
I think the evidence is very strong that e-cigs help people quit smoking. The question is the success rate. Even if the success rate is as dismal as FDA approved nicotine patches and gum, isn't that enough to allow e-cigs to exist as an alternative for those who wish to try it?
At minimum, these policies should be implemented immediately:
Prohibit the use of e-cigarettes anywhere where the use of conventional cigarettes is
prohibited
Why? What evidence is there that e-cigs are harmful to bystanders? (Hint: there is none). The use of e-cigs in an establishment should be the choice of the proprietor and not the government.
Apply the same restrictions on e-cigarette advertising and promotion as apply to conventional
cigarettes
So that current smokers will stay hooked on conventional cigarettes or keep wasting hundreds of dollars on patches that don't work? It seems your plan will only help "big tobacco" for which you have so much disdain.
Ban the use of characterizing flavors in e-cigarettes
Once again, we are back to the "save the children" scare tactics. If the kiddies see those sweet and fruity flavors, they will just have to try them! As a result we should force all *adults* who use e-cigs to be stuck with one or two bland flavors. And God forbid that parents have any input or control of their children. It must be up to the government to save them all!
Prohibit claims that e-cigarettes are effective smoking cessation aids until such time as there
is convincing scientific evidence that such claims are true for e-cigarettes as they are actually
used in the general population.
I can agree with this. We need more studies about the efficacy of e-cigs as a smoking cessation device. The anecdotal evidence (surveys) is strong, but we need more thorough studies. Until that time, e-cigs should be marketed as an "alternative to smoking" with "likely harm reduction."
Regulate e-cigarettes to set standards for product performance in order to minimize risks to
users and bystanders
I agree, but most of this effort should be put on the juice manufacturers. That is the "portion" that goes into the lungs and is the portion that will have the most impact on health. We need things like certified labs that meet strict sanitary conditions, randomized health inspections, proper labeling, regulation of ingredients, etc. I don't know of many e-cig users who are opposed to common sense safety guidelines and regulations.
