Unfortunately they don't just make one undisputed claim - some of them make several (including the manufacturers). These include claims of safety and cessation. Neither claim is valid and shame on them for that.
The safety claims wouldn't be valid even if applied to recognised NRT products. Nicotine isn't safe for long-term consumption. It is likely implicated in a whole raft of medical problems such as thickening of the arterial walls, vasoconstriction , and issues within the central nervous system that modern neuroscience is probably only beginning to get a handle on.
The cessation claims, however, could be demonstrated with a longitudinal study involving several hundred people. But of course, even this type of study can be biased in the favour of the companies funding it - that is to say, nothing is proven with a clinical trial.
Respectfully, I have to disagree with Bob on the idea that clinical studies can prove the safety of a medicine. They cannot, and this is not a mere academic point.
Clinical studies operate by measuring objective outcomes (eg. the cessation of smoking) while also measuring side effects - both those that are expected, and thus the participant is prompted to report (so, perhaps, the irritation caused to the mucous membrane by PG), and those that are unexpected and spontaneously reported or observed in participants (eg.
There is a huge grey area in between predicted and spontaneous reporting of side effects
during clinical trials which means that drugs have been allowed on the market, with side effects being reported only later on.
The most famous example of this is the sexual dysfunction caused by SSRIs. The effect was not observed in trials, principally because participants were not asked whether they were experiencing it. It is also believed that patients did not spontaneously report them because they were embarrassed, or did not make the link between their dysfunction and the drugs. Sexual dysfunction is now the primary reason for discontinuation of successful ssri treatment (although it's hard to define any treatment as "successful" that robs one of such a central component of human existence).
In the UK, Medicines and Healthcare Regulatory Authority runs the
Yellow Card Scheme which encourages patients and doctors to report side effects they report while taking a drug.
So, what does this mean for e-cigarettes? Well, nothing actually. The fact is that the FDA is set up in such a way that once they declare a product to be under their jurisdiction, they have a series of procedures that the manufacturer must follow to have their product approved.
Is this right? I'm in two minds about this. On the one hand it would seem to provide patients and doctors with a relative level of confidence that medication they use has been evaluated to the best possible standard.
On the other hand, there are massive shortcomings with this system.
For one, the cost of bringing a new drug to market, coupled with patent laws means that vast swathes of generic drugs or un-patentable drugs with potential new-uses will never be brought to market, even though they are far superior to novel (ie patentable) drugs. The cost of trialling them is simply too great, and if the return of investment cannot be guaranteed, it just won't happen.
The system also locks out small, dynamic and inventive companies who cannot raise the resources needed to go through the process. Meaning that BP has an effective monopoly on drug research - and further that they decide on the diseases "worth" investing in.
Lastly (from me, anyway), it means that there is an atrophying effect within pharma reseach. I don't have the figures to hand, but the number of new pharmacologically active compounds discovered each year has steadily dropped since the 1950s. As a result older drugs have been re-patented in new forms, and marketed as superior - even though the medical evidence is lacking. In doing so, companies are able to register new patents to protect their market share for another 10 years or so (20 years total minus the 10 years it takes to bring a product to market).
For me, the question that Bob fails to address with his resolute allegiance to the law, is the philosophical one of harm reduction.
Presently, harm reduction is simply not acknowledged as a legitimate avenue of medical enquiry, by law. Now, if you believe it should be (as I do, strongly) - what should your course of action be? Or more to the point, what
is your course of action?
The only course of action is to have the law changed, of course. And this is the only course of action that will see the e-cigarette lawfully for sale in the US. Unless the FDA chooses not to regulate.
Interestingly, I received an email from our trading standards forwarded by a UK supplier a little while back. They seem perfectly happy for e-cigs to be on the market, so long as the consumer is made aware of what they are buying and don't make any claims for safety/cessation.