1) Smokers should try e-cigarettes.
E-cigarettes deliver heated nicotine vapor with few chemicals, relatively low in danger -- compared to cigarettes. Nicotine e-cigs can substitute for cigarettes. They have been sold since 2009 and are growing in popularity, having many manufacturers, including cigarette companies, and are increasingly attractive to industry analysts. Smokers should try e-cigs to completely replace cigarettes. Given the variety of e-cigs, one should ask around and explore Web forums and videos for advice on brands. The goal is to stop smoking forever and use e-cigs as long as needed.
2) Say "No" to cigarette-type Food and Drug Administration (FDA) regulation, but "Yes" to some regulation.
Existing FDA tobacco regulation is not an emergency response system for lowering risk or use of cigarettes. Moving e-cigs under FDA tobacco rules could favor the cigarette industry. The current "wild west" of e-cigs has led to winners and losers in the marketplace.
Under FDA rules, cigarettes cannot be banned, and no change in the product can be required that would promote contraband markets. Product regulation that is overly cautious could slow e-cigs competition with cigarettes, and protect sales of the deadliest tobacco product.
Perhaps FDA should regulate e-cigs more like dietary supplements. Knowing ingredients in all e-cigs and minimizing toxins would be desirable. Consumer groups should also be encouraged to do testing of e-cigs (battery life, nicotine levels, toxin levels).
3) Death from cigarettes: a public health emergency!
Reducing cigarette use is an urgent, important public health goal: About 2 of 3 smokers die early (about 60 percent for men and women), with more than 10 years of life lost. And quitting smoking dramatically reduces health risks. If smokers stopped smoking by about 40, they gained about nine years of life; if by 30, they gained an additional 10 years of life. Quitting smoking when older also reduces risks greatly. The deadliness of cigarettes and the powerful effects of quitting argue for action.
4) Unfair chances.
In the U.S., despite control efforts, cigarettes are still bought easily by adults and resourceful youth, still undiminished in deadliness, and used mostly by those with other health handicaps -- mental illness, less wealth, and less education. If these smokers, resistant to current anti-tobacco efforts, switched to e-cigs, they would be better off.
5) E-cigs much safer.
E-cigs are much safer than cigarettes. We don't need clinical trials to know that a large rock falling on a person is much more dangerous than a small rock falling on someone. Compared to cigarettes, reduced risks of e-cigs are obvious. The number and level of toxins are much lower in e-cigs. It is easy to be less dangerous than fire-causing, carcinogenic, smoke-generating cigarettes.
Safer does not mean safe. Many popular products are unsafe -- bicycles, alcohol, aspirin, acetaminophen, off-label prescription drugs, and on-label prescription drugs, as examples. Consumers and regulators need information on comparative risks, not just on whether a product is safe or not safe.
6) E-cigs satisfy.
A product that proposes to replace cigarette use in addicted smokers doesn't require controlled trials to demonstrate this. Why? Because not just any substitute will satisfy an addict. Time and sales can establish that it works. An ineffective cigarette substitute could fool an addicted smoker for a few hours or a few days, but not for weeks or a few months. After many months, it will be rare to see a placebo effect satisfying an addicted smoker. Doubtless e-cigs can substitute for cigarettes (but it can take trial and error to find a brand that works for you). Will they work for every smoker? Probably not. Can they work for many smokers? Probably.
E-cigs raise issues of addiction. What should we think of a drug addiction that itself offers relatively little impairment to health, that would not prevent gainful employment or care for loved ones? And that would not produce the ill-effects of intoxication -- as can alcohol? Addiction is for some a brain disease, others a sin, others a failing, others a fact of life that comes to many of us in many forms. Those without an addiction of some sort in their lives (even smartphones) should be casting the first stone.
Premature death and disability from cigarettes justified public efforts to reduce smoking. Personal distaste, disapproval, or disgust of smokers or vapors may spur some, but major harm to health should be the bedrock of public health efforts.
8) Moral and scientific conflicts.
Many public health experts are committed to stamping out all forms of tobacco use, and the concept of "harm reduction" or "reducing risk" can be unacceptable to some as an unnecessary compromise. Because of the tragic, historical problem of "compensatory smoking" with conventional, low-tar cigarettes that only appeared to be safer, the idea of "reduced-risk" cigarettes has been discredited. Still on the market although with changed labels, these cigarettes failed because of increased puffing and blocking ventilation holes on filters with fingers or lips. While some makers of e-cigs are cigarette makers, other e-cig makers are disconnected from the dark history of cigarette selling. Many anti-smoking experts will be disgusted by or contemptuous of any recommendations that encourage the use of a nicotine product, especially one that likely continues the harm of addiction. For some, support for e-cigs is a non-starter because they deliver too much nicotine and are likely addictive. Others hope to insert a solid science-based regulatory process between any new tobacco product and consumers. Some view that having any toxic ingredients at all is unacceptable.
9) It's all relative (risk).
For me, with so many using the death trap of cigarettes, it is the fear of repeated years of sales, unchanged by major risk reduction in cigarettes sold legally in corner shops, that supports encouragement and watchful waiting on e-cigs while further evidence accrues. And, when I imagine what I should do if I had a brother, or a child, or friend who smoked, I would try to get them thinking about e-cigs.
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Follow Lynn T. Kozlowski, Ph.D. on Twitter: www.twitter.com/ltkoz1