States Considering Electronic Cigarette Bans Get Advice from Doctors

State legislatures considering banning electronic cigarettes have now heard the advice of their doctors, namely the Tobacco Control Task Force of the American Association of Public Health Physicians, an organization of physician directors of state and local health departments, who say bans are going too far and that this new product may actually be of great benefit in their fight against cancer and smoking related deaths.

The AAPHP is recognized by the American Medical Association as a medical specialty society and even has formal representation in the AMA House of Delegates. These are just the people one might think politicians should be turning to for recommendations on proposed legislation affecting the public health.

However, prompted by a strong lobbying effort from groups like the American Cancer Society, the Campaign for Tobacco-Free Kids, the American Heart Association and the non smokers rights group Action on Smoking and Health, which critics claim is largely funded by drug companies out to protect their profits, many states like New York, Utah, Illinois and New Jersey have recently introduced legislation that would ban or restrict the sale of E-cigarettes or their use in public spaces.

In a two page statement issued April 02, 2010 outlining their recommendations to state lawmakers, Dr. Joel Nitzkin, chairman of the Tobacco Control Task Force says the AAPHP doesn't agree electronic cigarettes should be banned and "favors a permissive approach to E-cigarettes because the possibility exists to save the lives of four million of the eight million current adult American smokers who will otherwise die of a tobacco-related illness over the next twenty years."

E-Cigarettes are a "More Acceptable" Smoking Alternative with a "Remarkable Public Health Benefit"

"Conventional cigarettes account for about 80% of nicotine consumption in the United States, but more than 98% of the illness and death. This harm is not caused by the nicotine, but by toxic products of combustion." says Dr. Nitzkin who advises that smokers "could cut that risk by 99.9% or better by switching to a nicotine-only delivery product like one of the pharmaceutical products or E-cigarettes."

While the anti smoking lobby claims the only effective way to quit smoking is by using FDA approved smoking cessation products manufactured by the large pharmaceutical companies that donate millions each year to their cause, Nitzkin points out that only about 3% of smokers successfully quit each year and that "the current pharmaceutical products fail 93% of those who try them, even with the best of health education and counseling."

Dr. Nitzkin says e-cigarettes, or personal vaporizers as some users prefer to call them, "may be more acceptable to smokers than currently available pharmaceutical alternatives" and that "smokers can secure almost all the health benefits of quitting if he or she transitions to an E-Cigarette." But, says Dr. Nitzkin "The only feasible way to achieve this remarkable public health benefit will be to inform smokers of the differences in risk posed by different categories of nicotine-delivery products."

But Do We Know the Risks of Electronic Cigarettes?

The FDA and the anti smoking lobby claim there has not been enough research into electronic cigarettes and that the risks are, as yet, unknown. After a small study conducted by the FDA in 2009 of 18 cartridges from two different manufacturers suing the government over the seizing of their products by customs, the FDA and anti smoking groups issued warnings regarding e-cigarettes claiming "tobacco-specific impurities suspected of being harmful to humans -- anabasine, myosmine, and B-nicotyrine -- were detected in a majority of the samples tested."

But the American Association of Public Health Physicians points out to lawmakers that "E-cigarettes deliver the same nicotine found in the pharmaceutical products, with no more contamination by toxic substances than the pharmaceutical products already approved by FDA"

And indeed the FDA and lobbyists chose to leave out the exact quote from their own report which said that "Tobacco specific nitrosamines and tobacco specific impurities were detected in both products at very low levels." levels so low they couldn't quantify them while other impurities were found in the FDA approved Nicotrol inhaler at very quantifiable levels. Namely: Cotinine: .5%, Myosmine: .5%, Nicotyrine: .5% and these same impurities are found in the patch, the gum and many other nicotine replacement therapies that derive flavors or nicotine from tobacco.

Long time anti-smoking researcher Dr. Michael Siegel of the Boston University School of Public Health pointed out in his blog on tobacco control "the rest of the Story" that the levels of these tobacco impurities added up to the following:

Electronic Cigarettes: 8.18 nanograms / gram (ng/g)
Nicotine Patch: 8.00 ng/ patch
Nicotine Gum: 2.00 ng/ piece
Marlboro Cigarette: Eleven thousand one hundred and ninety ng/g

Dr. Nitzkin and the American Association of Public Health Physicians have, as doctors must do each and every day when prescribing drugs and courses of treatment that might have unforseen and possibly dangerous side effects, come to the conclusion that for users of electronic cigarettes, in the words of modern drug commercials, "the benefits outweigh the risks."

What about Public Smoking Bans?

State legislatures, however, are and should be concerned about the effects of second hand smoke on the health of non smokers. After all, this has been the catalyst for the smoking bans in public and work places and even the more recent bans on smoking in private homes and automobiles. Some research suggests second hand smoke can cause cancer or induce heart attacks and lawmakers, confused by the anti smoking lobby's constant references to "second hand vapor", worry that e-cigarettes may pose a similar hazard even though there has been no scientific evidence of this.

So the AAPHP advises legislators that "Propylene glycol and glycerin are used as carriers of the nicotine. These cause the visible vapor. These substances are generally recognized as safe. They are commonly used in theatrical fog machines, asthma inhalers and air fresheners. There is no smoke, and no products of combustion." and surprisingly even goes so far as to say "All this creates a situation in which we can confidently state that the risk to others sharing an indoor environment with one or more vapers (E-cigarette users actively using this product) is almost sure to be much less than 1% the risk posed by environmental tobacco smoke."

But, they also admit "we cannot rule out the possibility that some individuals who may be extremely sensitive to indoor air irritants or to minuscule concentrations of nicotine in indoor air might be adversely affected by E-cigarette (or pharmaceutical nicotine vaporizer) vapor." and recognize that "Some worry that sight of E-cigarettes in non-smoking areas will make smoking restrictions harder to enforce", a situation known as 'modeling.' Nitzkin points out though "It is important to note that, on second glance, E-cigarettes are easy to distinguish from tobacco cigarettes."

So, instead of taking a stand one way or the other, the AAPHP says "We therefore recommend that research be done to address these two issues (possible hazard to a very small number of highly sensitive individuals and modeling). The problem here is that, with end points so difficult to document, such research could cost millions of dollars and take many years to complete. For the reasons noted above, we do not offer a stance in favor of or against banning E-cigarettes in non-smoking areas."

Ban the Sales of Electronic Cigarettes to Minors

There is some common ground between the recommendations of the doctors, retailers, manufacturers and those of the anti smoking lobby though. Everyone agrees with the doctors that "Sales to minors should be prohibited. If someone does not become addicted to nicotine as a minor, it is unlikely that he or she will ever become addicted."

Even the retailers of these devices own lobby group, the Electronic Cigarette Association, demands of it's members that "online vendors must verify to reasonable certainty that their customers are of legal smoking age; and retail vendors must verify that their customers are of legal smoking age by inspecting the customer’s state-issued photo identification."

The Final Recommendations from State Health Officials

So what is the advice those physicians who run our state and local health departments have for lawmakers considering electronic cigarette legislation when you boil it all down?

Ban the sale to minors but allow the sale to adults. "E-cigarettes can and should be marketed as a substitute for conventional cigarettes for smokers unable or unwilling to quit. State legislatures and, hopefully the FDA should see them in this light and regulate their marketing to reflect this purpose." while research continues.

Only time will tell if the state legislatures listen to their doctors or their lobbyists.