April 1, 2015
“This issue is not about a perfectionist, absolute, zero tolerance for nicotine addiction. It is about harm reduction-like seat belts, air bags, condoms and vaccinations.”
The Star Tribune, a Minneapolis newspaper, recently published two articles in their Opinion section. The first was written by John McClay, who credits e-cigarettes with freeing him from 55 years of smoking tobacco cigarettes. The second article, written in response to McClay’s, was written by physician Lisa Mattson who states “McClay does not mention whether he has a medical or scientific background, but some of his claims are mistaken, or at least premature.”
The combination of the two articles is an excellent and revealing example of a subject that history may show to be the most controversial public health topic in generations. The following are excerpts, taken for comparison purposes, from both articles.
McClay – “As e-cig use — “vaping” — has increased, smoking prevalence has decreased nationally from 21 percent in 2005 to 17 percent this year, which translates into millions of former smokers.”
Mattson – “Research shows that smoking reductions historically are caused by many combined factors, such as smoking bans and tobacco tax increases, over very long periods of time. To attribute all declines since 2005 to e-cigarettes is a serious overstatement — especially since cessation science has not suggested e-cigs are particularly effective as quit aids.”
- DIYELS – I’m not sure McClay intended to imply that all smoking declines since 2005 can be attributed to e-cigarettes which were only introduced in the U.S. in 2007. Mattson’s point that historical smoking reductions have primarily been the result of smoking bans and tax increases, while factual, fails to acknowledge that options for significantly reducing smoking have been very limited in both number and effectiveness – until now. On the other hand, Mattson’s statement that “cessation science has not suggested e-cigs are particularly effective as quit aids” would be considered by many to be an overstatement. One contrary to an existing and growing body of evidence.
- Michael Siegel, M.D., Professor, Boston University School of Public Health
- University College London
- Konstantinos Farsalinos Study of 19,000 E-Cig Users
McClay – “The vast majority — probably well over 90 percent — of vapers are adult former smokers…”
Mattson – “Most e-cigarette users, contrary to McClay’s claims, are not former smokers, but rather people who are still smoking.”
- DIYELS – Perhaps there is a misunderstanding of the wording here? A number of studies in the U.S. and the U.K. have found that the overwhelming majority of first time e-cigarette users are cigarette smokers. At least one study found that number to be over 95%. The number of first time e-cigarette users who are non-smokers has been shown to be very low – less than 1%. Perhaps Mattson’s statement that most e-cig users are still smoking refers to dual use by e-cig users? Assuming a common sense definition of “most” as more than 50%, research suggests that is an accurate statement.
- E-Cigarette Use Rare in Non-Smokers
- Worldwide Survey of 19,000 E-Cig Users
McClay – “E-cigs are not for everyone, but for me and many others they are an elegant solution. As one who loved to smoke, I can testify that they work better than other nicotine delivery systems precisely because they mimic the smoking experience — holding them, drawing, inhaling, feeling the throat hit and watching the exhaled water vapor, which looks like exhaled smoke.”
Mattson – “McClay may prefer e-cigarettes to cessation medications, but the fact is that medications, when combined with expert counseling, remain the most effective treatment for breaking tobacco addiction successfully.”
- DIYELS – Several studies on the effectiveness of e-cigarettes compared to cessation medications have yielded mixed results. But most of those studies have shown that e-cigarettes are at least as effective, and some have shown they are substantially more effective, than traditional Nicotine Replacement Therapy including cessation medications. The last link below was conducted using second generation e-cigarettes which appear to be especially promising.
- U.K. Study
- Belgium Study
- Study Using 2nd Generation Devices
McClay – “This issue is not about a perfectionistic, absolute, zero tolerance for nicotine addiction. It is about harm reduction — like seat belts, air bags, condoms and vaccinations. It is both fair and accurate to say that vaping is a much less harmful alternative to smoking, even though nothing that we put into our bodies is 100 percent risk-free.”
Mattson – “E-cigarettes do contain fewer carcinogens than conventional ones, but the jury is far from in about their long-term effects. We know the vapor does contain carcinogens, toxic chemicals and particulate matter. It isn’t simply water, and the health effects of breathing it for users like McClay, and for anyone exposed secondhand, won’t be known for many years.
- DIYELS – Long term effects are not known. And will not be known for many years. It literally took decades for the dangers of tobacco cigarettes to be identified and proven. By definition, determining long term effects takes a long time. But it only takes one year for 480,000 Americans to die prematurely from smoking related diseases. The price for perfectionistic, absolute, zero tolerance for harm reduction is very high.
- DIYELS – In other words, public e-cigarette use has been prohibited on the basis of questions that we don’t have answers to. Instead of allowing them on the basis of questions that we do have answers to. Instead of allowing them based on the fact that although carcinogens have been detected in vapor, under any reasonable use scenario they are trace amounts so low that numerous studies have concluded they present very little, if any, risk. Instead of allowing them based on a large and growing body of scientific evidence showing that vaping is at least 95% safer than combustible cigarettes. Some would consider that a perfectionistic, absolute, zero tolerance standard for evaluating any harm reduction option falling short of absolute certainty.
How many of the smoking cessation products currently on the market – rigorously endorsed by pharmaceutical companies, many healthcare providers, and most of the public health community – were required to meet an “absolute certainty” standard prior to FDA approval? Followed by national and international distribution. What possible justification was there for the release of those products if not – harm reduction? On what basis can the considerable and growing body of science supporting e-cigarettes as a safer alternative to tobacco cigarettes, continue to be ignored?
The number of adult smokers in the U.S. is currently estimated at 42 million or 17% of the U.S. population. The Public Health community has successfully reduced the number of adult smokers by well over 50%. That is a remarkable; some would even say miraculous accomplishment. Countless lives have been saved as the result of the efforts of these dedicated individuals. But it took 50 years.
Bonnie Herzog, a securities analyst for Wells Fargo, has estimated that in the absence of unnecessarily restrictive regulation, sales of e-cigarettes could surpass sales of tobacco cigarettes in ten years. Ten years after that, tobacco cigarettes could be obsolete.
It is unrealistic to expect that e-cigarettes will ever be found to be completely “harmless”. Opponents will continue to say that we don’t know the long term risks of e-cigarettes. But many of even the staunchest, most outspoken opponents concede that there is virtually no doubt that e-cigarettes are a safer alternative to tobacco cigarettes. How long can we afford to wait? Are we seriously going to watch hundreds of thousands die in the short term while we debate the absence of long term data? What kind of twisted logic justifies death in the name of public health?
“We didn’t have long term data” isn’t going to mean much to the families of those who die.
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Dave Coggin has a Master’s Degree in business and spent 35 years in corporate America. He is a co-founder and partner in DIYELS. He has spent the last five years actively researching and following the evolution of the e-cigarette industry. He is a strong proponent of e-cigarettes as the most promising option currently known for tobacco harm reduction. He may be contacted directly at email@example.com.
The opinions presented here are exclusively those of the author. Vaper’s Vortex is offered as a service to our customers and followers. Anyone considering e-cigarettes as an alternative to tobacco cigarettes should seek qualified advice from a medical professional.