Let’s not panic about e-cigarettes

If e-cigarettes substitute for smoking, the health benefits might be huge. Let’s not regulate them to death.

The FDA, the CDC, and five Senate Democrats, cheered on by anti-tobacco advocacy groups, are viewing-with-alarm new statistics about the use of e-cigarettes. It may turn out that concern is warranted, but for now I’d advise everyone involved to exhale slowly and calm down. Based on what’s now known, it looks to me as if over-regulation poses a bigger risk to public health than under-regulation.

The market for e-cigarettes – devices that deliver nicotine vapor without the cloud of particulates, polycyclic aromatic hydrocarbons, ammonia, and hot gasses that a cigarette provides, and without the smell – is growing rapidly, among adolescents as well as adults. Many adults are switching from cigarette smoking to e-cigarette use, while many adolescents seem to be heading directly to e-cigs or using both forms at once.

Of course, you’d expect the availability of a new form of nicotine delivery with attractive features to increase total nicotine use. But the the risks of nicotine are a tiny fraction – almost certainly less than 10%, arguably even lower than that – of the total health risks of smoking. If e-cigarettes substitute for smoking, the health benefits are likely to be very large. Even if they substitute for not smoking or for quitting, the damage is likely to be limited.

And yes, some e-cigarettes may be improperly manufactured and contain some of the same noxious chemicals contained in regular cigarettes, though even then at orders-of-magnitude lower doses. And it’s possible that it will turn out that chronic inhalation of one or more of the liquids now used as vehicles will turn out to cause currently-unsuspected health damage. In principle, you couldn’t know that the devices are safe without exposing large numbers of people to them and waiting 50 years.

The FDA’s desire to have enough authority to require e-cigarette sellers to manufacture them properly and label them accurately, to limit marketing aimed at minors, and to be able to force the removal of unsafe product from the market, seems quite reasonable. What’s not reasonable, and what is likely to be bad, on balance, for health, is the idea that anything that delivers nicotine vapor should have the same rules applied to it as an actual cigarette.

For example: one of the current goals of the anti-smoking movement is to ban menthol cigarettes; all other flavors are already banned. But there wasn’t ever much of a market for vanilla or cherry-flavored cigarettes, or even for clove-flavored cigarettes. Menthol, by contrast, accounts for something like a third of all cigarettes sold, and a much higher proportion than that among African-Americans. Many menthol smokers, according to surveys, say they’d rather quit smoking altogether than switch to regular. That, of course, would be good news on the health front. But the bad news is that menthol smokers who don’t want to switch and find they can’t quit will instead swell the customer base of the already-flourishing markets for illicit (untaxed) tobacco products. As Peter Reuter has pointed out, banned drugs lead to nasty black markets, and there’s no reason to think that banned cigarettes won’t do the same.

Maybe that price – in the form of criminal revenue, enforcement expenditure, arrest, incarceration, and illicit-market violence and corruption – is worth paying for the health benefits of reduced smoking. (Recall that a 5% shrinkage in cigarette use would, in the long run, mean 20,000 fewer tobacco-related deaths per year.) But you’d much rather have the benefit without paying the price. If displaced menthol smokers have menthol e-cigarettes available as a substitute, their interest in illicit menthol-flavored normal cigarettes would be that much less.

And that’s why I’m nervous about the possibility that the FDA, in a rulemaking expected soon, will “deem” that e-cigarettes are cigarettes for regulatory purposes, which would mean that a ban on menthol smokes would include a ban on menthol e-cigs.

None of this is simple or straightforward. I can imagine myself, five years from now, bitterly regretting not having spotted the e-cigarette menace before it got out of control. But regulations can do harm as well as good, and what I’m not hearing right now is much willingness to think carefully and proceed with caution. The principle of aggregate harm minimization, net of benefits (and nicotine does have benefits, including at least a temporary cognitive boost) still seems to me the right approach, for nicotine no less than for cannabis or cocaine. Unless and until someone can point to demonstrated and serious risks, rather than speculative ones, e-cigarettes ought to be thought of mostly as a part of the solution rather than as a part of the problem.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: Markarkleiman-at-gmail.com

26 thoughts on “Let’s not panic about e-cigarettes”

  1. Tobacco companies are now embracing electronic cigarettes to help offset the loss of traditional cigarette smokers – even as the U.S. Food and Drug Administration prepares to put forth regulations that could put the skids on the nascent e-cigarette industry. The nation’s largest tobacco company, Marlboro-maker Altria Group Inc., announced plans for the release of its electronic cigarette, the “MarkTen,” at an investor meeting today. The company’s Nu Mark branch will be introduced first in Indiana in August; consumers will have the option of disposable or rechargeable models, and classic or menthol flavors; the experience, executives said, “closely resembles the draw of a cigarette.”

    http://www.cbsnews.com/8301-201_162-57588583/tobacco-companies-bet-on-electronic-cigarettes/

    1. What else is new? Of course the tobacco companies are moving into what is likely to be a growing market segment. But will they be able to bring their brand equity with them? Not clear. Remember when IBM decided to get into personal computers?

      The question I’d like to focus on is whether restricting the growth of e-cigarettes would, on balance, save lives or cost lives. Doesn’t that seem like the key issue?

      1. I’m not sure how it could NOT save lives. Almost the entire long term health effect from smoking comes from components of the smoke other than nicotine. You could likely have everybody in the country using E-cigarettes, and if it resulted in nobody using actual tobacco, the health effects would be positive.

        I’m having a hard time here seeing the attack on E-cigarettes as anything more than proof that a lot of the animus against smoking was indeed anti-hedonistic, all along.

        1. I’m seeing it as evidence not so much of anti-hedonism but more of people not really having any idea what issues are involved in the question.

      2. Mark I didn’t post that as evidence that e-cigarettes are made more evil by association.
        It was just information. It answered some questions I had: Are cigarette companies worried? Are they advocating for or against e-cigarettes?

        No one knows what is going to happen and this seems am admirably wise hedge:

        I can imagine myself, five years from now, bitterly regretting not having spotted the e-cigarette menace before it got out of control.

        My own sense of things to come:

        Cigarette companies will market e-cigarettes wisely: cognitive boost, positive health effects, saving lives.
        I see hybrid products that melt the genres: Drug delivery thru your e-cig device.
        I see “Generation naught” waving colored wands; the return of cigarette gestures and parlor cigarette magic.
        And I see this: an e-cig/air-pen device that not only spell-checks, but warns you when your nico is getting low and you are approaching 140 chars.

        So I think this is going to be big: the blending of pharm, electronics, and nico addiction.
        For various reasons I’ve always wanted to buy cigarette company stock…
        Now may be the time.

          1. Freedom is a difficult concept in the context of consequentialist theories of ethics, too, but that doesn’t count against freedom, but against the theories. We’re not talking Thionite here, but substances people actually do quit using.

          2. The problem is that door swings both ways. Many things are addictive. Sex addiction could justify all sorts of Victorian style restrictions on sex. Sugar addiction could justify all sorts of limitations on what we eat and drink. Gambling addiction is so pervasive that it could probably justify a flat ban.

            In other words, unless you want the government controlling all of our choices, you have to at least indulge the fiction that people are making free choices and take a harm reduction approach towards addicts. Otherwise, you end up punishing all the non-addicts and taking away THEIR freedom to enjoy themselves.

            Further, even addicts may be enjoying themselves. A gambling addict might be engaging in destructive behavior, but might also enjoy it. Is the government’s job to deprive people of hedonistic pleasure just because it is addictive?

      3. When IBM got into the personal computer market two things happened:
        1. The market was immediately legitimized: “No one was ever fired for buying IBM” was the saying in the mainframe world. The attitude was carried across onto the desktop market.
        2. A de facto standard was created when IBM developed its system from off-the-shelf components and resisted the urge to go with a proprietary architecture. Prior to IBM legitimizing the market, there was a hodge-podge of architectures: Apple and its 6502, Zilog and Intel and the S-100/8080 CP/M world were the two largest, but they weren’t the only ones. IBM’s architecture wasn’t particularly good but it was good enough.

        It isn’t too much of an exaggeration to say that IBM created the PC market. They didn’t win the marketing war, but they had a lot to do with the battlefield the war was fought on.

        Similarly, by entering the e-cigarette market, Altria and its sisters will legitimize and probably expand the market. I am amazed to be agreeing with Bellmore that I don’t quite see how e-cigarettes can’t save some lives. We know that nicotine is horribly addictive. Despite numerous attempts to quit, my father was only able to quit after a serious heart attack. My wife’s mother was never able to quit. When she died last year of lung cancer, she told me, “It’s my own damned fault.” I didn’t quite get her point, so she explained that she’d never been able to quit smoking.

  2. Okay, who really wrote this post? It clearly can’t be Mark (and I think we can eliminate Humphreys from the list of suspected fraudsters) because he hates anyone who is trying to enjoy themselves and just wants to make things illegal.

  3. The law and our lives would be a lot simpler if there was something in the constitution in the form of “Congress shall make no law protecting citizens from themselves.”

    1. would that still leave the states free to set speed limits, fix blood alcohol limits, or require the use of seat belts?

    2. This is a common Cato Institute-type framing, as if there are just free citizens, the government and nothing else in society. It lets off the hook the multi-national corporations which produced, marketed and sold a deadly product and lied about how deadly it was (And in their spare time, funded places like Cato Institute…hmmm).

      Protecting people from themselves would be the issue if we were losing 400,000 people a year due to home grown tobacco hand rolled by smokers. What anti-tobacco legislation is about is protecting people from corporations.

      p.s. This is a general comment about this sort of argument, not a critique of what Mark said at all.

      1. When I see someone smoking, I think, Kill yourself if you want, but do it with home grown tobacco. You are immoral to support corporations that lied to us, hooked children with Joe Camel, and are now hooking the people of Asia.

      2. I find airlines pretty evil too, but I don’t want the government to try to stop me from flying them.

        The tobacco companies were sued up the wazoo for deceptive marketing, which is fine and proper. But they also efficiently and inexpensively supply a product people like to use. I don’t buy the anti-corporate spin. Big corporations give us what we want. Your problem is you want to control what other people want.

        1. “Big corporations give us what we want.”
          This is true and it isn’t. The billions spent on advertising is pretty good evidence that people can be manipulated into wanting all sorts of things we hadn’t prior to being manipulated. Rational action is a concept we need to use with caution.

          1. Advertising can be – is – extremely effective at getting people to pick flavor A of a thing rather than flavor B. Coke versus Pepsi, or versus Dr Pepper, maybe versus lemonade and juice. The Marcuse type view that it manufactures desires out of whole cloth seems to me like nonsense on the other hand. Not all the marketing in the world will make carrot sticks as appealing as french fried potatoes.

  4. UCLA has banned e-cigs. We are “tobacco free” instead of “smoke free.” I couldn’t make sense of it until I learned there is a marijuana e-cig. If we don’t ban e-cigs, who knows what people will consume in public?

    Just to be clear: I’m against the ban. You can find me hiding with my e-cig in empty stairwells and restroom stalls…

  5. Sensible post.

    Going after e-cigs is basically proof of drug warriors’ bad motives. They think pleasure is suspect. People who like nicotine should be able to enjoy it. The only valid objection to cigarettes is that they caused cancer, not that people like smoking.

  6. Well, I smoked for fifteen years. Have any other posters to this site smoked? Smoking is far less harmful than nonsmokers suppose. You can smoke a pack a day for ten years when you are young, and nothing bad will happen to you. In my early fifties, I could run five miles and smoke all the way. Smoking just doesn’t hurt you that much in the short term, and may I be struck down with lung cancer next Tuesday if I am lying to you. Now then, I know from having smoked about antismokers, who hate smoking in and of itself, and are just using the health risks as an excuse to emiserate smokers. They hate the smell of cigarettes, they hate the indolent, give-a-damn attitude that smokers present, they hate the very way that smoking looks. It’s more than a health thing, it’s an aesthetic thing and a cultural thing So antismokers are going to move to limit the sale of e-cigaretes, because they are designed to deliver most of the pleasures of cigarettes to smokers, and antismokers hate smokers. Antismokers are not, as they pretend to be, concerned with the health of smokers. That’s a moral pose. They want smokers to die in agony, and only wish that cigarettes were more lethal than they are.

  7. This commentary is one of the best yet.

    In sharp contrast to the recent lies by Obama appointed CDC director Tom Frieden (who has long been an intolerant abstinence-only tobacco/nicotine prohibitionist), the rapidly growing mountain of scientific and empirical evidence consistently indicates that e-cigarettes:
    – are 99% (+/-1%) less hazardous than cigarettes,
    – pose no risks to nonusers,
    – are not marketed to youth,
    – have never been known to create nicotine dependence in any nonsmoker (or youth),
    – emit similar levels of constituents as FDA approved nicotine inhalers.
    – are consumed almost exclusively (i.e. 99%) by smokers and former smokers who quit by switching to e-cigs,
    – have helped several million smokers quit and/or sharply reduce cigarette consumption,
    – have replaced/reduced about 750 million packs of cigarettes in past five years in the US,
    – are more effective than nicotine gums, lozenges and patches for smoking cessation and reducing cigarette consumption, and
    – pose fewer risks than FDA approved Chantix or Wellbutrin.

    Had Obama’s FDA successfully banned e-cigarettes in 2009, several million e-cigarette consumers would have smoked an additional 750 million packs of cigarettes, which would have threatened their lives and public health, and would have protected cigarette markets.

    But thankfully for public health, individual freedom, market competition and common sense, all thirteen federal judges who adjudicated litigation filed by two e-cigarette companies (whose products were seized by Customs agents at US ports) agreed that the FDA’s import ban on e-cigarettes was unlawful, and struck it down in 2010.

    In response, on April 25, 2011 the FDA stated its intent to regulate e-cigarettes as tobacco products by imposing the “deeming” regulation and by imposing additional regulations on e-cigarettes (despite the agency’s repeated lies that it only bases its regulatory policies on scientific evidence).

    Meanwhile, the FDA (and the news media) has refused to acknowledge that the “deeming” regulation would ban all e-cigarettes (per Section 905(j) and Section 910 of the Tobacco Control Act), would prohibit e-cigarette companies from truthfully claiming that e-cigs “emit no smoke” (per Section 911), and would otherwise decimate the e-cigarette industry.

    Even if the FDA exempts e-cigarettes from the most absurd and counterproductive provisions in Chapter IX of the FSPTCA, imposing the “deeming” regulation and additional regulations on e-cigarettes would likely ban 99% of e-cigarette companies and products, and basically give the entire fledgling e-cigarette industry (comprised of many small companies) to the existing oligopoly of Big Tobacco and perhaps several of the largest e-cigarette companies.

    The best thing the FDA can do to further protect public health is to propose no regulations, and simply allow the largely free market for e-cigarettes to continue saving smokers from cigarettes. Although the FDA, CDC and other public health agencies have an ethical duty to truthfully inform smokers that e-cigarettes are far less hazardous alternatives, don’t expect that to occur during the Obama administration, as FDA, CDC and other DHHS officials are far more concerned about covering up their many lies about e-cigarettes, smokeless tobacco products, dissolvables, tobacco harm reduction, flavorings, etc.

    More than half of the states have already banned the sale of e-cigarettes to minors, and many more states would have done so had those common sense laws not been opposed by drug industry funded CTFK, ACS, AHA, ALA and other e-cigarette prohibitionist groups that urged FDA to unlawfully ban and seize e-cigarettes in 2009, that have lobbied state and local governments to ban the sale and use of e-cigarettes, that have made many false and misleading fear mongering claims about e-cigarettes, and that have refused to disclose that they’ve been paid off by Big Pharma to promote their products and to oppose competitive (but more effective) smokefree tobacco/nicotine alternatives.

    The old anti smoking coalition has forever split into two irreconcilable factions: those of us whose goal has always been to reduce tobacco attributable morbidity and mortality (99% of which is caused by daily inhalation of tobacco smoke) in a reasonable, respectful and civil manner, and the intolerant abstinence-only activists who now control many/most public health agencies and health organizations and who vehemently oppose smokers quitting smoking by switching to far less hazardous smokefree alternatives.

    Bill Godshall
    Executive Director
    Smokefree Pennsylvania
    1926 Monongahela Avenue
    Pittsburgh, PA 15218
    412-351-5880
    smokefree@compuserve.com

  8. I smoked for about fifteen years before I quit, so I know well the fury of anti-smokers. They claim to be concerned only about the harms to health of smoking, but that ain’t so. They hate the pleasure of smoking itself, and the selfish rudeness of people who smoke around nonsmokers. They particularly hate the smell, and they hate the casual, indolent, give-a-damn look of people smoking. It’s a cultural and aesthetic thing as much as a health thing. In fact, a lot of them probably are angry that smoking isn’t more harmful, and that it takes decades to significantly harm the health of smokers. So these folks are going to hate e-cigarettes too. They don’t want anyone smoking and they don’t want anyone doing anything that mimics smoking either. They’re anti-hedonists more than they are pro-healthers.

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