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Nicotine without death

Cigarette smoking among high school students dropped to 12.7% in 2013, the lowest ever, but the use of e-cigarettes tripled during those same two years, and stood at 4.5%

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Joe Nocera
I attended Wells Fargo Securities' "2nd Annual E-Cig Conference" last week, and if I had to describe the mood of the speakers it would be a cross between cautious optimism and deep frustration.

"E-cigs," of course, is shorthand for electronic cigarettes. Executives from the still-new industry happily talked about its rapid growth and their expectation that it would continue. Bonnie Herzog, who follows the industry for Wells Fargo, reiterated her belief that in 10 years, e-cigarette users will outnumber smokers.

"The winning product hasn't been invented yet," said Craig Weiss, the chief executive of NJOY, an e-cigarette start-up. What he meant was that while the e-cigarette devices developed so far have helped some people switch from smoking to "vaping," they haven't yet become so good as to "obsolete the cigarette," which is, he says, his company's goal. But that day will come, he is convinced; the industry is innovating like crazy.

Yet, at the same time, most everyone at the conference expressed dismay that e-cigarettes aren't being embraced by the tobacco-control community - even though they are much less harmful than combustible cigarettes, which kill 480,000 Americans each year. Are e-cigarettes completely safe? asked Saul Shiffman, an addiction expert at the University of Pittsburgh. "There is not enough data to say that," he acknowledged. But on a relative basis, electronic cigarettes are far preferable to the old-fashioned kind. After all, e-cigarettes are essentially nicotine delivery devices, and while nicotine is addictive, it is the tobacco in cigarettes that kills.

Another speaker, Clive Bates, a proponent of electronic cigarettes who runs a website called The counterfactual, noted that in 2010, 80 per cent of the public believed that e-cigarettes were safer than regular cigarettes. In 2013, however, that percentage had dropped to 60 per cent. His view was that this was largely because of the anti-e-cigarettes bias displayed by far too many people in the public health community.

A good example of this came a week before the conference. The Centers for Disease Control and Prevention issued the results of its latest National Youth Tobacco Survey. The news was good: cigarette smoking among high school students had dropped to 12.7 per cent in 2013 - the lowest it has ever been. But the use of e-cigarettes had tripled during those same two years, and stood at 4.5 per cent. That was the news that grabbed the headlines. The Campaign for Tobacco-Free Kids issued a press release urgently calling for e-cigarettes to be regulated.

When I spoke to Michael Siegel, a professor at the Boston University School of Public Health, about the CDC's results, he said they should be comforting for tobacco control advocates: they showed that e-cigarettes are not the "gateway" to cigarettes that many in the public health community feared.

Still, the public health community is not united in opposition to electronic cigarettes. Slowly but surely, some tobacco control proponents are coming to view e-cigarettes as a way to help smokers quit. One such person is Kenneth Warner, a University of Michigan economist who has been an important tobacco-control voice for many years. In mid-November, a long article he co-authored with Harold A Pollack, of the University of Chicago, entitled The Nicotine Fix, was published on The Atlantic's website.

Warner and Pollack divide the modern tobacco-control community into three groups. First are the Traditionalists, who believe that the way to reduce smoking is to keep doing what they've been doing all along: running public service campaigns, putting warnings on cigarette packs, continuing to push for smoke-free workplace laws, and so on. The Traditionalists mistrust any claims of reduced harm because the tobacco industry has made those claims before - with light cigarettes, for instance - and they turned out to be a marketing fiction.

The second group is the Harm Reductionists, who believe, as they put it, that "instead of eliminating a given risky behaviour, proponents of this idea seek to reduce the dangers involved - often by substituting a closely related, less dangerous behaviour." To this group, moving smokers to e-cigarettes is like moving heroin addicts to methadone.

The third group is the End-gamers, who want "variations on prohibition" - for instance, prohibiting anyone born after a certain year to possess tobacco products, or reducing the amount of nicotine in cigarettes until they are no longer addictive.

Warner and Pollack believe that using tactics from all three groups might give us the best chance to end smoking once and for all. Yes, continue the marketing campaigns that have helped reduce smoking, but, at the same time, allow advertising that promotes e-cigarettes as a viable alternative. The Food and Drug Administration could allow makers of e-cigarettes to market their products as "significantly less dangerous than smoking cigarettes." Finally, they advocate reducing the nicotine levels in cigarettes until they no longer addict.

Reading Warner and Pollack's article made me, well, cautiously optimistic.
©2014 The New York Times News Service
 

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First Published: Nov 29 2014 | 9:49 PM IST

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