Clearing the air on e-cigarettes

Lynn Kozlowski: If you target messages to smokers, I think it’s a no-brainer. Cigarettes shorten your life significantly, and quitting makes a big difference in how much your life is shortened. It’s in the context of how dangerous cigarettes are that it becomes easy for me to say, “Smokers, if you can use [e-cigarettes] as a tool to quit, do it. Start today.”

Gary Giovino: I have a nephew who smoked and he switched to e-cigarettes, and people would say to him, “Are you kidding yourself? These things are no better.” I just find that ridiculous. There are a small number of chemicals at very low concentrations in e-cigs compared to the hundreds of toxic and carcinogenic chemicals concentrated in tobacco smoke.

LK: For somebody to say e-cigarettes are just as bad is a very harm-causing statement. The evidence base for that is nonexistent. Can you find things that would be of concern in them? Yes. Do they approach cigarettes in risk? Not even close.

GG: People oppose them partly because of the way they’re marketed and partly because the big tobacco companies are getting involved in the business. In some ways, the marketing is similar to how they used to market tobacco cigarettes decades ago. That is offputting to a lot of people, myself included. If I had my way, they would be marketed as a way for smokers to get off the extremely dangerous products—combusted cigarettes and cigars. The companies that are making e-cigarettes are not making it easy for people who really care about health to be supporters of them.

LK: There’s a conflict in that one of the reasons the products have been so successful is that they haven’t been marketed as a smoking-cessation device. They’re a fun thing to do. If you market it as a product that’s fun to use, you’re likely to get more penetration in the market, but you’re also likely to attract some new users to the product rather than, “OK, you can only use this if you smoke cigarettes and we want you to quit.”

GG: The youth issue is a bit of a game-changer for me. Part of the logic of people who oppose e-cigarettes is that if kids are using these products, then they must be bad. I don’t have a problem if a kid who was going to smoke tobacco cigarettes instead uses an e-cigarette. I do have a problem if a kid who never would have started on tobacco cigarettes starts with e-cigarettes and then converts to smoking tobacco. That’s the scenario that scares me. Another issue is flavorings. They put a lot of flavorings in e-cigarettes, and we know that younger people prefer flavored tobacco products.

LK: I agree that’s a valid issue, but it doesn’t take away from the bigger point. From a public health point of view, cigarettes are a gigantic challenge. If all cigarette use was converted to a well-regulated vaping product that minimized risk, the government wouldn’t have an office focused on the health issues with these. They’d be more concerned with alcohol, for example—any number of things. In the public health business, you can’t be thinking of living in an imaginary world where there’s no risk. Take the risk of bicycle riding. Helmet wearing reduces it but it only reduces it. There’s still a risk. It’s not safe.

GG: Every prescription drug carries a risk. Nothing is risk-free.

LK: I’ve had colleagues in public health who would not make a public professional statement that you should switch to [e-cigarettes] because they would be better for you, but they would tell their loved ones to. I wrote a piece in the Huffington Post out of the conviction that smokers needed to know about e-cigarettes ASAP, and that to sit on what was, in a sense, clearly known would have been irresponsible. Based on the evidence I’ve seen, it would probably be desirable to have some restrictions on flavorings, but that doesn’t make me want to say I’m going to withdraw my Huffington Post position until we get this flavor matter sorted out.

GG: Stay tuned. We’re working on papers and the reality is, you’ve got to get them out fast, because as these products bloom, the research on them is also exploding. There’s a ton of work being done on this right now. Hopefully, the research will help the government to get it right.