E-cigarettes: too soon to judge
E-cigarettes: too soon to judge
18/12/2013
One group of public health experts warned against dogmatically rejecting e-cigarettes.
"Although abstinence-only and strict denormalization strategies may be incompatible with e-cigarette use, the goal of eliminating smoking-related risks is not," Amy L. Fairchild, PhD, MPH, of Columbia University School of Public Health in New York City, and colleagues wrote in a perspective online in the New England Journal of Medicine.
The battery-powered devices vaporize liquid for nicotine delivery that, proponents are quick to note, produces none of the thousands of carcinogenic substances released by burning tobacco. Early evidence from small studies and FDA analysis has suggested the devices aren't entirely harmless, but the potential for use in smoking cessation and reduced lung cancer rates if smokers replace their habit with e-cigarette "vaping" is widely acknowledged.
"The most vocal supporters of e-cigarettes, other than those with commercial interests in them, have been public health professionals who've embraced the strategy of harm reduction -- an approach to risky behavior that prioritizes minimizing damage rather than eliminating the behavior," the authors noted, likening it to needle exchanges.
However, there's another group who feel just as strongly that an opposite approach is the best way to reduce harm, seeking radical "endgame" strategies to snuff out smoking worldwide.
"Most endgame strategists have advanced prohibitionist policies, from complete bans on traditional cigarettes, to regulatory strategies that would reduce and eventually eliminate nicotine, to efforts to manipulate pH levels in tobacco to make inhaling unpleasant," noted.
Many worry that marketing campaigns for e-cigarettes would reverse the hard-fought, decades-long public health campaign to denormalize smoking, Fairchild and colleagues explained.
The stigmatization of smoking has steadily driven down smoking rates, but e-cigarettes in many ways mimic the look and feel of smoking in public, while getting around most indoor smoking bans. Only a few states and some cities have explicitly included e-cigarettes in their smoke-free laws, although New York and Los Angeles appear poised to join that list. Marketing of e-cigarettes has gone well beyond anything Big Tobacco has been allowed to do for 4 decades, with celebrity endorsements and even a Super Bowl ad.
Fairchild's group didn't support either extreme of opinion on e-cigarettes but instead called for speedy FDA regulation and for public health experts to keep an open mind.
"We may not be able to rid the public sphere of 'vaping,' but given the magnitude of tobacco-related deaths -- some 6 million globally every year and 400,000 in the U.S., disproportionately among people at the lower end of the socioeconomic spectrum -- an unwillingness to consider e-cigarette use until all risks or uncertainties are eliminated strays dangerously close to dogmatism," they concluded.
The FDA has regulations in the works that many expect to rein in such advertising, eliminate sales to minors, and otherwise bring e-cigarettes into line with other tobacco-based products. An agency spokesperson told MedPage Today that the proposed rule is already under review by the Office of Management and Budget (OMB), which is the last step before public release for a comment period.
However, the review process can take months at times, so it's still not clear how far into 2014 e-cigarettes will continue entirely unregulated.
The OMB confirmed to MedPage Today that the proposed rule would be the anticipated Tobacco Deeming rule, which would officially deem e-cigarettes as a tobacco product under the FDA's jurisdiction. The agency declined to comment further on the ongoing review, other than noting that the 90-day window usually given for the review can be extended.
Source: MedPage Today: http://www.medpagetoday.com/PrimaryCare/Smoking/43502