HEALTH CARE/Joan Retsinas

E-Cigarettes: Health vs. Business

How nifty! Cooler than an iPod. You stick a slim battery-operated gizmo into your mouth and breathe. You get a nicotine high — but you emit no smoke, no ash, no odor. Therefore, you can ignore all those no-smoking prohibitions. With e-cigarettes, you are breathing nicotine-infused vapor, not smoking. NJoy, Green Smoke. Luciano. Even their names are cool.

The entrepreneurial genius behind these e-cigarettes is as astounding as the technology. People like to smoke. People who have quit will generally concede that they can still taste the cigarette, can still feel the sometimes-urge to drop that lollipop or chewing gum for a few puffs of their old friend. Public health graybeards blame the addictive power of tobacco. They are right: it is addictive. But the addiction is eminently satisfying. If it weren’t for the health ramifications, many more Americans would light up.

If e-cigarettes can detour around the no-smoking strictures, this industry will have carved out a profitable niche. Imagine: e-cigarettes on planes, in offices, in restaurants. No need for ashtrays or fans. No more smokers clustering on sidewalks. No fear that a smoldering cigarette will ignite a sofa — e-cigarettes don’t burn. They may become a badge of sophistication (much as cigarettes — the old-fashioned kind — were in the 1950s, when John Wayne lit up). The websites show young hip e-smokers.

Developed in Beijing in 2003, e-cigarettes entered the European market in 2006. By 2009 they were making inroads into the United States.

Until the Food and Drug Administration stepped in. The FDA evaluated a few samples, and discovered a trace chemical found in anti-freeze. More crucially, the FDA saw no large-scale controlled studies of safety. The FDA had questions: how much nicotine is in the vapor? How carcinogenic are these cigarettes? What is the impact on a smoker’s heart and lungs? Industry honchos proclaimed the safety of their product, but people poised to make millions are not unbiased.

The FDA has the authority to evaluate drugs or devices. It considered the gizmos “devices” for delivering nicotine, much like patches and gums. So the FDA decided to subject this new high-tech end-run around all those no-smoking strictures to the same scrutiny it would give any other “device.” This summer the FDA issued a warning about their use, and tried to ban their import.

The industry rose up. An Electronic Cigarette Association (for every product, a lobbying arm) argued against the FDA’s interference. They claimed that e-cigarettes were simply another — safer, cheaper, more ecologically sound — version of a cigarette. The patches and gums proclaimed a therapeutic intent: they are supposed to help smokers wean themselves from the habit. E-cigarettes let smokers embrace their habit.

And the FDA does not have the authority to ban tobacco. Although the government can limit where cigarettes are sold, to whom, and the extent of advertising, particularly to young people, the FDA cannot bar their sale. The government can insist that packages of cigarettes describe the dangers of smoking, but consumers are free to make their own choices.

The industry took the FDA to court, arguing that it didn’t have the authority to regulate e-cigarettes — that the FDA had to leave this product alone, letting it flourish, unencumbered by all those pesky public health considerations that would stifle an embryonic industry.

This January the court ruled with the industry. Scientists have amassed no long-term data on the impact of these gizmos; yet the court gave manufacturers a green light to enter the US market. Instantly the industry flooded the Internet with a mass-marketing blitz aimed at young hip smokers, and would-be smokers.

In February the FDA appealed. The appeals court stayed the ruling. For the present, pending more legal tussles, the FDA can regulate e-cigarettes.

For the sake of the public’s health, let’s hope that the FDA prevails. The scientific questions are valid. Let the FDA seek answers before a generation of Americans is hooked.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, March 15, 2010

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