Anti-Tobacco Experts Spar Over E-Cigarettes

Err on the safe side.

That’s what one of the main arguments against e-cigarettes boils down to.

“When in doubt, why put your hand over the fire?” said Joseph Califano, former Secretary of Health, Education and Welfare under President Jimmy Carter, and founder of The Center on Addiction and Substance Abuse at Columbia University. “We don’t’ know the answers to all the questions about e-cigarettes -- whether it’s cancer, whether it’s emphysema, whether it’s chronic bronchitis, whether it’s heart disease or heart ailments. We don’t know the extent of the relationship. Why take that chance?”

Califano supports a proposed ban on e-cigarettes in a wide range of public places, indoors and out. The final public health law proposed by Mayor Michael Bloomberg’s administration has echoes of one of the first: a bill being voted on Thursday in City Council would add e-cigarettes to the city’s landmark Smoke Free Air Act from 2002.

But despite the support of many in the public health community, other experts say the evidence of harm from e-cigarettes is nowhere near as clear-cut as it is regarding tobacco, and restricting the nicotine vapor would limit the ability of smokers to access a powerful tool that can help them quit.

“It’s reducing tobacco consumption, even among smokers who are using them who have no intention of quitting,” said Amy Fairchild, Professor of Sociomedical Sciences at Columbia University’s Mailman School of Public Health and its Center for the History & Ethics of Public Health. “So far, the few studies that are out are indicating it is probably as effective, perhaps more effective, than the nicotine patch and gum."

Fairchild disagrees with her Columbia colleague, Califano, about the play-it-safe strategy ethicists call “the precautionary principle” when it comes to e-cigarettes. She says by all means, do more research and gather more evidence, but so far the apparent benefits of vaping trump the known risks of smoking.

“If we weren’t talking about a current epidemic, and this were just a new product on the market, I would say, ‘Absolutely, err on the side of precaution, show us it’s safe, before you let it onto the market,’” she said. “I don’t think anyone would argue it’s completely risk-free. But almost everybody would argue that it is far less hazardous than cigarettes.”

When Talia Eisenberg lived in Boulder, Colorado, she found all her peers veritably glowing with good health, and she got into running and rock-climbing and yoga.

But she couldn’t quit smoking, even with help from nicotine patches and gum and other techniques. And then she found e-cigarettes.

“I took myself from a high level of nicotine, down through steps every week to a lower level of nicotine, and that worked for me,” Eisenberg said. “I did smoke, probably for a few months, but I smoked way less than I would’ve normally, as I used the e-cig, and then finally I didn’t really desire the cigarette any more.”

She was so impressed, that she started her own company, manufacturing disposable e-cigarettes and the liquid that goes into reusable models. A few months ago, she opened a store and café in SoHo, where people can get dozens of different flavors of e-cigs, as well as coffee, tea and baked goods.

She concedes e-cigarettes basically replace one addiction with another, but she says until she sees medical evidence to the contrary, she and her customers are much better off puffing steamed nicotine than burning tobacco.

“I don’t want anybody to come into my shop or buy our products and get addicted to nicotine who’s not already addicted to nicotine,” she said. “I don’t think that’s wise, just to pick up a new addiction. But nicotine is similar to caffeine. It is addictive and yet not harmful.”

But “not harmful” could be in the eye of the beholder, given the limited and conflicting evidence. For Califano and the city Health Department, one of the risks from e-cigarettes is cultural: smoking was once widespread and respectable, and over the past half-century it’s been marginalized. Health Commissioner Dr. Thomas Farley, in testimony to the City Council Health Committee, said that advertising is now glamorizing “vaping” the way it once did smoking, and that cultural phenomenon could entice children to try both.

“Allowing the use of electronic cigarettes in places where smoking is prohibited could accentuate this problem, making the act of smoking conventional cigarettes socially acceptable again and undermining the enormous progress in tobacco control over the past few decades,” Farley said.

But this, too, is a risk worth taking, Fairchild says. Research some day could back Farley up, but it’s currently more ambiguous – and seems to suggest vaping e-cigarettes is leading more people to quit smoking than to start.

“If, in the future, the evidence points in the direction that the anti-tobacco folks are worried that it’s going to point in, I would say, that’s the moment where you need to reconsider and say, ‘This is not a harm-reduction effort. It’s a harm increasing effort,’” she said. “But if the evidence continues to point in the direction that it’s pointing now, I’d say you have a number of years in which you can save lives by allowing easier access to e-cigarettes.”

Banning e-cigarettes from bars, restaurants and nightclubs will not make them go away. People would still be able to smoke them in non-public places – and in places like Talia Eisenberg’s SoHo “Vaporium.” Eisenberg says it could even be good for business.

And while similar measures have either been taken or are being considered by various cities and states, many are waiting for the U.S. Food and Drug Administration to release long-promised guidelines on e-cigarettes. Federal regulations might well have something to say about how and where e-cigarettes can be purchased and used.