Leading tobacco control experts say that when it comes to regulating vaporized nicotine products (e.g. e-cigarettes) the public needs a trusted guide, and that should be the U.S. Food and Drug Administration. For that reason, they are calling on the FDA to stop predetermining that vapor nicotine products might act as a gateway to cigarette use, and instead look at the evidence to-date about their harm reduction benefits.
"We believe that the discussion to date has been slanted against e-cigarettes, which is unfortunate, because the big picture tells us that these products appear to be used mostly by people who already are or who are likely to become cigarette smokers," says David T. Levy, PhD, a professor in the department of oncology at the Georgetown Lombardi Comprehensive Cancer Center and lead author of a new paper in Addiction.
Though smoking remains a leading cause of premature mortality, cigarette use has plummeted domestically since the 1960s. It remains high in many other countries but in the United States under 20 percent of people smoke today. Up to 70 percent of smokers want to quit, at least according to surveys, and for that reason neutral public health officials opt for anything that works in helping them, including gums, patches and, more recently, e-cigarettes.
But because e-cigarettes are inhaled nicotine rather than through a patch or gum, some anti-tobacco proponents believe they may act as a gateway to smoking -- they contend the similar motions (and even ritual) that makes it easier for smokers to migrate from cigarettes by using e-cigarettes might instead encourage young people to start. The synthesis of the research published in Addiction does not show that, instead the number of "nicotine naive" people (who never smoked but took up e-cigarettes and got addicted) is so tiny as to be chance.
Yet there is a culture war that has migrated from ending smoking to ending tobacco companies, and that has caused a schism in the public health community. People who simply care about health believe that nicotine, in and of itself, is no different than any other thing the public might do (drink Red Bull, race motorcycles) that has some risk of harm. It is the carcinogens in smoke that remain killers, not nicotine, they contend, and so going through the motions of smoking, while not smoking, will work as well or better than patches or gums, which only replace the nicotine but do not replicate the behavior and therefore will have less success in ending smoking.
The statistics bear out what tobacco control experts contend. In the U.S., Canada and England, cigarette smoking rates have fallen more in the last two years than they have in the previous five, which coincides with the increase in e-cigarette use in those countries. Thus, while an e-cigarette might be a gateway to cigarette smoking in some, it seems to most certainly be a gateway off of them for a lot more. Critics are using a hypothetical problem to block a real benefit, experts say, and they don't want the FDA to do the same.
"We don't want to encourage e-cigarette use by youth and young adults who would not have otherwise smoked. However, the primary aim of tobacco control policy should be to discourage cigarette use while providing the means for smokers to more easily quit smoking, even if that means switching for some time to e-cigarettes rather than quitting all nicotine use," the authors write in their article.