Delaware lawmakers are now considering H.B.5, a bill that would ban e-cigarette use everywhere smoking is prohibited. Experience as a public health physician has taught me to consider both direct and indirect impacts and to be wary of seemingly obvious consumer protections. On this basis, I believe that this bill would do more harm than good.
More than 40 million Americans smoke cigarettes. Smoking kills an estimated 480,000 Americans each year. Every day an estimated 3,000 teens try cigarettes for the first time. Many of them proceed to lifelong addiction and premature death.
Meanwhile, smokeless tobacco and other non-pharmaceutical nicotine delivery products represent about 20 percent of nicotine consumption in the United States. The numbers of deaths from all of these other products are so small that they are not tracked by the Centers for Disease Control and Prevention or anyone else.
Physicians and public health authorities routinely recommend nicotine gums, patches, lozenges and inhalers for smoking cessation and as a substitute for cigarettes for smokers unable to quit. The nicotine in these products is derived from tobacco and contains traces of other tobacco-related toxins.
They are available on open shelves in fruit and candy flavors. They are sold without age restriction. Despite having so much in common with e-cigarettes, neither physicians nor public health authorities have expressed concern about the potential of these over-the-counter pharmaceuticals to attract teens to nicotine addiction or to harm adults.
We know exactly what is in e-cigarettes. Most contain nicotine, but some do not. The only other ingredients are limited to flavoring, propylene glycol, glycerin, citric acid and water.
Many vapers have successfully quit smoking after failing to quit using the currently recommended pharmaceutical products. E-cigarettes are the only products with proven success in getting smokers unwilling or unable to quit smoking to do so.
Environmental tobacco smoke (ETS, also known as “second-hand smoke”) kills an estimated 40,000 Americans each year because it contains high concentrations of the same toxins that kill smokers. About 85 percent of ETS is the smoke that curls off the end of the cigarette when no one is puffing on it.
E-cigarettes do not contain tobacco. Nothing is burned. Nothing is emitted when they are put aside.
The concentrations of toxins in exhaled e-cigarette vapor are so small that they are not detectable above background levels in most indoor environments. Traces of nicotine are present in exhaled vapor, but these are far too low to cause addiction or harm. Nicotine is also present in eggplant, potatoes and tomatoes, yet, no one has proposed banning these foods because of a threat of nicotine addiction or toxicity.
I fully support measures that could be effective in reducing tobacco-related addiction, illness and death. I oppose H.B.5 because it will provide no substantive protection to non-smokers and will do nothing to reduce nicotine use by teens. Banning e-cigarettes where smoking is prohibited will promote the myth that e-cigarettes might be as hazardous as tobacco cigarettes. By doing so, it will encourage smokers who might otherwise switch to keep on smoking. E-cigarettes can save lives. H.B.5 cannot.
I know this message conflicts with what you are hearing from local public health authorities. Their fear and distrust of “big tobacco,” and decades of conflating smoking with all use of tobacco, have strongly biased them against accepting any use of a non-pharmaceutical nicotine product in a public health initiative.
This fear and distrust has been amplified by national authorities who have taken bits and pieces of survey and scientific studies out of context to claim that e-cigarettes present risks for addiction and illness similar to tobacco cigarettes. It simply is not so.
I would welcome the opportunity to meet with Delaware public health authorities, advocates, legislators and journalists to present the surveys and studies on both sides of this issue. Emphasis would be on risk to bystanders and addiction of teens. Such a presentation would be readily understandable by legislators and journalists and would require no more than an hour of their time.
I therefore urge deferral of any further action on H.B.5 until these surveys and studies have been presented and discussed.
Editor’s note: Dr. Nitzkin, of New Orleans, is past co-chairman of the Tobacco Control Task Force of the American Association of Public Health Physicians; current principal consultant, JLN, MD, Associates, LLC; and current senior fellow for Tobacco Policy, R Street Institute, New Orleans.