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New York Profs see Points of Agreement

Just as California's department of health is pushing the panic button on electronic cigarettes, two New York professors of public health are speaking with the cool voice of reason. Amy Fairchild and Ronald Bayer, both professors at Columbia University's Mailman School of Public Health, have published the article “Smoke and Fire over E-Cigarettes” in America's premiere scientific journal, Science, available by subscription. Eliza Gray and Alexandra Sifferlin have summarized their conclusions in Time Magazine.

The professors acknowledge the uncertainties about e-cigs, and the fierce debate that surrounds them, and argue for a regulatory regime that recognizes their possibilities for benefit as well as the potential dangers. They opine that the stance of “deep precaution... has served as a kind of trump argument, hostile to the notion of trade-offs, seeing in them perilous compromise. Such a posture does not serve either science or policy well.” Overblown fears are hindering research, they think, and a flexible regulatory approach is more likely to benefit public health.

Readers unwilling to pony up for a subscription to Science, but wanting more than Time gives, may want to look at a short piece by the same two authors on the website Cancer Prevention, published by New York's Presbyterian Hospital.

Fairchild and Bayer show that e-cigarettes are more effective than nicotine replacement therapies for smoking-cessation, and contain no higher levels of toxicants than the trace (harmless) levels in those NRTs. They also note that many e-cig users are able to cut down radically on the number of cigarettes smoked, and they see this as a benefit, something staunch opponents are unwilling to countenance, calling out the dreaded “dual use”, and numbering it with cessation failures rather than successes. The authors note that most young vapers are already smokers, and that the move from smoking to vaping is a youth trend.

The authors note that there are substantial points of agreement between proponents and detractors of e-cigs, an amazing novelty in this often vitriolic controversy. First, they say, both want regulation for uniform quality. Second, both sides agree that e-cigarettes are less harmful than smoking at the individual level. “The main concern [of opponents] is how e-cigarettes might shape tobacco use patterns at the population level.”

The authors note the concern of e-cig detractors about dual use and the possibility of a gateway to smoking for youth. Most important, they note, is the detractors' fear that e-cigs will “renormalize smoking”. “The fear is that e-cigarettes will allow for reentry of the tobacco cigarette into public view... [and] unravel the gains created by smoke-free... environments.

Fairchild and Bayer call for careful epidemiological study to determine whether the gains will counteract the potential harms. “For policy makers the challenge is how to act in the face of uncertainty,” they say. Certainly the calm voice of reason trilling down the Hudson seems a preferable alternative to the shrill voices of fear blasting from the Bay.