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NY Health Gurus: “Hands Off E-Cigs!”

In the New York Times recently, public health advocates Amy Fairchild and James Cosgrove voiced reluctant support for a moderate regulatory approach to electronic cigarettes, in an op-ed article entitled "The Case for Tolerating E-CigarettesTheir rationale for doing so is prudently thought out, and could form a platform for sensible harm reduction, as an alternative to the sweeping bans being considered by city councils in New York and Chicago.

Fairchild and Cosgrove, both of whom hold professorial appointments at the Mailman School of Public Health at New York's prestigious Columbia University, acknowledge that research has begun to show the effectiveness of e-cigarettes as a smoking cessation tool, presumably referring to studies like those done by Konstantinos Farsalinos of the Onassis Institute in Athens. Although they call such evidence "still thin," the fact that they acknowledge its existence represents a step forward, beyond the pronouncements coming from the more strident smoking ban advocates, who continue to insist that there is no such evidence at all. Fairchild and Cosgrove also give an anonymous nod to the recent New Zealand study showing marginal but consistent superiority to the nicotine patch, when they state that "e-cigarettes may be better at helping to sustain smoking cessation than pharmaceutical products". They also seem to agree with the study of Igor Burstyn at Drexel University in Philadelphia, which showed no significant toxicity in e-cigs, when they argue that the product is "undoubtedly less hazardous".

The medical experts concede with obvious displeasure that much of the e-cigarette industry is now dominated by Big Tobacco, but they manage to suppress their disgust in view of the fact that harm reduction will save more lives than sanctimonious prohibition. They mention the fact that some e-cigarette manufacturers do not have ties to Big Tobacco, and it seems to this reader that they harbor a wistful longing to give the go-ahead to the segment of the industry with clean hands. However, effecting that kind of distinction would prove complicated, of course.

They describe earlier government efforts to further “research aimed at creating a less hazardous cigarette,” and even note that the American Cancer Society once supported “frank scientific discussion about the possibilities of developing cigarettes that will be less harmful and still satisfying to smokers.” But later revelations of unscrupulous behavior by Big Tobacco upped the ante, tipping the balance in favor of prohibition over harm reduction.

In passing, Fairchild and Cosgrove mention the harm reduction strategies used in the battle to control AIDS, in particular, the distribution of clean needles to addicts. Predictions that greater drug use would follow were simply not born out, they observe. They note that smoking alternatives like snus and smokeless tobacco carry more risks than those clean needles did, since they can cause oral cancer, and that e-cigarettes are freer of risk, since nicotine is toxic only at very high levels.

The mistake, say Fairchild and Cosgrove, was not to seek a safer cigarette, but to do so with a dishonest partner. Big Tobacco cannot be trusted to seek harm reduction, but the public can. "Banning vaping in public won’t help," they say.

They advocate the regulation of the product under the rubric: “sold or distributed for use to reduce harm or the risk of tobacco-related disease.”

This idea just might fly, especially with such distinguished proponents, who have proceeded with greater circumspection than smoking-ban zealots have displayed. In any case, keeping e-cigs out of sight, say Fairchild and Cosgrove, would be "counterproductive". We concur.