Big Government, Public Health, and E-Cigarettes, Part I

Jul 03 2017
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Since the US Surgeon General’s report on smoking and health in 1964, governments (local, state, federal) and tobacco control groups have waged a comprehensive campaign to encourage smokers to quit and discourage non-smokers from starting. They have used every tool available with cost being of little concern.

They’ve educated about the harms associated with smoking. When that didn’t do the trick, they attempted to shock and scare smokers away from the habit with graphic images. They’re in a half-century cycle to fight for increased taxes. They’ve banned smoking anywhere people congregate. They’ve filed individual lawsuits, class action lawsuits, and lawsuits from state attorneys general (resulting in the tobacco master settlement agreement that forced tobacco companies to pay billions to the states, all costs passed on to consumers via increased prices).

They’ve restricted the ability of companies to sell and market products, restricted use of brand-name advertising and eventually they decided scaring children might discourage them from becoming smokers. They also thought sending terrified kids home to shame their smoking parents could only benefit their cause.

Years ago, they decided that their noble ends justified any means and they deliberately misrepresented the health risks associated with smokeless tobacco, just as they are doing with e-cigarettes now.

Finally, after 45 years, Congress passed and President Obama signed the Family Smoking Prevention and Tobacco Control Act of 2009, which created FDA regulation of tobacco products. The Tobacco Control Act effectively allowed all current tobacco products to continue to be sold and made it nearly impossible to introduce new products to market, even if the products were safer and might save smokers’ lives and reduce the toll of lung cancer, COPD, heart disease, and stroke rightly attributed to smoking.

About three years before the FDA started regulating tobacco, e-cigarettes started to trickle into the US market. The products were invented by a smoker. Hon Lik was a pharmacist in China who lost his father to lung cancer and struggled to kick the smoking habit himself. Hon Lik recognized what tobacco researcher Michael Russell concluded years earlier and widely understood by scientists – that “people smoke for the nicotine, but die from the tar.”

That’s a critically important point. Surveys of Americans, smokers, tobacco users and even people with a medical background in the US demonstrate that most people do not understand the critical distinction between smoke and nicotine. The CDC, FDA, various Surgeons General, and tobacco control groups like the Campaign for Tobacco Free Kids, the American Cancer Society, and state, county, and city health departments have misled the public and the media and perpetuated ignorance by deliberately conflating harms associated with smoking, tobacco, and nicotine.

Pharmaceutical companies understood it, however. The recognition that people smoke for the nicotine but die from the tar provided the foundation for the development of nicotine replacement therapies like gums and patches. If nicotine itself is largely innocuous, but if delivered via a combustible cigarette causes death and disease, why not give smokers the nicotine they desire without the toxic smoke? It’s a simple and brilliant concept.

The pharmaceutical companies developed medical products designed to help smokers quit. They invested heavily, sought and received government approval and began marketing gums and eventually patches and inhalers designed for smoking cessation. While the products worked for some, they fail over 93 percent of the time. Despite the high failure rate, the products are still highly profitable. People come back to them again and again. And getting government to mandate smoking cessation coverage or include such coverage for government employees across the country, taxpayers ultimately dump cash into the pockets of giant companies for repeated purchases of products that don’t work very well.

Nicotine gums and patches provide nicotine, but it’s not absorbed as effectively as it is when inhaled from a burning cigarette (or as effectively from much safer smokeless tobacco). And we’ve learned (mostly from the introduction of e-cigarettes) that while smokers do seek nicotine, there is more to smoking than simply delivering a plant-derived chemical. Anyone who has been a smoker understands that it’s not just the cigarette delivering nicotine that becomes part of the habit, but also the ritual of smoking. Smokers pack their tobacco, they use lighters and matches, they physically engage their hands and mouths in a daily smoking ritual for years. It’s not only inefficient delivery of nicotine, but also because of the failure to address the physical habit of smoking that gums and patches fail so often.

And then, along comes the electronic cigarette. E-cigarettes or vapor products are not medicines or medical devices designed to treat a medical condition. They are alternative products that surveys demonstrate are used almost exclusively by smokers or former smokers. Tobacco control groups fail to acknowledge that smoking provides pleasure and enjoyment for those who do it. Through different devices, liquids, and flavors, vapers can come close to replicating and even exceed the pleasure they got from smoking. If getting smokers to quit is your true mission, that’s a fabulous thing. It’s also contradicts the narrative of anti-tobacco zealots that seem to have a real problem with people enjoying smoking or those who quit because they enjoy vaping even more.

It’s a fundamental distinction that their ideology obscures for them. Gums and patches are just tolerable enough to treat what they see as a medical condition, like a medicine. Vapor products aren’t medicines. They work, often gratuitously, to help smokers quit because people enjoy them, make them a hobby, and develop social networks around them. Vapers are connected online, they travel the country to get together at conventions, meet ups, and “cloud competitions” where they show off their vaping skills. They create and are connected through YouTube channels, online radio shows, podcasts, and Facebook groups.

Smoking can be a very social behavior, especially since tobacco control groups sent CEOs and janitors outside together to smoke in the alley next to the garbage dumpster. No one socializes around gums and patches, but the socialization around vaping contributes significantly to its appeal and its ability to transition smokers away from combustible cigarettes. It works because it’s fun and it responds to the human need to interact with others. No smoker (or vaper) wants to interact with tobacco control nuts who disrespect them and want to use government force to impose their standards upon others.