– Adam Sullivan, 8/2/19

Last week, members of Congress held a hearing about one of the greatest misinformation campaigns in contemporary politics.

No, I’m not referring to former Special Counsel Robert Mueller’s testimony to the House Judiciary Committee about Russian election interference, although that certainly was important as well.

You probably didn’t hear much about another meeting that took place on the same day as the widely covered Mueller spectacle. Democrats on the U.S. House Oversight Committee led a hearing examining e-cigarettes and the “youth nicotine epidemic.”

“We don’t need more studies. We already know the truth here.” – U.S. Rep. Rashida Tlaib, D-Mich.

Unfortunately, the event was dominated by gross misinterpretations of the facts and plainly anti-scientific rhetoric.

Vaping is an important public policy topic here in Iowa, where some policymakers have proposed restricting access to vapor products in response to the popularity of Juul brand e-cigarettes. Last year, Iowa lawmakers introduced bills that would increase taxes on e-cigarettes, and increase the age to purchase all nicotine products from 18 to 21.

Those bills did not pass, but restrictionists vow to try again next year, and the federal government is in the process of imposing new rules on e-cigarette sellers.

Many of the claims made by anti-vaping advocates cannot be traced back to scientific research, and many that can have been distorted or overstated.

The main points of the arguments presented at the Capitol last week are that e-cigarettes are just as harmful as combustible tobacco, and that e-cigarettes have no value as smoking cessation tools. Neither claim appears to be true.

“I’m not going to sit here and allow this committee to be used by anybody, even from the other side, to say that e-cigarettes, vaping, Juul is not killing our people. They are,” said U.S. Rep. Rashida Tlaib, D-Mich.

Does vaping kill people? There are two known cases of vape devices exploding and killing users in the United States. To compare, estimates for the number of Americans killed by lightning strikes each year range from 30 to 100.

The critics’ underlying insinuation — that inhaling flavored nicotine vapor is closely linked to human mortality — is not supported by evidence.

England’s national public health agency reports e-cigarette use is 95 percent safer than smoking cigarettes.

Similarly, the National Academies of the Sciences wrote in a report last year, “There is conclusive evidence that completely substituting e-cigarettes for combustible tobacco cigarettes reduces users’ exposure to numerous toxicants and carcinogens present in combustible tobacco cigarettes.”

Since we know vaping is significantly less hazardous than smoking, we should celebrate the prospect of nicotine addicts switching over. Politicians disagree.

“There is no credible medical evidence of Juul’s most fundamental marketing claim. None,” U.S. Sen. Dick Durbin, D-Ill., said last week, referring to marketing of Juul e-cigarettes as smoking alternatives.

The literature is somewhat less clear on this question, but the evidence certainly is greater than “none.” The National Academies of the Sciences reports there is “moderate evidence” that e-cigarettes are an effective smoking cessation tool.

Since the current body of research is inconclusive, it was especially troubling to hear Tlaib say, “We don’t need more studies. We already know the truth here.”

That is the exact opposite of the truth. Even researchers who are concerned about e-cigarettes’ health hazards consistently emphasize the need to continue researching the long-term effects of a practice that has been common for less than a decade.

The new generation of drug warriors is particularly alarmed at the “teen vaping epidemic,” pointing to research that shows an uptick in nicotine consumption by middle school and high school students. However, a closer look at the data shows little evidence e-cigarette use by young Americans represents an epidemic.

About 21 percent of high school students used vaporizer products in 2018, according to the Centers for Disease Control and Prevention’s National Youth Tobacco Survey. Journalists and politicians consistently neglect to mention that figure includes teens who have tried e-cigarettes just one time in the 30 days preceding the survey.

To put that in context, 20 percent of high school juniors said they had at least one drink of alcohol — which everyone agrees poses significant health risks — in the past 30 days, according to the 2018 Iowa Youth Survey.

It turns out only about 5 percent of American high school students are regular vape users, according to federal research. Any substance dependency among minors unequivocally is a bad thing, but it is not an epidemic.

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By MICHAEL SIEGEL July 26, 2019

Coast to coast, cities are feeding dangerous misperceptions and making it harder for smokers to quit.Today, cigarette smoking remains the No. 1 cause of preventable death in the United States. So why are cities and towns coast to coast taking harm-reduction alternatives off the shelves while allowing Marlboros to remain?

Last month, San Francisco banned the sale, including the online sale, of e-cigarettes. Around the same time, Brookline, a Boston suburb, did the same thing. Livermore, Calif., followed suit. Also moving in this direction are Morristown, N.J., Blufton, S.C., and Seattle.

Perplexingly, these strict regulations essentially ignore traditional cigarettes. Menthol cigarettes are banned in both San Francisco and Brookline, but other flavors — which constitute the vast majority of the cigarette market — are still sold.

With an uptick in teen vaping, parents and residents are understandably worried about our youth picking up a bad habit. But in their eagerness to tackle one problem, these municipalities are revealing a deep misunderstanding of vaping, ignoring the unintended consequences of bad policy, and putting many more lives at risk.

As the FDA acknowledges, nicotine “is most harmful when delivered through combustible tobacco products.” Vaping doesn’t release the toxins that come from burning tobacco and that lead to lung cancer, emphysema, and heart disease. By itself, nicotine is addictive — but not toxic.

As a result, Public Health England considers e-cigarettes 95 percent safer than traditional cigarettes for adult smokers; and in 2015, Britain’s Royal College of Physicians stated that e-cigarettes are “likely to be beneficial to public health.” In fact, the U.K. views e-cigarettes as so much better than traditional smoking that several hospitals there are now providing them as a part of their anti-smoking efforts. What’s more, The New England Journal of Medicine published British research finding that smokers who use e-cigarettes are twice as successful at quitting as those who rely on other approaches. And now a similar American study has arrived at the same result: Daily e-cigarette use “was associated with a 77% increased odds of prolonged cigarette smoking abstinence over the subsequent two years.”

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MAKING E-CIGS LESS APPEALING TO YOUTH MAY HAVE UNINTENDED EFFECTS ON EXISTING USERS

Efforts by the FDA and some cities to limit the availability and appeal of e-cigarettes to young users could drive some existing users to smoke more tobacco cigarettes to get their fix, according to new research from Duke Health.

The findings, from a survey of 240 young U.S. adults who use both e-cigarettes and traditional tobacco cigarettes, are scheduled to be published July 15 in the journal Substance Use & Misuse

“The FDA now has regulatory authority over all tobacco products, including e-cigarettes and we know that some communities have taken action to ban flavored e-cigarette products,” said Lauren Pacek, Ph.D., the study’s lead author and an assistant professor in psychiatry and behavioral sciences at Duke.

“We wanted to take a first pass at seeing what users’ anticipated responses to new regulations might be,” Pacek said. “Our findings suggest that while some regulations, such as banning certain flavors to limit appeal to adolescents, might improve outcomes for those young users, the new regulations might have unintended consequences with other portions of the population.”

The online survey asked participants aged 18 to 29 to predict their use of two products they already used — e-cigarettes and traditional tobacco cigarettes — in response to hypothetical regulations to limit e-cigarette flavors, limit the customizability of e-cigarettes or eliminate the nicotine in e-cigarettes.

About 47 percent of respondents said if regulations eliminated the nicotine in e-cigarettes, they wouldn’t use e-cigs as much and would increase their use of traditional cigarettes.

About 22 percent said if regulations limited the customizability of devices, such as features allowing users to adjust nicotine dose or vapor temperature, they would use e-cigs less and smoke more tobacco cigarettes.

About 17 percent said if e-cigarettes were to be limited to tobacco and menthol flavors, they wouldn’t use e-cigs as much and they would smoke more tobacco cigarettes.

According to other research on e-cigarette use, about a third of people who use e-cigarettes also use other tobacco products, Pacek said. For instance, some smokers might use an e-cigarette where tobacco smoking is not allowed, such as at work or a restaurant.

The survey was small and not designed to predict the behavior of e-cigarette users across the U.S., Pacek said. However, the data suggest that when considering changes to e-cigarettes, such as limiting fruity flavors proven to appeal to youth, that regulators also consider the downstream effects of new regulations on other users.

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Two vaping shops have opened at a West Midlands healthcare Trust offering staff, patients and visitors an alternative to smoking following a site-wide ban on the habit.

Ecigwizard shops are based at Sandwell and City Hospitals, which are run by Sandwell and West Birmingham NHS Trust (SWBH).

Smoking is not allowed anywhere on the grounds of the organisation, including in cars parked on site.

Anyone ignoring the ban and lighting up on site will receive a £50 fine. Smoking enforcement officers have been on site from 5 July and work alongside staff, including security staff, to challenge people smoking on site. Cameras to support the policy are also in place.

Joe Lucas, Head of Retail for Ecigwizard said: “We’re incredibly happy to announce the opening of our two shops at Sandwell and City Hospital, supporting the Trust’s smoke-free status. We are keen to offer vaping as an alternative to smoking, as a means to help people cut down or quit.

“Sandwell and West Birmingham NHS Trust chose to partner with Ecigwizard because of our attention to detail on quality and safety, from testing eliquids in a purpose built laboratory and state of the art cleanroom.”

Ecigwizard director Ben Potter revealed his delight with their new partnership with the NHS and the UK’s stance on e-cigarettes: “We are thrilled that Sandwell and West Birmingham NHS Trust has taken positive steps forward in combating tobacco smoking. The UK continues to show the world that vaping products are a valuable tool in the long-term goal of creating a smoke-free world.”

Dr David Carruthers, Medical Director of the Trust, added: “The Trust’s Board, and our clinical leaders, are united in the view that smoking kills. Given that simple truth, we can no longer support smoking on our sites, even in shelters or cars. Every alternative is available and we ask visitors and patients to work with us to enforce these changes. Giving up smoking saves you money and saves your health.

“No more passive smoking on our sites is a public health necessity.”

Ecigwizard, are celebrating their eight-year anniversary as one of the leading retailers in the e-cigarette industry and have been working with stop smoking services for the past 5 years.

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By:  Elizabeth Chuck

San Francisco’s ban on electronic cigarettes is an “insane public policy,” some public health experts say, arguing that the city should ban all tobacco products instead.

The criticism came after San Francisco on Tuesday became the first major city in the United States to ban e-cigarettes. The ban, which will go into effect 30 days after the mayor signs the ordinance, was approved by city supervisors who cited the “growing health epidemic of youth vaping” in their decision.

E-cigarette use has undeniably soared among youth, alarming public health officials: 20.8 percent of high school students reported in 2018 that they had used the vaping devices within the past 30 days, compared to 1.5 percent in 2011, according to the Centers for Disease Control and Prevention.

The CDC says e-cigarettes are not safe for children and teens, but adds that they have “potential to benefit adult smokers who are not pregnant if used as a complete substitute for regular cigarettes and other smoked tobacco products.”

Still, the long-term effects of vaping devices are unknown, particularly on youth who smoke them. They contain the addictive substance nicotine but far fewer of the toxins that combustible cigarettes have.

While e-cigarettes are generally understood to be less harmful than cigarettes or cigars, many parents, school administrators and pediatricians have expressed concern that the way e-cigarettes deliver nicotine is negatively affecting the development of teens’ brains, particularly because they can deliver a higher dose more quickly than traditional cigarettes can.

But some public health experts feel banning them altogether like San Francisco alienates an entire population of adult cigarette smokers who are trying to quit and need an alternative.

“We’re taking the risk of addiction among kids,” said Kenneth Warner, a professor emeritus at the University of Michigan of Public Health, “and comparing that with the immediate danger of smoking-related illness and death in smokers who have not been able to quit otherwise and who might be able to quit with vaping.”

Warner cited a New England Journal of Medicine study from January 2019 that found among smokers in a smoking cessation clinic trying to quit traditional cigarettes, nearly double the number of people — 18 percent versus 9.9 percent — who used vaping over nicotine-replacement products such as gum or patches were able to quit. Other studies have concluded there isn’t enough evidence yet to say whether e-cigarettes are an effective long-term aid to quit smoking.

“If the board of supervisors were interested in public health, they would prohibit the sale of cigarettes in San Francisco.”

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By: Editorial Board

Anyone over 21, and with an ID to prove it, can purchase cigarettes, booze and even marijuana in retail establishments across San Francisco. But as soon as next month, one age-restricted product won’t be available for purchase, not even online. That’s because San Francisco officials, in a misguided attempt to curb teen vaping, are moving to ban sales of all electronic tobacco products to anyone within the city until the federal government adopts regulations on them.

The San Francisco Board of Supervisors gave a tentative thumbs-up to the ban last week, and the supervisors are expected to reaffirm their support in a final vote Tuesday. We hope the supervisors will see the light before then. Not only is it bad public policy to outlaw a legal product that’s widely available just outside the city’s borders, but it’s bad public health policy to come down harder on the lesser of two tobacco evils.

Electronic cigarettes are new enough that we don’t fully understand the health effects from vaping, which involves inhaling the fumes produced by heated liquid nicotine. Nicotine in any form comes with health risks. But it’s well established that smoke from conventional combustible cigarettes can kill both smokers and bystanders, and that some longtime smokers have been able to quit that deadly habit by switching to vaping.

Granted, teen vaping is a serious concern. While smoking rates have dropped significantly among U.S. middle school and high school students — they’re down to just about 8% — electronic cigarettes are gaining popularity rapidly. In less than a decade, e-cigarette use among U.S. teens has soared from less than 2% to more than 20%. In just one year, from 2017 to 2018, teen use increased by 36%. The Centers for Disease Control and Prevention reports that, as of 2018, about one-fifth of all U.S. high school students reported using an electronic cigarette in the last 30 days. By comparison, San Francisco’s Youth Risk Behavior Study determined that as of 2017, just 7% of the city’s high schoolers had reported vaping in the last 30 days.

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By: Sally Satel and Erica Sanberg

San Francisco is a city of mind-bending contrasts.

Park your car for more than two hours on a residential street and you’ll face a steep ticket or a tow. But set up camp on a sidewalk with a collection of tents, shopping carts, and stolen bicycles and the city gives you days or more to move.

Sip from an open container of alcohol in a city park and you may be cited. Inject yourself with heroin in public, and you’re unlikely to face official response.

Enjoy your boba tea through a single-use, plastic straw – but only until July 1. After that, municipal policy aimed at keeping plastic from ending up in the ocean forbids vendors from offering them to the non-disabled.

Speaking of plastic, about 2 million of the 5.8 million syringes distributed last year by the city littered the streets or washed into the bay.

To be fair, the city is trying to rein in homelessness, drug use, and errant syringes, but the latest policy has its full-throated support: A ban on the sale of electronic cigarettes.

Yesterday, the San Francisco Board of Supervisors decreed that vaping products — from the widely popular cartridge models, of which JUUL is the best known, to tanks, vape pens, and e-liquids — can no longer be sold in brick and mortar stores or purchased online and delivered to local addresses.

The ban is intended to “protect youth from e-cigarettes,” according to a press release from City Attorney Dennis Herrera.

Doubtless, non-smoking teens shouldn’t vape. But what about smoking adults, the target audience for e-cigarettes?

If they can’t quit or don’t want to, they must have access to nicotine in a safer form. This is the principle of harm reduction.

E-cigarettes are estimated to be at least 95% less hazardousthan conventional cigarettes. This is because they do not burn tobacco, which release carcinogens and carbon monoxide. Vapers inhale nicotine via a propylene glycol-based and/or glycerin-based aerosol.

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– Daren Bakst, 6/5/19

Sometimes, it feels like we live in Bizarro World, where everything is the opposite of what we would expect.

Consider, for example, the regulation of e-cigarettes and other alternatives to traditional cigarettes. Those who advocate policies that would help maintain existing levels of cigarette smoking are somehow viewed as the “righteous.”

The Tobacco Control Act, which gave the Food and Drug Administration the power to regulate tobacco products, is creating major obstacles for the sale of e-cigarettes and other alternative products, thereby doing more to block cigarette smokers from quitting than allowing them to stop.

This all needs to change.

One of the leading tobacco researchers, the late Michael Russell, famously said, “People smoke for nicotine but they die from the tar.”

It’s the burning of tobacco that releases thousands of harmful chemicals. New products like e-cigarettes reflect this understanding, delivering nicotine without burning tobacco.

That doesn’t necessarily mean they are safe, but the research shows that they are less harmful than combustible cigarettes.

The liberal Left continue to push their radical agenda against American values. The good news is there is a solution. Find out more >>

In the most comprehensive government report of its kind, Public Health England described e-cigarettes in 2015 as “95% less harmful that tobacco cigarettes.”   The FDA also recognizes that these new products are less harmful than combustible cigarettes.

Yet, the FDA, through its implementation of the Tobacco Control Act, has issued regulations that will effectively put an end to many alternative products that are currently available to smokers.  Specifically, the FDA is requiring these products to go through the costly and burdensome pre-market tobacco-application process. That’s a barrier that, once enforced, will jeopardize the continued existence of many of these products.

Ironically, some e-cigarette opponents irrationally justify their dislike for the products based on a dislike of big tobacco companies.  Yet, the big tobacco companies and other big businesses are the ones that will be able to afford the costly approval process, while the many small businesses in the field will likely cease to exist.

The entire narrative and policy debate around e-cigarettes ignores the critical benefits of these products.  Instead of shouting from the mountaintops that private innovations are now available that can help reduce cigarette smoking, the FDA is using concern over youth usage of e-cigarettes as a way to demonize the products.

To be clear, the FDA should be concerned about youth usage of nicotine delivery products; nicotine is addictive and the safety of these new products still needs to be monitored.  The FDA, however, shouldn’t be using this concern as a reason to promote policies that would help maintain current levels of smoking or prevent Americans from having access to products that could save their lives. Nor should they be diverting attention from the critical importance of these alternative products.

Underlying this entire narrative is an unfortunate and arguably dangerous conflating of two very different issues: the harmful and cancer-causing effects of smoking cigarettes and the harmful effects of nicotine.  Smokers get cancer from the combustion of cigarettes, not the nicotine.

In fact, data show that about half of American adults incorrectly think nicotine is the main substance in cigarettes that causes cancer.  Further, American adults increasingly think that using e-cigarettes is as harmful or more harmful than smoking cigarettes (as high as two-thirds of adults).

This is a true crisis, arguably caused in large part by government messaging.  If cigarette smokers don’t even know that e-cigarettes are less harmful than cigarettes, then they don’t have much reason to switch.

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While both Public Health England and the National Academies of Sciences, Engineering and Medicine acknowledge that completely switching from combustible cigarettes to non-combustible products, such as e-cigarettes, exposes users to substantially less toxicants and dangerous chemicals, there remains lacking support for their use as a quitting tool. For example, NASEM’s report concludes that: “Overall, there is limited evidence that e-cigarettes may be effective aids to promote smoking cessation.” On the contrary, however, there is evidence to suggest that e-cigarettes are growing in popularity as a quit tool.

Accordingly, in an effort to further probe the role of e-cigarettes in initiating cessation and/or maintaining abstinence, Peter Hajek and colleagues developed a randomized trial to compare smoking cessation and abstinence among populations that use traditional nicotine replacement therapies (NRT) versus those who use e-cigarettes (EC).

In terms of participant selection, subjects were accepted into the study if they were currently not using any products and had no strong preference for use of either nicotine replacement therapies or electronic cigarettes as a quit method. After being accepted, participants were randomized to receive either an e-cigarette or an NRT of their choice (the nicotine patch was used by 84 percent of participants generally along with a fast-acting oral product) and asked simply to adhere to their treatment group (EC or NRT). Participants were then asked about smoking status at 4, 26 and between 26-52 weeks—52-week abstinence was biochemically verified at the final visit.

With respect to findings, overall, the e-cigarette group had significantly higher abstinence rates at all time points than those in the nicotine replacement therapy group. For example, at the conclusion of the study (52 weeks), the abstinence rate was 18 percent for those in the EC group and only 9.9 percent for those in the NRT group. At the 4-, 26- and between 26-52-week points, it was approximately 44, 35 and 21 percent for the EC group and 30, 25 and 12 percent for NRT.

Moreover, even participants in the EC group who were unable to achieve abstinence had higher rates of reduction in cigarettes smoked (biochemically verified as a 50 percent reduction or more) than those in the NRT group (12.8 vs. 7.4 percent respectively). At the conclusion of the study, participants in the EC group also had a much higher rate of treatment adherence than those in the NRT group at 39.5 and 4.3 percent respectively.

While these numbers overwhelmingly suggest that ECs have the potential to be more effective quitting tools than NRTs, some limitations in the study’s methodology suggest that their full potential as a cessation tool may not even yet be realized. For example, at four weeks, 56 percent of participants in the EC group were not abstinent and although statistically significant, the urge to smoke in the first four weeks was only marginally lower for those in the EC group versus those in the NRT group. However, this may have been an unintentional result of the study’s design. Those in the EC group, were given an initial supply that consisted of a 30 ml bottle at 18mg/ml and were then encouraged to experiment with nicotine concentrations in subsequent refills. While supplementary data indicated that most participants moved to lower and not higher concentrations as the study progressed, it stands to reason that if a higher concentration had been delivered initially, it may have prevented drop out early on.

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When Gov. Larry Hogan and the Maryland legislature took a firm stance against selling Electronic Nicotine Delivery Systems, or “ENDS,” to minors, I applauded their efforts to keep these products out of the hands of children. Minors should not vape, plain and simple.

However, vaping products are designed specifically as a healthier and safer alternative for adult smokers. Vapor provides a pathway away from cigarette addiction. These products were never intended to encourage teenagers to smoke and therefore should never be marketed towards children.

Unfortunately, regulators are also taking steps to limit access to these important smoking cessation tools for adults that need them. As an active member of the Asian-American business community in Maryland, I am deeply concerned that pending regulations will not only harm adult Marylanders attempting to quit smoking, but also cause potentially devastating effects on Maryland small businesses.

Recently, the Trump administration announced plans to restrict the sales of most flavored e-cigarettes in convenience stores, a measure that baselessly attacks law-abiding business. In addition, there is state level legislation under consideration that would cripple access to vapor products for adults throughout Maryland.

The Maryland General Assembly also passed measures further restricting access to vaping products and the city of Baltimore is considering a ban on flavored e-liquid – a tool that many former smokers credit with helping them quit smoking.

The industry is in full support of denouncing the issue of teen vaping. It’s now illegal to sell vaping products to anyone under the age of 21 in the state of Maryland and businesses that sell vaping products go to great lengths to adhere to the law. Just as identification is required to purchase tobacco products, purchasers of e-cigarette products must provide state-issued identification. Duplicating regulations that restrict adult access to these products do not bring us any closer to solving this problem.

Furthermore, sales of e-cigarette products play a vital role in the Maryland economy and enable retailers to employ more Marylanders. Reducing access to these products in stores would make them only available online, therefore hurting Maryland businesses, impacting the number of jobs available, and ultimately reducing the tax revenue brought in by our state. With regulations coming down on the industry at the federal, state and local level, we need to critically evaluate where the line is for safety and health and a knee-jerk regulatory reaction.

I urge the city of Baltimore, the state of Maryland and the Trump administration to consider these facts before advancing additional unnecessary regulatory burdens on the industry. It’s not too late for our elected officials to change course and take a stand against these misguided proposals.

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