Last October we were expecting to hear a round of regulations that would determine the brave new frontier of vaping, but nothing game. It’s expected that it will come soon. Ordinarily, I’d fear the silence. In this case, though, I wonder if longer isn’t a little bit better. It all depends. At this point I believe the facts are on the side of less regulation and more thought out regulations will be more measured, though it seems a bit like the anti-vaping crusaders are gaining some traction.

Megan McArdle wrote a reasonably good piece on ecigarettes. In which she speaks to the fear:

As nothing but a replacement product for existing smokers, e-cigarettes seem like a public-health win. Widespread adoption by current smokers “could potentially reduce smoking deaths by more than 90 percent,” says Joel Nitzkin, a public-health physician who is a senior fellow at free-market think tank R Street in Washington.

But what if current smokers aren’t the only people who use them? What if e-cigarettes lure back people who used to smoke or attract new smokers? What if people who otherwise would have quit keep using nicotine? And perhaps the No. 1 argument: What if e-cigarettes make smoking normal again in public places, with the attendant annoyance of a neighbor or officemate blowing nicotine-laced steam everywhere?

What is really frustrating is that we don’t know. As important as anything, we don’t even know if there will be much wrong with people choosing to vape. Almost all of the anti-vaping sentiment is based on potential and hypothetical dangers. Well, it’s hard to argue with potential and hypothetical. It’s hard to argue with the notion that vaping may be dangerous, because it’s hard to prove a negative. Tests on propylene glycol, one of the chief ingredients of the eliquid, have been performed because that’s what they use for theatrical fog, and it was found to be safe. They have tested this stuff on animals saturated 24/7 for extended periods of time (eighteen months) and they found minimal consequences (reversible dehydration of the nasal and ocular areas). The head of the FDA himself has said that nicotine addicts you and tar kills you. Ecigarettes do not have tar.

I have previously expressed some skepticism of the health consequences of these things, taking the middle ground that while they’re not nearly as dangerous as the critics claim they’re probably not as safe as the advocates say. The more I’ve read, though, the more confident I am that the health threat is likely very minor to non-existent. The advocates’ claims are based on study after study after study, while the opponents claims are based on hypotheticals. Not even hypothetical models, but vague statements about what we don’t know.

Which brings us to the next argument, which is that it will prevent people from quitting smoking or quitting nicotine. In the case of the latter, if the health risks are so marginal, should we really care? In the case of the former, that could be bad, save that there is no real reason for it to be true. According to a UK study (STS140122) on cigarette, ecigarette, and NRT (nicotine replacement therapy – the gum or patch), “There is no evidence that electronic cigarettes are undermining motivation to quit or reduction in smoking prevalence.”

It goes on to say: “Use of e-cigarettes by never smokers or long-term ex-smokers is extremely rare.”

It does not provide any data on people starting with ecigarettes and moving to the regular kind, which is another concern (supported by hypotheticals). Speaking from a personal perspective, once you’re using ecigarettes and get the regular cigarettes out of your system, the latter becomes superfluous. I can quite honestly say that I have no desire to pick up a real cigarette at all. What I’m doing now isn’t just healthy, it’s more enjoyable. Vaping offers advantages that smoking can’t match. Including, I should add, the very flavoring that the anti-vaping advocates want to ban. Not to mention the ability to do it in more places, though right or wrong anti-smoking crusaders are going after that, too.

In other words, due to their anti-smoking zeal, they are methodically trying to reduce incentives to take advantage of an amazing new tool to help people quit. Even if they don’t quit the vaping, they’re still ahead. Arguments otherwise assume that if they can’t vape they will quit For Real. They remind me of my father who, on finding out that I had indeed quit smoking entirely and was now vaping, wondered if I could just quit without vaping. The last eight years of my life indicate otherwise. Strongly.

And on a more personal level, by god I have found something that works for me. Not just because I don’t smoke anymore, but because it allows me the ability to continue to do the things that drew me to smoking in the first place. I may quit the ecigarettes or I may not. But I have finally found myself not having to obsess over this question. Do you know how amazing that is? A world has been lifted from my shoulders. The monkey that has been on my back for years and years is gone. At worse, replaced by something by all measures benign by comparison. It makes me want to kiss the skies. And it makes me furious at those who see this as some nefarious new threat to the public health.

Right now I am just waiting to find out how bad it’s going to be. Whether the thing that right now costs me twenty-five cents a milliliter will shoot up to seventy-five cents (a very real possibility). Whether the people I get my supply from will be allowed to remain in business. Whether I am going to have to throw everything out and start all over with an FDA-approved device. I’m concerned about the number of people out there who could take the same path as I did to recovery, but as much as anything I just want to keep doing the thing that has put more distance between me and cigarettes than I have had in over ten years. Or whether it will be made more complicated and disrupted with right-now unthinkable consequences. In the name of public health. In the name of my own well-being.

Now, having talked abstractly about regulations, I wanted to go into many of the specific proposals.

Who doesn’t want to protect children from nicotine? It’s extremely hard to take issue with the aims, no matter how harmless you tend to think that ecigarettes are. Too often these discussions break down on regulation or unregulation. I’ll confess that I do have an inclination to oppose all regulation because I’m pretty sure that when regulation comes we are going to get too much regulation. But I will instead try to focus on appropriate and inappropriate regulation, and address the suggested regulations one by one:

  • Restricting Advertising to minors: The devil is in the details on this one, though to be honest I don’t care too much of all advertising is banned or banned to the extent that cigarette advertising is. Reason being, the main people I want to get a hold of these things are smokers, and smokers talk to smokers. So the best way to reach the target audience, without reaching people who otherwise wouldn’t consider it (which seems prudent, from a precautionary level) is to let the rely primarily on word-of-mouth advertising as well as signs in windows and convenience stores where smokers tend to look (and that I scarcely even noticed until I was a smoker). The only hesitation I have here is that it gives the bigger companies a huge leg up on the competition. I’d just assume that the industry leaders are not owned by tobacco companies. Right now there are three industry leaders and one is. If we restrict advertising, it seems very likely that the ecig companies will need the tobacco companies for their networks. I could be wrong about that, or they could be needing it anyway, so by and large I am pretty open-minded on this. Especially given the odd state of affairs that while companies can sell their product as a lifestyle product they can’t sell their product for the very thing we want people to use it for, smoking cessation. The real problem for me, though, is that “marketing to children” is interpreted to mean…
  • Candy flavors: Leave them alone. Flavored cigarettes (except menthols) were banned on the basis. I have no real opinion on that. I do, however, have an opinion here: Leave them alone. The fact that there were these flavor varieties were one of the things that helped me get over the hump. It was one of the things that ecigs offered me that the analogs did not. Yes, kids like candy, but so do grownups. Kids like fruit, but so do grownups. Personally speaking, I am not as big into the flavors as a lot of people. Now, if all this is going to be is a requirement that they come with “grown up names” then I can deal with that. Blu tended to name theirs after alcohol drinks. Except you know who likes or is intrigued by alcohol? Kids. Which makes me fear that what they mean is “no flavors but menthol.” Which I can deal with, but which I don’t think would be a good thing for people trying to jump the chasm. Also, the less you make these things like regular cigarettes, the less likely the hypothetical gateway effect will occur.
  • Register and pay fees: This one actually bothers me a little bit, though it is (not without reason) the least objected to by the big boys. I get my eliquid from independent sources where it’s significantly cheaper than through the maker of the ecigarettes itself. By “significantly cheaper” I mean roughly half to a third the price. I think the best way to keep prices low is to allow as much competition as possible. Lower price points on eliquid are a selling point to people who want to quit but higher prices are not a barrier to people looking up to start from scratch. The barrier to people looking to start of from scratch is the upfront cost of the equipment.
  • Restricting online sales: Please no. For the same reasons as previous, except much more emphatically. I understand that there are concerns as far as age verification, but please figure them out. This isn’t the worst suggestion I’ve heard, which is to limit sales from convenience stores, but it’s probably the one that would hurt me the most. It’s the one I look at and say “If they do this wrong, in conjunction with other mis-steps, I might end up smoking again.” If you want to limit sales of the apparatus, I guess I can go along with that (though that again means a likely conglomeration under the banner of the tobacco companies) but not the liquid.
  • Obtain prior approval for new products: I don’t understand the rationale behind this one other than “it seems like something we should want.” If done right, I don’t see a whole lot of harm. My only concern would be if every slight modification required thousands and thousands of dollars worth of testing or something. Otherwise, there are a lot of options out there and I’m not sure we need new and great innovations. If it’s limited to devices, it could be a positive if it prevents the upfront costs from falling too much as one would expect over time. I can also think of a lot of ways this could go wrong, however. And if it applies to eliquids, it could jack up prices seriously. (“Wait, you want to put in coconut and pineapple? You’ll have to fill out these applications…”)
  • Ingredient labeling: More information is better than less information, but I see this creating problems for independent makers. This would, once again, lead to more consolidation and probably more consorting with the tobacco companies. I’d want to know more about the specifics here. I’d honestly want to know more about how onerous this would be for suppliers.
  • What about nicotine-free liquid?: A lot of my above objections could be alleviated if it didn’t apply to makers of eliquid without nicotine. I could get my own nicotine and add it myself, which would be a pain but would be something I could do. It might still do some damage to the industry and would jack up prices, but I’d love some differentiation here. This partly goes to the question of “What hazards are we regulating these to prevent?” (the nicotine or the PG or it just looks too much like smoking?) and the answer to that seems to be “I don’t know, but it all just seems kind of dangerous to me.”

Category: Hospital, Statehouse

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2 Responses to Vaping: Regulatory Uncertainty

  1. Dr X says:

    Great post! And congratulations on kicking the tobacco. I’m enthusiastic for substitution with e-cigarettes, but I do think the moral zeal of anti-smoking crusaders will present obstacles. That’s unfortunate, because it’s difficult to intelligently argue that e-cigarettes don’t represent a vast improvement over tobacco smoke delivery of nicotine.

    I quit years ago when the gum came out. I did it with very basic behavioral techniques and chewing far more of the gum than recommended to keep by nicotine concentration up. The latter was probably the more important factor in my success.

    I did get addicted to the gum and that took another two years to quit. The interesting thing is that no one thought the gum was a bad thing. Aside from the second hand vapor, the mere simulation of tobacco smoking seems to throw some people over the edge. I don’t think they can quite process the possibility that it could be relatively harmless.

    • trumwill says:

      Thanks, X. And contragulations on your own quitting! I think for me it was much more of the habit thing than the nicotine thing, which is why I didn’t go the gum route. I will say that my appreciation for the nicotine part of the equation has been made more clear since moving to the ecigs. Attempts to draw down have been hard.

      I don’t think they can quite process the possibility that it could be relatively harmless.

      I think this is exactly right.

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