Can E-cigarette Regulation Protect the Public’s Health?
Making Sense of the Science

Summary

The burgeoning e-cigarette market has provoked deliberations about emerging e-cigarettes science, public health concerns and regulatory policy approaches. Some scientists perceive e-cigarettes as a potentially less harmful alternative to traditional tobacco products. By contrast, others fear e-cigarette use will promote tobacco consumption by “re-normalizing” tobacco use, especially among teens and young adults. The FDA plans to regulate e-cigarettes and will release rules regarding warning labels, youth access and vending machine sales sometime in the future. The World Health Organization also has weighed in, issuing strong guidelines for regulation. These steps have been applauded by some public health pundits and criticized by others. This Forum event explored aspects of the fiercely debated e-cigarette market, including marketing to youth, content of warning labels, design of products, evidence for science-based policymaking, and context of e-cigarettes within the lengthy history of tobacco use and control.

Presented in collaboration with Reuters, this event was organized with the Center for Global Tobacco Control and the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health.

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Presented in Collaboration with Reuters

Background Articles

Image Credit: © Reuters/Christian Hartmann

  • O D Irony

    What we do know is e-cigs are clearly less harmful than real cigarettes, and pose no quantifiably significant danger to those around the e-cig user. What we don’t know: how much the tobacco industry is investing to hamper the e-cig market and the extent that tax-grubbing politicians loathe the idea of losing the tax cow that is the tobacco market.

    • Tina K.

      Great to see that you based your comment on the actual discussion being sponsored here. Not.

    • mybrainworks

      We do know that millions of children who would never have picked up a cigarette are now addicted to nicotine, harming their brain and making them much more likely to become addicts of other drugs.

      • Chris Lee

        Same could be said about Alcohol and anything that becomes addictive. Enjoy your coffee this morning?
        I used vaping to quit smoking, been 6 months with one and my health has improved loads. Not that I expect you to believe or understand as clearly you’re the one brain washed in your approach to those of us that use these products. Smoking or Quit smoking has implications either way, the governments are losing tax on the ever dropping sales of tobacco, the main culprit no doubt is that people are taking up e-cigs instead. So we are now seeing those that are losing out on this ‘taxing’ trying to get a grip of something they are losing to.

        Obviously you have such a wonderful (all be it single minded) life that you clearly do not smoke, drink alcohol or coffee and have never eaten candy in your life so clearly you wouldn’t understand the other 99.99999% of the populous that haven’t been blessed with the life you clearly lead.

        Have a great day – although I am sure every day is a great day for someone such as yourself 🙂

        • mybrainworks

          No, my mind is not addled by nicotine so I can see the issue without a huge bias, just from the standpoint of common decency.

          • Chris Lee

            That is very fortunate for you but just because you are not dependant on Nicotine gives you an advantage over someone that is. It doesn’t make you a better person or someone that should frown upon someone that smokes. We want to quit and this is a healthy way (that actually works) that actually doesn’t involve big pharma or anyone else that may be affected by the lowering of tobacco sales. Surely the fact that we are trying to lesson the harmful chemical intake shouldn’t be restricted by tobacco companies or big pharma. Take California for instance, they receive huge sums of money from the Tobacco companies in exchange for preventative measures that protect the tobacco companies of huge lawsuits by people that have had adverse effects from tobacco. Rather that waiting for the tobacco companies to pay the money, they governments borrowed the money from elsewhere – this works until the tobacco companies start to lose sales due to e-cigs etc, their income drops which rolls onto the Governments that borrowed the money from elsewhere who will no be left massively out of pocket because the tobacco companies are not paying as much. This is just one example of how E-Cigs/Vaping is affecting those that rely on the sale of tobacco products, Big Pharma too, an empty doctors waiting room means the end of the doctors waiting room thus doctor no longer needed. As soon as something is shown to affect the Powers that be, whether it’s the tobacco companies, Pharmaceutical companies or your GP – you get healthy someone loses out. I have never felt so great health wise, I have tried many times to quit but after trying everything my doctors suggested (and failed) I tried E-cigs and haven’t looked back.

          • mybrainworks

            Market it only to adults, use it where you can smoke instead undermining our clean air laws. Why is that too much to ask?

          • Chris Lee

            I actually agree with you there MBW, although I am not too sure about the clean air thing. Vaping for instance isn’t burning anything and I am at 0.6% nicotine. I am conscious of where I vape but feel these are no where near (If at all) as bad as a regular cigarette. I know of many many people that use vaping for instance without no nicotine at all. I agree these shouldn’t be marketed to minors but I also think we shouldn’t be restricted to devices that yet again are supplied by tobacco companies. Oddly, the only one here in the EU that has been approved is by British American Tobacco :/ << Coincidence I think not and this is just the start of it. Also I believe they are limiting the nicotine dosage to 1.8mg/18% which is way higher than I am on for instance. People need to understand the difference between E-Cigs and Vaping too, I used vaping to quit because I found the e-cigs (the ones with the lights in the end) too harsh and not much different to a normal cigarette, even down the burnt taste in my mouth afterwards – one of the reasons I wanted to quit! I guess time will illustrate who is losing out the most and who stands to gain the most, my fear is that it will be the usual suspects that come out on top. FDA have way too much control of things, who are they a part of and whose interests do wish to protect the most – lets just say it is not yours or mine.

          • RightWingPooFlinger

            He cannot be reasoned with. The shrill rhetoric, the name-calling and personal smears… I’d just leave this putz be. There are rational people to talk to.

          • Pomegranny

            Because it’s not smoking, and hasn’t been proven guilty the way smoking has. So denying reality kinda IS too much to ask.
            I would not vape where it might bother someone, but I know I’m not hurting anyone, and resent the uneducated chronic Shamers who can’t be bothered to learn the difference. P.S. The Earth isn’t flat, either.

      • O D Irony

        Nicotine has never been clinically shown to be harmful to the brain.

      • RightWingPooFlinger

        you are demonstrably stating untruths, and engaging in bigotry by demonizing people who wish to quit smoking (or already have, like myself) via the most effective quit method ever devised. Shame on you.

    • mybrainworks

      “What we do know is e-cigs..pose no quantifiably significant danger to those around the e-cig user” – LIAR!!!!!! Stop spewing your toxins in our faces and then lying about it. I know addiction makes you do anything to keep your next fix easily available, but the harm you addicts do with your lies in defense of your pushers (E-cigarette vendors who make ILLEGAL claims about helping people quit) has got to stop!

      • zzz05

        Dial it back to 11 there, Toxic Avenger.

        • mybrainworks

          No, lies that harm the public and children are evil. He’s either an desperate addict or an industry shill. These lies too often go unchallenged.

          • O D Irony

            You are more likely the “industry shill” as it is in the tobacco industry’s interest to keep people away from ecigs and to push them to towards cigarettes – you know, true tobacco products with all those tars that cause cancer.

          • mybrainworks

            Just regulate them.

          • Pomegranny

            I agree! Please ask Public Health to quit lying!

      • O D Irony

        Clearly, you don’t recognize that there are levels of addictions and an addiction to nicotine is not the same as heroin. Period. If you deny this fact you are beyond discussion.

        • mybrainworks

          I work in substance abuse treatment, and heroine addicts regularly state that nicotine is harder to quit.

      • Pomegranny

        No, that’s like voter fraud: it doesn’t really happen much.
        The liars causing harm are Public Health, butt hurt about their equally-toxic nicotine patches and gum not selling well. (They don’t work well for most smokers, either.)

      • Pomegranny

        Shaming of adults for personal choices by other supposed adults has to stop. Shaming is an unhealthy addiction that it seems you might need some professional help with. That’s what’s got to stop.

  • Franck KOMAN

    I would like to say thank you at all members of this forum. I think we must help people to stop smoking or reduce all kind of cigarette. Help people have forgotten the cigarette. If the e-cigarette can protect people, I cannot if is true or false but the regulation is a good thing. Today the most important is to help men, women to stop smoking. Thank you very much

  • The Forum Moderator

    Welcome everyone. Our event has begun

  • Vishnu

    Is anyone having transmission problems?

    • The Forum Moderator

      Hi Vishnu, You may see a drop in the stream here and there but the video should be restored in a second or two. Thanks!

  • The Forum Moderator

    We’re glad everyone can join us today. Just a gentle reminder to please keep comments civil. Looking forward to a constructive conversation today.

  • mybrainworks

    The public health community does recognize that e-cigs are harm reduction, but also recognize the harm to kids that leaving them unregulated is causing, and the undermining of strides made to protect the public.

    If I am in an enclosed area with a person spewing vapor from an untested, unregulated product, that is a nuisance at best, and it may blow up and injure me! Test and regulate this product like all the cessation devices are, or shut it down!

    • RightWingPooFlinger

      iPhones and laptops blow up every day. Anything with a Li-ion battery is susceptible. Google some images of phone explosions, count the matches.

      As for the exhaled vape; you can stand by a major arterial street for 5 minutes and get more environmental chemical exposure than you will by being in a room with a vaper for 1 hour. If you eat a large tomato, you will consume more nicotine than you’d get from that same vaper in the room for several days.

    • Pomegranny

      The public health community realizes it is out of a job, i.e. smoking cessation, if they can’t stop vaping by any means possible….so far this has included lying and cheating, if not stealing. (Stealing will be performed by Big Tobacco, with the sin tax addicted government’s blessing.)
      I think you’re gonna get injured by far more than vapor if you don’t quit shaming adults.

  • The Forum Moderator

    We will be posting the full on-demand video on this website tomorrow and also in YouTube and iTunesU in case you missed any of it.

  • The Forum Moderator

    We’ll be hosting a brief Q&A towards the end of our event. Viewers can post their questions for the panelists here or email them to theforum@hsph.harvard.edu

  • CuriousStudent

    In the past, tobacco users denoted the use of tobacco on insurance policy applications. More recently it is shown that those who use e-cigarettes are denoting that “no” they do not use tobacco, but through health exams it is revealed that nicotine is present in their systems. How will the insurance industry need to change theories of thinking when it comes to this product?

    • The Forum Moderator

      Thanks @CuriousStudent.

    • Pomegranny

      Well, for one thing they could notice there IS no tobacco in e cigs, so people are answering the applications truthfully. I think they will need a new separate category, which is what states should be doing for vaping, rather than lumping it in with tobacco….something it’s not.

  • Sharon

    the “please stand by” message comes on after less than a minute of broadcast????

    • The Forum Moderator

      Hi Sharon, Yes. The stream seems to be dropping here and there for some of our viewers. We will post the full on-demand video tomorrow on this site. Thanks

  • Tim Sanborn MD

    I am having technical difficulties viewing the webcast. Will a written summary or slide sets be available? Why don’t we establish Tobacco 21 laws which include e-cigarettes nationally?

  • LaToya

    Mr. Kenneth Warner mentioned that there are toxic substances in some e-cigs not in others, besides the known Nicotine, what might some of those be? Can you expound on this?

    • Chris Lee

      The higher the wattage and/or voltage can mean the difference in harmful/non-harmful chemical release.

      • LaToya

        Thank you Chris for your reply. This is really good information.

      • RightWingPooFlinger

        to be accurate; ostensible chemical formation happens only at temperatures higher than are tolerable. Long before the required temps for, say formaldehyde production, are reached; the user will stop and try to figure out why it tastes so bad and burnt. No one vapes at those levels, it just isn’t pleasant and indicates something is wrong or being done wrong.

    • The Forum Moderator

      Thanks LaToya.

      • LaToya

        Many thanks for taking my question. Warm Regards.

  • Alex Knuckles

    Adults like flavors too. I wouldn’t have been as likely to switch if I wouldn’t have been able to vape flavors that I like.

    • RightWingPooFlinger

      flavor availability is invariably a top reason why people stick with it. I’m vaping a tasty bubble gum flavor right now. 9 mos without a cigarette.

  • The Forum Moderator

    CDC just released this data:

    E-cigarette use soared, smoking rate fell among U.S. youth in 2014: CDC, http://www.reuters.com/article/2015/04/16/us-ecigarettes-cdc-data-idUSKBN0N723O20150416

    • RightWingPooFlinger

      despite attempts to spin it as some sort of danger; statistical analysis in no way supports any such ‘gateway’ theory. In fact, I’d say the CDC numbers fairly quash that idea outright.

  • Atipong Pathanasethpong

    There have been reports indicating that cigarette usage is predominant in low-income social demographics. Is e-cigarette similar or different? And how can regulations for e-cigarette be tailored to address this group?

    • mybrainworks

      Children who would have never picked up a traditional cigarette are now addicted to nicotine thanks to these products going unregulated for too long.

  • oldgypsybird

    How do the expert participants foresee the likely FDA regulations affecting the shape of the e-cigarette manufacturing market with respect to the makeup of traditional “big tobacco” companies versus smaller “e-cig” only companies? Do they believe most smaller e-cig companies will have the technical and financial resources to meet FDA regulations and applications? How, if at all, will the FDA handle potential conflicts of interests between companies that sell both e-cigarettes and conventional cigarettes?

  • The Forum Moderator

    Thanks all for your great questions. We’ve also received lots to our email account. And we’ll try to get to as many as we can.

  • Ram

    How can you regulate overt or implied health claims made by ecigarette companiees

  • Laura Searcy

    So far I have not heard any discussion of the neurodevelopmental effects
    of nicotine when used by youth. Additionally, I would like the panel to
    comment on the issue of youth and the gateways to addiction that
    nicotine represents

    • Pomegranny

      So far I’ve heard no convincing proof that teens aren’t vaping zero nicotine e liquid, which would make this whole false conflation with tobacco moot.

  • The Forum Moderator

    Our event will end in about 5 minutes. Just a quick reminder that we will post the full video on-demand on this site by COB tomorrow. You can also look for it on YouTube and iTunesU, where we will also will post a podcast.

  • The Forum Moderator

    Thank you all for joining us! Our event has ended.

  • Bill Godshall

    According to the growing mountain of scientific and empirical evidence, nicotine vapor products (aka e-cigarettes):
    – are 99% (+/-1%) less hazardous than cigarettes,
    – have never been associated with any disease or disorder,
    – are virtually all (i.e. >99%) consumed by smokers and by ex-smokers who switched to vaping,
    – have replaced more than 4 Billion packs of cigarettes worldwide in the past eight years,
    – have helped several million smokers quit smoking, and have helped several million more smokers sharply reduce their cigarette consumption,
    – are more effective for smoking cessation than FDA approved nicotine gums, lozenges and patches (which have a 95% failure rate),
    – pose fewer safety risks than FDA approved Verenicline (Chantix),
    – have never been found to create nicotine dependence in any nonsmoker (youth or adult),
    – have never been found to be a gateway to cigarette smoking for anyone,
    – emit trace levels of nontoxic aerosol that poses no harm to nonusers, and
    – have further denormalized cigarette smoking (as youth and adult smoking rates and cigarette consumption have declined every year since 2007 when vapor sales began to skyrocket).

    All of the following emit more indoor air pollution than vapor products, but vaping opponents aren’t complaining about or trying to ban any of them.
    – every exhale by every smoker for more than an hour after smoking every cigarette,
    – smoker’s clothes and hair,
    – cooking,
    – plywood and other building materials,
    – glues and paint,
    – carpeting and most furniture,
    – printers and photocopiers,
    – household cleaning products,
    – dry cleaned clothes,
    – hair sprays, perfumes, nail polish and remover,
    – air fresheners, and even
    – a cup of coffee or tea.

    Unfortunately for science, public health, ethics and human rights, since 2009 Obama appointees at DHHS and their Big Pharma funded allies at CTFK, ACS, AHA, ALA, AAP, AMA, Legacy, etc. have been falsely claiming that e-cigs:
    – are target marketed to youth,
    – have addicted many youth,
    – are gateways to cigarette smoking,
    – renormalize smoking,
    – are poisonous,
    – are carcinogenic, and
    – don’t help smokers quit smoking.

    Even though none of those widely repeated claims, concerns and worries are supported by any evidence, Big Pharma shills, Obama’s DHHS and their left wing Democrat allies in Congress continue issuing weekly press releases restating those same false and disproved allegations to confuse, scare and lobby for the FDA’s proposed deeming regulation (to apply Chapter IX of the FSPTCA to e-cigs).

    Unfortunately, the FDA’s proposed deeming regulation would protect cigarettes by banning >99.9% of e-cigs and by giving the entire e-cig industry to Big Tobacco companies (because they are the only entities that have the $25 million and dozens of highly specialized scientists, engineers and regulatory staff necessary to submit a Premarket Tobacco Application for an e-cigarette product).

    Smokefree Pennsylvania’s 110 pages of comments analyzing the scientific and empirical evidence
    on e-cigs, exposing the many false and misleading fear mongering claims by Obama’s DHHS about e-cigs, and delineating how the FDA’s proposed deeming regulation would protect cigarettes and threaten the lives of all vapers and smokers, is available at:
    http://www.regulations.gov/#!documentDetail;D=FDA-2014-N-0189-80846

    It’s telling that not one opponent of the FDA’s deeming regulation was invited to participate on Harvard’s panel. So much for a balanced or objective discussion.

    Bill Godshall
    Executive Director
    Smokefree Pennsylvania
    1926 Monongahela Avenue
    Pittsburgh, PA 15218
    412-351-5880
    BillGodshall@verizon.net

  • RightWingPooFlinger

    Does root beer ‘re-normalize’ underage drinking? It’s also marketed to children.

    • Indira Iman

      Except the root-beer is sarsaparilla and non-alcohol in general.

  • mybrainworks

    Bid LIE! MILLIONS of children who NEVER smoked a cigarette are addicted to nicotine thanks to liars like you, Bill. If the statistics mean nothing to you, just open your eyes! Everyone can SEE the kids smoking this drug delivery device that causes lung irritation in smokers and those exposed to the vapor. A vapor shop opened near a local junior high school and e-cig rates there SKYROCKETED! No protection for our youth thanks to liars. Why don’t you push the already FDA approved cigarette-like NRT?

  • Kenneth Svensen

    What the heck! Why are they taking about those stupid youth’s/teenagers? I see non of them going against all those fast food restaurant’s, energy drinks like Red Bull, suger products and sweet’s. There are a lot more fat kids in the US and other industrial countries than there are teenage vapers.

    What about flavoured alcohol? Are these products targeting teenagers?

    If the goverment ban all products some teenagers would find others way to “harm” them self. Some teenagers are stupid and teenagers will always be stupid.

    1 billion tobacco users and all they think about is those few teenagers who want to try vaping or want’s to vape.

    The goverments should ban “cigalikes” and all vaping products that big tobacco are selling. Big tobacco should die out and be bankrupted in the next 10-20 years.

    Nicotine on it’s own are not that addivtive that the nicotin and other chemicals that are in a cigarette. Why are caffeine not regulated?