[We had a bit more to say about this one than would fit in the Weekly Readings, so are making a separate post of it. The Weekly Readings should appear later today.]
aThis week, two authors, the first of whom is employed by the tax-funded anti-tobacco extremist organization, American Legacy Foundation, wrote an anti-e-cigarette editorial in the New England Journal of Medicine. Despite the fears of some THR advocates, no one seems to care much about it. This is not too surprising since the essay is basically content free, repeating the same old prohibitionist claims with even less substance than is typical. But we should not overlook the real implications of this: It has to be interpreted as a policy declaration by Legacy, that they are going to campaign against all low-risk alternatives to smoking, not just smokeless tobacco.
The essay reads like it was written by someone following the instructions in a high-school science class to make a paper sound sciencey, with pointless few hundred word descriptions of what nicotine and e-cigarettes are and do — too short and narrow to be useful (they describe a single e-cigarette technology that has already been better described , failing to recognize the explosion in variations over the last year) and nothing new for anyone interested in the topic.
The only reward for the reader is the unintentional irony of their complaint that the term “e-cigarette” is misleading. Notice that this complaint about naming is coming from an anti-smoking/tobacco (and now anti-nicotine) propaganda marketing organization called “American Legacy Foundation”. Jefferson et al. would be rolling in their graves if this were really the American legacy. Their reason for calling the term misleading is not entirely clear, but it seems to be that these devices work more like other inhalers than they do like real cigarettes. This is true, but totally missed the point that more consumers find e-cigarettes to be the most appealing mimic of cigarettes, and so they are similar in the one way that counts. Of course, caring about what consumers actually want and like is not exactly Legacy’s strong suit, so their failure to understand this is not too surprising.
Most of the content is the typical “throw everything against the wall to see what sticks” approach of propagandists. They make the usual unsupported claims about safety risks. They point out that e-cigarette rigs can be used for delivering illicit drugs, though their policy proposals about nicotine will do nothing to stop this from happening. They misconstrue legitimate concerns about quality control and the trivial amount of data that exists (and which does not really support their claim) as actual existence of quality problems which have never arisen. They repeat some of the dumbest claims about poor nicotine delivery, apparently not realizing that this is one aspect of quality that consumers can detect and compensate for themselves. Again, the bias of treating nicotine users as complete morons who need to be nannied is clear.
The recommendations in the essay mostly focus on the usual nonsense about “approved” cessation methods and other nicotine products (though, not surprisingly, even as they allude to pharma nicotine products as if they are a satisfying alternative, they do nothing to address to problem that activists like the authors, and the FDA regulators they have blind faith in, are the reason that even the few people who like these products mostly do not know about THR).
But here is the bit that might matter:
For refined nicotine to ever be safely marketed under these standards, regulation must also include strict requirements — no different from those for other consumer drug products — for evidence of safety, consistent specifications, quality control, and functional dose limitations. Regardless of how regulation of refined nicotine occurs, it must ensure that no existing or future products slip through the cracks.
Though a bit subtle, this is a call from the richest anti-tobacco extremist organization in the world to make nicotine itself a scheduled substance, the only way they could fulfill this goal of asserting control over both existing and not-yet-imagined delivery systems. In other words, this is not the usual attack on branded manufacturers (“Big Tobacco” et al.), but is aimed more at the artisan vaping community. A regulation of the form they propose might be used to ban all e-cigarettes, of course. But what it would definitely do would be to criminalize the innovative small-manufacturer and do-it-yourself products that are preferred by many dedicated aficionados and advocates. Perhaps Legacy has figured out that their prohibitionist agenda is best served by letting cigarette companies and maybe a few new firms take control the e-cigarette market with highly regulated products, with the plan to then eliminate them in ways that a populist movement could not be stopped.
This might be reading too much into a single, mostly cut-and-pasted editorial, but given the authorship and choice of periodicals, it is seems perilous to assume it is a throw-away. The press was (unusually) wise in not giving this screed any play because it contained no content that was relevant to their readers. But the public health community (i.e., those of us who support THR) and e-cigarette producers and consumers should not ignore the subtle threat of a ramping up of attacks by the extremists.