Category Archives: policy

Health Canada’s anti-cigarette stance: Cui bono

Thanks to Health Canada, the e-cigarette climate in this country is an inhospitable one to say the least. There is no problem vaping if you can get them but availability is hit and miss.

Though the view in the community has been that Health Canada does not understand the nature of the product and thus are wielding inapplicable arguments against suppliers and vendors, what remains somewhat confusing is trying to understand what Health Canada has to gain in its actions. (We will assume for the sake of debate that it is purposeful in its ways – we would like to think but cannot presume that it acts in the public interest).

There is no doubt that vaping is massively safer than smoking. It is so much safer that if the whole population vaped rather than just a small portion of the population smoked you would still have a great reduction in smoking related disease. Were there no impediments to obtaining e-cigarettes it is likely that many smokers would switch.

So why the anti-vaping stance of Health Canada? Or to put it this way – who stands to lose if vaping becomes more popular than smoking?

1. The cigarette industry – dropping sales.
2. The pharmaceutical industry – a superior alternative to products that are both less effective and more dangerous. Again dropping sales.
3. The anti-smoking groups – less smoking means less need for activist anti-smoking groups.
4. Government revenues – less collected from smokers and less from tobacco settlements.
5. Health budgets – people living longer lives means increasing the national health burden.

Many of these would not hurt Health Canada. They might face budget cuts along with other departments due to shrinking tobacco revenues but that should be offset by their increased responsibility with more older but ailing folks to take care of.

So again, what do they gain by protecting tobacco and pharmaceutical interests? Do they not chafe from the internal contradictions which arise from encouraging harm reduction in every area except this one?

Note: I am pleased to announce that I have begun consulting for ECTA. While I do not anticipate any conflicts of interest (our goals are the same – improve the availability of e-cigarettes for vapers and smokers in this country) I should stress that my writing here should not be construed as communication from ECTA, These are my opinions.

What I will be doing however is writing more and more about the Canadian situation (perhaps eventually a dedicated blog). It is clear that, even in countries where strong infrastructures supporting vaping exist, attempts at banning continue. One of the great challenges in this country is to build those supports and knowing that every day that goes by more smokers develop a smoking related disease. Hopefully the day will come when Health Canada bestows on smokers the same respect it bestows on every other citizen. The true hope is for collaboration rather than conflict.

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E-cigarettes are NOT banned in Canada

You know the old canard – if it walks like a duck, sounds like a duck and looks like a duck its probably a duck? Well, what we have here in Canada is the opposite. Though Health Canada acts as though there is a ban, suggests there is a ban, and though just about everybody in this country refers to the current situation as a ban, there really is no ban.

E-cigarettes are not a health product. They are a recreational consumer good and as such do not fall under the Food and Drugs Act. Nicotine replacement therapies (pharmaceutical nicotine products used for the purpose of quitting smoking) make therapeutic claims and therefore are covered under the act. E-cigarettes make no such claims.

Despite the fact that many smokers have switched to e-cigarettes, vendors do not claim that their products aid cessation. They also do not claim their product, or nicotine, has any health benefits.

Users do make those claims but policy is based on what producers claim and how the product behaves rather than what people say it does for them. For example I could be a smoker who took up scuba diving. The more time I spent underwater the less I smoked. After a while the desire to smoke lessened more and more and I eventually quit. I could tell you that I quit smoking through scuba diving but it does not make scuba diving a quit smoking therapy.

Granted that interpreting where e-cigarettes should be categorized can be a little confusing since they are rather unique in that they are both like and unlike cigarettes, smokeless nicotine products and nicotine inhalers. What makes them really unique is that they deliver enough nicotine to satisfy smokers who are not trying to quit.

There is a strong advisory on the Health Canada website that has been interpreted as a ban.

There is also an additional document aimed at potential vendors in which you see that though they claim e-cigarettes fall under their jurisdiction they refer to them as “health products”.

Market authorization is granted by Health Canada following successful review of scientific evidence demonstrating safety, quality and efficacy with respect to the intended purpose of the health product.
In addition, the delivery system within an electronic smoking kit that contains nicotine must meet the requirements of the Medical Devices Regulations.

Apart from the point that you require a therapeutic claim to be made to be classified as a “health product”, I think many vapers though they certainly believe their e-cig is healthier than smoking still do not consider it a “health product” nor would they think of it as a “medical device”. E-cigarettes are a consumer product and as such are governed by guidelines of consumer protection (safety standards, product labelling, quality control). In many ways consumers are more fully protected there than under Health Canada guidelines. In fact, in the UK, US and in Canada too (see the ECTA site), e-cigarette vendors have banded together to create standards of excellence for the product and marketing guidelines (no selling to minors, no health claims).(See this ECITA post on how nicotine replacement therapies would not pass the standards required of consumer products – it is a British context but roughly similar to the Canadian).

The wording of the advisory is harsh but the strongest evidence for this not being a real ban is the behavior of Health Canada when someone appeals one of their cease and desist letters.

One courageous vendor has stood up to Health Canada (HC) and remains in business. On a recent VapeCast this vendor, who openly sells e-cigarettes via a website, reported on their experience with threats from HC. They received cease and desist letters and said that when they asked HC for the specific law that was being broken HC would not furnish that information. A little time would pass and then HC would send another letter with another argument. These actions ran the gamut from cease and desist to getting customs to seize product.

If there was a legitimate ban in place all they would have had to do was cite the law and take the vendor down. It appears that while they are saying there is a ban there really isn’t.

The problem is that if you think there is a ban then you start acting as though there is. Many vendors have switched to selling non nicotine e-cigarettes (Health Canada does not seem to have a problem with those as “medical devices”) or have simply closed their doors. And though it is easy enough to say that everyone should stand up for the cause, in Canada, almost of these companies are too small to muster the resources that they think might be required.

There is a lot more to say about this. Stay tuned. This will be a recurring topic on the site. Bullying by Health Canada is depriving smokers of a safer alternative to using nicotine – it is saying in no uncertain terms that smoking is the preferable route.

If you have a story about an experience dealing with Health Canada on this issue leave a comment or send me an email describing it and I will report it (I am happy to keep it as anonymous as you wish).

New Four Country E-cigarette Survey Published

I’ll get back to the Bad Apple post but this is worth publicizing (noticed it on Michael Siegel’s Rest of the Story).

The citation is Adkison SE, et al. Electronic Nicotine Delivery Systems: International Tobacco Control Four-Country Survey. Am J Prev Med. March, 2013 (article here).

If you go to the article and take a look at Table 1 (awareness and use of e-cigarettes among smokers) you will see how smokers are faring in countries where e-cigarettes are essentially banned (Canada and Australia). While the awareness of e-cigarettes was substantially lower in Canada, the real difference comes in how many smokers actually tried them (roughly half compared to America). The real killer (and it is unfortunate that that does really describe the end result) is that the percentage of Canadians who tried vaping and then became users is about the same as the percentage of Americans.

In other words, it is equally attractive and effective for users in both countries but in Canada the current restrictions (not surprisingly) lessen the number of how many smokers know about e-cigarettes and thus how many try them and how many will switch from smoking. Thus current policy serves to maintain higher national smoking numbers than would naturally occur.

And by naturally I mean if e-cigarettes were as available as cigarettes.

There is a lot more meat to chew over in the article and I do encourage everyone to read it over. The one sour note I find on a cursory first scan through is the final line of the conclusion: “If credible evidence can be provided that ENDS reduces the number of cigarette smokers and does not attract use among nonsmokers, then the net public health effect is likely to be positive”.

Its been quite clear for some time that the level of risk associated with vaping is so much lower than that with smoking that if everyone vaped rather than anyone smoke the net public health effect would be overwhelmingly positive.

Canada’s health experts don’t mind lying to the public

Two items this week once again make me think twice about self-identifying as Canadian. I suppose I can take solace in the fact that one’s country and one’s identity is something quite different from what occurs in the corridors of power, or whenever prohibitionism rears its mishapen head.

The first item, brought to my attention via Velvet Glove, and reported in the Huffington Post, is about a spate of tainted ecstacy related deaths in Western Canada. What is crucial in the report is that the coroner, Lisa Lapointe, had pinpointed the unique look of the bad batch but did not make this information available to potential victims because “We don’t want to give the impression that these are the tablets that are risky, and other tablets are safe”.

While we might not be certain that the other ones are safe, we do know that the ones she found were poisonous, and in the interests of a political and not a health-related aim, she left the public at the same level of risk as before. Her job, as I understand it, is to find out what is causing harm and then taking the steps to reduce the likelihood of it recurring.

What is also remarkable about this is that the most prominent Canadian reports on this ceased to mention that the unique design had been uncovered and that that information was being deliberately withheld from the public.

How provincial are we getting when we need another country’s news agency to report on the most information in a domestic story, and the locally relevant life and death ramifications.

As far as I know, this dereliction of duty has not imperiled Lapointe’s appointment; how do you suppose we would treat a transport commissioner who did not label dangerous roads because that might give the false impression that all the other roads were safe?

The second story did get good local coverage but reported verbatim misinformation (lies to be perfectly accurate about it) from physicians who claimed to be concerned about public health. The story was a bit of a press release/ activism trying to raise support for the banning of shisha (flavoured tobacco used in hookahs).

The “good” doctors don’t seem to have much of a problem with unflavoured tobaccos but just tart up the product a bit and suddenly it is more dangerous.

They start with the old loophole complaint in that tobacco companies responded to the banning of flavoured small cigars by making them bigger and thus not subject to the regulation. What they seem to ignore is the ban was motivated by the belief that kids liked small cigars (which is why they did not target regular cigars in the first place). So if the company, which is well aware that there were plenty of adults who liked small flavoured cigars, sought to deliver a second-best choice to their stranded adult customers, how is that a loophole?
But I digress.

The passage I found such exception to was

Physicians for a Smoke-Free Canada wants all flavoured tobacco products banned, including shisha, because of their appeal to young people. Shisha, flavoured chewing tobacco and other flavoured products are sold with no warning labels, or with small ones, leading the public to believe they are not as dangerous as cigarettes, the group said.

“If Health Canada required these products to carry large health warnings like those on cigarettes, kids would be more likely to understand how harmful these products are,” Kapur said.

I find it quite strange when most of us regular folks are quite concerned about tossing around anything that could be construed as lies or ignorance, that this Dr. Atul Kapur, the leader of a national organization, has no problem parading, in full view, what is certainly one or the other. Insanity or arrogance, take your pick.

As in the case with the ecstacy, health officials are deliberately withholding information from the public which could affect their future prospects. Here they wish the authoritative line to be that cigarettes are no more dangerous than smokeless tobacco.

Of course what we really should all be clamouring for are large product descriptions saying just how much safer these products are than smoking.

What these maps imply about tobacco control in the developing world

I ran across a fascinating resource (Worldmapper.org) which maps various health outcomes onto regions of the world and thus produces a global picture which when compared against the typical map indicates imbalances or concentrations depending on your outlook.

This first map is one of prostate cancer deaths; that is, a cancer unrelated to smoking history. What you notice is that Africa roughly approximates its shape on a typical map.

Now take a look at lung cancer deaths ( see map below).

What you see in an Africa attenuated to the point of almost disappearing. Not of course if you look at something like malaria (again see map below).

This of course is quite a simplistic observation to make with just a few specifically chosen maps but I think the point is valid. When the FCTC targets regions like Africa and asks (demands) that health resources be used for tobacco control operations, the money that would make a difference if applied toward malaria (or countless other endemic diseases …see more maps on the site), that would save many lives, is funnelled off into satisfying political aims with little effect on mortality.

More on menthol: contradictions and implications

As a followup to Carl’s post on the menthol issue and specifically in regards to his paragraph on how someone in harm reduction could be torn between supporting any drop in quality of cigarettes (since that would drive people to lower harm alternatives) and the wish to maintain individual liberty, I would like to add a few related (and unrelated) points.

If you pressure people to safer use by reducing cigarette smoking pleasure there is no reason to believe that such actions will remain specific even to tobacco. As the world generally becomes safer, the minimum standards for safety become ever more stringent and relatively low risk and common every day behaviors might end up generating similar regulatory responses. And then you start worrying about the loss of overall quality of life (as in the salt free future of Demolition Man).

Recall that the argument here has been not that menthol cigarettes are more harmful but that for enough people they are more appealing. Or as one Jonathan Turley put it: “The message seems to be: you can sell tobacco products unless they are too popular with consumers”. But you could just as well argue that for even more people non-menthol cigarettes are more appealing so in a sense you are penalizing smokers who happen to exhibit a certain taste preference. Much has been made of menthol cigarettes being the cigarette of choice in the African American community but could it not have been just as easily concluded that Caucasian Americans overwhelmingly preferred non-menthol cigarettes and perhaps that would be a more effective prohibition? The harm reduction argument of course is that some menthol smokers might stop or switch because they cannot abide non-menthol smoking but I would bet the same would be true of non-menthol smokers contemplating a future of undesired freshness.

If removing menthol products actually resulted in some people quitting (and thus lowering their health risks) this would end up as a benefit. However, it would be a cost if all that happens is that menthol smokers keep smoking but enjoy it less. So if there really is that racial divide on this, nobody is telling African Americans they can’t smoke, just that they won’t be allowed to enjoy it as much as everyone else. I doubt that anyone was really thinking this but it should have popped up on the radar considering that only a few decades ago, it was not uncommon to limit that same community to lower quality goods than would otherwise be the rule.

But to move this up to the level of a more general health-relevant concern, people who advocate reducing product quality have as their purpose reducing consumption and not shifting users to safer sources. What we have seen in tobacco is that the FDA flavoured cigarette ban has ended up being the impetus for attempted bans of all flavoured tobacco products and e-cigarettes. If the menthol debate results in menthol reduction demands for cigarettes, it is pretty well certain that it will generalize to smokeless products as well.

What would resolve the issue (from the harm reduction point of view) is if the same voice that promoted reducing the quality of harmful products would also promote high quality in the less risky products. Lower the menthol in cigarettes but leave it untouched in the safer products and actively promote them as mentholated products.

You need to make switching appealing and not just good for you. Safer alternatives should be given all the leeway in the world to be the tastiest nicotine products available. If product appeal drops across the board, there is less of an incentive for anyone to switch; you might as well then just keep on smoking.

By Paul L. Bergen

Statements made at the Scientific Standards for Studies on Reduced Risk Tobacco Products meeting

Thanks to Bill Godshall, we can give you the links to some of the statements made at the Scientific Standards for Studies on Reduced Risk Tobacco Products meeting to advise the FDA on the minimum standards for scientific studies to allow the marketing of modified risk tobacco products, and for post-market studies of marketed products.

1. Statement from Scott Ballin

Excerpt:

I also suggest that we consider redefining our terms about the spectrum of products in the market place. Calling any tobacco product that is a not burned a ‘smokeless product’ is no longer accurate or even useful. I prefer to use the term Smoking Replacement Product or SRP because that allows us to look at the growing spectrum of noncombustible products (tobacco, nicotine, and alternatives) in terms of risks and relative risks and intended use, and to label and set marketing standards for such products based on those risks.

2. Statement from Bill Godshall

Excerpt:

Requiring additional scientific studies before a company can make these types of modified risk or reduced exposure claims would be a “truth tax” for far less hazardous smokefree alternatives, would unfairly protect cigarettes from market competition by lower risk alternatives, and would threaten instead of improve public health.

3. Statement from Elaine Keller

Excerpt:

We were astonished and outraged to learn that, decades before the invention of electronic cigarettes, we could have stopped inflicting smoke-related damage to our bodies without becoming nicotine-abstinent. We were deceived about the relative safety of non-combusted tobacco products. The government and so-called public health organizations misapplied the word “safe” in the messages, “This product is not a safe alternative to smoking” and “There is no safe form of tobacco.” Most folks think they’re saying there is no safer form of tobacco than smoking. These messages encouraged smokers who did not want to give up nicotine to keep inhaling smoke, when they could have switched to products that reduce smoking-related disease risks by up to 99%! Their half-truths have killed millions of smokers and continue to do so today.

To provide your own feedback on this project…

Gulf States discussing total ban of e-cigarettes

Just yesterday the GCC Health Ministers Council (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and UAE) set the stage for a total ban of e-cigarettes.

A statement issued by the conference underlined the “necessity for imposing a total ban” on e-cigarettes in line with the WHO guidelines and the findings of recent studies on the product.

Anti-smoking activists in the region have been campaigning for a ban on e-cigarettes, which are used as an alternative for traditional cigarettes, on grounds that it is more dangerous to the users compared to the traditional cigarettes.

I’m not sure why the level of misinformation regarding e-cigarettes is so astonishingly high in this part of the world but every few weeks there seems to be another outrageous statement such as:

Water vapour is absorbed by lungs, which can cause even lung cancer, says WHO report.

The US Food and Drug Administration (FDA) recently issued a warning to e-cigarettes users after it found the sticks contain carcinogens and toxic chemicals such as diethylene glycol, an ingredient used in antifreezes.

The recurring two items that seem to show up in almost every one of these articles out of this region are the FDA findings and the WHO advisory.

Oddly enough, the WHO advisory simply stated that there was no evidence yet for long term safety, and no non-anecdotal evidence that would support producers making cessation claims. This now close to three year old and rather restrained communication has through the wonder of the embellishment machine we call the media become a howling warning of danger.

And quite similarly, despite being widely dismissed as substandard work, the FDA report has become the official word on e-cigarette safety. What I fail to appreciate is why this report ever assumed the stature it did, and why (in the world) it achieved any prominence outside the borders of the United States. (Yes, I know they are a big country, and the FDA is well known but still, these are independent countries with their own research facilities, and some sense of national pride, are they not?)

Now of course it is quite possible that, just like most everyone else, the powers that be have an end in mind and then cast about for supporting (and tweakable) views.

One of the issues here is that we have authoritarian or tending toward authoritarian governments using tools generated in regions that are less so. As misguided as the FDA is, various agencies and the population itself act as checks on them, and as cynical as we might be about that process, it is still much more likely to end up benefiting the many than what happens in many other parts of the world. But then, these same tools generated in a democratic context, even if discarded on the home front, are then picked up by others to use.

So in summary, we have a substandard product assay from a far away country (otherwise often demonized in this part of the world) and a warning about proper product description from an international health agency being used as the main evidence to support the actions of a government to remove the availability to its people of a safer alternative to smoking.

And this too will be chalked up as a victory for the anti-smoking forces.

-Paul L. Bergen

When quitting is an option and not a necessity

Though it seems to be so much more common and easier to divide behaviors into good and bad, the problem with drug use is that it is so much more complicated than that. Drug users are as varied as anyone, and since almost everyone is a drug user of some kind, its pretty specious to draw such presumptuous demarcations. Once you replace morality with health (health, in my opinion, actually being the more “moral” approach) more natural and pragmatically useful categories come into play.

Rather opposing abstention and use, why not envision an opposition of bad enough to worry about and not bad enough to worry about. Forgive the vernacular but to me it seems to make more sense than terms like safe or dangerous.

With the dominant mindset we have all nicotine users (whether snus-ers, smokers or vapers) lumped together and on the other side the abstainers. The inappropriateness of this grouping (in the context of public health) is also evident when nicotine users are contrasted with prescription drug users, alcohol consumers or any other drug users. Its just not helpful when someone on anti-depressants or beta blockers criticizes someone for boosting their neural process or relaxing via a dose of nicotine.

But the main point is that the practical division is along the lines of how risky a behavior is. Once health is the measure then we will find that the constructive nicotine use breakdown is smokers on one side and everyone else on the other. (This is not meant in any way as castigating individuals who choose to smoke but is simply a breakdown of what health risks the behaviors are associated with. Its no different that separating high from low risk sports activities. Higher risk activities are not morally suspect; they are just higher risk.)

Once the powers that be stop blocking basic information about the comparative risks of various nicotine deliveries and once people understand that in the long run switching to snus or e-cigarettes is roughly equivalent to quitting then we should see a dramatic increase in switching and we might also see attitudes toward quitting change.

As mentioned in the last post, even if the health risks of using nicotine are perceived as negligible some people will still want to quit -and all the power to them. The point is that people should have the information and they should have the right to do what they will with that information.

What intrigues me is what might happen to the multi-billion dollar cessation industry should the THR message be widely acknowledged. Obviously some of the current cessation products will be reconfigured or remarketed as “dual use”, that is, as either cessation or switching products. (I’m pretty sure this is already taking place to a degree.) This industry, which maintains such mutually beneficial bonds with tobacco control, just might need to disengage in the interest of developing and then promoting products for tobacco harm reduction.

If Big Pharma holds its present course, and tobacco/nicotine use policy moves to being health-based, then the whole cessation industry will become even more like the diet or exercise fad industries – useful for a very small part of the population but a waste of time, money and effort for most. Those industries serve to delay too many people from pursuing the real solutions to their problems.

Most smokers have been browbeaten into believing that they have to try and quit on a regular basis, and many do the quit and relapse dance to exhaustion. (I wonder how much smoking takes place to take the edge of having to contain that identity clash of simultaneously being a smoker and being a quitter.) They have also been misled to believe that pharmaceutical aids to quitting are pretty well mandatory. (See here for Chapman’s critique of the lack of official support for cold turkey; if you are in the market for quitting nicotine, it seems to be the way that has worked for most).

The “official” explanation of the failure rate is that it takes many attempts to successfully quit. I can just imagine the meeting on that one.

“Bob here says the figures show that almost all our customers are failing up to ten times. They do eventually quit but hey, there must be something wrong with our product. And thanks for that Bob but you are looking at it the wrong way. Its not a product problem; its a user profile. The product is perfect. Smokers are just so addicted that it takes that many time to break through their addiction.”

“Maybe they’re just quitting after trying that long and it has nothing to do with our product?”

“Don’t be an idiot.”

Regardless of the THR message being widely accepted or not, these companies will still push their products as being healthier and safer than e-cigarettes and smokeless tobacco. In the meanwhile, most everyone will come to understand that there are few real differences among all these low risk nicotine delivery methods (especially once the smoke clears on the crucial combustion/noncombustion divide). People will also realize they have the power to choose between continued use or quitting with negligible differences in health consequences.

When we reach that point, those who have been actively opposing and obscuring the truth about these products will be revealed for what they really are: not public health advocates, not beneficient guardians of the public trust, but as sadly impoverished abstinence-only advocates. And not only just abstinence-only advocates, but abstinence-only advocates of a relatively benign (and in fact very useful) drug. Here’s hoping that day comes soon.

-Paul L. Bergen

Two Canadians scratch their heads over New York moving closer to banning e-cigarette

[Catherine and I write this with the warning to readers that we know just enough about U.S. politics to get at least something wrong. On the other hand, as we know from trying to understand our own country’s politics, being American might not have gotten us much closer to the truth.]

As most readers of this blog are now probably aware, just recently New York’s Assembly Health Committee overwhelmingly passed a measure (21-4) that would ban the e-cigarette until the FDA passes final judgment. This is, of course, terrible news not only for New York vapers, but also for all those would-eventually-switch smokers. Should this bill advance (it has yet to pass the Senate), a ban here could set a precedent for other states to follow.

Historically we (and we mean us two – we cannot speak for all Canadians) have always rooted for the Democrats in the United States, because being left-leaning ourselves, they have always seemed the better choice (just a little more like Canadians if that doesn’t offend anyone; we’d even say socialist, since up here that’s just another word, but we realize that down there it might cause some readers’ heads to explode). However, in light of the direction they seem to be going in recent years, both parties seem increasingly alien to us. As Carl explained in a previous blog posting, when it comes to drug wars and being anti-harm reduction (and too pushy in general when it comes to passing bills that limit people’s choices, ostensibly in the name of public health), the Democrats seem to be in the lead.

It’s strange that this bill has been passed by the same health committee that just last year defeated a bill that would have reduced abortion rights, on the ground of defending women’s choices. Now, a little over half a year later, this committee apparently feels that smokers do not deserve the right to reduce their own health risks by having access to a vastly safer nicotine product. So it would seem that they feel the need to protect women’s choices, but not the safer options for smokers? We’re baffled. All this, of course, is done in the name of public health. However, as Chris Snowdon has pointed out, Linda Rosenthal (the Democrat who sponsored the bill) has indicated that it actually has more to do with her own anecdotal experience with cigarettes. She has stated that because she quit smoking without the aid of e-cigarettes, so should everyone else. This does not quite seem in line with promoting a more equal society based on the acknowledgment that all people are different and that luck plays a part in whether we end up rich or poor, healthy or not healthy; this bill instead seems intent on punishing those engaging in something considered sinful. (At the very least it demands that only politically correct means of atonement – sorry, we mean “quitting cigarettes” – will be acceptable.)

Another crucial piece of this puzzle of course is that lawmakers seem to be unable to separate nicotine use from health effects. Fixated on the fact that these devices will allow people to continue using nicotine, it does not seem to matter to them, or they are too blinkered to see that what matters more is whether users are healthy or not.

In the January 18 Wall Street Journal Opinion Page, Barack Obama had an article published in which he wrote

I am signing an executive order that makes clear that this [striking the right balance] is the operating principle of our government. This order requires that federal agencies ensure that regulations protect our safety, health and environment while promoting economic growth.

In his e-letter, Bill Godshall pointed out that this could easily read as an endorsement of harm reduction and in particular, electronic cigarettes. Currently the amount of money and effort being spent (and much if not all of that being financed by the American public through taxation) to erect barriers to e-cigarettes and their use is at the best a colossal waste of money and at worst a betrayal of the public trust.

Unfortunately Obama’s seeming valuation of consensus over leadership, as further evidenced by yesterday’s State of the Union address, holds out few hopes of changing the present sorry state of affairs. In 2009, Ethan Nadelmann held out the hope that change for the better would arise out the recession; that tighter budgets meant, as he put it, “we can no longer afford to pay for our prejudices”. He was referring more to the drug war and the high rate of incarceration but the remark would aptly fit anti-tobacco policy as well.

America is still in recovery and has additional challenges to face at this time – a rocky road for the foreseeable future – and if Obama is like the driver, he is also suggesting that the others in the car (including the kids presently fighting in the back) should help steer. With any luck, he’ll pull over to have one of his rare smokes, maybe try an e-cigarette, and then maybe his anecdotal evidence might outweigh Rosenthal’s; when it comes to anecdotal evidence, as we all know the validity of anecdotal evidence is directly related to the fame of the expounder.

The promise of vaping, quite possibly the holy grail of tobacco harm reduction, should not be being sullied by the likes of Rosenthal, who does a little research and finds e-cigarettes “too mysterious” to be allowed. This is just a baby step up from the public warning on e-cigarettes from the Department of Health in Manila that these products not only might not help with quitting smoking but “worse, it could even deliver nicotine to the lungs”. It’s just sad when the person on the street seems to know so much more about these than the people who have the power to ban them.

At the end of the day, however, this bill has advanced whether we like it or not, and our disappointment in the the New York Assembly Health Committee is obviously great. It will be interesting to see if hope is revived through the Senate (currently held by the Republicans), where there is still a chance for some intelligence on this issue and thus its defeat. Considering the track records on this issue, it would be simple enough to continue castigating the Democrats and expecting more of the Republicans, but party memberships seem to be only one small indicator of where someone might stand on this issue.

If there is ever an issue that should transcend party lines, it is access to better health, and the protection of the right to choose that better health. Individual ideas about what people *should* be doing, and forcing them along that path in the name of public health (when it really has to do with purity), should simply not be on the agenda of any legislator, Republican or Democrat.

(Disclaimer: We cannot claim the slightest superiority in this issue. We speak from sad experience; we suffer because our “health experts” deemed e-cigarettes to be more dangerous than smoking banning them before most Canadians even knew what they were, and we also have a leader who, as much as we criticize Obama, would trade for him in a New York minute. )

-Paul L Bergen and Catherine M Nissen