Testimony to the Baltimore Judiciary and Legislative Investigations Committee

Published October 7, 2014

Distinguished members of the committee:

Thank you for the opportunity to testify on the important topic of vapor products, which are commonly referred to as electronic cigarettes or e-cigarettes. I am a Research Fellow with the Heartland Institute with a specialization in the area of tobacco and vapor products. 

Nearly 4 years ago – after struggling to quit for much of my adult life with products like the nicotine gum, patch, and lozenge — I quit smoking overnight with a watermelon-flavored electronic cigarette.  After having such a positive experience, I was shocked to see that so-called anti-smoking advocates were out urging state governments to ban the sale of electronic cigarettes to adults – a tactic that they have wisely abandoned in recent years – and restrict their usage in the same way combustible cigarettes are.  I began intensely studying the issue, and not long after came to the conclusion that these public health groups were, in effect, communicating a dangerous message: Quit or Die.[1]  These groups’ opposition to a third choice for smokers – use of low-risk nicotine products – was and remains a true public health problem.

Heartland is in agreement with many in the public health field that electronic cigarettes represent our best hope yet to get millions of American smokers to quit inhaling burning smoke into their lungs on a daily basis.  Every month, as the scientific literature grows supporting e-cigarettes as likely being 98-99% less hazardous than smoking, the support for harm reduction policies among public health advocates, and even some in the tobacco control community, grows as well.  Indeed, earlier this year more than 50 scientific experts signed a letter to the World Health Organization calling vapor products “among the most significant health innovations of the 21st century — perhaps saving hundreds of millions of lives.”[2]

Additionally, in January the staunchly anti-tobacco Dr. David Abrams of the Legacy Institute, which used to run the very graphic anti-smoking Truth Campaign commercials, penned an editorial in the Journal of the American Medical Association entitled, “Promise and Peril of e-Cigarettes: Can Disruptive Technology Make Cigarettes Obsolete?”[3]  Dr. Abrams and many others believe the answer to that question is a resounding YES.

These public health advocates supporting e-cigarettes are almost universally extremely strong proponents of smoking bans.  But because e-cigarettes do not create smoke and have not been shown to emit levels of chemicals that are harmful to bystanders, these advocates do not support banning usage where smoking is banned.  Indeed, Dr. Abrams, speaking at a conference in New York at the end of last year, argued that electronic cigarettes should not be subject to sin taxes or usage bans as a way of nudging smokers towards voluntarily making a healthier choice.[4]

Unfortunately, opponents of vapor product use by adult smokers remain determined in their quest to have legislators, newsmakers, and the general public believe that there is no practical difference between an electronic cigarette and a combustible cigarette, even though electronic cigarettes are smoke-free, tobacco-free, and often nicotine-free.  Some of these misguided activist organizations have gone so far as to endorse banning e-cigarette use in people’s private homes like apartments and public and senior housing.

A favorite tactic of e-cigarette detractors is to make reference to scary-sounding chemicals that have been detected in e-cigarette liquid or vapor.  Critically, they fail to note the actual levels of these chemicals found.  In doing so, they ignore a central tenet of toxicology – the dose makes the poison.

For example, opponents are fond of saying that e-cigarette vapor contains metals, implying that e-cigarette vapor is a source of inhaled toxic metals.  Without proper context, presentation of this information is misleading.   Dr. Michael Siegel, a long-time anti-tobacco researcher who testified against cigarette companies in lawsuits that cost them billions, has noted that the levels of metals delivered to vapor product users are far lower than the daily exposures permitted by the authoritative United States Pharmacopeial Convention for inhalable medications.[5]  Indeed, Dr. Siegel compared the levels of metals expected to be inhaled by the average e-cigarette user vs. the average Nicorette inhaler user and found that the levels were nearly identical. For some metals, electronic cigarette vapor contained LESS metals than the Nicorette inhaler. But again, these trace levels are allowed in medications, and metals in neither e-cigarette vapor nor the mist released by a nicotine inhaler is a threat to the user or bystander.

I’d like to bring your attention to two critical indoor air studies.  First, the medical journal BMC Public Health recently published a study by Drexel University Professor and toxicologist Dr. Igor Burstyn entitled “Peering Through the Mist.”[6]  Dr. Burstyn utilized over 9,000 observations of electronic cigarette liquids and vapor in order to assess possible threats to the direct user and bystanders.  With regard to bystanders, Dr. Burstyn concluded that the levels of chemicals in e-cigarette vapor are so low so as to pose no apparent risk.

Second, the journal Tobacco Control published an excellent study a year ago that was funded in part by the National Institutes of Health.  That study tested 12 different e-cigarettes vs. a traditional combustible cigarette vs. the FDA-approved Nicorette inhaler.  That study reported the levels of toxicants and chemicals identified as causing harm in cigarette smoke were present at trace amounts 9-450x less than in cigarette smoke.[7]  Even more importantly, the researchers noted that the levels were similar to those that are released by the Nicorette inhaler. 

States should follow the lead of respected public health advocates who have studied and published on the issue.  Vapor products are creating ex-smokers every day in Maryland. The State and Baltimore should seek out any measure that would welcome this switch.

In conclusion, e-cigarette usage bans have no basis in toxicology and allowing private businesses to make their own choices on the matter is the best policy at the present time. If usage bans are to be enacted, they should recognize the difference between traditional cigarettes and vapor products by, for example, permitting usage in adult-only establishments. 

Thank you for the opportunity to testify.

[1] Fagerstrom, K. “Quit or Die: Nothing in between?” Respiration, September 2002, https://www.karger.com/Article/Abstract/64017

[2] Hirchsler, B. “Top scientists warn WHO not to stub out e-cigarettes,” Reuters, May 2014, http://uk.reuters.com/article/2014/05/28/health-ecigarettes-idUKL6N0OD3ZE20140528

[3] Abrams, D. “Promise and Peril of e-Cigarettes: Can Disruptive Technology Make Cigarettes Obsolete,” Journal of the American Medical Association, January 2014, http://jama.jamanetwork.com/article.aspx?articleid=1812971

[4] Herzog, B. “A Vaping State of Mind – Regulatory and Public Health Panels – Transcript,” Wells Fargo Securities, November 2013, document available by request.

[5] Siegel, M. “Metals in Electronic Cigarette Vapor are Below USP Standards for Metals in Inhalation Medications,” Rest of the Story – Tobacco Analysis and Commentary, April 2013, http://tobaccoanalysis.blogspot.com/2013/04/metals-in-electronic-cigarette-vapor.html 

[6] Burstyn, I. “Peering through the mist: systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks,” BMC Public Health Journal, January 2014,http://www.biomedcentral.com/1471-2458/14/18/abstract

[7] Goniewicz, M., et. al. “Levels of selected carcinogens and toxicants in vapour from electronic cigarettes,” Tobacco Control, March 2013, http://tobaccocontrol.bmj.com/content/early/2013/03/05/tobaccocontrol-2012-050859.abstract