The Rules Committee of the San Francisco Board of Supervisors moved yesterday to recommend an ordinance amending the city’s Health Code that would “prohibit the use of electronic cigarettes where smoking is otherwise prohibited.” In addition, retailers of vaporizers would have to obtain a tobacco permit, and sales would be barred at locations where cigarettes are also barred, such as pharmacies which sell nicotine gum and lozenges.
Supervisor Eric Mar, the author of the bill, has been a valiant crusader against smokers during his term and opened the discussion of the matter by warning that “this might shock and horrify” before doing something that is “completely legal” and puffed on an e-cigarette. Though discussion on the matter had been stacked with supporters of the measure, opponents broke out with a boisterous cheer and applause. Later, Supervisor Norman Yee stiffly delivered his line: “Stop blowing that in front of my face!”
As theatrics go, Mar and Yee could benefit from taking an improv workshop together, or at least running through some rehearsals. But the sketch comedy was followed up by a line of equally passionate anti-smoking true believers, including UCSF researchers like Doctor Stanton Glantz who’ve built their careers on studies detailing the harms of tobacco smoking.
The only problem is, electronic cigarettes or portable vaporizers don’t emit any smoke. There is no combustion. While they do deliver nicotine, it’s not as fine smoke particulate but as an aerosol vapor for absorption through the mucus membranes lining the mouth, throat and nose. While it’s possible to inhale the aerosol into the lungs, most regular users don’t after a time because it doesn’t do much to speed delivery of nicotine to the blood stream, it just makes you cough like you might if you got a lungful of steam from a hot shower.
Glantz, who was invited to speak, and his colleague Lauren Dutra, who spoke during the public comment period, had just published a paper in the Journal of the American Medical Association Pediatrics using data over a year old from the National Youth Tobacco Survey which concluded that among minors who have experimented with vaporizers, there is evidence that they have also experimented with cigarettes. So they concluded that “use of e-cigarettes does not discourage, and may encourage, conventional cigarette use among US adolescents.” On which basis they argued in the hearing that, clearly, vaporizers were therefore going to lead more minors to smoke cigarettes. Sorry, vaporizers “may” lead more minors to smoke cigarettes.
Won’t somebody think of the children!
(No word on if this same cohort in the study also experimented with alcohol, pornography, video games, roughhousing, grabassing, sassback or other objectionable behaviors, but I’m sure a correlation could be found if an ambitious PhD candidate with an agenda looked hard enough.)
I poke fun because during most of the hearing, anyone presenting anecdotal evidence of the efficacy of nicotine vaporizers as a smoking cessation tool and harm reduction strategy, or even asserting that the aerosol is relatively more benign than tobacco smoke, or that what toxins there were in vaporized aerosol were in minute amounts, or evidence from studies that contradicted those presented by UCSF representatives were immediately and aggressively challenged by Mar from the dais and their assertions summarily dismissed. It became clear very quickly that this was in no way a hearing on the evidence, but a political passion play.
In other words, the nicotine fix is in. Having sailed through committee, this is probably going to pass the Board of Supervisors, possibly unanimously. And either way, Mayor Ed Lee will probably sign it.
It’s true that there aren’t a lot of studies on the topic of vaporized nicotine toxicity, but what studies exist aren’t necessarily conclusive. If anything, the medical consensus is that while there may be some unanticipated harms, for the most part, the levels of toxins are multiple orders of magnitude lower than those in tobacco or tobacco smoke, and while nicotine is a carcinogen, it is a relatively weak one compared to the compounds in tar. According to Reuters:
Mitch Zeller, head of the FDA’s tobacco division, said in an interview that there is a “continuum of risk” among nicotine products currently on the market, with cigarettes on one end and medicinal nicotine on the other. He declined to say where on the spectrum he expects e-cigarettes to fall or what is contained in the FDA’s proposals. In general, he said, people smoke for the nicotine and die from the tar.
“I’m not saying nicotine is benign, but when compared to the risk associated with regular tobacco, it pales,” he said.
The good news is, as Supervisor Katy Tang pointed out in her remarks asking to be included as a sponsor for the legislation before committee chair Yee banged the gavel on the motion to recommend it to the full board, is that it’s not a full ban. Though it’s not really clear how the new regulations will do anything more to protect children when sales of vaporizers to minors are already illegal under state law, it provides no provisions to regulate the production or marketing of the product (though the FDA should be handing down guidelines on these soon enough) and there’s no way this will impact the potential sale to minors online.
There were repeated assurances that this won’t impact the use of vaporizers for medical marijuana patients, based on the City Attorney’s interpretation of the language in the ordinance. And Mar suggested that the regulations will only apply to vaporizers that look like traditional cigarettes. In the definitions listed under Section 19, Number 2, item B of the proposed legislation, it reads:
“Electronic Cigarette” or “E-cigarette” means any device with a heating element, a battery, or an electronic circuit that provides nicotine or other vaporized liquids to the user in a manner that simulates smoking tobacco.
As Chris Roberts pointed out at the San Francisco Weekly, “other vaporized liquids” could mean a whole host of things, including simply flavored vapor with nothing otherwise fun about them. Mar suggested that this only means vaporizers that look like traditional cigarettes, including Lorillard’s market-leading Blu. Most of the vaporizer users I know, including myself, use devices that look more like a pen which can be used with both nicotine and cannabis solutions.
So Mar and supporters are arguing that vaporizers shouldn’t be used in bars and other public places because staff, security or police can’t necessarily tell the difference between a cloud of smoke or a cloud of vapor and that it’s asking too much for them to take the time to distinguish before intervening. But they turn around and assure people who legally use cannabis with a doctor’s recommendation or devices that don’t attempt to resemble cigarettes that they won’t be unduly harassed because, well, the City Attorney has assured everyone that the regulations don’t apply to them.
So which is it, are authorities and concerned citizens too busy to be bothered to tell the difference, or will they be expected to narrowly enforce the regulations? Users are concerned that it’s the former, and people will be fined first and forced to defend their use later. And whatever the City Attorney’s opinion, the interpretation of the language in practice will be up to the courts. As it stands, business owners are already allowed to make their own decisions regarding use in their establishments, much like they are with Google Glass and other new technologies, and the San Francisco Board of Education is set to mandate vaporizer use on public school campuses soon.
Trust me, I’m as uncomfortable as most San Franciscans with anything coming from the American Enterprise Institute, but Sally Satel’s recent opinion piece in the Washington Post has a number of good arguments as to why policy makers shouldn’t rush to make hasty decisions that aren’t unreasonable.
Yes, we still need research on the long-term health and behavioral impacts of e-cigarettes. Brad Rodu, a pathologist at the University of Louisville, offers an apt analogy between electronic cigarettes and cellphones. When cellphones became popular in the late ’90s, there were no data on their long-term safety. As it turns out, the risk of a brain tumor with prolonged cellphone use is not zero, but it is very small and of uncertain health significance.
In my own experience, I was a pack a day (or more) smoker for almost eighteen years before finally making the switch early last year — after trying traditional nicotine replacement therapy and varenicline (Chantix), neither of which ultimately proved successful and the latter’s side effects include suicidal depression. While I do occasionally still enjoy an analog cigarette, my use dropped almost immediately to two packs a month, then one, and is now considerably less than that.
I have a pack of cigarettes at home that I’ve been ignoring for weeks. Once in a while, they’re a special treat, but the times I’ve had to switch back for whatever reason it quickly became apparent after only three or four cigarettes when the headaches would set back in and my lung capacity and energy levels would begin to fall that vaping was by far the healthier option. Not to mention the fact that I quickly started to reek of tobacco again.
I spoke about the proposed legislation with a local business owner who sells vaping supplies and preferred to remain anonymous. He already has a policy of not selling to minors or even non-smokers in place. He said that he’d back restrictions on advertising and marketing, understood the concerns of other business owners who’d rather not have to distinguish between vapor and smoke, and was enthusiastic about regulations on the manufacture of the solutions, with and without nicotine, that are used in the devices.
His customers, by and large, “are working people,” he pointed out, something that’s been backed up by my experience—and while it costs a little more up front, it’s a cheaper habit over the long term, which reduces the economic harm of nicotine addiction as well. His biggest gripe is with the hypocrisy of pretensions to acting for the good of public health by restricting the use of something that’s pretty clearly less harmful to people addicted to smoking tobacco and those around them.
According to University of California, Berkeley Political Science professor Zachary Kahn and Boston University School of Public Health professor Michael Siegel in a paper for the Journal of Public Health Policy titled “Electronic cigarettes as a harm reduction strategy for tobacco control: A step forward or a repeat of past mistakes?”
With entrenched skepticism toward harm reduction now manifested as deep cynicism about electronic cigarettes - a distinct product that actually does reduce risk and threatens cigarette makers - the tobacco industry is ironically benefitting from its own past duplicity. The push to ban electronic cigarettes may repeat the mistakes of the past in the name of avoiding them. Regulatory policy for electronic cigarettes and other novel nicotine products must be guided by an accurate understanding of how they compare to tobacco cigarettes and [Nicotine Replacement Therapy] in terms of reducing toxic exposures and helping individual smokers quit.
With all due respect to Supervisor Mar and supporters of the regulation, they may be doing the smokers in their lives whom they’d wish to see live longer a grave disservice by eliminating incentives to switch, such as the ability to use vaporizers in public settings like bars and many workplaces where modeling behavior to minors isn’t an issue. In a perfect world, even I’d rather not be addicted to nicotine. But harm reduction saves lives, and vaporizers are one of the most exciting advancements in the field in a generation.