- Friday, 10 October 2014 18:48
Letter to New York Councilman concerning a proposal to ban flavored electronic cigarette liquids
By Dr Farsalinos
Yesterday I sent a letter to a New York Councilman who has proposed a bill to ban flavored e-cigarettes in New York.
The letter is shown below
Dear Mr Constantinides,
I took the initiative of contacting you after reading articles in internet newsmedia about your proposal to implement a ban on flavored electronic cigarette liquids.
Such proposals are usually associated with a significant level of misinformation about electronic cigarettes and patterns of use, as well as a misunderstanding of scientific findings. I understand that the news media (and several scientists too) have created a lot of confusion to the public and the regulators concerning electronic cigarettes.
I am sending this letter as a scientist, being actively involved in electronic cigarette research (laboratory, clinical and population studies) as principle investigator and research coordinator. I am currently the 2nd most productive researcher worldwide in terms of publications on electronic cigarettes (please see: Worldwide research productivity in the field of electronic cigarette: a bibliometric analysis).
I had the priviledge of performing the only study evaluating the impact of flavor variability in electronic cigarette experience among dedicated electronic cigarette users (please see the full text at the US National Library of Medicine). The study analyzed the responses of 4618 electronic cigarette users, half of whom were from the US. The results of the study confirm that flavors are marketed to satisfy demand by dedicated vapers (all of whom were adult smokers or former smokers), and not to attract youngsters. The main findings of the study were:
1. The most popular flavor types were fruit (69.4%), followed by sweet (61.4%) and tobacco (43.9%) flavors.
2. On average, electronic cigarette consumers used 3 different types of flavors on a regular basis. Of note, the number of flavors used was independently associated with complete substitution of smoking with electronic cigarette use.
3. Tobacco flavors were the most popular at initiation of electronic cigarette use, but there was a subsequent switch to other types of flavors.
4. The majority of participants (68.3%) switched between flavors daily or within the same day.
5. More than half of participants reported that the reason for using different flavors is a phenomenon of taste (or smell) receptor tolerance from using the same flavor for long-term.
6. Almost half of participants reported that if flavors variability was limited it would increase their craving for cigarettes, while 39.7% mentioned that it would be more difficult for them to quit smoking or reduce cigarette consumption.
This is the only scientific evidence that exists about flavors and electronic cigarette use, and shows that flavors play an important role in switching from tobacco to electronic cigarette use and in preventing relapse to smoking. There is also a lot of literature about the physiologic effects of flavors on human perception, and how this affects mood and sense of well-being. These are applicable to adults too, not only to youngsters. Therefore, it is questionable why the issue of flavors has been focused on electronic cigarettes and many ignore than flavor perception is a need of adults too.
I understand the legitimate concern about attracting youngsters. However, it is questionable, both ethically and legally, whether a group of the society (smokers) should be deprived from the ability and the right to choose a significantly less harmful product because of a legitimate but unsubstantiated (so far) concern. Moreover, considering the population effect (which is considered the most important factor by the FDA), the risk posed by electronic cigarette use is so low that even if a small proportion of non-smokers adopts electronic cigarette use, the risks will be by far outweighed by the benefits observed in smokers who switch to electronic cigarettes. Of note, none of the studies so far have evaluated regular use. In reality, the NYTS survey by the CDC is evaluating experimentation only (either ever experimenting or experimenting within the past 30 days, which is misleadingly characterized as "current e-cigarette use"). In an analysis that will be submitted for publication in scientific journals shortly, we have calculated that by endorsing electronic cigarette use by smokers, an additional 3,000,000 deaths will be averted in only 20 years, compared to only 670,000 deaths averted with current smoking cessation rates. In my opinion, this information should be seriously considered by regulators before making any decisions.
As a final note, allow me to comment on a statement attributed to you that "The e-cigarette industry has openly admitted that they are not in the tobacco cessation business” (http://observer.com/2014/10/american-vaping-association-fuming-over-proposed-ban-on-flavored-e-cigarettes/). In reality, it is the law which does not allow them to state (or even imply) that e-cigarettes should be used as smoking cessation products. Ironically, they can state that they are tobacco cigarette substitutes. This is exactly the same thing as cessations, however it creates confusion and misconception that the harm from e-cigarette use is equal or higher than smoking. I think you should be concerned about how legislation has created such erroneous situations.
I am certain your purpose and goal is to protect and to promote public health. I kindly urge you to reconsider your position and make any proposals based on scientific evidence and not theoretical or unproven concerns (even though they may be legitimate). Smokers also deserve to be protected, and, based on current evidence, there is no harm to any other part of the society by endorsing e-cigarette use as a tobacco harm reduction strategy and alternative to smoking.
Konstantinos Farsalinos, M.D.
Researcher, Onassis Cardiac Surgery Center, Athens Greece
Researcher, University Hospital Gathuisberg, Leuven, Belgium
Researcher, Department of Pharmacology, University of Patras, Greece