Clearing the air, and our heads.

I find it rare that I disagree with my public health colleagues. Oh sure, there's a disagreement here and there about the specifics, but it's been a while since the public health community has found itself fairly divided and kind of all over the spectrum on an issue. But it's happening now, all thanks to the e-cigarette.

While it's not entirely clear, the overall feeling I'm getting is that the public health community is preparing for a war against these battery-powered cigarettes. I could be wrong about this - but consider the official statements by certain key health organizations on the issue. The WHO cautions consumers against using e-cigarettes until proven safe and effective, and the American Lung Association's official statement on the twigs warns mostly against their potential harms. Advice from Health Canada and other agencies march to the same drum. 

Ok. So far, I'm towing the line. Warning against the potential harms of  product is fine. While it's certainly not something we do for every new product on the market, there's reason to think that e-cigarettes require extra oversight. One is loose labeling. We've seen some tests that show that e-cigarettes labeled as "nicotine-free" actually do contain nicotine, leading to a worry nicotine poisoning amongst the unsuspecting. 

One of the main concerns with e-cigarettes appears to be the potential for re-normalizing smoking. We've worked so long and hard to remove the cool factor from smoking, that we're terrified that this new product, with it's shiny lights and fun flavours, will bring smoking back into the mainstream. 

This fear however, has led to hasty activity and in my mind, a gross overreaction. I'm all for regulation ensuring people are getting a safe product, and that they know what they're getting, but jurisdictions (like Nova Scotia and Philadelphia)  are now moving towards banning e-cigarettes where they can. Let's be clear about what this means. People are now banning a product that 1) Has not been shown to be overall harmful, neither on an individual or population basis, 2) That may in fact have benefits to a population (i.e. smokers) who have substantially higher than average morbidity and mortality rates, and 3) Even if it does have direct health impacts on the user, it does not have a direct health impact on those around them, such as the case with regular cigarette smoke. 

I think it's time that public health takes a collective breath, and calm down. I know everyone wants to take a strong stance, but sometimes, it's ok to wait. Quitting smoking is hard - don't we owe it to the people trying to do the studies to find out if this can be an effective tool for smoking cessation? Even if it's not, are province-wide bans warranted? To be honest, while I am now aware of the some of the potential harms of e-cigarettes, when I first heard of them, I immediately thought "What a great harm reduction tool for people who smoke." I don't think we're ready to say that e-cigs are a benefit to society, but I'm surprised and disappointed to see how quickly and urgently we seem to be moving in the opposite direction. For most other contentious issues in public health, I rely on the science to back me up. Let's do the same for e-cigs.