The E-Cigarette Dilemma
WASHINGTON -- E-cigarettes pose a public policy conundrum. They are a gateway drug -- but it's not, or hasn't been, entirely clear in which direction most traffic through that gateway flows.
For some existing smokers, particularly those for whom other efforts to quit have failed, electronic cigarettes offer the advantage of a nicotine delivery device without risking the health consequences of smoking tobacco.
Meantime, for those not yet hooked, e-cigarettes present the risk of an alluring on-ramp to the real thing.
The question is whether the potential public health benefit of helping smokers quit outweighs the public health cost of enticing a new generation of addicts.
On the benefit side, the evidence is disappointingly inconclusive. The largest trial found that e-cigarettes were "modestly effective" in helping existing smokers quit, with verified quit rates of 7.3 percent versus 5.8 percent for the nicotine patch.
Indeed, even the e-cigarette industry is careful to emphasize reducing tobacco use rather than eliminating it. E-cigarettes are "probably the most effective tool right now in curbing the most preventable form of death we have in our society," said Phil Daman, president of the Smoke-Free Alternatives Trade Association, an e-cigarette industry group. But, he added, "I am not saying this helps you stop smoking at all."
On the cost side of the equation is the galloping growth of the market, particular among youth, enticed by televised advertising that portrays e-cigarettes as an emblem of glamorous independence, with flavors such as cotton candy and banana split.
Whatever the precise balance, it has become increasingly clear that e-cigarettes require far tighter oversight and regulation than are now in place -- especially as the Big Three tobacco companies have moved into the e-cigarette market.
"There is currently an enormous gap between what people hoped would be the public health potential of these products and the reality of what has gone on in the marketplace," said Matthew Myers, director of the Campaign for Tobacco-Free Kids.
The numbers help explain Myers' concern. E-cigarettes have been around for just over a decade, and they currently account for a tiny sliver of the market, just 1 percent.
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Copyright 2014 Washington Post Writers Group
