American Association of Public Health Physicians

[Christopher]

This is from KDmickey on ecigforum

..I really take the FDA issue seriously, and I would appreciate some help from all of you in addressing this issue. I sent this to Dr. Nitzkin of the American Association of Public Health Physicians. The e-mail goes as follows.

Dr. Nitzkin,

I stumbled across the letter which was posted by you on jointogether.org regarding the FDA tobacco bill. I find your arguments for implementation of harm-reduction as the method of choice regarding tobacco intake very compelling.

I decided to contact you because I have recently been worrying about the FDA banning a smoking alternative called the e-cigarette (or, I prefer, the Personal Vaporizer). Personal vaporizers use a mixture of propylene glycol and nicotine to deliver a smoking-like sensation without tobacco. As such, the product contains none of the 60 known carcinogens in tobacco (or the 3000+ other chemicals). And, of course, despite the exhalation of a smoke-like vapor, the personal vaporizer leaves no second-hand smoke in the air.

Currently, some very powerful senators are pushing the FDA to stop the importation of personal vaporizers. The claim is that the safety of the product is unknown. While I understand this take, I find it unlikely that a product with no carcinogens could be as great a health risk as continuing to smoke tobacco! I do, however, find it somewhat likely that pharmaceutical and tobacco companies both have an interest in stopping the product from catching on in the U.S.

I humbly request the support of Public Health Physicians in preventing the FDA from banning the product. I know that several hundred smokers have either significantly reduced or quit their cigarette habit with this product. Many of these individuals have been 1-2 pack a day smokers for over 20 years and have quit smoking entirely with the personal vaporizer. As a former smoker, I can say that traditional nicotine replacement therapies fail to appreciate the gratification the act of smoking brings. The personal vaporizer delivers that satisfaction with, I believe, a significantly reduced health risk. I cannot say how grateful I feel to know that my infant son does not get exposed to the smoke in my clothing or vehicle anymore!

For more information about personal vaporizers, I would recommend looking at www.e-cigarette-forum.com.

Regards,

-Kyle Mickey

A few hours later, I received this reply:

Kyle:

Thanks for your note.

I agree.

I am now in the process of drafting a response to Senator Lautenberg's proposal. I'll make sure to copy you.

Meanwhile, there are some issues that the e-cigarette manufacturers and vendors should address from a public health perspective:

1. Is there any data as to the age of purchasers -- most particularly below 18 years of age.

2. What standards are in place to assure freedom from bacterial and heavy metal contamination of the product during the manufacturing process? While the Ruyan company may be responsible with regard to these issues -- what process, if any, is in place to prevent less scrupulous manufacturers from producing look-alike products that might be heavily contaminated?

3. Has any effort been made by vendors or manufacturers to detect and document adverse effects of the e-cigarette relative to both health and fire-hazard related issues.?

Joel L. Nitzkin, MD, MPH, FACPM

Chair AAPHP Tobacco Control Task Force

(AAPHP = American Association of Public Health Physicians)

Still later, Dr. Nitzkin sent me a copy of the fax going to the senator wanting to outlaw e-cigarettes:

Draft FAX

March 25, 2009

To: Senator Lautenberg, with copies to all House and Senate Members, AAPHP list-serve, Tobacco control advocates and others

Subject: Open letter to Senator Lautenberg Opposing his proposed ban on electronic cigarettes

Honorable Senator Lautenberg:

In my capacity as Chair of the Tobacco Control Task Force of the American Association of Public Health Physicians, I must vigorously oppose your proposed ban on electronic cigarettes.

Conventional cigarettes kill about 400,000 adult American Smokers each year from cigarette-related illness. Over the next 20 years this will total 8 million deaths among current adult smokers, most of which are now over 35 years of age. Cigarettes kill about 30% of consistent adult cigarette smokers.

Smoking cessation rates among these smokers are abysmal –about 3% per year. Pharmaceutical products with counseling, quit lines, etc, are little better – resulting in quit rates no greater than 5% (as measured at 12 months post-intervention) among those willing to try these modalities. In other words, current approaches fail 95% of smokers using them.

Adult American smokers are health conscious, as evidenced by the fact that about 85% of them have switched to light and low-tar cigarettes, believing (incorrectly) that they pose less health risk.

Research to date has clearly demonstrated that smokers smoke because they are addicted to nicotine. This same research also shows that the illness and death due to cigarettes is not due to the nicotine, but due to products of combustion and, to a lesser degree, toxins in the cigarette tobacco.

Alternative nicotine delivery devices, including, but not limited to electronic cigarettes, have no products of combustion and none of the toxins in cigarette tobacco. On at least a theoretical basis, they could and should be seen as generic equivalents of the pharmaceutical nicotine products. As best we can tell, on the basis of currently available research data, these products promise a risk of illness and death well under 1% of the risk posed by cigarettes.

Stated another way – simply informing current adult smokers that they could dramatically reduce their risk of tobacco related illness and death by switching to alternative near-zero-risk nicotine delivery products could possibly save 4 million or more of the 8 million current smokers who will otherwise die of a tobacco-related illness over the next 20 years.

Both houses of Congress now seem poised to pass an FDA/Tobacco bill (H.R.1256 in the House). This bill, if passed in its current form will provide, at least on an interim basis, the FDA seal of approval on currently marketed cigarettes. That being the case, the safety standard that should be used for other tobacco products, and for alternative non-pharmaceutical nicotine delivery devices, should the hazard posed by cigarettes, not a pharmaceutical safety guideline.

All tobacco and nicotine delivery devices should be held to the same safety guideline. Exempting cigarettes, while holding alternative nicotine delivery devices to an impossibly stringent safety guideline, will not protect current American smokers. It will only protect Altria/Philip Morris cigarette sales and profits.

On behalf of the Tobacco Control Task Force of the American Association of Public Health Physicians, I therefore urge to consider the following:

Withdraw your proposal to ban electronic cigarettes.

Urge amendment of the proposed FDA/Tobacco bill to encourage the development and marketing of safer alternatives to cigarettes, under strict but fair FDA oversight, and with marketing restrictions in place to reduce the numbers of adolescents who initiate use of cigarettes and other nicotine delivery products.

The amendments we think will achieve these goals, and the results of our analyses and literature reviews, are posted on the tobacco issues page of our Tobaccolegfeb07 web site.

Joel L. Nitzkin, MD, MPH, DPA, FACPM

Chair, Tobacco Control Task Force

American Association of Public Health Physicians

This is some positive news guys!

[PoppaC]

This is fantastic! Absolutely the beginning of the statistics we need. What a great start. It also gives you a foundation for standards for your venture, (which you have already considered). If this isn't an indorsement of the highest kind, I don't know what is. I would like to see some investigative information on how close the good senator is tied to the tobacco and pharmaceutical lobbies. I can not believe Senator Lautenberg started this campaign without some strong encouragement from these lobbys. Either way, it is difficult to dispute facts like these from an expert with these credentials. Maybe you could begin a poll to establish some stats of our own in ref. to the smokers who have switched from analog due to a vapor device (e-cigs) and make it ongoing poll for statistic collection similar to the banner you have for how many days off analog. If the other forums jumped on the bandwagon with the same type of poll it couldn't do anything but help. This is encouraging information. Something else I can point to with others I meet and share e-cig info with. Thanks Again!

[Christopher]

Sounds like a plan to me.

I know there is already a member out there that is getting ready to create a google poll that can be used regardless as to what forum you belong to. I'll keep you update I find out more.

What type of questions would you like to see Poppa?

[PoppaC]

Questions that pertain to e-cig users:

How did you learn of e-cigs

How long using e-cigs

Were you a smoker before you started using e-cigs

How long you smoked befor e-cigs

Have you quit smoking tobacco products since

If a smoker, how many a day

How would you be affected if FDA outlaws e-cigs (i.e. would you go bace to tobacco procucts

Etc........ And maybe some health questions, or did you quit tobacco due to health problems.... or another reason

[Royce]

Good to know someone out there in the world of politics is on our side