Can we please have a rational discussion about e-cigarettes?
We all know smoking's bad for us. But surprise! It's even deadlier than we thought.
According to acting US Surgeon General Dr. Boris D. Lushniak, cigarettes are now proven to cause a host of new diseases, including diabetes, colorectal and liver cancers, erectile dysfunction, and ectopic pregnancy. That's in addition to the lung cancer and heart disease we've always known it to cause.
It gets worse: Thanks to manufacturing and design changes, the cigarettes we smoke today are far more deadly than the ones those cool, attractive, rich people smoke on "Mad Men." Cancer risk for men who smoke has doubled since 1959. For women, the risk has jumped tenfold.
On the same day this morbid report was published in the New York Times, however, we also saw a big report in the Los Angeles Times about one of the most contentious tobacco-related products since candy cigarettes: electronic cigarettes.
The fevered lede to the LA Times piece underscores how the debate over electronic cigarettes has become dominated by over-the-top opinions and false binaries:
Electronic cigarettes are either a potent weapon in the war against tobacco, or they are an insidious menace that threatens to get kids hooked on nicotine and make smoking socially acceptable again.In other words: E-cigarettes will either save the lives of the 400,000 Americans who die every year of smoking-related illness, or they'll breed a new young class of nicotine addicts that would never have started smoking otherwise, electronically or not. This rhetoric is not uncommon when reading about e-cigarettes. National Geographic embraces the same false equivalency: "Are e-cigarettes a boon or a menace?"
Why can't they be both? Or neither? Can't e-cigarettes be "generally regarded as safe" but also turn children onto smoking? Or maybe e-cigarettes will be found to cause significant longterm damage and people will stop smoking them anyway. After all, unlike real cigarettes, there's never been a time when it was considered "cool" to smoke e-cigarettes. Sorry Stephen Dorff.
Using the "boon or menace" rhetoric as a starting point for the dialogue doesn't help anybody. After all, the verdict is still out over how prolonged first- or second-hand contact with e-cigarette vapor affects our bodies and brains. Instead, let's take a look at what we do know:
1. The e-cigarette "smoke" is made up of vaporized propylene glycol and glycerin. The FDA says these are "generally regarded as safe," however we haven't had time to study the longterm effects of inhaling it.
2. Yes, there's still nicotine in e-cigarettes, which increases blood pressure and heart rate at the dosage contained in both conventional and electronic cigarettes. But nicotine's side effects are minimal compared to the carcinogenic tar and carbon monoxide found in real cigarettes. That's what causes cancer, not nicotine.
3. Some studies have detected in e-cigarettes some of the same harmful chemicals found in real cigarettes, like formaldehyde. But before you panic, it's extremely important to note that these chemicals were only produced under "unrealistic" levels of heat, according to Drexel University environmental and occupational health expert Igor Burstyn. Other critics say some of the devices tested came from unreliable sellers in China.
So before freaking out about e-cigarettes, let's establish that we simply don't know how dangerous they are, and we probably won't for years. That said, they do not contain tar or carbon monoxide, which are the biggest factors that make conventional cigarettes so terrible.
So what about the other side of the binary? Will youngsters take up smoking e-cigarettes because they see others doing it? Then will they up the ante and start smoking real cigarettes?
To answer the first question, sure maybe. Kids imitate adults and famous people on TV, so if they see them smoking e-cigarettes they might take it up too.
But are e-cigarettes a gateway to real cigarettes? Despite the rhetoric from Congress suggesting so, a survey from the CDC suggests this is not the case. Only 3.3 percent of college students said e-cigarettes were the first form of nicotine they’d tried. Of those, only 2.3 percent later started smoking conventional cigarettes.
Indeed, most people make the move from real cigarettes to e-cigarettes, not vice versa. After all, the benefits of using e-cigarettes to quit real cigarettes is more than just a PR talking point from the industry. I've seen four of my heavy-smoking friends accomplish this feat firsthand. Two of them ending up giving up nicotine altogether.
And therein lies the genius of the e-cigarette as a smoking cessation tool: They are tragically uncool. By de-contextualizing cigarettes, they reveal how silly the real things are. Congressman Henry Waxman [D-CA] criticized NBC for portraying Julia Louis-Dreyfus smoking an e-cigarette at the Golden Globes, but I don't think he got the joke: Tiny Fey and Amy Poehler were making fun of Louis-Dreyfus, a TV actress who was nominated for the film "Enough Said," for thinking she's too cool to sit with the other television stars. The joke is: Who is she kidding? "She's not cool! Look at her! She's smoking an e-cigarette!"
I quit nicotine for over a year using e-cigarettes. One reason it worked was that I'd rarely leave the house with the e-cigarette -- I wasn't crazy about the sideways glances or probing questions I'd receive, all with an ever-so-slightly mocking tone. (Yes, I am vain. I am human.) Instead I'd only take a puff when I was extraordinarily stressed, or maybe after getting home from a night of drinking, away from prying eyes with no one to shame me. Eventually, my nicotine intake was so low, I just stopped altogether.
So yes, e-cigarettes make you look incredibly silly. But for me, that's a feature not a bug.
I would be remiss, however, if I didn't mention that recently I've begun smoking a real cigarette every now and again. I could blame it on a huge life change and moving back to New York, where smoking is far more socially acceptable than in Los Angeles. But it doesn't change the fact that e-cigarettes ultimately failed me.
For some, nicotine gum and patches will always be the best way to quit. Others will prefer e-cigarettes. Some of my friends used them to quit nicotine. I did for a while but it didn't quite stick.
But this only underscores the point that every smoker or potential smoker is different. That's why starting the conversation from a binary of "e-cigarettes will save us all!" vs "e-cigarettes will kill us all!" doesn't help anybody.