Tuesday, March 11, 2014

CASAA Testimony to Philadelphia City Council Regarding Proposed Ordinance to Ban E-Cigarette Use Wherever Smoking is Prohibited

Testimony of Carl V. Phillips, PhD, Consumer Advocates for Smoke-free Alternatives Association (CASAA)

to the Philadelphia City Council

regarding e-cigarettes (in opposition to Bill No. 14009500 and in opposition unless amended to Bill No. 14009600)

11 March 2014

My name is Carl V Phillips, PhD.  I currently live in xxx, New Hampshire, but have close ties to Philadelphia and until a few months ago I was a resident of the Philadelphia suburbs and was affiliated with Drexel University.  I am the Scientific Director of CASAA, The Consumer Advocates for Smoke-free Alternatives Association, and also work as a private consultant.  I am testifying on behalf of CASAA, which is a public health non-governmental organization (NGO) and consumer representative, not an industry group.  CASAA is the leading consumer representative of users of e-cigarettes and other low-risk alternatives to smoking.  CASAA is a nonprofit volunteer organization and I am not being compensated for providing this testimony.

I am a public health scientist and award-winning epidemiologist.  I spent most of my career as a professor of public health, and most of that focusing on tobacco harm reduction.  I have been doing research on smoke-free alternatives to smoking, including e-cigarettes, for longer than almost any other researcher in the world and have published numerous journal articles and other writings on the topic.

CASAA supports prohibiting sales of e-cigarettes to minors at the city, state, and national levels.  There is really no honest opposition to such policies, with merchants and industry joining us, the consumer advocates, in supporting them.  Indeed, reputable merchants already enforce such restrictions even when they are not mandated by law.  The only opposition to such restrictions comes from so-called public health groups, who are apparently attempting to increase e-cigarette usage by children so they can use it as an excuse to restrict adult access.

However, we cannot support Bill No. 14009600 as currently written and ask that it be amended.  First, it defines e-cigarettes as “electronic smoking devices” which they are most certainly not.  There is no smoke produced, and referring to e-cigarette use as smoking is misleading, inflammatory, and potentially harmful since it might dissuade smokers from switching to this healthier alternative.  The Bill further uses the phrase “unauthorized nicotine delivery products”, which is both inflammatory and rather cryptic (are cigarettes authorized?).  Pennsylvania is currently considering SB 1055, which would impose similar restrictions on sales to minors, and uses the term “alternative nicotine product”.  We urge you to amend the language to match that of the Commonwealth’s bill or at least to choose some alterative phrase that, like theirs, is appropriately non-judgmental and technically accurate.  Second, SB 1055 would require different signage than you are currently considering.  In order to avoid imposing contradictory requirements on merchants, we ask that you change the wording of the required signage to match that of the Commonwealth’s bill.

There is little more to say about that, so the remainder of my testimony focuses on the proposed ban of e-cigarette use where smoking is banned.

The key observation is that the environmental exposure from e-cigarettes is not at all similar to smoking.  A recent review of all the available science on the vapor from e-cigarettes by Prof. Igor Burstyn of Drexel University concluded that the exposure to chemicals to the user, both intended ingredients and contaminants, was far below the level that would create any health concern.  That is to the user himself.  The conclusion was that the exposure to any bystanders is 100 or 1000 or 10,000 times less than that quantity which was already shown to be inconsequential.  Since Prof. Burstyn is expected to testify at the hearing on this Bill, I will defer to him on further details.

In short, the premise that vaping (e-cigarette use) should be restricted because of clean air concerns is misguided.  There is simply no appreciable risk to bystanders from vaping.  Standing next to someone who is eating, sipping coffee, or just breathing, exposes bystanders to measurable levels of chemicals that are toxic or carcinogenic in high quantities.  But the quantities are so low that they are not considered a risk.  The same is true for e-cigarette use.  Please do not be tricked by claims that there are a few molecules of scary-sounding chemicals in the air, and therefore restrictions are needed; pretty much everything puts out a few molecules of many chemicals into the air, and I assume you do not plan to ban steaming cups of coffee.

Moreover, as you have probably heard, vaping is about 99% less risky than smoking, and hundreds of thousands of American smokers who would not have otherwise quit have switched to e-cigarettes, thus reducing their health risks almost as much as if they had quit cold turkey.  Anything that discourages such switching is thus bad for public health.  You might be inclined to say “better safe than sorry” about the environmental exposure issue, but sometimes “safe” is very costly.  In this case, it is very costly to public health.  Being able to use an e-cigarette in a bar or one’s office, rather than having to trudge outside to smoke, is a big draw:  Come for the convenience, stay for the 99% reduction in health risk.  Take away that convenience and you are going to be responsible for causing many people who would have quit to just keep smoking because they feel like they might as well.  This will kill people.  This is hardly “erring on the side of caution”.

Another argument that is sometimes made in favor of bans is to prevent children from seeing people using e-cigarettes.  The goal is dubious in itself.  Kids see adults doing a lot of things that they are not allowed to do – that is just part of life.  Moreover, seeing people ostentatiously not smoking, and seeing them seeking a substitute because they find that quitting cold turkey is not an option, seems like a good message to send to the kids.  But even if we assume that this is a legitimate goal, how does making smokers step out of bars and private offices onto the street further this goal?  This seems like it would make e-cigarettes more visible, not less.  Yes, there are stories – probably mostly apocryphal – about teachers vaping in front of their pupils.  But if that is the concern, it is easy enough to prevent that and similar specific concerns without imposing an unjustified, burdensome, and anti-public-health blanket restriction.

You have no doubt heard so-called public health organizations urging you to enact these restrictions, and wonder why they would be making such claims given that there is no scientific or public health justification for them.  The reason is, quite simply, that they are not motivated by genuine health concerns.  They will claim that there is a risk to bystanders or that we just don’t know enough, both of which are false.  If someone you hear from does not know that, it is only because he has avoided reading the scientific literature on the topic before presuming to opine to you about it.  They will claim that there are unknown risks to the user herself, but that is not relevant.  If there really were great risks to the user – and there is overwhelming evidence that there are not – we would be talking about a ban, not an environmental restriction. 

The reality is that these organizations are not worried about protecting bystanders or even product users themselves.  They are not really concerned about children, as evidenced by their opposition to minor sales bans (perhaps not the one you are considering, but many others in other jurisdictions).  They are frustrated that this solution to the public health scourge of smoking is happening in spite of their dismally ineffective efforts to eradicate all tobacco use, rather than because of them.  These organizations have lost touch with their original goal of eliminating the health impacts from smoking – something that e-cigarettes do almost as well as quitting cold turkey – and have become an industry in themselves that is devoted to the hopeless dream of eliminating all tobacco product use.  They are hostile toward e-cigarettes not because they are a threat to public health, but because they will achieve the public health goal in a way that they simply find morally objectionable.

They will argue that restricting the use of e-cigarettes is an easy extension of restricting smoking, and therefore we should just do it.  But please pause and think about that.  Bans like this get called “public place” bans, but most of the places they affect are private.  It is an enormous imposition on people’s freedom to deny an employer, restaurateur, or bar owner the right to decide whether a legal activity that causes no measurable harm will be allowed on her private property.  Our society very reluctantly came to the agreement that smoking was uniquely harmful enough that such a huge restriction on private free choice was warranted.  Now you are being asked – based on hand-waving speculation – to impose such enormous restrictions on private behavior.  You are being asked to forbid people from engaging in a low-risk activity that reduces smoking in thousands of private venues – even though vaping does not appear to pose any threat to bystanders.  Not only will this hurt, rather than benefit, public health, but it will also casually take away personal freedom in a way that is not befitting the cradle of American liberty.


mainusch said...

Finally a voice of reason. This needs to be read by all that are considering similar bans and restrictions.

Ray Yeates said...

We the people who have stopped smoking as a result of electronic cigarettes already know about harm reduction. We are living it. Even those of us with COPD related diseases, like myself. Millions of users already are testement . Millions more need to have that choice passed onto them. For anyone to be denied this freedom of choice is to dictate to them their certain fate to keep smoking. That is not health care. That is careless! This device has been around long enough for the regulatory bodies and health care parties to have done research enough to know most if any harms by now. In the frenzy of anti smokers advocates however, an opportunity got so immersed in propaganda it still looks like a demon cigarette. It is not. Start letting the truths be heard. The science is there already and has been for years. Including the science on nicotine addiction. Already millions have been spared the horror of smoking related diseases and millions are just now starting to observe the possibility of a less harmful way to say the least. To deny this is to take responsibility for those lives at risk. If you are Health Care Advocates. Do the right thing .......Please.