Rebuttal to APPEAL's Arguments Against E-Cigs

By Reid Mukai (Cascadia Vape)

Last month, Seattle’s Northwest Asian Weekly published an op-ed I wrote regarding the potential positive impact of e-cigs on the Asian-Pacific Islander community as a harm reduction strategy against smoking (you can read the original article here). Recently I was a little surprised to read the rebuttal from Sean Yokomizo, the Communications & Development Manager for APPEAL (an organization whose studies I cited in my article).

It was disappointing to say the least that a representative of an organization that does so much good for the community would hold such a simplistic and misguided stance against a smoking alternative that has been proven to be safer than cigarettes and an effective means to quit smoking.

Mr. Yokomizo opens his arguments by stating APPEAL’s position on e-cigs: they should be regulated exactly the same as tobacco cigarettes. To make my position clear, I’m not against intelligent and rational regulation based on scientific facts. Regulatory measures need to address real potential dangers and not misinformation or moral stance. Mr. Yokomizo is correct in arguing for regulation of e-liquids to ensure quality control. I would add there also needs to be warning labels on e-liquid bottles and laws against nicotine sales to minors. However, arguments for e-cigs to be regulated in the exact same way as tobacco cigarettes are based on the faulty assumption that they are equally harmful.

Mr. Yokomizo goes on to accuse me of failing to consider “key facts” regarding e-cigs while revealing his lack of diligent research. He begins a supporting paragraph by stating “While e-cigs don’t give off smoke, like traditional cigarettes, it’s important to understand that the vapor produced by e-cigs still contains chemicals from the nicotine, flavoring, and other additives.”

Actually, e-cig vapor doesn’t necessarily contain nicotine if one uses zero-nicotine e-liquids. As for other chemicals in the vapor, I stated in my previous article “According to a recent issue of the journal Addiction, scientists reported risks to users and passive bystanders from electronic cigarettes are far less than those posed by tobacco cigarette smoke, e-cigs contain fewer toxins than tobacco smoke and at much lower levels…” If Mr. Yokomizo read my original article more carefully he would see that I didn’t leave out any facts about harmful contents of vapor and put them in perspective.

Following the “key facts”, Yokomizo argues: “Scientific research is still ongoing to try and determine the actual effects that inhaling those chemicals has on e-cig users, as well as those in close proximity to “second-hand” vapor.”

Yes, scientific research is ongoing, but why does Mr. Yokomizo ignore the scientific data we already have? These are just a few examples from a growing body of supporting studies which indicate not only that e-cigs are safer than cigarettes but can aid smoking cessation and reduce overall levels of smoking-related morbidity and death:
http://onlinelibrary.wiley.com/doi/10.1111/add.12659/abstract
http://www.ncbi.nlm.nih.gov/pubmed/21150942
http://onlinelibrary.wiley.com/doi/10.1111/add.12623/abstract
http://www.mdpi.com/1660-4601/11/11/11220/htm

The next fallacy from Mr. Yokomizo is his implication that e-cigs act as a “gateway” to tobacco products targeted towards youth. This is similar to the (long dis-proven) claim that smoking marijuana leads to addiction to harder drugs. The gateway drug theory is effective (or used to be) as propaganda but doesn’t stand up under scrutiny. “Gateway” drugs can be any substance that is more easily available than stronger drugs and are dependent on peer environments which overlap with ones in which harder drugs are used. As in the marijuana as gateway drug campaign, it also undermines trust in authority if/when gateway drug claims are found to be untrue leading to rejection of more reasonable anti-drug messages. A study from Great Britain earlier this year found E-cigarettes were almost exclusively used by smokers and ex-smokers; more than 1 in 10 (12%) of cigarette smokers also used e-cigarettes, compared with 1 in 20 (5%) ex-smokers and almost none of those who had never smoked:
http://www.ons.gov.uk/ons/rel/ghs/opinions-and-lifestyle-survey/adult-smoking-habits-in-great-britain–2013/stb-opn-smoking-2013.html#tab-Use-of-e-cigarettes–and-the-relationship-to-smoking
Also from the study:
“E-cigarettes were found to be used mainly as smoking cessation aids and for the perceived health benefits (compared with smoking tobacco). Over half of e-cigarette users said that their main reason for using e-cigarettes was to stop smoking, and about one in five said the main reason for their use was because they thought they were less harmful than cigarettes.”

As for the implication that sweet “candy-like” e-liquid flavors are targeted towards minors, that’s as misleading as saying sweet liquor flavors are aimed at kids. Extra care must be taken to keep children away from all sweet things (including candies with refined sugar, corn syrup and aspartame) but the truth is, responsible adults enjoy sweet things as well and in many cases the variety of flavors to choose from have aided smokers in their efforts to quit.

To be clear, I am against the sales of e-cigs to minors and am strongly opposed to target marketing towards them. However, as a pragmatic Harm Reduction advocate I will not ignore or deny the fact that teenagers often go through rebellious and experimental phases. Just as abstinance-only programs have led to increased risk of teen pregnancies and STDs, or the War on Drugs has led to multiple societal problems, efforts to reduce e-cig use that are not based on truthful and honest education about objective risks are bound to backfire and make the problem worse.

Another erroneous statement from Mr. Yokomizo: “Ultimately, nicotine is an additive substance that provides no benefit and is associated historically with considerable adverse impacts on health.”
This is incredibly misleading because nicotine is associated with the adverse impacts of smoking as one of its many ingredients but is not the cause of cancer. As for the claim that nicotine has no benefits? Anyone with any experience smoking knows that it can provide a sense of alertness and relaxation and works as an appetite suppressant (which can be a health benefit for those with obesity-related physiological problems). There’s also a growing body of evidence that nicotine may help prevent Alzheimer’s and Parkinson’s Disease:

http://www.tampabay.com/news/health/study-finds-nicotine-safe-helps-in-alzheimers-parkinsons/2175396

In his concluding argument, Sean Yokomizo states: “Decades of work, millions of dollars, and literally millions of deaths have been invested in fighting the impact that tobacco and nicotine have had on AANHPI communities.  We strongly oppose products that threaten to undo that investment, no matter how profitable it may be for the few in the community who sell those products, as does Mr. Mukai.”

I support all efforts to reduce the harm caused by smoking and it is for this very reason I am an advocate for e-cigs as a healthier alternative. If Mr. Yokomizo researches the issue and talks to actual smokers whose lives have been improved by switching to electronic cigarettes, he would hopefully no longer view e-cigs as products which threaten the positive work done by groups such as APPEAL. However, if Mr. Yokomizo and APPEAL choose to ignore or deny the scientific data that we have, it would indicate an illogical stance that views all addictions as equivalent regardless of relative harm. If that’s the case, I urge APPEAL to do more to curb other addictions such as alcohol, caffeine, junk foods, gambling, shopping, work, internet, porn, sex, prescription drugs, smart drugs, New Psychoactive Substances (synthetic drugs) etc.

I hope Mr. Yokomizo and APPEAL continue their work to reduce smoking rates, but I also encourage them to learn how a Harm Reduction approach may make their efforts more effective.

More information about Harm Reduction can be found here:
http://www.ihra.net/what-is-harm-reduction
http://harmreduction.org/about-us/principles-of-harm-reduction/

Reid Mukai is a Seattle-based blogger and owner of Cascadia Vape.