When Paternalism Kills

Wednesday, November 16th, 2011

The New York Times looks at the e-cigarette debate:

A team led by Riccardo Polosa of the University of Catania recruited 40 hard-core smokers — ones who had turned down a free spot in a smoking-cessation program — and simply gave them a gadget already available in stores for $50. This electronic cigarette, or e-cigarette, contains a small reservoir of liquid nicotine solution that is vaporized to form an aerosol mist.

The user “vapes,” or puffs on the vapor, to get a hit of the addictive nicotine (and the familiar sensation of bringing a cigarette to one’s mouth) without the noxious substances found in cigarette smoke.

After six months, more than half the subjects in Dr. Polosa’s experiment had cut their regular cigarette consumption by at least 50 percent. Nearly a quarter had stopped altogether. Though this was just a small pilot study, the results fit with other encouraging evidence and bolster hopes that these e-cigarettes could be the most effective tool yet for reducing the global death toll from smoking.

Good news. But wait . . .

But there’s a powerful group working against this innovation — and it’s not Big Tobacco. It’s a coalition of government officials and antismoking groups who have been warning about the dangers of e-cigarettes and trying to ban their sale.

The controversy is part of a long-running philosophical debate about public health policy, but with an odd role reversal. In the past, conservatives have leaned toward “abstinence only” policies for dealing with problems like teenage pregnancy and heroin addiction, while liberals have been open to “harm reduction” strategies like encouraging birth control and dispensing methadone.

When it comes to nicotine, though, the abstinence forces tend to be more liberal, including Democratic officials at the state and national level who have been trying to stop the sale of e-cigarettes and ban their use in smoke-free places. They’ve argued that smokers who want an alternative source of nicotine should use only thoroughly tested products like Nicorette gum and prescription patches — and use them only briefly, as a way to get off nicotine altogether.

The article points out that the FDA has warned that there are traces of harmful and possibly toxic substances in e-cigarette vapor, but . . .

…the agency has never presented evidence that the trace amounts actually cause any harm, and it has neglected to mention that similar traces of these chemicals have been found in other F.D.A.-approved products, including nicotine patches and gum. The agency’s methodology and warnings have been lambasted in scientific journals by Dr. Polosa and other researchers, including Brad Rodu, a professor of medicine at the University of Louisville in Kentucky.

Writing in Harm Reduction Journal this year, Dr. Rodu concludes that the F.D.A.’s results “are highly unlikely to have any possible significance to users” because it detected chemicals at “about one million times lower concentrations than are conceivably related to human health.” His conclusion is shared by Michael Siegel, a professor at the Boston University School of Public Health.

“It boggles my mind why there is a bias against e-cigarettes among antismoking groups,” Dr. Siegel said. He added that it made no sense to fret about hypothetical risks from minuscule levels of several chemicals in e-cigarettes when the alternative is known to be deadly: cigarettes containing thousands of chemicals, including dozens of carcinogens and hundreds of toxins.

The analogy to abstinence-only sex education is spot-on. And it’s more evidence that the public health fanatics on the left can be just as ideology-driven and anti-science as the moral crusaders on the right. Of course if you’ve been following the medical marijuana debate, it shouldn’t be all that surprising that the FDA would let politics and fearmongering trump science. And on that issue, left and right are guilty.

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43 Responses to “When Paternalism Kills”

  1. #1 |  MH | 

    The opposition to e-cigs is explainable when you realize the “public health” movement is the modern incarnation of puritanism, the haunting fear that someone, somewhere, may be happy (to borrow a line from Mencken).

  2. #2 |  Murc | 

    As a card-carrying lefty and someone who is totally in favor of workplace smoking bans (yes, including bars and restaurants) this is total bullshit. A way to get nicotine into your system that DOESN’T involve additional noxious chemicals? Sign me the fuck up. This is an enormous ‘everybody wins’ scenario; people stop blowing toxic fumes around, but can still enjoy nicotine hits. It reduces the necessity of industrialized tobacco production, and it provided technology-driven jobs. There’s literally no downside. I keep hoping they come up with an economical way of decoupling caffeine from its current delivery systems next.

    Aren’t us lefties supposed to be the group filled with pot-smoking, acid-dropping hippies? You’d think we’d be all over this.

  3. #3 |  Scott Morgan | 

    I switched to electronic cigarettes in March and haven’t smoked tobacco since. As a former pack-a-day smoker, the transition was surprisingly easy and I’ve enjoyed all the noticeable health improvements I was told to expect after quitting smoking.

    For me, being tobacco-free is a miraculous change that felt impossible for many years. It’s something I feared I might never accomplish. Now that I’ve made it to this point, the continued ease and availability of the electronic cigarette option is a critically important health issue for me. Any effort to restrict or eliminate use of these products is murderously insane.

  4. #4 |  kant | 

    This kind of goes back to the whole problem of “if a person can get pleasure out of something without significant harm, that item is pure evil!”. That or it’s the idea (in their mind) that addiction necessarily means harm and e-cigs kind of defenestrates that premise (never mind the existence of coffee).

  5. #5 |  Bobnormal | 

    I don’t even like Cigarettes anymore, they smell,but my Blueberry flavored E-cig tastes great and now I can hike the Mountains again, Thanks GOV!

  6. #6 |  Just Plain Brian | 

    I keep hoping they come up with an economical way of decoupling caffeine from its current delivery systems next.

    Already done. Sites like Thinkgeek sell caffeinated mints, candy, brownies…they even have caffeinated soap! (they claim it works by being absorbed through the skin, although I’ve never tried it)

  7. #7 |  Bob | 

    Wow, this is insane. I’m the biggest anti-smoking person you’ll find, I hate smoking so much I can’t tolerate it at all. And I have good reason, an inherited genetic predisposition to getting cancer. Cancer has killed every member of my family that smoked. Usually at about age 60. My sister is 53. She smokes like a chimney. Her two daughters smoke too. “Abstinence only” doesn’t work, yo!

    E-Cigarettes sound like an awesome life saving technology. Win win across the board.

  8. #8 |  FloO | 

    They don’t like E-cigarettes because it’s not about health, but about control.

    A smoker can take an e-cigarette, stand outside, and appear to be enjoying a cigarette.

    Cops and security guards would be all confused. They can’t allow that.

  9. #9 |  StrangeOne | 

    “Conservatives” and “Liberals”, as defined by the mainstream media and American politics are exactly alike. Neither side, on average, is more reasonable or logical than the other. They stand on different sides of arbitrary lines and if they ever do side with logic and reason, it is purely coincidental.

    They both love them some government power, they just don’t agree on the methodology of oppression.

  10. #10 |  Dave Krueger | 

    I propose a constitutional amendment that would prohibit government from making any laws or rules that regulate activities that physically affect only the person doing those activities.

    I don’t care if a guy is standing in his front yard threatening to drive an icepick into his eye. That is his decision to make and, if anything, someone who forcibly intervenes should be the one prosecuted. I don’t care of the guy is drunk, strung out on drugs, or suffering from severe depression. If you don’t own your own body, then you own nothing.

    Such an idea naturally makes people think of all kinds of what-ifs. Save it. If you want to stretch exceptions into generalities be my guest, but the state has no business regulating any kind of consensual use of substances on private property and that includes over-dosing or eating yourself into a diabetic coma.

    Life comes with responsibility. I have no more regard for those who use force to save people from themselves than I do for people who piss their lives away through reckless behavior.

  11. #11 |  StrangeOne | 

    Murc, you do know that you can buy caffeine pills in any drug store? Brand names like No-Doze, will get you 60 200mg tablets for about 6-8 bucks. That is around 60 cups of coffee, i.e. way cheaper than soda or Starbucks and easier than brewing your own coffee.

    Its kind of weird to take them though, people look at you funny when you take a pill, but won’t bat an eye at the jittery dude whose consumed a pot of coffee before 9am.

  12. #12 |  2nd of 3 | 

    I’m a lefty who bought e-cigs for my parents (they didn’t catch on with them – oh well). I don’t know anyone who is for banning these, so I don’t think this is as left-right as it’s being portrayed (sample size of one, I know, I know).

  13. #13 |  David Harmon | 

    Agreed, this is pure paternalism and “liberal puritanism”. (Addiction being a “sin” against self-determination.)

    The last time I tried to quit smoking, my sister was telling me “but then you’ll still be addicted to the gum!” She was very confused when I responded “so? No smoke, no lung cancer”. All “but…”.

  14. #14 |  Sinchy | 

    While walking through NYC with my baby I am constantly dodging cigarette smoke so my baby doesn’t have to breath this crap as well as all the pollution from cars and trucks (ambulances are the worst). My wife says he has an unintentional pack a day habit, which I know is an exaggeration. I don’t care that these people taking cigarette breaks are ruining their health but I don’t want my baby getting a face full of smoke so if all these people were toking on e-cigs I would be much happier.
    Different topic but probably of interest to peeps here is a debate on drug legalization between Glenn Greenwald and former Drug Czar John Walters:


  15. #15 |  BamBam | 

    @2, another benefit of e-cigs is that they aren’t litter (cigarette butts everywhere), and the occasional fire caused by a tossed cig.

  16. #16 |  (B)oscoH | 

    Google “e-cigarettes” and notice all the ads. If they got El Goog to back down, we’re pretty much all fucked.

  17. #17 |  jmcross | 

    Don’t discount the effect the idea of all the lost taxes has on the government types.
    “But, but…the revenue! It will be lost! Forever! Unless…”

  18. #18 |  Brutusettu | 

    [quote]The analogy to abstinence-only sex education is spot-on. And it’s more evidence that the public health fanatics on the left can be just as ideology-driven and anti-science as the moral crusaders on the right.[/quote]

    And it would seem “one” side could fill up the Big House several times over and the “other” can get the Idaho Vandals’ Kibbie Dome near full capacity.

    But it’s apparently press stopping news that people of all stripes can be just as fanatical?

    How many leftist politicians run with anti-science in any planks?
    How many on the right run with anti-science in any planks?
    How many voters on each side see any of those planks as important or nice signally?

  19. #19 |  Johnny Clamboat | 

    #1: Indeed. Puritanism begat utilitarianism begat progressivism.

  20. #20 |  Tim P | 

    Rush Limbaugh advertises the e-cigs on his show, I think he uses them also.

  21. #21 |  MattZuke | 

    “Rush Limbaugh advertises the e-cigs on his show, I think he uses them also.”

    Yeah, I’ve seen him use a Volcano Inferno. It’s a basic 650mAh Ego style with a mini usb passthough.

  22. #22 |  the other rob | 

    I should imagine that the pharmaceutical industry isn’t too happy about the potential hit to its sales of NRT products.

    Of course, it’s not like it would use the FDA as a sock puppet…

  23. #23 |  derfel cadarn | 

    The problem that progressives have with e-cigarettes is that their “friends” in Big Pharma are not the ones making the money. Always follow the money. Big Pharma makes big contributions so their asses must get kissed and it appears that the left has the best lips for it.

  24. #24 |  Stick | 

    @ #10. Dave – Amen.

  25. #25 |  johnl | 

    Any brand suggestions from users? I’ve got a roomaate who is driving me insane with cigarettes in the dryer.

  26. #26 |  John Gordon | 

    ““Rush Limbaugh advertises the e-cigs on his show, I think he uses them also.”

    Yeah, I’ve seen him use a Volcano Inferno. It’s a basic 650mAh Ego style with a mini usb passthough.”

    Limbaugh has talked about ‘smoking’ them on his show and how he says people get “uncomfortable” and complain when they see him ‘smoking’ them in a restaurant.

  27. #27 |  Mike S | 

    Still waiting for the ‘When Maternalism Kills’ article.

  28. #28 |  Windy | 

    I smoke about 6 cigarettes a day, my hubby is bugging me to quit completely (he did 6 years ago and he was a 2-3 pack a day smoker, he used the savings to buy a Harley). Anyway, I did try an e-cigarette, I didn’t like it, it has no give like a real cigarette, it’s hard to my lips and therefore doesn’t give me the same sensation, also the lack of visible smoke leaves a lot to be desired, afaiac.

    Odd thing is I can easily go 9 days without any cigarettes when I am vacationing with my daughter, but I cannot quit completely, I will be back to my 6 a day habit as soon as I return home. Apparently I am not addicted to nicotine but I am addicted to the feeling of smoking a cigarette. I’ve smoked since I was 15, I am 67 now, I did smoke a pack a day from my early 20s on, but it’s been over a decade since I cut that back to the 6 cigarettes a day habit I now have.

  29. #29 |  Bluebottle | 

    I’ve been vaping for about 3 years now and quit cigarettes even WITHOUT the intention of quitting when I got the ecig. I just wanted a way to skirt the state smoking ban. Almost everyone that has asked me about the ecig has been very accepting and accommodating. All it takes is a little bit of explanation. It would be a serious travesty if a handful of anti-nicotine zealots were allowed to ban these devices based on weak and mis-represented ‘evidence’ that they ‘could possibly be harmful’. If they cared one whiff about public health they would call for more research before they made such sweeping conclusions. The fact that they are already taking sides shows their bias.

    johnl- I would highly recommend the Joye Ego as a good, reasonably priced starter kit. Do a web search.

  30. #30 |  Dave Krueger | 

    I was a 2-pack a day smoker for 34 years and finally quit about 10 years ago. I question the entire concept of addiction. If addiction is being unable to stop, then how is it that so many people do, in fact, stop? And, if being able to stop isn’t a factor, then why isn’t everything you do regularly for fun an addiction?

    Anyway, I tend to organize my life around routine and smoking became an integral part of my routine. I quit by interrupting those routines and replacing them with routines that don’t involve smoking. It wasn’t withdrawal from the nicotine that posed the biggest challenge for me. I cooked up the new routines in advance and went from 2-packs a day to zero overnight.

    Personally, I think the biggest reason people have a such hard time stopping is because they are bombarded with bullshit propaganda everyday telling them cigarettes are like heroine and how hard it is to quit. The idea that cigarettes are like heroine is ludicrous on its face. The reason people don’t give up cigarettes more readily is simply because they don’t have to. But, the comparison to heroine was what finally made me realize that much anti-smoking rhetoric is bullshit and believing it actually makes it much harder to quit.

    If I were in the smoking cessation industry, I sure as hell wouldn’t want people thinking they could quit on their own without my product. There is no incentive for self-anointed addiction experts (government or private) to tell us anything other than how difficult it is to quit. And yet, everyone I know who quit successfully, did it without using any other form of nicotine, while everyone I know who used the patch or the gum, went back to smoking. But, the choice of whether to use gum, patches, or e-cigarettes should be up to the consumer, not government.

  31. #31 |  Brewlady | 

    Many people try the expensive kits that look like a cigarette, and while some people are successful with them, many others need to step up to a different model. I replaced my cigarette-sized kit with an eGo kit, and was much happier. I’ve been vaping for over a year, which is amazing since I smoked for 36 years and never thought I would be able to quit. This product was invented to give current smokers a safer alternative. Thousands of people have quit using this, but our government is protecting Big Tobacco and Big Pharma by trying to ban e-cigs. The Boston Public Health Commission has banned their use wherever smoking is banned, because it LOOKS like smoking. This was despite the efforts of the Consumer Advocates for Smoke-free Alternatives providing the board with a wealth of information showing that the vapor is harmless.

    When our government actively works against a product that has been repeatedly proven to be healthier, there is something grossly wrong. I am disgusted with the FDA, The DOT and the government officials who continue to lie about the safety of these products.

  32. #32 |  James | 

    The government both left and right can’t figure out how to tax this new way of getting out nicotine. Cigerettes are heavily taxed and bring in tons of money. Of course, when ever we find something we like, the good ole government is there to save us. Funny though, the left is suppose to be so free loving and liberal, but the federal government is cracking down hard on pot smoking in states that have voted in medical pot. FDA is going to ban food suplements also. I guess I better stock up on ecig supplies before it’s too late.

  33. #33 |  Chip | 

    I switched to e-cigs almost two years ago. For several years before I switched, I had a persistent smokers cough and would get winded walking up even a single flight of stairs. I stank (even though I didn’t notice it myself) and my senses of taste and smell were shot. Within a few months of switching, all my health problems disappeared. I feel better than I have in years, and I’ve saved several thousand dollars to boot. E-cigs may not be for everybody and they may not be as safe as quitting completely, but they’ve certainly worked for me and they’re *definitely* less harmful than cigarettes.

    My only advice to those who have tried them and didn’t like them is to get a *good* one. All the little e-cigs that look like real cigarettes are weak and short-lived. You might have to spend $100 or so on something that looks like a mini-flashlight, but it will be worth it for the health and financial benefits.

  34. #34 |  johnl | 

    Thanks for tips Tots. I’ll ask my roomate to look at the Joyce and Volcano, and be thinking about something miniflashlight sized. $100 is cheap to get the cigarettes out of my laundry, garage floor, … Even my kids smell like smokers now.

  35. #35 |  USAGeorge | 

    These special interest anti-smoking groups always need a cause to self substain,justify their existance. If the E-Cigarettes work,and they do so very well,their employment is put at risk. They care more about their jobs than your life. It’s that simple.

  36. #36 |  Sean L. | 

    So now the government is trying to ban something that LOOKS like you’re doing something they don’t like?

    I say we all start drinking water in our cars using martini glasses. Raise ’em to a cop when you see one. (Bonus points if you have an olive garnish… But olive-flavored water sounds pretty nasty.)

  37. #37 |  MattZuke | 

    “I say we all start drinking water in our cars using martini glasses”

    They’re not practical. Pint glasses are as they fit in cup holders, but I can’t say ever had an issue with cops with those.

  38. #38 |  Tor Munkov | 

    I would call this Schizophrenic Catch 22 Fascism, not paternalism. Like in the movie War Games, the only way to win these psyops games is not to play.

  39. #39 |  Kitty Antonik Wakfer | 

    The practice of government – all of them at every level – is to prohibit individual full self-responsibility, whether to smoke or stop or anything else, because if such came to be used by even moderate numbers, the idea that government is a necessity would crumble. Instead people are taught from early childhood in government schools that government knows best. Of course some doubt this, but then there are the government enforcers, those willing to initiate physical force.

    An essential point to remember about governmnet though is that all of the regulations/laws/edicts/directives/rulings/etc of all legislators, executives (including President), judges and bureaucrats are merely words whether uttered in some official government chamber or written in one of the millions of documents issued by any of 3 arms of the federal government, and all the levels in the 50 states. These words only become reality because there *are* government enforcers, those willing to threaten and actually initiate physical force to compel individuals to do something they would not do of their uncoerced choice. And there are plenty of instances, more each year and well documented, of enforcers initiating physical force – even to the point of death – as they enforce various “orders” from above.

    The far greater number of non-enforcers in the population of the US (and anywhere) have a non-violent option by which to change the situation. Turn government enforcement – both domestic agencies and the military – into an undesirable role to play and there will be far far less harm possible by government at all levels. An undesirable job is one in which the holder is shunned by all others if s/he will not be persuaded by reasoned logic – negative Social Preferencing! No voluntary association – no sales, no service, no camaraderie, no anything!

  40. #40 |  Matt | 

    There is a parallel to prohbition era politics. Part of the motivation of prohibition proponents was their distaste for the social conventions of new immigrants including Germans (beer) and Italians (wine).

    Quoting wikipedia “Prohibition represented a conflict between urban and rural values emerging in the United States. Given the mass influx of immigrants to the urban dwellings of the United States, many individuals within the prohibition movement associated the crime and morally corrupt behavior of the cities of America with their large immigrant populations. In a backlash to the new emerging realities of the American demographic, many prohibitionists subscribed to the doctrine of “nativism” in which they endorsed the notion that America was made great as a result of its white Anglo-Saxon ancestry. This fostered xenophobic sentiments towards urban immigrant communities who typically argued in favor of abolishing prohibition”

    So the movement became a lot broader in what they were going after than the really hard (and harmful) stuff like distilled spirits.

    There were loopholes for medicinal use and people could get a drink for a lot more money if they had a doctor and pharmacy involved (sound familliar).

    So the problem with e-cigarettes is that is allows people to continue doing something that’s social frowned upon – namely public drug use for the purpose of pleasure. Nicotene is OK if “medicine” and expensive.

  41. #41 |  November 29 roundup | 

    […] Stossel on death by FDA [Reason] Disapproving stance on e-cigarettes might cost lives [Balko] Company abandons pioneering stem-cell research after running up $45 million in costs to win FDA […]

  42. #42 |  wildwood | 

    So it is OK to consume alcohol without a blink in bars and airlines but no tobacco or substitutes. So just whoses health are THEY concerned with? I have rarely heard of a smoker leaving a bar and killing someone while under the influence. Not to mention the by products of acceptable homosexual “encounters”,like Aids. I guess Anything or those negative consequences are more acceptable behaviors. To hell with public health. Wow.

  43. #43 |  wildwood | 

    Ad a taxpayinh citizen (yes in every way I pay for my nicotine sin) I am appalled at what we over look wife and child abuse, elder abuse, alcohol abuse,rampant indiscriminate deviant sexual behavior, to include child molestation by sports big shots. I could go on and on at the dangerous and criminal behavior where some look the other way and then swing all their wrath on smokers,who basically only harm self,if anyone amazing stupidity. This is shameful hypocricy.