San Fran Fallout

Posted 1st July 2019 by Dave Cross
The toxic news that San Francisco’s Board of Supervisors had dropped a bomb on tobacco harm reduction spread around the world like a tornado, becoming the number one item in every news room. Critics lined up to denounce the nonsensical decision to prohibit the sale of vape products yet allow the continued legal sale of tobacco.

Neal Benowitz is a respected expert on the subject of nicotine. The University of California Los Angeles medicine professor announced he was “disappointed and frustrated” by the move, but his response was still guarded: “While I am sympathetic with the parents’ concerns, whether e-cigarettes use among adolescents will persist, as opposed to being a fad, and if there are any long-term harms for e-cigarette use in youth are unknown. On the other hand, we know that if a smoker decides to quit smoking using e-cigarettes, and uses e-cigarettes daily, e-cigarettes can be very helpful in aiding that quitting.”

University of Buffalo’s Lynn Kozlowski comment was less restrained. The tobacco use and nicotine policy expert said: “For cigarettes that are proven to kill three in five smokers prematurely to remain on the shelves, while a product that eliminates or dramatically reduces the toxins ingested is banned, is a bizarre public health act.”

University College London’s Dr Lion Shahab said the move was “nonsensical beyond belief” and a “ludicrous decision”. Interviewed on the BBC’s World Service, Dr Shahab was moved to correct the BBC journalist at the outset after he said “…there is a huge advantage, in terms of the amount of harmful substances you inhale, smoking e-cigarettes to smoking a cigarette?”

“May I just correct you there, you don’t ‘smoke’ an e-cigarette, there is no combustion going on, you vape it.”

“We have asked long term users of e-cigarettes and long-term users of cigarettes to come into the laboratory, and we took samples of their bodies to look at the levels of exposure to harmful chemicals. What we find is that compared to cigarette smokers, an e-cigarette vaper reduces exposure to toxicants and carcinogens by around 95% or more – so they’re magnitudes of order safer than smoking cigarettes.”

“I think [the San Fran ban] is quite inconsistent in so far as there as the most dangerous product there is, the combustible cigarette product, are still legally available – and we know, based on research I and others have done, that e-cigarettes are magnitudes of order safer.”

Pushed further on the subject of the growth of bans justifying further bans, Shahab replied: “There are bans in place in places like Brazil, but at the same time there are countries like Canada and New Zealand that have gone the other way, persuaded that evidence coming to light over the last two years or so  shows that e-cigarettes are very helpful in getting the level of smokers to stop smoking…and they’re beneficial to public health.”

“One of the unintended consequences of a ban like this is that it may mean that smoking prevalence, that has continued to plunge, among adolescents in the US may increase again. There’s a choice as a parent, I’d be much happier if my child used an e-cigarette rather than a cigarette.”

Public Health England’s Martin Dockrell spoke on Radio 4’s ‘PM’ programme: “E-cigarettes are not risk-free, but far, far safer than smoking. Even the US National Academy of Sciences, who did a report about a year ago, said that on the available evidence it’s far less harmful than smoking. So, if you’re a smoker it makes a great deal of sense to switch and switch completely. If you don’t smoke, there’s no point in starting vaping and, what’s more, hardly anybody does.

“[The San Francisco ban] is a very strange thing. They’re still allowing you to buy combustible cigarettes that kill half of lifelong users – you can buy alcohol, you can buy cannabis, but you can’t buy e-cigarettes which are much less harmful. I don’t get it at all!”

Asked if he would advocate a similar ban in the UK, Martin Dockrell responded with an unequivocal: “Oh my, no!”

The interviewer suggested that many people believe that we already have vices like smoking and drinking, “we’ve got all of those bad habits, we don’t have to let people start on a new one”.

Dockrell responded: “Professor Robert West, University College London, has calculated that in a typical year we get sixty thousand additional quitters from e-cigarettes – people who wouldn’t have quit otherwise. We have around 3 million e-cigarette users in this country, half of them have completely stopped. One of the reasons they’re motivated to stop is that in the UK we point out that e-cigarettes are far less harmful.”

In the US they say, ‘Oh no, we don’t know how harmful they’re going to be’, and smokers who are uncertain are much less likely to switch completely. We have really good data. The worrying thing is that smokers are increasingly uncertain … and more likely to carry on smoking.”

“You can stop vaping, but the important thing is to carry on vaping until you’re confident you won’t go back to smoking. My sister was one. She said she was on high nicotine, and was going to cut down to medium, then low, then no nicotine – and I said DON’T. Take your time, make sure you’re not going to relapse back to smoking, and then you can start cutting down.”

University of Michigan’s professor Kenneth Warner said: “We're taking the risk of addiction among kids and comparing that with the immediate danger of smoking-related illness and death in smokers who have not been able to quit otherwise and who might be able to quit with vaping.

"If the board of supervisors were interested in public health, they would prohibit the sale of cigarettes in San Francisco. That's a far higher priority than banning vaping from a public health point of view. There really is an irony that now you can buy your marijuana and your cigarettes, but you won't be able to get vaping products, which are certainly far less dangerous than cigarette smoking. It's ludicrous."

Dr Michael Siegel called the move, "insane public policy. It makes it easier to get cigarettes than e-cigarettes. I fear it really sends a bad message to other cities and to youth. It basically says we think vaping is worse than smoking. The worst part of this, beyond the fact that it makes no sense from a public health perspective, is I think it's actually going to do public health harm. By taking e-cigarettes off the shelves, you're basically going to force a lot of ex-smokers to go back to smoking."

Even the University of California San Francisco’s Dr Neal Benowitz was dubious about the action: "The risks of e-cigarettes kids are using now are unknown and of concern. But to me, the logical thing would be to focus more on restricting youth access to these devices," he said. "If they wanted to get them out of gas stations and grocery stores, that's fine, but I think e-cigarettes should have remained available in places like tobacco shops and online access, where there's verification of age."

Dr Nick Hopkinson, Chairman for Action on Smoking and Health, was also highly critical when interviewed by Channel 5 News: “Smoking kills about 40,000 people a year in California, 100,000 people a year in this country. One way people can reduce the risk of premature death is by stopping inhaling tar – so people who smoke, who switch across completely to vaping, will get a major health benefit from that.”

“[The San Fran vape ban] isn’t a measure that we would support. It seems a little peculiar to ban e-cigarettes while allowing people to buy much more harmful normal cigarettes.”

Interviewer: “Presumably, San Francisco think they’ve got some evidence that this is not a good road to go down at this point, and they just want to make sure that in a couple of years they don’t say ‘ahh, we were wrong about this?”

Dr Hopkinson replied: “I think it’s important to understand about relative risk; e-cigarettes are not completely harmless, it’s much better for people to breath clean air, but the difference between smoking a cigarette and an e-cigarette is enormous. We know the chemicals that cause cancer in tobacco smoke are not present, we know they are going to be much safer. The rough estimate is 5% of the risk.”

Interviewer: “Anecdotally, isn’t there some evidence among young people that some who might not have taken up smoking have started taking up vaping?”

“In this country, absolutely not,” Dr Hopkinson responded. “The data show really, really clearly that firstly smoking is going down, very rapidly among young people. But also, among 11-18yr-olds, only about 0.6% vape regularly – and that’s actually lower because it was 0.9% last year – the level is not going up. And among people who don’t smoke, the level is vanishingly small. So, all the children who are using e-cigarettes are also smokers.”

Interviewer: “So, in a word, you don’t want us to go down the road San Francisco has gone down?”

Dr Nick Hopkinson: “Absolutely not.”


 Dave Cross
Article by Dave Cross
Freelance writer, physicist, karateka, dog walker