• by Thom Forbes  @tforbes, December 19, 2013

E-cigarettes are increasingly in the air—and hence on the minds of politicians, activists and commentators. The news this morning includes stories about six senators calling for a federal investigation into the marketing practices of electronic cigarette makers, articles on proposed bans in public spaces in North Texas and Spain, a Wall Street Journaloverview of ongoing anti-e-cigarette efforts in New York, Los Angeles and Chicago, and a “Perspective” piece in the New England Journal of Medicine that carries the hed: “The Renormalization of Smoking? E-Cigarettes and the Tobacco ‘Endgame.’” 

Forbes’ Natalie Robehmed recently reported that that “vaping” is a rapidly growing industry, with sales expected to double to more than $1 billion this year and billowing from there. “According to ratings agency RPT-Fitch, consumption is expected to grow 40% - 50% in the next year, while Citigroup predicts e-cigarettes will have a $3 billion market segment by 2015,” she wrote.

Let’s start with the NEJM article— a piece by three Ph.D.s in the public health arena who point out that “marketing campaigns for e-cigarettes threaten to reverse the successful, decades-long public health campaign to denormalize smoking after decades of public smoking bans that arose to protect “innocent bystanders” from secondhand smoke.

“The once-widespread habit didn't simply become denormalized or marginalized; it became highly stigmatized,” write Amy L. Fairchild, Ph.D., M.P.H., Ronald Bayer, Ph.D., and James Colgrove, Ph.D., M.P.H. “The pervasive became perverse.”

But the piece doesn’t end where you think it might be going, even as it makes clear that some observers fear that e-cigarettes are increasingly becoming a gateway product for youth. (The Centers for Disease Control and Prevention reported in September that the percentage of U.S. middle and high school students who use e-cigarettes more than doubled from 2011 to 2012). 

The authors support governmental efforts to ban the sale of e-cigarettes to minors and applaud the 40 states attorneys general who have urged the Food and Drug Administration “to promptly issue a promised set of rules governing the sale of e-cigarettes,” as CBS reported a couple of months ago, but they point out that “some studies suggest that the majority of e-cigarette users treat them as cessation aides” and suggest that “an unwillingness to consider e-cigarette use until all risks or uncertainties are eliminated strays dangerously close to dogmatism.”

The authors urge that “harm reduction” — rather than “abstinence-only” — become the rallying cry of public health advocates. Bottom line: tobacco-based products still kill 6 million people globally, and 400,000 in the U.S. each year.

Meanwhile, six Democratic senators sent a message to FTC Chairwoman Edith Ramirez saying “the commission should pursue enforcement action against any company found to have made unsubstantiated assertions in their advertising” for e-cigarettes, The Hill’s Ben Goad reports. 

“These claims may be false, misleading, and deceptive — as they state or seem to imply that these products have been found safe and effective in helping smokers quit,” they wrote, citing the CDC study. 

The Wall Street Journal’s Mike Esterl reports that pending legislation in the three largest U.S. cities — New York, Los Angeles and Chicago — to ban e-cigarettes in places where smoking is prohibited “are the biggest threat yet to what many view as the cigarette of the future in the $100 billion-a-year U.S. tobacco market.”

Not that other legislators have been passive. “New Jersey, Utah and North Dakota have broadened smoking bans to include vaping in public areas including offices, stores and restaurants,” Esterl writes. “So have more than 100 cities, including Boston, Seattle and Indianapolis. Gainesville, Fla., Hermantown, Minn., and Pocatello, Idaho, joined the list this month—Pocatello moving after county judges complained about courthouse vaping.”

Former smoker Gregory Conley — now a practicing “vaper” — is among those who believe that the New York City proposal, which includes a requirement that stores put up signs prohibiting the use of e-cigarettes, goes too far.

"That's the equivalent of a multimillion-dollar anti-e-cigarette campaign, not just for residents, but tourists as well,” he said.

Across the pond, European Union diplomats yesterday approved the bloc's first rules on electronic cigarettes, Reuters reports in The Guardian, with an agreement that represented a victory for the industry. “Most e-cigarettes will be sold as consumer products rather than as more tightly regulated medical devices, as governments had initially wanted,” the story says.

“Puff for puff, no one is calling e-cigarettes worse than normal cigarettes,” writes The Daily Beast’s Alex Halperin in a piece this morning that focuses on the campaign in New York City. “It’s simply that not enough research has been done to determine how dangerous they are.”

Halperin also points to a recent study published in The Lancet “finding that e-cigarettes were about as effective as nicotine patches in helping smokers to quit. Both showed a success rate below 10%.” 

Insidious as e-cigarettes may be, the industry’s best argument seems to be: What’s 10% of six million lives?