Public health researcher ignites debate on e-cigarettes

Wasim Maziak, M.D., Ph.D., one of the world’s leading experts in nicotine and tobacco research, has come out strong against promoting e-cigarettes as a healthier alternative to traditional cigarettes.

Professor and chair of epidemiology at FIU’s Robert Stempel College of Public Health and Social Work, Maziak published an op-ed piece in the August issue of the American Journal of Preventive Medicine, “Harm Reduction at the Crossroads: The Case of E-Cigarettes” and letters in JAMA and The Lancet noting that e-cigarettes are being marketed to young consumers and they are hearing that message—and responding to it in alarming numbers.

There is no safe way to use tobacco argues Professor Wasim Maziak.

“New data from the National Youth Tobacco Survey (NYTS) show that the number of e-cigarette experimenters among high school students in the U.S. more than doubled between 2011 and 2012. Figures…suggest that [e-cigarette sales] could even surpass conventional cigarettes within a decade or so,” Maziak said in his op-ed. Colorful designs, multiple flavors and cheap prices “leave little doubt about which age group is targeted.”

This is a stance that some scientists are disputing. “Harm reduction” proponents believe that switching to lower tar alternatives, such as e-cigarettes, can lower the risks to both smokers and those around them. This includes a group of public health researchers at University College London. They authored a September 1 editorial in the British Journal of General Practice estimating that 6,000 lives could be saved for every million smokers who switch to e-cigarettes. David B. Abrams, a researcher at the Schroeder Institute for Tobacco Research and Policy Studies at Legacy Foundation, says that e-cigarettes can provide a way to help smokers quit, offering an alternative to “abstinence-only” options. Abrams responded to Maziak’s letter in JAMA stating that “policy making relies on science, not dogma… It is not nicotine per se that kills people; it is exposure to toxic compounds generated by burning tobacco. If nicotine can be decoupled from deadly tobacco smoke, adults and youth can be saved.”

But Maziak says that it might take only a few exposures to hook young users, and that “nicotine causes a real addiction with lifelong psychosocial, economic, and health effects.” What is also missed in the “harm reduction argument,” Maziak noted, is that e-cigarette sellers do not abide by the harm reduction paradigm of helping hard to quit smokers, as their goal is to sell the product to as many people as they can. Harm reduction has a societal dimension, moreover, that is repeatedly overlooked by harm reduction advocates like Abrams, Maziak added, and this concerns spreading nicotine addiction in the community without even having sufficient evidence that e-cigarettes can help individuals reduce their risks. Even experts within the tobacco industry, such as Helmut Wakeman of Philip Morris, recognize that “people will take cigarettes ahead of food if starved of nicotine.” Harm reduction advocates seem to have no problem with that as they portray nicotine as an innocent bystander of cigarettes. Thankfully, many others do not agree, Maziak said.

There are no regulations against the sale of e-cigarettes on a national level, though Maziak notes that some lawmakers have pushed legislation in their districts. In Florida, a new law was passed July 1 prohibiting the sale to minors of any “nicotine dispensing device,” including e-cigarettes. First-time offenders will get hit with a $25 civil fine, or 16 hours of community service. Anyone under the age of 18 who is caught three times risks losing a driver’s license. It’s a good start, but it’s not enough says Maziak.

“We are dealing in e- cigarettes with a product that is marketed and appeals to youth, is highly addictive, reminiscent of a very popular one, and finally is driven by an industry with a profit-based model rather than public health’s harm-reduction one,” he wrote in his editorial.

According to Maziak’s research, there is no safe way to use tobacco. In more than a decade of study, he has noted that alternatives to cigarettes that may seem less toxic, such as water pipes, are still hazardous to one’s health, and harmful to society as a whole.

“Why should we breathe anything but air?” Maziak said. “We should be grateful for that.”