The debate over the health impact of e-cigarettes keeps getting more contentious.
On the one side, there are public health officials who want people to proceed with caution because much of the medical evidence is still uncertain. E-cigarettes, after all, have only been around for a decade, which means there are many unknowns about their long-term health consequences.
By contrast, the vaping community sees e-cigarettes as a powerful tool to get people off tobacco. Even if e-cigarettes have side effects, these advocates say, they can't possibly be as harmful as regular cigarettes. Many believe these devices have saved their lives, and they see any effort to slow down the adoption of e-cigarettes through regulation as extremely harmful.
To make matters more complicated, there's a lot of uncertainty about the impact of vaping on traditional smoking. And the ingredients in e-cigarettes aren't always disclosed, making it harder to be clear on their health impact. So for now, regulators aren't sure how to deal with the $2.5 billion e-cigarette market — which means their marketing and use has long been a free-for-all.
But that's starting to change. Last April, the FDA proposed a rule that could regulate e-cigarettes as "tobacco products," which would restrict who can buy these products, how they're advertised and labeled, where they're sold, and so on. That rule could take years to finalize and enact. In the meantime, states are coming up with their own awareness campaigns and regulations on marketing and use.
These clampdowns have enraged vaping advocates. So to better understand their point of view, I spoke to Michael Nance, an e-cigarette fan in Oak Ridge, Tennessee. Though Nance works in the food-services industry, he says he volunteers a lot of his free time advocating for the rights of e-cigarette users. He even launched a blog, Big Vapor, to spread the word.
Nance has a very nuanced and thoughtful perspective. He explained why he thinks vaping is an important public health tool, what he feels the medical community gets wrong about e-cigarettes, and how he'd like these devices to be regulated. Here is our conversation, lightly edited for length and clarity. (I've interspersed a few notes into the transcript for added context.)
Julia Belluz: So you started a website called Big Vapor. Why?
Michael Nance: There’s really no Big Vapor. I thought it was amusing, tongue in cheek, to re-appropriate that term. I was getting tired of hearing that Big Tobacco and Big Vapor are the same thing. It’s a little bit of sarcasm, humor. Most people are taking it as a joke. If I’m not mistaken, about 60 to 70 percent of the vaping industry is made up of brick-and-mortar stores.
The shops next door to me, and the one up in Knoxville, none of them will carry products from Big Tobacco. Vapers in general want people to quit smoking.
How can you trust an organization — lumping all of the Big Tobacco companies together — that for 60 years told people smoking is safe? And it came out that they were paying pharmaceutical companies and doctors to say it’s safe, and then it was uncovered that it’s not safe. I would not trust cigalikes, the e-cigs that look like cigarettes. I would not trust them as far as you can throw them.
JB: What kind of e-cigarettes do you use?
NM: I use a regulated mod. The juice I get was made here in East Tennessee. The ingredients are listed — they're USP-grade vegetable glycerol, USP-grade propylene glycol, and natural and artificial flavorings, which are in the Sprite in front of me and the ketchup to my left.
It also can contain nicotine, though for me, it doesn’t now. When I started off, it was 24 milligrams of nicotine, but over the past year I don't need nicotine anymore. I enjoy the flavors now. Specifically right now, I’m hooked on strawberry lemonade. I have an ulcer on my stomach, so I can't drink lemonade, and through vaping I’m able to enjoy a summertime classic without putting myself through pain.
JB: The evidence appears pretty mixed on whether e-cigarettes actually help people quit, but you say they worked well for you?
MN: I started smoking when I was 12 years old. That’s not uncommon for the South. We’re in tobacco country out here. By 18, I was smoking two and a half packs a day, sometimes three if I had a bad day at work, spending anywhere between $3,900 and $4,200 a year on my cigarette habit.
I had tried other types of smoking cessation. I tried Chantix, and it turned me into the Hulk. I was angry all the time. I tried the patch, nicotine gum, a nicotine inhaler. I tried cold turkey, and that just made me sick.
On February 9 [last year] I found out that I was having a little boy. When we found out we were pregnant, I thought, "Now’s a good time for me to stop smoking." Me and [my wife] discussed the smoking habit. We thought that any time I smoked, I'd have to come in and wash my shirt, so none of the harmful cigarettes on me would get on him. So I went out and bought a $100 e-cigarette setup from a brick-and-mortar store here in East Tennessee. I have not smoked a cigarette since. I went from two and a half packs a day to none.
JB: I need to ask you: Are you paid by, or do you have any connections to, the vaping or tobacco industry?
MN: I'm not on anyone’s payroll. And I do not believe that any vaper with any sort of ethics or moral code is accepting money from Big Tobacco.
I want to be clear: I am an average guy. I don't have connections anywhere. I don't even think I’m a member of the advocacy groups. I am someone who knows the harms of smoking. My father was a lifelong smoker, and had two heart attacks. I lost my grandmother to emphysema and lung cancer. My uncle has COPD [chronic obstructive pulmonary disease] from smoking.
I hate that I smoked for so long. But I know now that, give or take a few percent, vaping is at least 94 or 96 percent safer than smoking — 4,000 chemicals versus four. [Note: It's not yet clear how much safer vaping is, though many medical experts believe it's less harmful than combustible cigarettes, while studies have shown that e-cigarettes contain toxic chemicals besides nicotine.]
JB: As far as I can tell, from a public health perspective we actually don't know how safe vaping is. It's still very early days. For instance, a recent literature review in the journal Tobacco Control found that "scientific evidence regarding the human health effects of e-cigarettes is limited."
MN: I’m not going to say vaping is safe. I have corrected many vapers who have tried to say it is safe. Safe to me is a myth. Nothing in life is 100 percent safe, even water. Water can kill you by drowning. But vaping as a whole — from 2006, which is when it really kicked off, until now, until the future, we are trying to close in on safer and safer and safer.
JB: There's a pretty big battle going on between vaping advocates and the public health community. What do you think people on the other side get wrong about vaping?
MN: They think it’s smoke. I’ve had a lot of people saying it’s still smoke. It’s not. It’s not specifically water vapor, but it’s vapor. It’s really sad that so many people in public health aren’t interested in harm reduction. With [so many people] dying every year from cigarettes, they still demand we use FDA-approved quitting methods that in general haven't worked. For vapers, those methods don't work.
It feels like public health doesn't care about smokers who are dying. They just want to prevent new ones from starting. Why can't we have both: get people who are currently smoking off of cigarettes and prevent new smokers at the same time? I feel vaping fills that gap. From a public health and personal health standpoint, it's better to say, "I want to smoke," and pick up a vaporizer versus "I want to smoke" and picking up a pack of Camels. I’m sure many people in the medical field would agree with me on that.
Everyone likes to bring up flavors: "Oh, it’s attracting kids." I can walk into a liquor store down here, get cotton-candy liquor, or strawberry-flavored — there's no regulation on that, other than you have to be 21. But they want to say e-cig juice is attractive to kids. I'm pretty sure the number of deaths of people under 21 attributed to alcohol is way in excess of kids who have touched e-cigarettes.
JB: What, to you, is the ideal regulatory situation?
MN: I don't feel it should be banned in parks and stuff, which is something New York passed recently. They banned vaping in all public places. I’m not a big-government person. My political leaning is often in so many different directions that I can't call myself a Democrat or Republican or libertarian. But I feel it is a business's decision whether they want to allow vaping.
JB: What about selling to minors?
MN: Absolutely not. I am staunchly against it. It should start at 18. If you’re able to smoke, or want to vape, it should be your right.
JB: None of us has the long-term data on the effects of e-cigarettes — the evidence is often inconsistent, and many studies are flawed. But I have still found that many in the vaping camp seem to want to suggest otherwise, though maybe it's also true that the public health side may be overblowing the certainty about the harms.
JB: Imagine if, for years after trying without success to quit something you knew would kill you, you find something that really worked. And people like the government, public health, want to regulate and tax and ban it. We’re adults; this is what works for us.