My Testimony for Electronic Cigarette Hearing in Windham, New Hampshire

Attorney Fred Kelly Grant conducted a very nice interview with me regarding electronic cigarettes which will be submitted as testimony for an e-cigarette informational hearing in Windham, New Hampshire. Fred did a great job of asking questions that covered the gamut of important scientific and regulatory issues, so I hope this will be a good resource to provide a solid background on this issue.

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American Heart Association Still Clings to Alternative Facts: Claims that Smoking is No Safer than Vaping

Scientists like myself are often frustrated by “denialists” who refuse to acknowledge global warming, disseminate false information about adverse effects of vaccines, or – historically – failed to acknowledge the severe health effects of cigarette smoking. But I never expected this denialism to be coming from within my own movement in public health.

Today, it appears that the American Heart Association is still taking a public denialist stance with regards to the health benefits of quitting smoking by switching to vaping. Despite overwhelming scientific evidence that vaping is much safer than smoking and that quitting smoking by switching to electronic cigarettes has dramatic and immediate health benefits, the American Heart Association is still clinging to the false message that smoking may be no safer than vaping.

According to an article appearing today in The Daily Mail:

“Dr Aruni Bhatnagar, director of the American Heart Association’s Tobacco Research and Addiction Center, added: ‘We just don’t know if moving to e-cigarettes is good enough to reduce the harm.'”

As the Daily Mail is not necessarily a trustworthy source (note the headline that a single e-cigarette can potentially lead to a heart attack), I confirmed this quote with other sources. The same quote appeared in the San Diego Union-Tribune two weeks ago. It seems clear that the American Heart Association, through its Tobacco Research and Addiction Center, is still clinging to the belief that smoking may be no more hazardous than vaping. Furthermore, the American Heart Association is disseminating this false information to the public.

The Rest of the Story

The American Heart Association’s claim that quitting smoking by switching to electronic cigarettes does not reduce the harm of cigarette smoking flies in the face of overwhelming scientific evidence that switching from smoking to vaping leads to an immediate improvement in respiratory symptoms and improves lung function. Improvement in spirometry measurements was observed even in dual users, but was most substantial in smokers who switched completely to e-cigarettes. Remarkably, respiratory symptoms improved in patients with chronic obstructive pulmonary disease (COPD) who switched to electronic cigarettes.

In addition to improving respiratory health, e-cigarettes also lower carcinogenic risk compared to smoking, as they deliver many fewer and much lower levels of carcinogens. 
The American Heart Association’s claim is not only false, but it is potentially damaging. If smokers believe this false information, they may decide that there is no reason to quit smoking using e-cigarettes. Or, even worse, ex-smokers who quit using e-cigarettes may return to smoking. After all, if it is not clear that vaping reduces harm compared to smoking, then what’s the point of vaping? You might as well enjoy the real thing.
I’m surprised that cigarette companies haven’t jumped on the opportunity to use the American Heart Association’s endorsement of smoking:
“We at Philip Morris believe the public should heed the advice of respected public health organizations. According to the American Heart Association, we just don’t know if quitting smoking by switching to e-cigarettes reduces the harm. So if you’re thinking of trying to quit smoking by switching to vaping, don’t bother. There’s no certainty that it will reduce your health risks. But it will certainly decrease your enjoyment of the tobacco smoking experience.”

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NYC’s Anti-tobacco and -vaping package passed – Update and Digest

Update – 08.11.17

On Wednesday, August 9th, The New York City Council voted to pass a package of anti-tobacco and anti-vaping ordinances. Please see the table below for a digest of each law that was passed and their effective dates.

– §3. (Effective following enactment) No pharmacies can apply for a new dealer’s license. Renewals will only be valid until Dec. 31, 2018.

Int. No 1547-A

– Prohibits pharmacies from obtaining an electronic cigarette retail dealer license.

– Establishes a 90-day period that begins when the law is enacted in which existing vapor retailers are able to apply for a new license. After this 90-day period, no new licenses will be issued.

– (Effective Immediately) The commissioner of consumer affairs must publicize the 90-day application period to maximize awareness.

– Establishes biennial licensing fee of $200

– Establishes a community district electronic cigarette retail dealer cap. This cap will be set at HALF the number of licenses issued during the 120-day period following the expiration of the 90-day application period.

– Electronic retail dealer licenses are allowed to be sold but are only valid for the property that was originally licensed. Effectively, these licenses are non-transferrable.

– Establishes financial penalties for violations (Effective date: See Int. No 1544-B)

– Establishes penalties for violation and grounds for revoking licenses.

after becoming law

(see exceptions in description)

– Expands the existing cigarette licenses to include OTP henceforth referred to as “tobacco dealer license.”

– Raises the price floor for cigarettes from $10.50 to $13.00.

– §17 Establishes minimum package sizes for cigarettes and OTP.

– §18 Prohibits delivery of cigarettes, OTP, and e-cigarettes by foot, bicycle, or any motor vehicle outside of a retail dealer’s place of business.

after becoming law

after becoming law


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Bill Number Description Effective Date
Int. No 0484-A – Prohibits smoking and vaping in the common areas of ALL multiple dwellings. Existing law limits this prohibition to buildings containing more than ten dwelling units. 180 days

after becoming law

Int. No 1131-B – Prohibits the sale of Tobacco and Vapor products in pharmacies. Jan-01-2019
Int. No 1471-A – Increases biennial retail cigarette dealer license fee from $110 to $200. See effective dates for
Int. No 1532-A – (Effective 360 days after becoming law) Requires anyone selling electronic cigarettes to have an electronic cigarette retail dealer license for EACH place of business where e-cigarettes are sold. 150 days
Int. No 1544-B – §3 Establishes price floors and taxes for other tobacco products (OTP). This includes a price floor for low-risk products like American moist snuff and Swedish snus which is set at $8.00. (please see the table on page 6 of the bill for more details) The first day of the calendar month next following the 270th day after it becomes law, provided that subdivision b of §17-704.1 of the administrative code of the city of New York, as added by §18 of this local law, takes effect 150 days after it becomes law.
Int. No 1547-A – §10, subdivision e directs the commissioner of finance to establish a community district retail dealer cap for each community district in the city. This cap will be set at HALF the total number of licenses issued excluding retail dealer licenses issued to pharmacies. 180 days
Int. No 1585-A – Requires owners of co-ops and condominiums to adopt and disclose smoking policies. 365 days

It's Official: Anti-Tobacco Groups Willing to Throw Away the Lives of Smokers to Promote Radical Ideology

For months, I have been arguing that the major anti-tobacco groups in the United States have been waging a war against electronic cigarettes that is motivated not by a pure concern for the public’s health, but by an ideological opposition to the idea that anyone could get pleasure from nicotine in whatever form — even if they are improving their health and saving their life.

Today, the American Thoracic Society (ATS) made it official.

In a letter to the editor published in the Washington Post, the American Thoracic Society confirmed what I have been suggesting for months.

The vice chair of the American Thoracic Society’s Tobacco Action Committee essentially confirmed that the ATS is willing to throw away the lives of smokers in order to promote the radical ideology that no one should derive pleasure from nicotine in any form, even if it is a life-saving switch from deadly cigarettes to very low-risk e-cigarettes.

In the letter, Dr. Enid Neptune writes: “As a physician who treats patients devastated by tobacco-caused lung disease, I was concerned by the Aug. 5 editorial “Breaking nicotine’s grip,” which embraced Food and Drug Administration Commissioner Scott Gottlieb’s plan for regulating tobacco products. The commissioner seems unconcerned about switching one form of nicotine addiction with another. Nicotine in any form is bad for your health, adversely affecting neurological and cardiovascular systems and reproductive health. Evidence shows that nicotine can be a gateway drug. … The FDA’s job is to protect youths from all types of tobacco and nicotine addiction, not to negotiate which types of nicotine addiction it will allow.”

The title of the letter is: “The FDA’s new plans could just switch one form of nicotine addiction with another.”

The Rest of the Story

The writer makes a great point. We should never promote the idea of people switching from one addiction to another. And it is not the concern of public health what health risks are associated with any form of addiction. All addiction is bad and our job in public health is to make sure that no one, anywhere, at any time, is addicted to any substance.

For example, when heroin addicts are treated with methadone or bupenorphine, the physician is just substituting one addiction for another. These physicians seem unconcerned about switching one form of nicotine addiction with another. Opiates in any form are bad for your health, adversely affecting neurological and cardiovascular systems and reproductive health. Evidence shows that opiates can be a gateway drug and there is a great risk of overdose with any opiate. The job of physicians is to protect people from all types of opiate addiction, not to negotiate which types of opiate addiction they will allow.

OK – I was being facetious. But this demonstrates the insanity of the argument that the e-cigarette industry should be decimated through burdensome regulations because vaping is just another form of nicotine addiction and all nicotine addiction is equally evil.

I, and fortunately the new FDA Commissioner, strongly reject this radical ideology. Risk does matter. Addiction is a public health problem not because the concept of someone being addicted to a substance is severely damaging, but because the addictive substance carries severe health risks. Switching from a high-risk addictive substance to a low-risk addictive substance is not a zero-sum game. It is a critical and life-saving intervention. Just as methadone maintenance programs have saved thousands of lives from heroin-associated morbidity and mortality, electronic cigarettes are saving thousands of lives from smoking-associated disease and death.

While this writer speaks only for the American Thoracic Society, it is clear to me that this is indeed the underlying philosophy of all the major anti-tobacco groups, and even of many health departments and agencies, including the Centers for Disease Control and Prevention and the state health departments in California, Vermont, and Washington (to name a few).

Fortunately, Commissioner Gottlieb has rejected this philosophy, strongly and definitively. Public health is about saving lives, not fighting for some ideological principle of no addiction to any substance, regardless of how low-risk the product might be or how the product might be saving a life by switching someone to a much safer form of drug delivery.

Of course we need to restrict the sale and marketing of vaping products to youth and educate them about the health risks of all types of nicotine products, including real cigarettes and fake ones. But discouraging youth from using e-cigarettes should not come at the expense of wiping out 99% of the e-cigarette market, depriving millions of former smokers of the product they are using successfully to stay off tobacco cigarettes, and risking tens of thousands of these former smokers returning to cigarette smoking because their vaping products are taken off the market.

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NYC – Take action to stop a package of anti-THR ordinances

A package of ordinances that were introduced in April in New York City aimed at raising the floor price of tobacco products, prohibiting tobacco sales in pharmacies, adding further restrictions on where people can smoke and vape, and enacting a moratorium on retailer licenses are heading back to the NYC Health Committee on

Tuesday, August 8th, 2017

10:30 AM

250 Broadway, Committee Room, 16th Fl.

Take Action – Send a Message

An ordinance (Int. No 1532), which would require licenses for anyone selling vapor products and stop issuing licenses within 90 days of becoming law, is scheduled for a hearing on

Please make plans to attend this hearing. Even if you do not plan to speak, your presence is important as it demonstrates the large numbers of people affected by this issue.

Please take action NOW by sending a message to members of the Committee on Health urging them to oppose this ordinance!

Take Action – Send a Message


Consumers and business owners need to be aware that, although this is a separate licensing regulation for vapor retailers, it is not a beneficial consideration. The city intends to cap the number of vapor retailers at half the current number, by community district, in the five boroughs and phase them out of business over time.

Please take action TODAY!

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New Study Provides Strong Empirical Support for New FDA Approach to Tobacco Product Regulation

A new study published in the journal Tobacco Control reports that the modeled cancer risk associated with vaping is less than 1% of that associated with smoking and is only slightly higher than, if not comparable to the cancer risk associated with nicotine replacement therapy (NRT). In select circumstances, electronic cigarettes produced high levels of aldehydes but only when the voltage was cranked up to excessive levels. Thus, under conditions of normal use, this study finds that tobacco-free e-cigarettes present a drastically reduced carcinogenic risk compared to tobacco cigarettes.

The study methods were as follows: “The cancer potencies of various nicotine-delivering aerosols are modelled using published chemical analyses of emissions and their associated inhalation unit risks. Potencies are compared using a conversion procedure for expressing smoke and e-cigarette vapours in common units. Lifetime cancer risks are calculated from potencies using daily consumption estimates.”

The results were as follows: “The aerosols form a spectrum of cancer potencies spanning five orders of magnitude from uncontaminated air to tobacco smoke. E-cigarette emissions span most of this range with the preponderance of products having potencies less than 1% of tobacco smoke and falling within two orders of magnitude of a medicinal nicotine inhaler; however, a small minority have much higher potencies. These high-risk results tend to be associated with high levels of carbonyls generated when excessive power is delivered to the atomiser coil. Samples of a prototype heat-not-burn device have lower cancer potencies than tobacco smoke by at least one order of magnitude, but higher potencies than most e-cigarettes. Mean lifetime risks decline in the sequence: combustible cigarettes much greater than heat-not-burn, which is much greater than e-cigarettes (normal power), which are greater than or equal to nicotine inhaler.”

The study concludes that: “Optimal combinations of device settings, liquid formulation and vaping behaviour normally result in e-cigarette emissions with much less carcinogenic potency than tobacco smoke, notwithstanding there are circumstances in which the cancer risks of e-cigarette emissions can escalate, sometimes substantially. These circumstances are usually avoidable when the causes are known.”

The Rest of the Story

This study should put to rest any doubt within the tobacco control movement about whether vaping greatly reduces health risk compared to smoking. Numerous anti-tobacco groups and health departments have repeatedly asserted that vaping is no less hazardous than smoking, but this claim is false, and the present study adds significantly to the already substantial evidence that vaping is orders of magnitude safer than smoking. The anti-tobacco groups and health agencies that have made such statements should immediately correct them and issue retractions to alert the public to these important findings.

These results add strong empirical support to the new FDA approach to tobacco products, announced one week ago by FDA commissioner Dr. Scott Gottlieb, which emphasizes the regulation of tobacco products and e-cigarettes based on the wide differential in their health risk. It makes no sense to lump e-cigarettes in the same basket as tobacco cigarettes, given their drastically different health risks. However, that is precisely what the FDA was doing prior to Dr. Gottlieb’s appointment as the new commissioner. Now, the agency is taking a much more sensible and evidence-based approach.

While this study does find that there are conditions under which e-cigarettes can be made to produce rather high levels of certain hazardous chemicals — most notably aldehydes — these conditions involve jacking up the voltage to excessive levels that typically produce dry puff conditions, something that vapers would almost certainly detect immediately and not tolerate. Nevertheless, the results do suggest that FDA safety standards related to the maximum allowable voltage or coil temperature may be warranted.

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FDA’s New Approach to Nicotine Regulation – What’s In and What’s Out

On Friday, July 28th, FDA Commissioner Dr. Scott Gottlieb announced the agency’s new vision for tobacco regulations. As stated, the central driving force behind the proposed shift in policy is the commitment to reduce the harms caused by combustible tobacco use. The most immediately significant part of Commissioner Gottlieb’s announcement is a proposal to extend the deadline for pre-market tobacco approval applications (PMTA) for newly-deemed tobacco products to August 8th, 2022. FDA will issue guidance on the matter soon.

  • Proposed new deadline for submission of PMTA applications is August 8, 2022
  • Compliance deadlines that have already passed are not affected.
  • Future compliance deadlines (here) for warning statements, ingredient listing, health document submissions, harmful and potentially harmful constituents (HPHC) reports, and the removal of modified risk claims are not affected.

Although Friday’s announcement is a clear signal that the FDA is granting the vapor industry a four-year stay of execution, it bears repeating that this is simply a delay. Commissioner Gottlieb included several pressing issues that concern the vaping community, future vapor consumers, and tobacco harm reduction (THR) advocates, all of which will need to be addressed in short order so that 2022 isn’t just another cliff edge.

Proposed regulation of nicotine content in cigarettes

The proposed policy shift for the FDA centers around refocusing the agency’s regulatory efforts to address the “astonishingly addictive” nature of nicotine. Specifically, the FDA is targeting nicotine delivered via smoking and will be considering a rule that would mandate lower nicotine levels in cigarettes. By forcing manufacturers to produce cigarettes that are, in theory, less or non-addictive, FDA speculates that young people who are at risk for initiating smoking will quickly lose interest or, if they go on to become regular smokers, will have an easier time of quitting.

Very low nicotine content (VLNC) cigarettes are not a new idea and this raises questions that stakeholders and public health advocates will need to tackle. Probably the most immediate concern is how consumers will react to lower nicotine levels: Does such a mandate create an underground market for full-strength cigarettes and will smokers just end up smoking more? Appropriately, these questions will be addressed during the rulemaking process.

As the discussion on vapor products moves toward standards-based regulation and given FDA’s notice of intent to seriously consider limiting the nicotine content in combusted cigarettes, it is worth raising the concern now that we will be having a conversation about nicotine limits for e-liquid and possibly smokeless tobacco. Regulations in the EU have already set the precedent which has spilled into policy being debated in Australia. There is little reason to believe that this won’t be part of the discussion in the US going forward.

Proposed regulation of flavored cigars and noncombustible nicotine products

Unsurprisingly, the FDA will be taking a hard look at flavored tobacco and nicotine products, menthol cigarettes, and using the rulemaking process to issue product standards. While much of the discussion around flavors still revolves around the effect on young people, Commissioner Gottlieb has already started to shift this conversation. Most notably, his comments during his Senate confirmation hearing signaled a potentially more enlightened view of the role flavors play in helping smokers transition to low-risk nicotine products. Going forward, it is vital that the agency’s investigation into flavors is framed around what will benefit smokers and vapers the most.

Many, including CASAA, believe the conversation about flavored nicotine products is more appropriately framed as a discussion about marketing. There are nuances when we talk about marketing, most importantly, establishing the boundaries of the first amendment. It should suffice to say that any regulation regarding marketing standards can not be reduced to “I know marketing-to-children when I see it.” However, the standards should not be so strict that consumers are less interested in the products or left largely in the dark about their pleasurable elements.

Consumer engagement on flavor/marketing standards is paramount and cannot be left to agenda-driven researchers. Although there is cause for celebration over the announcement of FDA’s new vision for tobacco and nicotine regulation, policy change is slow, especially when the walls of long-held beliefs are high. Challenging the decades-old narrative that flavors in tobacco (and nicotine) products exist solely to entice children to become addicted is still necessary–now more than ever.

Clear guidance regarding PMTA, MRTP, and SE applications

Since 2009, the pathway to premarket approval for tobacco products has been fraught with uncertainty. This lack of clarity in the FDA’s expectations regarding the information required to successfully bring a product to market or advertise it as lower risk is presenting financial and paperwork hurdles that very few can overcome. Revising the FDA’s guidance regarding the approvals process is a necessary step in creating a regulatory environment where innovation can occur and low-risk products can more easily be sold.

While a PMTA deadline delay is important to keeping low-risk vapor products on the market for the next four years, the temporary reprieve will be all-for-naught if only a few products will be available after August of 2022.

What’s missing from FDA’s announcement

Grandfather Date

Significantly, FDA did not address modernizing the predicate date for newly-deemed products. Although there was mention of revisiting the agency’s backlog of substantial equivalence (SE) applications and the SE pathway, there is no indication, at this time, that Commissioner Gottlieb will be using FDA’s discretion to enforce a modern predicate date. The February 2007 grandfather date is still a massive barrier to innovation and keeping most vapor products on the market after 2022.

CASAA is asking our members to continue contacting their representatives and urging them to support HR 1136. This bipartisan bill is playing a vital role in keeping the conversation about predicate products and the need to modernize the grandfather date alive. Please visit to take action.

Updated Language

Even though the FDA is signaling that it will be taking an enlightened approach to regulating reduced- and low-risk tobacco and nicotine products, some of the language used to communicate this policy shift is reminiscent of the old tobacco control playbook. Phrases like “for those who need [nicotine]” and “astonishingly addictive” ignore an evolving understanding of how and why people use nicotine. It also ignores the complexities of substance use and perpetuates the misunderstanding that chemical dependency = addiction = harm.

CASAA has long been a proponent of communicating the benefits of harm reduction without using the language of our opponents. Sometimes, appropriating phrases can be useful in lampooning absurd policies, but in a serious discussion about public health strategy, using the language of our opponents has the unfortunate tendency to validate their fact-free claims about harm. If we are truly going to reframe the conversation around nicotine, we need to be thoughtful and vigilant about how we communicate risk. The idea that low-risk alternatives to combusted tobacco exist solely as a means to achieving complete nicotine or smoking cessation is old thinking. Although this idea has its place in discussions about harm reduction, it cannot be the basis of the overall strategy.

Mandating very low nicotine content in cigarettes

The proposal to limit the nicotine content in cigarettes is being presented as a necessary first step in transitioning smokers to low-risk products. In reality, the real first step was taken when the electronic cigarette was invented (of course, prior to the rise in popularity of vaping, smokeless tobacco should have been promoted as a low-risk alternative to smoking). Steps two through three happened when consumers, backyard innovators, and independent manufacturers modified and improved the products that were on the market. All of that to say that the availability of effective and enjoyable low-risk nicotine products has been and currently is the cornerstone of any strategy to reduce the harm of smoking.

What the FDA is proposing, however, is that vapor products need a heavy assist from the government so that smokers will make the decision to use a lower-risk nicotine product. In no uncertain terms, this is just more coercion and flirts dangerously close to prohibition.

As mentioned above, there are new questions of public health to contend with. We are also mindful that states that are dependent on cigarette tax revenue will be looking to replace those dollars as the smoking rate continues to fall. We should be very concerned that the easiest target will be the rest of the tobacco and nicotine category–which is already happening in several states and municipalities.

What does all of this mean for consumers

In theory, the FDA’s recent decision to delay the PMTA deadlines means consumers will continue to have access to the diverse vapor market for several more years. While the extended timeline for compliance means that vapor manufacturers are likely to stick around, the current compliance deadlines will likely translate to slightly increased costs and, as mentioned above, the 2007 grandfather date remains unchanged. Another reality we will face is heightened opposition from groups who would rather see tobacco and nicotine banned completely.

The narrative from the usual tobacco control groups for the past several years is that the lack of federal regulation of vapor products means 1) we can’t be sure how risky the products are and 2) therefore, state and local governments must take action to impose their own strict regulations. Although Friday’s announcement from the FDA is a clear declaration that the agency is moving forward with regulations, anti-tobacco activists continue to spin the news as if the FDA is giving up their authority.

In addition to the predictable press releases in response to the FDA’s announcement, the disinformation coming from tobacco control was on full display during Dr. Jerome Adams’ confirmation hearing to become the next US Surgeon General. When Senator Maggie Hassan (D-NH) asked Dr. Adams about protecting young people from tobacco and nicotine, she introduced the question by stating that the deeming rule had been delayed. While it is true that one aspect of the rule (PMTA compliance) has been extended, the rest of the rule remains unchanged. In fact, as discussed above, the FDA announced that it will be promulgating even more rules in the near future regarding product standards for e-liquid and batteries.

Senator Hassan’s mischaracterization of the FDA’s announcement is very likely to be repeated and exaggerated at the state and local level. Therefore, it is important to remind lawmakers that the deeming rule took effect and the timeline for compliance began on August 8, 2016. That date has not changed. The national minimum legal purchase age for all tobacco and nicotine products is still 18-years-old. Moreover, compliance deadlines for product registration, ingredient listing, toxicology, and warning labels remain unchanged.

While vapor businesses and their consumers have been given a lifeline, there are still sharks in the water. Now, more than ever, it is vital that lawmakers hear from voters about the benefits of vaping and other low-risk tobacco products.

CASAA is urging our members to continue contacting their representatives and urging them to co-sponsor HR 1136 by visiting

Your senators also need to hear your stories about how vaping and other smoke-free tobacco products have affected your life. You can find contact information for all of your lawmakers by visiting

CASAA relies on contributions from our members to provide timely and accurate information about legislative engagement and the benefits of low-risk tobacco and nicotine products. Please donate today! Any amount will go a long way to helping us keep consumers informed and provide opportunities to engage with lawmakers. Thank You!


Additional Coverage:

FDA News Release –

Dr. Scott Gottlieb’s full remarks –

Brad Rodu –

Clive Bates –

Jacob Sullum (Reason), “A Cap on Nicotine in Cigarettes Would Be Hazardous to Health” –



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