The real question about “e-cigarettes”

I’ll preface this by saying, whoever thought to call inhalable nicotine delivery devices “e-cigarettes” probably deserves a marketing prize. More generally, the whole framing of these devices seems bizarre.

There’s an article by Sally Satel in The New Republic, under the title “Everyone Is Asking the Wrong Questions About E-Cigarettes”, which presents current opposition to the e-cigarrette phenomenon as a kind of neuropharmacological Luddism. The argument — which is depressingly common — is that electrically generated nicotine vapour is so clearly a health gain relative to tobacco smoke that no regulatory hurdles should inhibit an addict from replacing the latter by the former.

This sounds compelling, but it’s not, because it ignores fundamental principles of government regulation, and in particular the awkward respect that it shows to stasis: Very often we impose new regulations on changes, allowing the old to remain in place because the expense or disruption imposed by requiring the old to be replaced is seen as excessive. An example that first caught my attention many years ago was the way Boston (and presumably Boston is not at all unusual in this) imposed a requirement that, for example, new outdoor light fixtures or windows need to meet requirements of historic preservation — even (and this was the part that amazed me at first) if it’s just a matter of replacing one fixture by a new but identical fixture. But of course, the idea is that over time replacements will be made, and that will the appropriate time to upgrade to the desired (historically sensitive) appearance.

Walking around downtown Berkeley you see shops with plaques warning customers that the shop does not meet current standards of seismic safety. We don’t tear down the buildings, but we also would not allow a plan to knock down one seismically unsound building and replace it by a substantially equivalent building that is slightly better, but still not up to current codes, with the reasoning that any improvement is better than none. (At some point the motivation to renovate rather than replace may lead to philosophical quandaries.)

It’s not that “common-sense” exceptions should never be made to general rules, but they need to be viewed skeptically, taking into account the entire context. We don’t normally allow people to choose psychoactive drugs to take because they think it will improve their health, or help them quit another drug. Think of the tight constraints on methadone. LSD at one point showed some promise as a treatment for alcoholism.

There has been considerable progress in preventing the health damage due to tobacco by socially denormalising its consumption, and preventing children from having access to it. We have to consider the danger that this work could be undone.

Furthermore, the safety of these devices is still completely conjectural. The damage induced by tobacco took decades to be established — and it takes decades to develop in an individual smoker. The e-cigarettes remove many of the hazardous substances known to be in tobacco, but add many more substances — in particular, a wide variety of flavour additives — whose long-term effects are completely unknown. That is not even to mention the fact that concentrated nicotine is known to be a lethal poison, one that used to be completely unknown in the home environment, and that people are surely going to treat carelessly. The first fatal poisonings of children cannot be far away, if they have not already happened.

What I find most interesting about e-cigarettes — and never mentioned in any of the articles I have seen on the subject — is their potential for the future. If we accept that people will publicly dose themselves with nicotine from aseptic electrical devices because they think it’s a good idea, then why not other drugs? And, more to the point, who can stop them? Presumably I’m not the first person who has thought that the nicotine cartridges in these e-cigarettes could easily be replaced by some other liquidised drug, and as long as it is reasonably odourless no one will know what anyone else is smoking. The manufacturers are currently competing on design and flavourings, but how long before they are competing on the psychoactive properties of their mixtures?