Neil Pakenham-Walsh asked: "Can anyone explain what are the biggest flashpoints of the debate? On what does everyone agree, and on what do they disagree?"
Let me start by re-highlighting one of the personal truisms I listed earlier, that folks on both sides are honestly doing what they think is best for public health. I say that not to be magnanimous or even-handed or to avoid insulting people (although those are fine reasons), but as a launching point to talk about the difficulties in employing the precautionary principle. Both sides are using it, but have come to different conclusions as to what it means. These are my interpretations, of course, and I hope I can characterize the positions fairly.
Pro e-cig argument: Currently, combustible cigarettes kill someone roughly every four seconds. We have tried for decades to reduce their use, but with limited success. If there is an alternative product available that is less harmful, we have a duty to make it available and provide public information and encouragement for people who smoke to switch.
Anti e-cig argument: We don't know how dangerous e-cigs are, but we know they are not safe. We have a duty to prevent a new epidemic, and a moment in history when it is still possible to do so. There are tested and regulated products available already to help people who smoke to quit. If e-cig manufacturers truly want to help people who smoke, they can go through the process of getting regulatory approval as smoking cessation products.
There are a few - a very few - public health advocates that have gotten it objectively wrong. A couple of years ago one organization ran a campaign to convince people who had switched from combustibles to e-cigs to switch back. I don't know how successful the campaign was, but if they convinced even a few people, they are likely culpable for additional deaths.
One other point I'd like to make, and at the risk of insulting some folks. People have a right to accurate health information, and governments and public health advocates have a duty to do their best to provide it. There have been and are several public campaigns, understandably aimed at preventing kids from becoming addicted to nicotine, that breach this duty by cherry picking or massaging information. The ends cannot justify the means. This is not to say that taking liberties with the truth is isolated to one side of the debate - there have been dubious claims from the other side as well. But it comes from a very tiny fraction of a field filled with selfless and passionate people.
Chris Bostic, Policy Director
ASH > ACTION ON SMOKING & HEALTH
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HIFA profile: Chris Bostic is Action on Smoking and Health’s Policy Director. Since 2001, Chris has worked in tobacco policy at the local, state, national and international levels. Prior to joining ASH, he worked at the Campaign for Tobacco-Free Kids and the American Lung Association. He has also served as a public health law clinical instructor at the University of Maryland Francis King Carey School of Law and was a founding board member of the Human Rights and Tobacco Control Network (HRTCN). bosticc AT ash.org