My friend lit up her electronic cigarette during intermission when we were in line for a bathroom at a Broadway theater. People in the line looked at her disapprovingly. She responded quickly: “I am not smoking. It’s only water vapor.” That’s the argument that the e-cigarette industry makes, and it is clearly one that my friend wants to believe. Her response put a stop to any questions about second-hand smoke. Nobody else said anything. Maybe nobody wanted an argument on a night out for theater or maybe people knew too little to comment confidently. She waited for a bathroom stall and continued smoking.
While questions about electronic cigarettes stayed below the surface in the ladies room, they are hotly debated in the world of tobacco control and public health. There are concerns about the exact benefits and potential harms of electronic cigarettes, secondhand smoke, and air quality. Proponents see e-cigarettes as a safer alternative to traditional cigarettes, but skeptics question how safe they really are, both for users and people exposed to them as second-hand smoke. So far, they have been manufactured and distributed without oversight, data, or proof that they are a bridge to quitting more toxic cigarettes. Also, many experts question the industry line that just water vapor is released when users light up.
Product Regulation Considered
In today’s Lancet Respiratory Medicine, two commentaries put forth opposing views on the question of regulating electronic cigarettes as medical devices. Nathan K. Cobb, MD, and Caroline O. Cobb, from the Department of Pulmonary and Critical Care Medicine, Georgetown University Medical Center, Washington, DC, warns: “Without oversight or consumer safety regulations, the manufacturers of ENDS produce products that are more widely available, much cheaper, and might contain more nicotine and contaminants than competitor products manufactured by pharmaceutical companies.”
Cobb and Cobb want regulation. They frame the issue this way: “The question should be what regulatory system will get safe and effective refined nicotine products into the hands of more smokers and promote elimination of the most lethal combusted products?”
In the second commentary Peter Hajek, Director of the Tobacco Dependence Research Unit at the Wolfson Institute of Preventive Medicine, Queen Mary University of London, UK, and colleagues, argue that regulation will stifle innovation, the development of better healthier electronic cigarette designs, and hinder competition of e-cigarettes against more toxic traditional cigarettes.
Product regulation is only one part of the story. It is what the Food and Drug Administration can address. Local governments will have to decide where people can use e-cigarettes, whether air quality statutes should issue standards.
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