Should electronic cigarettes be as freely available as tobacco? YesBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3845 (Published 14 June 2013) Cite this as: BMJ 2013;346:f3845
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Should electronic nicotine be as freely available as smoked nicotine? Professor Chapman argues "no" while Professor Etter says "yes." What's being missed is that, in order to protect youth, the e-cigarette's arrival mandates revision of nicotine product sales laws worldwide. It's a golden opportunity for health advocates to unite in demanding that merchants be compelled to select between having adolescents as customers, or the sale and marketing of what's arguably the planet's most captivating chemical.
If heroin were legal, would we remain silent and allow it to be marketed in front of our children or grandchildren?
Why compel teenagers to stare into evolving neo-nicotine industry store power-walls when purchasing candy, chips or ice-cream? Why allow their brains to be hammered by countless use invitations suggesting e-cigarettes are flavorful, as safe as cola, lots of fun, allowed nearly everywhere, a rite of passage into adulthood (expect second generation large yellow "We Card" signs), and will aid them in making (enslaving) lots and lots of new friends?
How hard would it be when amending existing youth nicotine dependency prevention laws to simply add a provision which reads: "Nicotine products, other than government approved smoking cessation products being marketed for smoking cessation (not nicotine maintenance), shall not be sold or distributed in any business location allowing access to persons under eighteen years of age. Each entrance to any nicotine product sales location shall conspicuously display a legible sign having minimum dimensions of 21 x 21 centimeters (8 x 8 inches). The sign shall use white lettering on a red background and read, 'YOUTH WARNING - NICOTINE SALES LOCATION - DO NOT ENTER – Nicotine is highly addictive. Our law requires that you must be at least 18 years of age to enter this location. The penalty for violating this law is a fine of up to $500 dollars.' This section shall take effect one year from date of enactment."
While in full agreement with Etter that clean nicotine delivery is a no-brainer and vastly safer than smoke, as Chapman suggests, dual use, retarded cessation, ex-smoker relapse and youth experimentation have potential to quickly erase 50 years of nicotine dependency recovery gains.
And nicotine's known burden upon the body (cancer promotion and artery hardening via angiogenesis, possible mutagenesis, apoptosis inhibition, cell proliferation, insulin resistance, together with a host of fetal harms) is in stark contrast to Etter's surprising assertion that nicotine is "not a public health problem." Informed consent mandates honesty in detailing residual risks, including the fact that none of us as yet have any idea of the long-term consequences of inhaling vaporized nicotine into lungs already damaged by years of smoking.
Let's not forget that nicotine cessation is being asked to take a backseat to a permanent brain dopamine pathway wanting disorder and mental illness that is every bit as real and permanent as alcoholism. Picture substantial brain circuitry overlap between the wanting, urges and craves for food felt by Chapman and Etter once or twice daily, and the wanting, urges and craves endured by those dependent upon nicotine, which are just as real and felt 10, 15 or 20 times daily..
Nicotine dependency isn't nearly as much about the addict's eventual cause of death as it is about how each day gets lived, as slave to mandatory nicotine feedings, every waking hour of every day. While Etter suggests that e-cig use is "for enjoyment," it isn't that e-cig users like or love using, but that they don't like what happens when they don't. Suggesting that bringing an end urges, craves and anxieties is joyful is akin to saying that it feels good to stop pounding your fingers with a hammer.
We stand one youth fad away from causing millions of teenagers to spend the balance of life battling to reclaim their freedom and priorities. As argued by Chapman, it's myopic to think that the nicotine industry won't seize and rely upon arguments similar to Etter's "safer alternative" and "not a public health problem" assertions in targeting youth for dependency and ex-smokers for relapse. The time for public health leadership is now.
John R. Polito
Nicotine Cessation Educator
 Blum K, Liu Y, Shriner R, Gold MS, Reward circuitry dopaminergic activation regulates food and drug craving behavior. Curr Pharm Des 2011;17(12):1158-67. Medline - http://www.ncbi.nlm.nih.gov/pubmed/21492092
Competing interests: Director of nicotine cessation websites (WhyQuit, Turkeyville, Freedom from Nicotine) and author of a nicotine cessation book.
Nicotine is a drug. Why should e-cigs not be regulated accordingly?
Competing interests: No competing interests