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Are e-cigarettes a path to quitting? – nytimes.com

Greensboro, northcarolina tobacco stores find discounts for ryo & cigarettes

The Case for Tolerating E Cigarettes, by Amy L. Fairchild and James Colgrove (Op Ed, Dec. 9), and Two Cheers for E Cigarettes, by Joe Nocera (column, Dec. 7), argue that e cigarettes should be regulated by the Food and Drug Administration as drug delivery devices. I agree. Tellingly, it is the e cigarette companies themselves that have blocked this.

For e cigarettes to be approved by the F.D.A. as drug delivery devices, manufacturers would have to conduct rigorous studies to demonstrate that e cigarettes are both safe and effective for smoking cessation. Either because they didn t want to do these studies or because they feared the results, manufacturers instead sued the drug agency in federal court, arguing that e cigarettes should instead be regulated as tobacco products. They won.

Big Tobacco, which now owns many e cigarette companies, can t have it both ways. If it wants to avoid antismoking regulations, it should do the studies to prove that these devices are safe and effective in helping smokers quit.

Commissioner, Department of Health and Mental Hygiene
New York, Dec. 9, 2013

To the Editor

In the 1978 speech in which I called smoking Public Health Enemy No. 1 and slow motion suicide, and announced the first national antismoking program, I said research into the harmful and fatal effects of smoking would continue, including, as Amy L. Fairchild and James Colgrove quote me, research aimed at creating a less hazardous cigarette. But I do not support exempting e cigarettes from restrictions applied to regular cigarettes.

I believe that smoking e cigarettes should be banned in public places, that sales to minors should be prohibited, and that appropriate labeling and point of sale restrictions should be required.

The already sharp increase in teenage use of e cigarettes, with the potential of nicotine addiction to encourage smoking tobacco burning cigarettes, signals the danger ahead for our youth and the country s health. Indeed, tobacco companies are reported to see the potential of e cigarettes to make smoking once again commonplace and socially acceptable.

Subjecting e cigarettes to restrictions similar to those on smoked cigarettes would in no way limit their use to reduce harm from tobacco related disease for example, to help adults like those unable to quit smoking after lung or esophageal cancer surgery.

New York, Dec. 9, 2013

The writer, secretary of health, education and welfare in the Carter administration, is the founder and chairman emeritus at CASA Columbia.

To the Editor

Re Joe Nocera s column about e cigarettes

Because e cigarettes are not approved and marketed as a medicine to quit smoking, it is unclear if they are meant to help smokers quit or to be just an additional way to get nicotine in environments where smoking is prohibited.

According to the only two well designed published trials studying e cigarettes, well over 90 percent of smokers who used them did not quit smoking. E cigarettes also did not outperform the nicotine patch.

Unlike e cigarettes, nicotine patches are marketed with the intent to be used with psychosocial treatments to boost their effectiveness. For many smokers, quitting is not just about nicotine. It is equally, if not more, crucial to also address ingrained behavioral, emotional and social aspects of cigarette addiction.

Unfortunately, Mr. Nocera gives little consideration to the long term unknown health effects of e cigarettes. Given the uncertainties and the lack of proven benefit beyond medicines already on the market, it is difficult to justify recommending e cigarettes.

New York, Dec. 7, 2013

The writer is the director of Smoking Cessation Services at Columbia University Medical Center and the author of the book Smoke Free in 30 Days.

To the Editor

Three cheers for Joe Nocera s column. As an ex smoker, 37 years and counting, I appreciate the fact that many smokers just can t quit successfully. All the smokers I know have tried many times. Most who succeeded did so after more than 10 tries.

A person who has never tried quitting smoking cannot appreciate the fact that a huge number will die of it before they succeed (400,000 a year, according to Mr. Nocera). To place barriers between these people and what is clearly a less deadly maintenance approach is morally repugnant.

Sterling, Mass., Dec. 7, 2013