When it comes to e-cigarettes, critics seem to prefer regular cigarettes. Or snuff. Or snus. Or they just want to ban behavior. And the biggest tool they have is the precautionary principle. Sure, there are no known health effects but that is easy to fix - speculate about unknown potential ones.

Smoking is, of course, bad. E-cigarettes are not smoking, it is instead a nicotine vapor. The number of people who have gotten lung cancer from nicotine vapor is zero, which is not evidence for much, but it is certainly not evidence it is harmful. Since even among lung cancer patients, up to 50 percent have never smoked, smoking itself is only a risk factor for the disease. E-cigarettes are not even that.

But for asthmatics it's a bad idea, just like fields full of organic pollen are. That would seem to be common sense. Yet an article in Annals of Allergy, Asthma  &  Immunology, focuses on those asthma risks, and then highlights dependence on nicotine and the dual use of e-cigarettes and regular cigarettes.  How many people have died of nicotine dependence in history? There's less evidence for that than there is second-hand smoke.

The authors reverse the way science is done and note that smoking cessation benefits of e-cigarettes haven't been proven.

"Despite the apparent optimism surrounding e-cigarettes and their purported therapeutic role in smoking cessation, there just simply is not enough evidence to suggest that consumers should use e-cigarettes for this purpose." said allergist Andrew Nickels, MD, lead author, ACAAI member, Mayo Clinic Division of Allergy and Immunology.


This logic is in defiance of what studies accomplish. Studies seek to show something is harmful and/or to show that it is more effective than a placebo and competing treatment. If e-cigarettes are not harmful and basically a placebo, like homeopathy or organic food, people can spend their money on them. No smoking treatment 'works' so people will use whatever works for them, including nicotine patches or going to church or just quitting.

The article intentionally obfuscates smoke and vapor, insisting that e-cigarettes are not helping people quit smoking and therefore kids and asthmatics will still be exposed to second-hand smoke. How do they know e-cigarette users are still smoking cigarettes indoors around their asthmatic kids? They don't. But they say that e-cigarettes are an addition to regular smoking, a claim that would seem to apply to nicotine patches as well, yet doesn't. 

"Dual use of both e-cigarettes and regular cigarettes carries the risk of secondhand smoke exposure, causing worsening respiratory effects on children and asthma sufferers. It also promotes ongoing nicotine dependence," said Chitra Dinakar, MD, co-author, ACAAI fellow and Professor of Pediatrics, Children's Mercy Hospitals.

Because e-cigarettes are fairly new, they could have long-term health complications that have yet to be discovered but leading with that is in defiance of the scientific method and is instead advocacy. No product in the world could be approved today if the metric for safety was assuring there could be no long-term health implications.

Even the obvious facts - that the US Food and Drug Administration finds them safe - is framed as that the efficacy of e-cigarettes hasn't been fully studied, and consumers have no way of knowing if e-cigarettes are safe for their intended use.

The American College of Allergy, Asthma, and Immunology wants these regulated and insist it is a drug delivery system and therefore must seek FDA approval.