The American Heart Association has drafted a policy recommendation on the use of e-cigarettes and their impact on tobacco-control efforts and says that because e-cigarettes contain nicotine, they are tobacco products and should be subject to all laws that apply to these products. 

Writing in its in-house publication, Circulation, the association also calls for new regulations to prevent access, sales and marketing of e-cigarettes and for more research into the product's health impact. 

Yet their website encourages nicotine chewing gum and patches, so this new statement is a bit of a turnaround. Nancy Brown, CEO of the American Heart Association, makes no secret of the fact that their new recommendation is not based on health concerns or evidence, but on being against anything tobacco companies are for; "Over the last 50 years, 20 million Americans died because of tobacco. We are fiercely committed to preventing the tobacco industry from addicting another generation of smokers." 

So if cigarette companies made patches and chewing gum with nicotine, those would come down from the AHA website. Instead, they are prominently displayed as smoking cessation tools. Big Tobacco Stinks is not science policy.

They are lobbying for a federal ban on e-cigarettes for minors and details concerns that these products may be another entry point for nicotine addiction among young people. The authors cite one JAMA Pediatrics survey finding that adolescents consider e-cigarettes as high-tech, accessible and convenient, especially in places where smoking cigarettes is not allowed.  

They want the US FDA to limit advertising of e-cigarettes and ban flavorings in those products.

"E-cigarettes have caused a major shift in the tobacco-control landscape," said Aruni Bhatnagar, Ph.D. FAHA, lead author and chair of cardiovascular medicine at the University of Louisville. "It's critical that we rigorously examine the long-term impact of this new technology on public health, cardiovascular disease and stroke, and pay careful attention to the effect of e-cigarettes on adolescents."

Smoking is what gives people cancer, not nicotine, and levels are lower than those in cigarette smoke, but the AHA insists non-smokers could "second-hand nicotine" and be placed at risk. More importantly, they believe that if e-cigarette users are not properly vilified (as smokers are, with an industry built on taking fees from cigarette companies to criminalize cigarette smokers) e-cigarettes could be acceptable in public. 

They even undermine e-cigarettes in tobacco-cessation counseling. The statement points to the lack of evidence establishing e-cigarettes as a primary smoking-cessation aid - the same lack of evidence that existed when nicotine patches and gums were created. Yet the studies that do exist show e-cigarettes help smokers quit and may be equal or be slightly better than nicotine patches. They don't try to undermine the data and instead want to have clinicians tell users that e-cigarettes are unregulated and have not been FDA-approved as cessation devices.

"Nicotine is a dangerous and highly addictive chemical no matter what form it takes – conventional cigarettes or some other tobacco product," said association President Elliott Antman, M.D. "Every life that has been lost to tobacco addiction could have been prevented. We must protect future generations from any potential smokescreens in the tobacco product landscape that will cause us to lose precious ground in the fight to make our nation 100 percent tobacco-free."

Citation: Aruni Bhatnagar, Laurie P. Whitsel, Kurt M. Ribisl, Chris Bullen, Frank Chaloupka, Mariann R. Piano, Rose Marie Robertson, Timothy McAuley, David Goff and Neal Benowitz, 'Piano, Rose Marie Robertson, Timothy McAuley, David Goff and Neal Benowitz', Circulation August 24 2014 doi: 10.1161/​CIR.0000000000000107. Source: American Heart Association