Issues

A Case of the Vapers

What I saw at the E-Cigarette Summit 2017

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The Georgetown Marriott offers a Virtual Concierge, on-site laundry, in-room coffee/tea service, valet dry-cleaning, and something called "Bourbon Program." But the top amenity listed on its website is "All public areas non-smoking." A sign advises smokers to stay at least 25 feet from the entrance; the Smokers Pole lies a few paces beyond the overhang that shields guests from the elements. Six people puff away defiantly underneath the carport. They marvel at the injustice of it all. They don't belong outside, let alone next to that pole; that's for the killers who leave cotton butts, smoldering ash, and cancer in their wake.

"This is the first hotel I've been in that doesn't allow it," the indignant woman says, gesturing to the electronic cigarette dangling from her lanyard. She's got four more in her purse and one in her hand. The crowd nods and exhales plumes of strawberry and coffee and Granny Smith Apple-flavored mist that give the area the aroma of a Jelly Belly factory that has exploded.

This is their victory smoke. For the past two hours they have watched heavyweights of the tobacco control movement go toe-to-toe on the merits of "non-combustible nicotine delivery systems" at the 2017 E-Cigarette Summit. On one side lies the "renormalization of smoking" crowd that sees these millennials with their gizmos miming the exhaust of the traditional cigarette and proclaims: "What about the children!" On the other, the "harm reduction" camp that sees smokers quitting and cries out: "What about the adults!" This is the great schism of the tobacco control movement, pitting the traditional antismoking Mainline against the E-Cigarette Evangelicals.

There's no question about who won among the carport vapers. Their clouds dance and dissipate. The scent doesn't linger like the genuine article.

They were magnanimous winners, at least at first. They suppressed their cheers when University of Michigan professor Kenneth Warner introduced initial data predicting that e-cigarettes would save 15 lives for every one lost even if opponents are correct that vaping leads to smoking. They didn't boo when Dartmouth professor Samir Soneji explained that cherry e-cigarettes use the same flavoring as Kool Aid proving that they will hook children. They didn't puff away in protest when Soneji compared Atticus Finch's Chesterfield ad to Stephen "Straight to DVD" Dorff's endorsement of Blu e-cigs.

They couldn't help themselves when the panel opened the floor to questions. The microphone was passed around the room and one academic after another stepped up to praise e-cigs as a quitting tool. One questioner from Johns Hopkins—yes, THE Johns Hopkins—compared the tobacco control movement's resistance to e-cigarettes to the medical community's failures during the AIDs crisis. There's some PGA applause.

"I think it'd be premature and dangerous [to recommend e-cigarettes] when there's the lack of scientific evidence," Soneji says.

"Smokers are dying everyday!" a pro-vaping panelist interjects. The applause grows. The pile-on begins. Deborah Arnott, the undisputed queen of the antismoking movement in Great Britain, the former TV broadcaster who helped institute Europe's most comprehensive smoking bans, the enemy of pub-goers the world over, takes to the mic and calls Soneji's fears "pure rubbish." Wrestlemania applause follows.

Since the Surgeon General's Report of 1964, the antismoking movement has been united. It rolled through the country like a juggernaut and operated with the peculiar kind of mercilessness that only those on missions of mercy can possess. It started with the big players, hitting tobacco companies for hundreds of millions of dollars in civil and federal settlements. Then it set its sights on users, casting out those who refused to quit from their office buildings and bars and public parks and, in some cases, their own homes and cars. It's one thing to get New York City to banish smoking, but North Carolina? Virginia? That takes a campaign in which all the chips—the doctors, public health experts, and the softest of the social scientists—are on one side of the table. The juggernaut appeared unstoppable until cheap doodads full of liquid nicotine hit the market.

The indignant woman is Lori Switala, founder and president of the His Gift to Us Foundation. Switala, 60, smoked for 30 years and tried every FDA-approved method of quitting before e-cigarettes arrived. She believes that God planted the idea in man's head and has been evangelizing around Panama City, Fla., ever since with her chain of vape shops and self-funded foundation that teams with medical and dental centers to give away vaping equipment to underprivileged smokers. Since 2016, the foundation has given away 300 starter kits and Switala has donated $136,364 to keep it running.

"We put a man on the moon before we came up with a way to help smokers quit. That's how I know He gave it to us," she says.

Gaetano Putignano takes a drag from what appears to be a gold-plated hand grenade. The 46-year-old makes his living building luxury ski chalets. He opened three vape stores in the state after quitting cigarettes about five years ago. The patch failed, gum too. Lozenges? Get out of here. The e-cigarette took fewer than three months to replace the Devil's weed.

"I watched my father-in-law die from smoking in hospice and was going out on the porch to smoke," he says. "I tried all the other stuff and this was the only thing that worked. We shouldn't be denying an adult his choice [to quit]."

Putignano considers himself a caseworker in the antismoking movement. He keeps a sign-up sheet in each of his shops to catalog all of the ex-smokers who have joined his movement. It has more than 1,000 signatures, he says.

The next presentation is titled, "Patient-Provider Communications on E-Cigarettes: Perception of Safety and Harm." Stanford University professor Judith Prochaska reads humorous quotes from doctors about their feelings on e-cigarettes, the type of hard-hitting research that gives participants the chance to use the bathroom and witness the main event: construction worker Putignano squaring off against Dr. Soneji and his compatriot Prof. Thomas Payne from the University of Mississippi.

Each wears the appropriate uniform. Putignano wants to be taken seriously, so he is dressed in his Sunday best: black pinstripe suit, black shirt, and a tie knotted in a full Windsor, a look that screams Persian Nightclub Owner or low-level Gambino enforcer. Payne wants to be taken seriously, so he is dressed in an academic's Sunday best: no tie, the expensive blazer rumpled just so to give the impression that he doesn't care about his appearance. Soneji, like every conference speaker, is dressed like an accountant on the up-and-up.

"My intention is to help people quit smoking," Putignano says.

"Okay, but I'm interested in patient health. Why push a product before you know it's safe?" Payne replies.

It's a question that weighs heavily on both sides. The mainline camp compares e-cigarettes to the opioid crisis. Heroin was originally used to help morphine addicts and ended up killing too many to count and inspiring today's rampant prescription pill abuse and the heroin overdoses that now dominate headlines. The evangelicals see it as Coca-Cola, a product created to help people quit the deadly vice of alcoholism. If a century later the product is revealed to be unhealthy in the long-term, as in the obesity epidemic, we'll deal with it then.

Putignano goes in for the kill. If e-cigarettes don't help you quit smoking, then how was he able to give up a decades'-long habit when everything else failed?

"That's not scientific evidence. That's anecdotal," Payne replies. Soneji gives a hint of a smile.

Putignano asks him his preferred method of smoking cessation.

"I've treated 10,000 patients with Chantix. We've seen a success rate of 40 percent," Payne says.

"Chantix? That's Pfizer, isn’t it?" Putignano responds, letting the anti-Pharma sentiment hang in the air.

Clinical trials of Chantix have found that the long-term success rate is about 20-26 percent, slightly better than the patch and nicotine gum. As much as vapers complain about not being allowed to use their product on airplanes, Chantix users have it worse. The Federal Aviation Authority banned pilots and air traffic controllers from taking the pill because of its link to depression and suicidal thoughts. The Food and Drug Administration had it black bottled from 2009 to 2016, the most severe penalty available to any pharmaceutical drug. An FDA panel voted 10-9 to recommend removing the warning label in 2016. The 10 yeas acknowledged that there may be side effects to the Pfizer pill, but the benefits of quitting smoking far outweighed any costs—harm reduction, in other words. The FAA has yet to lift its ban.

Putignano is getting tired of the condescension.

"It's not just me. I have a list of a thousand customers," he says. He talks of the Vietnam veteran with lung cancer, the single mother on fixed income, and countless other individual smokers who showed up at his store and walked out ex-smokers.

"You may not be helping them as much as you think," Soneji says.

"Where did you publish that?" Payne muses. Soneji can't hide the smile anymore.

The mainline's fallback has always been #Science. Putignano can gather all the signatures he wants, but until he has a peer-reviewed study, he can shove it. E-cigarettes have to be one of the most heavily scrutinized products of the 21st century. The National Institutes of Health has spent $68 million on research since 2011, funding 85 studies on everything from its effect on teenagers and the throat to the "delivery of graphic health warnings from within virtual gaming environments." Look up "e-cigarette" on Google scholar and you'll come back with 15,400 hits in academic journals.

A typical experiment goes something along these lines: An academic tracks down a group of 40 to 100 high school students and polls them on whether they smoke or could ever see themselves smoking. They use the response from this one moment in time—when a teen's relationship may be going well, his grades adequate, and the SATs in the distant future; or maybe none of those things—to label them as Smokers, E-Cigarette Users, or Never Smokers. The academic asks the same questions week after week for six-months, a year maybe. Despite the small sample sizes many of these studies never bother to add context behind why a teen lit up, nor do they try to gauge the intensity of use. There's a difference between taking up the habit with the zeal of a convert and puffing away the day before a final, but adding that context could undermine the definitive conclusions that partisans on each side attach to their studies, which could explain why presenters on both sides of the argument point to the same literature to prove that e-cigarettes save or damn, depending on how one reads the data.

When tobacco-control experts talk about the science of vaping, it is not the hard stuff of the 1964 Surgeon General's Report that proved definitively that smoking was bad for one's health. Nearly all of the presenters at the summit are psychologists—the very same field under the biggest academic crisis in the country after researchers revealed that only half of all their studies can be replicated. Soneji is a demographer. The pro-vaping Warner is an economist. Arnott has an MBA. There are just three medical doctors speaking from the dais today.

The 2017 E-Cigarette Summit is the first that has taken place in Washington, D.C., after a years-long run in the United Kingdom. Great Britain immediately incorporated vaping into its tobacco control policy and medical professionals have been encouraged to recommend it as a quitting tool. They tout their success as proof that the puritanical Americans get on board. Hence, Arnott's dismissive "rubbish" comment. Payne's not buying it.

"We don't have a society or culture that is the same as the British," he tells the Washington Free Beacon as he walks away from the battle with Putignano. He says this as if he is explaining the theory of gravity. He continues talking about the need for more data and hard science and how the "best scientific approaches" in the United States all dispute the link between vaping and smoking cessation. He never pauses to consider why it is that a hard fact like gravity is the same in Great Britain and America, but smoking cessation is not.

"Want to see me commit a crime?" the man on the next barstool over asks. He takes a long puff of the espresso-flavored VaporFi and exhales a thick plume as the bartender laughs nervously. "There's a crime."

Like any conference full of scientists, the true wisdom can be found at the hotel bar. That's where I find Brian Carter, an early morning panelist, clinical psychiatrist, and board member at the Consumer Advocates for Smoke-Free Alternatives Association. He spent his career doing lab research on smoking cessation at the prestigious University of Texas M.D. Anderson Cancer Center, becoming fascinated with the subject after seeing his grandmother quit cold turkey one day. He is one of the few academics at the conference who admits to using tobacco in the past. He used to smoke four to five cigars a day until he developed an oral condition. He started using e-cigarettes at the age of 59 and hasn't looked back, but that doesn't mean he counts himself an evangelical.

"I have my doubts about it. I don’t know about the relative safety of these carrier agents or the flavors. It just means we need [research] surveillance to monitor the product," he says.

Nor does Carter consider himself a mainline Puritan. He refuses to cater to the condescending ideas behind much of the tobacco control movement, the treatment of smokers as an alien species that leads University of Illinois-Chicago psychology professor Robin Mermelstein to blurt out, "If we want to transition people from using combustibles to e-cigarettes … we can't assume that they know how to do that," at the morning panel. That is the type of attitude that creates the all-or-nothing approach that produces true believers who want to ban e-cigarettes and the partisans who argue that e-cigarettes are a panacea that can cure nicotine addiction, the common cold, depression, and poverty. Progress will begin when both sides acknowledge that "smokers are a complex, confusing bunch."

"We have to see that smoking is not a disease in need of treatment. It's more like fingernail biting and everyone that has done it knows," Carter says.

I finish up at the bar and reenter the conference and listen to Soneji explain that he and the evangelicals "are not enemies. We're just struggling with the same questions." I look over and Putignano is having another animated discussion with a smug man in professor's attire. A panicked e-cigarette representative exclaims that Arnott-the-Prophet is now Arnott-the-Heretic, having betrayed the cause over a (then-looming, now-delayed) FDA regulation. Each side continues to attack, burning enough straw men to choke every occupant in the hotel. By day's end the battle is no closer to a resolution than Dante's misers and spendthrifts doomed to roll weights back and forth for all eternity.