Former Surgeon General on e-cigarettes

There's a short interview with former Surgeon General Richard Carmona in the current issue of Science. Carmona caused consternation amongst the intensive care wing of the anti-smoking lobby when he joined the board of NJOY.In this interview, he addresses some of the standard objections.

Q: As a doctor and former surgeon general, why did you join the board of an electronic cigarette manufacturer?

R.C.: At first, I immediately rejected their offer. But with some due diligence I came to see that they were willing to do the necessary science and that we could be allies in the antitobacco movement. That said, I offered to join only under certain conditions: that they request FDA regulation— which is in the public’s best interests—that they conduct and publish their own research in peer-reviewed journals, even if the findings hurt the bottom line; that they don’t use my name or refer to the surgeon general in their advertising campaigns; and that they don’t market to kids. So far, they’ve delivered on all those promises.

Q: E-cigarettes are touted as a way to stop tobacco smoking. But would you advocate that people who do that successfully then also try to wean themselves off e-cigarettes?

R.C.: Yes, but the urgency isn’t as great because people who use them aren’t inhaling large amounts of carcinogens and cardiovascular disease–causing agents.

Q: How can you be sure they’re safe?

R.C.: As research priorities, we’re asking about cons from long-term nicotine use, and we’re examining the different components in side-stream vapor to make sure they’re not unsafe. So far we don’t see any problems. And we’re also looking into long-term efficacy: How many people who use e- cigarettes quit and for how long? We just have to craft the right questions and then report back to the public.

Q: Won’t e-cigarettes just lead to more people getting hooked on nicotine?

R.C.: That same question came up decades ago when nicotine gum, patches, and sprays came on the market. People said they would create new nicotine addicts and that never happened. But e-cigarettes are a different kind of nicotine delivery device, so they raise unanswered questions that we’re looking into.

Q: On what basis do you think e-cigarettes can help people quit smoking?

R.C.: There is evidence that gums, patches, and sprays work, but they don’t work well enough. And early evidence suggests that because e-cigarettes reinforce the physical movement of smoking, they can enhance tobacco cessation, but we don’t have all the information yet. We have to continue doing the research and publishing data to demonstrate that they’re helpful.

Q: What about children? Some of these e-cigarettes are candy flavored.

R.C.: As a company, we’ve made a commitment that these products should not be sold to kids under any circumstances. Children don’t factor into NJOY’s marketing, but if a customer says they like a particular flavor, then I have no problem with that—adults enjoy these flavors, too.

Q: How would you respond to critics who say you shouldn’t be doing this?

R.C.: Making tobacco obsolete is part of NJOY’s value ... and it’s consistent with my efforts to move people away from cigarettes with combustible toxins that lead to cancer and cardiovascular diseases. I accept that my colleagues have concerns and that the antitobacco world is divided on this. You’ve got two camps here: an abstinence-only camp that thinks anything related to tobacco should be outlawed, and those of us who say abstinence has failed, and that we have to take advantage of every opportunity with a reasonable prospect for harm reduction.