Public Health

E-cigarettes fall short as a harm-reduction tool

Sara Berg, MS , News Editor

While there has been a reduction in combustible tobacco use, it still remains the leading cause of preventable death in the U.S. While a growing number of noncombustible tobacco products, such as electronic cigarettes, are often thought to be less hazardous options, limited evidence exists on their actual long-term health risks.

At the 2018 AMA Annual Meeting, several policies were adopted to improve the regulation of tobacco products, specifically the safety of electronic cigarettes. An AMA Council on Science and Public Health report focused specifically on the evidence examining electronic cigarettes as a harm-reduction approach to reduce tobacco-related mortality.

The AMA House of Delegates amended existing policy to:

  • Recognize that currently available evidence from short-term studies points to electronic cigarettes as containing fewer toxicants than combustible cigarettes, but the use of electronic cigarettes is not harmless and is associated with the use of combustible tobacco cigarettes in youth.
  • Encourage long-term studies of vaping and recognize that complete cessation of the use of tobacco and nicotine-related products is the goal.
  • Recognize that the use of products containing nicotine in any form among youth, including e-cigarettes, is unsafe and can cause addiction.

E-cig ingredients should be listed

Many believe that e-cigarettes are a successful way to quit smoking. However, e-cigarette cartridge makers are not currently required to list the ingredients of these products on the label.

“We are concerned that consumers have an inaccurate reflection of the amount of nicotine and type of substances they’re inhaling when using e-cigarettes," said AMA President Barbara L. McAneny, MD. "We urge the federal government to move quickly to regulate e-cigarettes and require manufacturers to list the ingredients and nicotine content on product labels—further delaying regulation will only serve to put youth at further risk.

“The AMA will continue to advocate for more stringent policies to help keep all harmful tobacco products, including e-cigarettes, out of the hands of our nation’s youth,” Dr. McAneny said.

To address ingredients and the amount of nicotine contained in the product, delegates adopted policy that asks the AMA to urge federal officials, including but not limited to the Food and Drug Administration, to:

  • Prohibit the sale of any e-cigarette cartridge that does not include a complete list of ingredients on its packaging, in the order of prevalence (similar to food labeling).
  • Require that an accurate nicotine content of e-cigarettes be prominently displayed on the product alongside a warning of the addictive quality of nicotine.

Delegates at the meeting also directed the AMA to develop a report on the individual health and public health implications of a low nicotine standard for cigarettes. This report should:

  • Consider and make recommendations on scientific criteria for selection of a nicotine standard that is nonaddictive.
  • Regulatory strategies to ensure compliance with an established standard.
  • How a low-nicotine standard should work with other nicotine products in a well-regulated nicotine market.

Read more news coverage of the 2018 AMA Annual Meeting in Chicago.