E-cigarettes: safer than what?

To hear their proponents tell the tale, you could be excused for believing that e-cigarettes are the health equivalent of the Second Coming.

The most harmful part of smoking is the smoke, which e-cigarettes eliminate while keeping the experience of smoking. Physically resembling cigarettes, they are actually electronic devices containing a cartridge of liquid nicotine solution that is heated and vaporized for inhalation.

For addicted smokers, e-cigarettes are a kinder, gentler way to needlessly empty their wallets into a wealthy corporation’s bank account in order to gratify an artificially manufactured craving for a toxic non-essential.

But e-cigarette proponents resolutely refuse to address the two major flaws in their argument.

-   Backwards burden of proof. They believe that e-cigarette use or “vaping” should be permitted everywhere that smoking is not. Then, if in 50 or 60 years we find out that, like secondhand smoke, e-cigarette vapour harms bystanders, we can spend another 30 to 50 years fighting to outlaw their use in public. They describe anyone who objects to being volunteered as a lab rat to protect their comfort and convenience as a heartless zealot at best and genocidal maniac at worst.

-  Irrelevant safety standard. Few doubt that inhaling e-cigarette vapor is safer than smoking. Or for that matter, leaping in front of an oncoming train. Or gargling drain cleaner. If we used smoking as a benchmark against which to measure acceptable safety standards for everything, there would not be much left in the world to describe as harmful.

History has already shown the irresponsibility of legalizing a dangerous product and then waiting for decades to see whether the suffering it causes is really a direct result of that product. People have needlessly suffered for over a century while fighting tobacco industry propaganda. Decision-makers have only begun to understand that the harm caused by secondhand smoke warrants smoking bans.

Do we really need to repeat this lesson yet again?

The only acceptable safety standard for a non-essential recreational drug with potential to harm bystanders is conclusive proof by independent research that passive exposure to e-cigarette vapour is “as safe as or safer than not being exposed to it at all.”

And e-cigarette proponents alone bear the entire burden of proving their product safe for use around others by this standard. The public does not owe it to them to act as lab rats once again for yet another questionable tobacco product simply so that users may be spared the inconvenience of respectful behaviour toward others.

Lawmakers owe it to us to ban public e-cigarette use until proponents have met this standard of proof.

Secondhand smoke and SIDS on Law & Order SVU

Last night’s Law & Order SVU’s Episode 1305, Missing Pieces, held an important public health education message. And then dropped it.

Spoiler alert!

A young mother, popping into a store to buy organic diapers, keeps an anxious eye on her car, where she left her 3-month-old baby. Before completing the purchase, she runs outside, screaming that someone has driven off with her child. She stresses the urgency of finding him as he requires a special lactose-free formula.

The father is found, an amber alert is issued, and tremendous police resources are engaged. Police treat the frantic parents kindly, but keep and question them separately. Details reveal that the mother smokes and that smoking is a normal part of their lives.

Eventually the car is found and its contents recovered, but the baby is still missing. Forensic analysis shows that the baby had been in the cooler. The mother admits that she buried the body, which is sent to the medical examiner to determine cause of death.

The ME finds that the baby died of “natural causes.” She asks whether the mother smokes, noting that this is one of the leading risk factors for Sudden Infant Death Syndrome, the likely cause of the baby’s death.

Then the show drops the issue. The mother emphasizes having put her child to sleep on his back. The parents don’t know why their baby died and concocted their act because they thought no one would believe them. Police console them, “sometimes babies ‘just die.’”

The producers could have made this important message more powerful in two ways:

• Before asking whether the mother smoked, the ME should have tested for cotinine to determine the extent to which the child was exposed to secondhand smoke. This would have strengthened the message about protecting babies from secondhand smoke by establishing that there are actual biomarkers to measure this risk factor.

• At that moment the detectives understandably preferred to shield the grieving parents from knowing that the mother’s smoking was the likely cause of their baby’s death. But the final discussion among the detectives about whether to press criminal charges for wasting police resources should have included mention of negligent homicide or manslaughter.

I also found it implausible that a mother who smokes around her baby, presumably smoked while pregnant, and doesn't breastfeed would think about organic diapers, a lactose-free diet, or sleeping position, the other major SIDS risk factor. Obviously the producers wanted to show that the mother’s negligence arose from ignorance, not lack of love. But despite an excellent performance, the character rang false for me.

I am grateful that a major network with a history of glamorizing smoking would tell this story at all. But the message that smoking around babies is a leading risk factor for killing them is more important than sparing a few smokers a couple of guilt pangs. I hope that any shows addressing this issue in the future will be clearer and more direct.

For a full episode description see http://allthingslawandorder.blogspot.com/2011/10/law-order-svu-missing-pieces-recap.html .