Editor’s Note: This post was furnished to us courtesy of Dr. Michael Siegel, M.D. He is a Professor in the Department of Community Health Sciences, Boston University School of Public Health with 32 years of experience in the field of tobacco control.
Philip Morris – the nation’s largest cigarette manufacturer – is about to land a huge legislative gift from the most unlikely of sources: the San Francisco Board of Supervisors.
Earlier today, the Board approved an ordinance that will ban the sale of all electronic cigarettes in the city, including both brick-and-mortar and online sales. Before it becomes law, the ordinance is subject to a final vote, which is expected to take place next week.
The Philip Morris USA cigarette company could not have dreamed for a more favorable legislative gift from the city of San Francisco. Right now, the chief competitor to the sale of the company’s deadly cigarettes is vaping products, which are today the most widely used and most effective product for smoking cessation. In fact, there are at least 2.5 million ex-smokers in the United States who have successfully quit smoking using e-cigarettes and who remain dependent on the availability of these products to stay off cigarettes. However, in San Francisco, unless the Board reverses its decision, these products will soon be taken off the market.
Absurdly, the San Francisco Board of Supervisors is allowing the continued, unfettered sale of real cigarettes — the ones that kill more than 400,000 Americans (including more than 40,000 Californians) each year. The nation’s leading brand of cigarettes – which is literally the #1 cause of preventable death in the country – is Marlboro. Due to a giant exemption in the ordinance, Philip Morris will be able to continue selling its deadly Marlboros thanks to the hospitality being shown to the company by the San Francisco Board of Supervisors, which is, ironically, requiring e-cigarettes to gain FDA approval before being sold in the city but not requiring any further assessment or regulation of the safety of Marlboros and other combustible cigarettes.
From a public health perspective, this is the most insane piece of legislation I have ever seen. The Board of Supervisors apparently thinks that it is in the interest of the public’s health to ban much safer e-cigarettes while allowing deadly cigarettes to remain on the shelves.
The San Francisco City Attorney argued that e-cigarettes are “a product that shouldn’t even be on the market.” So let’s get his reasoning straight. He is saying that e-cigarettes shouldn’t even be on the market, but cigarettes should! This is contrary to every public health principle in the book. We aim to help the public make healthier choices. Forcing them to consume the most deadly and toxic consumer product on the market is the last thing in the world that any policy maker concerned about public health should be doing.
There is no question that this ordinance will result in the deaths of a large number of ex-smokers in the city, who will almost certainly return to cigarette smoking when their vaping products are no longer available. It will be far easier for them to just pick up a pack of Marlboros then to cross the Bay Bridge, the Golden Gate Bridge, or venture down into Daly City to locate a store that sells the e-cigarettes upon which they are currently relying to stay smoke-free. The ordinance will also deter thousands of smokers from trying to quit smoking using e-cigarettes, since the absence of vaping products on convenience store and gas station shelves will leave the market wide open for Marlboro and Camel to retain their current customers, with little threat of losing those customers to the much safer alternative of vaping.
Sadly, the Board of Supervisors has been misled by a campaign of misinformation. They have been told that e-cigarettes are deadly – that they increase the risk of heart attacks and stroke. The truth is that there is no evidence to support this claim. In fact, data from the National Health Interview Survey demonstrate that among nonsmokers, vaping is not associated with any increase in the risk of cardiovascular disease.
The data that supporters of the e-cigarette ban are citing to buttress their claim that vaping causes heart attacks is actually from a cross-sectional study which shows an association with people reporting ever having had a heart attack and currently vaping. But the explanation for this association is quite simple: when people have a heart attack, they are highly motivated to quit smoking. Many of them switch to vaping, and that is why there are so many former smokers with a history of a heart attack who now vape.
Supporters of the ban also claim that vaping leads youth to start smoking. There is no scientific evidence to support this claim. In fact, the truth is exactly the opposite. Youths who become regular vapers are much less likely to start smoking. Talk to any kid who Juuls. They will tell you that smoking is disgusting and that they wouldn’t even think of it. In fact, that is the entire appeal of Juul. It is an enticing alternative to smoking for kids who would never even think about smoking. The culture of smoking is being replaced by a culture of vaping — not the opposite.
The press release announcing the introduction of the ordinance explained that: “Banning vaping products that target young people and push them towards addiction to nicotine and tobacco is the only way to ensure the safety of our youth.”
But if it is true that vaping is pushing kids towards tobacco, then certainly banning the sale of tobacco products (i.e., cigarettes and smokeless tobacco) would be the most effective solution. I don’t for a minute believe that any politician who is serious about trying to prevent youth smoking would propose as a solution allowing cigarettes to remain on the shelves without any further restrictions whatsoever. But that is precisely what the Board of Supervisors is poised to do.
In the same press release, the City Attorney boasted that: “San Francisco has never been afraid to lead, and we’re certainly not afraid to do so when the health and lives of our children are at stake.”
If San Francisco wants to lead, then why isn’t it taking cigarettes off the shelves? After all, the chief concern about vaping is that it is a gateway to tobacco use. What possible sense does it make to ban e-cigarettes in order to prevent kids from smoking, but to leave the cigarettes readily accessible on the store shelves?
The truth is that the Board of Supervisors is apparently afraid to lead because they are willing to take the politically expedient step of requiring safety testing for e-cigarettes, but they are not willing to place the same requirement on real cigarettes. In fact, tobacco cigarettes have already had their safety testing and they failed miserably. That’s apparently of no concern to the San Francisco Board of Supervisors.
The message that San Francisco is about to send to the rest of the nation is absurd: the best way to protect kids from cigarettes is to leave cigarettes on the store shelves.
This story is so ironic that one would think it would be fine material for the Onion. However, I’m afraid that it is so far-fetched that it wouldn’t even qualify. After all, who would honestly believe that a board of policy makers who allegedly are aiming to prevent an epidemic of cigarette smoking among youth would attack that epidemic by doing nothing about the sale of cigarettes in their city and focusing their entire efforts on fake cigarettes.
Hopefully, the absurdity of what they are about to do will be realized by the Board of Supervisors this week before it is too late. They need to take a step back from the hype and hysteria and examine the issue from a public health perspective. If they truly do that, they can come to no conclusion other than that it is completely counter to the basic principles of public health to remove a safer alternative from the market, thus forcing consumers to be stuck using the single most hazardous consumer product on the market.
I’m happy to speak to any of the Supervisors and set the record straight on this issue.
If the ordinance does pass, it will have to go down as the greatest legislative favor ever done in this century to help boost a cigarette company’s profits.
Michael Siegel, MD, MPH
Department of Community Health Sciences
Boston University School of Public Health
801 Massachusetts Avenue, 4th Floor
Boston, MA 02118
This is an open letter to the San Francisco Board of Supervisors, also being shared with the media. It also appears as a commentary on my tobacco policy blog, at: http://tobaccoanalysis.blogspot.com/2019/06/san-francisco-board-of-supervisors.html.