Electronic Cigarettes and the Pharmaceuticalization of Tobacco

In the past few years we have witnessed the rapid emergence of a new technological and social object: the electronic cigarette. By offering an alternative to traditional combustible cigarettes, proponents argue these devices have the potential to reduce the staggering harm associated with tobacco use. The need for an alternative to smoking remains an urgent global health priority; the World Health Organization estimates that if current trends continue, one billion people will die from tobacco-related diseases in the 21st century.

E-cigarette advertisement in Manhattan. Photo courtesy Emily Anne McDonald
E-cigarette advertisement in Manhattan. Photo courtesy Emily Anne McDonald

And yet, despite great promise, the appearance of this new artifact has unearthed a contentious divide among public health scholars and raised new questions about the long-settled status of smoking as a risky behavior. My research explores the electronic cigarette as a controversial scientific, cultural and political object by looking at three distinct groups: young adults in New York City who experiment with the product; global tobacco control experts fiercely debating its merits and dangers; and, by looking at historical documents and recent media accounts, the role of the tobacco industry for whom electronic cigarettes promise a reduced harm product that could breathe new life into a dying business. I am particularly interested in how public health science and tobacco industry profit become entangled in everyday experiences, examining how the polluted subjects rendered through tobacco smoke are understood as distinct from the clean, rational, pharmacological forms of subjectivity imagined through electronic cigarettes.

E-cigarettes (also called vapes, vape pens and hookah sticks, among other names) vary in appearance from slim cylinders that mimic traditional cigarettes to boxy, futuristic designs rendered in vibrant colors. Common elements include a small computer chip, a lithium-ion battery, and a cotton wick soaked in a solution of nicotine and propylene glycol. Such solutions are often flavored to simulate cured tobacco, but additionally come in flavors such as menthol, coffee or even gummy bear and peanut butter. In the US, the market has, in only a few short years, become a $2 billion market comprised of small, independent companies and increasingly, established tobacco corporations like Altria (which includes the Marlboro, Parliament and Skoal brands) and Lorillard (Newport). E-cigarettes are often marketed as producing “harmless water vapor” in place of smoke; as a way to smoke anywhere including bars, clubs and workplaces; and as a socially acceptable alternative to conventional smoking.

E-cigarette in ashtray. Photo courtesy Emily Anne McDonald
E-cigarette in ashtray. Photo courtesy Emily Anne McDonald

What precisely these products are considered under the law is ambiguous and the subject of debate. In 2009, the FDA began seizing shipments of e-cigarettes as they hit US shores, on the grounds that they were “drug delivery devices” that had failed to clear proper approval processes. In response, several companies successfully challenged the FDA ruling, arguing that e-cigarettes should be treated instead as existing tobacco products because their nicotine solution is derived from tobacco leaves. The logic of this challenge is far from straightforward, however, as the nicotine used in therapeutic gum and patches (such as Nicorette) is also derived from tobacco leaves, but is required to be tested and approved through the FDA’s Drug Evaluation center. The FDA has recently issued a draft of their initial deeming regulation of electronic cigarettes, but currently there are no requirements to disclose ingredients or test product safety.

For public health experts there is quite a bit at stake in maintaining the distinction between the “polluted” nicotine that comes in the form of a cigarette, the “therapeutic” nicotine of the patch, and now this shape-shifting, ambiguous nicotine delivered in streams of vapor. E-cigarettes, in many ways, effectively blur the lines between substances of addiction and treatment, medication and recreation, and pleasure and pollution. Tobacco companies are increasingly adopting tactics common to the pharmaceutical industry. E-cigarettes are only the latest in a number of smokeless and reduced harm products that have entered the market, including pouches of tobacco to place in one’s cheek, tobacco drops, and most recently, over the counter therapeutic nicotine gum manufactured by RJ Reynolds, the parent company of Camel brand cigarettes.

The pharmaceuticalization of tobacco implies that products such as e-cigarettes should be used to treat nicotine dependency. This represents a continuation of the shift away from broad level public health interventions to localizing the burden of health management on the individual consumer. As anthropologist Matthew Korhman and others have pointed out, this is an example of corporations using the very health problems that their commodities generate as a market opportunity for selling new harm-reduction products or therapies for newly-medicalized conditions. In this formulation, the tobacco industry, with a historical record of attempting to deliberately hide the dangers of their products from the public, is reframed as a partner in improving public health.

While there remains little scientific evidence establishing their safety, my research among young adults reveals that e-cigarettes are experienced as a cleaner form of nicotine, vapor understood as a lighter form of smoke, and the futuristic robot cigarette design as evidence of enhanced safety. Until tobacco corporations are compelled to conduct clinical trials investigating the effects of such products, those using electronic cigarettes will remain in the position of serving as the experimental test subjects for such devices, the health effects of which will be discovered through their bodies in decades to come.

To submit contributions to this column please contact SMA Contributing Editor Megan Carney (megcarney@gmail.com).

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