The attorney general of Iowa, who has monitored the tobacco industry for almost 20 years, has added his voice to a growing chorus saying that electronic cigarettes are significantly less harmful to smokers than traditional cigarettes.

In a statement last week, Tom Miller also questioned the quit-or-die approach of several public-health advocacy groups that are pushing for severe limitations on, if not banning, e-cigs and vaporizers.

The typical e-cig, or cigalike, is a battery-powered device that heats a liquid nicotine solution in a disposable cartridge and creates a vapor that is inhaled. A vaporizer, which is also heated, can be supplied and reused through the insertion of a liquid capsule.

Among the main arguments by anti-tobacco advocates against e-cigs and vaporizers is they appeal to youths because some vaporizers include candy and fruit flavors, and the products may be a gateway to traditional cigarette use. They also say questions remain on potential dangers in the chemicals used in the liquid nicotine

Miller cited studies that indicate e-cigs and vaporizers have the potential to be up to 98 percent less harmful than traditional cigarettes. He also acknowledged that many of those studies are disputed by anti-tobacco groups.

“The combustible cigarette is by far the most harmful consumer product known to mankind,” Miller said. “This is largely due to the many deadly toxins created and released by the combustion.

“Whatever number is correct, e-cigarettes are dramatically less harmful than combustible cigarettes.

“There has been an effort to say that combustible cigarettes and e-cigarettes are equally harmful, that their companies are equally evil, and that they should be strongly regulated the same way,” Miller said. “This view is incorrect, but it has gotten significant traction.”

Geoff Greenwood, communications director for the Iowa Attorney General’s Office, said Miller “simply wanted to state his position on e-cigarettes so people, including state lawmakers, understand where he stands” when the next session begins in early January.

Miller’s statement comes as the industry, elected officials and advocates await the response of the federal Office of Management and Budget to the Food and Drug Administration’s submissions of final regulations on smokeless tobacco-product innovations.

As part of the Tobacco Control Act, FDA officials want new and enhanced products to be “substantially equivalent” to products already in the marketplace as of Feb. 15, 2007.

The FDA defined substantially equivalent as “being the same in terms of ingredients, design, composition, heating source and other characteristics to an existing, single predicate product or have different characteristics, but not raise different questions of public health.”

Some industry observers believe such restrictions would drastically curtail product innovations, particularly by companies that don’t have the research-and-development budgets of Reynolds American Inc. and Philip Morris USA and their affiliates.

Clear up misconceptions

Part of what makes Miller’s statement stand out is that he is in his ninth four-year term as Iowa’s attorney general and has served as chairman of the tobacco committee for the National Association of Attorneys General.

Miller helped negotiate the landmark 1998 Master Settlement Agreement between the nation’s largest tobacco manufacturers and 46 state attorneys general, including North Carolina. Tobacco companies, including R.J. Reynolds Tobacco Co., agreed to settle lawsuits over smoking-related health care costs by paying those states about $206 billion over more than 20 years.

In November 2013, Miller urged the FDA and the Iowa legislature to ban the sale of e-cigs and vaporizers to minors, as well as limit how they are marketed and sold.

Miller said he is concerned that if nearly one-third of Americans believe there is equal harm between traditional cigarettes, e-cigs and vaporizers, “as many as 13 million adult smokers are very unlikely to switch when switching may save their lives.”

Scott Ballin, past chairman of the Coalition on Smoking or Health, said Miller’s statement is intriguing considering he serves as chairman of Truth Initiative, a prominent anti-tobacco advocacy group.

“It is in my view a very important statement from Miller from a national perspective,” Ballin said. “It is intended, it seems, to clean up and clear up many of the misconceptions about (these products).”

Research linked to Truth Initiative, released in November by the Rutgers School of Public Health, found that some former traditional cigarette smokers quit in part because of e-cigs. It also found that e-cig experimentation is “extremely low” for nonsmoking adults.

Researchers said their aim was providing clarity to the “ongoing debate as to whether e-cigarettes are effective aids for smoking cessation, promote uptake by nontobacco users, discourage cessation via dual use of cigarettes and e-cigarettes, or encourage relapse to cigarette use among former smokers.”

Decline in youth smoking

In June 2009, Congress gave the FDA the ability to regulate tobacco products and marketing, but not the authority to ban nicotine or tobacco.

The FDA has to approve any new tobacco product being marketed as a potential reduced-risk product compared with combustible cigarettes.

A wild, wild West environment has emerged in the absence of FDA e-cig regulations, outside of recommendations announced in April 2014 to ban sales to those under age 18, require health-warning labels, a FDA review of existing and future products, and no more free samples.

The FDA did not call for an outright ban of e-cigs, which some anti-tobacco advocates had hoped. It did not curtail Internet sales or current marketing efforts that include television and social media.

A Yale University study, published Oct. 19 in the Journal of Health Economics, found states that have banned the use of e-cigs and vaporizers by those under age 18 — including North Carolina — have experienced an increase in traditional cigarette smoking by youths.

“The empirical findings provide the first causal evidence that e-cigarette access reduces teen smoking,” researcher Abigail Friedman wrote. “Banning e-cigarette sales to minors counteracts 70 percent of the downward pre-trend in teen cigarette smoking in the states that implemented such bans.”

The 2015 version of the Monitoring the Future study by the University of Michigan, as well as the Centers for Disease Control and Prevention’s 2014 National Youth Tobacco Survey, found that e-cigs and vaporizers, at 13 percent, had been used more frequently by youths during a 30-day period than traditional cigarettes at 7 percent.

Miller said that digging deeper into the National Youth Tobacco Survey results finds that regular use, “if defined by usage in 20 or more days in the last 30 days, is actually 2 percent.”

Michigan researcher Richard Miech said 40 percent of youths tried an e-cig or vaporizer because they were curious about the taste because of the flavorings.

“Our finding that so few adolescents use e-cigarettes to stop smoking contrasts with studies of adults who are more likely to use e-cigarettes to try to stop smoking cigarettes,” Miech said.

Dr. Gilbert Ross, medical and executive director of the American Council on Science and Health, said it is not unexpected for some teens to say they have tried an e-cig over a 30-day period.

“A large number of kids are experimenting with vaping, given the massive increase in e-cigs all around us,” Ross said. “The most important finding is the historic declines in young people smoking deadly addictive cigarettes.”

Miller said, “People making misstatements about e-cigarettes have the best of intentions — to keep kids from being addicted to nicotine through e-cigarettes.

“But adults misleading kids to get them to do what we want has always been a failed strategy.”

rcraver@wsjournal.com (336) 727-7376 @rcraverWSJ

rcraver@wsjournal.com (336) 727-7376 @rcraverWSJ

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