Testimony to the Philadelphia City Council Public Health and Human Services Committee Opposing Bills No 140095 &

140096 March 13, 2014 Robert B. Sklaroff, M.D. Medical Oncology Hematology Independent Medical Examination Smylie Times Building, Suite 500C 8001 Roosevelt Boulevard Philadelphia, PA 19152-3041 215-333-4900 rsklaroff@gmail.com

Im Dr. Bob Sklaroff and, just like Bill Godshallwhom I have known since the 1980sI am here to oppose passage of these two ordinances. My private office is a block from Nazareth Hospital in Northeast Philly and I am a lifelong resident of the Delaware Valley. It is absolutely uncanny for such legislation as this to be taken seriously, inasmuch as e-cigs do not transmit the major disease-causing agentstar and carbon-monoxideas are contained in each puff of tobacco. That is whyin an article discussing the potential for e-cigs to cause an acute increase in airway pressureit was found that, The medical profession and scientists generally agree that e-cigs, if they do pose any dangers to health, are much less harmful than tobacco smoking. http://www.medicalnewstoday.com/articles/249784.php The key-concept here is harm reduction, a concern that has dominated the blast e-mails emanating from Bills Smokefree computer for yearseven before the advent of e-cigs. Candidly, although I was deeply involved in the anti-tobacco movement during a two-decade period [from 1980-2000], I have found myself satisfied with recognizing Bills advocacy and that of a handful of other true-scientists such Elizabeth M. Whelan, M.P.H., M.S., Sc.D., the long-term President of the American Council for Science and Health, based in New York City. The best way to convey my viewpoint, therefore, is simply to list the titles of each article that the ACSH has disseminated during this calendar-year, alone; the data are overwhelming: E-cigarettes encourage teen smoking! No, they dont in fact. The e-cigarette: by any other name, still helping smokers quit? NY Times Editorial Board gets it wrong on EU e-cigarette regulations EU enacts harmful restrictions on e-cigsit could have been worse NY Times article tries (and fails) to elucidate the e-cigarette landscape. E-cigarette bans and propaganda are driven by cronyism, not public health Dont listen to the e-cigarette haters: ENJOY these Super Bowl ads, and learn! ACSH submits written testimony to Oklahoma State Capitol re: e-cigarette legislation If you want to ban e-cigarettes, you want to kill smokers

Certainly, more research is always needed when a new product of this type emerges. Yet, it is counter-intuitive to ascribe a negative-impact to this far-safer approach to delivering nicotine, particularly when it is recognized that nicotine is, itself, a neurotransmitter in human beings. Consider these few paragraphs from a cover-story in Bloomberg BusinessWeek last month: A 2011 study published in the Journal of Public Health Policy concluded that a preponderance of the available evidence shows [e-cigs] to be much safer than tobacco cigarettes and comparable in toxicity to conventional nicotine replacement products. [There is] reason to believe that they offer an advantage over traditional nicotine delivery devices. The other main ingredients in e-cigs are what the FDA calls generally recognized as safe: glycerine, found in many foods, and propylene glycol, the main ingredient in theatrical fog. E-cigs dont only assuage the desire for nicotine but also the desire to have a cigarette, which isnt exactly the same thing: One study found that even an e-cig rigged to deliver minimal nicotine could reduce cravings in a substantial minority of smokers. V2Cigs Verleur estimates that, while half of his customers use his product to replace cigarettes, either completely or in places where they arent allowed to smoke, about one-quarter start at the highest concentration and work their way down toward the no-nicotine version, at which point some stop entirely, while others keep buying the nicotine-free ones. Even without the combustion, nicotine is a vasoconstrictor that narrows blood vessels and drives up blood pressure. Doing that a dozen times a day is less bad than getting lung cancer, but its still not great. Besides, there is no study on what inhaling those generally recognized as safe compounds might do to your lungs if you inhale them daily for a few decades. Its hard to imagine that the health effects could be worse than setting something on fire and deliberately breathing the smoke. But theyre probably not as good as quitting. http://www.businessweek.com/articles/2014-02-06/e-cigarettes-fda-regulation-looms-for-1dot-5-billion-industry#p4 I will close by reading a crucial paragraph from this article and show why, if it indeed captures the motive of the people who promulgate these laws, this entire mindset is wrongheaded: The antismokers think were going to winthat we can get to zero tobacco, says Kleiman. If thats what you believe, then youre likely to endorse stiff restrictions on e-cigarettes. On the other hand, if you think U.S. tobacco consumption will stay stubbornly stuck between 10 percent and 20 percent of the population for the foreseeable futurewhich means tobacco deaths will remain in the hundreds of thousands annuallyyoure more likely to be agitating for the federal government to take a light hand, even if it means opening the door to the possibility of a renewed national mania for nicotine.

I dont know what will happen; I hope consumption will continue to drop, but I have been hoping this would transpire since the 1970s, when I first became involved in the anti-tobacco movementthrough the American Cancer Societyduring my fellowship at the Memorial Sloan-Kettering Cancer Center. Regardless of prognostication, there is no need for Government to weigh-in when there is no definable public-health issue at-stake. A medical-politics mentor, George Ross Fisher, III, M.D., once declared that he became involved in Organized Medicine simply to avoid adoption of bad policy. These two bills embody the need to apply this aphorism and, thus, must be jettisoned; better you should beef-up enforcement of existing law precluding sale of cigarettes to minors, for stopping them from starting would obviate creation of nicotinedependence and, therefore, the temptation to adopt laws such as these two proposals.

Testimony to the Philadelphia City Council Public Health and Human Services Committee Opposing Bills No 140095 & 140096 March 13, 2014 William T Godshall, MPH Executive Director Smokefree Pennsylvania 1926 Monongahela Avenue Pittsburgh, PA 15218 412-351-5880 BillGodshall@verizon.net

Im Bill Godshall, founder and director of Smokefree Pennsylvania. Since 1990, weve advocated local, state and federal policies to ban smoking in workplaces, stop cigarette marketing to youth, increase cigarette tax rates, hold cigarette companies accountable in civil court, and help smokers quit. During the past decade, weve been educating the public that cigarettes are 100 times more hazardous than all smokefree tobacco/nicotine alternatives, including smokeless tobacco, nicotine gums, lozenges, patches, inhalers, and e-cigarettes. For disclosure, neither Smokefree Pennsylvania nor I have ever received any funding from any tobacco, drug or e-cig company. Back in 2009, the Campaign for Tobacco Free Kids, American Cancer Society, American Heart Association and American Lung Association (which have received several hundred million dollars from Big Pharma) urged Obama appointees at FDA to ban e-cigs. After FDA banned all e-cig imports, the agency revealed its unscientific, unethical and inhumane policy by telling reporters We don't want the public to perceive them as a safer alternative to cigarettes," (Appendix 1). After Customs Agents seized their shipments, two e-cig companies sued the FDA and Smokefree Pennsylvania filed a supportive amicus brief with the DC Court of Appeals, which unanimously upheld Judge Richard Leons ruling that FDA unlawfully banned e-cigs (Appendix 2). Since our goal is to reduce the leading cause of disease and death, we urge this committee to reject Bill No 140095 because it bans the use of lifesaving e-cigs, threatens the lives of vapers, discourages smokers from quitting, deceitfully defines smokefree e-cigs as Electronic Smoking Devices, imposes a $300 fine on employers and managers for violations, cannot be enforced, requires posting of signs that falsely claim e-cigs are smoking devices, and because the bill is preempted by the PA Clean Indoor Air Act.

In sharp contrast to many false and misleading fear mongering claims made by DHHS, Big Pharma front groups, and other e-cig prohibitionists since 2009, the scientific and empirical evidence during the past five years has consistently found that e-cigarettes are 99% (+/-1%) less hazardous than cigarettes, have helped several million smokers quit or sharply reduce cigarette consumption, and are consumed almost exclusively (i.e. 99%) by cigarette smokers and by exsmokers who switched. Since e-cigs are smokefree, public health benefits every time a smoker uses an e-cig instead of smoking. E-cigs have already replaced about 1 Billion packs of cigarettes in the US, and last year US cigarette consumption plummeted by 4.6% as e-cig sales skyrocketed. E-cigs are proving more effective for smoking cessation than FDA approved gums, lozenges, patches and inhalers, which have a 95% failure rate. And e-cigs pose fewer risks than FDA approved Chantix, as Pfizer is facing hundreds of lawsuits for causing depression, suicidal thoughts and suicides. E-cigs pose no risks to nonusers. Hundreds of common workplace and household products and activities emit far greater levels of indoor air pollution than an e-cig (including furniture, carpet, paint, printers, copiers, cooking, cleaning products, dry cleaned clothes, hair spray, perfume, nail polish, and even a cup of coffee), but we dont ban any of those things. Meanwhile, e-cigs have never been found to create daily dependence in any nonsmoker (youth or adult), and have never been found to precede cigarette use by any daily smoker. Although a CDC survey found that e-cig use doubled among teens from 2011 to 2012, smokers accounted for the overwhelming majority. Among high school students, 7.6% of smokers and .4% of nonsmokers reported past 30 day e-cig use in 2011, increasing to 15.7% of smokers and 0.7% of nonsmokers in 2012. Since CDCs survey (and all others) found that teen smokers are at least 20 times more likely than nonsmokers to report use of an e-cig, and found that teen smoking has declined every year since e-cigs have been marketed, e-cigs are a gateway away from (not towards) cigarette smoking for teens, just as they are for adults. Regardless, just as we dont ban adults from consuming alcohol, smokeless tobacco, coffee or candy because some teens consume those products, its absurd to ban e-cig use by adults for that reason. E-cigs benefit many employers and managements since workers dont waste company time on smoke breaks, and customers dont disrupt businesses by going outside. Some employers actively urge smokers to switch to e-cigs to improve employee health and save money, including health care costs. While we support banning vaping at preschools and K-12 schools, other employers and businesses can and have set their own policies for vaping, just as for cellphone use.

Besides, its impossible to enforce vaping bans, and unfair to impose $300 fines on employers and businesses for violations since e-cig users can eliminate all visible vapor by simply holding their breath for two seconds. Illegal use of e-cigs has skyrocketed in the three states and several dozen municipalities that banned vaping, and were aware of just two citations issued (both against vape shops). Since 2009, Smokefree Pennsylvania has also advocated state laws banning the sale of e-cigs to minors, which 27 states have already enacted, and many more are in the process of enacting, including four laws passed in the past two weeks that have been sent to governors. We strongly oppose the text of Bill No 140096 because it appears to be preempted by the state law banning tobacco sales to minors, because it falsely defines smokefree e-cigs as Electronic Smoking Devices and creates a new derogatory category of Unapproved Nicotine Delivery Products to confuse and scare, and because it requires all e-cig retailers to post intentionally deceptive signs stating "SALE OF ELECTRONIC SMOKING DEVICES AND UNAUTHORIZED NICOTINE DELIVERY PRODUCTS TO PERSONS UNDER 18 YEARS OF AGE IS PROHIBITED BY LAW. PHOTO I.D. WILL BE REQUIRED. THIS LAW WILL BE STRICTLY ENFORCED." I urge this committee to amend Bill No 140096 to make it is consistent with the language, requirements and penalties in Senator Tim Solobays bill (SB 1055) (Appendix 3) to ban the sale of alternative nicotine products to all PA minors that was unanimously approved by the PA Senate Judiciary Committee. We also urge the Philadelphia City Council to support Solobays bill. Please note that the ACS, AHA, ALA have opposed bills in many states, including SB 1055, that would ban e-cig sales to minors because the bills dont falsely redefine e-cigs as electronic smoking devices, which demonstrates their real agenda Thank you,

References 1. In April 2009, FDAs Rita Chappelle revealed the agencys policy on e-cigarettes We dont want the public to perceive them as a safer alternative to cigarettes. http://www.webmd.com/smoking-cessation/features/ecigarettes-under-fire 2. Judge Richard Leons January 15, 2010 ruling striking down FDAs e-cig ban as unlawful. https://ecf.dcd.uscourts.gov/cgi-bin/show_public_doc?2009cv0771-54 https://ecf.dcd.uscourts.gov/cgi-bin/show_public_doc?2009cv0771-55 3. PA bill (SB 1055) would ban sale of alternative nicotine products to minors. http://www.legis.state.pa.us/cfdocs/billinfo/billinfo.cfm?syear=2013&sind=0&body=S&type=B& BN=1055