Public health officials and electronic cigarette supporters vigorously debated whether New York City should add e-cigarettes to the Indoor Clean Air Act — now 12 years old — which bans smoking in public spaces, during a public hearing at City Hall in Manhattan on Wednesday.
The makeup of the audience painted an outlandish picture, with the buttoned-up suits and business attire of health and government workers mixed alongside the leather jackets, piercings and shaggy hair of e-cigarette supporters, many of whom wore badges that read "non-smoker" in a defiant statement that their cigarettes do not emit actual smoke.
New York City Council members heard testimony from public health experts, who said continuing to allow the smoking of e-cigarettes indoors was undermining decades of efforts to protect people from secondhand smoke.
"The primary concern of the Health Department is the enforceability of the Smoke Free Air Act against conventional cigarette smoking," said Dr. Robert Farley, chair of the New York City Department of Health and Mental Hygiene. "Because we know that that has been enormously important not just in protecting people against secondhand smoke but also reducing smoking rates overall and making it less socially acceptable."
He went on: "If allowing e-cigarette use indoors undermines that, then we've lost this incredibly important tool."
Also testifying were supporters of "vaping," the term coined by electronic cigarette smokers to describe the act of smoking their devices, which deliver a heated, nicotine-laced solution that's inhaled in vapor form. Representatives of electronic cigarette companies argued that their products effectively help smokers quit, and that they were far less physically harmful than regular cigarettes because they don't involve tobacco combustion.
"What your bill is trying to do is trying to de-normalize smoking. (But) these people quit smoking," said Spike Babain, founder of the National Vapers Club and owner of a chain of e-cigarette stores in New York City.
As the testimony continued, intermittent clouds of vapor erupted from audience members like miniature smoke signals as they puffed away during the indoor hearing.
At stake is whether e-cigarettes will remain in the regulatory territory of tobacco products like traditional cigarettes and cigars, as dictated by the U.S. Food and Drug Administration.
After e-cigarettes were introduced in the U.S. in the mid-2000s, the FDA tried to ban their import from China. The agency said e-cigarettes needed to undergo clinical trials and be regulated like other medical devices because manufacturers claimed that the devices helped people quit smoking. But the manufacturers filed a lawsuit arguing that the FDA should regulate e-cigarettes like tobacco products, and a federal judge ruled in the manufacturers' favor.
In 2011, the FDA formally announced its intent to regulate e-cigarettes like tobacco products, which means that — by law — e-cigarette manufacturers can't officially make the medical claim that their products help people quit smoking.
But while the FDA treats the devices like tobacco products, the agency still doesn't regulate quality control, meaning that there aren't requirements for consistency of ingredients, even within the same brand. The World Health Organization has warned that "there is no way for consumers to find out what is actually delivered by the product they have purchased."
And while more people use e-cigarettes, often with the hope of quitting conventional smoking, public health experts say regulators need to study the long-term consequences of inhaling the vapor, which contains fine particles that are deposited into the lungs and can reach the bloodstream.
In the long term, those particles in e-cigarette vapor can cause "pulmonary and inflammatory problems and increase the risk of cardiovascular and respiratory disease and death," said Lucy Popova, a postdoctoral fellow at the University of California, San Francisco's Department of Medicine, in testimony during Wednesday's hearing.
And studies have shown that despite their lack of tobacco, e-cigarettes contain some of the same toxic compounds like acetaldehyde and formaldehyde (PDF), the latter of which is known to be carcinogenic.
If New York City approves the inclusion of e-cigarettes in the Indoor Clean Air Act, it will join cities in a handful of states like New Jersey, California, Utah and Kentucky that already include e-cigarettes in their laws banning indoor smoking. Just last week, Chicago decided to consider legislation similar to New York's, and the city's Metropolitan Transportation Authority has already moved to ban e-cigarettes on trains.
Still, users of electronic cigarettes insist that the devices are saving lives.
Randy Credico, a comedian and political satirist who challenged Chuck Schumer for his Senate seat in 2010, showed up at the hearing to support the public use of e-cigarettes, which he started smoking about six months ago.
He had smoked tobacco cigarettes and cigars ever since a stressful moment during a 1986 comedy tour in Nicaragua pushed him to pick up an unfiltered Camel to relieve his anxiety — "It was a war zone," he said — and he found himself hooked.
"I went to cigars, I went to cigarettes, I went back and forth," Credico said of his efforts to stop smoking, but it never worked. But after losing both his parents to lung cancer and two of his brothers to smoking-related illnesses, he said he wished he'd discovered e-cigarettes sooner.
"If they had these, they'd still be alive, probably," he said.