Thank you for doing something ambiguously between smoking and not smoking

“Funge” is a funny word. It refers to the thing which fungible things are able to do, sort of along the lines of what an extra unit of a good is going to replace. I don’t think it’s a real word and I’ve only heard it used by people connected to the Center For Applied Rationality. This is too bad, as it prevents everyone else from understanding, let along generating, important sentences. Like “Be careful what you’re funging against.”

Maybe this is why so many people are so careless what they’re funging against. Consider our recent discussion of the minimum wage. The minimum wage means no one has to work for below minimum wage. Its desirability depends a lot on whether below-minimum-wage funges against above-minimum wage jobs or against unemployment. That is, if we ban 100 below-minimum wage jobs, do we get 100 above-minimum-wage jobs, 100 more unemployed people, or a mixture of both?

This was also part of the thrust of my argument about drone warfare – it’s not funging against peace, it’s funging against much worse types of warfare. The same piece cited the status quo bias and indeed these two ideas are probably related.

This, combined with a complicated regulatory environment and sheer bad luck, seems like the best explanation for the trials (both metaphorical and literal) of e-cigarettes.

E-cigarettes (the “e” is for electronic) are pseudo-cigarettes that contains nicotine without tobacco. They don’t smell bad, they don’t produce secondhand smoke, and they don’t cause cancer. They are strictly better than regular cigarettes in every way. The governments of several countries are doing their best to ban them.

The governments’ position is that they are a stealth attempt to trick people who have successfully avoided regular cigarettes into smoking anyway. There’s some merit to this. Some of them have nice fruity flavors that might appeal to children. And because they don’t produce smoke, they’re legal to use indoors, where some people might not be allowed to use the real thing. There might be this tiny contingent of non-smokers who were just waiting for a flavorful and indoor-useable way to get the addictive expensive chemical they have no reason to want.

And yes, this would be bad. Nicotine is addictive no matter how you get it. There are some claims – and I don’t yet know how seriously to take them – that the other chemicals in tobacco inhibit monoamine oxidase which further perverts dopamine levels and makes cigarette smoking more addictive than nicotine alone would be, but this is different from saying nicotine isn’t addictive at all. Even if nicotine has few ill effects – and in fact this seems to be the case – there is a strong economic and convenience-based argument for not getting addicted to it.

I should clarify that “few ill effects” claim. A massive overdose of nicotine can kill you (so can a massive overdose of caffeine, Tylenol, or vitamins). Nicotine is a stimulant which raises your heart rate and blood pressure a bit (so is caffeine). It may increase the risk of diabetes, but it may treat cognitive impairment. Overall, it seems to have a complicated mix of minor bad and minor good effects, about the same as anything else in health. And like everything else in health, tomorrow three labs will come out with studies proving it causes cancer, and a fourth will come out with a study proving it prevents cancer, and one of them may even be right.

There are some studies that show that e-cigarettes have “toxic additives”, but these seem to be in ridiculously tiny trace amounts, don’t seem to make it into the vapor or the body of the user, and the entire problem could be solved by regulation anyway if anyone had a desire to regulate them. This entire issue struck me as a red herring and I bet you can buy fish at any market in the country with more toxic additives than the worst e-cigarette on the market.

So let’s accept that using e-cigarettes will get you addicted and set you back a lot of money and otherwise be annoying but probably not deadlier than anything else you do on a daily basis. What then?

Well, in that case, it’s worse than not smoking but much much better than smoking. And whether or not their existence is a good thing depends on what they funge against. Do they funge against smoking tobacco or not smoking at all?

I would have liked to get the CDC’s opinion, but their webpage on the issue is missing and from commentary I gather it didn’t have the information I wanted anyway. But I did find this:

A June 2011 national study conducted under the supervision of ECH Research of Cincinnati, in conjunction with Opinionnaire, surveyed more than 200 smoker households that use electronic tobacco products and found that 99% of e-cigarette users are either current or past users of multiple forms of tobacco. Approximately 70% of survey respondents said they intended to quit smoking before starting e-cigarettes.

I can’t find the original or even so much as a description of what “ECH” stands for. A sketchy online survey claims that 70% of e-cigarette smokers were former smokers.
So let’s just say “probably some high number”. This seems quite plausible to me. How many non-smokers think “You know, I want a product with all of the addictiveness and expense of cigarettes, but none of the coolness? In fact, I want to look like a chronically uncool recovering addict inexplicably smoking a glowstick.”

That same Etter and Bullen paper says that 96% of the ex-smokers said the e-cigarette helped them quit or reduce smoking, and 79% felt they might relapse to smoking again if they didn’t have e-cigarettes. Randomized trials seem to confirm this result, with the average smoker in the trial dropping from 19 cigarettes per day to 2 cigarettes per day after trying e-cigs.

It’s not really surprising that e-cigarettes work. My current model of cigarette addiction is that it consists of the interaction between (1) nicotine, (2) smoking-associated behaviors which have become associated with the rush from nicotine over time and might have more complicated components like “oral fixation”, and maybe (3) a contribution from MAOIs in the tobacco. Normal cigarettes have all three. E-cigarettes have (1) and (2). Nicotine patches have (1) only. Therefore, e-cigarettes should be more useful in quitting than nicotine patches, albeit not a perfect replacement for regular cigarettes. This does indeed seem to be what has been observed.

Some people argue that the effects of e-cigarettes haven’t been perfectly studied, that they might be unsafe in some unclear way. And that as a smoking-cessation device, they’re technically a medical device and therefore need to undergo as much study and regulation as any other medical device before being given to the public.

I know there’s constantly a debate between the people who want to evaluate each new medical intervention for safetly and the people who want to use exciting new potentially life-saving technologies now, and I know that sometimes the former group do turn out to be right. Varenicline is a popular antismoking drug that was eventually discovered to drive people insane in various way and sometimes lead to suicide; although it is still used on people with both an extreme desire to quit smoking and impressive mental fortitude, it’s nice that people paid careful attention to the side effects and didn’t just give it out like candy.

But e-cigarettes are literally the exact same thing as something that’s given out to anyone who asks in convenience stores, except without the cancer. To suddenly hold them to an extremely high standard of safety seems like a fallacy of fungibility.

The worst are the people – one of whom has so far appeared in every article I have read on the subject – who say that we should be careful because “Big Tobacco” is pushing them as a “solution” to the problem of declining cigarette sales. First of all this is just factually wrong; most e-cigarettes are made by alternative companies in direct competition with Big Tobacco. Second, if your reasoning strategy is identifying the Evil People and then minimizing their utility, you probably shouldn’t be making public policy.

So I’m against banning e-cigarettes, and I’m even against things like taxing them or prohibiting their use in public places, on the grounds that the more smokers are encouraged to switch to e-cigarettes, the better. Like, if a public e-cigarette ban reduces the number of smokers who switch to e-cigarettes by 2%, you’ve just killed an extra 9000 people per year – about three 9-11 attacks, or twice the number of US soldiers who died in the Iraq War.

(this is why public health is about a hundred times more important than any other political issue, and even tiny little marginal issues in public health are more important to get right than, say, anything you will see people changing their profile pictures about on Facebook.)

So obvious conclusion is obvious and almost too boring to discuss. I got interested in e-cigarettes because a friend asked me whether he should start taking them even though he didn’t smoke as a way to get the cognitive enhancement effects of nicotine.

I guess that depends on what you value. I personally wouldn’t do this because I’m terrified of addiction. Then again, I avoid coffee and I drink like three glasses of alcohol per year in order to avoid addiction, which most people would consider sort of excessive. And I frequently take weird psychoactive Mexican herbs in order to achieve lucid dreams and would use LSD in a heartbeat if it were legal. So I guess my answer is that my feelings on the costs vs. benefits of various substances aren’t likely to generalize across the population.