Leading the fight against e-cigarettes

When Susan Liss became the top lobbyist for Massachusetts in Washington in 2006, she had a million things to juggle, from the rollout of the state’s new health care law to the search for federal funds. But it was a tough personal time for such a big assignment: Her husband, Jeffrey Liss, a partner with the law firm DLA Piper, was dying of pancreatic cancer.

Jeffrey died the following year at age 55, leaving behind Susan and two children in their twenties. The death was fateful, not only in the toll it took on her family but in the career redirection it eventually prompted. Liss blamed her husband’s death on the second-hand smoke he breathed as a child. He was not a smoker himself. So when the Center for Tobacco-Free Kids, the leading anti-smoking group in Washington, advertised for a new executive director in 2011, Liss jumped at the opportunity. She is now leading the organization’s fight against electronic cigarettes, devices that are essentially nicotine-delivery systems without tobacco and smoke.

Liss isn’t convinced e-cigarettes are safe and fears cigarette manufacturers are using e-cigarettes to lure more people to try real cigarettes. “They are marketing with cartoon characters and using sexuality and glamour to promote their product,” says Liss. “It’s all designed to encourage a whole new generation to think smoking is cool.”

But advocacy groups for e-cigarette makers say the devices should be welcomed because they are a far less dangerous alternative to smoking and in fact help some people kick their smoking habit. Elaine Keller, the president of Consumer Advocates for Smoke-Free Alternatives, says the nicotine delivered by e-cigarettes is not all that different from caffeine. “It will temporarily increase blood pressure and heart rate, the same thing that happens with a strong cup of coffee,” she says.

Keller’s group, along with the Smoke Free Alternatives Trade Association, the Tobacco Vapor Electronic Cigarette Association, and the Heartland Institute are all lobbying against e-cigarette regulation. All receive backing from the cigarette industry. The groups have some non-tobacco industry allies. The American Association of Public Health Physicians, for instance, argues that e-cigarettes should be treated as a legitimate smoking cessation aid.

When a person takes a drag from an e-cigarette, a battery-powered metal coil inside heats a cartridge, vaporizing liquid nicotine. The smoker inhales the nicotine and exhales odorless water vapor, the reason e-cigarette users often call it vaping, not smoking. In addition to not being particularly unhealthy, Keller says, the devices help smokers quit using traditional cigarettes and pose no second-hand smoke danger to non-smokers.

But Liss fears that the big cigarette makers are using e-cigarettes as a gateway to the real thing. “Something like 20 percent of middle school kids who’ve never touched a cigarette tried an e-cigarette in the last year,” Liss says, citing data from the Centers for Disease Control and Prevention. “That to me is a really scary number. It demonstrates a willingness for kids to try this in what could well be the first step in a progression to cigarettes that can do real harm in a very short period of time.”

Liss says the tobacco companies are following their old playbook for cigarettes in promoting e-cigarettes on cable television with sexy or amusing ads. Former Playboy model Jenny McCarthy has done ads for Lorillard’s Blu-eCigs company. “I get to have a Blu without the guilt,” she says in one of the ads. Lorillard, the number 3 US cigarette company, boosted its ad spending for Blu-eCigs to more than $12 million during the first quarter of last year, according to Kantar Media, a firm that monitors the advertising market. Another e-cigarette firm, eJuiceMonkeys, has used a smiling, cartoon monkey with a cigarette in its mouth in its promotions.

Since their introduction into the US market in 2007, e-cigarette sales have grown steadily. The Tobacco Vapor Electronic Cigarette Association says more than 3.5 million Americans are using them now. By comparison, the Centers for Disease Control and Prevention says 43.8 million Americans smoke traditional cigarettes, a number that has been steadily dropping. The adult smoking rate has fallen from 42 percent in 1965 to 19 percent in 2011, the most recent year for which figures are available.

The major US tobacco companies are all moving quickly into the e-cig business. Lorillard in 2012 purchased Blu-eCigs and last year bought England’s SKYCIG. Reynolds launched its VUSE Digital Vapor Cigarette line last year. Philip Morris owns the MarkTen e-cigarette brand.

Liss says there hasn’t been nearly enough research yet to deem e-cigarettes safe or unsafe. In 2009, the Food and Drug Administration tested electronic cigarettes and warned doctors that they contained carcinogens and toxic chemicals. Since then, however, the CDC has said that electronic cigarettes “appear to have far fewer of the toxins found in smoke compared to traditional cigarettes.”

For Liss, her position with the Campaign for Tobacco-Free Kids marks a big career shift. She’s known best as a Democratic Party operative in Washington, who’s held a range of high level jobs, from chief of staff to Tipper Gore, when Al Gore was vice president, to top aide to Deval Patrick when he was assistant attorney general for civil rights under President Bill Clinton. She ran Patrick’s Washington office for a year, helping rebuild ties between the governor’s office and the Massachusetts congressional delegation that had become strained during the 16 years Republicans held the governorship. Before joining the Campaign for Tobacco-Free Kids, she held a series of consulting gigs and a position at New York University promoting election reform.

Still, her political connections are helpful in her new job, the No. 2 position at the Campaign for Tobacco-Free Kids, where she oversees lobbying in Washington and state capitals.

At first, it seemed her job would mostly entail watching over the implementation of a 2009 federal law granting the FDA authority to regulate tobacco as a drug, to restrict cigarette marketing, and to ban the sale of flavored cigarettes. The law gave the FDA the option to regulate e-cigarettes, but so far the agency has taken no action.

The states aren’t waiting for the FDA. More than half of them have enacted laws banning the sale of electronic cigarettes to people under the age of 18. Others have banned their use in public places, such as restaurants and bars. On Beacon Hill, Jamaica Plain Democrat Jeffrey Sánchez, the House chairman of the Joint Committee on Public Health, is pursuing legislation to ban the sale of e-cigarettes to minors and to add them to the state’s smoke-free air law.

The Bay State has traditionally taken a tough line on tobacco. It was one of the first states to use Medicaid funding to provide smoking cessation assistance, and in 1992 state voters approved an increase in the cigarette tax to fund a tough anti-smoking advertising campaign, one of the first of its kind in the nation. The Centers for Disease Control and Prevention urged other states to follow Massachusetts’ lead. The percentage of adult smokers in the state is now lower than in all but eight other states. The rate fell from 24 percent in 1992 to 16 percent, while the youth smoking rate has fallen from 30 percent to 14 percent.

Liss remains hopeful that the FDA will spring to action and there’s plenty of reason to believe it will. Howard Koh, an anti-smoking crusader in his days as Massachusetts public health commissioner, oversees tobacco policy at the agency’s parent, the Health and Human Services Department, and the FDA tried in 2009 to block e-cigarette sales, seizing imports of the devices from China as unapproved medical devices. It said the manufacturers needed to conduct clinical trials and prove the devices had a medical benefit. In December 2010, however, the e-cigarette industry won a court battle challenging the seizures.

As she awaits word on whether the FDA will regulate e-cigarettes, Liss is focusing on bills like Sánchez’s in Massachusetts in order to slow e-cigarettes’ growth. She has her organization’s Northeast director, Kevin O’Flaherty, working to promote the legislation in Boston. “Right now, unless we have state and local regulation, it’s the wild West,” she says.