The bare truth – Interview with Michael Siegel

Michael is a physician who completed his residency in Preventive Medicine at the UC Berkeley School of Public Health and trained in epidemiology for two years at the Centers for Disease Control and Prevention in Atlanta before coming to Boston. His primary research interest is in the area of tobacco control, focusing on secondhand smoke health effects, exposure, and policies, cigarette advertising and marketing practices and their effects on youths, and evaluation of tobacco control policies and their impact on youth and adult smoking behavior. Follow Michael’s blog at

Finding the best electronic cigarette may not matter if global governments legislate against the industry. Professor Michael Siegel, from the Department of Community Health Sciences at Boston University School of Public Health, tells us more about this crucial debate. This interview was originally posted on in 2013.

Powersmoke: Is regulation going to develop or damage the global vaping industry?

Michael Siegel: It all depends on the nature of that regulation. If electronic cigarettes are regulated as alternative tobacco products, rather than as drugs, and if they are treated differently than actual tobacco products, then regulation could be a great boon for the industry. On the other hand, if electronic cigarettes are regulated as drugs, or if they are treated similarly to real tobacco products, it could be a disaster for the industry. So it all depends on what public health agencies and policy makers decide, including the decisions of the EU and the FDA which we will hear about over the next few weeks and months.

Powersmoke: What real life evidence is there that vaping is an effective anti-smoking solution?

Michael Siegel: There are literally thousands of smokers who have quit smoking successfully using electronic cigarettes. We know this from a combination of evidence; including testimonials from individual users, survey evidence, sales data, focus group data, and most recently, clinical trial results. We don’t yet know exactly the proportion of smokers who are able to quit successfully using electronic cigarettes, but at a minimum, the use of these products appears to be at least as effective as traditional nicotine replacement therapy.

Powersmoke: What rights should vapers demand, on things like ingredients listings?

Michael Siegel: There need to be uniform standards that all companies must follow. With more than 250 brands on the market, consumers need to know that whatever brand they purchase, there are certain standards that have been adhered to, both in the manufacturing of the device and the preparation of the liquid. For example, listed nicotine levels need to be accurate, batteries must be safe without risk of overcharging and exploding, there should not be loose metal joints. These are all issues which I am hoping the FDA will address in its proposed regulations.

Powersmoke: What one step would ease the transition into a wider global vaping community?

Michael Siegel: The one step that would do the most to facilitate the marketing of electronic cigarettes would be for regulatory agencies to explicitly allow companies to tell the truth about the intended use of these products: namely, that they are intended to be used to quit smoking. Unlike every other consumer product on the market, electronic cigarettes are the only ones for which companies are presently not able to tell consumers what the products are actually for. This is because of the fear that if companies make smoking cessation claims, their products will fall under the Food, Drug, and Cosmetic Act or similar pharmaceutical/medicinal laws internationally. My hope is that in its regulations, the FDA will make it clear that a simple statement that these devices are intended to be used for smoking cessation will not be considered to be a therapeutic claim.

Powersmoke: Is vaping a healthy alternative, a profit making alternative for companies, or both?

Michael Siegel: I wouldn’t call vaping ‘healthy,’ but it is clearly a much ‘healthier’ alternative to cigarette smoking. It is true that the major tobacco companies have purchased or developed electronic cigarettes but people need to understand that these products developed not as a ploy by Big Tobacco to make it harder for customers to quit smoking. Instead, they developed as a bona fide attempt to provide an alternative to cigarette smoking for smokers who are concerned about their health yet haven’t been able to quit using available methods. Tobacco companies got into the act simply because they saw that they could create an additional niche on the other side of the smoking equation. But I see no evidence that the tobacco companies are not serious about marketing these products for smoking cessation.

Powersmoke: Can vaping ever be truly healthy?

Michael Siegel: It is theoretically possible that someone could come up with an excipient that is both absolutely safe and which produces enough of a throat hit so that it satisfies the smoker. If such a product did not deliver nicotine, then yes, it might be a truly ‘healthy’ vaping product. However, it’s doubtful that such technology is going to be available in the near future. Nevertheless, I do think that a search for alternative excipients would be a worthwhile research endeavour.

Powersmoke: Are bans on vaping in public places in any way reasonable or effective?

Michael Siegel: At the present time, there is no evidence that ‘secondhand’ vapour poses any public health hazard. For this reason, I do not support banning vaping in public places. My view is that in order to ban a behaviour in public such as smoking or vaping, one has to show evidence that the behaviour is actually causing harm to bystanders. With smoking, we have solid evidence. With vaping, we have no evidence at the current time.

Powersmoke: What is the motivation behind the mistruths and the attacks on e cigarettes?

Michael Siegel: There are two primary motivations, I believe. First, there is a strong ideology among many in the tobacco control movement that the act of smoking is bad. Even just the motions of going through what looks like smoking are frowned upon. Thus, even though vapers are greatly reducing their risks and perhaps saving their lives, anti-smoking advocates look down upon them because they are through going through an act that looks like smoking. The second motivation is money. There are strong financial ties between many of the anti-smoking groups that oppose electronic cigarettes and pharmaceutical companies that manufacture competing products. This is a conflict of interest that is often hidden in the public statements made by these anti-smoking groups.

Powersmoke: Is there a conspiracy against the electronic cigarette and other safe alternatives to smoking, and if so who is behind it and why?

Michael Siegel: I don’t believe it is a conspiracy, but simply, the result of strong ideology combined with pharmaceutical financial ties. These factors are combining to generate tremendous opposition to electronic cigarettes, despite the scientific evidence that these products are having a tremendous public health benefit.

Powersmoke: Do a lot of the government issues towards vaping have to do with fear of the unknown?

Michael Siegel: Fear of the unknown is certainly part of the picture, but it makes no sense. Why would we rather that people use cigarettes, which have known risks, than electronic cigarettes, which are much safer but for which the precise risks have not been articulated? Do these groups really prefer that people smoke because at least we know how terrible cigarettes are for you, rather than vape because although it’s much safer, we don’t know the exact risk? This is ludicrous.

Powersmoke: Where do you see electronic cigarettes going in the future?

Michael Siegel: It all depends on how these products are regulated. With the ‘wrong’ approach, regulation could literally destroy the industry, or at very least, put a huge obstacle in its way. With the ‘right’ approach, I truly believe that electronic cigarettes could transform the tobacco epidemic in a way that we have never seen before. Let’s hope that the FDA, the EU, and other public health agencies and policy makers will make the right decisions.

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