The rest of the story is that this is not an employment policy based on health principles. Instead, it is part of a moral crusade against a particular health behavior (i.e., a vice) which is being punished in a discriminatory fashion.

The finding of reduced exhaled nitric oxide is an indication that an exposure is causing some sort of inflammatory effect on cells lining the respiratory tract. It doesn't mean anything more or less than that. You can't take two exposures - each of which causes respiratory tract inflammation - and make the statement that the effects of both exposures are equal. Risk posed by an exposure depends on many other factors, including the degree of inflammation induced, the reversibility of the effect, the nature of the exposure, the chronicity of the exposure, etc.

If the Senate truly wants to reduce cigarette smoking and protect the public's health, it will shift its attack from e-cigarette companies which are trying to get the public off tobacco cigarettes and over to the federal government, which is doing everything it can to protect the cigarette market.

The requirement by the FDA that this black box warning be placed on Chantix is based on the agency's assessment of hundreds of cases of suicides that occurred in patients who had recently been treated with the drug, as well as thousands of cases of other serious adverse neuropsychiatric symptoms associated with the use of Chantix. In making a decision to require a black box warning, the agency takes into consideration the likelihood that the observed association between the drug and the adverse effects is a causal one.

Actually, I would go one step further. I don't see a need for pre-market review of new electronic cigarette products, as it is the older ones which pose the most concern and the product quality has improved with innovation and time. Moreover, such requirements would stifle innovation. Instead, if I were the FDA, I would simply establish a set of safety standards that all products must meet. These standards would address issues such as battery safety, quality of ingredients used, type of ingredients used, temperature regulation, quality and safety of metal parts, and child-safety of packaging.

"The challenge that the FDA has is that they will be challenged by the tobacco industry, as they have been at every step of the way. [The FDA] tried to regulate e-cigarettes earlier, and they lost to the tobacco industry. … So the FDA has to balance moving quickly with moving in a way that’s going to be able to survive the tobacco industry’s highly paid legal challenge."

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