How Safe are E-Cigarettes?

Putting a Price on Happiness

Amidst the bureaucratic lexicon of the U.S. Food and Drug Administration’s (FDA) proposed rule to extend the FDA’s authority over electronic cigarettes and other tobacco products is something called the “happiness quotient.”

In lay terms, the happiness quotient is a cost-benefit analysis that weighs the health benefits of reduced smoking versus the loss of pleasure smokers endure when they quit. This calculation could make it harder for the FDA to take strong action against tobacco companies, say critics of the legislation. The calculation assumes that the benefits from reducing smoking must be discounted by 70% to offset the loss of happiness smokers experience when they quit, according to an article published in August 2014 in The New York Times.

Robert Jackler, MD, an otolaryngologist at Stanford University and co-founder of Stanford Research into the Impact of Tobacco Advertising, says that argument is invalid. “You’ll find the industry will come up with all sorts of arguments that on the surface might sound reasonable to you, [but] scratch slightly under them,” he said. “The amount of suffering that goes on from tobacco-related illness far outweighs any pleasure.”

The quotient, which has drawn derision from economists and others, may or may not make the final rule. An FDA spokeswoman said in August that there remains “a great deal of uncertainty” and that the agency was still exploring the issue. The quotient is tied to a longstanding federal rule that regulations with more than $100 million of impact on the economy need a cost-benefit analysis to prevent endorsing rules with incongruously high costs and low benefits.

Otolaryngologist Laurence DiNardo, MD, of Richmond, Va., says that measuring the benefit is not a simple equation, as the ancillary and tertiary impacts of smoking can be voluminous, especially if secondhand dangers are tallied. “It’s very nebulous, and I don’t know how you’re going to quantify that, but it’ll be interesting to see the government try,” he added.—RQ