到底有沒有健康隱患 電子煙與尼古丁

“We need a national debate on nicotine,” said Mitch Zeller.

“我們需要就尼古丁展開一場全民大討論，”米奇·澤勒(Mitch Zeller)說。

Zeller is the director of the Center for Tobacco Products, a division of the Food and Drug Administration created in 2009 when Congress passed legislation giving the F.D.A. regulatory authority — at long last! — over cigarettes. In addition, the center will soon have regulatory authority over other tobacco products, including electronic cigarettes, which have become enormously controversial even as they have gained in use. Through something called a “deeming rule,” the center is in the process of asserting that oversight over e-cigarettes.

澤勒是菸草製品中心(Center for Tobacco Products)主任，這個食品與藥品管理局（Food and Drug Administration，簡稱FDA）下屬機構，是國會2009年——終於！——立法授予FDA香菸管制權後成立的。除了香菸，中心不久還會獲得其他菸草產品的管制權，包括使用量在增加但爭議極大的電子煙。通過一個叫做“推定規則”的條款，菸草中心即將得到監管電子煙的權力。

Opponents of electronic cigarettes, which include many public health officials, hope that the center will treat these new devices like it treats cigarettes: taking steps to discourage teenagers from “vaping,” for instance, and placing strict limits on the industry’s ability to market its products.

包括許多公共衛生官員在內的電子煙反對者希望菸草中心能把這些新型煙具當成普通香菸一樣處理：比如着手抑制電子煙在青少年中的流行，對該產業的產品營銷能力進行嚴格限制。

Proponents, meanwhile, hope that the center will view e-cigarettes as a “reduced harm” product that can save lives by offering a nicotine fix without the carcinogens that are ingested through a lit cigarette. In this scenario, e-cigarette manufacturers would be able to make health claims, and adult smokers might even be encouraged to switch from smoking to vaping as part of a reduced harm strategy.

與此同時，支持者則希望中心把電子煙當做一種“減害”產品，它能讓人過尼古丁癮，但又不會產生燃燒的香菸會有的致癌物。照這個說法，電子煙生產商就可以聲稱它們的產品有益健康，甚至將之納入整體的減害策略，提倡成年菸民從吸菸轉向吸電子煙。

When I requested an interview with Zeller, I didn’t expect him to tip his hat on which direction he wanted the center to go, and he didn’t. Indeed, one of the points he made was that the F.D.A. was conducting a great deal of scientific research — more than 50 studies in all, he said — aimed at generating the evidence needed to better understand where to place e-cigarettes along what he calls “the continuum of risk.”

在向澤勒提出採訪請求的時候，我並不指望他會透露自己希望中心該走哪條路，他也確實沒說。事實上他的其中一項表態是，FDA在做大量的科學研究——據他說在50項以上——希望能充分積累證據，以便更好地判斷電子煙在他所說的“風險序列”中處於什麼位置。

Zeller is a veteran of the “tobacco wars” of the 1990s, working alongside then-F.D.A. Commissioner David Kessler, who had audaciously labeled cigarettes a “drug-delivery device” (the drug being nicotine) and had claimed regulatory authority. Zeller left the F.D.A. in 2000, after the Supreme Court ruled against Kessler’s interpretation, and joined the American Legacy Foundation, where he helped create its hard-hitting, anti-tobacco “Truth campaign.” After a stint with a consulting firm, Pinney Associates, he returned to the F.D.A. in early 2013 to lead the effort to finally regulate the tobacco industry.

澤勒是參加過1990年代“菸草戰爭”的老兵，輔佐當時的FDA局長戴維·凱斯勒(David Kessler)，後者曾甘冒大不韙將香菸稱爲“藥物遞送裝置”（藥物指的是尼古丁），併爲此聲稱自己擁有監管權。凱斯勒的解釋遭到最高法院否決後，澤勒於2000年離開FDA，進入美國遺產基金會(American Legacy Foundation)工作，並在那裏策動了強有力的反煙活動“真相運動”(Truth campaign)。之後他在諮詢機構Pinney Associates工作過一段時間，於2013年初回到FDA，着手實現對菸草行業的監管。

“I am fond of quoting Michael Russell,” Zeller said, referring to an important South African tobacco scientist who died in 2009. In the early 1970s, Russell was among the first to recognize that nicotine was the reason people got addicted to cigarettes. “He used to say, ‘People smoke for the nicotine but die from the tar,’ ” Zeller recalled.

“我喜歡引用邁克爾·拉塞爾(Michael Russell)的話，”澤勒說，這位南非著名菸草科學家已於2009年去世，他在1970年代初提出尼古丁是人對香菸上癮的原因，是這一理論的先驅之一。“他說過，‘致人抽菸的是尼古丁，致人死亡的是焦油，’”澤勒說。

This is also why Zeller found e-cigarettes so “interesting,” as he put it, when they first came on the market. A cigarette gets nicotine to the brain in seven seconds, he said. Nicotine gum or patches can take up to 60 minutes or longer, which is far too slow for smokers who need a nicotine fix. But e-cigarettes can replicate the speed of cigarettes in delivering nicotine to the brain, thus creating real potential for them to become a serious smoking cessation device.

這也是爲什麼當市場上剛出現電子煙的時候，澤勒會說這是個“有意思的”東西。他說香菸可以在七秒鐘內將尼古丁送達大腦。尼古丁咀嚼糖或貼片需要長達60分鐘，甚至可能更久，對希望過尼古丁癮的菸民來說實在太慢。但電子煙的尼古丁遞送速度可以和香菸媲美，因此有望成爲正經的戒菸手段。

But there are still many questions about both their safety and their efficacy. For instance, are smokers using e-cigarettes to quit cigarettes, or they using them to get a nicotine hit at times when they can’t smoke cigarettes? And beyond that there are important questions about nicotine itself, and how it should be dealt with.

但人們對它的安全性和功效仍然有很多疑問。比如菸民是在用電子煙戒香菸，還是在不能抽香菸時，用它來過尼古丁癮呢？除此之外，關於尼古丁本身及其處置方式，也有一些重要的問題尚待解答。

“When nicotine is attached to smoke particles, it will kill,” said Zeller. “But if you take that same drug and put it in a patch, it is such a safe medicine that it doesn’t even require a doctor’s prescription.” That paradox helps explain why he believes “there needs to be a rethink within society on nicotine.”

“尼古丁和煙塵顆粒在一起，可以致命，”澤勒說。“但同一種藥物放到貼片裏就安全了，安全到連醫生處方都不需要。”正是出於這種困惑，他認爲“社會對尼古丁需要有一個重新的認識”。

Within the F.D.A., Zeller has initiated discussions with “the other side of the house” — the part of the agency that regulates drugs — to come up with a comprehensive, agency-wide policy on nicotine. But the public health community — and the rest of us — needs to have a debate as well.

澤勒在FDA內部已經開始跟“房子那一頭的人”——負責藥物監管的部門——討論制定一個全面的、各部門統一的尼古丁政策。但公共衛生領域，以及我們大家，也需要展開討論。

“One of the impediments to this debate,” Zeller said, is that the e-cigarette opponents are focused on all the flavors available in e-cigarettes — many of which would seem aimed directly at teenagers — as well as their marketing, which is often a throwback to the bad-old days of Big Tobacco. “The debate has become about these issues and has just hardened both sides,” Zeller told me.

澤勒說，“阻礙這種討論的其中一個因素”是，電子煙反對者抓住了電子煙的多種口味——其中許多口味是直接迎合青少年的——以及它們的營銷方式，時常讓人想起窮兇極惡的“大煙草公司”時代。“討論已經開始圍繞這些問題展開，導致雙方的態度都強硬起來，”澤勒對我說。

It’s not that Zeller believes nicotine is perfectly safe (he doesn’t) or that we should shrug our shoulders if teenagers take up vaping. He believes strongly that kids should be discouraged from using e-cigarettes.

這並不表示澤勒相信尼古丁是絕對安全的（他不這麼認爲），或者我們不需要把青少年吸電子煙太當回事。他堅信應該設法制止青少年使用電子煙。

Rather, he thinks there should be a recognition that different ways of delivering nicotine also come with different risks. To acknowledge that, and to grapple with its implications, would be a step forward.

他的看法是我們應該認識到，不同的尼古丁遞送方法，帶來的風險也是不同的。明確這一點，面對它可能帶來的後果，就是一種進步。

“This issue isn’t e-cigarettes,” said Mitch Zeller. “It’s nicotine.”

“問題不在電子煙，”米奇·澤勒說。“在尼古丁。”