The debate is heating up about electronic cigarettes, also called e-cigarettes or e-cigs, which are blurring some of the lines in the battle against smoking. Touted as a healthier, cleaner and cheaper alternative to regular cigarettes, these rechargeable or disposable battery-operated devices look like real cigarettes, but instead of tobacco they hold a cartridge containing a solution of nicotine plus other chemicals and flavorings.
When you suck on the device, the liquid heats up and produces a fine mist or vapor that you inhale and exhale. There is no combustion or smoke, so users call it vaping instead of smoking.
Developed in China and first marketed in 2004, e-cigarettes are becoming increasingly popular and trendy (another day, another celebrity sighted puffing on an e-cig). There are now hundreds of brands, and the big tobacco companies—banking on big profits, customer loyalty and a supply of new addicts—are getting into the business, too. While TV and radio ads for cigarettes have been banned in the U.S. since 1970, ads for e-cigarettes are increasingly common.
Some people use e-cigs to try to quit smoking and still get their nicotine fix (companies are not allowed to market e-cigarettes as smoking cessations aids, however). Other smokers resort to them in public places where regular cigarettes are not allowed, though e-cigarettes are forbidden on airplanes and in many restaurants.
Meanwhile most anti-tobacco experts are skeptical, seeing e-cigarettes as a way to keep people hooked on nicotine and reinforce smoking behavior. And many fear that candy-flavored e-cigarettes will serve as a gateway for teenagers to start smoking regular cigarettes, since they look and feel like the real thing. One in 10 high school students tried e-cigarettes last year, according to the Centers for Disease Control and Prevention (CDC), and some of them had never smoked a conventional cigarette.
E-cigarettes: faux smoking, faux safety?
E-cigarettesmay well be safer than regular cigarettes, though that isn’t saying much, since tobacco smoke provides such a lethal and addictive mix of nicotine, toxins and carcinogens. However, it’s impossible to know for sure, since there hasn’t been much good research on them.
In addition, the chemical content of their vapor varies, depending on the brand and even the flavor; the ingredients don’t have to be disclosed. Nearly all contain nicotine (levels vary widely), which has a stimulant effect that can raise heart rate and blood pressure in some people. That’s also true of other nicotine replacement products, such as gums and patches, but those are regulated by the Food and Drug Administration (FDA), come with warnings and are supposed to be used for a limited time so that people wean themselves off nicotine.
Besides nicotine, e-cigarette vapor contains (again, depending on the brand) some of the same toxic and potentially carcinogenic substances found in tobacco smoke—notably nitrosamines, formaldehyde, acetaldehyde, toluene and other volatile organic compounds—though apparently at much lower levels. Some researchers, including those who conducted a recent study published in Tobacco Control, have found that the levels are insignificant and very unlikely to pose any risk, but others question this.
Many of these chemicals also end up in secondhand vapor. A German study published in the Indoor Air Journal, for instance, found that e-cigarettes pollute indoor air with volatile organic compounds as well as propylene glycol (a solvent used to vaporize liquid nicotine).
Can e-cigarettes help you kick the habit?
Two recent studies suggest that e-cigarettes can help some people stop smoking or at least cut down. The best study, one from New Zealand published online in the Lancet in September, found that e-cigarettes were as effective as nicotine patches in helping smokers quit. The quit rate was low in both groups—just six to seven percent had stopped smoking after six months. And in an Italian study published in PLOS ONE in July, e-cigs helped nine percent of smokers quit for a year. One concern, however, is that by keeping people hooked on nicotine and reinforcing smoking behavior, e-cigarettes may result in people cycling back and forth between electronic and real cigarettes, never really quitting smoking.
No one’s in charge of e-cigarettes yet
Government agencies around the world have been struggling with how to regulate e-cigarettes. In the U.S., the devices occupy a gray area—not treated as tobacco products or medical devices, though they share qualities with both. In 2010 the FDA warned some e-cigarette marketers that they were making unsubstantiated claims about unapproved drug-delivery devices (nicotine is a drug). The agency is expected to soon propose rules for the devices, which could regulate the chemical composition of the liquid as well as their labeling and marketing.
Meanwhile, Health Canada (the equivalent of our FDA) does not allow the sale of nicotine-containing e-cigarettes in stores and advises people not to use them, though the devices are readily available online. France is planning to treat e-cigarettes like regular cigarettes and ban them in public places. The UK will start regulating them as a drug in 2016, which means that, among other things, they can’t be marketed to those under 16. Some other countries have banned e-cigarettes outright. The American Lung Association has warned about potential risks of e-cigarettes and called for their strict regulation.
E-cigarettes: the bottom line
The popularity of e-cigarettes has far outpaced the science on them. No one knows how they will affect the lungs, airways, mouth, digestive tract, eyes and other organs over the long term. Nicotine is a highly addictive drug; thus the FDA should regulate e-cigarettes the same way it regulates tobacco and nicotine patches and gums. Bystanders should not have to inhale secondhand vapor until its safety has been demonstrated. Millions of people are now being guinea pigs, actively or passively inhaling unidentified compounds at unknown levels.
E-cigarettes may turn out to be a valuable stop-smoking aid, but long-term independent research is needed. In the meantime, if you’re trying to quit smoking, stick to methods such as nicotine gum, patches, nasal sprays and medication, along with counseling and support. These help only a small proportion of smokers quit for good, but at least they have a proven track record. Bear in mind, too, that most people who successfully quit do so cold turkey, without the aid of nicotine replacement therapy or medication.
If you’re not a smoker, don’t start the habit with e-cigarettes. You may become hooked on nicotine and be unable to quit. And years from now you may learn that they have damaged your health.