And vapers pollute the air around them. Far from just exhaling “harmless water vapor,” as many e cigarette ads proclaim, vapers pollute the air with nicotine, ultrafine particles, volatile organic compounds and even metals. That’s why more than 100 cities, including New York City, and three states now sensibly include e cigarettes in their clean indoor air laws.
Such a plan that would treat e cigarettes like other tobacco products is moving through the Chicago City Council now it deserves speedy enactment.
E cigarettes are sold as a way to quit smoking. Twitter and other social media are filled with testimonials from people who claim anecdotally that e cigarettes saved their lives by helping them quit cigarettes. And, no doubt, there are some people who believe that e cigarettes helped them stop smoking. However, population level statistics tell a different story. Studies that have followed smokers over time show that e cigarette users are, on average, less likely to stop smoking. In practical terms, this means that for every person e cigarettes helped to quit smoking, there is at least one person whom e cigarettes kept from quitting.
It is telling that not a single e cigarette company has submitted evidence to the U.S. Food and Drug Administration backing up claims that e cigarettes help people quit smoking.
Indeed, when the FDA tried to regulate e cigarettes as a drug (nicotine) delivery device, e cigarette companies sued and blocked the FDA in court. When, eventually, the FDA tries to regulate e cigarettes as tobacco products (what the companies claimed in their first lawsuit), e cigarette companies will sue again, which will delay any federal regulation for more years.
In the meantime, for the first time in 42 years, nicotine addiction advertising is back on television. Today’s e cigarette ads resemble cigarette ads from the 1950s and 1960s sex, glamour and rebellion, with celebrities even doctors endorsing them.
Fueled by marketing tactics borrowed from cigarette company playbooks of the past (which is not surprising since many e cigarette companies are owned by tobacco companies) and the addition of kid friendly flavors now banned in cigarettes, sales are doubling every year, with the current market estimated to reach $2 billion annually.
Not surprisingly, kids are responding to these ads. The U.S. Centers for Disease Control and Prevention recently reported that e cigarette use among middle and high school kids doubled between 2011 and 2012. And they are not just “vaping,” or smoking an e cigarette. Eighty percent of these kids are smoking cigarettes at the same time, a double win for Big Tobacco.
On the eve of the release of a new surgeon general’s report on the 50th anniversary of the first surgeon general’s report linking tobacco with disease, we are hearing the same false statements extolling the virtues of the next generation of nicotine addiction products that we heard about cigarettes and smokeless tobacco products in times past. That’s why Chicago and communities everywhere should ban the sale of e cigarettes in kid friendly places and, most important, include e cigarettes in clean indoor air laws.
Stanton A. Glantz is a professor of medicine at the University of California at San Francisco and the American Legacy Foundation’s distinguished professor of tobacco control.
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But because little research has been done on the effects of e cigarettes, such moves lack a solid scientific grounding. It is generally accepted that the devices are safer than conventional cigarettes, although studies by the FDA and Health New Zealand, a research consultancy based in Christchurch, have shown that some brands contain carcinogens and other toxic chemicals, including diethylene glycol and N nitrosamines (A. D. Flouris and D. N. Oikonomou Br. Med. J. 340, c311 2010).
If e cigarettes are used in moderation, the nicotine doses they provide may be lower than those attained from smoking cigarettes. But although the devices are smoke free, nicotine itself causes high blood pressure and palpitations, and is highly addictive. Little is known about the long term effects of e cigarette vapour.
Some experts think e cigarettes are a saviour. They may kill smoking as we know it, says Peter Hajek, director of the Tobacco Dependence Research Unit at Barts and the London School of Medicine and Dentistry. That s the biggest hope we have of ending the tobacco epidemic.
But as big tobacco companies have piled into a market worth more than US$2 billion worldwide, regulators have failed to keep up, in part because the chemicals in e cigarettes vary so widely. Some countries, such as Norway and Brazil, have banned the products. But in the United States, e cigarettes are currently regulated only if they are marketed as quitting aids. The United Kingdom has said it will regulate them as medicines meaning they will have to meet strict quality standards but its regulator, the Medicines and Healthcare Products Regulatory Agency, is holding fire until the new European rules are in place.
The decisions that regulators make will shape not just the future of the industry but also the public health response and scientists both for and against e cigarettes have waded into the debate while regulation is still up in the air.
Right now, electronic cigarettes are the triumph of wishful thinking over data, says Stanton Glantz, a tobacco control researcher at the University of California, San Francisco, who thinks that the products should be regulated. He points to a report released earlier this month by the US Centers for Disease Control and Prevention in Atlanta, Georgia, that shows some children who have never smoked cigarettes are using e cigarettes, suggesting that the devices may be a gateway product. And he notes that several surveys have reported high levels of smokers using both cigarettes and e cigarettes, indicating that the products are being used to sustain nicotine addiction. The use of vapour flavourings, such as vanilla, could also be seen as an attempt to prolong use and appeal to younger consumers.
Other scientists, such as Hajek, say that regulating e cigarettes as medical devices would be a disaster. He believes that the cost of complying with rules for medical devices would allow big tobacco companies to dominate the nascent e cigarette industry, squeezing out innovative new products.
To overregulate now could threaten the existence of e cigarettes and cut down the options for people who want to quit, agrees Christopher Bullen of the National Institute for Health Innovation at the University of Auckland in New Zealand. He was the lead author on a study published this month showing that e cigarettes were as effective as nicotine patches in helping smokers to quit (C. Bullen et al. Lancet 2013).
Vaughan Rees, a tobacco researcher at Harvard School of Public Health in Boston, Massachusetts, thinks that e cigarettes need to improve before they can replace cigarettes and that, for now, they should be regulated as tobacco products. Although they do present an opportunity to improve public health, he adds, care needs to be taken to ensure that they don t flourish alongside conventional cigarettes. Then we ve got a double problem, he says.