We spoke with Dr. Alberto de Hoyos, director of robotic and minimally invasive thoracic surgery at Northwestern Memorial Hospital, about the risks and benefits of e cigarettes.
What is an e cigarette and how do they work?
E cigarettes deliver nicotine, and were designed as an option for smokers to use smokeless tobacco as a way of getting nicotine, in an effort to provide relief of symptoms of nicotine withdrawal. Some people argue that e cigarettes help people to quit smoking regular cigarettes because it s smokeless and there s no combustion. Typically, it s battery operated and delivers a small amount of nicotine to the system, with the addition of some flavoring. The amount of tobacco in the product is very small, just for flavoring, but there is no significant amount of tobacco in this product. Typically, e cigarettes can last from 150 300 puffs. Tobacco cigarettes last 10 20 puffs.
How do they compare with regular cigarettes?
There is definitely less risk to a person to use a smokeless product, like e cigarettes. They are not smoking, they are vaping. The product of combustion in tobacco cigarettes has thousands of different chemical products. It s been demonstrated that tobacco cigarettes have up to 4,000 different chemicals, many of which are carcinogenic. E cigarettes, because there is no combustion and no tobacco, doesn t have all that toxicity. So definitely it s safer to use than a tobacco cigarette. The real question is are they risk free? And we don t think that they are risk free.
Do they all contain nicotine?
There are some products that have no nicotine. Most give you the option to use nicotine delivery, plus additional flavoring. And the person that uses these devices has the satisfaction of putting the e cigarette in the mouth and they feel like they are smoking a real cigarette, so there are some psychological benefits.
But it s not harmless because there is nicotine, and different studies have demonstrated that there are some chemicals, though the amount is small. We don t know if there is any carcinogenic potential at this point we don t have enough evidence. Preliminary results indicate there is a significantly less risk of cancer using these e cigarettes, but we are not completely sure if they are risk free in terms of cancer.
Can e cigarettes help people quit smoking?
There have been well done, randomized studies with other smoking cessation treatments. We still don t have the same evidence with e cigarettes, but there is evidence from smaller studies that e cigarettes might help people quit tobacco smoking. Nicotine in the e cigarettes is delivered to the system and replaces the nicotine that is delivered through cigarette smoking, and relives symptoms of nicotine withdrawal.
What are the secondhand smoke risks from e cigarettes?
Vapor of the mist that is generated is delivered into the environment. Studies that have been done in indoor and outdoor environments appear to indicate that the concentration of these chemicals is very, very small and there s not enough to cause harm to bystanders. But there are studies that have found small amounts of heavy metals and other chemicals that could be toxic for the person that uses the e cigarette, but not a bystander.
In your medical opinion, should e cigarettes be banned from locations where regular cigarettes are banned?
The argument is that they are not completely harmless, so they are being regulated as regular tobacco because they contain nicotine, which is a drug.
The ban passed City Council today. What are your thoughts on that? Do you think it is a move in the right direction?
We support that decision. Anything that can prevent the use of any form of smoking, especially in teenagers, is highly recommended because teenagers can use e cigarettes for some period of time, but later on they may be hooked on real tobacco. The position of the city of Chicago to pass these recommendations is very beneficial. E cigarettes should be regulated the same as tobacco cigarettes.
Interview has been condensed and edited.
We also spoke with Dr. Bechara Choucair, the Commissioner for the Chicago Department of Public Health, who said the ordinance that passed City Council today has no relevance on whether or not e cigarettes are effective smoking cessation devices. He continued
We want to make sure our residents enjoy the right to breathe clean air. Until we know more about the effects and impact of the vapor that s being emitted, we want to make sure we do no harm and protect those residents. This is not really a ban on e cigarettes people can still buy them from over 3,000 retailers in the city. Today s vote confirms that Chicago is being a national leader on tobacco issues. It s another step in the right direction to making sure our youth are protected from tobacco and being addicted to nicotine and allowing residents the right to breathe clean air.
Meanwhile, tobacco policy experts at The Heartland Institute, a Chicago based free market think tank, released statements in opposition to the ban. Senior Policy Analyst Matthew Glans said
By choosing to lump e cigarettes into its smoking ban ordinance, Chicago has taken a lazy and shortsighted approach toward regulating what is a very different product than cigarettes. Although most e cigarettes have nicotine derived from tobacco, they are very different from other tobacco products, and they should not be regulated the same way.
E cigarettes have far fewer consequences for personal and public health, and several studies have found e cigarettes to be an effective and viable option for smokers seeking a nicotine replacement therapy. Adding e cigarettes to the smoking ban only disrupts an increasingly popular and successful method of helping Chicagoans reduce smoking or quit altogether.
View graphics on e cigarette sales across the United States, and watch Carol Marin and four Chicago aldermen take up the issue.
The time to regulate e-cigarettes is now – csmonitor.com
For most of the 20th century, Big Tobacco companies argued that the hardworking tobacco farmer was the ultimate victim in any attempt to regulate their industry. It s a familiar argument that industry regulation just hurts the little guy.
Today e cigarettes are largely produced in China. No US farmers or factory workers have livelihoods that depend on e cigs. But if the e cig industry continues unregulated, it may get a bigger foothold in the US economy, and public health may again become beholden to a small handful of heartstring pulling stakeholders who speak on behalf of an even smaller number of corporate executives.
The political history of tobacco farming furnishes a cautionary tale. Since the surgeon general first linked cigarette smoking to lung cancer in 1964, farmers and their representatives have been mainstays in the opposition to tax increases, marketing restrictions, and other antismoking legislation.
At one 1969 congressional hearing on cigarette labeling, a Kentucky representative argued that farmers, the thousands of decent, law abiding people should not be sacrificed on a statistical altar erected by many who are antismoking zealots.
Farmers also testified frequently at congressional hearings, providing a living illustration of their congressmen s overheated rhetoric. For whatever health benefit would be rendered by more stringent warning labels, tobacco growers were made earthy ambassadors of the tangible social costs of regulation or, in the words of the farmer who spoke that day, the economic devastation which would come to tobacco growers if tobacco is sentenced and executed.
It is true Many US tobacco growing regions have never fully recovered from the antismoking measures that have served to safeguard public health. Fortunately, no such dilemma faces those who want tighter oversight of e cigarettes. Today, that means any oversight at all, as the devices are not currently governed by federal law, though New York City and a few other states and cities have placed e cigs under their smoking bans.
E cigs are much less pernicious than a tobacco cigarette and may even have a public health benefit if they can help smokers quit. But because of the regulatory vacuum, the public doesn t know, exactly, what s in e cigs, neither do we know much about how people use them.
If e cigarettes can be cessation devices, as many hope, then they should be regulated like the patch or nicotine gum. But other data raise the possibility that in fact, e cigs could be activation devices, particularly for young people or equally problematic, that they actually weaken smokers ability and resolve to quit smoking. If that s the case, there should be common sense restrictions on flavor additives or advertising.
Such regulations have obvious benefits They would help consumers make more informed choices, reduce youth consumption, and help preserve the public s antismoking victory.
And, for now, the economic costs are minimal. No state economy is today dependent on the production of e cigarettes. This may not be the case forever, though. As electronic cigarettes grow in popularity, more Americans may find themselves invested in those little glowing cylinders.
Right now, electronic cigarettes don t have much of a place in our narrative about America Thomas Jefferson never grew an e cigarette, the noble yeoman farmer never once hauled his harvest of e cigs to market, and whole regions have not grown on the proceeds of their sale.
But the hardworking laborer is still a potent political cover. When New York Mayor Michael Bloomberg banned the sale of sugary drinks, it was the small business owners minority owners of bodegas that became the emblem of the perils of regulatory overreach. And earlier this year, when President Obama proposed a tax hike of 94 cents on cigarettes (to no avail), the tobacco farmer reappeared as a sympathetic proxy for the rest of the industry. Senator Kay Hagan, a Democrat from North Carolina, argued that the tobacco tax would hurt farmers and the economy in North Carolina.
Yesterday s tobacco farmer might be tomorrow s hardworking e cigarette entrepreneur. Swift regulation by the Food and Drug Administration can help ensure that parts of the US economy do not, once again, become dependent on nicotine.
Sarah Milov is a visiting scholar at Harvard s Center for History and Economics and will be an assistant professor of history at the University of Virginia beginning August 2014. She is writing a book on tobacco and politics.