September 19, 2012
As sales of electronic cigarettes soar in the United States, a flurry of new research does little to settle the fiery debate about whether they’re good or bad for human health.
The latest, a small Greek study presented earlier this month, says the small battery-operated devices may damage the lungs, but research unveiled in August says they don’t harm the heart. Other studies this summer cite potential hazards, including a second-hand effect from their vapor.
People who use e-cigarettes say they don’t smoke but “vape” because the devices heat nicotine into a vapor they inhale. Many see the cigarette lookalikes, which contain no tobacco and far fewer chemicals, as safer, so they’re using them to quit smoking or circumvent smoke-free laws. But are they?
Some researchers say they may addict kids to nicotine, while others argue they may do more good than harm. What’s clear, though, is that plummeting prices are making e-cigarettes an increasingly popular and less expensive alternative to cigarettes. U.S. sales are expected to hit 5 million this year, up from 50,000 units in 2008, according to Thomas Kiklas, director of the Tobacco Vapor Electronic Cigarette Association (TVECA), an industry group.
Each unit, which has three parts—battery, charger and nicotine-containing cartridge—now sells for about $21, down from at least $200 three years ago, says Jerry Newton, owner of Earth N Ware in Orange, CA, which sells them and cigarettes. He says his replacement cartridges, which provide about as much nicotine as a pack and a half of cigarettes, cost $3 each.
Young adults view e-cigarettes positively, and half say they would try them if offered by a friend, particularly because they come in flavors, according to a University of Minnesota study published online in July in the American Journal of Public Health.
Researchers interviewed 66 Americans, ages 18 to 26, about snus (a Swedish type of smokeless tobacco), dissolvable tobacco products and e-cigarettes, which come in bubble gum, cherry and chocolate flavors.
“There’s a danger e-cigarettes could lure in kids who might not otherwise smoke,” said anti-smoking activist John Banzhaf, a professor at the George Washington University Law School in Washington, D.C. He pushed for the Food and Drug Administration to regulate them.
The FDA, after finding trace amounts of toxic and carcinogenic ingredients in several samples, sought to regulate e-cigarettes as drug-delivery devices. A federal judge ruled in 2010 that it lacked such authority, so the FDA is moving to regulate them as tobacco products.
“Many people use them as a bridge product” to avoid smoke-free laws, and as a result they delay or avoid quitting, says David Abrams, executive director of the Schroeder Institute, operated by the anti-tobacco group Legacy. He co-authored a study in the same issue of the public health journal that found 70% of Americans believe e-cigarettes are less harmful than regular cigarettes.
Yet researchers from the University of Athens in Greece found e-cigarettes caused breathing problems or “significant airway resistance” after 10 minutes of use in eight non-smokers and 11 smokers with normal lung function.
They found no immediate lung effect in the 13 smokers tested who have either asthma or chronic obstructive pulmonary disease. “This research helps us to understand how these products could be potentially harmful,” study co-author Christina Gratziou said in announcing the findings Sept. 2.
Another peer-reviewed study found e-cigarettes may emit aerosols, volatile organic compounds (VOCs) and nicotine, posing a “passive vaping” risk to bystanders. The study, by German researchers, appeared in July in Indoor Air.
Nonsense, the TVECA says. “There’s no smoke. It’s water vapor. You don’t smell anything,” said Kiklas, who added that e-cigarettes contain only five ingredients: nicotine, water, glycerol, propylene glycol (used in inhalers) and flavorings. He says the samples the FDA tested a few years ago had minuscule amounts of other ingredients, but the products have improved.
Kiklas said U.S. retailers try not to sell to kids, and he rebuffs the argument that sweet flavorings are meant to lure them, adding that nicotine gum also comes in cherry. “The amount of good we’re doing is phenomenal,” he said, because the devices help thousands of people quit cigarettes. “The technology works. Smokers have embraced it.”
Celebrities, so often trendsetters, have been seen vaping on screen. In “The Tourist,” Johnny Depp took puffs from a slim stick, saying, “It’s not a real cigarette; it’s electronic.” On the Late Show in 2010, actress Katherine Heigl whipped out her electronic cigarette, telling David Letterman it helped her stop smoking: “You’re blowing out water vapor, so you’re not harming anyone around you, and you're not harming yourself. I’m essentially humidifying the space.”
Even some in the medical community see possible benefits: “E-cigarettes may hold promise as a smoking-cessation method,” concluded Michael Siegel of the Boston University School of Public Health in a study published in April 2011 in the American Journal of Preventive Medicine.
He and two co-researchers found that 67% of the 222 smokers queried said they smoked less after using e-cigarettes for six months, and 31% said they kicked the tobacco habit.
Greek researchers from the Athens-based Onassis Cardiac Surgery Center also found a potential upside. They tracked the heart activity of 20 young people after smoking one cigarette and 22 after seven minutes of e-cigarette use. They found “significant” cardiac disruptions only for the smokers.
“Substituting tobacco with electronic cigarettes may be beneficial to health,” Konstantinos Farsalinos told the annual meeting of the European Society of Cardiology in Munich on Aug. 25.
Others are more skeptical. “We’re not saying they’re safe or unsafe. We just don’t know. The responsible research needs to be done,” Abrams said, adding that FDA-approved nicotine-replacement devices have been thoroughly tested.
His Legacy colleague, pulmonologist Nathan Cobb, says there are quality control issues with e-cigarettes, almost all of which are imported from China. He says nicotine levels vary widely and contamination can occur with propylene glycol, which is used in a variety of products, including inhalers and as an antifreeze.
“We’re still trying to understand what happens when people inhale them,” Cobb said. As for smoking cessation, he added, “Some e-cigarettes might be effective, some might not.”
Unlike cigarettes, these devices are not federally taxed, although some states are moving to impose their own taxes. An increasing number of cities and states are banning e-cigarette use in smoke-free places. Amtrak has banned their use on trains, and the Navy banned them below decks in submarines. In September, the U.S. Department of Transportation proposed a ban aboard airplanes because of concerns about health risks from the vapors.
Some who use them find them helpful. Newton, 63, says he was a chain-smoker for 51 years despite repeated efforts to quit. On Aug. 16 last year, when he started using the electronic device, he took his last smoke from a real cigarette.
“My brain thinks it’s still smoking,” he said, referring to the nicotine effect from e-cigarettes. “But my smokers’ cough is gone. I feel a lot better.”
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