More research is on the way on the benefits, risks of e-cigs.
Public health experts say they are just beginning to untangle basic questions about electronic cigarettes.
“The simplistic answer is they have the potential to do harm, they have the potential to do good.”
That’s the quick appraisal from Mitch Zeller, director of the Center for Tobacco Products at the U.S. Food and Drug Administration.
The new nicotine-delivery devices have been cast as a great hope for smokers who want to quit. Critics worry e-cigarettes will get a new generation of Americans hooked on nicotine.
A year ago, the FDA announced a proposal to regulate e-cigarettes, if that happens, Zeller’s the man who will be in charge. He wants Americans to have an open mind.
There’s no doubt that nicotine creates addiction, he said, but added that the drug is also safe enough that it is available in gums and patches to help you quit smoking without a prescription.
What kills people is puffing burnt tobacco leaves and the chemicals in that smoke, Zeller said.
“Those are compounds linked to cancer, heart disease and lung disease, not the nicotine,” he said. “It’s not the drug, it’s the delivery mechanism and there really needs to be a societal debate about the role of nicotine and e-cigarettes really has become the poster child.”
What is it?
An e-cigarette is a metal tube attached to a battery and a heating coil. When you puff, heat transforms the liquid and nicotine inside to a vapor or aerosol that pours out of the mouth and nose. That’s the basics, but at Delaware Vapor shoppers come in for custom-built hardware and accessories.
First-generation vape sticks looked a lot like traditional cigarettes, but these days store manager Brendan Styles sells bedazzled devices in Tiffany blue and hot pink. His is a masculine-looking metal vapor flask wrapped in embossed leather.
All the seats are full at the shop’s “juice bar” where customers taste-test flavored e-liquids before they buy. Csilla Lakatos is chatting with the barista and looking for the right flavor.
The 33-year-old has been smoking traditional cigarettes for just a year and a half, and now she’s trying e-cigs because she wants to eventually quit her menthol ultra lights.
That’s the big selling point, Styles says. Smokers come in to switch from traditional cigarettes—or at least cut back.
Electronic cigarette makers are not allowed to market their products as quit-smoking tools, but many consumers say the devices have helped them.
“You blow out a cloud, see that visual representation, your body receives its nicotine,” Styles said. “It know it’s getting its nicotine fix but it’s not getting the 4,000 chemicals that are in a cigarette, and that’s why these things work so well. The patch, the gum, it satisfies the chemical craving but it doesn’t do anything for your physical habit, that’s what people really get addicted to.”
Back in 2009, the government banned all flavors–except menthol–in tobacco cigarettes. But at the vape shop, there are dozens of flavors to choose from. Poppa Smurf is a blend of blueberry and whipped cream flavors. Lakatos decided on strawberry-banana smoothie.
“If your e-liquid tastes like Robitussin, you’re not going to quit smoking, you’re just going to go back to your cigarettes,” Styles said. “You need to find a flavor you like.”
Concerns over marketing
You have to be 18 to buy electronic cigarettes in Delaware–and the law is the same in about 40 other states. But critics suspect that all those brightly colored bottles and flavors are deliberately designed to tempt teenagers.
“Electronic cigarettes come in chocolate and butterscotch or even gin and tonic. You can break two adult taboos by vaping gin and tonic or wine-flavored e-cigarettes,” said physician Robert Jackler, he leads a group of investigators at Stanford University that tracks the images and messages used in vaping ads.
He says lots of that marketing happens on social media where minors see it. Nicotine exposure during adolescence can hurt brain development and Jackler says in recent years an increasing number of middle school and high-school students have tried electronic cigarettes.
The group, Stanford Research into the Impact of Tobacco Advertising, compiles examples of electronic cigarette ads and Jackler says the marketing appeals are very similar to those now banned in the tobacco industry.
“We would like any claims to be science based,” Jackler said. He thinks brands such as “Lung Buddy” and ads that say, “breathe easier” cross the line.
The federal government restricts claims about traditional cigarettes but those limits don’t apply to electronic devices.
At the American Vaping Association, President Gregory Conley says anti-nicotine activists complain about vaping ads even when they are directed at adults. Conley says e-cigs are a safer—if not safe–alternative for adult smokers.
“It’s important that they learn about these products,” he said.
Assessing the health impacts
Serious science is on the way to assess the benefits of electronic cigarettes, but it’s early days.
Tobacco researcher Thomas Eissenberg says regulators need good research before they can make good rules that both protect kids and help smokers quit. He’s a psychologist at Virginia Commonwealth University. He said he studies electronic cigarettes as an alternative because smoking is more than a just habit; it’s a drug-induced dependence, a brain disease.
“If e-cigs are to have a place in the public health landscape in the United States, it’s “A” that they are less risky than tobacco cigarettes–cause less death and disease–I don’t know that that’s true, but a lot of people believe that it’s true. And number two, they’re going to help tobacco cigarette smokers stay away from all tobacco cigarette smoking for the rest of their lives,” Eissenberg said.
Lots of smokers say they feel better and breathe easier when they switch to electronic cigarettes, and researchers at Creighton University in Nebraska are testing that idea. Shavonne Washington Krauth and her team recruited new e-cigarette users then monitored their lung function.
“We were fortunate enough to run into a vape shop owner who was very excited about the concept of researching e-cigarettes without necessarily trying to vilify them,” she said.
Vapers came in the lab, blew into a tube called a spirometer. At the end of six months, the average pack-a-day smoker was down to five tobacco cigarettes. Once again, Washington asked them to huff into her machine.
The study was small. Nineteen people remained in the study after half a year. Some of those study dropouts stopped vaping, others never returned calls and requests from the researchers.
“Even though a large number of people were still both smoking and vaping at six months, their lung function in this particular area was getting better,” Washington said. She said her study is one of the beginning building blocks regulators will need if they decide to make rules about electronic cigarettes.
Are marketers targeting kids? Does switching to e-cigs improve a smoker’s health? In addition to those questions, researchers are also trying to figure out if it’s dangerous to breathe in second-hand vapor.
Health researchers have found preservatives and nicotine in e-cigarette clouds –but industry-lobbyist Gregory Conley says the real question is: How much? Wood burning stoves and perfumes also leave emissions in the air, he said. Is it just trace contaminants—or enough to harm bystanders?
“Right now, I can’t tell you what’s in the aerosol, that’s why we say it’s the Wild, Wild West for e-cigarettes,” Zeller said. “I’m the regulator and I can’t tell you what’s in the aerosol.”