Experts: More research needed on electronic cigarettes

Jean Duncan sat at a bar inside Crazy Vapors while her son, Charlie, puffed on a small cylinder that flashed a green light. He is trying the electronic cigarette because he would like to quit smoking.


“I want to start living a little healthier,” Charlie Duncan said.

Electronic cigarettes were added to the proposed tougher smoking ordinance that would ban their use as well as smoking tobacco in most public places in Augusta. The ordinance will come before the Augusta Commission on Nov. 5.

But a panel of experts at the international meeting of the American Association for Cancer Research said much is not known about electronic cigarettes and much more research is needed. One of the big questions is how the devices will be regulated. The Food and Drug Administration, through the Family Smoking Prevention and Tobacco Control Act, has asserted its authority to regulate cigarettes, roll-your-own tobacco and smokeless tobacco.

“(The) FDA is moving to release for public comment a proposed rule to regulate additional categories of tobacco products,” spokeswoman Jennifer Haliski said in a statement but she could not elaborate further. The agency had given October 2013 as the date for releasing the proposed rule but it could be later, she said.

Experts say the agency should help clear up some of the uncertainty surrounding electronic cigarettes through its work, said Dr. Peter Shields, deputy director of the Ohio State University Comprehensive Cancer Center.

“Let the FDA do its job,” he said. “Let it finish the research over the next couple of years and we’ll figure that out.”

Until then, there is a “Wild West” of scores of products being marketed to young consumers, particularly through social media, said Dr. Scott Leischow, co-leader of the Cancer Prevention and Control Program at Mayo Clinic in Scottsdale, Ariz. YouTube, for instance, has scores of videos for “hookah pens” that are not marketed as electronic cigarettes.

“Hookah pens are e-cigarettes in terms of their design and their function but they’re called something else,” he said. “The challenge of this is a regulatory one and how they ultimately become marketed is going to be one of the fundamental regulatory challenges facing the U.S. FDA as well as in Europe and other regulators.”

Public health officials were alarmed to see the number of students in grades 6-12 who had tried an e-cigarette more than doubled from 2011 to 2012, from 3.3 percent to 6.8 percent, and nearly doubled among middle school students, from 1.4 to 2.7 percent, the Centers for Disease Control and Prevention reported last month.

Overall, the use of the devices has “skyrocketed,” Leischow said. Sales in retail stores like Crazy Vapors already have topped $700 million this year and online sales added another $600 million, Leischow said. Overall, sales will be at least $1.7 billion this year alone, he said. According to one Wells Fargo analysis, e-cigarettes will eclipse traditional cigarettes in the next decade, Leischow said.

Part of the problem in studying them is the sheer variety of different devices and how they work, said Dr. Maciej Goniewicz, assistant professor of oncology at Roswell Park Cancer Institute in Buffalo, N.Y.

“There is a huge variability and variation of the products,” from how they function to what kind of heat source to what goes in them, he said. “We need to be careful even using the same term for electronic cigarettes.”

Crazy Vapors has row after row of glass cases offering different devices, some made to look like cigars or pipes but most with no resemblance to traditional tobacco products. CDC Director Thomas Frieden said there are over 200 e-cigarette products out there and “there are definitely that many, if not more,” said Crazy Vapors owner Craig Perryman. Part of the problem with doing the research is the products being studied may change in a year or two and may be replaced by something else by the time a study is completed, Leischow said.

“The science is not right now keeping up with the product changes,” he said. “That is a fundamental challenge for the FDA.”

Because of that variability, it is difficult to generalize about the safety of the devices, Goniewicz said. One study found the device emitted metallic particles but that could be peculiar to that device, he said. Many of the devices use propylene glycol, which FDA considers safe for use in food or on the skin, Shields said.

“But we don’t know about what happens when you inhale it, especially when it gets heated,” he said.

Proponents of e-cigarettes have said they should not be subject to smoking bans because they only emit vapor, but that is not true, Goniewicz said.

“Unfortunately we found a few toxicants there that are of concern,” he said. “We are aware that these products can generate some toxicants, some carcinogens even. Though when we compared the levels we found in the vapor (to) what we know in the tobacco smoke, these levels are very, very low.”

And that is part of the appeal of e-cigarettes, Perryman said. The store can adjust nicotine levels, helping wean people off it if they so desire, “and it doesn’t change the taste much,” he said. The stores has 170 different flavors and unlike tobacco cigarettes they know exactly what is going in each device, Perryman said.

“We know what chemicals are in this,” he said.

While it can’t be marketed as a smoking cessation aide, Perryman said it has helped some people quit entirely and for others offers what he thinks is a safer alternative even as more research is being done.

“What they do know is it is much safer than cigarettes,” he said.

That is why Perryman said he hopes the proposed smoking ban does not include e-cigarettes.

“That’s my biggest fear is if Augusta bans smoking in public places with this, then they may just turn back to the cigarettes themselves, which we know is not healthier for them,” he said.

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