No smoke, but there could be fire: E-cigarettes might not be the answer

Donna Long listens as Scotty Wolkow, owner of Victorious Vapors on Bobby Jones Expressway, explains how to use her new VAMO V3 e-cigarette in this 2013 photo. Touted as a method to quit smoking tobacco, e-cigarettes carry with them several unanswered health questions.

 

It’s been 50 years since the Office of the U.S. Surgeon General officially linked smoking with an increased risk for cancer. In the years that followed, any number of measures have been introduced to entice, encourage and aid people in giving up lighting up.

A lot of effort has gone into establishing strong messages, rules and regulations surrounding smoking, which have gone a long way toward ensuring people never start smoking. Still, for those who do smoke, science provides an impressive array of products.

For years, companies have stacked the shelves with all manner of remedies aimed at curbing the urge to smoke. Be it patches, gum or lozenges, all were presented as answers to the quitting problem with varying degrees of success.

But none proved quite as popular as the electronic cigarette.

 

THE FIRST ELECTRONIC cigarettes were introduced in 2004, initially in China and then around the world. In 10 years, they have proved popular not only for people trying to quit smoking, but also as an alternative for those who claim they will never start. In 2014, it is estimated that the e-cigarette business will generate $1.5 billion in sales and from approximately 2.5 million e-cigarette users in the United States.

The question now is: Are they keeping people from smoking, or is this a case of taking one step forward and two steps back?

On April 24, the Food and Drug Administration released a plan to regulate the electronic cigarette industry. The reason: With more than 250 brands, all unregulated, there’s no way to measure the health effect of these devices.

If adopted, the FDA plan would require the industry not only to submit their products for approval; list ingredients on packaging; and cease making health claims without scientific evidence. It also would also ban sales to minors, a federal reinforcement of a law already adopted by most states; ban distribution of free samples; and require health warnings on packaging.

 

A RECENT STUDY by Nicotine and Tobacco Research, a health journal dedicated smoking-related issue, recently released findings that many e-cigarettes contain formaldehyde – a known carcinogen – in amounts comparable to standard smoke. The truth is, without regulation there’s no way of knowing what e-smokers are drawing into their bodies and what effect that might have.

What is difficult, if not impossible, for the FDA to address through regulation is the societal and psychological effects electronic cigarettes have on the public. Today, there is a stigma attached to smoking. It has taken nearly 50 years, but the idea of lighting up in an office, school or other public place is unimaginable. What was once accepted social behavior has become taboo.

 

BUT THAT’S NOT the case with electronic cigarettes. Because the vapors produced are regarded as harmless steam, e-smokers have little compulsion to confine their habit to more private environs. As a result, there is a growing acceptance of smoking – or vaping, as it is often called – as permissible behavior. So while pulling out a pack of Pall Malls after an evening meal or before a movie starts has long since been discarded as unacceptable behavior, the firing of the battery on the electronic equivalent has become more acceptable and commonplace.

A recent survey published by the Centers for Disease Control and Prevention found that in 2012, approximately 1.8 million middle- and high-school students had tried e-cigarettes.

 

THERE IS ANOTHER concern. The electronic cigarette has been designed with the same primary purpose as a cigarette: to introduce nicotine into the human bloodstream. What happens, however, to the vaper who determines that the controlled doses offered by an e-cigarette no longer are satisfying that craving? Chances are, many of them will look toward a more efficient delivery system – the traditional cigarette. The CDC survey found that 76.3 percent of students who had tried e-cigarettes in the past 30 days also had smoked conventional cigarettes.

The fact is that after 10 years of unregulated free-for-all marketing of these products, they have become popular and commonplace without the public, government regulators or even the health-care community really having a clear understanding of what the consequences of their use might be. Right now they are regarded as the straw that might break Camel’s back, but it is our responsibility to ensure that we are not trading one problem for another.

 

(The writer is director of the Georgia Regents University Cancer Center.)

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