Benefits, health risks of electronic cigarettes are debated

Tyson Nuss inhaled his first e-cigarette about two years ago, hoping to kick a 20-year tobacco habit.
After he switched to the nicotine-delivery device, the 41-year-old Tucson resident tried smoking a conventional tobacco cigarette. He snuffed it out halfway through and says he hasn’t used tobacco since.
Now, he persuades other smokers to switch and recommends the brands and equipment to use. He is convinced that e-cigarettes reduce a user’s exposure to tobacco’s well-documented health risks, from lung cancer to cardiovascular disease.
Though researchers and pundits debate the safety and health impact of e-cigarettes, no one disagrees about the growing popularity — and visibility — of these battery-operated devices.
In Arizona, which does not regulate e-cigarettes, ex-smokers such as Nuss increasingly are puffing away in bars, public places and at work. Consumers are snapping up e-cigarettes at convenience stores, smoke shops and online retailers.
A Scottsdale-based e-cigarette company, NJOY, aired a commercial during the Super Bowl and the Oscars that showed a man “vaping” on an e-cigarette, even though smoking ads have been banned from television since 1971.
Global financial-services firm UBS projects e-cigarette sales will reach $1billion this year. About 5million units were sold nationwide last year, a tenfold increase since 2008, when the devices started getting attention, according to Ray Story, CEO of the Tobacco Vapor Electronic Cigarette Association.
The appeal of vaping is that it mimics smoking. Users inhale and exhale a cloud of vapor from a nicotine and chemical solution, without the odor of cigarette smoke. They can even choose flavoring such as menthol, mint, chocolate and strawberry.
Costs range from about $25 for disposable packs to nearly $200 for a more comprehensive kit.
Scientific debate
While users such as Nuss are convinced the products are safe, the scientific community isn’t sold on the idea.
“Over the short term, e-cigarettes are almost certainly less harmful than smoking cigarettes,” said Tom Glynn, director of the American Cancer Society’s International Cancer Control. “What are the long-term effects of inhaling pure nicotine into the lungs? That is something we don’t know.”
Food and Drug Administration-approved nicotine-replacement therapies such as prescription patches, Nicorette gum or inhalers typically recommend use for a limited period, usually three to six months.
In 2009, the FDA sought to regulate e-cigarettes as drug-delivery devices that could not be sold unless clinical trials showed the products were safe and effective. The federal agency also reported that samples from two e-cigarette brands had small amounts of toxic chemicals and carcinogens such as tobacco-specific nitrosamines.

The FDA warned about one ingredient, diethylene glycol, which it described as an ingredient in antifreeze. Pro-vapers point out that the main ingredient, propylene glycol, is an FDA-approved food additive and commonly used in fog machines. They say the amounts of this chemical found in e-cigarettes are so miniscule that they pose no harm. 

The FDA never disclosed the amounts of toxic chemicals and carcinogens found in the sampled e-cigarettes. Other researchers conducted studies that found trace levels similar to amounts in other FDA-approved nicotine-replacement therapies.
“The products from the larger manufacturers on the American market present no more risk than products like Nicorette. They are using the same nicotine,” said Dr. Joel Nitzkin, past chair of the American Association of Public Health Physicians. “The track record to date has been excellent.”
The FDA’s attempts to regulate e-cigarettes as drugs were halted following a federal court ruling in 2010 in a lawsuit brought by Scottsdale-based Sottera, the parent company of NJOY, after the government seized its products. A judge ruled that e-cigarettes are not drugs unless they are marketed for therapeutic purposes.
The FDA is now reviewing its regulation of tobacco products, which could include efforts to impose new restrictions and controls on the e-cigarette industry. A spokeswoman said the federal agency believes more research is needed to assess the “public health benefits and risks” of e-cigarettes.
Some supporters believe that public-health officials should advocate use of the devices because they have the potential to wean smokers off cigarettes. Dr. Michael Siegel, a professor at the Boston University School of Public Health, concluded in a 2011 study in the American Journal of Preventive Medicine that e-cigarettes “hold promise as a smoking-cessation method” worthy of more rigorous study.
While companies are not allowed to claim e-cigarettes help smokers quit, they are still aggressively marketing their products, including the television commercials. The president of the American Lung Association’s Southwest chapter called NJOY’s ad a “definite loser” and urged government regulators to act to prevent similar ones from airing.
Not all public-health officials discourage the devices.
Will Humble, director of the Arizona Department of Health Services, said e-cigarettes should be another option for smokers who want to quit.
“I’m a flat-out pragmatist,” Humble said. “If you are a smoker and you want to kick the habit, find a way. That might mean nicotine-replacement therapy, cold turkey or one of these things (e-cigarettes). I don’t have a problem with it.”
Personal choice
Glynn, of the American Cancer Society, said e-cigarettes may hold promise as a bridge to help people quit smoking tobacco, but if ex-smokers plan to use e-cigarettes for several years, they are venturing into unknown territory.
“If you are a consumer, it is caveat emptor,” he said.
Glynn added that other FDA-approved nicotine-replacement therapies have been vetted for safety and effectiveness and may be a safer bet for someone who wants to quit smoking.
“None of them are magic bullets to get people to stop,” Glynn said. “They are certainly helpful, and if used as directed, you are not going to get sick.”
Never a heavy smoker, Nuss said he vapes at public places and even at work, a technology-consulting company located in a small office shared by a handful of employees. When he pulls on an e-cigarette in public, he draws attention from curious onlookers but rarely hears objections.
“When I’m at bars and coffeehouses and such, it is courtesy to clear it with the manager or bartender,” Nuss said. “They are usually pretty encouraging. If they are seen as a vapor-friendly establishment,” it could draw more customers.