A Harmless Cigarette?

by Danielle Taubman on March 19, 2013

“The tobacco epidemic is one of the biggest public health threats the world has ever faced.” –World Health Organization

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With the dangerous combination of tobacco and nicotine still universally available in the form of a cigarette, smoking threatens to remain one of the leading causes of preventable deaths for quite some time.

With that said, in 2003 a Chinese pharmacist invented a new type of cigarette that some say has already started (ever so slightly) to take on Big Tobacco.

A tobacco industry analyst was quoted saying, “E-cigarettes are to tobacco what energy drinks were or are to beverages.  It is a small category that is growing very fast, embraced by retailers and consumers.”

These smokeless cigs, known as the electronic cigarette or e-cigarette, were  marketed in China as an aid for smoking cessation and replacement (e-cigarettes are no longer marketed as smoking cessation tools in most countries).  They were introduced in the U.S. in 2007.

The role that e-cigarettes play in encouraging quitting —as well as their safety —has been the source of heated debates in public health circles nationwide.  These debates are likely to remain unsettled until more rigorous, peer-reviewed studies are available to present hard evidence one way or the other.

Until then, it’s still important to take a look at the information that’s already out there —as far as I can tell, the e-cigarette is here to stay.

I first came into contact with an electronic cigarette last summer when I was abroad. I saw someone using one, forgot my manners, and eagerly asked him what it was. He explained that it is a battery-operated device that turns a liquefied nicotine solution into a vapor that is delivered to the user’s lungs.  The user can select the amount of nicotine that is delivered, and some people even choose to use the device with no nicotine at all.

Oh, and another thing. These cigarettes are 100% tobacco-free. That’s a new one.

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The tobacco and pharmaceutical industries do not manufacture or distribute electronic cigarettes. Instead, small distributors sell them over the internet and in mall kiosks.  According to the Centers for Disease Control and Prevention (CDC), about 60% of American adults are aware of the devices, one in five adult cigarette smokers has used an electronic cigarette, and about 6% of all adults (that’s smokers and non-smokers) have tried e-cigarettes.

The head of the CDC’s office on smoking and health, Tim McAfee, noted that increasing awareness and utilization of e-cigarettes highlights the need for government regulation and evaluation.

A brief regulation history:

  • In 2009, the U.S. Food and Drug Administration (FDA) publicly discouraged the use of electronic cigarettes and tried to stop e-cigarette sales by classifying them as drug delivery devices.  These devices would be subject to regulation until their safety could be demonstrated in clinical trials.
  • In 2010, the drug delivery device classification was challenged in Federal District Court and overruled.
  • Also in 2010, the FDA took the case back to court, but the appeals court blocked the product from regulation as a medical device, arguing that e-cigarettes would only be subject to drug legislation if they are marketed for therapeutic use—targeted at those trying to quit. (This only speaks to the way in which companies market their e-cigarettes and nothing about whether people are choosing to use them as a smoking cessation aid or their potential effectiveness as a smoking cessation tool).
  • The FDA currently has been given the okay to regulate e-cigarettes as “tobacco products” and is expected to begin doing so later this year.  However, this distinction allows for less control over the product than the agency had hoped.

What the fans say:

Users report buying electronic cigarettes to help quit smoking, to reduce cigarette consumption, and to relieve withdrawal symptoms as a result of smoking restrictions at work or other places.  E-cigarettes are thought to address both the nicotine addiction and behavioral components of smoking.  They are also free of smoke, tar, ash, and odor (a nice bonus for the public, the user, and the user’s clothes!).  So, supporters claim that whether or not there are some risks associated with use of the electronic cigarette, they don’t carry the great harm of traditional cigarettes.

Among other studies that have looked at the effectiveness of the e-cigarette for smoking cessation, a study from the Boston University School of Public Health found that the use of e-cigarettes as a smoking cessation or smoking reduction tool appears promising.   Using an online survey of 222 first-time e-cigarette users, Michael Siegal and colleagues looked at the prevalence of smoking abstinence 6 months later.  They found that 31% of respondents were not smoking at the 6-month point and of those not smoking, 56.7% were using e-cigarettes, 9.0% were using tobacco-free nicotine products, and 34.3% were not using any kind of nicotine.

What the critics say:

E-cigarettes appear to have fewer toxins than traditional cigarettes, but people still worry about whether the nicotine vapor in e-cigarettes may be harmful or toxic.  The long-term health effects of e-cigarettes are still largely unknown, which makes many people uncomfortable with the idea of allowing their promotion, sale, and utilization.

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Critics also note that research is needed to assess how marketing could impact initiation and use of traditional cigarettes, especially among youth.  Particularly for e-cigarette brands like NJOY, which really try to emulate the entire experience of smoking, people worry that e-cigarettes could be a gateway to smoking.  Available research suggests that this could be the case, but more work still needs to be done in this arena.

Those hoping for tighter regulation on e-cigarettes claim that these devices should be illegal until proven safe.  These individuals and various agencies are not poo-pooing the idea of e-cigarettes.  Rather, they will not condone their use until they can be certain that the device’s public health impact is a positive one.

The FDA warns that, “As the safety and efficacy of e-cigarettes have not been fully studied, consumers of e-cigarette products currently have no way of knowing:

  • whether e-cigarettes are safe for their intended use,
  • how much nicotine or other potentially harmful chemicals are being inhaled during use, or
  • if there are any benefits associated with using these products.”

McAfee of the CDC adds to this, stating,

“If large numbers of adult smokers become users of both traditional cigarettes and e-cigarettes — rather than using e-cigarettes to quit cigarettes completely — the net public health effect could be quite negative.”

Both sides in the debate believe that e-cigarettes should be studied more, subjected to greater quality-control standards, and banned on sales to minors.  It seems that only time and more research will reveal the regulatory fate of the electronic cigarette.