I think it was around Christmastime last year, while frantically traipsing through the mall in search of bargains, that an over-eager kiosk salesperson stepped into my path.  Wonderful, I thought.  Another person trying to sell me overpriced hand cream. I tried to go around her, hoping she’d get the hint—to no avail.  Oddly, instead of launching into a speech about my unhealthy cuticles, she asked me if I was a smoker.

And that’s when I noticed she was selling e-cigarettes:  plastic cigarettes that look almost exactly like the real deal. (They even puff out odorless vapor that looks strikingly like cigarette smoke.)  She explained to me that these can be a great tool for quitting smoking, because they look and feel like cigarettes.  “It’s just like smoking, but without the nasty health effects.”

What a cool idea, I thought.  My father, a former (heavy) smoker, told me once that quitting smoking was a total nightmare for him.  Why? Because he didn’t just crave the nicotine in the cigarettes; he craved the whole smoking ritual: taking that first puff of the day while sipping his coffee, taking breaks at work and chatting with his friends, etc, etc.  Quitting smoking wasn’t just about omitting nicotine from his life; it was about changing his lifestyle.

From that perspective, e-cigarettes seem like a good way to ease the transition from smoker to non-smoker. They look like cigarettes, taste like cigarettes, and feel like cigarettes but the “smoker” is no longer exposed to  40+ human carcinogens multiple times a day.  On top of that, e-cigarettes don’t produce that thick, noxious cloud of smoke that clings to your hair, skin, and clothing, and makes everyone around you cough.   “I feel like this could save my life,” said one satisfied customer, who reported cutting her smoking from 3 packs a day to 1 ½ packs a day.(1)

But Katie Zezima of the New York Times astutely points out the dark side of these products—namely, that we don’t really know anything about how safe they are. In addition to delivering nicotine, which is obviously an addictive drug, e-cigarettes use propylene glycol to create the artificial smoke. Propylene glycol, also used in anti-freeze, is “generally recognized as safe” (GRAS) to consume, but is it safe to inhale? Says Dr. Richard D. Hurt, director of the Nicotine Dependence Center at the Mayo Clinic: “I don’t think so, but I’m not sure anyone knows for sure.”

Critics are also asking if these products could be a “gateway” through which children and teens become addicted to nicotine-containing products.  E-cigarettes can be smoked without the nicotine, but there are no restrictions on purchasing them either way. Marketed as a safer way to “enjoy smoking” that provides users with the “freedom to smoke most everywhere,” e-cigarettes are easy to get online or in shopping malls. They also come in a variety of flavors.   “There’s nothing that prevents youth from getting addicted to nicotine,” says Jonathan Winickoff, chairman of the American Academy of Pediatrics Tobacco Consortium.

But then, of course: there’s the obvious question: 

Could they really be worse than smoking regular cigarettes?

It’s a good question. Smoking remains THE number one cause of preventable death in the United States, with 400,000 people dying each year from smoking-related causes. There are more than 4,000 chemicals in tobacco and tobacco smoke, 60 of which are known human carcinogens…. and the statistics go on and on…(2)

Still, there’s reason to be concerned. E-cigarettes are well-advertised, easy to purchase nicotine-delivery (AKA drug delivery) systems that no one is regulating.  And because Congress is close to giving the FDA power to regulate tobacco, their producers are getting nervous. Already, their lawyers are coming out of the woodwork, ready to pounce.  The Electronic Cigarette Association, an industry trade group, already has on its website a petition to the FDA wherein customers can “stand up for [their] rights.”  The petition requests that “the FDA allow us to continue to use and purchase these nicotine delivery devices at our own discretion while further testing commences from the FDA.” It continues: “If you ban these devices millions will return to tobacco products which would be a guaranteed death sentence for many.”

Meanwhile, e-cigarette distributor Smoking Everywhere is pulling out the bigger guns and getting ready to challenge the authority FDA doesn’t yet have. “The FDA has the power to regulate Nicorette gum and the like because it is marketed as a smoking cessation product,” one of their lawyers told the New York Times.  In contrast, e-cigarettes are “just a tar-free way to enjoy smoking.”(3)

And I thought they could be used to quit smoking. How naive of me!

All I can say right now is that we should keep our eyes open on this one. The more I read about this issue, the more intrigued I am.  Even if e-cigarettes are a much healthier alternative to regular cigarettes, the way they are being marketed sets off my alarm bells.  Like regular cigarettes, e-cigarettes deliver nicotine– a highly addictive drug.  And manufacturers have a clear incentive to market their product as a cigarette “supplement” or cigarette “replacement” rather than as a tool for reducing nicotine dependence. Something tells me that the proponents for the “future of smoking” (4) aren’t as health-conscious as they claim they are.

Notes

(1) This quote from Katie Zezima’s NY Times article: “Cigarettes without Smoke, or Regulation.” June 1, 2009.

(2) See:  CDC. Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses—United States, 2000-2004. JAMA. 2009;301(6):593-594 OR MMWR. 2008;57:1226-1228.  See also “Fast Facts:  Morbidity and Mortality Related to Tobacco Use.” Accessed June 1, 2009.

(3) Lawyer quote from Katie Zezima’s article, Ibid. “..tar-free way to enjoy smoking” quote from “What is an electronic cigarette?” FAQ page from Smoking Everywhere. Accessed June 4, 2009.

(4) Ibid.

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