E-cigarettes forging new pathway to addiction, death and disease

By Ross P. Lanzafame and Harold P. Wimmer – Redwood Times
Electronic cigarette use among middle school children has doubled in just one year. Last month, the Centers for Disease Control and Prevention (CDC) announced that e-cigarette use also doubled among high school students in one year, and that one in 10 high school students have used an e-cigarette.
Altogether, 1.78 million middle and high school students nationwide use e-cigarettes. Yet, the Food and Drug Administration (FDA) still is not regulating e-cigarettes. The absence of regulatory oversight means the tobacco industry is free to promote Atomic Fireball or cotton candy-flavored e-cigarettes to our children. Clearly, the aggressive marketing and promotion of e-cigarettes is reaching our children with alarming success.
It is well known that nicotine is a highly addictive substance, whether delivered in a conventional cigarette or an e-cigarette. The use of sweet flavors is an old tobacco industry trick to entice and addict young children to tobacco products, and the entrance of the nation’s largest tobacco companies into this market clearly is having an impact.
Why does Big Tobacco care about e-cigarettes? Tobacco use kills more than 400,000 people each year and thousands more successfully quit. To maintain its consumer ranks and enormous profits, the tobacco industry needs to attract and addict thousands of children each day, as well as keep adults dependent. Big Tobacco is happy to hook children with a gummy bear-flavored e-cigarette, a grape flavored cigar or a Marlboro, so long as they become addicted. We share the CDC’s concern that children who begin by using e-cigarettes may be condemned to a lifelong addiction to nicotine and cigarettes.
In addition, the American Lung Association is very concerned about the potential safety and health consequences of electronic cigarettes, as well as claims that they can be used to help smokers quit. With no government oversight of these products, there is no way for the public health and medical community or consumers to know what chemicals are contained in an e-cigarette or what the short and long term health implications might be. That’s why the American Lung Association is calling on the FDA to propose meaningful regulation of these products to protect to the public health.
The FDA has not approved e-cigarettes as a safe or effective method to help smokers quit. When smokers are ready to quit, they should call 1-800-QUIT NOW or talk with their doctors about using one of the seven FDA-approved medications proven to be safe and effective in helping smokers quit.
According to recent estimates, there are 250 different e-cigarette brands for sale in the U.S. today. With that many brands, there is likely to be wide variation in the chemicals that each contain. In initial lab tests conducted by the FDA in 2009, detectable levels of toxic cancer-causing chemicals were found, including an ingredient used in anti-freeze, in two leading brands of e-cigarettes and 18 various e-cigarette cartridges. That is why it is so urgent for FDA to begin its regulatory oversight of e-cigarettes, which must include ingredient disclosure by e-cigarette manufacturers to the FDA.
Also unknown is what the potential harm may be to people exposed to secondhand emissions from e-cigarettes. Two initial studies have found formaldehyde, benzene and tobacco-specific nitrosamines (a well-known carcinogen) coming from those secondhand emissions. While there is a great deal more to learn about these products, it is clear that there is much to be concerned about, especially in the absence of FDA oversight.
Ross P. Lanzafame is the American Lung Association National board chair and Harold P. Wimmer is the American Lung Association national president and CEO. For more information, contact Gregg.Tubbs@lung.org or 202-715-3469.

Cotton Candy and Atomic Fireball flavored electronic cigarettes are forging a new pathway to addiction, death and disease

By:  Ross P. Lanzafame, American Lung Association National Board Chair
Harold Wimmer, American Lung Association National President and CEO
E-cigarette use among middle school children has doubled in just one year.  Last month, the Centers for Disease Control and Prevention (CDC) announced that e-cigarette use also doubled among high school students in one year, and that 1 in 10 high school students have used an e-cigarette.  Altogether, 1.78 million middle and high school students nationwide use e-cigarettes.  Yet, the Food and Drug Administration (FDA) still is not regulating e-cigarettes.  The absence of regulatory oversight means the tobacco industry is free to promote Atomic Fireball or cotton candy-flavored e-cigarettes to our children.  Clearly, the aggressive marketing and promotion of e-cigarettes is reaching our children with alarming success.
It is well known that nicotine is a highly addictive substance, whether delivered in a conventional cigarette or an e-cigarette.  The use of sweet flavors is an old tobacco industry trick to entice and addict young children to tobacco products, and the entrance of the nation’s largest tobacco companies into this market clearly is having an impact.   Why does Big Tobacco care about e-cigarettes?  Tobacco use kills more than 400,000 people each year and thousands more successfully quit.  To maintain its consumer ranks and enormous profits, the tobacco industry needs to attract and addict thousands of children each day, as well as keep adults dependent.   Big Tobacco is happy to hook children with a gummy bear-flavored e-cigarette, a grape flavored cigar or a Marlboro, so long as they become addicted.  We share the CDC’s concern that children who begin by using e-cigarettes may be condemned to a lifelong addiction to nicotine and cigarettes.
In addition, the American Lung Association is very concerned about the potential safety and health consequences of electronic cigarettes, as well as claims that they can be used to help smokers quit.  With no government oversight of these products, there is no way for the public health and medical community or consumers to know what chemicals are contained in an e-cigarette or what the short and long term health implications might be.   That’s why the American Lung Association is calling on the FDA to propose meaningful regulation of these products to protect to the public health.
The FDA has not approved e-cigarettes as a safe or effective method to help smokers quit. When smokers are ready to quit, they should call 1-800-QUIT NOW or talk with their doctors about using one of the seven FDA-approved medications proven to be safe and effective in helping smokers quit.
According to recent estimates, there are 250 different e-cigarette brands for sale in the U.S. today. With that many brands, there is likely to be wide variation in the chemicals that each contain.  In initial lab tests conducted by the FDA in 2009, detectable levels of toxic cancer-causing chemicals were found — including an ingredient used in anti-freeze — in two leading brands of e-cigarettes and 18 various e-cigarette cartridges. That is why it is so urgent for FDA to begin its regulatory oversight of e-cigarettes, which must include ingredient disclosure by e-cigarette manufacturers to the FDA.
Also unknown is what the potential harm may be to people exposed to secondhand emissions from e-cigarettes. Two initial studies have found formaldehyde, benzene and tobacco-specific nitrosamines (a well-known carcinogen) coming from those secondhand emissions. While there is a great deal more to learn about these products, it is clear that there is much to be concerned about, especially in the absence of FDA oversight.
http://www.gilmermirror.com/view/full_story/23870545/article—Cotton-Candy-and-Atomic-Fireball-flavored-electronic-cigarettes-are-forging-a-new-pathway-to-addiction–death-and-disease?instance=home_news_bullets

Letter: E-cigarettes will burn users in the long run

DR. THECKEDATH MATHEW BRIGHTON, Senior interventional cardiologist, Rochester Heart Institute
E-cigarettes are real nicotine products, camouflaged in heat and vapor, carrying all the ill effects that nicotine could do on the cardiovascular system.
Nicotine is a vasoconstrictor agent that produces spasm on the blood vessels, including the coronary arteries and the vessels in the brain, leading to heart attack and stroke. Nicotine can lead to blood clots that eventually leads to heart attack and stroke.
Nicotine is an atherogenic agent. It promotes plaque formation in the blood vessels that contribute to plaque rupture in the heart and brain, again leading to heart attack and stroke. Nicotine has a deleterious effect on the arteries to the legs compromising the blood supply leading to amputation of the legs in many cases.
E-cigarettes are real nicotine products carrying all the adverse effects of nicotine and there is nothing to be glamorized about it.
http://www.democratandchronicle.com/story/opinion/letters/2013/10/12/letter-e-cigarettes-will-burn-users-in-the-long-run/2969185/

POV: Seven reasons the FDA should regulate e-cigarettes

By Kevin Keenan
In a recent online blog post by Campaign for Tobacco Free Kids, it was clearly explained why e-cigarettes should soon be regulated by the Food and Drug Administration (FDA). The CDC recently reported that rates of electronic cigarette use among U.S. youths more than doubled from 2011 to 2012, when 10 percent of high school students reported ever having used e-cigarettes.
These numbers are troubling but not surprising. There has been an explosion in e-cigarette marketing in recent years, and e-cigarette manufacturers are using the same slick tactics long used to market regular cigarettes to kids. The following are seven ways in which makers of the e-cigarette are using the same marketing strategies as the tobacco industry used back in the 1950s through the early ’70s:
1. They have celebrity spokespeople.
Like cigarette ads of old, television, online and print ads for e-cigarettes feature catchy slogans and celebrity endorsers, including actor Stephen Dorff and rock musician Courtney Love for NJOY. Their message: Using these products is trendy and cool.
2. Their magazine ads feature rugged men … and glamorous women.
These ads feature today’s equivalents of the Marlboro Man and the Virginia Slims woman, depicting e-cigarette use as masculine, sexy or rebellious. E-cigarette ads have appeared in magazines that reach millions of teens, including Rolling Stone, Sports Illustrated, InStyle and Us Weekly.
3. They know sex sells.
Like cigarette companies have long done, e-cigarette makers portray use of their products as sexually attractive. The allure for young people to start using is just as real; particularly in the Internet age we live in.
4. They sponsor sports … and music festivals.
For decades tobacco companies used sponsorships of sports and entertainment events, especially auto racing and music festivals, to promote cigarettes to huge audiences, including kids. Cigarette sponsorships are now banned, however today e-cigarette brands have auto racing sponsorships of their own. The Blu Cig company is one of them.
5. Their products come in sweet flavors.
A 2009 federal law banned fruit- and candy-flavored cigarettes, but many e-cigarette companies gleefully pitch similar flavors. Apollo Vapors, for example, offers Almond Joyee (“the candy bar taste without the calories!”), French Vanilla (“like biting into a deliciously sweet vanilla cupcake”) and Banana Cream (“yummy ambrosia of bananas and whipped cream”).
6. They use cartoons.
The website for blu eCigs has featured a cartoon pitchman named “Mr. Cool.” It was reminiscent of the Joe Camel cartoon character that so effectively marketed cigarettes to kids in the 1990s.
7. Their ads say, “Switch, Don’t Quit.”
Tobacco companies have long tried to discourage smokers from quitting by marketing cigarette changes as reducing health risk. Some e-cigarette ads carry a similar message. No wonder youth e-cigarette use is on the rise. These developments underscore the need for the FDA to quickly regulate e-cigarettes and take steps to prevent their marketing and sale to kids.
Kevin Keenan is project director for Smoke-Free NOW, a program of Genesee/Orleans Council on Alcoholism and Substance Abuse.
http://thedailynewsonline.com/opinion/article_84e8a47a-32f7-11e3-a8fc-001a4bcf887a.html

The risks are still unclear as the use of e-cigarettes grows

Article by: EDITORIAL BOARD , Star Tribune
The offerings at Fridley’s eCig & Supply Company store sound like something a kid might choose as a slushie or smoothie flavor on a hot summer day: Melon Mist; Blueberry Cream; Lemon Blast, and Papa Smurf’s Brother, a root beer and vanilla combo named for the iconic cartoon character.
Instead, these are among the more than 50 flavorings of “juice” — a liquid vaporized and inhaled through a pen-shaped device — that the store and others like it offer to those who want a nicotine hit without puffing on a traditional cigarette. Earlier this week, the number of customers streaming into the Fridley store attested to the rapidly growing popularity of e-cigarettes and “vaping.” (Since these devices produce a vapor, e-cigarette users say they “vape” instead of “smoke.”)
While e-cigarette sales are still a small fraction of the $80-billion-plus annual market for traditional tobacco cigarettes, sales of these essentially unregulated delivery devices for a highly addictive drug are skyrocketing, with 2012 sales of $300 million to $500 million expected to double in 2013, according to the Economist magazine. Neither regulators nor researchers assessing the potential health risks have kept up. That needs to change.
The U.S. Food and Drug Administration is still sitting on the sidelines when it comes to e-cigs. The agency has oversight of regular cigarettes and smokeless tobacco but not e-cigarettes unless they are sold along with a health claim. What that means is that minors in many states can buy e-cigs. Manufacturers may also advertise their often candy-flavored concoctions in ways that traditional cigarette companies are restricted from. An e-cigarette ban would go too far, given the uncertainties regarding their effects, but restrictions on e-cig sales and marketing to minors are common sense and overdue. Forty state attorneys general, including Minnesota’s Lori Swanson, recently sent a letter to the FDA demanding that the agency finally issue its expected but much-delayed regulations by the end of this month. An FDA spokesman this week declined to say if that deadline will be met.
States and cities also need to set parameters on e-cig use to protect public health while researchers determine the safety of their use — both for those who vape and those who may be exposed secondhand to the vapor.
While Minnesota does prohibit e-cig sales to those under 18, the state’s Clean Indoor Act does not restrict adult use. Legislators in 2014 need to ensure that the state’s smoke-free laws are up to date. Large tobacco companies, which are buying up e-cigarette makers, should not be able to exploit loopholes to get new Minnesotans hooked on nicotine and, potentially, their traditional tobacco products.
It’s unclear if e-cig users are more likely to eventually smoke cigarettes, but respected public-health experts, such as Minnesota Health Commissioner Dr. Ed Ehlinger, are concerned that e-cigs “normalize” smoking behaviors and may be a gateway to traditional tobacco use. This could potentially undo hard-won progress to cut smoking rates.
E-cig advocates, particularly those on social media, fairly point out that these products likely are safer than traditional smoking. It’s also clear from talking with customers at the Fridley store that e-cigs may have an important role to play in helping people quit tobacco. For Lisa Stegeman of Brooklyn Park, e-cigs are the only stop-­smoking product that has worked for her.
Still, data on e-cigs’ effectiveness is mixed, with a recent study in the Lancet showing no significant efficacy compared with a placebo. Data on the risks of long-term use is also inadequate. And with little oversight of the manufacturing of these products or the “juice,’’ who’s to say what’s in them? Not every proprietor is as conscientious as eCig & Supply Company’s Scott Huber, who uses only a reputable “juice” supplier based in Minnesota.
Medical research is also insufficient to determine the risk of secondhand exposure to the vapor. One study found that metal and silicate particles from e-cig aerosol were present in bystanders.
The Duluth City Council recently voted to prohibit e-cig use in public places, putting the city at the forefront of municipalities in Minnesota and elsewhere when it comes to e-cig safeguards. Duluth’s elected officials got it right. Medical researchers are only starting to determine e-cigs’ risks and potential benefits. Until these are known with more certainty, spaces free of cigarettes should be e-cig-free as well.
http://www.startribune.com/opinion/editorials/227144351.html

Forum editorial: Minn. tax on tobacco is a health tax

Opponents of Minnesota’s new tobacco tax seem to believe the $2.83 per pack of cigarettes tax is about only revenue and business. It’s not. It’s first and foremost about public health.
While the tax has had expected impacts on revenue and business since it went into effect July 1, its primary purpose is to discourage smoking. The tax is having the predicted results: Sales of cigarettes are down. Early evidence suggests the steep rise in the tax will generate a corresponding decline in smoking. That has been the experience of every other state that raised its cigarette tax substantially. Young smokers or potential smokers are especially sensitive to price.
Even as sales of cigarettes slipped as the tax took hold, revenue increased, as forecast. The tax is up 30 percent, after all. Some of that additional revenue will be used to fund the new Vikings stadium.
However, as fewer Minnesotans take up the habit and others quit or reduce cigarette purchases, revenue will decline. The ideal situation, of course, would be that tobacco use falls so far as to make revenue from the tax unimportant to the state’s overall financial picture.
Reacting to the decline in sales, one person at a retail store said: “It’s very bad.” No, it’s not. In the long term, fewer people smoking cigarettes is a good thing. It’s good for their health, their medical bills and the nation’s health care system.
Often characterized as “sin taxes,” taxes on cigarettes and other tobacco products are in effect health taxes. There is no sin in public policy that aims to improve and protect health. The real sin is peddling a product that sickens and kills people.

Forum editorials represent the opinion of Forum management and the newspaper’s Editorial Board.
http://www.inforum.com/event/article/id/414349/

Our view: State, feds can step up for e-cig safety

Duluth News Tribune Editorial
Three weeks ago today, Duluth made headlines across the state, becoming the first city in Minnesota to ban e-cigarettes indoors where tobacco use already is forbidden, among other restrictions and regulations.
Then, last week, Hermantown made news by passing a moratorium on the sale and use of electronic cigarettes inside public spaces. In addition, Mankato restricted e-cig sampling; North Mankato placed a moratorium on sampling; and Beltrami County, Bemidji and other communities all are considering their own restrictions, bans, regulations and other measures related to a suddenly booming e-cigarette industry, an industry dogged by serious and legitimate questions and concerns about health and safety.
“There are so many communities that have taken action or are percolating right now on this issue,” Pat McKone of Duluth, director of the American Lung Association of Minnesota, told the News Tribune Opinion page on Friday. “There’s so much unknown. We have to take a serious look. It’s not just a fad.”
With so many communities in Minnesota and around the country scrambling to catch up to ensure safety, especially the safety of a growing number of young people who are using unregulated e-cigarettes, the Minnesota Legislature and the federal government could step up and take a lead. Then, rules, regulations and restrictions would be uniform rather than the patchwork of policies taking shape now that change from border to border and community to community.
“Would it be better if the state regulated this? I do believe that’s the way, but we’re going to have a short legislative session, and I don’t think (lawmakers) are swift enough to do anything this (coming) year,” McKone said. “We do the heavy lifting at the local level and then the state takes it on. That’s a common pattern. And that appears to be what’ll eventually happen here. But every month (we) delay another group of young people is making decisions and poor choices.”
In most communities, kids can buy e-cigarettes easily and legally. And they are. The percentage of U.S. middle school and high school students taking their first drags on e-cigarettes more than doubled from 2011 to 2012, the Centers for Disease Control and Prevention announced this month. In 2012, more than 1.78 million middle school and high school students nationwide had tried
e-cigarettes, a precursor to tobacco cigarettes.
And no wonder. E-cigarettes, as addictive, dangerous and harmful to health as they may be, are actively being marketed to kids, just the way tobacco cigarettes used to be. Remember Joe Camel and the portrayal of smoking as cool and hip and what everyone who’s anyone was doing? This time — powered by nearly $21 million in advertising in 2012, according to the New York Times — it’s kid-friendly flavors such as watermelon and cookies-and-cream milkshake and the portrayal of e-cigarette use as cool and hip and what everyone who’s anyone is doing.
And just what are those kids inhaling? Because e-cigarettes aren’t regulated, no one can say for certain.
So shouldn’t the U.S. Food and Drug Administration step in, test e-cigarette products for safety and regulate what’s in them to ensure continued safety?
Attorneys general from around the country think so. Minnesota Attorney General Lori Swanson joined 40 of her colleagues in a letter last week to FDA Commissioner Margaret Hamburg, urging her “to take all available measures to meet the FDA’s stated deadline of October 31, 2013, to issue proposed regulations that will address the advertising, ingredients and sale to minors of electronic cigarettes.”
The American Heart Association, American Academy of Pediatrics and 13 other agencies think so, too. They sent a letter Sept. 19 to the president, urging him to ensure that the FDA “moves forward promptly with a rule that would assert the agency’s authority over all tobacco products, including
e-cigarettes, little cigars, cigars and other tobacco products not currently under its jurisdiction. More than two years ago, FDA announced its intent to take this action, yet no progress has been made. This delay is having very real public health consequences.”
Delay no more, FDA.
Or state Legislature.
Local communities are scrambling and doing their best to do what’s right. They and the health and safety of our nation need authority and leadership that can only come from St. Paul and other state capitols and from Washington, D.C.
http://www.duluthnewstribune.com/event/article/id/279202/group/Opinion/

Duluth News Tribune view: Obvious danger requires fair and responsible rules

The packaging on electronic cigarettes, or e-cigarettes, doesn’t say much. Which actually is kind of scary. Just what’s being inhaled into the body when “vaping?” Certainly not just vapors, as suggested by the slang verb for puffing on the products. And what’s being exhaled for everyone around to breathe in and ingest?
One thing the packaging does say: e-cigarettes contain nicotine. How much? Doesn’t say, and, according to experts, it can vary from manufacturer to manufacturer and from brand to brand. But does it even matter? It’s not like there’s such a thing as a safe amount of the highly addictive, cancer-causing drug nicotine.
Even scarier? E-cigarettes, as addictive, dangerous and harmful to health as they may be, are actively being marketed to kids, just the way tobacco cigarettes used to be. Remember Joe Camel and the portrayal of smoking as cool and hip and what everyone who’s anyone was doing? This time — powered by nearly $21 million in advertising in 2012, according to the New York Times — it’s kid-friendly flavors like watermelon and cookies-and-cream milkshake and the portrayal of vaping as cool and hip and what everyone who’s anyone is doing.
Unlike tobacco, however — and this may be most troubling of all — kids can buy e-cigarettes easily and legally, including online. And they are. The percentage of U.S. middle school and high school students taking drags on e-cigarettes more than doubled from 2011 to 2012, the Centers for Disease Control and Prevention announced last week. In 2012, more than 1.78 million middle school and high school students nationwide had tried e-cigarettes, a precursor to tobacco cigarettes.
So something clearly has to be done, right, before a whole new generation embraces a filthy, unhealthy habit and sees it as just a normal part of our culture? On Monday, the Duluth City Council has an opportunity to take some sensible action.
The first of three ordinances the council owes it to the community to approve would require a license to sell e-cigarettes the same way sellers of tobacco have to be licensed. In fact, an existing tobacco license would cover e-cigarettes under the measure. A second ordinance would prohibit the use of e-cigarettes in places already designated by law as no-smoking, like inside public buildings, along the Lakewalk, at bus stops and elsewhere. And a third ordinance would close a loophole in clean indoor air laws meant to allow the sampling of tobacco in tobacco shops prior to purchase. Some are exploiting that provision to sell group-smoking experiences in lounge settings.
“The big misconception for a couple of weeks was that Duluth wants to ban e-cigarettes. That’s not it at all,” Jill Doberstein, program manager for tobacco prevention and control for the American Lung Association in Duluth, said in an interview last week with the News Tribune editorial board.
No, the idea is responsible regulation of their use, not the banning of e-cigarettes altogether.
Some users of e-cigarettes swear by their effectiveness in quitting tobacco even though the government has yet to certify them as safe and effective smoking-cessation devices the way it has nicotine patches and other products.
The safety and effectiveness for smoking cessation of e-cigarettes is still being studied and determined, and while the jury is out, adults certainly should be allowed to ignore the health risks and dangers and use e-cigarettes. They can be allowed to forget that the only safe air to breathe is clean air. It is a free country.
But allowing e-cigarettes to pollute the air of others, to be pushed on unsuspecting kids, or to be used without any rules, regulations or controls whatsoever is, well, it’s just downright scary.
http://www.duluthnewstribune.com/event/article/id/277303/

Health Matters: N.D. resources for tobacco cessation

By: Dr. Joshua Wynne, Grand Forks Herald
Q. I know that I need to quit smoking cigarettes, but it sure is hard! My doctor tells me that I need to quit cold turkey, but when I’ve done that, I soon restart puffing away. I think I can stop by gradually reducing my smoking. What do you think?
A. Although many might favor abruptly discontinuing cigarettes as the preferred strategy (similar to what often is recommended for abusers of alcohol), the available evidence actually suggests that the gradual route may not be significantly inferior to abrupt cessation. Some patients I’ve worked with have stopped smoking completely by setting targets — and then meeting them. So, for example, a patient might be smoking half a pack per day (10 cigarettes) and cut down by one cigarette/day every week.
Thus, in less than three months, the patient can be free of tobacco use. The key to the gradual option is to hold to the preselected targets — otherwise the patient will end up right back where she started. One very helpful resource in North Dakota is NDQuits, a free telephone-based service available to smokers and smokeless tobacco users. People using NDQuits have about a 10-fold higher chance of staying off of cigarettes after one year than those choosing to go cold turkey on their own. Give them a call at (800) QUITNOW or (800) 784-8669. And please call them soon!
http://www.grandforksherald.com/event/article/id/271022/group/homepage/

Vaping May Be Hazardous to Your Health

By the Editors
“Mind if I vape?”
The question may become more common as electronic cigarettes become more popular. The answer, however, remains elusive. Etiquette aside, the health effects of inhaling nicotine vapor (hence the term) are largely unknown. More research is clearly needed, but in the meantime, the U.S. Food and Drug Administration has to start regulating e-cigarettes.
U.S. consumers will spend $1 billion on battery-powered smokes this year, 10 times more than they did four years ago. Are e-cigarettes, which come in such flavors as chocolate and butter rum, a benign device to help people stop smoking? Or are they just a new way to feed an old addiction? How safe, compared with tobacco smoke, is the vapor they create?
No one knows. The small studies that have been done so far hint at both pros and cons; one found that smokers cut back on real cigarettes after trying the electronic kind, while anotherfound particles of metal and silicates in e-cigarette vapor that could cause breathing problems. That there are more than 200 brands containing varying levels of nicotine and other substances only makes it harder to assess their safety.
The FDA has indicated it will begin to regulate e-cigarettes this fall. After a federal judge ruled that it couldn’t classify them as medical devices (because they deliver a drug, nicotine), the FDA will regulate them as tobacco products (because nicotine is derived from tobacco). Unlike regular cigarettes, however, e-cigarettes are not known to be lethal. Wariness is warranted, but it’s safe to assume that their vapors are not nearly as dangerous as tobacco smoke.
The FDA’s approach, therefore — and that of states and cities that regulate tobacco use — should be two-pronged: It should find out whether e-cigarettes are indeed safe. And while it does, it should ensure that “vaping” remains restricted to adults who are fully informed of the potential risks.
To begin, e-cigarette makers should be required to report and label all ingredients in the nicotine solutions they use. Even though these deliver fewer poisons than are found in traditional cigarettes, they nevertheless have been found to contain carcinogenic nitrosamines and other harmful impurities derived from the tobacco, as well as the additive diethylene glycol, an ingredient in antifreeze.
Manufacturers should also disclose the amount of nicotine that can be inhaled from their e-cigarettes. Today’s models haven’t been found to give users as large a hit of nicotine as regular cigarettes do, but that may not always be the case. (Some bottles of solution meant to refill e-cigarette cartridges have been found to contain enough nicotine to kill an adult if ingested.) Once more is known about the potential hazards of e-cigarette vapors, the FDA may need to restrict certain substances or place limits on nicotine levels.
Then there is the issue of flavoring — something the FDA forbids in standard cigarettes. All electronic cigarettes are flavored, so to ban flavoring would be to ban the product entirely. But it’s possible to allow tobacco- or even mint-flavored e-cigarettes and still ban or restrict flavors designed to appeal to children, hard as they may be to define.
While they’re at it, the FDA should also ban sales to those younger than 18 and restrict e-cigarette marketing and advertisements in much the same way it limits them for cigarettes. As for health warnings, the agency will need to wait for more data before deciding what exactly they should say.
States and cities, meanwhile, should include e-cigarettes in their restrictions on smoking in public places and office buildings, and apply the same rules on the retail sale of e-cigarettes as they do to tobacco products. Even in towns where there are few restrictions, bars and restaurants would be wise to prohibit “vaping” until they know whether it pollutes the air.
On the question of taxes, states and cities may want to act gradually. If e-cigarettes are found to be valuable smoking-cessation tools, then they may warrant a tax rate that’s lower than what’s imposed on real cigarettes.
It would be great if e-cigarettes turned out to be the breakthrough that gets people to give up smoking tobacco. In the meantime, we should all be careful that e-cigarettes not perpetuate a habit that society has come a long way toward snuffing out. Sensible regulation can help protect that progress.
To contact the Bloomberg View editorial board: view@bloomberg.net.
http://www.bloomberg.com/news/2013-08-18/vaping-may-be-hazardous-to-your-health.html