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Editorial: Kids and e-cigs

Gainsville Sun Editorial:
As anti-smoking campaigns reduce tobacco use among young people, public health advocates see a new threat in electronic cigarettes.

E-cigarettes convert liquid nicotine into a vapor that users inhale. They come in flavors such as various types of fruits and candies, potentially attracting children to use them.
The 2013 Florida Youth Tobacco Survey found that 12 percent of high school students had tried e-cigarettes, an increase of 102 percent since 2011.
Alachua County Commissioner Robert Hutchinson asked staff to draft an ordinance to ban the sale of e-cigarettes to minors, require them to be placed behind counters in stores and prohibit their use in non-smoking areas. Clay County has enacted and Marion County is considering similar measures.
The U.S. Food and Drug Administration is also considering the regulation of e-cigarettes. A federal rule would be more effective than a patchwork of local ordinances.
In the meantime, Alachua County and other municipalities are right to work to keep e-cigarettes out of the hands of minors. Yet the county should resist the urge to regulate the personal behavior of adults that doesn’t affect others.
Some research suggests that e-cigarettes help a small percentage of tobacco users quit. But the health effects of inhaling nicotine vapor are unclear, and the track record of the tobacco companies that sell some e-cigarette brands gives reason to be skeptical of claims that it is a safe alternative to smoking.
It’s reasonable to regulate an addictive product that poses potential health risks. Hopefully the FDA soon does it job and prevents the need for Alachua County to act.
http://www.gainesville.com/article/20131102/OPINION01/131039866/-1/entertainment?Title=Editorial-Kids-and-e-cigs&tc=ar

Regulators unsure how to treat electronic cigarettes

By Nathan Porter – The Washington Times
The questions concerning the safety of electronic cigarette use are neatly matched by the questions concerning how — and even whether — governments should regulate the product.
Having long strictly limited marketing and use of traditional tobacco products, the Food and Drug Administration is expected in the coming days to propose its first rules and restrictions on electronic cigarettes.
About half of the states, including Colorado, Maryland, Minnesota and New Hampshire, haven’t waited for federal action and have banned the sale of e-cigarettes to minors. A group of 41 state attorneys general wrote to the FDA urging the federal government to “take all available measures” to regulate the product.
The U.S. Department of Transportation has said that federal regulations that prohibit smoking on airplanes will be extended to e-cigarettes.
But the industry is arguing that e-cigarettes are fundamentally different from traditional cigarettes and shouldn’t face the same one-size-fits-all restrictions. Some companies go further, saying e-cigarettes can lower smoking rates for more dangerous tobacco products and should, in certain circumstances, be encouraged.

Critics say that when it comes to regulation — and, just as important, taxation — the booming e-cigarette industry is trying to have it both ways as the government considers its regulatory approach.
“When it’s convenient to be like tobacco, they’re like tobacco,” Stanton A. Glantz, director of the University of California-San Francisco’s Center for Tobacco Control Research and Education, recently told The New York Times. “And when it’s not convenient, they’re not.”
The regulatory mishmash is not limited to the United States.
In Germany, Norway, Ireland, Poland and Portugal, the sale and use of electronic cigarettes is completely legal. In a closely watched vote last month, the European Parliament decided to regulate e-cigarette marketing the same as regular tobacco products, forbidding sales to minors and most advertisements in the economic bloc.
But EU legislators rejected a proposal to regulate e-cigarettes with the same stringency as medical devices, which would have put a major crimp in a product that is gaining increasing popularity in markets such as France. If the measure passed, e-cigarettes could have been sold only in pharmacies.
Charles Hamshaw-Thomas, spokesman for E-Lites, Britain’s biggest e-cigarette seller, called the Parliament’s vote a “fantastic result for public health and the millions of smokers around Europe who are switching to e-cigarettes.”
“Common sense,” he added, “has prevailed.”
In Britain, e-cigarettes are not subject to the same use, sale and advertising regulations as traditional tobacco products. Three e-cigarette commercials, however, were aired by E-Lites, and its rivals were banned last month.
The Canadian government has stated that officials do not endorse e-cigarettes but that the sale and use of the product are legal. South Korea also has deemed e-cigarettes legal, but the government has imposed heavy taxes on e-cigarettes to discourage use, particularly among teenagers.
Switzerland has adopted a split approach: While nicotine-free e-cigarettes are legal nationwide, e-cigarettes containing nicotine cannot be sold within the country. They can, however, be imported.
Dubai, Lebanon, Mexico, Panama and Singapore are among the many countries that have adopted outright bans on the e-cigarette use.
http://www.washingtontimes.com/news/2013/oct/31/regulators-unsure-how-to-treat-electronic-cigarett/?page=2&utm_medium=RSS&utm_source=RSS_Feed

Electronic cigarette peddlers are just blowing smoke, health officials say

By Nathan Porter – The Washington Times
That cloud hanging over electronic cigarettes these days isn’t just from the nicotine-laced vapor that the newfangled butts emit.
As big tobacco companies rush to cash in on e-cigarettes and governments scramble to regulate their use, the nation’s top researchers say basic questions about the safety and long-term effects of e-cigarettes have yet to be answered. They also caution that regulators may be about to go too far without knowing what they are dealing with.
At a gathering of the nation’s leading cancer specialists outside Washington this week, a panel on e-cigarette smoking, or “vaping” as it is often called, cast a skeptical eye on the intense regulatory interest in the e-cigarette phenomenon.
“One of the problems and challenges with the regulation will be how to not overregulate the product,” said Maciej Goniewicz, assistant professor of oncology at the Roswell Park Cancer Institute in Buffalo, N.Y. “We want the regulation to provide safer, better products, and this is a huge challenge.”
E-cigarettes are battery-powered electronic inhalers designed to resemble and function much like traditional tobacco cigarettes. Many electronic cigarettes release nicotine like tobacco cigarettes, but some release just flavored vapor. Because they do not use tobacco, e-cigarettes are viewed by many as less harmful than traditional cigarettes and a way for smokers to transition to a less-dangerous alternative.

Still, no conclusive long-term research has been conducted on the effects of vaping, and critics and many health officials warn that e-cigarettes can be a “gateway drug” to the real thing, especially among younger users.

The Food and Drug Administration has been forced to address the issue in large part because of the market excitement generated by e-cigarette sales.
Although still a fraction of the $90 billion U.S. tobacco market, annual e-cigarette sales have gone from $20 million five years ago to as much as $1.7 billion this year, according to analysts. North Carolina-based Lorillard said its market-leading Blu e-cigarette brand recorded $63 million in sales in the most recent quarter, a fivefold increase aided in part by a national television ad campaign featuring model and actress Jenny McCarthy.
The increasingly large sums involved also have sparked a lobbying battle. The Smoke Free Alternatives Trade Association — the “voice of the electronic cigarette industry” — plans a Capitol Hill “fly-in” next week to talk to lawmakers and staffers about the potential negative effects of state and federal regulatory initiatives.
“While our industry understands reasonable and appropriate regulation is needed, it is vital our young industry not be grouped with combustible cigarettes” as federal guidelines are drafted, said Cynthia Cabrera, executive director of the trade association. “Excessive regulation could limit adult access to e-cigs and stifle growth and innovation in the segment.”
Many industry watchers say e-cigarettes’ popularity may override concerns over their health effects.
“The challenge here is that big tobacco companies now have their own brands of electronic cigarettes. What drives this? Of course, the market,” Mr. Goniewicz said.
Some CEOs of e-cigarette companies have said that their goal is to make tobacco cigarettes obsolete. Government regulation, they fear, could undercut the market before it can truly take off.
Because of the lack of research, there is no way of knowing whether e-cigarettes help smokers quit or whether they merely cause smokers to switch, and only temporarily, to a less-harmful habit.
“The whole point here is that people who are addicted to tobacco are switching. This notion of switching from one thing to another is cognitively very different than quitting,” said Scott Leischow, a senior associate consultant at the Mayo Clinic’s Cancer Prevention and Control Program.
http://www.washingtontimes.com/news/2013/oct/31/electronic-cigarette-peddlers-are-just-blowing-smo/

City Council to Vote on Raising Cigarette Purchase Age

In the latest move to snuff out smoking in New York, the City Council could vote Wednesday to bar anyone under the age of 21 from buying cigarettes and e-cigarettes.

Under federal law, no one under 18 can buy tobacco anywhere in the country, but some states and localities have raised it to 19.

Public health advocates say a higher minimum age discourages, or at least delays, young people from starting smoking and thereby limits their health risks. But opponents of such measures have said 18-year-olds, legally considered adults, should be able to make their own decisions about whether or not to smoke.

Some communities, including Needham, Mass., have raised the minimum age to 21, but New York would be the biggest city to do so.

Officials say 80 percent of NYC smokers started before age 21, and an estimated 20,000 New York City public high school students now smoke. While it’s already illegal for many of them to buy cigarettes, officials say this measure would play a key role by making it illegal for them to turn to slightly older friends to buy smokes for them. The vast majority of people who get asked to do that favor are between 18 and 21 themselves, city officials say.

Under Mayor Bloomberg and the health commissioners he has appointed, including Farley, New York has rolled out a slate of anti-smoking initiatives.

Bloomberg, a billionaire who has given $600 million of his own money to anti-smoking efforts around the world, began taking on tobacco use in the city shortly after he became mayor in 2002.

Over his years in office, the city — at times with the council’s involvement — helped impose the highest cigarette taxes in the country, barred smoking at parks and on beaches and conducted sometimes graphic advertising campaigns about the hazards of smoking.

Earlier this year, the Bloomberg administration unveiled a proposal to keep cigarettes out of sight in stores until an adult customer asks for a pack, as well as stopping shops from taking cigarette coupons and honoring discounts, but the proposal was dropped earlier this week, according to the New York Times.

Bloomberg’s administration and public health advocates praise the initiatives as bold moves to help people live better. Adult smoking rates in the city have fallen from 21.5 percent in 2002 to 14.8 percent in 2011, Farley has said.

http://www.nbcnewyork.com/news/local/Cigarettes-Vote-New-York-Wednesday-229822281.html

Conceal and carry: kids with e-cigarettes

By KEPR-TV, Pasco, WA
KEPR went to Kennewick High School to talk candidly with your kids; they say electronic cigarettes and pocket vaporizers are in their peers’ pockets and right under parents’ noses.
What you need to know about this growing trend.
“Is it here in the Tri-Cities,” KEPR asked a high school student, “yeah, definitely,” he replied.
We’re not just talking tobacco, we’re talking pot smoked through e-cigarettes. Within a minute of school getting out, KEPR found out not just if kids were using it, but where to go. “Go over there to the park,” another student told us.
A park, car, even your house to smoke and you probably won’t know. “The house won’t stink, clothes won’t stink, car won’t stink,” said Randy Schiewe, the owner of 9’s Electronic Cigarette shop in Kennewick. The same reason many adults are switching from a cigarette to an electronic smoker, but for kids consider it conceal and carry.
“It probably looks like a pen to them,” said Schiewe about parents who don’t know. He says it’s not the intent for electronic smokers to look like something they’re not. They were never intended for kids, and you have to be 18 to buy them. But just like kids can get their hands on alcohol, Schiewe says kids can get their hands on these and that’s why he wants to make sure you know what to look for.
The pens are elongated and most have a tapered end. “This would be the easiest way you would see liquid marijuana being used,” he said. People put liquid THC, the active ingredient of pot, or hash oil in the vaporizer instead of tobacco. As a parent, he says you might not find the vaporizer laying around, but you might find the charger and dismiss it. It looks like a cell phone charger, USB port on one end, a small box with a female screw port on the other. “You might find it plugged into a wall, computer or car,” he said.
Pull up You-Tube and in less than two minutes, a kid has a way to smoke pot without a trace.
“If there’s a way to do something bad with it, they will find a way,” said Schiewe. The one benefit says Schiewe, right now liquid THC isn’t as easy to get. “I am in the business and I don’t know how to get it,” he said. It’s a matter of being informed of the new trends hitting your kids to keep them safe. Schiewe hopes it’s a conversation you’ll now be ready to have.
Reporter’s notes:  However you feel on the electronic cigarette issue, I did find when talking to kids one overwhelming trend.  All the kids who knew teens who smoked e-cigs, called it a safe alternative.
http://www.keprtv.com/Conceal-and-carry-kids-with-e-cigarettes-229818931.html

The E-Cigarette Industry, Waiting to Exhale

By , New York Times
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Geoff Vuleta was in the crowd at a Rolling Stones concert last year when Keith Richards lit up a cigarette on stage, the arena’s no-smoking policy be damned. Feeling inspired, Mr. Vuleta, a longtime smoker, reached into his pocket and pulled one out himself. People seated nearby shot him scolding glances as he inhaled. So he withdrew the cigarette from his mouth and pressed the glowing end to his cheek.

His was an electronic cigarette, a look-alike that delivers nicotine without combusting tobacco and produces a vapor, not smoke. Mr. Vuleta, 51, who has a sardonic humor, clearly relished recounting this story. He is the chief marketing officer for NJOY, an electronic cigarette company based in Scottsdale, Ariz., and it is his job to reframe how everyone, nonsmokers included, view the habit of inhaling from a thin stick and blowing out a visible cloud.

Mr. Vuleta, who told his tale in the office of Craig Weiss, the NJOY chief executive, calls this a process of “renormalizing,” so that smokers can come back in from the cold. He means that literally — allowing people now exiled to the sidewalks back into buildings with e-cigarettes. But he also means it metaphorically. Early in the last century, smoking was an accepted alternative for men to chewing tobacco; for women, it was daring and transgressive. Then, in midcentury, it became the norm. As the dangers of tobacco — and the scandalous behavior of tobacco companies in concealing those dangers — became impossible to ignore, smoking took on a new identity: societal evil.

Mr. Vuleta and Mr. Weiss want to make “vaping,” as e-cigarette smoking is known in the industry, acceptable. Keith Richards might still be smoking tobacco, but in Mr. Vuleta’s vision, that grizzled guitarist’s gesture could inspire the audience, en masse, to pull out e-cigarettes. “The moment Keith Richards does it,” he said, “everyone else does, too.”

Mr. Vuleta’s words are more exuberant than the official company line, which is that NJOY doesn’t want everyone to smoke e-cigarettes but only to convert the 40 million Americans who now smoke tobacco. The customers NJOY attracts, and how it attracts them, are at the center of a new public health debate, not to mention a rush to control the e-cigarette business.

At stake is a vaping market that has grown in a few short years to around $1.7 billion in sales in the United States. That is tiny when compared to the nation’s $90 billion cigarette market. But one particularly bullish Wall Street analyst projects that consumption of e-cigarettes will outstrip regular ones in the next decade.

NJOY was one of the first companies to sell e-cigarettes; now there are 200 in the United States, most of them small. Just last year, however, Big Tobacco got into the game when Lorillard acquired Blu, an e-cigarette brand, and demonstrated its economic power. Within months, relying on Lorillard’s decades-old distribution channels, Blu displaced NJOY as the market leader.

Mr. Weiss still sees NJOY as having an advantage — in building e-cigarettes that look, feel and perform like the real thing. It’s a different strategy than that of competing products that look like long silver tubes or sleek, blinking fountain pens.

“We’re trying to do something very challenging: change a habit that is not only entrenched but one people are willing to take to their grave,” said Mr. Weiss, who is not a smoker but has tried both regular and e-cigarettes. “To accomplish that, we have to narrow as much as possible the bridge to familiarity. We have to make it easy for smokers to cross it.”

To some, though not all, in public health, that vision sounds ill-conceived, if not threatening. Among their concerns is that making smoking-like behavior O.K. again will undo decades of work demonizing smoking itself. Far from leading to more smoking cessation, they argue, e-cigarettes will ultimately revive it, and abet new cases ofemphysema, heart disease and lung cancer.

“The very thing that could make them effective is also their greatest danger,” said Dr. Tim McAfee, director of Office on Smoking and Health at the Centers for Disease Control and Prevention.

To achieve his ends, Mr. Weiss is building a company of strange bedfellows. He has hired former top tobacco industry executives, but also attracted a former surgeon general, Dr. Richard H. Carmona, who has joined the board. NJOY recently hired away a prominent professor of chemistry and genomics from Princeton to be the company’s chief scientist. The company has attracted investment from Sean Parker, the former Facebook president, and Peter Thiel, the PayPal co-founder. There has also been a celebrity endorsement from the singer Bruno Mars.

Mr. Weiss sees his company as doing something epic. Not long after he was named its president in June 2010, he asked his psychologist if he might record his regular sessions. It was an unusual request, but he thinks that recording his thoughts might ultimately help him write a book or movie script about how he and the company made the cigarette obsolete.

“We’re at this incredible inflection point in history,” he said, adding that the company has a chance to “make the single most beneficial impact on society in this century.”

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Over dinner at Federal Pizza, a trendy place in Phoenix owned by a close friend, Mr. Weiss put a Camel Crush cigarette onto a table beside an NJOY King. “These are almost identical,” he says, “but we still have a ways to go.”

The two sticks on the table were roughly the same size. But NJOY’s weighs around 5 grams, more than twice as much as the Camel. When squeezed, the NJOY isn’t as spongy, and it lacks the Camel’s fragrance (though a nimbus of tobacco bouquet emerges when you open the pack). The tip is plastic with an LED glow, not real fire, and it produces no ash.

These distinctions can mean everything to heavy smokers for whom each detail in the smoking ritual — a “moment in the day,” as Mr. Vuleta summarizes the experience of each cigarette — adds up to something exquisite.

“Smokers talk about a ‘throat hit,’ ” Mr. Weiss explained as he sipped a strawberry wine cooler over pizza, referring to a tickle or slight burn at the back of the throat, a part of the overall Pavlovian experience that comes before the nicotine rush. It’s something, he said, that the company’s products are becoming better at imitating, along with changing the chemistry inside the e-cigarette so that nicotine is absorbed more quickly by the body, more like the real thing. But it is not there yet.

The NJOY King, which sells for $7.99, is disposable and tries to deliver as much nicotine as a pack of 20 cigarettes; other kinds of e-cigarettes are rechargeable, their nicotine fluid refills costing around $3 or $4.

If the NJOY and a regular cigarette look similar on the outside, the inside is another story. Inside the e-cigarette’s polycarbonate tube casing is an integrated circuit, a small computer chip. Then comes a lithium-ion battery and a wick wrapped in cotton soaked in a mixture of nicotine and a carrier liquid of glycerol and propylene glycol. The battery is turned on when the user drags on the stick, heating the gadget’s inside to around 180 degrees and turning the nicotine into vapor. When inhaled, it leaves the throat with an “ambient feel,” Mr. Weiss calls it — a caress, not the desired throat hit.

Not all e-cigarette companies embrace experiential authenticity the way NJOY does, and some make a deliberate effort at difference. NJOY executives like to mock the more exotic efforts. “An e-cigarette that doesn’t look like a cigarette, but looks like a silver tube with a white light at the end, is anything but an exquisite experience,” said Roy Anise, NJOY’s executive vice president in charge of sales, who came to the company from Philip Morris, the tobacco company whose parent is Altria. Mr. Anise worked in the tobacco industry for 24 years, eventually in the division that sold smokeless products.

Blu eCigs, NJOY’s biggest competition, are slender black tubes, with tips that glow blue, not ember-red. Murray S. Kessler, the C.E.O. of Lorillard, which sells Blu, described the look as “edgy” and “cool” and said that, with such a look, there is a better chance to make it a “complete replacement” to the cigarette. “I don’t want to emulate a cigarette,” Mr. Kessler said. “The big idea isn’t to try to keep people in cigarettes, but to normalize smoking e-cigarettes and vaping as the next generation.”

E-cigarettes that look different, he said, could “solve the social stigma issue” and erase the tension of smoking in public places.

Doesn’t that cannibalize his tobacco business? Yes, he said, it might, but he added that his shareholders “don’t care whether we sell cigarettes or e-cigarettes” so long as the company maintains profits. Right now, though, real cigarettes are much more profitable, as Mr. Kessler conceded, but he said he thought that e-cigarette profit margins could grow.

Bonnie Herzog, a tobacco industry analyst at Wells Fargo who is particularly bullish on e-cigarettes, said that there was room for different e-cigarette styles. But tobacco companies have a decided edge over small companies like NJOY, she said, because of their entrenched distribution, deep pockets and databases of contact information for millions of customers.

Her assertion seems to be borne out by the success of Blu. Since being acquired by Lorillard, Blu has a convenience-store market share that has climbed to 39 percent from 12 percent in a little more than a year, while NJOY’s has fallen to 30 percent from 48 percent. (NJOY expects its revenue to triple over this year to more than $100 million; Mr. Weiss declined to be more specific about sales.)

Lorillard is pushing hard, saying it will spend $40 million this year on marketing — a budget that amounts to 35 percent of the $114 million in Blu sales in the first half of the year.

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Two other big tobacco companies are exploring the market. The MarkTen, from Altria, can be recharged; it is being sold in Indiana in a test. The Vuse, from the R. J. Reynolds Tobacco Company, is a long, silver model that is being tried in Colorado.

If those large companies decide to go full force into the market, they could further erode NJOY’s market share, adding a business reason for Mr. Weiss to vilify the tobacco giants. One selling point of NJOY may be its likeness to real cigarettes, but another could be that it was never a tobacco company. He has brought on Mr. Anise and others with tobacco experience, he said, because success depends on relationships with convenience stores that sell cigarettes. But, unlike Mr. Kessler, Mr. Weiss can still rail against the companies that “kill half their customers.”

Mr. Weiss, who turned 40 in July, didn’t come to NJOY as a public health advocate or even as someone whose life was touched by the hazards of smoking. “I have no personal ‘my dad died of lung cancer’ type of story,’ ” he said. Rather, his zeal seems to be equal parts outrage and inborn entrepreneurial excitation. He obtained the first of his three patents at age 15 — it was for a net to catch tennis balls — and went on to become a lawyer before starting a hedge fund.

NJOY was started by Mr. Weiss’s brother, Mark Weiss, a lawyer in Scottsdale, who was inspired by a crude version of an electronic cigar at a trade show in China in 2005. In 2009, the company faced a near-death experience when a shipment from China, where the NJOY cigarettes are made, was seized at the port of Long Beach, Calif. The Food and Drug Administration charged that the e-cigarettes were an unapproved drug-delivery device.

NJOY initially argued that it had made no health claims and therefore shouldn’t be regulated. But just months after the seizure, the Family Smoking Prevention and Tobacco Control Act was passed. It gave the F.D.A. the power to regulate tobacco products, but not to ban them. (At the time, Craig Weiss was a shareholder but not part of management; he did weigh in on legal matters.) After the change in federal law, NJOY updated its legal position, arguing that nicotine is derived from tobacco, and therefore that the F.D.A. had the power to regulate e-cigarettes under the new law. In a 2010 ruling, a federal district court in Washington accepted that argument, preventing an outright ban of NJOY’s product as an unregulated drug delivery device and punting the specifics of how the products should be regulated over to the F.D.A.

The F.D.A. has said it plans to issue preliminary rules for public comment on e-cigarette regulations as soon as the end of this month, but the partial government shutdown appears to have delayed that process. Earlier this month, the European Parliament endorsed limits on sponsorship and advertising of e-cigarettes, and on their sale to minors, but scrapped tougher regulations favored by some in public health that would have regulated them as tightly as medical devices.

Some critics say NJOY and other e-cigarette companies are trying to have it both ways. “When it’s convenient to be like tobacco, they’re like tobacco,” says Stanton A. Glantz, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco, “and when it’s not convenient, they’re not.”

One day in mid-August, Dr. McAfee, the tobacco expert from the C.D.C., received an e-mail with statistics about e-cigarette use among young people. The statistics compared e-cigarette experimentation in 2012 with that of 2011, the first year the C.D.C. had collected data on the phenomenon.

Alarm bells went off the instant Dr. McAfee saw the numbers: among students in grades 6 to 12, experimentation with e-cigarettes had doubled, to 6.8 percent from 3.3 percent. Not surprisingly, the numbers were higher among high school students, 10 percent of whom reported trying an e-cigarette, more than double the share in 2011.

Within hours, Dr. McAfee called Mitch Zeller, the director of the Center for Tobacco Products of the F.D.A. As Dr. McAfee recounted his conversation, he told Mr. Zeller: “This is not business as usual.”

One of the strongest predictors of whether someone becomes a lifelong smoker is how early he or she starts experimenting, and Dr. McAfee saw experimentation with e-cigarettes as a gateway to tobacco. Three weeks later, the C.D.C. issued an “emergency note from the field,” a communication typically reserved for acute disease outbreaks.

From a public health perspective, e-cigarettes raise two questions: How harmful are they? And, regardless, will they lead to smoking cessation or, perversely, reinforce the tobacco smoking habit?

Most public health officials seem to agree that the levels of toxins in e-cigarettes are far lower than those in traditional cigarettes. But they also say that far too little is known, not just about potentially harmful aspects of particular brands of e-cigarettes, but also about whether there is harm from “secondhand vapor.” Dr. Glantz of U.C.S.F. says that in the absence of data, indoor smoking bans should also cover e-cigarettes.

Mr. Weiss asserted that such indoor bans would eliminate a competitive advantage for e-cigarettes and thus harm the effort to normalize this alternative behavior. More broadly, he said, public policy should err on the side of giving e-cigarettes a chance, even if everything about the health effects isn’t known. “This idea of saying we don’t have data — that ‘in the absence of data we’re going to act’ — is potentially condemning people to a painful and early death,” he said. Public health officials who want more research before accepting vaping, he said, are “suffering from P.T.S.D. from the lies they were told by tobacco companies.”

The public health officials don’t disagree; in fact, they say they blew it with cigarettes by ignoring warning signs, waiting years to mount ironclad scientific proof and thus allowing a deadly habit to take hold. They are trying to learn from the past. “We can’t allow e-cigarettes to establish themselves the way cigarettes did and, five years from now when all the scientific questions are answered, try to stuff the genie back in the bottle,” said Dr. Glantz, who advocates tighter regulation.

Another area of sharp disagreement is the question of whether e-cigarettes really help people quit smoking. Given that electronic cigarettes aren’t considered as satisfying a nicotine rush, skeptics worry further that if the e-cigarette takes hold, it will lead people to using the tobacco version.

There is no data to validate that concern, just as there is little data on cessation. Surveys suggest that e-cigarette users are quitting or cutting down on cigarettes. But one scientific study, published in September in The Lancet, a British medical journal, found that six months into smoking e-cigarettes, 7.3 percent of users had quit smoking tobacco. That was the statistical equivalent to the modestly effective patch (a quit rate of 5.8 percent).

“We were hoping for the magic bullet,” said Natalie Walker, director of addiction research at the National Institute for Health Innovation in New Zealand, and one of the study’s authors. “We were surprised by the low quit rate.” Still, she says she thinks e-cigarettes have potential as “another tool” and notes that they have a crucial advantage over other nicotine replacement strategies: “E-cigs have a large and dedicated fan club.”

Dr. Carmona, the former surgeon general who has joined NJOY’s board, is not willing to accept defeat. As surgeon general, he emphasized the dangers of secondhand smoke, and e-cigarettes seem to him the best bet for a cessation device. “We don’t have all the answers” he said, “but we see there is potential for this to be a very disruptive force in cessation.”

Mr. Weiss favors regulation that would require companies to disclose ingredients, set manufacturing standards and prohibit sales to minors, but he objects to restrictions on marketing. At the moment, absent F.D.A. regulations, e-cigarette companies, unlike tobacco companies, can sponsor sports and entertainment events, or advertise on television.

What they can’t do is make health claims; if they did, they would face regulation as a drug company. So the ads tend to be implicit, as in one that ran during the Super Bowl last year. In it, a handsome man smoked an NJOY with a voice-over that said: “You know what the most amazing thing about this cigarette is? It isn’t one,” and then continued, “The first electronic cigarette with the look, feel and flavor of the real thing.”

Reynolds, the maker of Vuse, has a commercial that sounds much like old TV ads for cigarettes, promising “a perfect puff, first time, every time.” A commercial for Blu features Jenny McCarthy complaining she doesn’t like a kiss “that tastes like an ashtray.”

Mr. Weiss said NJoy’s Super Bowl ad prompted a 40 percent uptick in sales in the five markets where it ran. That kind of impact is why he doesn’t want the F.D.A. to forbid television advertising. “Any ad restrictions that limit our ability to let smokers know they have an alternative only serves the interest of Big Tobacco,” he said, because tobacco companies have such an edge on the traditional channels of distribution. He does agree, however, that there should be no advertising during children’s TV shows. He declined to say how much the company spends on marketing.

The push for regulation is coming from many quarters, including a majority of the state attorneys general. Forty of them wrote a letter in September to the F.D.A., seeking “immediate regulatory  oversight of e-cigarettes, an increasingly widespread, addictive product.” The letter said that the nicotine in e-cigarettes “has immediate biochemical effects on the brain and body at any dosage, and is toxic in high doses.”

Then, last week, the group sent a second letter reiterating its position, urging rules that would “ensure that companies do not continue to sell or advertise to our nation’s youth.”

In the first letter, the state attorneys general singled out NJOY’s Super Bowl ad, not in its appeal to youth but the way it looked just like the thing it seeks to replace: “The advertisement depicted an attractive man smoking an e-cigarette that looked just like a real cigarette.”

Mr. Weiss doesn’t see a problem with this. “We want it to look exactly like a cigarette because that’s how we’re going to get smokers to change behavior,” he said. For decades, he noted, there have been smoking alternatives, like patches and pills and gum, that were nothing like cigarettes. Going down that road, he said, is “Einstein’s definition of insanity — doing the same thing over and over again and expecting a different result.”

At the same time, he conceded that his strategy “creates some confusion” that “is not irrational to me, and just requires education.”

“People say, if it looks like a duck, and quacks like a duck, it must be a duck.”

Mr. Weiss’s challenge, if he’s to reach what he envisions as a place in history, will be to prove that looks can be deceiving.

http://www.nytimes.com/2013/10/27/business/the-e-cigarette-industry-waiting-to-exhale.html?pagewanted=1&_r=1

Mayo Clinic Experts: What Should You Know About E-cigarettes?

ROCHESTER, Minn. — E-cigarettes are becoming increasingly popular and widely available as the use of regular cigarettes drops. Recently, the Centers for Disease Control and Prevention (CDC) reported that e-cigarette use by children doubled from 2011 and 2012. The health effects of e-cigarettes have not been effectively studied and the ingredients have little or no regulation. Mayo Clinic’s Nicotine Dependence Center experts are available to discuss what people should know before trying e-cigarettes.
Electronic cigarettes, often called e-cigarettes, are battery-operated devices that provide inhaled doses of a vaporized solution of either propylene glycol or vegetable glycerin along with liquid nicotine. An atomizer heats the solution into a vapor that can be inhaled. The process, referred to as “vaping,” creates a vapor cloud that resembles cigarette smoke. Some liquids contain flavoring, making them more appealing to users.
“As of right now, there is no long-term safety data showing the impact of repeated inhalation of propylene glycol or vegetable glycerin on lung tissue,” cautions Jon Ebbert, M.D., associate director at Mayo Clinic’s Nicotine Dependence Center. “There is some short-term data suggesting that e-cigarettes may cause airway irritation, but until we have long-term safety data, we are not recommending e-cigarettes for use among cigarette smokers to help people stop smoking.”
So, what is known about electronic cigarettes?

    • Manufacturers claim that electronic cigarettes are a safe alternative to conventional cigarettes.
    • The Food and Drug Administration (FDA) has questioned the safety of these products.
    • FDA analysis of two popular brands found variable amounts of nicotine and traces of toxic chemicals, including known cancer-causing substances (carcinogens).
  • The FDA has issued a warning about potential health risks associated with electronic cigarettes, but is not yet regulating their use or standards of manufacture.

“It’s an amazing thing to watch a new product like that just kind of appear. There’s no quality control,” says Richard Hurt, M.D., director of Mayo Clinic’s Nicotine Dependence Center. “Many of them are manufactured in China under no control conditions, so the story is yet to be completely told.”
Mayo Clinic’s Nicotine Dependence Center offers FDA-approved medications and evidence-based care that is safe and effective in helping people quit smoking.
The American Association for Cancer Research (AACR) will host a press conference about e-cigarettes and their health effects on Tuesday, Oct. 29 at 9:30 a.m. ET, at the 12th Annual AACR International Conference on Frontiers in Cancer Prevention Research, held Oct. 27-30 in National Harbor, Md. Scott Leischow, Ph.D., co-lead, Cancer Prevention and Control Program, Mayo Clinic, Scottsdale, Ariz., will join other experts for a discussion about existing scientific research on e-cigarettes and their impact on health, as well as the need for additional research that can inform effective cancer prevention strategies, public health messages, and regulatory activities.
The press conference will be held in the Camellia Room at the Gaylord National Resort and Convention Center in National Harbor, Md. Reporters who cannot attend the press conference in person can join by telephone: 800-446-2782 (toll-free).
To schedule an interview with a nicotine dependence expert, please contact Kelley Luckstein at 507-284-5005 or newsbureau@mayo.edu.
http://www.webwire.com/ViewPressRel.asp?aId=181927#.Une3C5RUM0M

E-cigarette industry lobbies to avoid regulation as tobacco product

By Stuart Pfeifer
They have the shape, feel and nicotine of tobacco cigarettes, but e-cigarettes should not be regulated like tobacco products, makers of the popular new product say.

The Smoke Free Alternatives Trade Assn., an industry group, is lobbying to avoid Food and Drug Administration regulation under the Family Smoking Prevention and Tobacco Control Act.
“This is a critical time for … the e-cig industry at large,” said Cynthia Cabrera, the trade group’s executive director. “While our industry understands reasonable and appropriate regulation is needed, it is vital our young industry not be grouped with combustible cigarettes as federal guidelines are developed for these products. Excessive regulation could limit adult access to e-cigs and stifle growth and innovation in the segment.”
Members of the trade organization said they are traveling to Washington on Nov. 4 to urge members of Congress to not classify the devices as tobacco products.
Last month, attorneys general from 40 states urged the FDA to regulate e-cigarettes as tobacco products, noting the cigarette alternatives contain highly addictive nicotine and, unlike cigarettes, can be advertised and sold to children.
“People, especially kids, are being led to believe that e-cigarettes are a safe alternative, but they are highly addictive and can deliver strong doses of nicotine,” Massachusetts Atty. Gen. Martha Coakley said. “We urge the FDA to act quickly to ensure that these products are regulated to protect the public, and are no longer advertised or sold to youth.”
E-cigarettes are plastic or metal devices, shaped like oversized cigarettes, that use batteries to heat nicotine oil and create a vapor that users inhale. They provide nicotine without inhaling the smoke of burning tobacco.
The products have become so popular that some tobacco companies have been acquiring e-cigarette manufacturers as a way of getting into the business.
The Centers for Disease Control reported recently that e-cigarette use by middle and high school students doubled from 2011 to 2012. The trade group has scoffed at that report, noting that it was based on the number of students who tried the product, not those that regularly used them.
Further, the group said, studies have found that e-cigarettes are a safe alternative to tobacco cigarettes, the health risks of which are widely known.
“There is no evidence of which we are aware which would suggest that the risk/safety profile of e-cigarettes is in any way comparable to that of tobacco products,” Todd A. Harrison, an attorney for the trade group, said in an Oct. 17 letter to the White House Office of Information and Regulatory Affairs.
http://www.latimes.com/business/money/la-fi-mo-ecigarette-industry-lobby-tobacco-product-20131024,0,2455539.story#axzz2iesS7W00

Study finds cigarette alternatives may not be safer than cigarettes

UC Davis Researchers Examine E-Cigarettes, Cigars, Hookah
Written By CATHERINE MAYO

If you’ve ever been convinced to smoke hookah — or anything else for that matter  — because someone told you it was completely safe, you aren’t alone (but you’ve been lied to).

Are smoking alternatives as safe as people think? UC Davis pulmonary physicians recently published a study concluding these replacements can be addictive gateways to cigarette smoking. The assessment — which focused on cigars, hookah, e-cigarettes and a Swedish smokeless tobacco called snus — provides new insight on why people trying to quit smoking (and those who haven’t started) should avoid all types of tobacco products.

“Everything I included … in some way or another has become popular in America or worldwide… [These products] are the most commonly used, and because [of this], there is a misperception about them,” said Michael Schivo, assistant professor of internal medicine at UC Davis Health System and lead author of the study.

The research team found that because of a lack of regulation and research, e-cigarettes show unclear risks. From 2011-12, e-cigarette use among students in grades six to 12 doubled. Many people trying to quit smoking view e-cigarettes as a safe way to wean themselves off nicotine, but according to the study, Schivo recommended smokeless tobacco before e-cigarettes to better avoid lung cancer and cardiovascular disease. Moreover, for non-smokers trying something new, the nicotine can be dangerously addicting.

Smoking hookah, a technique that employs a special form of tobacco called shisha smoked out of a water pipe, is growing in popularity among college-aged adults and is commonly perceived as a harmless recreational activity, was discovered to be significantly worse than cigarettes. Waterpipe use leads to deeper and longer inhalation of tobacco smoke than other forms of smoking. In fact, the Mayo Clinic says a typical one-hour-long hookah session consists of 200 puffs compared to the cigarette’s average of 20 puffs. Nicotine levels are reduced in waterpipe smoking, but the amounts of arsenic, chromium and lead — chemicals known to be carcinogens — are all significantly higher.

While this information may come as a shock to some, many others know it and choose to ignore it as best they can.

“I’m sure that almost everyone who smokes … has been told countless times that they should stop. It’s not that they don’t know the risks, it’s just a tough habit to quit,” said Brad Howard, a second-year civil engineering major.

The study arrives in the final months of UC Davis’ tolerance for smoking. Beginning in January 2014, the UC Davis Smoke-Free policy takes full effect. The campus will no longer tolerate any forms of smoking, including e-cigarettes and hookah.

Krystal Wong, a second-year human development major and intern at the Student Health and Wellness Center, welcomes the addition of this new policy.

“Davis is trying to promote a healthier environment … Second-hand smoking can cause health hazards for many students,” Wong said.

Schivo is in support of the new rules.

“Public awareness is good however it’s employed,” he said.

Whether you are for or against the policy, we can at least now know not to believe anyone who tries to convince us smoking alternatives are safe. We only have evidence to prove the opposite. Take it as you will, live your life, be smart.

http://www.theaggie.org/2013/10/24/study-finds-cigarette-alternatives-may-not-be-safer-than-cigarettes/

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.