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Are e-cigarettes dangerous?

By Harold P. Wimmer
Editor’s note: Harold P. Wimmer is the president and CEO of the American Lung Association.
(CNN) — For the makers of electronic cigarettes, today we are living in the Wild West — a lawless frontier where they can say or do whatever they want, no matter what the consequences. They are free to make unsubstantiated therapeutic claims and include myriad chemicals and additives in e-cigarettes.
Big Tobacco desperately needs new nicotine addicts and is up to its old tricks to make sure it gets them. E-cigarettes are being aggressively marketed to children with flavors like Bazooka Bubble Gum, Cap’n Crunch and Cotton Candy. Joe Camel was killed in the 1990s, but cartoon characters are back promoting e-cigarettes.
Many e-cigarettes look like Marlboro or Camel cigarettes. Like their old-Hollywood counterparts, glamorous and attractive celebrities are appearing on TV promoting specific e-cigarette brands. Free samples are even being handed out on street corners.

A report from the Centers for Disease Control and Prevention shows the promotion of e-cigarettes is reaching our children with alarming success. In just one year, e-cigarette use doubled among high school and middle school students, and 1 in 10 high school students have used an e-cigarette. Altogether, 1.78 million middle and high school students nationwide use e-cigarettes.

The three largest cigarette companies are all selling e-cigarettes. Because tobacco use kills more than 400,000 people each year and thousands more successfully quit, the industry needs to attract and addict thousands of children each day, as well as keep adults dependent to maintain its huge profits.
Nicotine is a highly addictive substance, whether delivered in a conventional cigarette or their electronic counterparts. The potential harm from exposure to secondhand emissions from e-cigarettes is unknown. Two initial studies have found formaldehyde, benzene and tobacco-specific nitrosamines (a well-known carcinogen) coming from those secondhand emissions. We commend New York City recently for banning the use of e-cigarettes indoors.
No e-cigarette has been approved by the FDA as a safe and effective product to help people quit smoking. Yet many companies are making claims that e-cigarettes 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 one study, there are 250 different e-cigarette brands for sale in the U.S. today. With so many brands, there is likely to be wide variation in the chemicals — intended and unintended — that each contain.
In 2009, lab tests conducted by the FDA found detectable levels of toxic cancer-causing chemicals — including an ingredient used in anti-freeze — in two leading brands of e-cigarettes and 18 various e-cigarette cartridges.
There is no safe form of tobacco. Right now, the public health and medical community or consumers have no way of knowing what chemicals are contained in an e-cigarette or what the short and long term health implications might be.
Commonsense regulation of e-cigarettes by the U.S. Food and Drug Administration is urgently needed. In the absence of meaningful oversight, the tobacco industry has free rein to promote their products as “safe” without any proof.
A proposal to regulate e-cigarettes and other tobacco products has been under review at the White House Office of Management and Budget since October 1, 2013. The Obama administration must move forward with these rules to protect the health of everyone, especially our children.
The opinions expressed in this commentary are solely those of Harold P. Wimmer.
http://www.cnn.com/2014/01/06/opinion/wimmer-ecigarette-danger/

E-cigarettes: a burning question for U.S. regulators

Marina Lopes, Reuters
NEW YORK (Reuters) – At the Henley Vaporium, one of a growing number of e-cigarette lounges sprouting up in New York and other U.S. cities, patrons can indulge in their choice of more than 90 flavors of nicotine-infused vapor, ranging from bacon to bubble gum.
The lounge, located in Manhattan’s trendy Lower East Side, features plush seating, blaring rock music, and fresh juice and coffee. A sprawling sign on one wall lists all the carcinogens that e-cigarette users avoid by kicking their smoking habits and using the e-devices instead.
But the growing popularity of e-cigarettes has not escaped the notice of the industry’s critics, who have stepped up calls for new regulations, including bans on their use in public places, even though the scientific evidence about exposure to their vapors remains inconclusive.
Selling for about $30 to $50 each, e-cigarettes are slim, reusable, metal tubes containing nicotine-laced liquids that come in exotic flavors. When users puff on the device, the nicotine is heated and releases a vapor that, unlike cigarette smoke, contains no tar, which causes cancer and other diseases.
The product, introduced in China in 2006, has become a worldwide trend at least in part because it may help smokers of regular cigarettes break the habit.
“It’s an addiction – not everyone can quit cold turkey,” said Nick Edwards, 34, a Henley employee who says he kicked a 15-year cigarette habit the day he tried his first e-cigarette. “E-cigarettes give you a harm-reduction option.”
That’s one reason why the market for e-cigarettes is expected to surge, reaching $2 billion by the end of 2013 and $10 billion by 2017, according to Bonnie Herzog, an analyst at Wells Fargo Bank in New York.
Herzog said the U.S. market alone could top $1 billion this year. She predicts that by 2017 e-cigarettes sales will overtake sales of regular cigarettes. That estimate does not take into account the impact of potential government regulations on sales.
E-cigarettes may help smokers save money too. Edwards, for one, says he cut his $60 monthly cigarette bill in half when he switched. On top of the cost of the device, the smoking liquids cost around $10 per refill.
Despite the perceived benefits, critics worry that the addictive nicotine found in e-cigarettes could lure more people into smoking and discourage others from quitting all together.
“Essentially e-cigarette companies are selling nicotine addiction,” said Dr. Neil Schluger, chief scientific officer for the World Lung Foundation, which advocates for tobacco control.
“Once you have them addicted to nicotine, you can sell them all sorts of things, including conventional cigarettes,” he said. “This is a giant Trojan horse.”
In the United States, such concerns have led to calls for increased government regulation.
The U.S. Food and Drug Administration currently has no regulations on e-cigarettes, but it is expected to release rules this month that would extend its “tobacco product” authority over the devices. New FDA rules could follow.
“Further research is needed to assess the potential public health benefits and risks of electronic cigarettes and other novel tobacco products,” said Jenny Haliski, an FDA spokeswoman.
To be sure, no one is expecting the federal government to go as far as Brazil, Norway and Singapore, where the devices are banned outright.
In the United States, Utah, North Dakota, Arkansas and New Jersey have already passed legislation outlawing e-cigarettes wherever smoking is prohibited.
Other jurisdictions are considering new rules of their own. New York City could decide as early as next week whether to prohibit e-cigarette use in public places.
Under Mayor Michael Bloomberg, who leaves office January 1, New York was one of the first cities to ban cigarette smoking in public places, and its decision could influence Chicago and other cities that are considering a similar controls.
The outcome is crucial for tobacco companies, which are banking on the devices to make up for a sharp decline in sales of regular cigarettes in the United States. Smoking among U.S. adults dropped to 18 percent in 2012 from 24.7 percent in 1997, according to the Centers for Disease Control and Prevention.
Reynolds American Inc, which makes Camel cigarettes, began selling its Vuse vapor cigarettes in Colorado retail stores in July and plans on expanding nationwide by mid-2014.
Other companies have also dipped into the e-cigarette business, too. Last year Lorillard Inc, maker of Newport cigarettes, acquired the best-selling blu eCigs brand, while Altria Group Inc, best known for the Marlboro brand, followed suit in August with the launch of MarkTen e-cigarettes.
“As society is transforming, so must the tobacco industry,” said Reynolds spokesman Richard Smith. “It’s just good business sense.”
The arrival of Big Tobacco could mean fierce competition for small e-cigarette companies that do not have the resources or experience to deal with tight government regulation.
But many e-cigarette companies say Big Tobacco is late to the game and has a lot to catch up on. “They are going to need to boost up their game if they want to compete,” said Christina Lopez, a saleswoman at Smokeless Image, an e-cigarette shop that sells smaller brands in Hoboken, New Jersey.
HEALTH RISKS UNCERTAIN
To be sure, there is still a dearth of scientific evidence about the safety of e-cigarettes and their effectiveness in helping smokers quit. For regulators, the big question is, are e-cigarettes a treatment for would-be quitters or “gateway” products to nicotine addiction?
Supporters say some e-cigarettes allow users to slowly reduce their nicotine intake and wean themselves off nicotine completely. A study published in the September issue in Lancet, the British medical journal, said the e-cigarettes are as effective as nicotine patches for smokers trying to quit.
Worldwide, conventional cigarette addictions kill 6 million people a year, in part because of the 250 harmful chemicals found in tobacco smoke, which can cause cancer, heart disease and stroke, says the Centers for Disease Control and Prevention.
But e-cigarettes may not be harmless, either. Nicotine addictions, fed by smoking, chewing tobacco or e-cigarettes, can cause high blood pressure, disrupt heart rhythms and lead to obesity and diabetes.
Electronic devices that feature fruit and candy flavors are even more worrying, critics say, because they could introduce children to smoking.
E-cigarette vendors say the sweet flavors make the process of quitting smoking less painful.
“By taking a sort of ‘Willy Wonka,’ fun approach to a serious matter, it breaks down people’s perceptions of e-cigarettes,” said Talia Eisenberg, owner of the Henley Vaporium, referring to the fictional candy maker.
The Centers for Disease Control and Prevention said 10 percent of high school students surveyed reported using e-cigarettes in 2012, up from 4.7 percent in 2011.
About 60 percent of current users are over 35 years old, and 43 percent are college-educated, according to Reynolds American.
Twelve states, including New York, have passed laws preventing e-cigarette sales to minors.
At a hearing on the proposed New York City ban on e-cigarette use in public places, Health Commissioner Thomas Farley said allowing it could glamorize all types of smoking and encourage teenagers and children to take up the cigarette habit.
“While more research is needed on electronic cigarettes, waiting to act could jeopardize the progress we have made over the last few years,” he said.
(Reporting By Marina Lopes; Editing by Jilian Mincer and Tim Dobbyn)
http://www.chicagotribune.com/news/sns-rt-us-usa-ecigarettes-20131211,0,720952.story?page=2

FDA’s anti-smoking campaign to target teens

By 

Early next year, half a century after the U.S. surgeon general first proclaimed the deadly effects of smoking, the Food and Drug Administration will launch a public health campaign unlike any the federal government has ever attempted.
Slick, data-driven and well-funded, the effort could cost up to $600 million over the next five years, all of it paid for by the tobacco industry under a 2009 law.
It will feature carefully crafted anti-smoking messages targeting specific types of teenagers, from rural kids who watch “Duck Dynasty” and drive pickups to gay and lesbian teens who prefer the nightclub scene.
In contracting with top-flight advertising firms, conducting intense demographic research and micro-targeting subsets of the 12-to-17-year-old crowd, the FDA is hoping to take a page from the marketing playbook of corporate America.
“It’s the federal government going to ad firms of the quality and ability that the tobacco industry has always used,” said Matthew Myers, president of the Campaign for Tobacco-Free Kids, a national advocacy group. “They’re ensuring that the media designed to educate and reach at-risk young people is of the same quality that the tobacco industry has used to attract them.”
The federal government can scarcely compete with the tobacco industry, whichspent more than $8 billion on advertising and promotions during 2011, according to the most recent data available from the Federal Trade Commission.
But Mitch Zeller, head of the FDA’s Center for Tobacco Products, said he hopes that in undertaking the first federally funded anti-smoking campaign aimed exclusively at young people, the government can put a dent in the number of teenagers who smoke their first cigarette each day — now roughly 3,300, with an estimated 700 to 800 becoming addicted.
“Once they become regular smokers or regular tobacco users, then it’s the progression to addiction, disease and premature death,” Zeller said. “We have a responsibility . . . to reduce the death and disease toll from tobacco use. That includes educating kids about the harms of tobacco use in an effective way, in a way that will reach them.”
Previous government-backed anti-smoking initiatives have not been on this scale. Some individual states have run campaigns designed to discourage youth smoking — efforts largely financed by a 1998 settlement under which tobacco companies paid states billions of dollars to settle Medicaid claims for tobacco-related health-care costs.
Last year, the Centers for Disease Control and Prevention launched the first federally funded national anti-smoking campaign, but that was geared toward getting existing smokers to stop, not toward teen prevention.
For the new campaign, the FDA is turning to people such as Jeff Jordan, 29. The agency has given him $152 million and a mission: Find a way to cut through the cluttered modern media landscape and persuade teenagers to steer clear of tobacco. And not just any teenagers, but those particularly at risk for becoming smokers, such as Hispanics, Asian Americans, African Americans, gays and lesbians.
Jordan’s San Diego-based firm, Rescue Social Change Group, has spent years developing anti-smoking campaigns that target slivers of youth culture, from teens in Northern Virginia’s alternative rock scene to gay, lesbian, bisexual and transgender teens in Las Vegas. He said he believes that to have any chance of reaching those and other at-risk populations, the government must break free of generic messages aimed at reaching all teens.
“If half the population likes blue, and the other half likes yellow, a government agency will make their campaign green,” Jordan told an audience in Finland in 2012. “But they need to realize that being everything to everyone doesn’t work in marketing. They need to segment their audience and tailor their campaigns to be effective.”
The FDA has committed $300 million to the anti-smoking ad blitz in 2014 and 2015, with the possibility of doubling that in coming years. While a chunk of the money will initially be used to target teens who have never smoked or are intermittent tobacco users, most will be aimed at young people with higher risks of becoming addicted to tobacco.
Kathy Crosby, an FDA official and advertising industry veteran overseeing the campaigns, said the agency hopes to replicate the ways in which corporate America focuses on certain demographic groups, including notoriously hard-to-reach teenagers.
“Brands are masters at understanding the marketplace, understanding the dynamics of the marketplace and carving out a way to reach their target audiences,” Crosby said. “That’s what we’re trying to do.”
Neither the FDA nor the firms it has hired have offered specifics about the campaigns, saying they are a work in progress. But Jordan said the first and most important step is researching which teens to target, then crafting messages that ring true to that group.
“No public health effort before has truly fit into a youth culture, the way they see their culture,” said Jordan, whose small firm has doubled in size to nearly 60 employees and opened a Washington office since starting to work on the FDA project. “The most important part is to be authentic and credible. . . . If we can make a campaign that’s specifically designed for a group, that looks like them, sounds like them, identified with them, we can help them see that people like them are deciding smoking is unhealthy.”
He calls the approach “creating bull’s-eyes” at the fringes of youth culture. “If it actually works,” he said, “we’re talking about reducing [smoking] rates among the groups that are most resistant to a generally targeted message.”
Previous anti-smoking campaigns created by the various firms hired by the FDA offer hints about what to expect. The ads tend to be more edgy than people might expect from a government-backed campaign and often feature young people talking in blunt terms to peers about the consequences of tobacco use.
The firms involved also are adept at getting messages out in ways beyond traditional television and radio advertising, such as creating specialized Web sites and blogs, using Twitter and Facebook, hosting events at bars and staging concerts headlined by bands popular among target audiences.
Better World Advertising, a firm that the FDA has hired to target Native American teens, created a campaign in New York to encourage doctors to talk more with patients about the risks of tobacco, and another in California reminding parents of the dangers of secondhand smoke. The slogan for the latter: “When you smoke, they smoke.”
Another firm working with the FDA, Draftfcb, recently helped the government revamp the image of Smokey Bear.
Zeller, the FDA’s top tobacco official, knows a thing or two about the potential benefits of an aggressive anti-smoking campaign. In the early 2000s, he spent time as an executive at the nonprofit American Legacy Foundation, where he oversaw the “Truth Campaign.”
Funded by a massive tobacco-industry settlement in 1998, the campaign was characterized by in-your-face ads meant to educate teens about the tobacco industry’s misleading marketing practices.
“I know how to do this, and I know what works,” Zeller said in an interview with The Washington Post earlier this year. “And what works is, get really smart people from the outside, do it under contract, do the right research, develop the right messages, have a laser beam focus on who your target is and then buy your media correctly. And then spend money. Because it’s a dose response. Once you’ve done those first three or four things, the more you invest, the more impact you will have.”
Studies have concluded that the “truth” campaign had a tangible effect, discouraging some young people from starting to smoke and prompting others to think twice about their habit.
Another recent study estimated that 1.6 million Americans tried to quit smoking after last year’s CDC campaign, which featured stark images and pleas from adult ex-smokers suffering from a variety of ailments, including amputated limbs and throat cancer.
Whatever shape the FDA’s anti-smoking ads take, Jordan said he’s encouraged to see the government trying to reach teenagers in new and creative ways, in part by taking a chance on firms like his, which aren’t exactly mainstream.
“From the perspective of a federal agency, we’re by no means a quiet company,” he said. “Our work is risque and really in your face, and it’s meant to really cause change. I’m thankful they were willing to take the risk.”
http://www.washingtonpost.com/national/health-science/fdas-anti-smoking-campaign-to-target-teens/2013/12/09/5b24030a-4d73-11e3-be6b-d3d28122e6d4_story.html

FDA: cigarette of the future could be non-addictive

By Deborah Kotz |  GLOBE STAFF

The US Food and Drug Administration submitted plans several weeks ago to increase regulation of tobacco products including chewing tobacco, cigars, and likely electronic cigarettes — which produce a nicotine vapor that’s inhaled. While the agency hasn’t announced what those restrictions will be — since they’re being reviewed by the White House budget office — Mitch Zeller, the director for the FDA Center for Tobacco Products, sat down for an interview Monday to discuss efforts to help people stop smoking and to keep kids from starting in the first place.
Here’s a run-down of some of the things on his agenda, with a few wrinkles that still need to be ironed out.
1. Create a non-addictive cigarette. We have the authority given to us by Congress to reduce nicotine in cigarettes down to nearly zero,” Zeller said. Since nicotine is the addictive chemical in cigarettes, teens who start smoking products that are almost nicotine-free could, in theory, never get hooked in the first place. Researchers now have access to 9 million cigarettes with varying amounts of nicotine to start testing whether products with lower amounts will lead to less addiction among new smokers. But don’t expect an ultra-low-nicotine product for at least a few years, Zeller added, since the studies are just beginning.
The wrinkle: Smokers already hooked on nicotine might find the new products seriously lacking, and they might need better nicotine replacement products than those currently on the market to help them overcome their cravings.

2. Run ads to scare teens away from smoking. Teens may think they already know about the dangers of smoking, but that doesn’t prevent 3,000 12- to 17-year-olds every day from lighting up for the first time. The FDA is planning an ad campaign for early next that is intended to make the thought of smoking turn teens’ stomachs. Expect, Zeller hinted, to see an anti-glamour campaign: ugly photos of smokers with rotting yellow teeth, wrinkles, and tar-stained fingernails.

The wrinkle: Teens still see their favorite movie stars — yes, you, Nicole Kidman, and you, Jennifer Aniston — glamourously smoking in photos and on the silver screen, so it may be tough for a government public safety announcement to effectively counter those influences.
3. Loosen warning labels on nicotine-replacement products. Zeller said the FDA might want to consider loosening the labeling on over-the-counter nicotine patches and gum, which currently state that users should not use them for longer than 8 to 12 weeks without consulting a doctor. “We need to look at how other Westernized nations, like Great Britain, are looking at nicotine,” he said. Other countries take the tack that smokers may always be addicted to nicotine and may need to be on some replacement product for life — which is far safer for them than continuing to inhale cancer-causing chemicals in tobacco.
The wrinkle: The FDA hasn’t determined how e-cigarettes should fit into the array of smoking-cessation products. Some smokers have told Zeller that the battery-operated devices are the only things that work to get them to stop smoking tar-filled cigarettes. But scant research has been done on the products to determine first, whether the vapor they release is safe to inhale, and second, whether e-cigarettes deliver the same quick nicotine rush to the brain that smokers seek. Those nicotine bursts aren’t delivered by FDA-approved nicotine replacement products.
4. Ramp up enforcement. The FDA has been making vigorous efforts to crack down on retailers who are selling cigarettes to minors. More than 10,000 stores throughout the U.S. have received warning letters since 2010, Zeller said, after minors serving as undercover agents were able to purchase cigarettes without an ID check. Hundreds of stores in Massachusetts were also warned that they would be fined if they didn’t change their practices.
The wrinkle: It’s tough to know how well the efforts have worked. The decline in smoking rates among teens has largely leveled off and many are still getting their hands on tobacco products.
http://www.bostonglobe.com/lifestyle/health-wellness/2013/11/05/fda-cigarette-future-could-non-addictive/sEZZVH2vR9JJ6OKviItX4J/story.html