A 1950’s cigarette ad shows two doctors lighting up smokes over a cup of coffee.
“You know, this night shift is kind of rough, isn’t it?” says one doctor to the other, who is just pulling his first drag.
“That’s right,” he replies. “But a Camel is always a pleasure”.
An announcer then goes on to say that Camel is a cigarette brand preferred by most doctors. And you should smoke it too.
Holy smoke, how much things have changed.
As unaware of the dangers of smoking as people were in the 1950’s, we may be just about as much in the dark about today’s puffing craze: e-cigarettes.
Since their arrival in the U.S. around 2007, electronic cigarettes have become all the rage on the nicotine market. They are currently a $2 billion-a-year industry, which still pales in comparison to $80 billion-a-year for regular tobacco. The e-cigarette business, however, is growing by leaps and bounds. Some experts estimate that it’s been doubling in size year-to-year and that it may catch up with conventional tobacco in about a decade. There are more than 200 e-cigarette brands on the market and new products are coming all the time.
The Theory: Cigarettes Without The Risk
In theory, e-cigarettes are supposed to be the best of both worlds: the enjoyment of nicotine, but without the carcinogens and other toxins associated with regular cigarettes. E-cigarettes reportedly accomplish that because they burn liquid nicotine, not tobacco. Most e-cigarettes look like a metallic-colored tube about the size of a regular cigarette. Inside, there is a battery and a container that holds liquid nicotine. The battery powers a small heating device that turns the liquid nicotine into vapor that users inhale, or “vape”. The theory goes, no tobacco, no cancer.
“E-cigarettes are a better alternative to regular tobacco,” says Tony Lombard, the Global Sales Manager at United Tobacco Vapor Group, an industry association. “All ingredients that go into e-cigarettes have been approved by the FDA individually.”
Health experts generally agree that e-cigarettes are healthier than regular tobacco. But how healthier is still an open question.
There is no conclusive research about how dangerous e-cigarettes can be either for their users, or the people who inhale second-hand vapor.
Some studies have suggested that e-cigarette vapor contains some of the same carcinogens and other toxins as regular tobacco. It is also unclear whether the dosage of those toxins is high enough to be harmful. A study by the Roswell Park Cancer Institute in Buffalo, NY suggested that vapor from some e-cigarettes contains carcinogens, but the amount is between nine and 450 times lower than in regular cigarette smoke.
The Problem With Liquid Nicotine
Another concern is the increasing number of poisonings related to those liquid nicotine bottles. The poisonings happen when someone ingests or spills the highly-concentrated nicotine. It can be absorbed through the skin, so spilling even a small amount can send someone to the hospital. That’s especially the case if the victims are children.
“A fifth of a teaspoon is the equivalent of a pack of cigarettes in terms of nicotine content,” said Gaylord Lopez, the Director of Georgia Poison Center, on GPB’s On The Story . “Imagine a kid just getting a squirt. It could be even lethal”.
Lopez said there were about 1,100 reported poisonings nationwide in 2013, but there have already been 1,400 cases this year. The CDC said that 51 percent of last year’s victims were children the age of 5 years or younger. Georgia had 22 poisonings last year, and more than 30 cases in the first four months of 2014.
Most poisonings end up with nausea, eye-irritation and vomiting.
The liquid nicotine if often packed in colorful bottles and flavored with things that can be appealing to children, such as gummy bear, fruit punch or chocolate. Some experts think those colors and flavors may be a factor in poisonings.
“Most children, if they see a little bottle that says ‘gummy bear’ on it, they are more likely to think it’s candy than nicotine,” said Michael Eriksen, the Dean of School of Public Health at Georgia State University, who also appeared on On The Story. “That’s a major concern.”
The liquid nicotine bottles are not required to be childproof, so that decision is up to the manufacturers. Many of them still childproof their bottle caps.
The e-cigarette industry generally blames the lack of FDA regulation for most of those problems.
“Without regulation anyone can do whatever they want to in this business,” Lombard told GPB. “It’s (sic) wild, wild west”
Some representatives told GPB the industry would like to have regulation, but the FDA has not come up with it until last month. Lombard said that his association has been fighting since 2010 for clear rules about things like childproofing nicotine bottles.
“We don’t offer gummy bear or any other such flavors,” he said about his association. “Why some manufacturers are doing that? Your guess is as good as mine.”
Some industry reps also said that it’s the responsibility of parents to make sure the liquid nicotine it kept away from children, as is the case with alcohol or sharp knives.
The FDA proposed its first regulation for e-cigarettes in late April. The proposal is currently going through a 75-day public comment period. Among other things, the regulation would ban selling e-cigarettes to minors, mandate warning labels on e-cigarette products, require manufacturers to disclose all the ingredients they use, and prohibit manufacturers from making health-related claims that are not backed by science.
In the absence of federal rules, some states have come up with their own ones. In Georgia, a law that would ban sales to minors was signed last month. E-cigarettes will also be banned in all public universities and colleges starting this fall.
Do E-Cigarettes Actually Help Smokers Quit?
E-cigarettes have also opened another big question: do they help smokers quit, or at least cut down on tobacco?
Chinese pharmacist Hon Lik invented modern e-cigarettes in the early 2000’s in an attempt to help people quit smoking. One line of thinking since then has been that smokers consume less tobacco when they switch to e-cigarettes, or they give up tobacco altogether. The other line is that smokers only end up consuming more toxins.
“If you exclusively used e-cigarettes instead of smoking, everybody would agree you would be better off,” said Michael Eriksen, who is conducting an FDA-funded study on e-cigarettes at Georgia State University. “But in reality, that’s not what’s happening. People are doing both.”
The National Cancer Institute says there are no reliable scientific studies to prove that e-cigarettes help smokers kick the tobacco habit. The World Health Organization says it does not consider e-cigarettes a legitimate therapy for quitting tobacco.
Some medical studies claim that e-cigarettes may do the trick. A 2013 study in New Zealand suggested that e-cigarettes can be more effective than regular nicotine patches. A British study published this month in the journal Addiction said that people who use e-cigarettes to quit smoking are 60% more likely to achieve that than those who use patches or nicotine gums.
Eric Soss, an e-cigarette user in Atlanta, told GPB that he easily switched from tobacco to e-cigarettes and never looked back. He said that it took him only about one month to make the transition, and he now consumes e-cigarettes exclusively.
E-Cigarettes: The Gateway Drug
Another big worry is that e-cigarettes could be a gateway to smoking regular tobacco. The concern is that those fruity flavors could be appealing to teenagers, who could start with e-cigarettes, but later switch to tobacco. The e-cigarette industry strongly rejects that claim.
Either way, teenagers are clearly jumping on the e-cigarette bandwagon. The CDC said that the e-cigarette use among high school students increased from 4.7 percent in 2010, to 10 percent in 2011.
Some health experts are also worried that e-cigarettes could open the floodgate to other dangerous products. For example, if nicotine can be inhaled when it’s in a liquid form, is it just a matter of time before someone does the some with, say, drugs?
“We are concerned that those devices can be a gateway to some other things, such as synthetic marijuana, or K2,” said Gaylord Lopez. “Imagine if those products are put into similar devices. How would you know that someone is not smoking one of those K2 products?”
Erikson is concerned that e-cigarettes may re-introduce some of the nation’s 50 million former smokers to nicotine. Those are the people who quit smoking, but they may give e-cigarettes a try because of their perceived safety.
“Ex-smokers will tell you that they enjoyed smoking, but they quit because it was bad for them,” he said. “They may try to get the nicotine buzz from e-cigarettes, and get addicted to regular tobacco again.”
Part of e-cigarettes appeal could be in their price tag. Once users buy the refillable e-cigarette, which in some stores starts at around $45, the liquid nicotine can be as low as $7.50 per bottle. In comparison, regular cigarettes easily cost more than $40 per carton.