We Don’t Know Enough About Electronic Cigarettes

You’ve probably seen people puffing on what look like fat, fancy pens, and exhaling what looks like smoke, then vapor that disappears faster than smoke would. They’re electronic cigarettes-e-cigarettes-that offer nicotine but not smoke, and they’re increasingly popular among smokers who want the pleasure of their habit but not the ill health effects, and those who are trying to quit.

The battery-powered devices supply inhaled doses of nicotine vapors and flavorings. According to the Centers for Disease Control and Prevention, approximately 6 in 100 adults have tried e-cigarettes, and the number has nearly doubled since 2010.

Which prompts these questions: Are they safe? Do they help people quit smoking?

According to research by scientists at the University of Texas MD Anderson Medical Center, the answer to the first question is … maybe.

“Independent studies must rigorously investigate e-cigarettes,” said Paul Cinciripini, Ph.D., director of Anderson’s Tobacco Treatment Program, “as there’s considerable potential benefit in these products if they’re regulated and their safety is ensured. But promoting the e-cigarettes already on the shelves as ‘safe’ is misleading and, if looked at as a harmless alternative to cigarettes, could potentially lead to a new generation of smokers more likely to become tobacco dependent.”

Cinciripini and his colleague, Alexander Prokhorov, M.D., Ph.D., who heads Anderson’s Tobacco Outreach Education Program, caution that more research is needed to understand the potential role of e-cigarettes in smoking cessation.

They advise consumers that:

  • E-cigarettes are unregulated and not approved by the FDA, so you don’t know exactly what you’re getting or if it’s safe. Nicotine levels have been shown to vary widely among e-cigarette products.
  • Because e-cigarettes are marketed as safer, are available in a variety of colors and flavors and are promoted by celebrities, they might entice younger people to begin smoking and serve as a gateway to cigarettes.
  • Switching from tobacco to e-cigarettes can help smokers avoid approximately 6,000 chemicals, some of which are carcinogenic, or cancer-causing. But objective studies, free from the ethical and legal challenges of clinical trials sponsored by tobacco companies are required to confirm their healthful role.

Writing on KevinMd.com, Deep Ramachandran, a pulmonary and critical care physician, pointed out that propylene glycol is one of the agents that creates the e-cig vapor, and that although it’s an FDA-approved food additive, it’s unclear how inhaling it regularly might affect the lungs.

As far as using e-cigarettes as a smoking cessation tool, Ramachandran referred to research conducted in Italy that enrolled 300 smokers who weren’t interested in quitting and otherwise healthy. Some were randomly assigned to use e-cigs at either a steady dose of nicotine, a decreasing dose or no nicotine at all for 12 weeks. They could use the e-cigs as they liked in addition to regular smoking.

After one year, quit rates (for all nicotine including e-cigs) among those using e-cigs with nicotine were 11 in 100, or as good as or better than most current nicotine replacement therapies. Among those who didn’t quit, the number of cigarettes they smoked daily decreased from 21 to 14.

Those researchers said that adverse event reports, including hunger, insomnia, irritability and depression, decreased over the course of the study, and that they were infrequent. There weren’t any significant changes in weight.

That encourages the perception of e-cigs as a useful, safe nicotine replacement therapy. But it was a short, 12-week study that can’t offer information about the long-term effects of e-cigs.

Of course, Big Tobacco has to slice itself a piece of the attractive e-cigarette pie. An Associate Press story earlier this month said that “Companies vying for a stake in the fast-growing electronic cigarette business are reviving the decades-old marketing tactics the tobacco industry used to hook generations of Americans on regular smokes.

“They’re using cab-top and bus stop displays, sponsoring race cars and events, and encouraging smokers to ‘rise from the ashes’ and take back their freedom in slick TV commercials featuring celebrities…”

AP said the FDA intends to regulate the product and its market, but that, “for now, almost anything goes.”

Matt Myers, president of the Campaign for Tobacco-Free Kids, told AP that “The ads, themes and messages are precisely the same [as those] used by the tobacco industry for decades that made those products so appealing to young people. For an industry that wants to project itself as helping to solve the tobacco problem, they’re behaving just like the tobacco industry in its worst days.”

Reynolds American Inc., the nation’s No. 2 tobacco company, is planning TV ads that promote a revamped version of its Vuse e-cigarette that launched last month. Altria Group Inc., owner of No. 1 Philip Morris USA, has the MarkTen e-cigarette, but won’t divulge its marketing plan.

For now, companies are not allowed to promote e-cigarettes for smoking cessation, AP said, “unless they want to be regulated by the FDA under stricter rules for drug-delivery devices. But many are sold as ‘cigarette alternatives.’ ”

E-cigarettes may have wonderful potential to reduce smoking and its harmful effects. But until we know more about them, until regulatory authority catches up, people who want to quit smoking should probably stick with approved devices, such as nicotine inhalers and gum.

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