Feature

The battle over e-cigarettes

Is "vaping" a healthier alternative to smoking or a lure to create more nicotine addicts?

Are e-cigarettes dangerous? They're clearly less dangerous than cigarettes, but that doesn't mean they're safe. Electronic cigarettes are small, battery-powered devices that heat up a liquid containing nicotine and create an inhalable vapor instead of smoke. Like cigarettes, they provide a nicotine buzz, but they do not produce the tar, arsenic, benzene, vinyl chloride, and dozens of other carcinogens that result from burning tobacco. But critics contend that the health risks of "vaping" are still not known, especially because the liquid used to produce vapor contains various chemicals; some brands contain diethylene glycol, which is also found in antifreeze. Nonetheless, e-cigarette sales are booming: About 6 million Americans use e-cigarettes, producing an estimated $2 billion in U.S. sales last year. Health advocates are warning that the devices are being marketed to minors, with bubble-gum-flavored liquids, and could hook a new generation on nicotine. "We can't allow e-cigarettes to establish themselves the way cigarettes did," says Stanton Glantz, director of tobacco research at the University of California at San Francisco, "then try to stuff the genie back in the bottle" once health risks come to light.

What's at stake? Smoking has killed some 20 million Americans over the past 50 years, making it the leading preventable cause of death in the United States. More than 16 million citizens suffer from a smoking-related disease, costing $132 billion in direct health-care expenses. Yet despite decades of warnings and widespread bans on smoking in public, 44 million Americans — one sixth of the total population — continue to light up every day. Surveys show that nearly 70 percent of smokers say they want to quit, but fewer than 10 percent are able to do it without the aid of cessation treatments like nicotine patches. Among smokers who do manage to kick the habit, three out of four will pick it up again within a year. "We need better treatments," says Jed Rose, director of the Duke Center for Smoking Cessation. "The current ones just aren't working all that well."

Do e-cigs help smokers quit? That issue is in dispute. E-cigarette-makers — which include emerging startups like NJOY and SmokeStik as well as Big Tobacco mainstays Altria and Reynolds American — are legally banned from making any claims that their products help smokers quit. Studies have produced conflicting results: One British study this year found that smokers who turned to e-cigs were 60 percent more likely to succeed in quitting tobacco than those who used other nicotine replacements or went cold turkey. But a U.S. study found smokers using e-cigs were no more likely to succeed in quitting. It's clear, however, that the devices do not break a smoker's addiction to nicotine, and it is primarily that drug that compels people to keep smoking despite the obvious hazards. Critics say the perceived safety of vaping could lead more young people to take up e-cigs and get them addicted to nicotine. "The very thing that could make them effective is also their greatest danger," says Tim McAfee of the federal Centers for Disease Control and Prevention (CDC).

Why aren't they regulated? Mainly because they're so new. E-cigarettes were created and sold in China in 2004. In 2009, about two years after e-cigarettes reached the U.S., the Food and Drug Administration tried to ban them as unapproved "drug-device combination products," but manufacturers filed suit, and the courts overturned the ban. This past April, the FDA reclassified e-cigarettes as "tobacco products" — the nicotine in them is derived from the plant — and put forth a slew of proposed regulations, including restrictions on sales to minors and the addition of health warnings on packaging. But health advocates, including the American Heart Association, say those regulations don't go far enough and are calling for restrictions on advertising and marketing and the banning of candy-like flavors that critics say are clearly aimed at adolescents. "We are fiercely committed to preventing the tobacco industry from addicting another generation of smokers," says Heart Association CEO Nancy Brown.

Are kids using e-cigarettes? Yes, and in growing numbers. The CDC recently reported that 260,000 middle and high school students had tried e-cigarettes in 2013, a threefold increase from just two years earlier. A separate study in the journal JAMA Pediatrics found that youths who tried e-cigarettes were six times more likely to take up smoking than those who didn't. Regardless of whether these teens eventually turn to traditional cigarettes, nicotine is highly toxic, and there is increasing evidence of its adverse effects on developing brains. The CDC says early exposure to nicotine can result in "lasting deficits in cognitive function." But vaping advocates insist the overall benefits of getting smokers off tobacco far outweigh the risks. "In a couple of generations, we could have everybody off combustible cigarettes," says Cynthia Cabrera of the Smoke Free Alternatives Trade Association. "But to do that, this industry has to survive." Overregulation, she says, could "completely obliterate this industry."

'Vaping' on the big screen A new film adaptation of William Shakespeare's Cymbeline, set in the present, will feature characters using thoroughly modern accessories: e-cigarettes. It's not the first time the trendy gadgets will be seen on film, and much to the displeasure of many public health advocates, it won't be the last. Canadian-based e-cig-maker SmokeStik signed a product-placement deal to get its vapes in Cymbeline and five other upcoming films — a marketing tool that's been off limits to traditional tobacco companies for nearly two decades. In the late 1990s, Big Tobacco agreed as part of a legal settlement with 46 states to stop hiring celebrity endorsers and paying Hollywood filmmakers to show characters smoking — a practice that had long been credited with boosting smoking's "glamorous" appeal. So far, the FDA hasn't imposed any similar marketing bans on e-cigarette-makers, opening the door to celebrity endorsers and big-screen cameos. "I don't see a problem with glamorizing something that saves lives," says SmokeStik's chief executive, Bill Marangos.

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