E-Cigs and Other Vaping Devices: Friends or Foes?
The challenge is these are new products and we don’t have evidence of how much harm there may be in inhaling propylene glycol or glycerin into your lungs in this manner ...
In 1994, when writing about nicotine replacement therapy for the journal Addiction, Professor Jonathan Foulds noted that what was needed to help people quit smoking was a cigarette-like device that delivered nicotine, but not the dangers that came with it. “So here we are,” Susanne Tanski, MD, MPH, says, with the electronic cigarette (e-cig). “But,” Tanski cautions, “this product hit the market without any research being done, so basically it’s being tested on consumers. It’s an uncontrolled experiment and we just don’t know how it’s going to play out.”
In April the Federal Drug Administration (FDA) has stepped in to change that.
What are e-cigs
Tanski, associate professor of Pediatrics and Adolescent Medicine at the Geisel School of Medicine at Dartmouth, and a researcher in the Norris Cotton Cancer Center at Dartmouth-Hitchcock, says e-cigs are just one of the smoking simulation products available. E-cigs look like regular combustible cigarettes, but do not contain tobacco. “They are used to vaporize e-juice made with either propylene glycol or glycerin, flavorings and usually nicotine. This e-juice creates a thick plume of vapor that looks very similar to smoke.”
The only real similarity with regular tobacco cigarettes is that they may contain nicotine and simulate the experience of smoking by the inhaling and exhaling, with a similar hand-to-mouth activity. However, real cigarettes yield a huge variety of known poisonous and carcinogenic chemical compounds—including tar—not present in e-cigs.
Use of an e-cig, or similar product, is not called smoking, but ‘vaping’ because of the vapor they produce.
Vaping devices can look like a variety of everyday items, from a cigarette to a pen, from a cigar to a thumb drive to a hookah.
There are a variety of e-juices, Tanski says. Some contain various concentrations of nicotine, others are nicotine-free. They frequently come in flavors with enticing names such as banana split, Hawaiian delight, or blueberry.
Enter the FDA
“Last month the FDA released their proposed regulations asserting jurisdiction over all tobacco-derived products,” Tanski explains. Currently the FDA regulates cigarettes, cigarette tobacco, roll-your-own tobacco and smokeless tobacco. The proposed changes would include electronic cigarettes, cigars, pipe tobacco, certain dissolvables that are not “smokeless tobacco,” gels, and waterpipe tobacco.
“The challenge is these are new products and we don’t have evidence of how much harm there may be in inhaling propylene glycol or glycerin into your lungs in this manner, or the risks of the flavorings. Without any long-term data that’s scary. Even more concerning is that right now I could mix up e-juice in my bathtub and sell it to you. There's no quality control. It’s all uncharted territory.”
The possibly good … or bad
As a step-down method, Tanski is optimistic that vaping may offer potential for those seeking to quit smoking, but she is quick to add that without research the benefits, as well as the risks, are still unknown. “It seems at face value they have to be safer than smoking, because you’re not exposing yourself to the thousands of chemicals in combustible cigarettes.”
Since vaping devices may contain nicotine that can be addictive, Tanski says “we also have to consider if people who have never smoked before may graduate to smoking.Individuals—children and adults—are drawn to e-cigs because of the way they are marketed, which is not as a cessation aid. Sellers are taking a lesson from the 1950s playbook of tobacco sales with marketing campaigns that make it look cool and sexy.”
The web is also inundated with videos of individuals doing smoking tricks like smoke rings with vapor. “We don’t want the image of smoking cigarettes to be popular anymore; we’ve fought really hard to make it unpopular over decades of effort. It’s the only product where ‘use as directed’ leads to 450,000 deaths a year in this country.”
Prioritizing population health
Through July the FDA has an open period for comments regarding the regulations on e-cigs and various devices. This provides an opportunity for anyone—the public, academia, and the industry—to voice their opinions and share data. “There are a lot of gaps and complexities,” Tanski says, that could benefit from research and the assembling of diverse information and perspectives. Yet, bottom line, “The intention of the FDA is to protect people by keeping them informed and having products labeled properly. The FDA also wants to protect kids, restricting sales to those under the age of 18. They haven’t gone far enough, however, by not limiting advertising or internet sales.”
Currently, Tanski says, vaping is being done primarily by adults, but “literature that came out in January showed that from 2012 to 2013 use among youth has doubled. If the trend continues who knows what this year will show?”
There are many things still unknown about vaping and the products being used, but one thing Tanski feels strongly about is that the industry has to stop glamourizing these products. “My goal as a pediatrician is to keep kids and their families healthy, and I’m worried about this changing image perception, because we want to protect children, and adults, from the hazards related to tobacco. Right now we just don’t know enough about these vaping devices. If they are successful in helping people quit tobacco completely then I will be turning cartwheels, but none of us know yet where the story is going to go.”
Tanski says overall she is “cautiously optimistic.” But for now, in these uncharted waters—or vapors as the case may be—Tanski believes it is better for everyone to err on the side of caution.