How Safe Are E-Cigarettes?

How Safe Are E-Cigarettes?

Electronic cigarettes are handheld nicotine-delivery devices that, despite a devoted following, are currently swirling in controversy.

New York is pushing to become the first state to ban the devices, which so far stay unregulated and mostly unstudied. With cutesy colors, fruity flavors, clever designs and other possibilities, e-cigarettes may possibly hold too much appeal for young people — critics warn — offering an simple gateway to nicotine addiction.

But those criticisms clash with equally strong arguments for the value of e-cigarettes. The devices, which are tobacco-free, may be a safer alternative to cigarettes — advocates say — who point to testimonials from thousands of smokers who say they have used e-cigarettes to help them quit.

As the U.S. Food and Drug Administration struggles to gain regulatory control, and as safety studies remain works in progress, the debate continues.

“There really are a lot of unknowns with respect to health,” said Prue Talbot, a toxicologist at the University California, Riverside. “I do not know of any studies in the literature which are peer-reviewed. Almost all of the studies have been paid for by the e-cigarette organizations.

“E-cigarettes are frequently sold as safe, which is most likely not true,” Talbot added. “They may possibly not be as harmful as real cigarettes, but on the other hand, they could be. We just don’t know.”

Electronic cigarettes normally use a rechargeable battery-operated heating element to vaporize the nicotine in a replaceable cartridge. Nicotine is typically dissolved in propylene glycol, a clear and colorless liquid that is commonly found in inhalers, cough medicines and other items.

Some e-cigarettes are made to look like real cigarettes, cigars or pipes. Others look like pens or USB memory devices. There is no tobacco involved, and no smoke either. Instead, users do what’s called “vaping.” As they inhale, they take in nicotine-filled vapor.

By isolating nicotine, e-cigarettes should carry far fewer chemical risks than typical cigarettes, said Michael Siegel, a tobacco researcher at Boston University. Tobacco contains about 5,000 recognized chemicals, he said, with as much as 100,000 more that haven’t been identified yet. E-cigarettes remove several of those ingredients.

Siegel and a colleague reviewed 16 studies that analyzed the contents of electronic cigarettes. In a paper just published in the Journal of Public Health Policy, they reported that levels of certain harmful chemicals were at par with levels discovered in nicotine patches and hundreds of times lower than what’s found in cigarettes.

The researchers also found evidence that vaping reduces cravings among smokers, not just for nicotine but also for the need to hold something in their hands and put something in their mouths, making the devices more appealing to them than patches or gum.

As a cigarette-quitting technique, Siegel compared e-cigarettes to heroin needle exchange programs. It’s not that the devices are great for anybody, he said. They are just much better than what they’re meant to replace.

“The relevant question is not, ‘Are these issues secure?’” he said. “But are these things significantly safer than real cigarettes, and do they help individuals quit smoking? The answer to both of those questions we know is yes.”

“What New York is doing is equivalent to outlawing lifeboats on a sinking ship because they haven’t been FDA approved,” he added. “It’s a truly crazy approach to public health.”

For other professionals, the list of unknowns is still too huge for them to contemplate e-cigarettes worth recommending. Some users, Talbot said, have reported difficulties with their lungs and throats that have forced them to stop using the devices.

And even though industry-funded studies have deemed the devices to be secure, an FDA report discovered levels of carcinogens and toxic contaminants that they determined to be worthy of concern. Without regulation, Talobt added, cartridges may possibly contain undisclosed chemicals that could end up being far more toxic than tobacco smoke.

Top quality control is also lacking. In a recent study, Talbot evaluated six brands of e-cigarettes acquired over the Web. None of the devices had been labeled clearly with nicotine levels, expiration dates or other info, she reported in December in the journal Tobacco Control.

Most cartridges leaked onto her hands, the study found, and all were defective in some way. Talbot also discovered unsubstantiated health claims on a lot of the websites and print materials. One says they put vitamins in their e-cigarettes.

Other professionals worry about the appeal of e-cigarettes to children. The devices are easy to acquire on the Web or in mall kiosks. They come in flavors ranging from chocolate to bubble gum. You can get them in pink, gold or blue.

“Once a youth has decided to try an e-cigarette, there is nothing that protects him from getting addicted to nicotine by puffing this product,” wrote Jonathan Winickoff, a pediatrician at the Mass General Hospital for Youngsters, in a letter to the FDA. “Nicotine itself is not safe for kids. Nicotine addiction is one of the hardest addictions to break.”

New York’s move is a reaction to what can’t yet occur on the national level. According to a series of recent court decisions, e-cigarettes cannot qualify as drug delivery goods, said Jeff Ventura, a spokesman for the FDA. As a result, the agency cannot ban them or require more arduous testing.

But even though they are now regarded as tobacco goods, they are not mentioned in the Tobacco Control Act, either. For now, then, they stay unapproved and unregulated.

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