10 things e-cigarettes won’t tell you

[Thomas3.20.2010]

They may be safer, but they also threaten to upend decades of anti-smoking efforts

1. “We’re Big Tobacco in disguise.”

When electronic cigarettes first debuted in the U.S. about five years ago, they seemed like a threat to the old-fashioned cigarette industry. The battery-powered devices, which turn nicotine-laced liquid into vapor, promised a less harmful and more socially acceptable alternative to combustible paper-and-tar cigarettes — and they were cheaper, not being subject to hefty tobacco taxes. Already, the underdog industry is on track to hit nearly $2 billion in sales for 2013, tripling its 2012 figures, says Wells Fargoanalyst Bonnie Herzog. And although the market for traditional cigarettes is still far bigger — topping $80 billion — Herzog predicts that e-cigarettes could surpass old-fashioned smokes in popularity within a decade. But Big Tobacco brooks no challenge. The Big 3 — Altria Group MO -0.13%  , Reynolds American RAI +0.13%  , and LorillardLO +0.49%  — have all begun making their own foray into e-cigarettes in the past two years, a main reason why Herzog says she is “very bullish” on the tobacco stocks.

Not everyone thinks that’s such a good thing. “It’s a new product with the same tobacco industry and the same tobacco-industry tactics to get people to try them,” says Erika Seward, assistant vice president for national advocacy at the American Lung Association. Indeed, e-cigarettes are such a hit, some worry that Americans will get hooked before all the risks are known — much as happened with regular cigarettes. “They’re certainly taking a page out of Big Tobacco’s playbook,” Seward says. Big 3 companies, however, say their only target customers are adults who already smoke, and they support more scientific studies on e-cigarettes. Altria, the manufacturer of Marlboros and the largest of the tobacco companies, for one, says its own research shows that 50% of adult smokers are interested in “innovative types of tobacco products” (such as e-cigarettes, which vaporize tobacco-derived nicotine). The company is exploring how to best meet their needs, says spokesperson Brian May: “Time will tell.”

But even e-cig proponents object to Big Tobacco’s involvement, though from a different perspective: “It’s not helpful to the acceptance of e-cigarettes by the public health community,” says Charles Connor, former president and CEO of the American Lung Association who is consulting with the Electronic Cigarette Industry Group (ECIG), a trade association representing e-cig makers. “It’s an optics problem for sure, and it will certainly raise a lot of caution flags among those who have to promulgate regulations.” The second largest of the Big 3, Camel cigarette makerReynolds American, however, says it, along with its vapor subsidiary, “are leading the transformation of the tobacco industry,” producing high-quality e-cigarettes “while also meeting societal expectations,” according to spokesperson David Howard, Adds ECIG president Eric Criss, “We don’t want to be anything like the bad old tobacco industry — in our product, or in our sales and marketing. Our goal is complete transparency. We’re not interested in sugar coating things.”

2. “We can’t promise this won’t kill you.”

Anti-smoking advocates and public-health officials at the Centers for Disease Control and Prevention alike concede that e-cigarettes have fewer toxins than regular cigarettes and none of the tar. But that’s no guarantee e-cigs won’t give you cancer or kill you the way tobacco-burning cigarettes are known to do. While traditional smoke carries nearly 5,000 chemicals, more than 50 of which are carcinogens, e-cigarette vapor appears to have far fewer deadly toxins, says Michael Fiore, a physician and director of the University of Wisconsin’s Center for Tobacco Research and Intervention. Still, a relatively small study of two leading brands of e-cigarettes, the Food and Drug Administrationfound carcinogens in half of the 18 samples it tested, and one sample contained small amounts of a toxic chemical found in antifreeze. Researchers at the University of California–Riverside recently found that “many of the elements” in e-cig vapor “are known to cause respiratory distress and disease,” and in some cases emitted higher concentrations of the elements than cigarette smoke produced.

E-cigarette proponents say the trace levels of toxins are unlikely to be dangerous, but Altria and Reynolds American say they don’t make any health claims about their electronic products, pointing out that the FDA has not ruled any tobacco product less risky than another. Both sides agree that more research is needed on the devices — as well as their secondhand effects. Until then, the industry will only go so far as to say the products are “less harmful” than traditional smokes: “It’s better than a cigarette,” says Criss.

“Are they safer than combustible tobacco? Without a question, yes. Are they 100% safe? I don’t think anyone can say that,” Fiore says. Even the implication that e-cigarettes are a little safer puts some health experts on edge, since companies in the 1970s marketed “lite” and “low-tar” cigarettes as a healthier option, only to learn later that they were equally toxic and deadly. “We don’t need another ‘lite, low-tar’ debacle in the United States,” Seward says.

3. “You didn’t quit smoking.You just think you did.”

Rob Fontano, the owner of an e-cigarette retailer Fort Myers, Fla., says e-cigarettes helped him quit smoking actual cigarettes “cold turkey,” after he’d tried nicotine patches, gum, and prescription Chantix without success. He even says his skin now looks healthier and he can breathe easier at the gym. But his version of “cold turkey” still includes e-cigarettes— which neither anti-smoking advocates nor tobacco companies would call quitting. After all, e-cigarettes contain nicotine, and therefore could keep people hooked on the powerfully addictive drug, Fiore says. Worse, they could increase a smoker’s habit if the person used e-cigarettes in places where they aren’t allowed to smoke — or reactivate the addiction in someone who had successfully quit cigarettes.“Once you provide a means for current smokers to maintain their nicotine addiction when they might otherwise think about quitting, you run the risk of continued and substantial use of deadly combustible tobacco,” Fiore says.

Still, e-cig users and advocates say that smoking cessation is one of the devices’ biggest selling points. A Gallup survey of former smokers in July found that 3% credited electronic cigarettes with helping them quit, compared with 2% who cited prescription drugs and 1% who used nicotine gum. (The rest cited everything from willpower to hypnosis.) Some research has tentatively supported e-cigs for smoking cessation: A recent New Zealand study of smokers attempting to quit found that more than 7% of those aided by e-cigarettes had successfully quit six months later, as had nearly 6% of those using nicotine patches. “The research that exists so far indicates that we might be on to something,” says Connor, the Lung Association president-turned-e-cigarette consultant. “My own personal view is that these will be the game-changers that finally get the smoking rate down below 20%.”

But e-cigarette makers don’t outright advertise that their products help people quit smoking — because they aren’t FDA-approved as a smoking-cessation product.“If a tobacco product consumer is concerned about the health effects from tobacco products, the best thing that they can do is quit,” says May of Altria. People who want to quit smoking can go to smokefree.com to learn about the seven treatments FDA-approved to help, or call 1-800-QUITNOW for counseling.

4. “We’re advertising like it’s 1960 — while we still can.”

E-cigarettes have so far evaded many of the restrictions that tobacco cigarettes are subject to: You won’t see a Surgeon General’s warning on e-cig packages, for instance. You will see them advertised on TV, from which cigarette ads have been banned since 1971. And you’ll see them promoted by celebrities — another no-no for cigarette marketers.

Indeed, there are now an estimated 250 brands of e-cigarettes sold in stores and online, and virtually no federal regulations on them. Some state regulators have sued e-cigarette brands over misleading advertising, so companies stop short of making health or smoking cessation claims, which the FDA would have to verify. “Many of these are mom-and-pop businesses, many of them are in China, and we really don’t know what’s in them or what sort of quality-control measures are used,” Fiore says. “It’s the wild, wild West out there.”

The FDA plans to issue new rules soon, however, and state lawmakers have tried to improvise a few of their own. Public health experts say the industry has run wild in the meantime, and is getting away with behavior that would not be tolerated from traditional tobacco, including glamorous marketing, failing to list ingredients and selling to kids. Even flash-sale sites like LivingSocial have offered deals on e-cigs. (Amazon, however, prohibits sales of them.) “It’s concerning to me that it has gone forward with no regulation, no restrictions and really no oversight,” says Sheelah Feinberg, executive director of the New York City Coalition for a Smoke-Free City, a non-profit. “There are trucks that just stop in neighborhoods and hand out free e-cigarettes, and they’re not necessarily doing an ID check when they hand them out.”

E-cigarette industry representatives, for their part, say they are just as eager for government watchdogs, as “reasonable regulation” can “protect adult tobacco smokers” with “sound science” about the risks of e-cigarettes relative to conventional cigarettes, Altria’s May says.

5. “We defy categorization.”

The e-cigarette industry says it welcomes regulation, but it’s also shown some ambivalence: On the one hand, it doesn’t want to be grouped with cigarettes and tobacco, because that would entail restrictions on who can buy them and how they can be advertised and because it has staked its success on being an alternative to those products. On the other hand, it doesn’t want to put its product on the shelf until it can be proven safe enough to get its own category. The industry would have to go through years of trials and FDA approval as a drug or drug-delivery device, effectively taking e-cigs off the market entirely, says Criss, the head of the the ECIG trade group. “I don’t really feel that it’s a tobacco product,” he says, “that’s maybe a compromise position that we maybe don’t think of as ideal.” (Altria, however, says its e-cigarette meets the definition of a tobacco product.)

So far, e-cigarettes have managed to dodge being categorized as cigarettes or tobacco. And two e-cigarette brands, NJOY and Smoking Everywhere, successfully sued when the FDA tried to regulate electronic cigarettes as drug-delivery devices, blocking the FDA’s restrictions. But the lack of categorization probably won’t last much longer: The FDA is expected to issue long-awaited rules regulating e-cigs as a tobacco product later this fall.

6. “We look like cigarettes, but please don’t tax us like cigarettes.”

E-cigarettes’ biggest advantage over traditional cigarettes is their price, market analysts say. Regular cigarettes carry high excise taxes of up to about 50% of their retail price; e-cigarettes, for the most part, are currently only subject to sales tax, says Wells Fargotobacco analyst Herzog.

The price of an e-cigarette, meanwhile, is hard to compare with that of a regular cigarette, as the electronic devices are sold to be either disposable or refillable and rechargeable. But assuming that it takes 1.25 e-cigarettes (or cartridges) to deliver the nicotine in a pack of cigarettes, and the average e-cigarette costs about $7, Herzog estimatesthat e-cigarettes are nearly 8% cheaper than cigarettes.“E-cigs are definitely more affordable than conventional cigarettes,” she says, adding that e-cigarettes’ price per usage falls with greater consumption.

Government regulation, however, and accompanying taxes are likely to increase prices, which could erode the price advantage very quickly. The industry, of course, opposes heavy taxes, arguing that making e-cigarettes more expensive could deter smokers from switching to something potentially better for their health. ““If you’re taxing combustible cigarettes because of the need to offset higher health care costs that’s one thing, but if there’s no higher health care costs because of e-cigs, that’s harder to justify,” Herzog says. Reynolds American adds that because its Vuse e-cigarette “is not a cigarette, and does not contain any tobacco, we do not believe it should be taxed the same as cigarettes,” Howard says. Herzog nonetheless predicts that e-cigarettes will be taxed 5% of their retail price next year, 10% by 2015 and 20% by 2019.

7. “Kids love us.”

If there’s one thing that the e-cigarette industry and the public health community agree on, it’s that e-cigarettes are not for children. Kids, on the other hand, seem to disagree, judging by the surging interest in e-cigs among adolescents and teens. The proportion of middle-school and high-school kids who have used e-cigarettes doubled to nearly 7%, or almost 2 million students, between 2011 and 2012, according to a recent report by the CDC. What’s more, “there’s a substantial concern that e-cigarettes will serve as a gateway product to nicotine addiction for a new generation of young people,” Fiore says. Indeed, more than 76% of students currently using e-cigarettes also reported smoking regular cigarettes. (E-cigarette defenders say the statistic can be interpreted the opposite way, too, illustrating that students who already smoked are switching to e-cigs.)

A crackdown on the way e-cigarettes are designed, marketed and sold is sorely needed, say critics. Flavored e-cigarettes, with labels touting flavors like gummy bear, fruit loop and cotton candy, are particularly offensive—especially since the FDA forbids regular cigarettes from being flavored, says Feinberg. (The e-cigarette industry says it wants to keep the products out of children’s hands, and people should only be able to buy them after showing they are of legal age. Altria and Reynolds American add that their e-cigs, like cigarettes, only come in regular and menthol.) Other chief complaints include e-cigarette ads in music magazines and celebrity endorsements in pop-culture tabloids. “We’re concerned that our youth is going to grow up thinking e-cigarettes are cool and they’re going to get addicted to nicotine,” Feinberg says.

Until the FDA sets age restrictions on e-cigarettes, children will continue to be able to buy them in many states without being carded, though some local lawmakers have enacted their own rules. Massachusetts State Rep. Jeffrey Sanchez (D), for one, is advancing a bill to prohibit sales to minors. “Right now my 7-year-old could go to the convenience store and literally take it off the shelf and buy it, and the store owner could sell it to them,” he says.

8. “We’re bringing smoking back inside…”

As new bans have pushed cigarette smokers ever further out into the cold — often as far as 25 feet from the entrance of restaurants, bars, and even outdoor spaces like parks and beaches — e-cigarettes have found a haven indoors. The devices, which emit vapor that is less noticeable and odorous than smoke, and don’t use a flame or smoldering butts that could pose a fire hazard, have largely been tolerated if not fully welcomed in places where smoking is banned, including workplaces. Some e-cigarette users reportedly even took drags while attending a recent New York City council meeting about raising the purchasing age of cigarettes as well as e-cigs. Indeed, part of the allure of e-cigarettes is that people can use them discreetly, without having to brave the cold or stink up their home, says Herzog: “There are a lot of smoking bans, and it’s easier to use these in many places that are difficult to smoke. There’s no real smell.”

Anti-smoking advocates, however, argue that observers can’t tell the difference between electronic cigarettes and the real thing. Inviting e-cigs into no-smoking zones threatens to undo public-health progress in making tobacco taboo, says Feinberg of the NYC Coalition for a Smoke-Free City. Some policymakers have recently stomped out e-cigarettes, applying smoke-free laws to e-cigs, too, and Amtrak prohibits them in stations and trains. The University of California, where researchers recently called for more studies on e-cigs’ impact on bystanders after finding that e-cig vapor released higher concentrations of some disease-causing elements also produced by cigarette smoke, has banned both products at all of its campuses.

Electronic cigarette makers, however, oppose banning them anywhere but schools, playgrounds and child-care facilities, saying the devices emit vapor, not smoke. Still, research on the secondhand risks of vapor is scant, and Altria’s May says the company supports restrictions in cramped, enclosed spaces — such as a packed subway car or elevator: “In small confined places, people might not want to be around the vapor; people might find it inappropriate.”

9. “… and back into aircraft.”

Lately, airlines have had to chastise not just passengers, but their own flight attendants for smoking — er, “vaping”— e-cigarettes on planes. After the flight attendants union for a regional branch of US Airways realized over the summer “that there are some crewmembers that are using electronic cigarettes on the aircraft,” it reminded members that the Department of Transportation’s blanket ban on airplane smoking also applies to e-cigarettes. The DOT, however, acknowledges that its current ban, which does not explicitly prohibit e-cigs, hasn’t been clear enough, with travelers and even flight staff using the devices openly in their seats, or in the airplane bathrooms. “This issue does come up occasionally and when it happens, a flight attendant will inform the passenger of current regulations to clear up any confusion,” and “that there is no-smoking of any kind in the aircraft,” says Corey Caldwell, spokesperson for the Association of Flight Attendants-CWA, a national union. (The Federal Aviation Administration finally approved the use of portable electronic devices like tablets and cellphones on airplanes, but the new policy, announced in October, doesn’t sanction puffing electronic cigarettes on planes.)

The DOT plans to issue new rules prohibiting using e-cigarettes on planes by mid-2014, and many airlines have specifically banned them. In the meantime e-cigarette proponents disagree about whether it’s okay to vape on planes — and some say they’ve been able to get away with it anyway, and don’t see a problem, as the battery-powered devices can’t start a fire. Caldwell, however, says it’s important to minimize any potential health risks for fellow passengers as well as the flight crew: “Right now the biggest question is, what are the effects of use?”

10. “E-joints and e-crackpipes are the new e-cig.”

The season premiere of Saturday Night Live in September included a mock commercial for “e-meth.” The skit parodied some of the arguments championing e-cigarettes, only instead of a nicotine substance, the devices supposedly contained the illegal drug crystal meth: “It produces vapor instead of smoke. And that means I can ride the ice pony anywhere I want,” said one actor. “Thanks to e-meth, I can now even smoke inside my favorite restaurant.”

The spoof was funny because it seemed outrageous, but e-cigarette experts say that using the devices to vaporize illegal drugs isn’t so farfetched after all. Some users say e-cigarettes can easily vaporize a liquid form of marijuana (now legal for medical uses in almost half of the country), and health advocates worry that it’s nearly impossible to tell what people are inhaling from the devices. “It sure concerns me that there are new methods to deliver illegal substances particularly to young people,” Fiore says, citing reports that the products could not only contain marijuana, but even crack cocaine. Industry spokesmen say they don’t endorse using e-cigarettes beyond their intended purposes; Reynolds American’s e-cig won’t work with anything other than its own vapor cartridge, and Altria has no plans to sell marijuana-based products. But a few companies are marketing devices for whichever substance their customers prefer, whether or not it’s legal. The $10 mCig, for one, is billed as the “cheapest eCig on the market that allows for heating of a variety of plant materials.” The eponymous company, trading over-the-counter as MCIG, is based in Washington state (which recently legalized pot), and says it is betting on two trends “sweeping the globe”—the legalization of medical and recreational marijuana, and the adoption of electronic cigarettes by the more than 1 billion smokers around the world. 

[Thomas: Is a little cyanide better than a lot of cyanide?]

I simply don't understand this safe-r language being used even by professionals that should know better! Balogna!