Many experts in tobacco control believe e cigs present the best hope of improving the unacceptably low rate of successful quitting among addicted smokers. Yet, in a perverse inversion of public health policy, these devices face relentless opposition and not from Big Tobacco, whose interests seemingly are most threatened by the switch from cigarettes to e cigarettes. Rather, it is the official public health agencies, such as the CDC and the FDA, and the big health nonprofits, such as the American Cancer Society and the American Lung Association, that are fighting this public health miracle. Even worse, they are using tactics akin to the deceptions and manipulations we recall from the cigarette makers of the 20th century. One of their more egregious tactics is simply redefining the words tobacco and smoke to include e cigs, which are linked to neither. The question is Why? One thing is certain Their antipathy is not based on science or the good of public health.

Our nation is home to over 40 million smokers, among whom about 480,000 die from their habit each year. Over half of the 40 million will die prematurely because of cigarette smoke. While the percentage of American adults who smoke has been in gradual decline since the groundbreaking 1964 surgeon general s report, the total number has hardly changed.

Most smokers desire to quit, understandably, but the addiction to smoking is extremely powerful, largely (though not solely) because of nicotine s power. Unfortunately, it is often believed by smokers, and even by some doctors, that it s the nicotine that is toxic and lethal. This is a dangerous myth. It is a proven aphorism that Smokers smoke for the nicotine but they die from the smoke. But it s not only the nicotine that is addictive There are many psychoactive chemicals in smoke these, along with the behavioral rituals and the nicotine, are what wrap the addicted smoker in a death grip.

E cigarettes provide not only a sufficiently potent dose of nicotine to satisfy a smoker s craving (unlike the ineffective patches and gums), but also the comforting rituals of inhaling and exhaling a smoke like mist, which is actually composed almost entirely of water. They use a battery to vaporize water and nicotine, which the user (called a vaper ) inhales, along with vegetable glycerin and/or propylene glycol and flavoring. They often have a cigarette like LED tip that glows red or some other color if preferred but without tobacco, without combustion, without smoke. The ingredients are generally recognized as safe by regulatory agencies, and have been in common use for decades although no long term health studies have been done on their safety in inhalational use. Such studies are being done, even now.

Sales of e cigarettes have doubled in each of the past few years, to the extent that a recent survey found that an astounding one fifth of smokers had tried them millions of smokers, now ex smoking vapers. At the same time, cigarette sales have shown a historic decline in this same period (a reliable analyst predicts that e cig sales may well overtake cigarette sales within a decade if regulators and health nonprofits get out of the way). While gold standard studies showing the markedly reduced health risk from e cigs haven t yet been completed, simple common sense would tell us that inhaling their ingredients, as compared to inhaling the thousands of chemicals from tobacco combustion (the smoke), is highly likely to be less harmful.

Despite the complete absence of any evidence or even report of harm from vaping, a bizarre trend seems to be sweeping the land, wherein towns, cities, and states are enacting measures to ban, restrict, or tax e cigs as if they were actually cigarettes. The rationales for such misguided, harmful regulation vary from locale to locale, politician to politician. But the fount of all these measures is unquestionably the federal agencies charged with the custodianship of our public health. The FDA initially tried to bar e cigs from even entering the country in 2009, but it was slapped down by a federal judge who accurately pointed out that nothing in the new law that gave tobacco oversight to the agency addressed e cigs. Perhaps out of spite, the FDA has continued to warn smokers not to even try vaping as a cessation method. The FDA s partner in such malfeasance, the CDC, has stooped to manipulating youth tobacco survey data to promote the anti e cig agenda, loudly alerting concerned parents that e cig use among teens had doubled between 2011 and 2012. The head of the CDC, Tom Frieden, conveniently neglected to note that almost all the young people who had experimented with e cigs were previously tobacco users. Even more revelatory, the official announcement lacked the key datum that during this ostensible epidemic of teen nicotine addiction, smoking rates among teens fell significantly, even more than they had fallen over the previous few years.

Other excuses for attacking e cigs range from We just don t know what will happen to vapers over the next five or ten years to We don t know what s in them. But we surely do know what will happen to many smokers over the next decade if they don t quit, and we surely do know what s in e cigs Their vapor has been extensively analyzed in objective academic labs, and nothing of concern to health has been detected as would be expected, based on their chemical constituents. Concerns about attracting and addicting young people to nicotine via e cigs have not been supported by valid evidence, despite a nearly hysterical response by the media to an outrageously deceptive study published last week by the formerly esteemed JAMA Pediatrics.

These days, when one reads about regulating e cigs, the real goal is usually to regulate them right off the market. Responsible scientists and the outnumbered members of the tobacco control movement who espouse reasonable regulation also want this groundbreaking technology regulated Age limits for sales and marketing good manufacturing practices, as with any consumer product accurate ingredient labeling childproof packaging these should all be mandatory. More stringent regulation is neither necessary nor desirable.

The unanswered question is this Why do all these public health groups and agencies abdicate their responsibilities in favor of deceiving smokers about the facts regarding e cigarettes? Can the leaders of these health bodies be so ignorant? Or are there darker forces at work Are the CDC and the FDA, perhaps, concerned more with abetting the collection of cigarette taxes than with saving smokers? Does the impressively generous funding support from Big Pharma to the nonprofit health groups generate influence, either overtly or more subtly? I cannot say. A particularly galling irony is that almost all the pompous hype calling for ever tighter restrictions and even outright bans emanates from the liberal Democratic camp, which has over the years been sympathetic to other forms of harm reduction, such as condoms for HIV positives and clean needles for addicts. But it s nicotine abstinence only for smokers Quit or die, they say.

The World Health Organization predicts that 1 billion lives will be lost to cigarettes this century, if current trends go unchanged. Everyone concerned with tobacco and health has been on tenterhooks since last November, awaiting the FDA s long overdue ruling on how it plans to regulate e cigarettes. The agency has the power to be flexible and maintain the current vibrant, innovative market or it could deem e cigs to be tobacco products, effectively banning them, which would be a catastrophe. One thing is certain This misguided, harmful crusade against e cigarettes is clearly detrimental to America s public health. While long term randomized clinical trials are desirable, the matter is too urgent and important to require these lengthy and expensive studies prior to market approval. In fact, those who demand a priori evidence before approval should be made aware that the effects of this type of r
egulation would be doubly destructive Smokers would lose access for years to their best hope of quitting, and Big Tobacco will be the sole survivor after years of trials prove what we can plainly see now. E cigarettes have the potential to save millions of lives, and those who would impede smokers access to them or to truthful information about them are, in fact, killing smokers.

Gilbert Ross, M.D., is medical director of the American Council on Science and Health.

E-cigarettes: separating fiction from fact

Learn about electronic cigarettes

By Serena Gordon
HealthDay Reporter

FRIDAY, Jan. 3, 2014 (HealthDay News) It’s the new year, a time when a smokers’ thoughts often turn to quitting.

Some people may use that promise of a fresh start to trade their tobacco cigarettes for an electronic cigarette, a device that attempts to mimic the look and feel of a cigarette and often contains nicotine.

Here’s what you need to know about e cigarettes

What is an e cigarette?

The U.S. Food and Drug Administration (FDA) describes an e cigarette as a battery operated device that turns nicotine, flavorings and other chemicals into a vapor that can be inhaled. The ones that contain nicotine offer varying concentrations of nicotine. Most are designed to look like a tobacco cigarette, but some look like everyday objects, such as pens or USB drives, according to the FDA.

How does an e cigarette work?

“Nicotine or flavorings are dissolved into propylene glycol usually, though it’s hard to know for sure because they’re not regulated,” explained smoking cessation expert Dr. Gordon Strauss, founder of QuitGroups and a psychiatrist at Lenox Hill Hospital in New York City. “Then, when heated, you can inhale the vapor.”

The process of using an e cigarette is called “vaping” rather than smoking, according to Hilary Tindle, an assistant professor of medicine and director of the tobacco treatment service at the University of Pittsburgh Medical Center. She said that people who use electronic cigarettes are called “vapers” rather than smokers.

Although many e cigarettes are designed to look like regular cigarettes, both Tindle and Strauss said they don’t exactly replicate the smoking experience, particularly when it comes to the nicotine delivery. Most of the nicotine in e cigarettes gets into the bloodstream through the soft tissue of your cheeks (buccal mucosa) instead of through your lungs, like it does with a tobacco cigarette.

“Nicotine from a regular cigarette gets to the brain much quicker, which may make them more addictive and satisfying,” Strauss said.

Where can e cigarettes be used?

“People want to use e cigarettes anywhere they can’t smoke,” Strauss said. “I sat next to someone on a plane who was using an e cigarette. He was using it to get nicotine during the flight.” But he noted that just where it’s OK to use an e cigarette indoors, for instance? remains unclear.

Wherever they’re used, though, he said it’s unlikely that anyone would get more than a miniscule amount of nicotine secondhand from an e cigarette.

Can an e cigarette help people quit smoking?

That, too, seems to be an unanswered question. Tindle said that “it’s too early to tell definitively that e cigarettes can help people quit.”

A study published in The Lancet in September was the first moderately sized, randomized and controlled trial of the use of e cigarettes to quit smoking, she said. It compared nicotine containing e cigarettes to nicotine patches and to e cigarettes that simply contained flavorings. The researchers found essentially no differences in the quit rates for the products after six months of use.

“E cigarettes didn’t do worse than the patch, and there were no differences in the adverse events,” she said. “I would be happy if it turned out to be a safe and effective alternative for quitting, but we need a few more large trials for safety and efficacy.”

Strauss noted that “although we can’t say with certainty that e cigarettes are an effective way to quit, people are using them” for that purpose. “Some people have told me that e cigarettes are like a godsend,” he said.

Former smoker Elizabeth Phillips would agree. She’s been smoke free since July 2012 with the help of e cigarettes, which she used for about eight months after giving up tobacco cigarettes.

“E cigarettes allowed me to gradually quit smoking without completely removing myself from the physical actions and social experience associated with smoking,” Phillips said. “I consider my e cigarette experience as a baby step that changed my life.”

Are e cigarettes approved or regulated by the government?

E cigarettes are not currently regulated in a specific way by the FDA. The agency would like to change this, however, and last April filed a request for the authority to regulate e cigarettes as a tobacco product.

The attorneys general of 40 states agree that electronic cigarettes should be regulated and sent a letter to the FDA in September requesting oversight of the products. They contend that e cigarettes are being marketed to children some brands have fruit and candy flavors or are advertising with cartoon characters. And, they note that the health effects of e cigarettes have not been well studied, especially in children.

Are e cigarettes dangerous?

“It’s not the nicotine in cigarettes that kills you, and the nicotine in e cigarettes probably won’t really hurt you either, but again, it hasn’t been studied,” Strauss said. “Is smoking something out of a metal and plastic container safer than a cigarette? Cigarettes are already so bad for you it’s hard to imagine anything worse. But, it’s a risk/benefit analysis. For a parent trying to quit, we know that secondhand smoke is a huge risk to kids, so if an electronic cigarette keeps you from smoking, maybe you’d be helping kids with asthma or saving babies.”

But on the flip side, he said, in former smokers, using an e cigarette could trigger the urge to smoke again.

The other big concern is children using e cigarettes.

“More and more middle and high school kids are using e cigarettes,” Tindle said. “Some are smoking conventional cigarettes, too. The latest data from the CDC found the rate of teens reporting ever having used an e cigarette doubled in just a year. We could be creating new nicotine addicts. We don’t know what the addictive properties of e cigarettes are,” she added.

“It’s shocking that they’ve been allowed to sell to minors,” Tindle said.

More information

The U.S. Food and Drug Administration has more about electronic cigarettes.

This HealthDay story describes options to help you quit smoking.

SOURCES Hilary Tindle, M.D., assistant professor of medicine, and director, Tobacco Treatment Service, University of Pittsburgh Medical Center, Pittsburgh Gordon Strauss, M.D., psychiatrist, Lenox Hill Hospital, and founder, QuitGroups, New York City Elizabeth Phillips, Philadelphia Sept. 9, 2013, The Lancet, online

Last Updated Jan 3, 2014

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