By Christopher Wanjek, Columnist
Published 11/22/2013 08 44 AM EST on LiveScience

At first, electronic cigarettes were a novelty something a braggart in a bar might puff to challenge the established no smoking policy, marveling bystanders with the fact that the smoke released from the device was merely harmless vapor.

Now, e cigarettes are poised to be a billion dollar industry, claimed as the solution to bring in smokers from out of the cold, both figuratively and literally, as e cigarettes promise to lift the stigma of smoking and are increasingly permitted at indoor facilities where smoking is banned.

So, are e cigarettes safe? Well, they’re not great for you, doctors say. What’s being debated is the degree to which they are less dangerous than traditional cigarettes.

1940 revisited

E cigarettes are battery powered devices, often shaped like traditional cigarettes, with a heating element that vaporizes a liquid nicotine solution, which must be replaced every few hundred puffs. Nicotine is inhaled into the lungs, and a largely odorless water vapor comes out of the device. Puffing an e cigarette is called vaping. Vaping How E cigs Work (Infographic)

Yet the industry’s duplicity is clear to medical experts E cigarettes are marketed to smokers as a means to wean them off of tobacco (although studies show they don’t help much) yet the same devices, some with fruity flavors, are marketed to young people who don’t smoke, which could get them hooked.

Hooked? Yes, e cigarettes are a nicotine delivery system, highly addictive and ultimately harmful because of their nicotine.

Cancer and respiratory experts see the same ploy being played out today with e cigarettes as was done in the 1940s with cigarettes, when America started smoking en masse. They often are distributed for free and pitched by celebrities and even doctors as cool, liberating and safe.

In an ad for a product called blu eCigs, celebrity Jenny McCarthy, infamous for encouraging parents not to vaccinate their children, encourages young adults to vape, enlisting words such as “freedom” and the promise of sex. In another ad, for V2 Cigs, a medical doctor named Matthew Huebner who is presented without affiliation but is associated with a Cleveland Clinic facility in Weston, Fla. implies that vaping is as harmless as boiling water.

As for the notion of e cigs as liberating, the cost of a year’s worth of e cigarette nicotine cartridges is about $600, compared with $1,000 yearly for a half pack a day of regular cigarettes.

As for whether they’re safe, it’s a matter of comparing the advantages of one addiction over another.

E cigarettes not a patch

One would think that vaping has to be safer than smoking real cigarettes. Experts say they are probably safer, but safer doesn’t mean safe.

“Cigarettes have their risk profile,” said Dr. Frank Leone, a pulmonary expert at the University of Pennsylvania Medical Center in Philadelphia. And just about everyone who breathes understands the risks circulatory disease and myriad cancers, for starters. “E cigarettes might be better off compared to that profile. But that doesn’t mean they don’t have their own risk profile.”

A top concern is the nicotine delivery rate, Leone said. With nicotine patches and gum, the nicotine delivery is regulated, with small amounts of nicotine released slowly into the bloodstream. But with traditional cigarettes and now e cigarettes, heat creates a freebase form of nicotine that is more addictive or what smokers would call more satisfying. The nicotine goes right into the lungs, where it is quickly channeled into the heart and then pumped into the brain.

Once addicted, the body will crave nicotine. And although nicotine isn’t the most dangerous toxin in tobacco’s arsenal, this chemical nevertheless is a cancer promoting agent, and is associated with birth defects and developmental disorders.

A study published in 2006 in the journal Obstetrics and Gynecology, for example, found that women who chewed nicotine gum during pregnancy had a higher risk of birth defects compared to other nonsmokers.

Great unknowns

This great unknown of possible negative health effects, along with the lack of regulation of e cigarettes, scares experts like Leone. The products come bereft of health warnings. How many pregnant women will vape following McCarthy’s promotion?

As for their merits in smoking cessation, e cigarettes don’t appear very helpful. A study published last month in the journal Addictive Behaviors found that most smokers who used them while they tried to quit either became hooked on vaping, or reverted back to smoking cigarettes. A study published Nov. 16 in the journal The Lancet found no statistically significant difference in the merits of the e cigarette over the nicotine patch in terms of helping people quit.

Leone said that e cigarettes might not help people quit smoking because the device keeps addicts in a state of ambivalence the illusion of doing something positive to mitigate the guilt that comes from smoking, but all the while maintaining the ritual of smoking.

The Jenny McCarthy blu eCigs ad hints at this notion, with such phrases as “smarter alternative to cigarettes,” “without the guilt” and “now that I switched…I feel better about myself.”

Editors of The Lancet called promotion of e cigarettes “a moral quandary” because of this potential to replace harmful cigarettes with something slightly less harmful yet just as addictive. Other researchers agree that e cigarettes might help some people quit, but at a population level, converting millions of smokers into vapers still addicted to nicotine might not lead to the cleaner, greener, healthier world implied by e cigarette manufacturers.

And then there’s the issue of not knowing what’s in the e cigarette nicotine cartridge.

“It’s an amazing thing to watch a new product like that just kind of appear there’s no quality control,” said Dr. Richard Hurt, director of the Mayo Clinic’s Nicotine Dependence Center in Rochester, Minn. “Many of them are manufactured in China under no control conditions, so the story is yet to be completely told.”

The authors of The Lancet study, all based in New Zealand, called for countries to regulate the manufacturing and sale of e cigarettes. The U.S. Food and Drug Administration, which does not approve any e cigarettes for therapeutic purpose, said it plans to propose a regulation to extend the definition of “tobacco product” under the Tobacco Control Act to gain more authority to regulate products such as e cigarettes.

Follow Christopher Wanjek wanjekfor daily tweets on health and science with a humorous edge. Wanjek is the author of “Food at Work” and “Bad Medicine.” His column, Bad Medicine, appears regularly on LiveScience.

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E-cigarette: as it becomes more popular, injury complaints also increase – interaksyon.com

Money and cigarettes – wikipedia, the free encyclopedia

The online news portal of TV5

Complaints of injury linked to e cigarettes, from burns and nicotine toxicity to respiratory and cardiovascular problems, have jumped over the past year as the devices become more popular, the most recent U.S. data show.

Between March 2013 and March 2014, more than 50 complaints about e cigarettes were filed with the U.S. Food and Drug Administration, according to data obtained through a public records request. That is on par with the combined number reported over the previous five years.

The health problems were not necessarily caused by e cigarettes. And it is not clear that the rate of adverse events has increased. In 2011, about 21 percent of adult smokers had used e cigarettes, according to federal data, more than double the rate in 2010.

Still, David Ashley, director of the office of science at the FDA’s tobacco division, said the uptick is significant, especially in light of a recent report from the U.S. Centers for Disease Control and Prevention showing an increase in the number of e cigarette related calls to poison control centers.

“Both together does suggest there are more instances going on,” he said.

The FDA is poised to regulate e cigarettes and other “vaping” devices for the first time, potentially reshaping an industry that generates roughly $2 billion a year in the United States. Some industry analysts see e vapor consumption outpacing that of traditional cigarettes, now an $85 billion industry, within a decade.

E cigarettes are battery powered cartridges filled with a nicotine liquid that, when heated, creates an inhalable mist. Little is known about the long term health effects of the products, which were developed in China and moved into the U.S. market in 2007.

“Some evidence suggests that e cigarette use may facilitate smoking cessation, but definitive data are lacking,” Dr. Priscilla Callahan Lyon of the FDA’s Center for Tobacco Products wrote in a recent medical journal article.

Contradictory findings from preliminary studies have become ammunition in the lobbying campaign around the devices, which allow users to inhale nicotine without the damaging tar produced by conventional cigarettes.

Public health officials have said the devices may encourage

nonsmokers, particularly young people, to try conventional cigarettes. E cigarette advocates have argued that they provide a safer alternative for smokers.

The FDA has sponsored research to try to answer safety questions, and it is examining its database of adverse events for any trends that might raise concerns.

RESPIRATORY PROBLEMS

The complaints from the public filed with the FDA cited trouble breathing, headache, cough, dizziness, sore throat, nose bleeds, chest pain or other cardiovascular problems, and allergic reactions such as itchiness and swelling of the lips.

One person told the FDA that while eating dinner at a restaurant a customer at the next table was smoking an e cigarette.

“The vapor cloud was big enough to come over my table and the e cig smoker was ‘huffing’ it voraciously,” the person, whose name was redacted, wrote. “I got dizzy, my eyes began to water and I ended up taking my food to go because of the intense heartbeat I began to develop.”

One woman wrote that her husband began smoking e cigarettes liberally in his car and home after being told they were safe and that the vapor was “just like water.”

“My 4 year old has had a raspy voice since he started but I really didn’t think anything of it till last night my husband was just puffing away on that thing for hours and I woke up wheezing and unable to breathe.”

Miguel Martin, president of Logic Technology, one of the biggest U.S. e cigarette makers along with Lorillard Inc and privately held NJOY, said the spike in adverse event reports reinforces the importance of regulation, especially in areas governing manufacturing practices and labeling, where standards can vary dramatically.

“Clearly, because of the business opportunities, you have companies in an unregulated environment that are importing without checks and balances,” he said, adding that while Logic pays attention to quality control, “some other companies just are not having the same diligence or focus.”

MADE IN CHINA

Most e cigarettes are made in China and sold under more than 300 brands in the United States, some through retail stores, others online.

The quality of the products is inconsistent, however, making it difficult to tease out the cause of any health problems.

One smoker began using e cigarettes following dental surgery after the dentist said quitting smoking would speed the healing process, according to a report filed last October with the U.S. Consumer Product Safety Commission that was forwarded to the

FDA.

“It blew up in my mouth while inhaling, burning my stitches and gum, lip and fingers,” the report said.

Others complained of over heating devices.

“The electric cigarette gets hot when you use it and alters the taste buds,” wrote one consumer. “I just recently realized what was turning my taste buds black.”

It is not possible to draw general conclusions from individual case reports, but there is a growing recognition that the inconsistent quality of the devices, aside from any risk inherent in the inhalation of nicotine vapor, poses potential safety risks.

In a bid to address quality concerns, some e cigarette makers are beginning to make them, either partially or wholly, in the United States.

Reynolds American Inc, which began selling its Vuse e cigarettes in Colorado last July and expects to expand nationwide this summer, makes its products in Kansas and North Carolina, though it still imports its batteries from China.

The reason, Richard Smith, a Reynolds spokesman said, is that inconsistent quality is turning off potential customers.

“There has been a high level of trial among adult consumers but a low level of adoption,” he said.

While the cost may be higher than sourcing ready made products from China, the pay off, Reynolds is betting, will be customer loyalty. If a quality problem arises during the manufacturing process, Smith said, “we can identify and fix it.”