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Dan J. Raz, M.D.

Assistant Professor and Co-director of the Lung Cancer and Thoracic Oncology Program, City of Hope

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E-Cigarette Safety Called Into Question: Too Many Unknowns, No Regulation

05/21/2014 10:20AM | 8494 views

E-cigarettes seem to be everywhere these days. You’ve probably noticed Vapor stores popping up on street corners and in strip malls, advertisements and celebrity endorsements. While cities like L.A. have started banning e-cigarettes in workplaces and public spaces, it comes after explosive growth and popularity. Within three years of entering the marketplace in 2007, Bloomberg reports that e-cigarettes had grown to a $1.5 billion industry. Between 2010 and 2011, the market continued to escalate as the number of smokers trying e-cigarettes doubled, according to the CDC, from 10% to 21%.

E-cigarettes are battery-powered nicotine delivery systems. They work by converting liquid nicotine into a vapor. Smokers inhale the vapor to get their nicotine fix, it is hoped while trying to wean themselves off of traditional cigarettes.

Given what we know about the dangers of real cigarettes, any alternative might seem to be a better choice on the surface. But we must be wary of electronic cigarettes and the perception that they are a safe alternative. Those using or thinking about trying e-cigarettes must take into consideration that any perceived benefit over smoking real cigarettes comes with a new set of potential risks. E-cigarettes are so new that the harm they may cause down the road is something we just don’t know enough about yet.

Before you pick up that e-cigarette, here are some reasons why they could be doing more harm than good.

Unknown Safety Issues

Though they may be different from the chemicals found in tobacco smoke, e-cigarette nicotine vapors still may contain many potentially harmful chemicals. Initial studies have shown that the content of vapors is highly variable. There are no safety or purity regulations for e-cigarette juice. Often times they come from China, where even less is known about what we’re getting than the e-cigarettes manufactured here in the United States.

But no matter where they come from, very few if any e-cigarette vapors are pure (nicotine). While the chemicals they contain may be safer than conventional cigarettes, that doesn’t necessarily make them safe.

Make no mistake, a false sense that they are safe can increase the danger, as people may smoke more of them if they think there is no risk. Furthermore, that misperception might have a spillover effect. In other words, e-cigarettes could easily move from being a nicotine replacement therapy to becoming a new bad habit that young people take up, especially those that wouldn’t have smoked otherwise.

This is quite possible given the way that they are being marketed as an affectation that looks hip and cool to some, just like cigarettes were back in the day. In fact, CDC data indicates that “twice as many young people experimented with e-cigarettes in 2012 as in 2011, although use of tobacco cigarettes declined in the same period,” according to a recent report by The New England Journal of Medicine (The Renormalization of Smoking? E-Cigarettes and the Tobacco “Endgame”). Nearly two million middle and high schoolers tried e-cigarettes in 2012.

No Regulation

One of the most alarming facts about e-cigarettes is that, unlike conventional cigarettes, there is no FDA oversight or regulation whatsoever. Because there is no regulation, we can’t be sure what chemicals are in nicotine vapor or what effects they might be having on users.

Furthermore, advances in tobacco control are easily being sidestepped with respect to advertising and smoking in public – regulation of which had been effective measures in reducing the number of young people who started smoking.

Today’s e-cigarette ads look eerily similar to the ads of old touting conventional cigarettes. In fact, many e-cigarette companies have caught the attention of big tobacco companies and are being purchased by them. There’s a lot of concern among public health officials that this is just a way to get around regulations for regular cigarettes, erase the advances made in tobacco control and get more people smoking again.

Long-Term Side Effects

Because they are so new, the long-term effects of inhaling e-cigarette vapors are not yet known. And it will be quite some time before we do know.

Consider that lung cancer rates have been slowly falling because of tobacco control; though fewer people smoke than at any time in the last 50 years, there has been a lag time in seeing the effects in regards to lung cancer.

The same holds true for e-cigarettes – we wouldn’t know the long-term effects of nicotine vapors for decades to come. It’s not something we can test in the lab (on mice) because we already know from research on tobacco smoke that the results won’t necessarily predict what we’ll see in the human population.

What we do know is that liquid nicotine is toxic. According to the American Association of Poison Control Centers, incidents of e-cigarette poisoning rose more than 300 percent between 2012 and 2013. Though some e-cigarettes come preloaded, other varieties are refillable and expose people directly to liquid nicotine. Users must handle with extreme care, and understand that exposure can be extremely dangerous, especially to children and pets.

Only time will tell if e-cigarettes truly help move smokers away from tobacco cigarettes and what the long-term risks are. Until then, they are a potentially risky, unregulated alternative.

Note:  Look for the FDA to announce its first regulations for electronic cigarettes later this month.

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