Although the presence of smoke doesn’t always indicate fire, the growing popularity of a new product that at least promises to be a safer alternative to deadly tobacco cigarettes, the electronic smokeless cigarette, certainly seems to have sparked some controversy in the U.S.
The e-cigarette (electronic cigarette) is a battery-powered gadget that delivers inhaled vapor solutions to the user which may or may not contain nicotine – the user makes that choice – and even though it makes no claims to help with smoking cessation, many of its users (including me) are saying that for the first time in their lives they have been able to finally quit smoking traditional cigarettes. Others who choose to use the devices with the nicotine feel that even though they are still addicted to the nicotine, they don’t feel like they are inhaling the thousands of harmful chemicals present in cigarettes.
The intent of the original electronic cigarette company, Ruyan of Beijing, China, was to provide an innovative method to afford the physical sensation, flavor and nicotine hit of smoked tobacco without the irritating smoke and harmful effects of combustion. And according to a 2009 survey conducted by the Electronic Cigarette Association, the total number of current e-cigarette users exceeds 300,000.
The ecigarette, which ordinarily resembles a real cigarette, cigar or pipe, has a mouthpiece consisting of a plastic cup within a second cup. The inner cup holds a flavored liquid solution which may contain nicotine, depending on the preference of the user. The typical solution is diluted in propylene glycol or glycerin, which are common food additives.
Several nicotine strengths and flavor choices are available, with nicotine concentrations ranging from full flavor down to ultra lite, and with flavoring selections including vanilla, cherry, coffee, menthol, tobacco, and others, depending on the electronic cigarette manufacturer you choose to go with. You can also of course choose to have no nicotine at all. The outer cup allows air to flow around the inner cup so that the flavored liquid vapor can be drawn into the user’s mouth, a process known as vaping.
The controversy surrounding electronic smoking and vaping centers on the very few well-designed, peer-reviewed clinical studies demonstrating the actual health effects or potential dangers of the electronic cigarette. Powerful antagonists, including the FDA, Health Canada, the American Lung Association, and the American Heart Association, are actively taking steps to ban them altogether at the time of this writing.
There are a number of concerns voiced by the opposition, including:
1. Possible erosion of the public health benefits derived from anti-smoking campaigns.
2. The potential appeal to and addiction of children due to candy and fruit flavors.
3. Potential toxicity of propylene glycol and nicotine delivery.
4. The failure of the manufacturers to go through the approval process for a drug delivery system.
5. And the absence of the clinical study support of health benefit claims.
Proponents of electronic smokes produce equally convincing arguments. Smokers can use the ecigarettes in smoke-free environments because vaping does not produce smoke, odor, or by-products of combustion. Therefore, vaping around people is very different than smoking around them. Electronic smoking allows smokers to selectively reduce the nicotine and propylene glycol and eliminate exposure to other harmful products of traditional tobacco products, typically consisting of 43 carcinogens and 4000 chemicals.
Vaping also reduces the unpleasant social effects of smoking, including the odor on clothes, bad breath, stained teeth, stained fingers, and the need to go outside to smoke. And just as importantly to many people, switching over to the e-cigarette has been found in most cases to be comparatively cheaper than traditional cigarettes, and in many cases they are found to be ‘much’ cheaper.
Regarding concerns about propylene glycol, the oral toxicity of this product is quite low, with large amounts being necessary to cause health problems in humans. Serious toxic effects occur only at blood concentrations exceeding 4g/L, a level that is nearly impossible to reach by oral consumption. Cases of propylene glycol poisoning have occurred either due to improper intravenous use or to children inadvertently ingesting large quantities. The risk for long-term oral toxicity is also low. One study involving rats fed products containing up to 5% PG over a period of 104 weeks showed no apparent ill effects.
Propylene glycol has been classified by the FDA as “generally recognized as safe” (GRAS) for use as a direct food additive. In early 2007, Health New Zealand found in a study of electronic cigarettes that the devices emitted only trace amounts of carcinogens that are roughly equivalent to the concentrations detectable in nicotine patches. It also found that the exhaled PG mist is not harmful to bystanders.
A review of the FDA’s May 2009 report by Exponent, Inc, a scientific consulting operation, criticized the FDA for poor standards of both documentation and analysis as well as failure to conduct relevant comparative analysis of electric cigarettes to other FDA-approved nicotine replacement products. Without definitive studies, it is difficult to answer the question ‘is vaping harmful’ with absolute certainty.
However, the anecdotes of users has been generally favorable, with most users reducing their consumption of traditional tobacco products in favor of the smokeless cigarette. They appreciate the ability to enjoy and experience the physical and emotional sensations of “smoking” without having to contend with the fire, ashes, and thousands of toxic chemicals associated with tobacco cigarettes.