E-Cigarettes Under Fire


“They are electronic, alternative smoking devices that simulate the sensation of cigars, and e-pipes, and have refused entry of these products into the country. We acted because these products appear to require FDA approval for marketing, and have not been reviewed by the agency.”

An informal FDA review of some of these products “indicated that these products are not currently approved,” Chappelle says.

If the FDA bans e-cigarettes, an action many observers believe imminent, it won’t be the first North American agency to do so. Last month, Canada’s health agency banned the importation or sale of e-cigarette products.

What’s all the fuss about? At the smoking cessation device and says his company does not make that claim. He also says his product is not sold to minors.

Youngblood does make this claim: E-cigarettes are green.

“There is no pollution of the environment with this product,” he says. “The vapor is not the same as smoke. And for every odor-free e-cigarette cartridge people throw in the trash, smokers throw 20 smelly cigarette butts out their car windows.”

Some firms do suggest that e-cigarettes are safer than tobacco cigarettes. Most point to a Ruyan-funded study by tobacco researcher Murray Laugesen, MBChB, of Health New Zealand, a private research firm.

Laugesen analyzed Ruyan e-cigarettes and found nothing inherently bad in them — that is, they contained what they said they contained and posed little threat of immediate harm.

But this was not a clinical study, notes Norman Edelman, MD, chief medical officer of the American Lung Association, one of the organizations that has called for an FDA ban on e-cigarettes.

“Laugesen is trying to project what the effects of e-cigarettes might be, but he doesn’t really know,” Edelman tells WebMD. “There are no clinical studies of long-term use of these products.”

And some firms do claim that e-cigarettes help people quit smoking. After all, there’s an FDA-approved nicotine inhaler already in drug stores — Pfizer’s Nicotrol. It doesn’t look much like a cigarette, but it doesn’t look much different than some e-cigarette products.

What’s the difference?

“The Nicotrol inhaler is an approved smoking cessation device,” says the FDA’s Chapelle. “Because these e-cigarette products haven’t been reviewed by the agency, their labeling has to be reviewed, their intended use has to be reviewed, and all of their ingredients and components have to be reviewed.”

E-Cigarettes: Bad?

Edelman says nicotine addiction is bad and that people with the habit need help quitting, not help continuing their habit in more socially acceptable ways.

And there’s no proof that e-cigarettes don’t cause long-term harm. That’s what bothers all the health experts who discussed e-cigarettes with WebMD.

“We cannot say they are good or bad because we don’t have any scientific proof,” says Eliana Mendes, MD, a pulmonology researcher at the University of Miami.

“What happens to someone who stops inhaling the tars of cigarettes and just inhales nicotine? We don’t know,” Edelman says. “We are talking about use that might be three years, five years, 10 years, we just don’t know. Once you have the nicotine habit, you are not likely to quit.”

Rather than quit, e-cigarettes might worsen users’ nicotine habits, says Michael Eriksen, ScD, director of the institute of public health at Atlanta’s Georgia State University and former director of CDC’s office of smoking and health.

“I have seen no evidence that people switch from tobacco cigarettes to e-cigarettes or other smokeless tobacco products,” Eriksen tells WebMD. “If you look at how smokeless products are marketed, they are sold as something to use at times you can’t smoke. The implication is you will increase nicotine exposure, not reduce smoking. We’ll just be encouraging people to use more nicotine.”

Youngblood says his e-cigarette products are being marketed only to people who already smoke and already have a nicotine addiction. But Eriksen says the unregulated sale of these products might get new users hooked — users who might then start smoking.

“Will e-cigarettes get fewer people smoking? Or will people start with e-cigarettes and graduate to tobacco cigarettes? It is unknown whether these things are good, bad, or indifferent,” he says. “If for every person who used e-cigarettes there was one fewer person smoking tobacco cigarettes, that would be good. But there is no evidence that will occur.”

And there’s one more issue that troubles doctors. University of Miami pediatrician and lung specialist Michael Light, PhD, says underage users will get their hands on e-cigarettes — even if marketers like Youngblood refuse to sell them to minors.

“It will be easy for kids to get the product,” Light tells WebMD. “It could be a way to get kids into the nicotine habit to get them to smoke. It is a ploy.”