Features & Columns

E-Cigarettes Replacing Tobacco Butts but Health Questions Persist

E-cigarette UP IN VAPOR: Eric Lunn, owner of It Is Vapor 7, opened his high-end e-cigarette store earlier this year after similar products helped him quit smoking tobacco in 2011. Photograph by Josh Koehn

Eric Lunn tried everything to quit smoking. He went cold turkey, but quickly went back to cigarettes. He tried a nicotine patch, but that didn't help either. "I was smoking with the patch on," Lunn says, laughing. "That made me sick."

But two years ago, the 36-year-old tried something that did work—electronic cigarettes.

Also known as e-cigarettes, the tobacco alternatives first hit U.S. markets in 2007. In just six years, they've become a $500 million industry. The slim, battery-powered devices simulate smoking by heating a cartridge of nicotine and flavored liquid into vapor that the user inhales, or "vapes." Many brands of e-cigs are designed to look like traditional cigarettes, but they don't contain any of the tobacco or tar—so they've been touted as a healthier alternative to smoking, and a safe way to kick the habit.

Lunn, who says he "officially, 100 percent quit" the same day he tried e-cigarettes, calls e-cigarettes "the most realistic" way to quit, since they allow him to adjust the amount of nicotine to gradually wean himself off, while satisfying his hand-to-mouth craving. It doesn't hurt his enthusiasm that e-cigarettes are his business. In March, he opened It Is Vapor7, an e-cigarette store in San Jose.

"I just wanted to try to get as many people on what I was doing, because I felt so much better," he says. From the time he stopped using tobacco, he noticed his sense of smell and taste returned, his energy level rose, and he was no longer "coughing up anything odd."

While many former smokers tout the benefits of e-cigarettes, the medical community isn't so sure. For one, they've never been studied in-depth.

The U.S. Food and Drug Administration has yet to approve a single e-cigarette for "therapeutic" purposes, i.e., smoking cessation, which means that no e-cigarette has officially been determined a safe and effective method to help quit smoking. Erika Sward, assistant vice president for national advocacy at the American Lung Association, says that if e-cigarette companies truly believe their products are healthy, they would submit them for FDA review.

"That is something any company could do today," she says.

A preliminary report published last week in The Lancet, a peer-reviewed medical journal, shows that e-cigarettes may be as effective as nicotine patches in helping smokers quit. But Daniel Ouellette, senior staff physician in the pulmonary division at Henry Ford Hospital in Detroit and a member of the American College of Chest Physicians, says these findings aren't as positive as they seem. The best smoking cessation programs produce about a 50 percent quit rate, he says, compared to the 7 percent of e-cigarette users in the study.

In addition to the questionable usefulness in quitting smoking, medical experts worry about the side effects e-cigarettes may have. "There's very little known about their short- and long-term health implications," says Sward. The FDA does not regulate e-cigarettes—even though it oversees the tobacco version—so consumers don't know exactly what they're vaping, or what the risks may be. And with more than 250 brands currently available, each made up of a different combination of ingredients, the range of potential health impacts could be wide.

The only information the FDA has comes from a 2009 laboratory analysis of two brands, which revealed the presence of carcinogens and toxic chemicals—including diethylene glycol, an ingredient found in antifreeze.

Ouellette also points out that on top of all of these unknowns, the one known ingredient in e-cigarettes—nicotine—should be enough to make consumers wary. Nicotine has "harmful effects," he says, including nausea, increased heart rate and cardiac irritability—and, of course, addiction.

"It's entirely possible that the purpose for making these cigarettes by some manufacturing companies might be to have some persons—particularly young persons—become addicted to nicotine," Ouellette says. "So instead of being a method to help people quit smoking, it may be an introduction for some people to start smoking."

The idea of e-cigarettes as a "gateway" to nicotine addiction and other tobacco products is supported by new data from the Centers for Disease Control and Prevention, which show that vaping among young people—who are far less likely to do it to quit smoking—has dramatically increased. The number of youth who have used e-cigarettes doubled between 2011 and 2012, and 10 percent of high school students now report trying the product. And without federal regulation, minors are able to buy e-cigarettes in many states. (In 2011, California banned the sale of e-cigarettes to those under the age of 18. Lunn says his business, which is admittedly high-end, only targets adult connoisseurs.)

"With flavors like bubblegum, atomic fireball and orange soda, we certainly are convinced that e-cigarette manufacturers are marketing their products to kids," Sward says. "We want to make sure that kids are not beginning an addiction that will ultimately kill them."

Also at stake is second-hand vapor, which manufacturers claim has no harmful effects. Most cities have gone along with this, excluding e-cigarettes from public smoking bans, so that people can vape in bars, restaurants and other public places. But Ouellette says this may not be a safe assumption.

"No one knows about the vapor," he says. "For many years, we thought that people who didn't smoke but were around those who did were not in danger—but of course, we now know that's not true at all."

The debate over second-hand vapor—and the general safety of e-cigarettes—is playing out locally, as California debates whether to amend the statewide public smoking ban to include vaping. Senate Bill 648, which passed through the Senate in May, is awaiting review by committee. While local health groups, such as the California Academy of Family Physicians, support this legislation, Lunn, owner of It Is Vapor, expresses disappointment.

"I'm super passionate about what I do here," he says. "I truly believe that more and more people will get on this, and soon enough, it will completely kill the cigarette market."