Safe or not? The risk of electronic cigarettes

More studies are examining the risk of electronic cigarettes, according to the Winston-Salem Journal.

How safe are electronic cigarettes and what public health role could they play in reducing the risk from consuming tobacco products?

As the tobacco industry, consumers and public health advocates continue to wait on the Food and Drug Administration – five years and counting – to answer those questions, numerous studies have been submitted recently that either attempt to fill a scientific information void or promote a preferred regulatory outcome.

E-cigs are battery-powered devices that heat a liquid nicotine solution in a disposable cartridge and create a vapor that is inhaled. Vapor products, a rival category, can feature a liquid capsule that is inserted into a cartridge. Vapors offer consumers a wider variety of flavors, included fruits and candy.

The financial potential of e-cigs could be stout. Wells Fargo Securities analyst Bonnie Herzog estimated there was $2 billion in overall e-cig revenue last year. She projects up to $10 billion by 2017.

One study by researchers at UNC School of Medicine probed N.C. physicians’ attitudes toward e-cigs as a potential smoking cessation product for adult smokers. The study was published July 29 in the journal PLOS One by four physicians, three of whom are with the Department of Family Medicine at the UNC medical school.

About 67 percent of the 128 physicians surveyed indicated e-cigarettes are a helpful aid for smoking cessation, 65 percent believe e-cigs represent a lower risk of cancer than traditional cigarettes, and 35 percent recommended them to their patients.

That’s even though the FDA has not approved or recommended any e-cig for a smoking cessation option. None of the Big 3 manufacturers – Lorillard Inc. (blu eCigs), Philip Morris USA (MarkTen) and Reynolds American Inc. (Vuse) – market their e-cig brands as smoking cessation products even as each has gone national in distribution.

“Yet, e-cigarettes appear to play a substantial role in tobacco users’ cessation attempts,” the UNC researchers said. The physician participation breakdown was: 28 family medicine; 28 surgeons; 27 psychiatrists; 24 internal medicine and 21 obstetricians/gynecologists.

“Physicians were more likely to recommend e-cigarettes when their patients asked about them, or when the physician believed e-cigarettes were safer than smoking standard cigarettes.” Eighty percent said patients had asked them about e-cig usage.

The survey also found 64 percent of physicians also recommended “intensive tobacco treatment counseling”

The UNC researchers said FDA regulation “will help ensure patients receive evidence-based recommendations about the safety and efficacy of e-cigarettes in tobacco cessation.”

“Physicians should remain cautious until more data is available about recommending e-cigarettes as tobacco cessation tools in clinical practice in favor of more effective modalities,” the UNC researchers said.

The researchers said part of their caution comes from determinations in other research studies that e-cigs could serve as a gateway to traditional cigarette use, or as a way to circumvent public smoking bans.

“Without widespread dissemination of clear, evidence-based research on e-cigarettes, it is likely these discrepancies will continue, and patients could potentially be given inaccurate information,” the UNC researchers said.

A study in the journal Addiction, published in June, found that the vapor used in e-cigs “can contain some of the toxicants present in tobacco smoke, but at levels which are much lower.” The study by five researchers, two of whom had connection to a FDA tobacco panel, drew upon 81 different global studies.

R.J. Reynolds Vapor Co. is sponsoring a study to determine what potential risks there are in the vapor smoke emitted from an e-cig compared with a combustible cigarette. The study began in May with 72 participants at Clinical Research Atlanta and is expected to last until December, according to a filing on – a website for the National Institutes of Health.

“Long-term health effects of e-cigs are unknown, but compared with cigarettes, they are likely to be much less, if at all, harmful to users or bystanders,” the researchers said in the study in Addiction.

The researchers said that although e-cig use is increasing, “to date, there is no evidence of regular use by never-smokers or by non-smoking children. They enable some users to reduce or quit smoking.”

“Health professionals may consider advising smokers unable or unwilling to quit through other routes to switch to e-cigs as a safer alternative to smoking, and as a possible pathway to complete cessation of nicotine use.”

A third study, in the May edition of Journal of American Medicine Association’s internal medicine publication, said there is no conclusive evidence that e-cigs can play a role in smoking cessation, particularly in comparison with a nicotine patch.

“A longitudinal, international study found that, although 85 percent of smokers who used e-cigarettes reported using them to quit, e-cigarette users did not quit more frequently than nonusers,” researchers said.

“Among U.S. quitline callers, e-cigarette users were less likely to have quit at seven months than nonusers.”

That study has come under criticism for saying e-cig manufacturers are “aggressively promoting them as cessation ads” even though the Big 3 manufacturers confirm they have not marketed their products that way. There’s also been criticism that the study’s researchers have ties to pharmaceutical companies whose products could face competition from e-cigs as smoking cessation products.

In an accompanying editor’s note, Dr. Michael Katz said the FDA should regulate e-cigs as a drug-delivery device, and that e-cigs should not be allowed to be used in public places where traditional cigarettes has been banned.

“Unfortunately, the evidence on whether e-cigarettes help smokers to quit is contradictory and inconclusive,” Katz wrote. He did say he was willing to support their use if “there were good data indicating that they helped smokers to stop.”

Dr. Gilbert Ross, medical and executive director of The American Council on Science and Health, said “allowing e-cigs to compete with cigarettes in the marketplace might decrease smoking-related morbidity and mortality.”

“Regulating e-cigs as strictly as cigarettes, or even more strictly as some regulators propose, is not warranted on current evidence.”

John Spangler, a professor of family and community medicine at Wake Forest Baptist Medical Center, said recent studies “have tempered my enthusiasm for using electronic cigarettes for quitting, showing they might not help.” Spangler did not participate in the UNC research study.

“There is also the concern for long-term effects. Still, some of my patients have found them useful to either cut down or quit.

“So I tell patients the possible risks of e-cig use, the benefits some of my patients have found, and the unknowns regarding use. Then I let them decide.”


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