As New York and Chicago become the first major U.S. cities to propose tighter regulation of electronic cigarettes, the row over their safety has caught fire. Supporters believe the battery-operated cigarettes are a harmless alternative to tobacco smokers, while opponents say they may carry the same dangerous health effects.
Tom Kiklas, the president and co-founder of the Tobacco Vapor Electronic Cigarette Association, said he believes the fears about e-smoking, or "vaping," are unfounded, and a bit misleading.
"First of all, nicotine is classified as a secondary stimulant, the same as caffeine. People believe it is dangerous on an emotional level, but it is not a dangerous drug," Kiklas said.
But many health experts vehemently disagree with this statement, including Dr. Roy Herbst, the chief of medical oncology at the Yale Cancer Center in New Haven, Conn., and a spokesman for the American Association for Cancer Research.
"We do know that nicotine is an addictive substance, and that it affects blood pressure and the blood vessels. It could also have other noncancerous side effects," Herbst said.
Jason Levine, a clinical psychologist who specializes in smoking cessation at the Source Health and Wellness Treatment Center in Los Angeles, said he had seen e-cigarette usage lead to headaches, nausea and other symptoms consistent with nicotine poisoning.
"Some people suck on their e-cigarette all day long like it's a pacifier. You don't have to light up, only plug it in, and you can keep smoking without a break," he said.
Regarding suspicions about e-cigarettes causing cancer, Kiklas said these fears are also unproved. E-smoke vapor contains just five chemicals, he said, compared with the up to 9,000 chemicals that have been identified in tobacco smoke.
"The vapor is closer to regular water vapor than tobacco smoke, and poses no risk of any kind," he said.
Citing a 2009 Food and Drug Administration report comparing traditional cigarettes with the e-cigarettes, Kiklas claimed that e-cigarettes are 1,400 times less harmful than tobacco. The flavorings and glycerin used in e-cigarettes have been consumed for generations without causing harm to humans, he said.
Most experts will admit that the scientific research conducted so far suggests that electronic cigarettes do pose a much lower cancer risk than regular cigarettes, and that in particular, they carry a greatly reduced risk of lung cancer and other cancers as well as lower risks for lung disease and heart disease. However, as Dr. Bechara Choucair, the commissioner of health for the Chicago Department of Public Health stressed, the question is far from settled.
"It is difficult to evaluate the risks, because as of now, there are no federal regulations imposed on the more than 250 e-cigarettes now on the market, which means that there currently are no restrictions on the ingredients manufacturers can or cannot use," he said.
Until more is known about these products, limiting their use is just good common sense, Choucair said.
But Kiklas countered that more study was not necessary.
"We've been on the market for seven years and used by millions of people. There is no proof that a single person has been harmed by the product. There is nothing to study," he said.
And as for the idea that e-smoking can be a gateway to more hardcore tobacco use, especially among young people, Kiklas dismissed these claims as irresponsible and misleading. He said that e-cigarettes were regulated by the FDA as tobacco products and as such, companies are forbidden to advertise or market them to children.
"I defy you to name one e-cigarette company that targets minors," he said.
Coming in such flavors as Captain Crunch, Fruit Loops and Bubble Gum, e-cigarettes seem clearly designed to appeal to young people, many health experts say.
"When you see these flavors, it's pretty obvious that these flavors could be attractive to kids, said Vince Willmore, a spokesman for the Campaign for Tobacco Free Kids.
Willmore also said that many of the tactics used to market e-cigarettes are the same as what the tobacco companies have used to market cigarettes to kids.
"They have ads that use celebrities, race car sponsorships -- they have even used cartoons," Willmore said. "They don't do this to just appeal to adult smokers, who they say are their main targets."
E-smoking among young people is on the rise. A Centers for Disease Control and Prevention study found that nearly 1.8 million young people had tried e-cigarettes, and that the number of U.S. middle and high school student e-smokers doubled between 2011 and 2012. Levine said that up until last week, it was legal to sell e-cigarettes out of ice cream trucks in Los Angeles.
Choucair said the increase in e-smoking raises alarms, considering the products have only been available for a short time. He said the reason for Chicago's proposed ban on their use in public places is to protect people, particularly young people, until there is conclusive evidence either way regarding the safety of the product.
Such restrictions make sense for now, Kiklas said, because they mirror other tobacco product related policies, though he opposes any outright bans. He believes that as people understand the technology better, public opinion will evolve.
"They will come to view this as an innocuous product with nothing in the vapor that is harmful or dangerous to humans," he said.
Whether electronic cigarettes will help people quit smoking or lower their risk of tobacco-related diseases remains to be seen.
In the meantime, lung cancer remains the single greatest threat to the health of smokers, according to the American Cancer Society. In the United States, tobacco use is responsible for nearly one in five deaths, or 443,000 early deaths, each year.
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