Are electronic cigarettes (e cigarettes) the answer to smokers prayers or a major threat to progress in reducing smoking rates? Too much remains unknown to provide a definitive answer to this question, but one thing is certain how these products are regulated will in large part determine whether they are a net benefit or a net harm to public health.

Jacob Sullum on e cigarettes Sowing confusion among anti smoking activists

E cigarettes have taken us back 50 years, according to the headline over a commentary that National Jewish Health, a medical centre in Denver, recently paid to place on the op ed page of The New York Times. The essay co authored by David Tinkelman and Amy Lukowski, who are in charge of the hospital s health initiatives, including its tobacco cessation program never substantiates that claim, which is typical of e cigarette critics who see a public health menace where they should see a way of reducing tobacco related disease and death.

You might think people concerned about the health effects of smoking would welcome an alternative that involves neither tobacco nor combustion and is therefore much less hazardous. But with some notable exceptions, anti smoking activists and public health officials have been mostly hostile to electronic cigarettes, which deliver nicotine in a propylene glycol vapour. This puzzling resistance seems to be driven by emotion rather than science or logic.

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At present, Health Canada has deemed that e cigarettes with nicotine and e cigarettes that make a health claim such as they can help you quit smoking fall under the Food and Drugs Act. As such, they cannot legally be imported, marketed or sold in Canada until they have undergone rigorous testing for safety, quality and efficacy and received approval as a drug/device. On paper, Canada has a strict regulatory regime for e cigarettes providing the gold standard in consumer protection, but the reality of the marketplace tells a very different story. The Wild West that is the current e cigarette market in Canada serves neither to promote quitting among current smokers nor to prevent youth from starting.

E cigarettes and e liquid with nicotine are widely available both online and at retail, with little enforcement action by Health Canada. Moreover, testing has demonstrated that products labelled as nicotine free often contain nicotine. There are no mandatory requirements regarding ingredient disclosure or provision of accurate information regarding strength of nicotine or relative risk of use. With no rigorous enforcement of good manufacturing practices, users cannot be assured that the devices meet general consumer safety standards. And with no controls on promotion, e cigarette companies, many of which are now owned by major tobacco companies, are using every trick in the tobacco industry s marketing playbook. For the first time in 40 years, ads showing sexy young men and women “smoking” are back on television.

Clearly, the status quo is not working. E cigarettes both with and without nicotine should be regulated the same way and should be subject to the same controls as tobacco products. It makes no sense that the most lethal consumer product ever made cigarettes can be sold with no restriction on nicotine content, but that e cigarettes, which are widely regarded by health researchers as much safer than their tobacco counterparts, cannot contain nicotine unless they are approved as medicines. It is a well known adage that smokers smoke for the nicotine, but die from the smoke. E cigarettes enable smokers to obtain the nicotine to which they are addicted, as well as satisfy the sensory and behavioural aspects of smoking, without inhaling the more than 4,000 chemicals, including over 50 carcinogens, in the tobacco smoke.

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Regulating e cigarettes in the same way as tobacco products would also allay many of the concerns of the health community that the widespread promotion and use of e cigarettes could serve to re normalize smoking, undermining the decades of progress in tobacco control. E cigarettes would be subject to controls on promotion, including bans on misleading ads and ads aimed at youth. Prominent retail displays of e cigarettes, themselves a form of promotion, would also be prohibited, as would the sale of e cigarettes to minors. While there is little evidence to date that e cigarettes are a new route to nicotine addiction or a gateway to smoking among youth, experimentation by teens and young adults is increasing rapidly, and it is too early to know the impact on the market of the tobacco companies financial might and marketing prowess.

Subjecting e cigarettes to the same controls as tobacco products would also mean that the use of e cigarettes in workplaces and public places would not be permitted, protecting non smoking workers and patrons from unwillingly inhaling the chemicals in second hand vapour. (While research suggests that the risks to others are likely quite small, especially compared to the risks of second hand smoke, there are few high quality scientific studies on the constituents of e cigarette vapour and too many unknowns to subject people to this risk unnecessarily.) As well, including e cigarettes in indoor smoking bans will promote cessation, by ensuring that smokers at work and play are not once again surrounded by cues to smoke and by reducing opportunities for dual use (of e cigarettes and cigarettes), which could also undermine quit attempts.

Smoking remains the number one cause of preventable disease and death in Canada and much more must be done to reduce the terrible toll on Canadians and their families. We know that the vast majority of smokers want to quit, but the current arsenal of cessation medications achieves low rates of long term abstinence. Two randomized controlled trials, numerous surveys and countless testimonials by users indicate that e cigarettes with nicotine, particularly second and third generation products, can be effective in helping smokers quit. And there is little doubt that they are safer than smoking cigarettes.

But that does not mean that they are absolutely safe. There is no research on the long term health impacts of inhaling propylene glycol or vegetable glycerin, the main ingredients in e lquid, into the lungs for months or years on end. Nor can there be for some time, given how new this product is.

Health Canada must do much more to ensure that the e cigarettes sold in Canada meet basic product safety standards, are accurately labelled, and provide full ingredient disclosure. At the same time, critical gains in driving down smoking rates need to be protected by ensuring that e cigarettes do not re normalize smoking and entice a new generation of youth into a life of nicotine addiction. Regulating e cigarettes as tobacco products offers the best way forward and the best hope for promoting quitting and enhancing prevention.

National Post

Melodie Tilson is director of policy for the Non Smokers Rights Association.

5 facts about e-cigarettes – abc news

E-cigarettes-online.net

The decision in a 2011 federal court case gives the Food and Drug Administration the authority to regulate e smokes under existing tobacco laws rather than as a medication or medical device, presumably because they deliver nicotine, which is derived from tobacco. The agency has hinted it will begin to regulate e smokes as soon as this year but so far, the only action the agency has taken is issuing a letter in 2010 to electronic cigarette distributors warning them to cease making various unsubstantiated marketing claims.

For now, the devices remain uncontrolled by any governmental agency, a fact that worries experts like Erika Seward, the assistant vice president of national advocacy for the American Lung Association.

“With e cigarettes, we see a new product within the same industry tobacco using the same old tactics to glamorize their products,” she said. “They use candy and fruit flavors to hook kids, they make implied health claims to encourage smokers to switch to their product instead of quitting all together, and they sponsor research to use that as a front for their claims.”

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Thomas Kiklas, co owner of e cigarette maker inLife and co founder of the Tobacco Vapor Electronic Cigarette Association, countered that the device performs the same essential function as a tobacco cigarette but with far fewer toxins. He said he would welcome any independent study of the products to prove how safe they are compared to traditional smokes.

The number of e smokers is expected to quadruple in the next few years as smokers move away from the centuries old tobacco cigarette so there is certainly no lack of subjects,” he said.