From Dysfonction érectile - Tobacco Info No. 4 - February 2011
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More questions than answers
about e-cigarettes

By Joe Strizzi

With the popularity of e-cigarettes growing worldwide, Canadians are beginning to ask questions about the potential of an e-cig as a quit smoking aid. Unfortunately, there are many more questions than answers.

In March 2009, Health Canada advised against the purchasing or use of electronic smoking products, “as these products may pose health risks and have not been fully evaluated for safety, quality and efficacy by Health Canada. These products come as electronic cigarettes, cigars, cigarillos and pipes, as well as cartridges of nicotine solutions and related products. These products fall within the scope of the Food and Drugs Act, and under the Act, require market authorization before they can be imported, advertised or sold.” Australia has banned nicotine-delivering e-cigs, while a complete ban has been put in place in Brazil.

An email to a spokesperson from the federal Health Department confirmed that Health Canada still “has not granted market authorization for any e-cigarettes containing nicotine. As a result, no one in Canada is permitted to import, advertise or sell them.”

What is an e-cigarette?

An e-cigarette is a battery-powered device that provides inhaled doses of nicotine or non-nicotine vaporized solution that may contain such chemicals as propylene-glycol and diethelyne-glycol, which can be found in anti-freeze. In addition to purported nicotine delivery, this vapour also provides a flavour and physical sensation similar to that of inhaled tobacco smoke, while no smoke or combustion is actually involved in its operation.

An electronic cigarette takes the form of an elongated tube, though many are designed to resemble the outward appearance of real smoking products, such as cigarettes, cigars and pipes. Another common design is the ‘pen-style,’ so named for its visual resemblance to a ballpoint pen. Most electronic cigarettes are reusable devices with replaceable and refillable parts. A number of disposable electronic cigarettes have also been developed. Although exact dates are unknown, industry executives claim that e-cigs made their debut in China around the year 2000 and started popping up in North America in 2007.

Misleading statements and half-truths

Despite Health Canada’s warning, e-cigs are making their way into the hands of Canadians through online providers and, according to the CBC, through some retailers across the country. However, not only is it illegal to sell or import them, but ‘buyer beware’ advice is rampant as the e-cigarette world is replete with misleading statements, half-truths and outright lies.

According to a two-part report by AOL News in September 2010, marketing statements made by sellers of these devices make promises that they can’t keep, including calling the e-cigarette a smoking cessation aid. “Scores of websites are filled with identical descriptions, product photos and claims, most promising a better, healthier life and the ability to smoke absolutely anywhere you want. There are links to hundreds of pseudo-news stories and mock television broadcasts, all touting the wonderful aspects of the Chinese made devices,” wrote Andrew Schneider, author of the special report.

According to his research, many of these websites used identical texts, but the bylines were different and contained strong implications that the devices, flavouring liquids and nicotine cartridges have been extensively tested. However, there is no mention as to who did the testing and when.

Early studies indicate a need for caution

Researchers at the University of California, Riverside, evaluated five e-cigarette brands and found design flaws, lack of adequate labelling, and several concerns about quality control and health issues.

The findings reported last December in EurekAlert.org, a website of the American Association for the Advancement of Science, state that batteries, atomizers, cartridges, cartridge wrappers, packs and instruction manuals lack important information regarding e-cigarette content, use and essential warnings; and e-cigarette cartridges leak, which could expose nicotine, an addictive and dangerous chemical, to children, adults, pets and the environment. Currently, there are no methods for proper disposal of e-cigarette products and accessories, including cartridges, which could result in nicotine contamination from discarded cartridges entering water sources and soil and adversely impacting the environment. Also the manufacturing, quality control, sales and advertisement of e-cigarettes are unregulated.

“Contrary to the claims of the manufacturers and marketers of e-cigarettes being ‘safe,’ in fact, virtually nothing is known about the toxicity of the vapours generated by these e-cigarettes,” said Kamlesh Asotra, a research administrator at the University of California Tobacco-Related Disease Research Program. “Until we know anything about the potential health risks of the toxins, the ‘safety’ claims of the manufacturers are dubious at best.”

An opinion piece released in mid-December in the journal Annals of Internal Medicine further highlights the potential hazards of e-cigarettes, suggesting they may not be as benign as they seem. The authors wrote that the devices pose several health concerns. “First, e-cigarettes may pose a risk as starter products for nonusers of tobacco. Also, the posturing of e-cigarettes as ‘green’ and ‘healthy’ could deceptively lure adolescents. E-cigarettes also may represent a way for adolescents and adults to skirt smoke-free indoor air laws.”

South of the border

In the US, the Food and Drug Administration (FDA) has recently banned candy-flavoured tobacco products and e-cigarettes in efforts to hinder marketing toward children, but a recent federal appeals court ruling found that electronic cigarettes should be regulated as tobacco products by the FDA rather than drug delivery devices. This ruling means that e-cig makers won’t have to conduct expensive clinical trials to prove to the FDA that their products are safe and effective stop-smoking aids. The agency filed a petition on December 21 with the US Court of Appeals to review the ruling.

Toxicologists, experts and cancer specialists from the US National Institutes of Health, the Centers for Disease Control and Prevention and the FDA have long been concerned with the potential hazards of using these devices.

“It’s criminal to allow diacetyl and other untested flavouring agents to be used in these devices,” said Dr. David Egilman, clinical associate professor at Brown University’s Department of Family Medicine, an expert witness in numerous cases for people allegedly harmed by diacetyl. “At the very least, it’s not smart to intentionally inhale substances that have been proven to cause irreversible lung disease.”

The limited analysis that the FDA has conducted shows potentially serious problems. The study entitled Evaluation of E-Cigarettes, conducted by the Center for Drug Evaluation and Research in early 2009, found nicotine present in e-cigs advertised as nicotine-free. In all, 19 different e-cigarette brands from two major distributors were examined with disturbing results, including significant quality problems indicating that quality-control processes used to manufacture these products are substandard or nonexistent; cartridges labelled as containing no nicotine contained nicotine; and three different electronic cigarette cartridges with the same label emitted a markedly different amount of nicotine with each puff. In addition, certain tobacco-specific nitrosamines, which are human carcinogens, were detected in half of the samples tested; tobacco-specific impurities suspected of being harmful to humans, such as anabasine and myosmine, were detected in a majority of samples tested.

Further concerns

Another growing concern is that youths may be the target of the marketing campaigns by sellers of these devices with e-cig flavours like bubblegum, buttered popcorn, fudge and cookie dough.

In addition, e-cigarettes are gaining exposure among teenagers from celebrity users like Katherine Heigl, former star of the TV series Grey’s Anatomy, who puffed away on one during an appearance on CBS’s Late Show in September, telling host David Letterman that they were not harmful. Unfortunately, it seems, Heigl is just another victim of false and unsupported promises.