TIME Addiction

Big Tobacco Is Ramming Home the Message About the Dangers of E-Cigarettes

World Health Organisation Calls For Regulation Of Ecigarettes
In this photo illustration, a woman smokes an E-Cigarette at the V-Revolution E-Cigarette shop in Covent Garden on August 27, 2014 in London, England. Dan Kitwood—Getty Images

Think of it as corporate image enhancement

When it comes to e-cigarettes, large tobacco companies are suddenly stepping up warnings about their own products, the New York Times reports.

“Nicotine is addictive and habit forming, and is very toxic by inhalation, in contact with the skin, or if swallowed,” reads a warning on packets of e-cigarette made by Altria, the company that manufactures Marlboro cigarettes.

Industry experts and critics say the warnings are serving as a legal safeguard or a corporate image-enhancer.

“Is this part of a noble effort for the betterment of public health, or a cynical business strategy? I suspect the latter,” said Dr. Robert K. Jackler, a professor and researcher on e-cigarette advertising at the Stanford School of Medicine.

MarkTen, a prominent e-cigarette brand, features a 100-word warning that, among other things, reiterates that e-cigarettes are not a way to wean oneself off cigarettes. This warning also appears on Reynolds American’s Vuse e-cigarettes.

According to Altria spokesman William Phelps, the MarkTen warning is created with a “a goal to openly and honestly communicate about health effects.”

“Why wouldn’t you warn about ‘very toxic’ nicotine on your cigarettes, when you do so on e-cigarettes?” is Jackler’s only question.

According to the Times, experts say the strategy is low-risk for the big tobacco companies because many people don’t read the warnings anyway.

[NYT]

TIME Addiction

Debate Over E-Cigarettes Lights Up

The debate over the safety of e-cigarettes, and whether they will help smokers to quit, or simply make it easier for them to start or continue lighting up, heated up this week.

On one side of the disagreement are those pushing for regulation. In 2013, the World Health Organization (WHO) began a review of data on e-cigarettes and based on studies conducted so far, last month recommended tighter regulation of the devices to protect consumers’ health. But in a new article published in the journal Addiction, other scientists argue that the WHO misinterpreted the data in a “misleading” way and that the group’s advice for more stringent oversight is problematic.

In the Addiction paper, the authors take issue with nine of WHO’s conclusions, some of which surround the safety of e-cigarettes, their toxin levels, and how likely younger people are to adopt them. They cite some of the same data as the original WHO review did, but interpret it differently, arguing that the benefits of e-cigarettes, especially as an effective tool in helping some smokers to quit, outweigh potential risks from the chemicals and nicotine used in the devices. Therefore, they say, e-cigarettes should be more accessible than the WHO recommendations would allow.

“…The WHO’s approach will make it harder to bring these products to market than tobacco products, inhibit innovation and put off smokers from using e-cigarettes, putting us in danger of foregoing the public health benefits these products could have,” said Ann McNeill, lead author of the paper and professor of tobacco addiction at King’s College London, in a press release. They’re not the only ones who have pushed back against the recommendations. More than 50 experts in public health signed a letter calling for a lighter approach, reported the New York Times.

Why the opposing interpretations of the same data? E-cigarettes are so new that research hasn’t had a chance to catch up with their meteoric rise in popularity. Some of the data based on earlier models of the devices, for example, might not even apply to e-cigs as we know them today, since the product has evolved so rapidly. The body of research is small. And because the devices are so new, much of it is funded by e-cigarette manufacturers.

In the latest paper in Addiction, for example, some of the work by one of the heavily-cited authors of the paper was conducted with funding from the e-cigarette industry.

On the first page in the “competing interests” section, the article discloses the following about Konstantinos Farsalinos of the Onassis Cardiac Surgery Center in Greece (click “Get PDF” at the link):

Some studies performed by KF were carried out using funds provided to his institution (Onassis
Cardiac Surgery Center) by e-cigarette companies.

In the paper’s 45 references, Farsalinos is listed as an author in nine of them; it’s unknown which of those studies were conducted with the help of e-cigarette funding.

It’s not uncommon for someone who makes a product to then sponsor research on that product, and it doesn’t mean the findings are worthless, says Steven Schroeder, a professor in the department of medicine and head of the Smoking Cessation Leadership Center at the University of California, San Francisco. (Schroeder does not conduct research on e-cigarettes.) But it also doesn’t mean the results are entirely objective, either. The potential for bias leads journal editors such as those at the peer-reviewed Addiction to require conflict disclosures from both its authors and its senior editorial staff.

It’s not clear yet whether e-cigarettes will turn out to hurt or help smokers. It’s probable that they will contribute to a range of health effects, both positive — as a smoking cessation device — and negative — as a potential gateway to tobacco-based cigarettes or other drugs. The evidence, at the moment, points in both directions.

TIME Addiction

E-Cigarettes Are Gateway to Substance Abuse and Addiction

An e-cigarette on March 05, 2013 in Paris.
An e-cigarette in Paris on March 05, 2013 Kenzo Tribouillard—AFP/Getty Images

Nicotine, in any form, can prime the brain for harder drugs

For a product so young, e-cigarettes are already generating volumes of research. And the latest, appearing in the New England Journal of Medicine, suggests that e-cigarettes serve as a “gateway drug” — meaning they could make users more likely to use, and become addicted to, other drugs like cocaine.

The wife-husband research team Denise Kandel and Eric Kandel has been studying nicotine for years, and in their earlier work they found that nicotine dramatically enhanced the effects of cocaine by activating a reward-related gene and shutting off inhibition. When mice had nicotine before cocaine, they behaved differently too — they ran around more and spent more time in the space where they were fed, likely driven by a need to satisfy their craving for the drug.

Denise’s epidemiological data shows that similar effects might be occurring in people; most who start taking cocaine were smoking at the time, and her studies showed that nicotine can prime users to turn to harder drugs to keep the reward system satisfied. While e-cigarettes don’t contain the tar and other byproducts of regular tobacco-burning cigarettes, they still rely on nicotine, and the Kandels believe they would lead to similar use of other drugs. “E-cigarettes are basically nicotine-delivery devices,” she says, and Eric agrees. “This is a powerful facilitator for addiction to cocaine and perhaps other drugs as well,” he says. “If people knew that this is in fact the danger … they’d be much less enthusiastic about using nicotine.”

While some, including those in the health community, have supported e-cigs as a tool to help smokers quit, the backlash against them has been building. Last month, the American Heart Association released a policy statement calling for stricter laws, more industry oversight, and a ban on marketing and selling e-cigs to adolescents. Toronto just banned e-cigs from the workplace. And the World Health Organization recommended a host of new regulations around the growing e-cigarette market. At the same time, it’s not clear whether the devices actually help smokers to kick the habit; at least one study found that they don’t.

The Kandels argue that it’s time to consider nicotine’s effect not just on the lungs but on the brain as well. “The fact that this is a significant influence on encouraging or facilitating the use of other drugs is never discussed, and it’s just a major omission,” Eric says.

“We’ve worked very hard to reduce smoking in this country, and I think it’s been a fantastic success,” Denise says. With the introduction of e-cigs, “Now I think we’re on the verge of destroying all of the progress that we’ve [made].”

TIME Addiction

WHO Urges Tighter Regulation of E-Cigarettes

A woman smokes an "Blu" e-cigarette in Washington, D.C., on Sept. 25, 2013.
A woman smokes an "Blu" e-cigarette in Washington, D.C., on Sept. 25, 2013. Jim Watson—AFP/Getty Images

The United Nations agency acknowledged both the "promise and threat" of the $3 billion industry

The World Health Organization recommended countries adopt a raft of tighter regulations over the sale and use of e-cigarettes Tuesday, including a ban on sales to minors, a ban on “vaping” indoors and tighter controls over advertising and flavored products.

The United Nations agency released a report on Tuesday that acknowledged both the “promise and threat” of the e-cigarette market, Reuters reports. The authors cast doubt on e-cigarette makers’ claims that the devices could help smokers kick the habit. Until those claims had been substantiated by a stronger body of scientific evidence, the U.N. health agency recommended that countries adopt regulations that would “minimize content and emissions of toxicants.”

Suggested regulations include restrictions on advertisements promoting e-cigarettes as a healthy alternative to smoking, prohibitions on sales to minors and sweetened flavors that might appeal to minors and a ban on using the devices indoors. The Food and Drug Administration proposed similar restrictions on sales to minors and advertising of e-cigarettes in April, but stopped short of banning television advertising or sweetened flavors.

The report comes amid a widening divide in the scientific community as to whether e-cigarettes constitute a help or a hindrance in the battle to stop people smoking. A group of 53 scientists signed an open letter to the WHO earlier this year urging officials to resist any measures that might suppress sales of e-cigarettes, calling them “part of the solution” in the fight against smoking.

[Reuters]

TIME E-Cigarettes

Toronto Bans E-Cigarettes From City Workplaces

An e-cigarette on March 05, 2013 in Paris.
An e-cigarette in Paris on March 05, 2013 Kenzo Tribouillard—AFP/Getty Images

Mayor Rob Ford reportedly voted against the ban

The Toronto City Council voted 36-2 in favor of banning e-cigarettes from all city workplaces on Monday.

According to a Toronto Sun reporter, Mayor Rob Ford was one of the two votes against the ban.

The vote was part of a marathon session for the city council which could last several days and will address some 400 items from e-cigarettes to traffic lights.

Toronto is not the first major city in North America to issue a prohibition on e-cigarettes. In March, Los Angeles became the third city after New York and Chicago to outlaw e-cigarettes at the office, and Philadelphia followed soon after.

But the L.A. ban extended further than city workplaces with bans in place for bars, restaurants, and parks. In New York, e-cigarette smokers cannot vape anywhere where conventional smoking is also banned, and in Chicago, there’s an indoor smoking ban in place. Smaller cities have also taken up the issue, and it’s expected that more cities will consider similar bans.

Health Canada, the government’s public health department, advised Canadians not to buy e-cigarettes as long ago as 2009, CTV News reports, but there are no formal prohibitions on the sale of e-cigarettes unless they are “expressly intended” for nicotine delivery. That allows many retailers to circumvent a crackdown by regulators.

Earlier this year, the FDA said it would increase its regulation over e-cigarettes, and on Sunday night, the American Heart Association called for stricter oversight, especially when it comes to marketing to kids.

TIME Addiction

E-Cigs Should Only Be “Last Resort” for Quitters, Experts Say

A salesman waits for customers as he enjoys an electronic cigarette at a store in Miami, Florida on April 24, 2014.
A salesman waits for customers as he enjoys an electronic cigarette at a store in Miami, Florida on April 24, 2014. Joe Raedle—Getty Images

E-cigarettes are everywhere—and are reportedly quitters’ favorite tool with some experts claiming it’s a healthy alternative to traditional tobacco. But vaping doesn’t deserve its health halo, says the American Heart Association (AHA) in a policy statement released today in its journal Circulation.

The group calls for an overhaul of how we deal with e-cigs, advocating for stricter laws, industry oversight by the government, and more rigorous research.

Right now, e-cigs are a Wild West industry, with 10 new companies coming to market every month. The FDA doesn’t yet regulate them—though the agency plans to—fueling concerns about possible contaminants, quality control, labeling, and marketing. There’s not much research about the public health impacts of e-cigs. Yet they’re a big business, and sales are expected to rake in $10 billion by 2017, according to predictions by Wells Fargo.

Many people use e-cigs, many of which contain nicotine but not tobacco, to wean themselves off of cigarettes. Their reputation as cigarette-cessation tools is widespread—though more research is needed to see if that reputation is warranted. “We don’t have much data on the efficacy as a cessation aid,” lead author Aruni Bhatnagar, chair of cardiovascular medicine at the University of Louisville, tells TIME. E-cigarettes aren’t approved by the FDA as tools to help people quit, and the AHA says that there’s a lack of evidence that they actually work for that purpose. However, some studies suggest e-cigarettes may perform as well or a bit better than nicotine patches, so they should be viewed as a last resort when other methods fail.

Another concern is marketing to young people. Television ads for e-cigarettes reached an estimated 24 million youth between 2011 and 2013, the AHA report says. And a separate CDC study released today in the journal Nicotine and Tobacco Research found that more than a quarter of a million youth who’ve never tried a cigarette puffed the electronic version in 2013. That’s a three-fold increase from 2011-2013.

“We have grave concerns about industry marketing and advertising of e-cigarettes to children,” Bhatnagar says. The AHA is calling for a federal tax on e-cigarettes, which may help deter young would-be adopters, in addition to a ban on flavorings. (E-cigs come in more than 7,000 flavors like mint and chocolate, which tend to appeal to younger users.) And while many states ban the sale of e-cigarettes to minors, the AHA is calling for a federal ban on the sale to minors.

Walk into any smoke-free area and you’re bound to encounter e-cigarettes—another fact the AHA wants to change by subjecting e-cigarettes to the same laws as tobacco products. On Monday, Toronto joined the growing list of cities banning e-cigs in the workplace.

There’s still a lot we don’t know about e-cigarettes, including how chemicals and nicotine interact with the environment and bystanders, and normalizing smoking behavior undoes years of anti-smoke crusading, the AHA says. So the group recommends that e-cigs be classified as tobacco products to subject them to the same smoke-free air laws.

“We don’t have much data on what their long-term health impact is going to be,” Bhatnagar says. “It will be five to seven years before we know what happens to cardiovascular health.”

TIME Heart Disease

E-Cigs Should Be Last Resort for Quitters, Heart Group Says

A salesman waits for customers as he enjoys an electronic cigarette at a store in Miami, Florida on April 24, 2014.
A salesman waits for customers as he enjoys an electronic cigarette at a store in Miami, Florida on April 24, 2014. Joe Raedle—Getty Images

The American Heart Association calls for tighter e-cigarette regulations, but gives the OK for a small amount of smoking cessation use

Electronic cigarettes should be used to help smokers quit only if proven cessation methods like nicotine patches fail, the American Heart Association said late Sunday.

The AHA acknowledged that e-cigs haven’t yet been proven to be good tools for quitting smoking, though some research has suggested they may be about equal to or slightly better than nicotine patches. The new recommendation is part of the AHA’s policy statement on e-cigarettes. The AHA calls for more regulation of e-cigs, which is something the FDA has promised in the past. The AHA says it fears any further delay in these regulations could have serious public health consequences.

Specifically, the AHA calls for new and stronger regulations for how e-cigarettes are marketed, especially to young people. It recommends a ban on sales to minors, since some research has shown that young people consider using e-cigarettes as a convenient method for smoking. Public health experts have long worried that e-cigarettes could serve as a gateway to other tobacco products, like the much unhealthier conventional cigarettes.

The group says some research suggesting e-cigarettes could normalize smoking are troubling, especially data showing youth exposure to e-cigarette advertising has spiked 250% from 2011 to 2013. “These disturbing developments have helped convince the association that e-cigarettes need to be strongly regulated, thoroughly researched and closely monitored,” AHA CEO Nancy Brown said in a statement.

Whether e-cigarettes are just another vector for nicotine exposure to American youth is a hotly debated topic among public health experts. Some hold the belief that pushing smokers toward lower-level nicotine carriers could ultimately help people quit, while others say there’s no space for more addictive products in the U.S. market.

TIME Addiction

E-Cigs Are Smokers’ Favorite Quitting Tool

A patron demonstrates an e-cigarette at Vape store in Chicago, April 23, 2014.
A patron demonstrates an e-cigarette at Vape store in Chicago, April 23, 2014. Nam Y. Huh—AP

"The fact that there isn't industry-wide, definitive proof that e-cigs help all smokers quit for good may be irrelevant to smokers"

Electronic cigarettes are a more popular tool for smokers trying to quit than nicotine gums and patches, according to a new study of consumer behavior from Kantar Media. As e-cigarettes have exploded from niche product to $2 billion-plus industry, big tobacco isn’t the only industry facing disruption. E-cigarettes are shaking up the pharmaceutical business too.

Of the adults who used a product to help them quit smoking in the past 12 months, 57% chose e-cigarettes, compared with 39% who used a prescription drug like Chantix and 39% who used other over-the-counter methods including nicotine gum and patches, according to the study. The study’s results are based on more than 20,000 responses to a questionnaire about health-related behavior mailed to a random sample of about 50,000 American households. The results do not show whether or not e-cigarettes are effective at helping people quit — just that people are trying them.

E-cigarette makers are legally prohibited from making claims that their products can help smokers quit. Among scientists, the question of whether or not e-cigs can really help smokers quit remains unanswered. A highly publicized study of almost 6,000 smokers trying to quit in England, published in the journal Addiction in May, showed that they were more likely to successfully quit if they used e-cigarettes than products like nicotine patches and gum. But the quit rate, while better than other options, was still relatively low — and this was among a group of smokers highly motivated to quit. The health effects of electronic cigarettes are also largely unknown.

But the Kantar Media study results show that right now, for smokers, the science on e-cigs may not matter. “The fact that there isn’t industry-wide, definitive proof that e-cigs help all smokers quit for good may be irrelevant to smokers,” reads Kantar Media’s summary of the findings. And, whether or not the science supports it, e-cigarettes make their users feel better about their health. E-cigarette users are 35% more likely than all adults to say their current health is much or somewhat better than it was a year ago, according to the study. Cigarette smokers were, unsurprisingly, less likely than most adults to think their health had improved. Interestingly, e-cig users were more likely to report feeling healthier than were people using other smoking-cessation methods.

The study also offers a window into the typical e-cigarette consumer. According to the study, almost 6 million adults in the U.S. use e-cigs, compared with the 44 million who use a tobacco or nicotine product (including cigarettes). E-cig users tend to be young and male and have lower household incomes than the national average and are more likely than other adults to play video games and poker, more likely to watch reality TV, and go to bars and nightclubs. E-cig users are also more likely to live in the South. In the region including Alabama, Kentucky, Mississippi and Tennessee, the ratio of electronic-cigarette users to traditional cigarette smokers is nearly 2 to 1, according to the study.

In light of the demographic findings, it maybe isn’t surprising that so many e-cigarette users prefer them to other methods of quitting. For young guys having fun, it’s more fun to “vape” than to do nothing at all.

TIME tobacco

E-Cig Benefits Outweigh Their Harms, New Research Says

A patron demonstrates an e-cigarette at Vape store in Chicago, April 23, 2014.
A patron demonstrates an e-cigarette at Vape store in Chicago, April 23, 2014. Nam Y. Huh—AP

That doesn't mean you should hop on the bandwagon

The debate over e-cigarettes—now a$2 billion industry in the U.S. and growing—is constantly up in smoke.

The primary problem is that we simply do not know what e-cigarettes’ long-term health impacts are, with some people heralding it an effective smoking cessation while others say it’s just more nicotine products on the market—and not smoking, no matter what you inhale, is your best bet. Some early research found that adolescents smoking e-cigarettes will also smoke regular tobacco products, and that there’s an increase in e-cigarette related calls to poison centers around the nation.

But this week, a new paper looking at over 80 studies on e-cigarettes’ safety and their effects on users plays devil’s advocate.

The researchers found that based on the evidence, e-cigs are much less harmful to smokers and bystanders compared to conventional cigarettes. They are becoming more popular, but the numbers—so far—don’t suggest that they are being regularly used by non-smokers or kids. Finally, the researchers found that e-cigs can help some users cut down on their use of regular cigarettes and even quit. As regulating bodies around the world make decisions about how to deal with e-cigs, the researchers conclude that letting e-cigarettes compete with traditional tobacco on the market might actually decrease smoking morbidity and mortality.

“Health professionals may consider advising smokers unable or unwilling to quit through other routes to switch to [e-cigarettes] as a safer alternative to smoking and a possible pathway to complete cessation of nicotine use,” the Queen Mary University of London researchers write in their study, published in the journal Addiction.

When it comes to the question of what’s safer, e-cigs or cigarettes, no one is in disagreement. E-cigarettes win. While they still provide smokers with nicotine, which is highly addictive, users do not inhale the toxic smoke and chemicals from regular cigarettes.

Public health experts are split on what role e-cigarettes will play in the nation’s health, but more evidence and further research from both sides of the debate will hopefully keep policy members informed about where the current science stands.

TIME Law

White House Softens Proposed E-Cigarette Regulations

A patron demonstrates an e-cigarette at Vape store in Chicago, April 23, 2014.
A patron demonstrates an e-cigarette at Vape store in Chicago, April 23, 2014. Nam Y. Huh—AP

The long-awaited regulations on electronic cigarettes go through a review phase before they become final.

Newly published documents show that the White House watered down restrictions on electronic cigarettes proposed by the Food and Drug Administration.

The White House’s Office of Management and Budget regularly analyzes proposed regulation for its potential economic impact. A Reuters review of the documents published in the Federal Register on Tuesday shows that the OMB weakened language detailing concerns over e-cigarettes and nixed a clause that could have been used to ban online sales.

The FDA proposed the long-awaited regulations in April, banning their sale to minors and requiring that makers of e–cigarettes register their ingredients within the next two years. The proposal also would ban “non-face-to-face sales,” which would have prohibited vending machine sales but also could have targeted online sales.

But the proposal was open to comment and review, and OMB edited that sentence to refer specifically to vending machines, Reuters reports.

The OMB’s review of the proposal aimed “to ensure that the regulations through which agencies implement policies are efficient, well-designed to achieve their objectives, and based upon the best available evidence,” spokeswoman Emily Cain told Reuters. “It is routine for agencies to make changes to their draft rules during the course of OMB review.”

[Reuters]

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