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The rise of electronic cigarettes and their impact on public health

Oxford Dictionaries has selected vape as Word of the Year 2014, so we asked several experts to comment on the growth of electronic cigarettes and the vaping phenomenon.

A new report from the US Centers of Disease Control and Prevention shows that use of e-cigarettes among high schools students has tripled in two years. The finding raises the question is vaping—the use of tobacco-free electronic cigarettes—an important tool for helping smokers quit or a ploy by Big Tobacco to addict another generation of young people to nicotine? Public health experts are poring over the modest evidence on the health consequences of e-cigarettes to find guidance for policy.

What is clear is that vaping—inhaling and exhaling vaporized nicotine liquid produced by an electronic cigarette—is on the rise not only in the United States but elsewhere. In the United Kingdom, the percent of current smokers had ever tried electronic cigarettes rose from 8.2 in 2010 to 50.6 in 2014.

Big Tobacco has jumped into the e-cigarette business with gusto. By the end of 2013, British American Tobacco, Lorillard, Philip Morris International and Reynolds—key players in the multinational tobacco business—had each bought e-cigarettes companies. While e-cigarettes still constitute a fraction of the tobacco business, their market share has grown rapidly. Retail sales value of e-cigarettes worldwide for 2013 was $2.5 billion and Wells Fargo estimates sales will top $10 billion by 2017.

Supporters of e-cigarettes argue that by satisfying the craving for nicotine these devices can wean smokers from tobacco, reducing the harm from inhaling more than 5,000 chemicals—many of them carcinogenic. Some studies have found that e-cigarettes were modestly effective at helping tobacco smokers to quit. Proponents believe that some tobacco use is inevitable for the foreseeable future so making e-cigarettes available helps reduce the world’s main cause of premature death. They compare e-cigarettes to offering injecting drug users free clean needles, a policy demonstrated to reduce HIV transmission.

Critics reject these arguments. They point to evidence that vaping exposes users to dangerous toxics, including cancer-causing formaldehyde. Of greatest concern, opponents fear that vaping will addict new users to nicotine, serving as a gateway to tobacco use. Some preliminary evidence supports this view. They also worry that e-cigarettes will re-glamorize smoking, undermining the changing social norms that have led to sharp declines in tobacco use.

Electronic Cigarette by George Hodan via PublicDomainPictures.net.
Electronic Cigarette by George Hodan via PublicDomainPictures.net.

The inconclusive evidence raises some basic questions. How do we make policy decisions in the face of uncertainty? In setting e-cigarette policy, what are appropriate roles for the market and government? Finally, in a political system where corporate interests have shown a growing capacity to manipulate the rules to achieve their goals, how can the public interest be best protected?

Over the past century, two warring principles have guided policy on consumer rights. The first, caveat emptor, let the buyer beware, says consumers have the obligation to find out what they can about the products they choose to consume. The more recent precautionary principle argues instead that producers should introduce only goods that are proved safe. For e-cigarettes, this would put the onus on manufacturers to demonstrate in advance of widespread marketing that the alleged benefits of vaping outweigh its potential costs. Few researchers believe that such evidence now exists.

The history of Big Tobacco suggest that no industry is less qualified to set public health policy than the corporations that are buying up e-cigarette companies. In her 2006 decision in the United States racketeering trial against the tobacco industry, Judge Gladys Kessler wrote that the tobacco industry “survives, and profits from selling a highly addictive product which causes diseases that lead to … an immeasurable amount of human suffering and economic loss, and a profound burden on our national health care system. Defendants have known many of these facts for at least 50 years or more. Despite that knowledge, they have consistently, repeatedly and with enormous skill and sophistication, denied these facts to the public, the Government, and to the public health community.”

Already the industry’s e-cigarette practices raise concerns. For example, companies have marketed products in flavors like cherry, vanilla, and cookies and cream milkshake. Their advertising has used the same sexual and risk-taking imagery employed to market tobacco to young people. Significantly, manufacturers decided not to promote their products primarily as smoking cessation devices, an approach that would have emphasized public health benefits, but instead as a glamorous, sophisticated new product. This strategy increases the likelihood that the product will create new generations of nicotine addicts rather than help smokers to quit.

Leaving e-cigarette policy in the hands of industry invites Big Tobacco to continue its deceptive practices and use its political resources to undermine public policy. The 2009 Family Smoking Prevention and Tobacco Control Act gave the US Food and Drug Administration the authority to regulate tobacco. In 2014, the FDA proposed new rules to regulate e-cigarettes. These rules would set the minimum age of 18 to use e-cigarettes, prohibit most sales in vending machines, mandate warning labels, and ban free samples. As these rules work their way through the system, advocates have suggested the need for additional rules including a ban on flavored e-cigarettes, limits on marketing, and strict oversight of the truthfulness of health claims.

Lax public health protection from lethal but legal products such as tobacco, foods high in sugar and fat, alcohol, firearms, and automobiles has produced a growing burden of premature deaths and preventable injuries and illnesses. Around the world, chronic diseases and injuries are now the main killers and impose the highest costs on health systems and tax payers. Allowing Big Tobacco to use e-cigarettes to write a new chapter in this sorry history would be a step in the wrong direction.

Recent Comments

  1. Tom Gleeson

    You have the wrong understanding of the precautionary principal. You are also wrong on the risks of ecigretted. However your list of lethal but legal products does show your thinking. I would suggest you do some research and rewrite this opinion piece.

  2. YKIM

    There is an obvious rise in the use of electronic cigarettes as the word “vape” made it to the Word of the Year 2014 in the Oxford Dictionaries. It is encouraging to know that the number of tobacco use has decreased which is a leading cause for premature death. I found it surprising that it was found to have tripled in the two years among high school students. There should be a set age restrictions. I completely agree with the FDA’s proposal on the regulation of the e-cigarette, “These rules would set the minimum age of 18 to use e-cigarettes, prohibit most sales in vending machines, mandate warning labels, and ban free samples.” Even until then, more researches should be conducted and set regulations on the composition the e-cigarettes.

  3. Noises

    I have never seen an e cig TV commercial, print ad or billboard. I got into vaping through word of mouth, a friend got into it to quit smoking after he happened across some youtube videos of it. My ejuice comes from a small Australian cottage business based in the snowy mountains, run by a woman called Del and five of her friends.

    My vape is an Innokin MVP, made by Shenzhen Innokin Technology Co which is a 100% chinese owned and operated business, manufacturer of one of the most popular box mods on the market. So tell me please, which big tobacco company are inokin and del’s juice shack owned by? Which of the big tobacco marketing corporations paid my mate to put me onto vaping?

    You see, when people make spurious, easily disproved claims like these, it make any other claims like “vaping exposes users to dangerous toxics (sic), including cancer-causing formaldehyde” harder to believe. Even harder when so many people who vape actually mix their own juice, and know exactly what goes into their vaporisers. How you get formadahyde out of Vegetable Glycerin and food flavorings, I don’t know. But hey, keep throwing mud, some of it just might stick.

    I have a theory. Most, if not all of the anti-vaping “science” is funded by the same wowsers and public health bullies who pushed smokers out of bars, cafes and clubs and into the streets recently. The same nanny state anti smoking brigade who so recently were celebrating and crowing about having forced smokers and smoking into the gutters are furious, utterly outraged, by the fact tha vaping looks like smoking, but doesn’t have the same overbaring, controlling, bullying laws attached to it. Yet. You can say I’m being paranoid, but look at the rhetoric. Look at the extremely negative but mostly unsupported misinformation. Formaldehyde magically appearing out of vegetable oils. Really? That’s your argument? Exposing vegetable glycerin to heat makes embalming fluid? I would LOVE to see the peer reviewed science on how that happens. Feel free to provide it.

  4. Elaine Keller

    If you take the time to read the proposed deeming regulation, you will learn that e-cigarette companies will need to put their products through very expensive extensive testing to gain approval to market the products. Thus, FDA regulation of e-cigarettes will put thousands of small to medium sized independent e-cigarette companies out of businesses. Only the tobacco companies (because they are large) will be able to afford to comply. Is that what you really want?

  5. Elaine Keller

    If consumers of e-cigarettes were moving from inhaling nothing other than pure air to inhaling vapor from e-cigarettes, then your reasoning about the precautionary principle would make sense. However, that is not the case. All studies to date show that over 99% of e-cigarette users are inhaling vapor instead of cigarette smoke. Since we all agree that inhaling cigarette smoke is dangerous to health, and vapor has not been proven to be anywhere near as hazardous, then the precautionary principle dictates that we should be encouraging adult smokers to switch to vapor.

  6. Linda

    E cigarette companies did not CHOOSE not to promote their products as a quit smoking tool. They are legally not ALLOWED to. But people who successfully quit smoking with e cigarettes can say whatever they want (at least until they take that right away from us too). E cigarettes are successful because they work and word of mouth is spreading like wildfire. Despite efforts from public harm advocates to stop it.

  7. Mike Kelly

    The only e-cigarette companies advertising on TV are the ones owned by established tobacco corporations. They’re also the main sellers of the “cig-like” devices — the disposable ones you see in gas stations. These are the same products that exclusively seem to be tested in studies on the toxicity of e-cig vapor, despite the fact that the vast majority of vapors eschew them in favor of higher-quality machines which allow the user to re-fill with their own liquid, which is almost universally comprised of only vegetable glycerin, propylene glycol, nicotine, and the same flavorings found in countless other products. The disposable e-cigs sold by Big Tobacco also tend to have the highest doses of nicotine; zero and low-dose liquids outsell high-dose liquids handily in the “serious” vaping market.

    The discourse surrounding vaping has been confused and distorted from the start. The regulations proposed by the FDA are favored by tobacco companies who sell e-cigs, because they know it will destroy the competition and limit the industry to the pre-packaged products they sell. They want e-cigs to look and taste like cigarettes, rather than continuing to primarily exist as a product only tangentially related to their own, which the can’t control.

  8. Kia Dragon

    “Lax public health protection from lethal but legal products such as tobacco, foods high in sugar and fat, alcohol, firearms, and automobiles has produced a growing burden of premature deaths and preventable injuries and illnesses.”

    That’s you former Mayor Bloomberg isn’t it? You can’t hide behind that fake Doctorate. No one who is actually educated would buy that load of conjecture and prohibition nonsense.

    Admit it Bloomberg. You just are cranky because no one liked your soda pop ban.

  9. staila

    I think people get confused when they hear that vaping can help you quit smoking. It’s a tool to help quit but someone has to be actually trying to quit for it to work in that way. Just because someone decides to switch it up doesn’t mean they will magically be cured from a nicotine addiction. Thanks for the great info!

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