Union calls for immediate regulation of e-cigarette products

Electronic cigarettes, or e-cigarettes, are growing in popularity at a remarkable pace. This has led many organizations, such as the International Union Against Tuberculosis and Lung Health, to issue statements regarding e-cigarette harm. E-cigarettes are easily obtained from convenience stores and over the internet, and are used by increasing numbers of smokers across the country. Surprisingly, these products are entirely unregulated – not held to the same standards as tobacco products with respect to safety or taxation, or the same standards as cessation products in terms of burden of proof for efficacy. This has not stopped manufacturers from advertising these products in a way not seen since the 1960s.

What is known is that e-cigarette vapor has been found to contain small levels of carcinogenic chemicals and therefore has the potential to increase risk of lung cancer. However, the degree to which this is the case is unclear. Until more is known, with FDA-approved medications available and safety and efficacy data supporting them, it is difficult for physicians to recommend e-cigarettes and assure they are “doing no harm.”

Electronic cigarettes are completely unregulated with regard to product, manufacturing and marketing. This leads to a great deal of safety and quality concerns, with isolated highly publicized product malfunctions leading to fire and injury, and unknown risks related to product use. Independent research has identified significant variability in the concentration of nicotine in e-cigarette solutions from product to product and within brands, as well as a variety of other chemicals, unclaimed contaminants and known carcinogens. Further, there may be risks to bystanders. Contrary to advertised “harmless water vapor,” the vapor that is not directly inhaled has been found to contain nicotine. This means it is likely that others will be exposed to this and ultrafine particles, which can immediately impact breathing. In short, the safety of these products for users and those around them has not been established.

Beyond safety, the marketing for electronic cigarettes is misleading and unchecked in the United States due to them not being regulated as tobacco products. Using highly effective advertising tactics from the 1950s, electronic cigarette manufacturers have contracted with Hollywood personalities to associate glamour and sex appeal with their products in the first television ads for tobacco products since the 1971 agreement that ended TV cigarette advertising. TV advertising reaches large audiences, and celebrity endorsements increase their appeal to adolescents and young adults. This could recruit new users to nicotine addiction.

Electronic cigarettes also mimic conventional cigarette use, and they provide pro-smoking cues to smokers and youth alike. Indeed, a person vaping an electronic cigarette is nearly indistinguishable from one smoking a tobacco cigarette, thus the public display of “smoking” may be seen with greater regularity. More importantly, electronic cigarettes are actively promoted for use in places where conventional cigarettes are not allowed, increasing the potential for smoking behaviors to be modeled, and dramatically undermining the WHO Framework Convention on Tobacco Control Article 12, which calls for denormalization of tobacco use.

The use of electronic cigarettes has skyrocketed among adults in the past several years, without scientific evidence of efficacy for smoking cessation. Any beneficial use of electronic cigarettes must be predicated on having FDA regulation take effect before the burgeoning industry creates products that have independent health risks and may recruit people into nicotine addiction. Any statements about the benefits of electronic cigarettes must be backed by scientific studies demonstrating the safety and efficacy of a standardized product.

Bottom line: The public should not be used as a test market for unregulated and potentially unsafe products. There are proven and effective ways to quit smoking that avoid the potential for toxic secondhand vapor and are not marketed to first-time users. As medical providers, we should be cautious about adopting electronic cigarettes before we know the consequences of their use. In particular for patients with lung cancer, there is an imperative to quit smoking completely using evidence-based methods without excess risks. Electronic cigarettes do not meet these criteria.