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Lung disease researchers speak up for ban or limits on electronic cigarettes

After the FDA proposed new rules for marketing electronic cigarettes (e-cigs) in April, 2014, the 70,000 member Forum of International Respiratory Societies (FIRS) issued a statement on July 9, 2014 that governments around the world should ban or restrict the use of e-cigs. This recommendation was made public by on July 10, 2014.

That cloud of e-cig vapor may not be safe after
Photo by Andrew Burton/Getty Images

The recommendation is that more studies be conducted to determine if e-cigs are safe and whether they are effective in reducing the smoking of cigarettes. It is generally agreed that e-cigs are less toxic to users and the general public than conventional cigarettes. What has been lacking are data on the safety of e-cigarettes with regard to the vapors impact on lung health for users and the general public.

There is now evidence that the by-products of vaporization contain carcinogens. The concentrated nicotine is a cardiovascular dilator that causes higher blood pressure that damages the heart, kidneys and liver.

This recommendation is based upon the absolute certainty that nicotine is highly addicting. E-cigs are the most effective way to get nicotine into the blood stream short of cooking cigarettes in alcohol and shooting the extracted nicotine directly into a vein.

The press release by FIRS mentions that the tobacco industry lied to the public regarding the safety of cigarettes and targeted minors and women in an attempt to increase the number of smokers. The tobacco industry also filtered the cigarettes to allow an increase in the amount of nicotine. Menthol and other “flavoring agents” were added to cloak the tar and nicotine in the cigarettes.

E-cigs call the liquid nicotine extract “juice”. It is nearly pure nicotine, with the only other major ingredients a hydrocarbon that can be vaporized under temperature and so-called flavoring agents. The higher the vaporization temperature, the more toxic the vapors are to the lungs. Newer e-cigs that have been developed to operate at higher voltages increase the quantity of extremely small particles in the vapor.

Maciej Goniewicz of the Roswell Park Cancer Institute in Buffalo, NY has released research results that show that the vapor generated by e-cigs approach the levels of formaldehyde found in conventional cigarettes with e-cigs that generate higher heat. The details of the study were released on May 15, 2014 in the journal Nicotine & Tobacco Research.

Introduction: Glycerin (VG) and propylene glycol (PG) are the most common nicotine solvents used in e-cigarettes (ECs). It has been shown that at high temperatures both VG and PG undergo decomposition to low molecular carbonyl compounds, including the carcinogens: formaldehyde and acetaldehyde. The aim of the study was to evaluate how various product characteristics, including nicotine solvent and battery output voltage, affect the levels of carbonyls in EC vapor.

E-cig liquids are flavored to appeal to young users with flavors such as cotton candy aimed directly at middle school and high school e-cig users. The e-cig manufacturers provide a website to find the “best” e-cig juices. One site listed popular flavors as The Godfather, Juicy Fruit, Tobaccolicious, Creamsicle, and Tobacco Menthol. Of these flavors, only the Tobacco Menthol is directed at adults instead of minors.

There are currently no age restrictions on e-cig purchases, and the largest growth is among minors. The Center for Disease Control and Prevention (CDC) estimates that 20% of high school students have now tried e-cigs. The estimated growth of e-cigs use among minors was estimated at 50% between 2011 and 2012.

E-cigarette experimentation and recent use doubled among U.S. middle and high school students during 2011–2012, resulting in an estimated 1.78 million students having ever used e-cigarettes as of 2012. Moreover, in 2012, an estimated 160,000 students who reported using e-cigarettes had never used conventional cigarettes.

The details of the FINS recommendations show an extremely cautious approach. This will be of temporary comfort to the e-cig manufacturers and users. The public is highly supportive of restricting sales of e-cigs to minors and restrictions of advertising of e-cigs on social media. This is a step in the right direction for improving public health.

The greatest hope to curtail e-cig use comes from the FDA declaring e-cigs to be just another tobacco product, which will then make e-cigs subject to federal, state and local excise taxes. Those already addicted to nicotine will still be able to choose between traditional cigarettes and e-cigarettes. This decision is a bad health choice that leads to serious diseases. At least, these changes will help slow down the growth of electronic cigarette use among children.

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