I was sitting in Bush Intercontinental Airport in Houston recently, on my way to a small
scientific conference where I gave a short talk on my current project.
As I'm sitting, waiting for boarding time, a very large man sits down right next to me
and pulls a cigarette out of his pocket, takes a long drag on it, and exhales deeply.
Now I'm old enough to remember the no smoking warnings being a bit of a novelty, but I hadn't
seen anyone smoke in an airport in a few decades, so I admit I was shocked.
The gate attendant sprinted over to ... I don't know what she had planned, but there
was murder in her eye.
The guy smirks and says, "It's not a real smoke, it's an electronic cigarette... see,
no flame, no second hand smoke."
The gate attendant explained, with poorly contained rage, that the FAA and the airline
both forbid the use of these devices.
The guy looked equally outraged, but put the e-cig back in its case as he started debating
federal policy with reference to nicotine gum, prescription drugs, and medical needs.
People have been asking me to address the controversy surrounding these very new alternatives
to smoking cigarettes.
It's not an altogether easy topic to cover.
There just isn't much data so far and what little evidence does exist is contradictory
on the health effects.
The e-cigarette was first described in a patent attributed to Herbert Gilbert in 1963, but
the modern commercial version has only been around since 2003, invented by Chinese pharmacist
Hon Lik.
In 2005, it was approved for export outside of China by a company called Ruyan and the
international patent was filed only 5 years ago.
In such a short time, they have really caught on, and are already presenting legislators
with difficult choices.
Should they be treated as drugs and devices, and regulated in the same way as medical inhalers,
since they do deliver nicotine, or should they be regulated as a smokeless tobacco product,
which in a way they are?
The difference is whether they meet stringent safety and purity criteria or merely the basic
standards of an agricultural product.
The US Food and Drug Administration strongly suggested that should be regulated as a combo
of drug and medical device.
Late last year they were over-ruled.
Starting in 2012, e-cigarettes will be regulated in the US by the FDA as though they were cigarettes,
following much more lax requirements for manufacturing and testing.
This benefitted manufacturers, because it keeps costs down, but probably doesn't do
anything good for consumers.
We should take a very quick detour to explain how they work.
There are two main elements in the electronic cigarette.
First the juice, which is solution of propylene glycol or glycerin base, flavor, nicotine,
and water.
The PG has been used for decades in nebulizers with minimal risk, and the FDA rates it as
GRAS, or generally recognized as safe.
The second element is the mini-vaporizer, which works by either heat or vibration to
generate a vapor of the juice.
The juice is inhaled by the smoker as vapor into mouth and lungs, where it condenses and
is absorbed into the bloodstream.
It all sounds like a safer, more convenient, less toxic way to avoid smoking those dreaded
cancer sticks.
The nicotine delivery works on very different time scale than cigarettes, and the delivered
dose is quite different.
If we measure nicotine derivatives in the blood of a cigarette smoker, there's an initial
spike within 5 minutes.
The e-cigarette can take up to 30 minutes to reach that initial spike.
The combustion products of cigarettes, and the particle size of delivery is actually
very different from liquid vapor delivery, so the e-cigarette is much more analogous
to a nicotine gum or patch product.
It's been suggested that the majority of the nicotine is actually being absorbed in the
gastrointestinal tract, essentially drunk as the juice condenses, passes into the stomach
and eventually the liver.
This is an important difference, because the liver acts as a filter for toxins, where in
smoked cigarettes, the lungs absorb the nicotine without passing first through that filtration.
The second paradox is that the delivered dose can be highly variable in e-cigarettes, and
they may actually be, if this is even possible, more likely to promote physical addiction
to nicotine than cigarettes.
What about secondhand smoke, or in this case, vapor?
Well, the exhaust of an e-cigarette doesn't contain tar, except when it does.
That's right, in a few cases the juice was contamined with some byproducts of its manufacture.
The cheapest place to get bulk nicotine is from tobacco extracts.
Sometimes those extracts aren't that purified, and some cancer-promoting substances other
than nicotine are co-purified.
The manufacturer acted very surprised when the lab tests were presented, but I suspect
that it was not that unexpected.
The risk is still relatively low in comparison to cigarettes, but higher than not breathing
in second-hand smoke.
What else is present in the exhaust of e-cigarettes?
Well, nicotine, and really quite a lot of it.
People around you can still be inadvertantly exposed to an inhaled stimulant, nicotine.
Nicotine is quite probably the most addictive drug produced by a plant.
It causes long term changes in neural plasticity, affecting learning, behavior, and possibly
promoting other addictive behaviors.
Unlike cannabis, where the gateway drug effect is not well supported, nicotine almost certainly
promotes the development of other addictions like alcohol and eating disorders.
As a friend of mine, who studies nicotine's effect on the brain describes it, nicotine
makes you neurotic.
That's because it increases the level of several neurotransmitters in your central nervous
system.
It stimulates the release of adrenaline and global changes in brain activity.
Long term, it affects the ability of your genes to be turned on and turned off by a
specific mechanism.
There's also a correlation to schizophrenia and some other conditions.
I would prefer that if you're addicted to cigarettes that you could stop cold turkey,
and simply never start again.
I know that may not be practical.
Research shows that nicotine replacement therapies can be effective at helping you quit.
That leads us to the final question of this video.
Are e-cigarettes effective at helping people quit their addiction?
The evidence so far is inconclusive.
People certainly substitute the e-cigarette for the cancer stick once they pick it up,
but it's still unclear if they can then wean themselves off the substitute.
I think in summary I think you're better off with another nicotine replacement therapy,
not e-cigarettes.
If you are interested in quitting, try the gum, the inhaler, or the patch.
Talk with a physician and take their advice.
E-cigarettes might end up as a safe alternative with better regulation, further technological
improvements, and more research, but right now they're probably not a great idea.
Keep in mind that they still aren't safe around kids or the elderly or people sensitive to
nicotine.
What worries me the very most about this new product is the hipster angle.
I'm worried that they'll become a popular new trend.
Public health agencies, medical organizations, and government have been combatting the rise
in smoking with great progress over the last few decades.
Fewer and fewer kids are making the big mistake of picking up the lifetime habit.
I would hate for some new marketing spin, some new media campaign or underground movement
to reverse all that progress.
It's estimated that smoking in the US results in 160 billion dollars in health care costs,
lost worker productivity, and indirect effects, to say nothing of the grief of a family that
loses mom or dad too soon to lung cancer, COPD or heart disease.
I'd support any legislation that promotes updated education for the general public,
but especially school-age kids, about the dangers of not just smoking, but also other
nicotine products.
If you have a young person in your life, take a minute to talk openly and honestly about
why smoking or other addictions are a bad thing.
Immaturity and the kind of bad choices we all make at that age shouldn't have life-long
consequences, but they do.
Do what you can to educate them so they can see the path ahead.
Do it honestly, but do it now.
Thanks for watching.