The Question of E-Cigarettes

Masood N. Khan M.D. F.A.C.P.

Through the “Family Smoking Prevention and Tobacco Control Act of 2009 and its amendment in April 2014, FDA has regulated consumption of tobacco in the U.S. It is well known that the use of tobacco in cigarettes, cigars, pipes and hookahs is the leading preventable cause of death. However, the regulatory rules do not go far enough in the controlling the use of e-cigarettes even though the FDA rules have set minimum age of 18 years to use e-cigarettes, require identification to purchase them, prohibit most sales in a vending machine, mandate warning labels on packaging, and prohibit manufacturers from providing free samples.

The use of e-cigarettes has increased substantially because of the impression that it lets one enjoy the pleasure of nicotine whiles sparing the body of harmful effects of regular cigarettes.

Studies and research are underway to investigate the balance between the benefits and harms of e-cigarettes. In a recent article by two lawyers associated with Health Law, from O’Neill Institute for National and Global Health Law have the following to say about the current understanding concerning the use of e-cigarettes.

“Preliminary evidence demonstrates the potential of e-cigarettes to reduce harm by weaning smokers from combustible tobacco, but the benefits appear minimal. At the same time, evidence of harm is emerging. More powerful e-cigarettes commonly known as tank systems, heat nicotine liquid hot enough to produce cancercausing carcinogens, such as formaldehyde and acetaldehyde in their vapor. Further, in a study of human bronchial cells that contained some mutations found in smokers at risk of lung cancer, scientists found a pattern of gene expression in cells grown in a medium exposed to e-cigarettes vapor that was similar to the pattern found in cells grown in a medium exposed to combustible tobacco smoke. In addition the virulence of drug resistant bacteria can be increased by e-cigarettes vapors and affect the ability of cells to destroy them.”

The above evidence as indirect as it is does point out to the fact that e-cigarettes are not free of harm completely. Environmentally it has been reported that the Centers for Disease Control and Prevention have received calls in increasing numbers to their poison control departments after unintentional exposure of children to e-liquid, including oral ingestion, eye contact and inhalation exposure with symptoms such as trouble breathing, headache, cough, dizziness, sore throat, nose bleeds, chest pain, heart palpitations and allergic reactions such as itchiness and lip swelling.

So, while there are few benets potential for harm is also there. The scientic circles are facing this conundrum as to how to regulate ecigarettes given scientific uncertainty about the nature and extent of harm.