Wednesday, August 5, 2009

E-Cigarettes: Another Look

FDA remains conflicted over safety concerns.

The Food and Drug Administration (FDA) issued a controversial Safety Alert over electronic cigarettes, known as “e-cigarettes,” then held a press conference to explain itself. The agency’s muddled response to the issue has prompted increased advertising and online sales for Asian e-cigarette manufacturers, as well as a countering burst of criticism about the newest nicotine delivery system under the sun.

The FDA conducted a small-scale lab analysis of two different brands of e-cigarettes, and found “carcinogens and toxic chemicals such as diethylene glycol, an ingredient used in antifreeze.” The FDA’s Division of Pharmaceutical Analysis also found evidence of small amounts of cancer-causing nitrosamines. “These products do not contain any health warnings comparable to FDA-approved nicotine replacement products or conventional cigarettes,” the agency bulletin said. Therefore, the agency “has no way of knowing, except for the limited testing it has performed, the levels of nicotine or the amounts or kinds of other chemicals that the various brands of these products deliver to the user.”

The agency did not seek to ban e-cigarettes, as Canada did in March. However, in a written statement to CNN in March, the FDA admitted it had been detaining or refusing importations of electronic cigarettes for more than a year.

Debate has raged recently over the safety of e-cigarettes, which are battery-operated cigarette substitutes that technically dodge no-smoking bans, since no actual smoke is emitted. When a smoker inhales on the e-cigarette, the battery warms liquid nicotine stored in a plastic filter, producing a smokeless but inhalable form of synthetic nicotine. Upon exhalation, there is a small puff of vapor that quickly evaporates (See my earlier post, "E-Cigarettes and Health").

Michael Levy, director of compliance for the FDA’s division of drug evaluation and research, said he believes the products are illegal. However, “There is pending litigation on the issue of FDA’s jurisdiction over e-cigarettes,” he said.

Proponents of the e-cigarette claim that the devices are self-evidently safer than smoking cigarettes, and can help people stop using tobacco products. Critics respond that the safety of synthetic nicotine drug-delivery devices has not been established. Moreover, the range of fruit and candy flavors offered by e-cigarette manufacturers suggests to Jonathan Inickoff of the American Academy of Pediatrics Tobacco Consortium that the devices seem “tailor-made to appeal to kids,” while addicting them to nicotine and turning them into future cigarette smokers.

With half a million Americans dying prematurely each year from smoking, according to figures from the Centers for Disease Control (CDC), some doctors and tobacco researchers have pointed out that nitrosamines are also found in everything from nicotine patches to bacon. According to one researcher, “FDA should be encouraging, not maligning the manufacture and sale of electronic cigarettes, and working with manufacturers to assure the highest possible quality control.”

For a robust discussion of the e-cigarette question, see

Photo Credit:


Johnny Blaze said...

In response to the FDA's findings, certain companies (such as ours) are having their e-liquid produced here in the USA. By doing so, we offer enhanced quality control to our customers, and have better control over what is being added to our smoke juice.

Contrary to the FDA's claims, most electronic cigarette companies DO NOT market to children, and are looking out for the bst interests of their customers.

Johnny Blaze
Fighting Big Tobacco armed only with an E-cigarette.

Dirk Hanson said...

It is my normal policy at Addiction Inbox to delete comments that are clearly links to commercial enterprises. However, I am leaving Johnny Blaze's advertisement so consumers can evaluate for themselves the product and the claims made on its behalf.

krakkan said...

The FDA's findings shows that E-cigs are magnitudes safer but they decided to not tell the whole truth see this article for more info

Dirk Hanson said...


Some interesting points in the news article, thanks. However, I wish they had appeared in a more reputable news source than the Washington Times, which objective journalists quote at their peril.

Also, the complaints were lodged by the American Council on Science and Health which, despite it's strong stance against smoking, basically serves as a pro-business cheerleader in cases involving potential health hazards to the public.

Katyusha said...

This is an older post, but an important one, and the comments have not covered the really crucial points as I see them.

I quit smoking using an e-cigarette. There are many others like me who have tried other methods, including NRT, and failed. What e-cigarettes do most crucially is replicate the behavioral aspect of the dependence as well as (some of) the chemical aspect of it. For those of us who have smoked as a soothing and frequent ritual, giving a safer alternative while maintaining the behavior may be the only way to ensure longer-term smoking cessation.
The liquid base of e-cigarettes also allows me to carefully titrate my nicotine intake and therefore taper it over time while maintaining the behavioral aspect I enjoy.

One problem, as I see it, is a cultural resistance based upon the appearance of e-cigarettes. The other is anti-harm-reduction dogma which states that even nicotine dependence is horrible, and insists that smokers must either quit tobacco and nicotine entirely or forget about it.

I participate in the largest online forum for e-cigarette users, E-Cigarette Forum. It's incredible to hear the number of stories there from those who smoked "analogs" (as we call tobacco cigarettes) for decades without ever finding a solution, who managed to quit successfully with e-cigs.
This poll reflects, of course, self-selection bias, but isn't it remarkable that so many long-time intractable smokers managed to quit?

I would encourage you to read the data at this website as well for information on safety data. The American Association of Public Health Physicians put out a call for further study, as well.

Users of e-cigarettes are often interested in the safety issues and come to their own conclusions based upon a mixture of research and their own improvement in health after switching to e-cigarettes. My own conclusion thus far is that as long as we are avoiding contaminants in the nicotine liquid, e-cigarette vapor is far less detrimental than the combustion products in cigarette smoke. FDA acknowledgement of e-cigarettes as a legitimate smokeless alternative would allow for regulation that best ensures the safety of e-cigarette liquid as well (and prohibit sales to minors, which almost all e-cigarette companies are extremely careful to avoid as it is - they don't want a fear-based ban to come down on them).

Unfortunately, the FDA's reactionary stance has been a step backward and based upon ridiculous conclusions from the safety data. (The nitrosamines they found were in no greater concentration than those found in standard NRT therapies, for instance.)

You are in a position of authority on matters of addiction, so your views and the views of your colleagues make a real impact in the national debate. I encourage you to take a balanced and informed stance, for the sake of all the current smokers who might be saved.

john said...

The fda is crappin their pants,feeling pressure from big tobcacco and pharmacutial special interest groups to kill the e-cig,why? $$$$$ money ,no cig profits, no tax profits, millions in maketing and research to create gums and patches,all gone. FDA looks foolish though: E-cigs are unsafe, so here is a pack of tobbaco cigarettes for you instead?! In my view electronic cigarettes do not contain the harmful substances found in traditional cigarettes such as tar, tobacco, smoke, and other dangerous chemicals. Electronic cigarettes only contain nicotine, which satisfies the smoker’s craving without all the nasty side effects from traditional cigarettes.

sidder said...

I agree electronic cigarettes are bye far more healthier because you get no tar,no tobacco.

Lenore Colflesh said...

the health related findings for electronic cigarettes have been mixed but most feel that they are a far healthier substitute for classic cigarettes. I would have to agree, in the past few weeks of vaping with my ecig I have a far better experience than in the past years I was smoking normal cigarettes. On top of that they they don't leave that awful tobacco scent on you.

Thuoc la dien tu | May cai thuoc la | Cai thuoc la said...

The FDA's findings shows that E-cigs are magnitudes safer but they decided to not tell the whole truth see this article for more info

In VietNam

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