Electronic cigarettes

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.