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Paging Dr. Frischer - E-cigarettes
WRITTEN BY :   Dr. Alan Frischer

In 1965, 42% of American adults were smokers. Today, the figure is 19%. However, after decades of falling smoking rates, people are flocking to a new trend: electronic cigarettes. Young adults, historically the ideal market for tobacco companies, are again being targeted. It’s been said “If you can get kids addicted and hooked between 18 and 21, you’ve got a user for life.” Smokers and non-smokers alike are well aware that smoking conventional cigarettes is extremely harmful. The sad fact is that it is an extremely tough addiction to kick. Could the e-cigarette actually be helpful?
E-cigarettes are battery-operated devices that heat liquid nicotine into a mist that is then inhaled. Proponents claim that they are a healthier alternative to smoking, as well as a method to help cut down or quit. At this time, however, these claims are unsubstantiated because the research simply hasn’t been done. We simply don’t know whether the e-cigarette is actually less toxic, whether it leads to fewer traditional cigarettes being smoked, and whether it can act as a bridge to help smokers quit.
E-cigarettes were invented approximately eight years ago in China, and currently, most are manufactured in China and the Philippines. They range in size and cost (from about $30 to more than $200). Instead of tobacco leaves, e-cigarettes use vials of “juice,” which contain between 6 and 32 milligrams of liquid nicotine, and cost between $6 and $20. (Nicotine-free varieties are available.) They come in various flavors, from cherry, watermelon and peach, to chocolate and bubble gum. Could it be any more clear that they are deliberately being marketed to our youth?
In spite of the lack of scientific data, their use has surged. The Center for Disease Control and Prevention (CDC) reports that from 2011 to 2012, the number of middle school and high school students who tried e-cigarettes doubled from 4.7% to 10%. “Vapor shops” are springing up. E-cigarettes have become recreational at concerts, restaurants, vapor stores and bars, and college campuses.
It is fascinating that while start-up companies initially manufactured e-cigarettes, as profits rose, major tobacco companies have become the significant players. The nation’s three top tobacco producers, Phillip Morris, R. J. Reynolds, and Lorillard have all entered the market, and 2013 annual sales are estimated to reach $1.7 billion. Without regulation, and with extensive marketing, e-cigarette sales tripled in this past year. We’re all aware that tobacco companies lied for decades about cigarette safety, and now those same companies are supplying information to the public regarding the safety of e-cigarettes!
What we do know is that E-cigarettes have no tar and lack a number of the cancer-causing chemicals of traditional cigarettes. They contain four basic ingredients: propylene glycol, vegetable glycerin, nicotine and food grade flavors. Propylene glycol and vegetable glycerin are common ingredients in food and cosmetics, but inhaling them hasn’t been studied. We’re all well aware that nicotine is highly addictive. It is a vasoconstrictor that tightens and hardens blood vessels. It can cause birth defects, and may be a carcinogen, although that is unclear. It affects the circulatory system and blood sugar levels, and is dangerous during pregnancy.
E-cigarettes do offer some clear advantages over traditional cigarettes. E-cigarettes have an upfront cost that includes batteries, pipes and coils, but they can be significantly less expensive than spending $4 to $6 per pack of conventional cigarettes. It appears that secondhand smoke worries are eliminated, although this is being questioned. E-cigarettes have a mild scent that lingers in the air for just a second or two, and doesn’t smell like smoke. There appears to be no residue left on the clothes, hair, or body, and they don’t leave yellowed fingernails or teeth. Some smokers feel less stigmatized when smoking an e-cigarette, and at least for now, they can use an e-cigarette in many places where a cigarette smoker would not be allowed.
E-cigarettes currently fly under the radar with few if any of the regulations that control the manufacture of standard cigarettes. However, most state attorneys general are urging the FDA to regulate their sale and advertising, and a decision is expected very soon. At this time, potential e-cigarette users need to keep in mind that they lack essential health warnings, proper labeling, clear instructions on how to use them, and safe disposal methods. E-cigarette manufacturers are not yet required to submit clinical study data, and the public truly has no idea what the real risks are.
It is clear that until e-cigarettes are studied further, they should be treated as we would any addictive, potentially dangerous drug, and caution is called for. If you are considering using them, please do your homework, and discuss it with your doctor. Understand the pros and cons, watch for further information, and make an educated and informed decision.
Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

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Published: Nov. 14, 2013 – Volume 12 – Issue 31



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