Are E-Cigarettes a Good Idea or a Bad Idea?

A group of nicotine researchers argue for an alternative.

Electronic cigarettes are here to stay. If you're not familiar with them, e-cigarettes are designed to look exactly like conventional cigarettes, but they use batteries to convert liquid nicotine into a fine, heated mist that is absorbed by the lungs. Last summer, even though the FDA insisted on referring to e-cigarettes as “untested drug delivery systems,” Dr. Neal Benowitz of the University of California in San Francisco--a prominent nicotine researcher for many years--called e-cigarettes “an advancement that the field has been waiting for.” And recently, Dr. Michael Siegel of the Boston University School of Public Health wrote: “Few, if any, chemicals at levels detected in electronic cigarettes raise serious health concerns.” Furthermore, Dr. Siegel took a swipe at the opposition: “The FDA and major anti-smoking groups keep saying that we don’t know anything about what is in electronic cigarettes. The truth is, we know a lot more about what is in electronic cigarettes than regular cigarettes.”

Harm reduction advocates are ecstatic. But do e-cigarettes simply reduce harm by eliminating combustion by-products--or do they perpetuate nicotine addiction, frustrate the efforts of smoking cessation experts, and give false hope to smokers that they can have their cake and eat it, too?

Dr. Siegel conducted a survey of e-cigarette users and found that 66% reported a reduction in the number of cigarettes smoked at the six-month point. “Of respondents who were not smoking at 6 months, 34.3% were not using e-cigarettes or any nicotine-containing products at the time.” Pretty impressive--although Siegel himself refers to the findings as “suggestive, not definitive”--and seemingly a giant leap forward for harm reduction.

However, even though they have dramatically altered the harm reduction landscape, e-cigarettes will not change anything for smokers who are attempting to completely quit using nicotine. When they inhale their last e-cigarette mist, several hours later they will begin to suffer the same withdrawal pains as regular cigarette smokers: “Irritability, craving, depression, anxiety, cognitive and attention deficits, sleep disturbances, and increased appetite,” as NIDA summarizes it. Current smokers are keenly interested in the new products, partly because of health concerns, and partly, it seems safe to venture, because a new generation of nicotine-based products like e-cigarettes “will enable them to put off the need to quit smoking,” as Dr. Dorothy Hatsukami, director of the Tobacco Use Research Center at the University of Minnesota, has asserted.

Harm reduction advocates for the electronic cigarette often make it sound like once the smoker is only inhaling nicotine, his or her problems are solved. But nicotine, of course, is the addictive part. Nicotinic receptors are present in moderate to high density in the brain areas containing dopamine cell bodies--the ventral tegmental area and the nucleus accumbens—the same pattern as almost every other addictive drug.

Even that part wouldn’t be a problem if addiction to nicotine were utterly benign. But it isn’t--although you wouldn’t know it from the pro-electronic cigarette propaganda. Nicotine in the blood is correlated with increases in arterial vasoconstriction, and is strongly suspected of playing a role in arteriosclerosis and other cardiovascular diseases. Nicotine increases LDL cholesterol, causes brochoconstriction, and has been implicated in the origin of lung tumors. There are also strong suggestions of links between nicotine and low birth weights in newborns.

So, it’s important not to kid ourselves about the hazards of nicotine, even though it may also be a medicine under certain conditions, like many other addictive drugs. Nicotine, you may recall, found industrial use as a farm crop insecticide. A poison, in other words. Nonetheless, what nicotine is NOT linked to certainly matters as well. Nicotine does not cause chronic obstructive pulmonary diseases, like emphysema—a huge plus. Nicotine won’t worsen asthma, as cigarettes do. And in the form of the electronic cigarette, it won’t cause secondhand smoke—another major plus for the e-cig.

There is another approach to regulating the harm caused by cigarettes. A group of scientists has been calling for a major effort at reducing the amount of nicotine in cigarettes so that, over time, a non-addictive level of nicotine would be reached--and cigarettes would no longer be addictive. Study after study has shown that if such were the case, about 80 to 90% of smokers would quit. And teens who experimented with truly low-nicotine cigarettes wouldn’t get hooked—unlike the “light” cigarette scandal, where the supposedly safer cigarettes may actually have turned out to be more dangerous because they forced smokers to smoke more in order to get the desired effect. Dr. Hatsukami and five other prominent nicotine experts contend that extremely low-nicotine cigarettes do not cause smokers to smoke more, “because it is harder to compensate for very low nicotine intake,” according to Hatsukami. Especially if there are no high-nicotine alternatives for sale—legally, at least. Mitch Zeller, who along with Hatsukami, co-chairs the National Cancer Institute’s Tobacco Harm Reduction Network, painted this picture: “Imagine a world where the only cigarettes that kids could experiment with would neither create nor sustain addiction."

Nonsense, counters Dr. Gilbert Ross of the American Council on Science and Health. “Asserting that smokers won’t smoke more cigarettes to get the nicotine they crave is a fairy tale,” he said. “The likely result is a major increase in cigarette-related diseases.”

These are the competing visions of our nicotine-addicted future. In one scenario, smokers stay addicted to nicotine, with its accompanying heath risks and all the other negative aspects of being addicted. But the immediate harm to their health is lessened due to fewer inhaled carcinogens, and they don’t create secondhand smoke. In the opposing scenario, smokers continue to smoke, and society continues to deal with secondhand smoke through no-smoking policies, while medical research agencies, under government mandate, oversee the gradual reduction of nicotine in cigarettes to a level below what is needed for addiction.

The optimistic thought here is that either of these approaches would bring much-needed improvement to the semi-controlled anarchy and hypocrisy of the current situation.

Photo Credit: http://whyquit.com 

Update on Smoking Bans Around the World

The noose tightens.

Smoking bans are everywhere. But what does the global picture look like as 2011 gets underway? Herewith, a brief rundown of the smoking situation in assorted countries, courtesy of an analysis late last year by BBC News.

-- Canada. In a nation known as one of the toughest of all when it comes to regulating cigarettes, the Canadian Medical Association Journal says the strict laws have been responsible for “cutting hospital admissions for heart and respiratory problems by about a third.”

-- China. In contrast, 2010 gave observers little reason to think that the Chinese government was actually going to enforce the promised national ban on smoking in public places. Enforcement varied from city to city but in general remained vague at best. Only about 25 % of the adult population believes that smoking is linked to cancer. “The country has an estimated 350 million smokers. For every three cigarettes lit worldwide, one is smoked in China,” according to BBC News.

-- Germany. The smoke-free movement hit some snags in Germany, where a ban on smoking in pubs and restaurants in 2008 has been fiercely resisted in some quarters. Tavern owners complain of lost income, and the bans are also disliked “because of an earlier crackdown on smoking initiated by Adolf Hitler’s Nazi regime,” says BBC News. Nonetheless, cigarettes were banned from Munich’s Oktoberfest for the first time in history.

-- France. Curiously, in a nation that was expected to rise up as one against workplace smoking bans, “correspondents say attitudes to smoking have changed dramatically in France since the 2007 ban, and any fears that people would generally ignore the laws have proved false.”

-- United Kingdom. Smoking is banned almost everywhere—“nearly all enclosed public spaces”—in England, Scotland, Ireland and Wales. This year, England may become the first nation to sell cigarettes in plain brown wrappers—a move government officials hope will make the packages less attractive to younger smokers.

-- Iran. Back in 2003, Iran banned smoking in public buildings. According to the BBC, the measures have had “little effect. However, in July 2010 smokers were banned from taking high-ranking jobs in the Iranian government, the news agency ILNA reported.”

-- Russia. The heavy-smoking Russians continue to astound: “A 2009 survey by the World Health Organization found that Russia has 43.9 million smokers—about 40% of the population.” About 60% of Russian men smoke. 500,000 people die of smoking-related illness each year. The Russian government is considering a blanket no-smoking policy for enclosed spaces—starting in 2015.

-- Uruguay. The host of a recent international summit on tobacco control strategies, Uruguay has adopted some of the toughest anti-smoking laws in the world—so tough that the government was forced to back down on some of its sweeping new restrictions due to tobacco industry pressure.

-- Australia. Starting last September, there was no smoking “in cars carrying children, on sections of beaches, and within 10m (32ft) of playground equipment.” Australia also bans smoking in public workplaces, and plans to follow England’s lead in forcing tobacco companies to use plain wrappers for cigarette packages.

-- United States. California, a state that almost managed to pass a proposition legalizing marijuana, has the strictest and most extensive set of anti-tobacco laws on the planet. Smoking is banned not just within public buildings, but also within 20 feet of public buildings, and on all state beaches.

Graphics Credit: http://www.nicotineedge.com/