Are e-cigarettes less harmful than real cigarettes? Advocates say they help smokers quit. But health officials aren’t so sure.
Following the lead of at least 10 other communities in Massachusetts, the Boston Public Health Commission last week voted to ban the use of e-cigarettes in workplaces in the city, effectively prohibiting them from most places where smoking is also banned.
Then Schwaber, a 29-year-old emergency medical technician from Lexington who smoked as much as three packs a day, tried electronic cigarettes. The battery-operated vaporizers, often shaped like a cigarette, use flavored liquids to deliver a dose of nicotine with each draw. She hasn’t smoked for more than two years.
Instead Schwaber puffs on “vape’’ that tastes like biscotti or peach. She no longer needs the asthma inhaler she once used regularly. She has no taste for tobacco. And she figures she has cut her daily nicotine intake to about one-fifth of what it was, with plans to wean herself off even that in the coming months.
“Give me a few more months, and I’ll just be breaking [the] hand-to-mouth’’ habit, she said.
Like many supporters of e-cigarettes, Schwaber believes the devices have saved her from a lifetime of smoking-related health problems. Yet public health and tobacco control officials have been loath to embrace them.
For one thing, the devices are completely unregulated by the federal government, with no industry standards for safety in manufacturing or marketing. That has prompted some states and municipalities to enact regulations on their own.
Following the lead of at least 10 other communities in Massachusetts, the Boston Public Health Commission last week voted to ban the use of e-cigarettes in workplaces in the city, effectively prohibiting them from most places where smoking is also banned. The commission also prohibited sale to minors.
Schwaber (left) adds liquid, which includes nicotine, propylene glycol, and flavoring, to an e-cigarette. She said she used a peach-flavored liquid when she quit smoking cigarettes in the summer of 2009.
“This is a device that is delivering a toxic, addictive substance,’’ Dr. Paula Johnson, a cardiologist at Brigham and Women’s Hospital and chairwoman of the commission. “We need to treat it as such.’’
Johnson noted that the product will remain on the market for those adults who want to use it. She said more research is critical, particularly on whether the e-cigarettes are truly effective in helping people to quit smoking and what the long-term effects are of inhaling the vaporized liquid, typically made from a base of propylene glycol.
Advocates of e-cigarettes argue that they are surely safer than breathing in burned tobacco and the thousands of chemicals that come with it. While nicotine, the addictive agent in cigarettes, can be poisonous in large doses, the harm it causes to a person’s health may be relatively minimal compared with that of other toxic components of cigarettes.
Others say it’s not clear what else might be inhaled in the vapor or what level of nicotine the electronic devices actually deliver in each puff.
No one interviewed for this story objected to the prohibition on the sale of e-cigarettes to minors. But users and some researchers said that putting restrictions on where they can be used sends the message that e-cigarettes are dangerous.
“Here we have a product that is helping thousands of people to get off of cigarettes and the public health response has largely been to discourage people from using the product,’’ said Michael Siegel, professor and tobacco researcher at Boston University School of Public Health. “To me, it just seems to be counter to the public interest.’’
Siegel acknowledged that research on the effectiveness of e-cigarettes for smoking cessation is scarce. A study published in October in the journal BMC Public Health found that, among 40 regular smokers who used e-cigarettes for six months, 55 percent cut their cigarette use by at least half. Nine stopped smoking altogether. But the study is small, and it is unlikely that large-scale, long-term studies of the devices will be available any time soon.
E-cigarettes, first patented in China, made their way into the US market about four years ago. The customer base grew quickly. Researchers with the US Centers for Disease Control and Prevention surveyed more than 10,000 people in 2009 and again in 2010 and found that awareness of e-cigarettes doubled in that time while the portion of respondents who said they had tried them more than quadrupled, to 2.7 percent in 2010.
On online forums, e-cigarette users chat about their favorite devices and “juices,’’ or “vaping’’ liquids. Schwaber tweets and video blogs as Vaping Valerie. She often attends monthly meet-ups at a Worcester bar, where “vapers’’ talk about the products they use and field questions from bar patrons.
Schwaber estimated that she has spent about $200 on e-cigarette devices of various sizes, colors, and battery life. She gives herself a monthly allowance of about $50 – about equal to what she once spent in two days on cigarettes – to buy liquids from US vendors she has researched and trusts.
Because the products are an up-front investment, with starter kits ranging from about $40 to over $100, and their regulatory future has been unclear, some smoke shop owners have been reluctant to buy into e-cigarettes. Some vendors sell them at mall kiosks.
In September 2010, the US Food and Drug Administration notified e-cigarette distributors that they were in violation of federal law and that their products would have to go through a drug application process that includes clinical trials. That process would have required removing e-cigarettes from the market for at least several years.
But the agency backed off that approach earlier this year after losing a lawsuit from a manufacturer that argued the products made no claim to therapeutic benefits, such as aiding cessation. The agency has said it plans to create regulations for e-cigarette production, however.
The American Cancer Society, the American Heart Association, the American Lung Association, and the Campaign for Tobacco-Free Kids said in a joint statement in June that until those regulations are in place, they would not oppose state bans on the sale of e-cigarettes altogether.
Dr. Nancy Rigotti, director of the Tobacco Research and Treatment Center at Massachusetts General Hospital, supports the regulations passed last Thursday by the Boston Public Health Commission. She is concerned in part about the fact that e-cigarettes mimic smoking.
Cigarettes are a powerful force in American culture, she said. Allowing e-cigarettes to be used in the workplace “reintroduces the idea of cigarettes into what are currently smoke-free environments and begins to renormalize tobacco use in these products,’’ she said.
Former tobacco smoker David Carlino said the fact that he could use an e-cigarette just about anywhere helped him kick the habit. Carlino, 23, of Allston works at Leavitt & Peirce, a tobacco shop in Harvard Square, and had been smoking for a decade. He, too, had tried other methods of quitting, but he always went back to cigarettes.
He bought an e-cigarette starter kit from the first batch that arrived at the store in March and used them for two weeks. He hasn’t smoked since.
Carlino said the product helped him to take control of his environmental triggers. If he could take a few puffs during his shift at work, for example, he was less likely to want a cigarette when he stepped outside on his afternoon break.
“The strength of the e-cigarette is in the fact that it breaks the ties that smoking has to your life, not so much your body,’’ he said.
Rigotti, of the Tobacco Research and Treatment Center, said she didn’t think e-cigarettes would catch on when they first appeared on the market. But given how consumers have taken to them, she said, they need careful attention.
“We can’t dismiss them out of hand,’’ Rigotti said. “We’ve just got to figure out how to use them in a way that is most helpful to smokers who want to quit and can’t quit and doesn’t cause harm to the overall society.’’
By Chelsea Conaboy