Electronic Cigarettes -- Let's Think Before We Inhale

Let's pause and think before we inhale the hype of electronic cigarettes (e-cigarettes). As is the case with conventional cigarettes, e-cigarettes deliver nicotine, an addictive drug. Beyond their addictive quality, the health consequences of e-cigarettes are largely unknown. Before we jump on the bandwagon of promotion, let's consider the facts:

Fact: Addiction is a complex brain disease involving a wide range of addictive drugs including nicotine with enormous costs to individuals and society. Addiction in all of its forms accounts for one-third of all hospital inpatient costs and drives more than 70 other diseases requiring medical attention.

Fact: 95 percent of cases of addiction involving nicotine originate with substance use before age 21; the younger the age of initiation, the greater the likelihood of addiction.

Fact: A growing body of evidence suggests that early use of nicotine increases the risk of addiction involving not only nicotine but also other drugs. High school students who have ever smoked cigarettes are nine times likelier to develop addiction involving alcohol or other drugs than those who have never smoked.

Fact: More than 20 percent of those with addiction involving nicotine also have addiction involving one or more other drugs and another 59 percent of users of nicotine laced tobacco products are risky users of other addictive drugs.

These facts suggest that e-cigarettes may well serve as training wheels for other drug use and addiction and most states do not restrict the purchase of these products by children. Are we okay with our 8- year-olds being able to buy e-cigarettes?

From Big Tobacco's sales and marketing perspective, these unregulated products will be a gold mine. As the tobacco industry knows only too well, the best way to get a lifetime user is to start them early. This explains current e-cigarette marketing tactics that revive the old glamorous promotional cues which for decades have attracted young people to the deadly habit of cigarette smoking.

From device to packaging, e-cigarettes are designed to look exactly like a traditional cigarette but without the harsh flavor or burning sensation when inhaled. This would seem to produce a greater likelihood of second use, third use, and so forth, setting the user on a faster path to addiction and guaranteeing sales for years. Flavoring the "e-juice" with cherry, peach and menthol creates direct appeal to children and adolescents. Clever advertising by the tobacco industry makes e-cigarettes the perfect bridge to other addictive substances including conventional cigarettes. Once again the tobacco industry is marketing the disease of addiction.

Harm reduction advocates argue that for those currently addicted to traditional cigarettes e-cigarettes are a less harmful substitute. In a perfect world this may be true, but the research on how these products are actually used is scarce and some of it suggests that e-cigarettes aren't being used as replacement products but instead are being used to simply supplement other tobacco use and to circumvent current no-smoking policies that have taken decades to achieve.

Harm reduction advocates also make the case that e-cigarettes are safer than combustible products because they do not present the risks to others associated with second-hand smoke. While this seems obvious, there is not enough evidence to prove that these products have no second-hand effects.

It is possible that there may be therapeutic value to a vaporized nicotine product for the purpose of tobacco use cessation and we should certainly explore this possibility. But, to make this decision, specific products must be reviewed and evaluated by the FDA through established processes demonstrating safety and efficacy before bringing them to market.

Today one in six Americans already have the disease of addiction -- that's more than the number with heart disease, diabetes or cancer. Another 80 million engage in substance use in ways that threaten health and safety. Addiction and risky substance use is the largest preventable and most costly health problem in the U.S. today. Given the history of cigarette marketing in this country and the horrific health consequences and costs that resulted, common sense requires immediately regulating and taxing e-cigarettes as cigarette products while developing a solid knowledge base about the content of these products, how they are used and by whom, their short- and long-term health consequences and the anticipated market for new users. After we have the facts, we can then build a sound regulatory structure around them. Let's not make a hasty decision to add another addictive product to the consumer market that could well sacrifice the health of another generation.