Assessing the risks

In a windowless basement office on the medical campus of Virginia Commonwealth University in Richmond, the hard science of investigating the health effects of electronic cigarettes has begun.

Thomas Eissenberg, professor of psychology and director of VCU’s Clinical Behavioral Pharmacology Laboratory, and Robert Balster, professor of pharmacology and toxicology in the VCU School of Medicine, are co-investigators studying novel tobacco products under an $18.1 million grant from the Food and Drug Administration and the National Institutes of Health.

Their charge is to develop evaluation tools that will help the FDA as it crafts rules in regulating the manufacture, distribution and marketing of electronic cigarettes and other new tobacco products. (The FDA announced its first proposed regulations in late April.) “With respect to e-cigarettes, there are a lot of opinions floating around out there, and there aren’t a lot of answers,” Eissenberg says.

“For me, the most important thing to remember is that the past 150 years of public health and successes in public health haven’t been driven by opinion — they’ve been driven by data.”

Eissenberg has been studying tobacco products for more than a decade, and electronic cigarettes are only the latest product to come under his review.
Electronic cigarettes have divided public health officials into opposing camps, according to The New York Times.

Some believe the devices eventually will make cigarettes obsolete, while others fear e-cigs provide a gateway for children to become smokers.

“We need to find what the effects of these products are likely to be,” Eissenberg says. “There is no data on the long-term use of electronic cigarettes and its effects on human health.”

He says existing data show that some people are using electronic cigarettes to get away from tobacco use altogether. Others, however, are using e-cigarettes to supplement their tobacco use, “vaping” in places that they might not be able to smoke.

One of the questions Eissenberg is exploring is whether people in this second group eventually will give up smoking entirely or give up electronic cigarette use completely.

“The answer to that question is something we don’t have data on. But I think it’s a key question,” Eissenberg says.

Janie Heath, associate dean and professor at the University of Virginia School of Nursing, is among those who fear the allure of e-cigarettes for the young.  She writes and lectures frequently about smoking, smoking cessation and tobacco products.

Heath describes the current e-cigarette market as a “wild, wild West” in terms of the claims made about some products and ads showing them being used by celebrities.

“You look at movie stars that are vaping, and you’re thinking, ‘Vaping must be okay,’” Heath says.

She adds that the wide variety of flavors available for e-vapor products — “Captain Crunch, chocolate, cotton candy, you name it!” — can be particularly appealing to young people.

Heath notes that the Centers for Disease Control found last year that e-cigarette use among high schoolers more than doubled, from 4.7 percent to 10 percent, between 2011 and 2012.

“Smoking rates are going down. Cigarettes aren’t being purchased as much,” Heath says. “I think big tobacco companies are looking at how they can replace their cigarette base.”

But David Sylvia, senior manager, corporate communications, at Altria Group, says that one of the main reasons that the company wants FDA regulation of e-cigarettes is to keep e-vapor products out of the hands of children.

He adds that Altria has tried to pass legislation in every state setting a minimum age for purchase. “We don’t believe that underage kids should use any tobacco products,” Sylvia says.

In April, the Centers for Disease Control and Prevention reported that the number of calls to poison centers involving liquid nicotine used in e-cigarettes has surged in recent years. After averaging one a month nationally in September 2010, these calls had increased to 215 a month in February. More than half the calls involved children under 6 who became ill after ingesting liquid nicotine.

The American Academy of Pediatrics called on the federal government to develop a national plan of action to keep children safe from liquid nicotine. 
In response to concerns about the potential health effects of e-cigarettes, a growing number of cities — Philadelphia,New York, Los Angeles and Chicago —  have restricted their use.