National Agencies and Associations evaluate in on Electronic Cigarettes

By Tariku Haque


As electronic cigarettes become more accepted, government agencies and national associations are weighing in with recommendations. At issue is the potential health impact of the devices, as well as the quality of the product and the manner in which it is marketed and labeled. Opponents suggest smokeless cigarettes may contain risky chemicals, are often faulty, have inconsistent amounts of nicotine contrary to labeling, and are marketing towards children and young adults. Proponents assert that smokeless cigarettes do not contain nearly as many cancer causing chemicals as tobacco products, and those that are present are at levels within the amount considered safe for human consumption. In addition, the same chemicals referenced are also present in FDA approved nicotine replacement therapies. They further state that smokeless cigarettes as a substitute for the traditional variety offer a safer alternative to cigarette smoke.


United States Food and Drug Administration
The United States Food and Drug Administration (FDA) indicated concerns with electronic cigarettes as a result of their 2009 study of 19 brands. Tobacco-specific nitrosamines (TSNAs), known carcinogens, were found in nearly all of the cartridges, and the nicotine levels listed on the labels were not always accurate. The FDA issued a press release in July 2009 indicating that consumers should avoid the product, as it lacks appropriate health warnings. FDA spokeswoman Siobhan DeLancey said, "The agency has not made a decision to remove all e-cigarettes from the market... [but] will regulate electronic cigarettes and related products in a manner consistent with its mission of protecting the public health."
To that end, letters were sent to a number of electronic cigarette distributers in September of 2010, strongly warning against violations of the Federal Food, Drug, and Cosmetic Act including failure to follow good manufacturing practices, making unsubstantiated drug claims, and using electronic cigarettes as delivery mechanisms for active pharmaceutical ingredients. The FDA has stated that it is in the process of developing regulations for electronic cigarettes under the Tobacco Act.


American Association of Public Health Physicians
The American Association of Public Health Physicians' (AAPHP) proposal is opposite that of the FDA. Instead, the AAPHP supports the sale of smokeless cigarettes to adults, though believes sale to minors should be prohibited. The Association indicates that it takes no position on whether smokeless cigarettes should be allowed in non-smoking areas. Reasoning behind this statement is strictly centered on improving public health.


Estimates show that approximately eight million American smokers will die of tobacco-related diseases over the next twenty years, and the AAPHP calculates that up to four million of these could be saved through transition to electronic cigarettes and other smoke-free nicotine delivery systems. The Association points out that while traditional cigarettes are the method through which approximately 80% of the country's nicotine is consumed, they are responsible for more than 98% of the illnesses and deaths. The nicotine is not the deadly agent - instead, it is the products of the smoke that are toxic. The AAPHP indicates a belief that by switching to a nicotine-only product, such as electronic cigarettes, smokers can cut their risk of tobacco-related death by 99%.


There is no argument about the fact that quitting smoking is the best way to stay healthy, but success rates are very low - particularly without nicotine replacement. Around 3% of smokers successfully quit every year without intervention, and achievement is increased to 7% with the use of currently available nicotine replacement therapies. Viewed another way, 93% of smokers cannot or will not quit with the current options available. Use of electronic cigarettes in this population can achieve nearly all of the benefits of smoking cessation for those who are unable or choose not to give up the habit.




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