Up in Smoke
Health and government officials go on the attack against the billion-dollar e-cigarette industry
By Kevin Uhrich 09/04/2013
For the past 43 years, local rock drummer and Pasadena Weekly Calendar Editor John Sollenberger has been an unapologetic cigarette smoker, more than earning each of the many “Best Bad Influence” awards that he’s won in our annual Best of Pasadena contests.
But over the past few months, Sollenberger’s been satisfying his cravings for nicotine not by smoking tobacco, but by “vaping” with still largely unregulated and untested electronic, or e-cigarettes. This new way of “smoking,” Sollenberger insists, not only satisfies his need for nicotine, but is actually improving his health.
“I was really kind of amazed,” Sollenberger says of his first taste of an e-cig. He had actually stopped smoking briefly while recovering late last year at Huntington Hospital from a nonsmoking-related medical emergency and didn’t want to start again. He just happened to see one of the many versions of the new gadget for sale in a liquor store when he decided to try it out.
“It satisfied whatever residual cravings I still had,” Sollenberger says. “It satisfies as much as any cigarette would.”
Despite the fact that e-cigarettes, or electronic nicotine delivery systems (ENDS), burn nothing — thus emit no smoke — and that many public health professionals encourage people who already smoke tobacco to switch to the less-toxic e-cigs, state and local officials are including the battery-operated devices in increasingly tough prohibitions against the use of smoking products in public areas and workplaces.
As far as Pasadena Tobacco Control Officer Statice Wilmore is concerned, nicotine, which is not a carcinogen but can be deadly in high enough doses, is still the toxic substance being inhaled and exhaled by the user. And, she said, the new heating coil-activated e-cigarettes have been found to contain other chemicals.
Among the best known ingredients are generally benign propylene glycol, a synthetic liquid substance that absorbs water and is recognized as a safe food additive. Propylene glycol is also used as a base for de-icing solutions and to create artificial smoke in theater productions. Also included is vegetable glycerin, an odorless and colorless carbohydrate derived from plant oils that is sometimes used as a skin softener.
But along with these, traces of other substances that have been found in “e-smoke,” according to a study conducted by scientists at UC San Francisco, include acetaldehyde, benzene, cadmium, formaldehyde, isoprene, lead, nickel and toluene — all listed among dangerous substances contained in Proposition 65, the Safe Drinking Water and Toxic Enforcement Act. Proposition 65 was passed in 1986 to help protect Californians from chemicals known to cause cancer, birth defects or other reproductive harm.
Although other cities around the San Gabriel Valley are now taking steps to ban e-cigarette smoking in public places, Wilmore says that under Pasadena’s tough anti-smoking laws, the devices are considered the same as any other smoking product.
“We’re still collecting information as we speak,” Wilmore says of the devices, which were first created in China in 2004. “More and more is coming out every day about this product and its use.”
For all the hard work of Wilmore and others in the city’s anti-smoking efforts, e-cigarettes are currently a $1-billion a year business, and market experts say they may even fully replace traditional tobacco smoking products by the middle of the century. As incredible as it sounds, considering all the well-known health hazards associated with smoking tobacco cigarettes, an estimated 45 million people still light up, with 293 billion traditional cigarettes sold in 2011 alone, according to a recent Wall Street Journal report, citing figures from the US Centers for Disease Control.
In the next five years, a Wells Fargo Securities analyst told the newspaper, e-cig sales could reach $10 billion, with many smokers, like Sollenberger, switching to the new devices.
“E-cigarettes are more than just a fad,” reads a separate Wells Fargo report on the devices. “E-cigarettes’ appeal stems from a variety of perceived advantages over traditional cigarettes, most commonly the perceptions that e-cigarettes are healthier, cheaper and can be used almost anywhere.”
A drag from an electronic cigarette is really not unlike a hit from the standard Marlboro Gold. Only instead of smoke and burning ash wafting down one’s throat and filling up his or her lungs, cravings are satisfied by a blast of nicotine-laced vapor that’s created after an electrical coil heats a liquid nicotine cartridge and then emits a vapor that is sucked through a faux filter attached at the end of a stainless steel tube, which has the look of a regular cigarette.
Here, instead of saturating lungs with tobacco smoke and its many harmful elements, the interior of a user’s upper thorax is misted with the addiction-satisfying aerosol spray, which is then exhaled in the form of quickly dissipating steam.
For smokers unable to quit, e-cigarettes, which come in different flavors and with or without nicotine, are an answer to a prayer. In a world in which smoking is increasingly being outlawed, these new kind of cigs create no smoke, and thus, at least by appearances, create no noxious secondhand smoke for people to complain about. When these devices arrived on the American market in 2007, it was believed they could be used anywhere, anytime, and “smoke everywhere” became a popular catchphrase among aficionados.
Taking advantage of the e-smoking craze is Benjamin Ocampo, owner of VAPE Supply Co., located in the 200 block of North Hill Avenue, a few blocks from Pasadena City College. The shop, nestled in a strip mall just south of the Foothill (210) Freeway, is comprised of a group of tables set against a wall, with shelves of flavor additives lined up behind a juice bar on the other side of the room, and a large glass case containing a variety of pipes and other types of e-smoking devices, or personal electronic vaporizing units, or PEVUs, against the wall facing the door.
Joseph Ocampo, Benjamin’s brother, says he understands some of the problems currently faced by the budding industry, just as he knows it is a business that is only growing by the day. In fact, Joseph Ocampo said his brother is opening another e-smoke shop in the coming weeks in downtown Los Angeles.
“I think it’s great that the [Food and Drug Administration] is coming in and having their say, especially on something that you ingest,” Joseph Ocampo said.
“As far as studies go, there haven’t been very many, and some have been good and some have been bad. But it’s certainly a good alternative” to traditional tobacco smoking, he said.
Today, public health officials around the world are reacting with caution to these new nicotine delivery devices.
The World Health Organization (WHO), as part of its Tobacco Free Initiative, questioned the use of e-cigs as replacements for tobacco cigarettes and formally opposed their use in July, stating, “The safety of ENDS has not been scientifically demonstrated. … The potential risks they pose for the health of users remain undetermined. Furthermore, scientific testing indicates that the products vary widely in the amount of nicotine and other chemicals they deliver and there is no way for consumers to find out what is actually delivered by the product they have purchased.”
According to the American Association for Justice (or AAJ, formerly the Association of Trial Lawyers of America), the only known clinical tests done on e-cigarettes up to 2009 were performed in New Zealand — bankrolled by the e-cigarette company Ruyan.
The study found that ENDS contain propylene glycol, but not heavy metals such as chromium, arsenic, and nickel, all of which are found in tobacco cigarettes. However, e-cigarette cartridges contained low levels of the gas benzene, a carcinogen, at a measurement of 1.2 parts per million (ppm). The US Occupational Safety and Health Administration (OSHA) has set limits of 1 ppm for workplace air for a standard workweek.
After that discovery, Ruyan “allegedly conducted independent tests that determined that the source of the contaminant was the nicotine flavoring, and the company then changed the formula, resulting in no detectable level of benzene. The study ultimately found that the Ruyan brand of e-cigarette is a safe alternative to cigarettes and ‘appears to be safe in absolute terms on all measurements’ applied,” according to AAJ.
Over the past few years, countries such as Australia (where nicotine is classified as a “poison”), Canada, Israel, Mexico, Panama and Brazil have all banned e-cigarettes. In the United States, New Jersey recently became the first state to prohibit their use in public places and in workplaces, and California appears headed in that direction as well.
Senate Bill 648, authored by Senate Majority Leader Ellen M. Corbett, would require electronic cigarettes to be regulated as tobacco products and be included under all existing California smoking laws.
“SB 648 limits the use of e-cigarettes as they pose unknown health risks in a public space,” the East Bay Democrat states in a post on her Web site. “We must always stand on the side of public health since we still do not yet fully understand the safety of chemicals present in e-cigarette vapors or when nicotine itself leaks from the products. It simply makes sense to regulate e-cigarettes as a tobacco product when they are already prohibited in many public spaces.”
The other side
Some health professionals, however, are not yet prepared to lump e-cigs and tobacco cigarettes in the same category. While opposed to all tobacco use, the American Association of Public Health Physicians states in its list of guiding principles that “Smoke-free tobacco/nicotine products, as available on the American market, while not risk-free, carry substantially less risk of death and may be easier to quit than cigarettes.”
When it comes to “harm reduction,” “smokers who have tried but failed to quit using medical guidance and pharmaceutical products, and smokers unable or uninterested in quitting should consider switching to a less hazardous smoke-free tobacco/nicotine product for as long as they feel the need for such a product. Such products include pharmaceutical Nicotine Replacement Therapy (NRT) products used, off-label, on a long term basis, electronic ‘e’ cigarettes, dissolvables (sticks, strips and orbs), snus, other forms of moist snuff, and chewing tobacco,” states the organization’s Web site.
Other physicians, while saying more research is needed, say e-cigarettes actually aid smokers to get off tobacco and are safer than cigarettes.
Dr. Michael Siegel, a tobacco control specialist at Boston University School of Public Health, said government agencies are not justified in regulating e-cigarettes without more data. “My view of public health regulations is that in order for the government to intervene there needs to be evidence that behavior is causing a public harm,” Siegel told the Pasadena Star-News.
“I don’t think it’s justifiable for the government to start banning things without having any evidence that electronic cigarettes are causing any significant damage in exposure,” Siegel said.
Last year, a federal judge shot down an attempt by the FDA to regulate e-cigarettes as “drug-delivery devices.” Now, in turn, the FDA is trying to regulate them as they would tobacco products, with agency officials presently in discussions with e-cigarette industry leaders on plans to prohibit their sale online, as well as a number of other proposals aimed at regulating the devices, according to the Wall Street Journal.
“It is true that more research is needed on the health effects of e-cigarettes. However, we do not need more research on whether e-cigarettes should or should not be included in proposed FDA regulations,” Mitch Zeller, director of the FDA’s Center for Tobacco Products, told the Journal.
Given the known deadly alternative to e-smoking, “It boggles my mind why there is a bias against e-cigarettes among antismoking groups,” Siegel recently told John Tierney of The New York Times.
The executive director of Smokefree Pennsylvania, William T. Godshall, told The Times that he also questions why anti-smoking forces are so against e-cigarettes as an alternative to tobacco use.
“E-cigarettes could replace much or most of cigarette consumption in the US in the next decade,” Godshall told Tierney. “There is no evidence that e-cigarettes have ever harmed anyone, or that youths or nonsmokers have begun using the products.”
The FDA is expected to be finished by October with a framework of regulations for the sale and use of e-cigarettes.
Better safe than sorry
When he smoked tobacco, Sollenberger says he was constantly coughing and was often winded. But “all that went away after I stopped smoking cigarettes. These [e-cigs] don’t seem to cause any of these symptoms. The coughing, shortness of breath … all gone. If they can work for a hardcore smoker like me, they can work for anybody,” he says.
As for his new way of “lighting up,” “I do it now because I want to, not because I have to, and there is a difference,” he says.
Joseph Ocampo said e-cigarettes have the potential to do great amounts of good by turning addictions into habits, then into hobbies. “I could put this down today and not miss it,” he said of the elaborate device he casually puffed on while greeting customers at the shop one day last week.
“You’re going to find that this is something that is certainly a health concern to some, but in the business we’re in, this a safer alternative than cigarettes, which have 4,000 chemicals,” he said.
Wilmore says it’s simply still too early to declare these devices safe for pubic use.
“The bottom line is there hasn’t been a lot of research deeming it safe,” Wilmore said. “The research being done on this product is not enough. It just hasn’t been done.”