“You mean I can smoke these indoors?!?”

Eli Cahan

So goes the typical reaction of an American cigarette smoker examining their first electronic cigarette. It’s a revelation in a country where, unlike the rest of the world, cigarette smokers must crawl outside, tail between their legs, to satisfy their craving. The pitch only gets better when the marketing geniuses at Blu tell smokers that “vapor, rather than smoke” has cured their impending cancer prognoses. Sounds like a miracle — all thanks to our good friends at Big Tobacco. But could it really be true? There certainly seems to be some allure to the blue glow in the hazy nightclub. And yet, the health facts on e-cigs are just that — hazy.

Scientifically, though it’s true that e-cigs vaporize liquid, rather than flaming tar, to create the “smoke” effect, the data remains inconclusive on the health implications of the vapor. Though they have been shown to contain fewer carcinogenic substances than the nicotine tar present in traditional cigarettes, the market is highly unregulated and harmful substances have been found in liquid samples.

Additionally, since other smokeless tobacco products, such as snuff or dip, have been shown to cause numerous cancers, there is fear that e-cigs might induce an analogous problem.
Further concerns parallel the technical name for e-cigs, which is “Electronic Nicotine Delivery Systems” (ENDS): The name still speaks to the addictive nature of the product.

So there is concern that while e-cigs might well reduce cancer cases among long-time smokers, they might also prove a “gateway substance” for new, prospective smokers. The theory is threefold: First, regarding the addictive nature of nicotine; second, regarding the pleasurable “burning” sensation upon inhalation; third, regarding the mimicked “pulling motion” of hand to mouth. Accordingly, the Centers for Disease Control released a report in 2013 showing that the number of e-cig smokers under 18 years old doubled in the past two years. The CDC recently released another report saying that the number of youths who have “tried” e-cigs tripled between 2011 and 2013. Big Tobacco’s aggressive marketing campaigns (spending increased tenfold from 2010 to 2012) and creative “candy” flavors are indicative of its awareness of this $3 billion future “market opportunity,” so to speak.

The counterargument regarding e-cigs’ benefits is made by a study conducted by the University of Nottingham. The study, by looking at recent statistics in the United Kingdom as well as illustrative case studies in Norway and Sweden, speaks to the public health benefits of cigarette replacements and smoking cessation tools. It shows that markets embracing viable alternatives to cigarettes have shown marked decreases in lung cancer rates. Thus, the study concludes that while information on e-cigs remains inconclusive, they may prove a useful tool as a smokeless alternative for nicotine users, an important opportunity worth consideration for public health organizations globally. This is the same argument that traditional tobacco companies (Lorillard, Phillip Morris, Altria, Reynolds, etc.) are backing and lobbying for.

All of this came to a head in the recent report released by the World Health Organization. In the report, WHO recommended regulatory action against e-cigs equivalent to that of typical cigarettes, claiming the potential risks are greater than the benefits. Of particular concern is the idea that e-cigs might “perpetuate the smoking epidemic,” through “glamorization” and “implicit targeting of minors.” Big Tobacco, as well as various public health experts, immediately fought the report, claiming that proposed regulation would be “overly restrictive” and would limit the health benefits of the product.

So what does all of this mean for us? In my opinion, it means that e-cigs will only increase in prevalence. Powerful lobbying campaigns in Washington and marketing campaigns on television are seductive, especially when they address health stigmas. Furthermore, as we’ve seen with trends in the food industry with labels like “organic” and “natural,” these movements, codified scientifically or not, tend to gain traction in a self-diagnosing, hypochondriac society like ours. The additional significance here is to a broader theme — the continued influence of the private sector on public health issues.

There remains considerable tension between political strategy (demonize corporate America for Main Street) and honest science (embrace the optimal health options for Main Street, regardless of the source): See the Sovaldi controversy. Whatever happens to e-cigs, that tension isn’t going away. But for the time being, expect Skeeps to glow a little more blue.

Eli Cahan can be reached at emcahan@umich.edu.

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