Electronic cigarettes challenge anti-smoking efforts

A new TV advert for a brand of electronic cigarettes marks the first time in decades cigarettes of any sort have been promoted on US television. Anti-smoking campaigners fear the rapid growth of tobacco-free cigarettes could undermine years of successful anti-smoking efforts.

A handsome actor poses and struts on a beach in a stylishly shot black-and-white television spot. He puts the cigarette to his lips, takes a puff, and exhales a rich flume.

"Blu lets me enjoy smoking without it affecting the people around me, because it's vapour not tobacco smoke," says Stephen Dorff, the scruffy heartthrob star of The Immortals.

"We're all adults here, it's time we take our freedom back."

The launch this autumn of the advert for blu eCigs marks a turning point in the fast-growing US market for electronic cigarettes, which use an electronic mechanism to warm a liquid nicotine solution and release mist into the lungs.

Most living Americans had never before seen a cigarette advertised on television - they were banned in 1971.

But the electronic cigarettes fall outside that law, since they contain no tobacco. That is just one way they fall into what one anti-smoking campaigner calls a regulatory "no man's land".

Electronic cigarettes have exploded in popularity in the US since they first appeared on the market in 2007. Blu is just one brand, with NJOY, SmokeAnywhere, Joye eGo, and many more also available.

Their appeal stems from perceptions - as yet untested by science - that they are safer than tobacco cigarettes and can even help smokers kick the habit.

And because they contain no tobacco, the e-cigarettes seem exempt, for now, from ever-stricter public smoking bans.

Since their emergence onto the US market, US sales have risen from $5m (£3.1m) to an estimated $250m, according to UBS estimates.

Amid the explosive growth, smoking opponents are eyeing the devices warily.

"We know that smoke-free laws encourage smokers to try to quit," says Danny McGoldrick, vice-president of research at Campaign for Tobacco-Free Kids.

If electronic cigarettes keep people smoking who would otherwise quit, that is harmful, he says.

Once sold mostly online and in small kiosks, they were given a huge boost in April when US tobacco giant Lorillard Inc purchased blu from the brand's creators for $135m (£84m).

Lorillard executives said they foresaw rapid growth and were keen to put their weight behind the brand.

Since the acquisition blu has seen a five-fold increase in its retail availability, and will be available in some 50,000 shops by the end of this year. The national advertising campaign launched in October.

"They've come in and put in their tremendous resources and experience and they've put us on steroids and given us the resources to grow well," blu's creator and president Jason Healy said of the Lorillard acquisition.

"We've established blu as a lifestyle brand for smokers."

Electronic cigarettes have been subjected only to minimal scientific study - not enough to demonstrate whether they are safer than tobacco cigarettes or effective as a smoking cessation product like nicotine gum or patches.

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It feels like what they're trying to do is re-establish a norm that smoking is okay, that smoking is glamorous and acceptable”

Cynthia HallettExecutive Director, Americans for Non-Smokers' Rights.

The World Health Organization has warned electronic cigarettes "pose significant public health issues and raise questions for tobacco control policy and regulation".

And a 2009 test by the US Food and Drug Administration of electronic cigarettes - none from blu - found traces of cancer-causing chemicals and other toxic chemicals.

Electronic cigarettes are either banned or heavily regulated in Australia, Brazil, Canada, Germany and several other countries.

But in the US, at present electronic cigarettes "are essentially unregulated" says McGoldrick.

Unless they make a therapeutic claim, for example that they can help people quit smoking, they fall in the cracks between federal tobacco regulations and rules covering drug devices like insulin pumps,

In the new commercial, Lorillard appears to have reached into the bag of advertising tricks that got previous generations of Americans hooked on cigarettes, tobacco industry critics say.

"It feels like what they're trying to do is re-establish a norm that smoking is okay, that smoking is glamorous and acceptable," says Cynthia Hallett, executive director of Americans for Non-Smokers' Rights.

The blu advert stokes the spirit of rebellion that appealed to smokers when they first started as adolescents, says David Abrams, executive director of the Schroeder Institute for Tobacco Research and Policy Studies at Legacy, an anti-tobacco organisation.

This time around, instead of defying parents and teachers, the ad encourages smokers to rebel against more recent anti-smoking social norms.

"They're capitalising on that with adult smokers by basically saying 'don't let society tell you what to do'," Abrams says.

"'You have the freedom to smoke. Thumb your nose at the anti-smoking policies and the FDA.'"

The thick flume of smoke streaming from Stephen Dorff's mouth creates the urge in smokers to reach for their pack, even as the seaside setting evokes associations of clean, fresh air, says Joseph Cappella, a professor of communication at the University of Pennsylvania.

"The environment is presented as a way of making clear there is a cleanliness, a healthiness linked to this nicotine delivery device," he says.

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We are not against them being on the market but they should be responsibly regulated and marketed”

David AbramsPublic health researcher

Electronic cigarettes are sold in a variety of flavours: The Eonsmoke brand, for one, sells cartridges in apple, menthol, strawberry, "mojito", "tobacco" and others.

Extensive research has shown flavoured tobacco appeals to young smokers and adolescents who are not ready for standard cigarettes, Abrams says.

Anti-smoking campaigners including the American Cancer Society fear electronic cigarettes could get young smokers and adolescents hooked on nicotine - and later onto tobacco.

Healy rejects that. He says blu's target customers are 35-55 years old and have been smoking for years.

"This is about giving smokers freedom and choice," says Healy, an Australian former professional basketball player.

Soon after e-cigarettes arrived on the market the FDA moved to regulate them under its authority over drug delivery devices, but a court rejected the move.

The FDA has since hinted it may regulate them like tobacco products and an extensive rule-making procedure is underway. That would give the agency authority to restrict how they are marketed and labelled.

Healy says regulation could help the category in the long-run by reining in makers of poor-quality products.

"There's a lot of cowboys out there who can't afford to do a lot of things you need to do to ensure product quality and safety," he says. "It's going to be great for the consumer."

Anti-tobacco campaigners say they're keeping an open mind about electronic cigarettes.

"We are not against them being on the market but they should be responsibly regulated and marketed and tracked over time in a way that protects the public health and fully informs consumers of their effects and indications for use," says Abrams.

"The introduction of these new non-combustible products that are appealing like e-cigarettes could have great public health value."

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Are Electronic Cigarettes A Genuine Threat To Big Tobacco?

Life is not getting easy for the tobacco industry these days. With the increasing taxes and widespread and concerted anti-smoking campaigns, more and more smokers are kicking the habit. Sales are slowly but surely going down and a horde of smaller players in the smokeless alternatives market are eating away at their core demographic of customers. Established players like Philip Morris (PM), RJ Reynolds (RAI) and British American Tobacco (BTI), who constitute the so called Big Tobacco are feeling the heat from electronic cigarette pioneers like privately held Bull Smoke who have literally turned the high margin and extremely profitable conventional cigarette business upside down by promising to deliver arealistic smoking experience with their vapor generating electronic devices. The question that begs an answer is -- how will the "empire strike back"?

Electronic Cigarettes: Riding the anti-smoking wave

The rise in this new smoking (or vaping as enthusiasts charmingly call it) technology has been meteoric to say the least. From an idea that never really managed to get off of the drawing board in the 1960s, to a rebirth in the early years of the new millennium in China, the smokeless electronic cigarette has certainly had an eventful journey. Introduced into the Chinese market in 2004 as an aid to quitting cigarettes, the electronic cigarette eventually found its way into other markets worldwide. The rest, as they say, is history; or rather, history in the making. In the last 4 years, electronic cigarette sales have skyrocketed, culminating in sales in excess of three and a half million this year alone. With no prospects of any slowdown in the near future, smokers that are looking for a cheaper and healthier alternative to cigarettes see these new e-cigs as the way to go. And therein lies the potential problem for Big Tobacco.

Not everybody is a fan, certainly not the FDA

The authorities are not exactly pleased with the widespread popularity and the kind of publicity that electronic cigarettes are attracting. The FDA and FTC have been decidedly unfriendly in their stance towards electronic cigarettes. The initial attempts by the FDA to block electronic cigarette imports into the US and their classification as drug delivery devices rather than as tobacco products were struck down by a Federal District Court a couple of years back. Electronic cigarette proponentshave noted the irony that an FDA-approved failure like going "cold turkey" is better than an unapproved success when it comes to smokers trying to quit.

The FTC is also challenging electronic cigarette advertising claims

At the same time that the FDA has their proverbial spotlight focused on the electronic cigarette industry, the Federal Trade Commission is increasingly becoming focused on the advertising claims made by manufacturers. Specifically, the FTC is interested in claims made that electronic cigarettes are a safe alternative to traditional cigarette smoking. Simply visit any reputable electronic cigarette website, like the one belonging to the aforementioned Bull Smoke brand for instance, and you will find scores of disclaimers that electronic cigarette companies are forced by their respective compliance departments to display. Despite some reputable testing that suggests that there is a benefit to electronic cigarette use over conventional tobacco, there admittedly has not been adequate scientific tests carried out that prove that electronic cigarettes are healthy or even less harmful compared to smoking tobacco. However, recent independent research out of Boston University has concluded that electronic cigarettes are indeed safer than their tobacco counterparts. So this begs another question -- why is there a crusade against this new and potentially safer technology?

Big Tobacco and electronic cigarettes

These last few decades have not been kind to the tobacco industry. After the devastating flurry of lawsuits by several US states, and the ensuing tightening of legislation at both the state and federal levels, this culminated in the Family Smoking Prevention and Tobacco Control Act of the Obama Administration. The writing is clearly on the wall for Big Tobacco. Sure, they have promising emerging markets in less developed nations where they can expand, despite hostile legislation. But still, if they want to prosper in the western hemisphere, they will have to look beyond conventional tobacco. They are already exploring the possibilities offered by smokeless alternatives like snuff and snus in the European markets. However, the rise in popularity of electronic cigarettes has put the major players in a sure quandary.

If you can't beat them, eat them!

Electronic cigarette technology is a product that is clearly hostile to Big Tobacco's already flagging interests in the tobacco market. One that contributes to the acceleration of the decline of their global sales numbers. It would have been surprising to say the least, if they, with their considerable economic resources and lobbying clout, did not try get on board themselves with this new technology. So the question remains, what do you do when you are sitting on piles of cash that exceeds the GDP of several small nations, let alone the entire electronic cigarette industry? The simplest move would be to move in and start buying the emerging electronic cigarette competition. It is as simple as that, and they are already doing it. The recent acquisition of blu Cigs by Lorillard (LO) is evidence of this new initiative. The tobacco giant, best known for their iconic Newport menthol brand of cigarette, easily gobbled up the largest electronic cigarette company in the US, for a paltry (for them) $135 million.

Why hasn't Big Tobacco swallowed the entire electronic cigarette market?

Well, there could be a few reasons that are playing around in the minds of Big Tobacco. For starters, just one cursory glance at the electronic cigarette market throws up a whole gaggle of smaller players all looking for a slice of the proverbial pie. Big Tobacco is better off biding their time waiting for established electronic cigarette companies to rise in the medium term to long term future and then deal with them -- they can always out-muscle and takeover the competition, rather than swallowing them whole. Besides, they would not want to get on the wrong side of US anti-trust laws, which can be harsh when it comes to dealing with oligopolistic conduct that may be deemed as anti-competitive. A group of companies (Big Tobacco) buying out the competition across the board would decidedly come under the purview of "anti-competitive." Also, the electronic cigarette market still needs consolidation in terms of regulatory framework. The federal government's stance towards electronic cigarettes, judging from the conduct of FDA and the FTC so far, still gives some measure of hope to tobacco companies. So at the moment, their conduct so far can be described as cautious and defensive, where they try to maintain a foothold in the electronic cigarette market by starting their own subsidiaries and buying a few of the bigger players at present (Lorillard acquiring blu Cigs), while waiting for further developments. Given the precarious position that they are already in, they definitely cannot afford throw caution to the wind.

Why should investors be aware?

Of all the alternatives to smoking tobacco, electronic cigarettes present the most promise. RJ Reynolds has already started its own line of electronic cigarettes under the Vuse brand. Rivals Philip Morris, British American Tobacco, Imperial Tobacco and Japan Tobacco are also planning to enter the market. However, as an industry observer, I would argue that their recent foray is late to the game and their offerings and planned releases to date have not been very attractive. As the electronic cigarette market continues to grow rapidly and presumably cannibalize traditional tobacco sales, Big Tobacco seems to be a step behind on every move and is now only playing catch up. This after previously writing off the rapidly growing industry as a fad and now being forced to pay up for acquisitions. Despite sitting on piles of cash and paying out healthy dividends, as an investor I would be very leery of backing any Big Tobacco names. This is simply due to the strong global trend away from conventional cigarettes and into this new disruptive electronic smoking technology whose dominance has so far escaped the grips of Big Tobacco.



E-cigarettes: a US$2 billion global industry – who should be worried?

24/11/2012 00:02 (1 Day 13:29 minutes ago)

The FINANCIAL -- All of five or six years ago, one would have been forgiven for not having heard of electronic cigarettes (or e-cigarettes, as they are more commonly known), but it’s hard not to notice the current swirl of interest in and bombastic big-upping of this niche category’s prospects, now worth in excess of $US2 billion globally (about the size of the global small cigars market), according to Euromonitor International estimates. 

Where do e-cigarettes fit in? E-cigarettes are non-tobacco containing, non-combustible cigarettes which work by vaporising nicotine liquid (hence the verb ‘to vape’ or ‘vaping’) which first appeared in the US, currently the world’s largest market for e-cigarettes, accounting for around a quarter of value sales. As non-tobacco containing and non-combustible products, they are commonly referred to in the industry as cigarette alternatives, though claiming any reduced harm credentials is currently banned by the WHO.


So what is it if it’s not a tobacco product? As nicotine delivery devices, e-cigarettes more closely resemble pharma NRT products such as inhalators, though e-cigarettes currently do not require a pharma licence and legal classification varies across the world – some countries such as Argentina, have banned them, whilst countries such as the US have classified them as tobacco products. Rumours abound that the EU is planning to ban any e-cigarettes that are not registered pharma products, though on an international level, the product remains largely unregulated. Who’s making them?

But wherever it lies in the world definitional soup, it straddles the interest of various players, including tobacco and pharma, two hitherto distinct industries competing for the same consumer and now faced with a completely new competitor on their turf. Crucially, e-cigarettes were not developed by either industry, instead being made exclusively in China (only recently has this changed with some production shifting to the US) as a generic product, and branded and marketed by totally novel players, such as NJOY and E-Lites.

As the Euromonitor International announced, after an initial fad period where the product was available exclusively on-line, e-cigs are now gaining acceptance as repeat usage products available through a variety of popular distribution channels, including convenience stores and supermarkets (for example, Tesco in the UK has signed a deal to stock E-Vapes) and the product is now no longer the preserve of specialists.

Who’s interested? Little wonder then that Tobacco and Pharma players have begun to sit up and take notice. In the world’s biggest e-cigarette market, the US, two leading tobacco players have entered the e-cig market by either buying an established e-cig brand (as in the case of Lorillard buying Blu for US$135mn in April 2012) or by launching their own e-cigarette brands on the market (eg Swisher’s eponymous e-cigarettes and e-cigars, also in 2012).

Larger tobacco companies with more sizeable financial outlay have decided to develop their own alternative cigarette-mimicking nicotine delivery devices, such as global no.2 tobacco player, BAT, which in 2011 set up a company called Nicoventures to develop modified risk and nicotine delivery products. According to its product developer, Kind Consumer, its lead product will be a "pharmaceutically regulated substitute cigarette”.

Fad or brave new future? Although Kind Consumer’s publicity material stresses the new product’s distinction from “other products within the NRT space”, it’s clear the product heralds direct competition for NRT players, who have enjoyed relatively unchallenged dominance of the nicotine delivery device market. Globally, the NRT retail market is worth US$2.4bn (excluding prescription sales), and enjoying stable overall growth, but how long before it is eclipsed by the already US$2bn-strong e-cigarettes market?  

Such is the optimism of BAT that e-cigarette-style products are the way of the future that its Chief Financial Officer Nicandro Durante claimed in an interview with the Financial Times in September 2012 that the size of the market for tobacco alternatives could account for as much as 40% of BAT’s revenues (which were £15bn in 2011) in 20 years’ time. “It will be sizeable in 20 years’ time … it’s going to grow,” he said.

In the face of increasing restrictions on tobacco consumption in developed markets, and the loss of smoking populations in sizeable value-generating regions such as Western Europe, the time is ripe for a non-tobacco cigarette and Euromonitor International predicts that by 2050, non-tobacco cigarettes (including e-cigarettes) will be worth 4% of the value of total tobacco – including cigarettes and OTP.

Should any future legislation clamp down on e-cigarettes which are not registered pharma products, tobacco companies such as BAT with their pharma-approved devices and those companies with the financial clout to afford the approval process will be poised to pick up the slack. In any event, the future of tobacco is glowing, but not burning.


Are E-Cigarettes Here to Stay?

Study Suggests Current and Former Smokers Are Turning to Electronic Cigarettes
WebMD Health News
Reviewed by Louise Chang, MD

July 20, 2012 -- Electronic cigarettes are picking up steam -- and not surprisingly, especially among smokers.

That is the main message that comes from a new study in theAmerican Journal of Public Health.

About 40% of individuals reported they had heard of e-cigarettes, and awareness was highest among smokers. What's more, smokers seem to be among the most likely to use e-cigarettes.

E-cigarettes go by many names including vapors, personal vaporizers, and nicotine vaporizers. There are many brands, flavors, and nicotine strengths available for purchase at convenience stores and on the Internet. They are not regulated by the FDA as a drug delivery device because they are not marketed as quit-smoking aids.

"This is an unproven device and we know very little about its long-term health effects," says researcher Jennifer Pearson, PhD, MPH. She is a research investigator at Legacy, an antismoking group in Washington, D.C. "E-cigarettes are probably less harmful than combustible cigarettes, [but] we don't have data to say that and can't talk about long-term effect."

There are many unknowns and unanswered questions, she says. For example, have they encouraged former smokers to reignite their nicotine addiction? Are current smokers using them to quit or to circumvent smoke-free indoor air laws? And how are they affecting people who have never smoked. "Are they acting as a gateway products?"

Pearson and colleagues call for greater regulation of these products until these questions are answered.

E-cigarettes resemble traditional cigarettes. They have a cartridge, a mouthpiece, a vaporizer, and an indicator light. Here's how they work: You inhale, and the vaporizer converts a nicotine-containing solution into a vapor mist. The smoker then inhales this vapor. When the vaporizer runs out, you can purchase refill cartridges.

According to many harm-reduction advocates, their main selling point is that they only contain nicotine, not all of the other hundreds of other chemicals found in tobacco. This suggests that they may be a safer cigarette.

The new findings suggest that smokers are interested and have tried e-cigarettes as cessation devices. E-cigarette manufacturers do not market their products as such. But "the word on the street is that these are cessation devices and should be used as such," Pearson says.

E-Cigarettes May Be Here to Stay

Another issue with e-cigarettes is that you can't always be sure what you are getting when you purchase nicotine cartridges.

Pearson suggests using FDA-approved smoking cessation tools to quit smoking.

Michael Siegel, MD, disagrees. He is the associate chairman of community health sciences at the Boston University School of Public Health.

They do have an important role to play in getting people to quit smoking, he says. "Taking them off of the market would be a disaster because essentially all of these smokers would be forced to go back to cigarette smoking," he predicts.

"They feel like a cigarette, look like a cigarette, and you smoke it like a cigarette and see vapor when you exhale," he says. This is appealing to a smoker who is often as addicted to the nicotine as the actual act of smoking a cigarette.

They are not attracting new smokers, he says. "Very few never-smokers are using these products, so all the concerns that kids and nonsmokers are going to use them seem unfounded," Siegel says.

Gilbert Ross, MD, agrees. He is the executive director and medical director of the American Council on Science and Health, a New York City-based consumer education/public health organization.

"E-cigs contain only water vapor, safe [diluents] such as glycerin, and nicotine, in a cigarette-like delivery device, and [are] highly likely to be much less harmful than inhaling combusted tobacco smoke."

This article can be found at:

E-Cigarettes Not Tied To Risk Of Heart Disease In Study


(Corrects brand spelling to “Blu” in seventh paragraph of story that originally ran Aug. 25.)

Electronic cigarettes used by smokers who want to kick the habit show no connection to heart disease, according to a study that adds to evidence of health benefits of switching from tobacco to smokeless alternatives.

E-cigarettes, electronic tubes that simulate the effect of smoking by producing nicotine vapor, prompted no adverse effects on cardiac function in the study, researchers from the Athens- based Onassis Cardiac Surgery Center said in a report presented at the European Society of Cardiology annual meeting in Munich today.

Investigators examined the heart activity of 20 young daily smokers after one ordinary cigarette against 22 people who smoked an electronic cigarette for 7 minutes. Whereas tobacco smokers showed “significant” disruptions of functions such as heartbeats or blood pressure, the effect of e-cigarettes on the heart was minimal, Konstantinos Farsalinos, one of the researchers, said in the presentation.

“Currently available data suggest that electronic cigarettes are far less harmful, and substituting tobacco with electronic cigarettes may be beneficial to health,” Farsalinos said.

Previous studies have found that the electronic devices would have to be smoked daily for four to 12 months to achieve the levels of nitrosamines, a carcinogen, that are present in a single tobacco cigarette, the researchers said. Industrywide e- cigarette sales this year are likely to double from $250 million in 2011, according to UBS AG.

Psychological Effects

Electronic cigarettes, which mimic the look and feel of traditional versions without generating smoke and ash, are one of the few smoking alternatives that provide users with their chemical need for nicotine and reproduce the psychological effect of holding and smoking a cigarette, the researcher said.

Makers of the battery-powered devices include Lorillard Inc. (LO), a Greensboro, North Carolina-based producer of standard cigarettes, which acquired Blu Ecigs for $135 million in April. The U.S. Food and Drug Administration has yet to impose rules on the testing and production of e-cigarettes.

About 2.5 million people use e-cigarettes in the U.S., according to an estimate by the Tobacco Vapor Electronic Cigarette Association.

Although nicotine is present in the devices’ vapor, it is absorbed by the blood at a far slower rate than tobacco smoke, accounting for the lower levels of toxicity, Farsalinos said. No traces of nitrosamine were found in the e-cigarettes in the study, he said.

The World Health Organization has asked that clinical studies be conducted to determine whether e-cigarettes are safe and effective as they aren’t regulated, he said. Manufacturers market the product as safer than smoking without studies to back it up, he said.

“Electronic cigarettes are not a healthy habit, but they are a safer alternative to tobacco cigarettes,” Farsalinos said in Munich today.


New Study Suggests E-Cigs Less Harmful Than Tobacco Cigarettes

Results show low emissions of volatile organic compounds from electronic cigarettes
Tobacco E-News | July 10, 2012

BOSTON -- The results of the first comparison of the level of volatile organic compounds emitted by electronic cigarettes as opposed to traditional tobacco cigarettes confirms e-cigarettes reduces a smoker's exposure to such dangerous chemicals.

The German researchers conducting the study had test subjects smoke either a tobacco cigarette or vaporize an electronic cigarette in an emission test chamber, with the concentration of a number of volatile organic compounds being measured using gas chromatography/mass spectrometry. The results of the study (which is currently available for purchase online and set to appear in Indoor Air) were broken down by professor in the Department of Community Health Sciences at the Boston University of Public Health Dr. Michael Siegel on his Tobacco Analyses blog.

According to Siegel, while 20 volatile organic compounds were found in tobacco smoke, only six of those compounds were detected in electronic cigarette vapor. The concentrations of these compounds in electronic cigarette vapor were also greatly reduced--ranging from 2.5% (for acetaldehyde) to 39.1% (for acetone) of the concentration found in the tobacco smoke. Additionally, researchers analyzed exhaled air from electronic cigarettes and the only compounds found were low traces of nicotine and flavorings, moderate levels of glycerin and high levels of propylene glycol, which is the main ingredient of e-cigarette liquid.

"This study confirms that electronic cigarette use greatly reduces the user's exposure to a wide range of chemicals in tobacco smoke," Dr. Siegel wrote in his blog. "The few chemicals for which exposure remains are at levels well below that of cigarette smoking."

The one chemical compound of concern found in electronic cigarette vapor was formaldehyde – whose presence was still five to ten times lower than the amount found in tobacco cigarette smoke. Siegel believes one hypothesis is the formaldehyde could be the result of the heating of propylene glycol.

"My sense is that in the long run, electronic cigarettes that use glycerin as an excipient may become the standard," said Siegel. "Using glycerin would probably avoid the production of most of the volatile organic compounds detected in this study, and would also alleviate any concerns about respiratory irritation."

Overall, this study is great news for retailers and manufacturers of electronic cigarettes. With previous studies having confirmed that the number of carcinogens is greatly reduced in electronic cigarettes (the levels of the only known carcinogen in the product are at trace levels), the Indoor Air study proves e-cigarettes also reduces a user's exposure to dangerous volatile organic compounds, likely reducing the risk of lung disease.


This article can be seen at:


Research article

Electronic cigarettes: a survey of users

Jean-François Etter



Background: Little is known about users of electronic cigarettes, or their opinions, satisfaction or how and why they use such products.


Methods: An internet survey of 81 ever-users of ecigarettes in 2009. Participants answered open-ended questions on use of, and opinions about, ecigarettes.


Results: Respondents (73 current and 8 former users) lived in France, Canada, Belgium or Switzerland.

Most respondents (77%) were men; 63% were former smokers and 37% were current smokers. They had used e-cigarettes for 100 days (median) and drew 175 puffs per day (median). Participants used the ecigarette either to quit smoking (53 comments), to reduce their cigarette consumption (14 comments), in order not to disturb other people with smoke (20 comments), or in smoke-free places (21 comments). Positive effects reported with ecigarettes included their usefulness to quit smoking, and the benefits of abstinence from smoking (less coughing, improved breathing, better physical fitness). Respondents also enjoyed the flavour of ecigarettes and the sensation of inhalation. Side effects included dryness of the mouth and throat. Respondents complained about the frequent technical failures of ecigarettes and had some concerns about the possible toxicity of the devices and about their future legal status.


Conclusions: Ecigarettes were used mainly to quit smoking, and may be helpful for this purpose, but several respondents were concerned about potential toxicity. There are very few published studies on ecigarettes and research is urgently required, particularly on the efficacy and toxicity of these devices.


American Lung Association Asserts that E-Cigarettes are Designed to Promote Cigarette Smoking; Can Anti-Smoking Groups' Reasoning Get Any More Absurd?


As quoted in an article in the Orange County Register, the American Lung Association now asserts that electronic cigarettes are designed as a ploy to encourage people to smoke regular cigarettes.


According to the article: "Dr. Ira Jeffry Strumpf, a pulmonologist who teaches at UCLA and is a spokesman for the American Lung Association, said e-cigarettes have not been independently proven as a safe alternative to tobacco. 'The vapor that you inhale is not without risk,' Strumpf says. 'It's not pure nicotine. It has with it some contaminants. When the FDA looked at 19 of these cartridges, they found half the samples contain impurities that are known to be toxic to humans. At least one cartridge contained diethylene glycol, one of the toxic compounds of antifreeze.' Strumpf said he's concerned that e-cigarettes are marketed to people who want to quit smoking but also to those who have never smoked before. 'The fact they present them in the shape of a cigarette, they're trying to capitalize on the social aspect of smoking and trying to promote the social appeal of smoking.'"

The Rest of the Story

The arguments that electronic cigarette companies want nonsmoking young people to start smoking and want to increase the social appeal of smoking are absurd. If that were to happen, there is no doubt that these products will be taken off the market with haste. The last thing in the world that e-cigarette companies want is for young people to start using their products. They are not trying to increase the social appeal of smoking. In fact, it's quite the opposite. Electronic cigarette companies make their money by encouraging smokers to quit. Anything that decreases the appeal of smoking is going to increase the demand for e-cigarettes.

What anti-smoking groups - including theAmerican Lung Association - do not understand is that the market for e-cigarettes is current smokers, not nonsmokers. The people using these devices are smokers and former smokers who are either trying to quit smoking, trying to cut down on the amount they smoke, or simply looking for an alternative to regular cigarettes that may be safer and less expensive.

It is in the e-cigarette industry's best interest to de-glamorize smoking as much as possible in order to encourage as many smokers as possible to quit.

What the anti-smoking groups are apparently confused about is the purpose of the cigarette-like design. The reason that the e-cigarette is designed to look like a cigarette is not to try to increase the social appeal of smoking, but to enhance the device's ability to allow successful smoking cessation. The e-cigarette inventor understands what few anti-smoking groups do: that cigarette smoking is far more than simply a pharmacologic addiction to nicotine.

People smoke not only because they are pharmacologically addicted to nicotine, but because they enjoy every aspect of the smoking behavior. Holding the cigarette, bringing it to the mouth, inhaling, and seeing the exhaled smoke are all critical behavioral aspects of the smoking addiction.

The fact that e-cigarettes are designed to operate like cigarettes is not a design flaw. In fact, it is the precise reason why these devices appear to be so effective in smoking cessation. Unlike traditional nicotine replacement or other pharmaceutical products, they address both the pharmacologic and the behavioral aspects of addiction to cigarettes. The brilliance of this invention, then, is precisely because these devices simulate cigarette smoking. Take away the simulation of smoking and you take away the efficacy of the innovation.

In other words, the American Lung Association has it exactly wrong. E-cigarettes are presented in the shape of cigarettes not because they are trying to increase the social appeal of smoking, but because they are trying to enhance smoking cessation.

The ALA and other groups seem most troubled not by the public health implications of the e-cigarette, but by the fact that the people using these devices are going through the motions of what appears to be "smoking." Apparently, it really isn't the health dangers of smoking that is the primary concern for these groups. It appears that the primary concern is simply the "act" of smoking or anything that resembles it, regardless of its relative safety.

The rest of the story is that through their misleading, inaccurate, and absurd publicity about e-cigarettes, these anti-smoking groups are actually harming the health of the public, not protecting the public's health.

Nothing in the world will enhance the appeal of smoking than to remove electronic cigarettes from the market. Such an intervention will create hundreds of thousands (if not over a million) new cigarette smokers over night. That the American Lung Association is apparently working towards such a result is disturbing.


ECA Letter to Congress

The Food and Drug Administration last month held a press conference warning people of what they claim are the potential health risks and harmful effects associated with electronic cigarettes. Unfortunately, the study was extremely narrow in scope and included only limited data, failing to include a scientifically significant sample of e-cigarette products on the market or their users. They also failed to acknowledge the efforts on the part of electronic cigarette suppliers in our association to market their products solely as alternatives to adult smokers looking to avoid inhaling all the harmful toxins that come from combustible cigarettes.

If you aren’t familiar, e-cigarettes are electronic devices that deliver various levels of nicotine, depending on the desires of the users. These devices look and feel like a combustible cigarette and include a battery, a cartridge that delivers the nicotine, and an atomizer that creates a vapor to simulate the appearance and experience of smoking. So, smokers get the nicotine they crave but aren’t exposed to the hundreds of toxins that are known to shorten a smoker’s lifespan, giving the more than 1 million Americans who now use e-cigarettes a potential health advantage over those who continue to smoke combustible cigarettes. In addition to reducing the toxins from their habit, e-cigarette users enjoy having an alternative that they can use in the workplace and in public without violating any laws or policies, nor annoying or exposing non-smokers to tobacco smoke.

The Electronic Cigarette Association, which I represent, acknowledges the health risks of cigarette smoking and advocates that smokers quit. But we also recognize the struggles that many have in quitting and who are looking for a more convenient and better alternative to tobacco cigarettes. While some of our customers have reported using our devices to help them quit smoking by slowing reducing the nicotine delivery in our products, it is important to note that our member companies do not market their e-cigarettes as smoking cessation products nor make any such claims. The enormous response our members have received from more than 1 million Americans undoubtedly demonstrates that smokers unable to quit are desperately looking for an alternative to cigarettes.

Our member companies are extremely careful to market only to committed adult smokers who simply want an alternative to combustible cigarettes. In addition to eliminating the toxins from their habit, e-cigarette users enjoy having an alternative that they can use in the workplace and in public without violating any laws or policies and nor annoying or exposing non-smokers to tobacco smoke.

ECA was disappointed in the FDA study, particularly because it failed to follow its traditionally sound, scientific practices but instead issued misleading and narrow data without thoroughly testing the potential health benefits of e-cigarettes that potentially could save the lives of millions of Americans. I have attached with this letter a technical review and scientific analysis of the FDA’s report that was performed by scientists at Exponent. Among the limitations in the FDA study, Exponent found the following:

* The FDA failed to present standard protocols for proper study design with regards to the testing of the referenced control devices.

* The chemical content of similar nicotine-containing, FDA-approved products was not completely described with respect to the presence of tobacco-specific nitrosamines (TSNAs) and other tobacco-associated impurities that have also been found in nicotine replacement therapy devices at similar, if not higher, levels.

* In the lots tested by the FDA, none of the chemicals of concern in the study were able to be quantifiably measured in the liquid of the device’s cartridges.

* Data presented in the report does not adequately support the opinion that users of the products would actually be exposed to TSNA’s and tobacco-specific impurities in the vapor phase during normal use and if exposed, that those levels would be a health concern as compared to other FDA-approved products.

Given the limitations of this study, we encourage the FDA to take a more scientific approach and to work with members of the ECA before making any rash decisions to ban e-cigarettes altogether. Such a ban would leave smokers without an alternative to combustible cigarettes, which are clearly documented and known for their unhealthy and life-threatening results and which the FDA has no intention of banning. The enormous response our members have received from the more than 1 million Americans undoubtedly demonstrates that smokers unable to quit desperately are looking for an alternative to cigarettes.

We believe Americans should have a right to choose an alternative and our association is willing to work with Congress and the FDA to provide the necessary data to encourage reliable and extensive studies that we are confident will demonstrate the efficacy of choosing a product that will not deliver the harmful carcinogens found in cigarettes. We also want to work to ensure that manufactures agree not to make any health claims nor market these products to those younger than the legal smoking age. Our members are committed to following such guidelines and to giving smokers an alternative until they can make the commitment to quit smoking. We do agree with the FDA, however; that E-Cigarettes should not be purchased or consumed by those under the legal age of smoking. We support any legislation, be it state or federal, that makes it illegal to sell e-cigarettes to children and those under the legal smoking age. We only market our products to committed long term smokers and would never want this to entice anyone who is not already addicted to nicotine to use our product. Before any rash decisions are made on the future of e-cigarettes, the ECA asks that you encourage the FDA to conduct comprehensive, scientific studies. I would be happy to discuss this issue with you further. Please visit our website at for more comprehensive information about our association and our product.



Electronic Cigarette Association


Proposition to Cancel Opposition to Electronic/Electric Cigarettes

To: Senator Lautenberg Fax: 202 228 4054

Subject: Please Cancel Opposition to Electronic Cigarettes


Honorable Senator Lautenberg:

In my capacity as Chair of the Tobacco Control Task Force of the American Association of Public Health Physicians, I must vigorously oppose your proposal that FDA ban electronic cigarettes. Among the many manufacturers and vendors of electronic cigarettes there appear to be some that make unjustified claims of health benefits. While it would be appropriate for FDA to address those manufacturers and vendors relative to their specific claims, banning all electronic cigarettes would not benefit the public. Conventional cigarettes kill about 400,000 adult American Smokers each year from cigarette-related illness. Over the next 20 years this will total 8 million deaths among current adult smokers, most of which are now over 35 years of age. Cigarettes kill about 30% of consistent adult cigarette smokers. Smoking cessation rates among these smokers are abysmal -about 3% per year. Pharmaceutical products with counseling, quit lines, etc, are little better - resulting in quit rates no greater than 5% (as measured at 12 months post-intervention) among those willing to try these modalities. In other words, current approaches fail 95% of smokers using them. Adult American smokers are health conscious, as evidenced by the fact that about 85% of them have switched to light and low-tar cigarettes, believing (incorrectly) that they pose less health risk. Research to date has clearly demonstrated that smokers smoke because they are addicted to nicotine. This same research also shows that the illness and death due to cigarettes is not due to the nicotine, but due to products of combustion and, to a lesser degree, toxins in the cigarette tobacco. Alternative nicotine delivery devices, including, but not limited to electronic cigarettes, have no products of combustion and none of the toxins in cigarette tobacco. On at least a theoretical basis, they could and should be seen as generic equivalents of the pharmaceutical nicotine products. As best we can tell, on the basis of currently available research data, these products promise a risk of illness and death well under 1% of the risk posed by cigarettes. Both houses of Congress now seem poised to pass an FDA/Tobacco bill (H.R.1256 in the House). This bill, if passed in its current form will provide, at least on an interim basis, the FDA seal of approval on currently marketed cigarettes. That being the case, the safety standard that should be used for other tobacco products, and for alternative non-pharmaceutical nicotine delivery devices, should the hazard posed by cigarettes, not a pharmaceutical safety guideline. All tobacco and nicotine delivery devices should be held to the same safety guideline. Exempting cigarettes, while holding alternative nicotine delivery devices to an impossibly stringent safety guideline, will not protect current American smokers. It will only protect Altria/Philip Morris cigarette sales and profits. On behalf of the Tobacco Control Task Force of the American Association of Public Health Physicians, I therefore urge to consider the following:

1. Withdraw your proposal to ban electronic cigarettes.

2. Urge amendment of the proposed FDA/Tobacco bill to encourage the development and marketing of alternatives to cigarettes, under strict but fair FDA oversight, and with marketing restrictions in place to reduce the numbers of adolescents who initiate use of cigarettes and other nicotine delivery products.


The amendments we think will achieve these goals, and the results of our analyses and literature reviews, are posted on the tobacco issues page of our web site.


Joel L. Nitzkin, MD, MPH, DPA, FACPM

Chair, Tobacco Control Task Force

American Association of Public Health Physicians

c/o JLN, MD Associates LLC


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