Last updated: Feb 26, 2010
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FRIDAY, Feb. 26, 2010 (Health.com) — Nikhil Rao, 23, a student at the University of Louisville, in Kentucky, took his first drag of a cigarette at age 18, while hanging out in a bar with buddies. Soon he was smoking half a pack a day. Then, like many smokers, he tried to kick the habit and—surprise!—found he couldnt do it.

But that was then. Now he goes by the screen name of PureVapor and extols the virtues of electronic cigarettes, also known as personal vaporizers. He saw an Internet ad for these battery-operated, smokeless cigarettes, and decided to see if they could help him quit.

So far so good, he says. “I have smoked four cigarettes in the last month, and only when I forgot to charge my batteries. Cigarettes now taste pretty disgusting, and I hate the thought of having to smoke one,” he says.

“My favorite thing about [electronic cigarettes] is that they're healthier and don't harm the people around me with secondhand smoke,” he says. “My mom says I don't emanate the stench of burnt tobacco, and I already feel less out of breath when doing heavy exercise.”

Healthier than cigarettes? Maybe, but some experts arent convinced theyre a safe or effective way to quit smoking. They say e-cigarette nicotine levels can range from nonexistent to toxic, and that some may contain dangerous additives. Others fear they are the 21st-century equivalent of candy cigarettes—attractive to children and teens as a sort of gateway drug for real cigarettes.

“These are not cigarettes,” says Nathan Cobb, MD, a research investigator at the Schroeder Institute for Tobacco Research and Policy Studies at the American Legacy Foundation, a Washington, D.C.-based public health foundation dedicated to stamping out smoking. “They are something completely different with a whole new set of risks that we dont understand.”

What is an e-cigarette?
They go by many names—electronic cigarettes, e-cigarettes, vapors, personal vaporizers, and nicotine vaporizers—and there are hundreds of brands available over the Internet and at stores. These devices are about the same size and shape as a regular cigarette. There is a cartridge with a mouthpiece, a vaporizer, and a battery topped with an indicator light.

When you take a drag, the vaporizer turns on and converts a nicotine-containing solution into a mist. The smoker then inhales this vapor. There are as many nicotine strengths and flavors, including chocolate, as there are brands. Once the vaporizer runs out, you purchase refill cartridges. The e-cigarette costs anywhere from $60 to $120, and the refill cartridges are about $10 a pack.

Unlike conventional cigarettes, e-cigarettes only contain nicotine, as opposed to the hundreds of other harmful chemicals found in tobacco. They sound great, because unlike other nicotine replacement products (patches, gum, lozenges, and inhalers), they come the closest to mimicking the feel of smoking.

Reasons to quit smoking
“The other products are only replacing nicotine; this product is also dealing with the behavioral aspect of smoking,” says Michael Siegel, MD, the associate chairman of community health sciences at the Boston University School of Public Health.

Theres only one catch: E-cigarettes, unlike smoking cessation products, are not regulated by the U.S. Food and Drug Administration (FDA). Thats because they are marketed as an alternative to cigarettes, not as way to quit—even though many people use them to try to cut down. E-cigarettes havent been studied to see if they can actually help you quit.

“There hasnt been enough research to show how effective these are as quitting tools, but there is lots of anecdotal evidence that many smokers are finding them helpful,” says Dr. Siegel. They have potential as a quitting method, he says.

“Holding and puffing are all part of addiction,” he explains. “The beauty of e-cigs is that they replace most of the behavioral stimuli that are associated with the smoking process.”


How safe are e-cigarettes?
E-cigarettes seem relatively safe—at least safer than smoking regular cigarettes, says Dr. Siegel. “They are a lot safer than smoking tobacco because there is no tobacco in these devices, only nicotine,” he says. They are not risk-free, he says—just less risky than cigarettes.

However, Dr. Cobb has studied about eight brands of electronic cigarettes and found some disturbing results. For starters, the nicotine dosages found in the refill cartridges vary widely.

“One refill cartridge had about a gram of nicotine in a bottle that was the size of a shot glass—that is enough to kill a horse, and it wasnt even childproofed,” he says. “We cant say they are safe to have around the house or use, or that they would help you quit smoking.”

On the other side, a study published in February in the journal Tobacco Research found that the products didnt deliver enough nicotine to satisfy a smoker trying to quit.

“We may find in a few years that e-cigarettes will be the next big thing for quitting smoking, but right now there are more questions than answers,” says Dr. Cobb.

He recommends that smokers instead ask their doctor for a prescription for a nicotine inhaler. “Its the same concept and has been tested and proven safe and effective,” he says.

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The FDA has done some initial testing of e-cigarettes and found traces of diethylene glycol, a toxic chemical used in antifreeze, in the nicotine-containing solution. The FDA blocked the importation of e-cigarettes, but in January, a judge ordered them to cease the efforts since they are considered an alternative to cigarettes, not a smoking cessation tool.

“These are a drug-delivery device and there is inconsistent or absent quality control,” stresses Alexander Prokhorov, MD, a professor of behavioral science at the M.D. Anderson Cancer Center, in Houston.

He is also concerned that these products may encourage children to start smoking. “These could be a gateway to regular, conventional tobacco products,” he says. “They also add flavors, and in a way, I would compare them to candy cigarettes. Children could get hooked on nicotine and be more likely to try conventional cigarettes.”

Dr. Siegel disagrees. “There is no evidence that these products are being used by people who dont smoke,” he says. The price is relatively steep and may be a deterrent from any casual use or abuse, he says.

“It is pretty clear that people who are using these devices are trying to quit smoking,” he says.

E. Neil Schachter, MD, a professor of pulmonary medicine at the Mount Sinai School of Medicine, in New York City, thinks e-cigarettes are a bad idea.

“They are an end run around the regular cigarette to lure new smokers,” he says. “They deliver nicotine, a well-established toxin, to the airway mucosa where it is absorbed.”

E-cigarettes harm the heart, according to Dr. Schachter. “The risk of particulate matter resulting from the burning of the cigarette is probably eliminated, but it is replaced by the unknown risk of the aerosol that is generated,” he says.

Dr. Prokhorov agrees. “If you use an FDA-approved nicotine replacement agent, it is OK because the dose of nicotine is lower than that in cigarettes, but that is not true with e-cigarettes,” he says.