Dr. Michael Siegel, a public-health researcher at Boston University, says e-cigarettes could be the beginning of the end of smoking in America. He sees them as a disruptive innovation that could make cigarettes obsolete, like the computer did to the typewriter.
But his former teacher and mentor, Stanton Glantz, a professor of medicine at the University of California, San Francisco, is convinced e-cigarettes may erase the hard-won progress achieved in the past 50 years in reducing smoking. He predicts the modern gadgetry will be a glittering gateway to the deadly, old-fashioned habit for children, and adult smokers will stay hooked longer now that they can get a nicotine fix at their desks.
These experts represent the two camps at war over the public-health implications of e-cigarettes. The devices, intended to feed nicotine addiction without the toxic tar of conventional cigarettes, have divided a public-health community that had long been united in the fight against smoking and Big Tobacco.
The core of their disagreement: Will e-cigarettes cause more or fewer people to smoke? The answer matters. Cigarette smoking remains the single largest cause of preventable death in the United States, killing about 480,000 people a year.
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Siegel says e-cigarette pessimists are stuck on the idea that anything that looks like smoking is bad. “They are so blinded by this ideology that they are not able to see e-cigarettes objectively,” he said. Glantz disagrees: “E-cigarettes seem like a good idea, but they aren’t.”
Science that might resolve questions about e-cigarettes is developing, and many experts agree the evidence is too skimpy to draw definitive conclusions about the long-term effects of the devices on the broader population.
“The popularity is outpacing the knowledge,” said Dr. Michael Steinberg, associate professor of medicine at the Robert Wood Johnson Medical School at Rutgers University in New Jersey. “We’ll have a better idea in another year or two of how safe these products are, but the question is, will the horse be out of the barn by then?”
This debate over what e-cigarettes mean for the nation’s 42 million smokers comes at a crucial moment. Soon, the U.S. Food and Drug Administration is expected to issue regulations that would give the agency control over the devices, which have had explosive growth virtually free of any federal oversight. (Some cities, such as Boston and New York, and some states, such as New Jersey and Utah, have weighed in, enacting bans in public places.)
The new federal rules will have broad implications for public health. If they are too tough, experts say, they risk snuffing out small e-cigarette companies in favor of Big Tobacco, which has recently entered the e-cigarette business. If they are too lax, sloppy manufacturing could lead to devices that do not work properly or harm people.
Many scientists say e-cigarettes will be effective in reducing the death toll from smoking only with the right kind of federal regulation — for example, rules that make ordinary cigarettes more expensive than e-cigarettes or that reduce the amount of nicotine in ordinary cigarettes so smokers turn to e-cigarettes for their nicotine.
Smoking is undergoing a rapid evolution.
Nicotine, the stimulant that makes traditional cigarettes addictive, is the crucial ingredient in e-cigarettes, whose current incarnation was developed by a Chinese pharmacist whose father died of lung cancer. With e-cigarettes, nicotine is inhaled through a liquid that is heated into vapor. New research suggests that e-cigarettes deliver nicotine faster than gum or lozenges, two therapies that have never quite taken off.
Sales of e-cigarettes more than doubled last year from 2012, to $1.7 billion, according to Bonnie Herzog, an analyst at Wells Fargo Securities. Herzog said that in the next decade, consumption of e-cigarettes could outstrip that of conventional cigarettes. The number of stores that sell them has quadrupled in the past year, according to the Smoke Free Alternatives Trade Association, an e-cigarette industry trade group.
Public-health experts like to say that people smoke for the nicotine but die from the tar. And the reason e-cigarettes have caused such a stir is that they take the deadly tar out of the equation while offering the nicotine fix and the sensation of smoking.
For all that is unknown about the new devices — they have been on the U.S. market for only seven years — most researchers agree that puffing on one is far less harmful than smoking a traditional cigarette.
But then their views diverge.
Pessimists like Glantz say that while e-cigarettes might be good in theory, they are bad in practice.
The vast majority of people who smoke them now also smoke conventional cigarettes, he said, and there is little evidence that much switching is happening. E-cigarettes may even prolong the habit, he said, by offering a dose of nicotine when getting one from a traditional cigarette is inconvenient or illegal.
The Food and Drug Administration (FDA) has ordered four tobacco products removed from the market, the first time the agency has done so since being given the legal authority in 2009.
Agency officials said Friday that four cigarette brands made by Jash International may no longer be domestically sold, distributed or imported. They are Sutra Bidis Red, Sutra Bidis Menthol, Sutra Bidis Red Cone and Sutra Bidis Menthol Cone. In 30 days, the FDA will begin seizing any goods that remain on shelves.
The unconventional cigarettes are bidis: thin, hand-rolled cigarettes stuffed with tobacco, wrapped in leaves from a tendu tree and sometimes tied with a colorful string. Popular in India, bidis are not widely smoked in the U.S., but their novelty appeals to some adolescents.