Vapor Vs. Smoke: A Look At The E-Cigarette Craze In San Diego
November 12, 2013 1:21 p.m.
Dr. Thomas Novotny, Professor of Global Health at UC San Diego, formerly with CDC's Office on Smoking and Health.
MAUREEN CAVANAUGH: This is KPBS Midday Edition, I am Maureen Cavanaugh. Our top story today, perhaps you may have seen the storefronts popping up or heard the commercials featuring electronic cigarettes, devices that deliver nicotine without tobacco. People who use them are exhaling vapor instead of cigarette smoke, so there are less dangerous than regular smoke. Many health advocates are wary of the new devices, they say they are untested and they claim they are being marketed to teenagers. I would like to welcome Thomas Novotny, Professor of Global Health at UC San Diego. Welcome back to the show. First I would like to start out with an excerpt from the e-cigarette internet ad featuring Jenny McCarthy.
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MAUREEN CAVANAUGH: Should she be scaring people away with the e-cigarette?
THOMAS NOVOTNY: It is very disturbing. Sell the addiction to young people, and tell others that this is somehow safe for you.
MAUREEN CAVANAUGH: How do these work? How are they like regular cigarettes? What is the actual device that delivers the nicotine?
THOMAS NOVOTNY: They don't have tobacco, so that is the biggest difference. They are marketed as a safe alternative. They contain nicotine in the form of a liquid delivery, that is heated by a device that is battery-powered and the delivery system contains an emulsifier for the chemical that can allow this vapor to be produced. That contains glycerin or glycol's which are sometimes used in antifreeze. Other chemicals that we don't know and these are not tested in terms of chemical delivery system, there is considerable variability in terms of nicotine delivery produced. They have not been tested for safety.
MAUREEN CAVANAUGH: The amount of nicotine delivered by the cigarettes is lower than the regular cigarettes, but is it safer?
THOMAS NOVOTNY: They are safer in terms there is no tobacco carcinogens, but there is the nicotine and whatever else is in the vapor. It hasn't been tested. That is the question, why we humans want to inhale untested chemical products into our bodies and just accept the fact that it is being marketed as a safe device. It should not be done.
MAUREEN CAVANAUGH: What kind of regulations are health advocates trying to promote.
THOMAS NOVOTNY: The biggest approach is to get the FDA to assert authority over it. The argument against that is that they do not contain tobacco, so the FDA does not have the authority. But if the FDA says they have the authority, it does. It should be regulated as the other tobacco products in terms of what is in it. It should be regulated relative to the claims that it can help people to quit smoking. We have a number of products that allow people to the supported in quitting smoking, but it comes with testing and clinical trials to say that they are effective and safe.
MAUREEN CAVANAUGH: So you would like to see these taken off the market until they are tested?
THOMAS NOVOTNY: They should not have gotten onto the market in the first place. The FDA is now behind the ball in terms of getting into the regulatory approach.
MAUREEN CAVANAUGH: Since there are no studies, there's really no data on whether they are harmful to people. Where are health advocates calling for them to be restricted like cigarettes. Secondhand smoke we know has a bad effect on people were standing around. While there are no tests, why is the assumption being made that they are hazardous?
THOMAS NOVOTNY: We don't know what is in the vapor. We don't know if it's having health effects. The biggest health concern that we have is that this is trying to re-normalize smoking. You heard this commercial from this actress Jenny McCarthy, who is completely unbelievable. If she is advertising this ìhealthyî product, it helps to re-normalize it. These commercials are reminiscent of those in the 50s and 60s that we got rid of. It took a lot of hard work to do that. To de-normalize smoking. It's not things that people want in public places.
MAUREEN CAVANAUGH: But for people who are smoking difficult for so many to quit. Can this be used be used as an aid for them? Limiting the dangers that they get from carcinogens?
THOMAS NOVOTNY: They will eliminate some risks from carcinogens. But whether it is going to help them quit smoking is not been tested. The few studies that have shown results from attempting to smoke have mixed results and are not very well worked out in terms of their validity. Some studies show that smokers in use the e-cigarette as a way of maintaining the addiction and having to use. It really has not been shown on it population basis to have any improvement in terms of the ability of smokers to quit. So far there is no good evidence about these things and I think one should take a precaution. We do not know what the problems are, we know that nicotine is very addictive and we know that normalization of this behavior is not good for public health.
MAUREEN CAVANAUGH: Across the street from SDSU there is an e-cigarette shop. We spoke to some of the people inside. Here's what one of the workers said about how he uses e-cigarette.
NEW SPEAKER: I used to smoke a pack a day and the Nicorette gum and has not helped to cure the oral fixation. I was smoking cigarettes on the patch at the same time.
MAUREEN CAVANAUGH: You have somebody here who is a pack a day smoker now using e-cigarettes and I guess the idea is they are decreasing his health risk.
THOMAS NOVOTNY: That's what he says, he is also selling the cigarette so there are conflicts of interest there. My advice would be the same as anybody. Use the cigarette to quit. This is something that you need to do in terms of your health and the health of your family. The same could be said about the e-cigarette.
MAUREEN CAVANAUGH: Are these addictive as well?
THOMAS NOVOTNY: They most certainly are. As a very powerful drug in 1988 I worked on the Surgeon General's report on nicotine addiction. They made the statement that nicotine is harder addiction to resolve than that of opiates and cocaine.
MAUREEN CAVANAUGH: The idea of just quit is difficult for people to take.
THOMAS NOVOTNY: And his intent is to get off cigarettes, then he should taper down. As would be expected of any nicotine replacement.
MAUREEN CAVANAUGH: One of the big concerns have read is the way e-cigarette's are being marketed. Who they are being marketed to. Tell me about your concerns.
THOMAS NOVOTNY: Received the market expand incredibly over the last three years. Almost 7% of kids six to talk with have tried e-cigarette spirit that is anonymous increase. Even adults about 6.5%. It's amazing how fast this is taken off. Regulatory authority and scientific investigations of this have not kept pace and we hope that the changes work that is the biggest concern.
MAUREEN CAVANAUGH: Another way this is being marketed is with flavor additives. Let's listen to Jacob, a manager of the store.
NEW SPEAKER: We have over forty flavors. Bigger fruit flavors like melon to dessert flavors like cinnamon roll.
MAUREEN CAVANAUGH: I know some advocates are basically saying that e-cigarette marketers are marketing the product in just the same way that tobacco marketers used to in trying to make things cool and get very young children to become interested in using the product. These flavors could be one way to get people to be interested in smoking e-cigarettes.
THOMAS NOVOTNY: That is one of the issues. The FDA has banned flavorings and all cigarette products. There working on banning menthol as well. And understand there's also bubblegum flavor. These things are attracted to kids in the flavorings to attract kids. That was what was the reason for the banning of flavorings in figure products and tobacco products. I think that has a clear occasion for the audience that is to be attracted to these.
MAUREEN CAVANAUGH: One of the things is that the manager told us is that some of these products come without nicotine. From what he said earlier, it seems that you don't like that idea either because it's normalizing smoking.
THOMAS NOVOTNY: Right, Jenny McCarthy whipping out her blue and smoking in a club or on an airplane and would need to be done is to restrict the use of these products in the same way that we restrict smoking in public places. We have had a hard battle that if they can so many years to free our restaurants and bars in airplanes of cigarette smoke the same should be done here. If someone were to sit to me next to me on a plane and whip out her blue and blow that smoke my direction I would react very negatively.
MAUREEN CAVANAUGH: There are studies done so that say that it is a rather harmless vapor appeared is the idea of this normalizing putting something about blowing out paper that is normalizing that idea again? Is this strong enough to actually be restricted?
THOMAS NOVOTNY: That is where we can use more research. The idea that they are marketing to be able to enjoy your nicotine a cushion in places where it you formally could enjoy your cigarette smoking means that what is being marketed for dual use. That is another part of this. I think additional research to be done on the behavioral aspects that you point out.
MAUREEN CAVANAUGH: What you're saying is that the way it's been marketed is to use when you're alone in your car something. If you got to a club or restaurant unless there's regulation you can use this e-cigarette device.
THOMAS NOVOTNY: That is happening. The other thing is that the tobacco industry have been buying up the e-cigarette manufacturers because they know that this going to become part of their product. It's going to be part and parcel of keeping people smoking something. So they don't keep losing the market.
MAUREEN CAVANAUGH: People who have advocated smoke which actions on smoking have been very successful. They've seen the rates of smoking decrease over the years and the culture of smoking has turned around especially in this country. He surprised the attraction of these e-cigarette's has been so profound?
THOMAS NOVOTNY: It's been very surprising but it has increased. Tobacco product uses going down but e-cigarette use is going up and remarkably so. It has the electronic fix for an addiction and almost fashionable activity here I think a lot of it is a result of the marketing done we go online to look at e-cigarette is amazing how effective it is your also reminiscent of what used be done for cigarettes decades ago.
MAUREEN CAVANAUGH: You're expecting to hear something from the FDA shortly?
THOMAS NOVOTNY: They're getting a lot of pressure. Because it's been from California has written on behalf of several other congressional representatives to say that you need to do something. It's time and we're losing ground because of the effectiveness of the marketing done so far. They're going to have to step up and they will.
MAUREEN CAVANAUGH: Thank you very much.