E-cigarettes may not be as safe as you think

(Repeats with no changes)

By Toni Clarke

WASHINGTON, April 17 (Reuters) Complaints of injury linked to e cigarettes, from burns and nicotine toxicity to respiratory and cardiovascular problems, have jumped over the past year as the devices become more popular, the most recent U.S. data show.

Between March 2013 and March 2014, more than 50 complaints about e cigarettes were filed with the U.S. Food and Drug Administration, according to data obtained through a public records request. That is on par with the combined number reported over the previous five years.

The health problems were not necessarily caused by e cigarettes. And it is not clear that the rate of adverse events has increased. In 2011, about 21 percent of adult smokers had used e cigarettes, according to federal data, more than double the rate in 2010.

Still, David Ashley, director of the office of science at the FDA’s tobacco division, said the uptick is significant, especially in light of a recent report from the U.S. Centers for Disease Control and Prevention showing an increase in the number of e cigarette related calls to poison control centers.

«Both together does suggest there are more instances going on,» he said.

The FDA is poised to regulate e cigarettes and other «vaping» devices for the first time, potentially reshaping an industry that generates roughly $2 billion a year in the United States. Some industry analysts see e vapor consumption outpacing that of traditional cigarettes, now an $85 billion industry, within a decade.

E cigarettes are battery powered cartridges filled with a nicotine liquid that, when heated, creates an inhalable mist. Little is known about the long term health effects of the products, which were developed in China and moved into the U.S. market in 2007.

«Some evidence suggests that e cigarette use may facilitate smoking cessation, but definitive data are lacking,» Dr. Priscilla Callahan Lyon of the FDA’s Center for Tobacco Products wrote in a recent medical journal article.

Contradictory findings from preliminary studies have become ammunition in the lobbying campaign around the devices, which allow users to inhale nicotine without the damaging tar produced by conventional cigarettes.

Public health officials have said the devices may encourage nonsmokers, particularly young people, to try conventional cigarettes. E cigarette advocates have argued that they provide a safer alternative for smokers.

The FDA has sponsored research to try to answer safety questions, and it is examining its database of adverse events for any trends that might raise concerns.

RESPIRATORY PROBLEMS

The complaints from the public filed with the FDA cited trouble breathing, headache, cough, dizziness, sore throat, nose bleeds, chest pain or other cardiovascular problems, and allergic reactions such as itchiness and swelling of the lips.

One person told the FDA that while eating dinner at a restaurant a customer at the next table was smoking an e cigarette.

«The vapor cloud was big enough to come over my table and the e cig smoker was ‘huffing’ it voraciously,» the person, whose name was redacted, wrote. «I got dizzy, my eyes began to water and I ended up taking my food to go because of the intense heartbeat I began to develop.»

One woman wrote that her husband began smoking e cigarettes liberally in his car and home after being told they were safe and that the vapor was «just like water.»

«My 4 year old has had a raspy voice since he started but I really didn’t think anything of it till last night my husband was just puffing away on that thing for hours and I woke up wheezing and unable to breathe.»

Miguel Martin, president of Logic Technology, one of the biggest U.S. e cigarette makers along with Lorillard Inc and privately held NJOY, said the spike in adverse event reports reinforces the importance of regulation, especially in areas governing manufacturing practices and labeling, where standards can vary dramatically.

«Clearly, because of the business opportunities, you have companies in an unregulated environment that are importing without checks and balances,» he said, adding that while Logic pays attention to quality control, «some other companies just are not having the same diligence or focus.»

MADE IN CHINA

Most e cigarettes are made in China and sold under more than 300 brands in the United States, some through retail stores, others online.

The quality of the products is inconsistent, however, making it difficult to tease out the cause of any health problems.

One smoker began using e cigarettes following dental surgery after the dentist said quitting smoking would speed the healing process, according to a report filed last October with the U.S. Consumer Product Safety Commission that was forwarded to the FDA.

«It blew up in my mouth while inhaling, burning my stitches and gum, lip and fingers,» the report said.

Others complained of over heating devices.

«The electric cigarette gets hot when you use it and alters the taste buds,» wrote one consumer. «I just recently realized what was turning my taste buds black.»

It is not possible to draw general conclusions from individual case reports, but there is a growing recognition that the inconsistent quality of the devices, aside from any risk inherent in the inhalation of nicotine vapor, poses potential safety risks.

In a bid to address quality concerns, some e cigarette makers are beginning to make them, either partially or wholly, in the United States.

Reynolds American Inc, which began selling its Vuse e cigarettes in Colorado last July and expects to expand nationwide this summer, makes its products in Kansas and North Carolina, though it still imports its batteries from China.

The reason, Richard Smith, a Reynolds spokesman said, is that inconsistent quality is turning off potential customers.

«There has been a high level of trial among adult consumers but a low level of adoption,» he said.

While the cost may be higher than sourcing ready made products from China, the pay off, Reynolds is betting, will be customer loyalty. If a quality problem arises during the manufacturing process, Smith said, «we can identify and fix it.» (Reporting by Toni Clarke in Washington Additional reporting by Jilian Mincer in New York Editing by Michele Gershberg)

«light» cigarettes and cancer risk — national cancer institute

  1. What is a so called light cigarette?

    Tobacco manufacturers have been redesigning cigarettes since the 1950s. Certain redesigned cigarettes with the following features were marketed as light cigarettes

    • Cellulose acetate filters (to trap tar).
    • Highly porous cigarette paper (to allow toxic chemicals to escape).
    • Ventilation holes in the filter tip (to dilute smoke with air).
    • Different blends of tobacco.

    When analyzed by a smoking machine, the smoke from a so called light cigarette has a lower yield of tar than the smoke from a regular cigarette. However, a machine cannot predict how much tar a smoker inhales. Also, studies have shown that changes in cigarette design have not lowered the risk of disease caused by cigarettes (1).

    On June 22, 2009, President Barack Obama signed into law the Family Smoking Prevention and Tobacco Control Act, which granted the U.S. Food and Drug Administration the authority to regulate tobacco products. One provision of the new law bans tobacco manufacturers from using the terms light, low, and mild in product labeling and advertisements. This provision went into effect on June 22, 2010. However, some tobacco manufacturers are using color coded packaging (such as gold or silver packaging) on previously marketed products and selling them to consumers who may continue to believe that these cigarettes are not as harmful as other cigarettes (2 4).

  2. Are light cigarettes less hazardous than regular cigarettes?

    No. Many smokers chose so called low tar, mild, light, or ultralight cigarettes because they thought these cigarettes would expose them to less tar and would be less harmful to their health than regular or full flavor cigarettes. However, light cigarettes are no safer than regular cigarettes. Tar exposure from a light cigarette can be just as high as that from a regular cigarette if the smoker takes long, deep, or frequent puffs. The bottom line is that light cigarettes do not reduce the health risks of smoking.

    Moreover, there is no such thing as a safe cigarette. The only guaranteed way to reduce the risk to your health, as well as the risk to others, is to stop smoking completely.

    Because all tobacco products are harmful and cause cancer, the use of these products is strongly discouraged. There is no safe level of tobacco use. People who use any type of tobacco product should quit. For help with quitting, refer to the National Cancer Institute (NCI) fact sheet Where To Get Help When You Decide To Quit Smoking, which is available at on the Internet.

  3. Do light cigarettes cause cancer?

    Yes. People who smoke any kind of cigarette are at much greater risk of lung cancer than people who do not smoke (5). Smoking harms nearly every organ of the body and diminishes a person s overall health.

    People who switched to light cigarettes from regular cigarettes are likely to have inhaled the same amount of toxic chemicals, and they remain at high risk of developing smoking related cancers and other disease (1). Smoking causes cancers of the lung, esophagus, larynx (voice box), mouth, throat, kidney, bladder, pancreas, stomach, and cervix, as well as acute myeloid leukemia (6).

    Regardless of their age, smokers can substantially reduce their risk of disease, including cancer, by quitting.

  4. What were the tar yield ratings used by the tobacco industry for light cigarettes?

    Although no Federal agency formally defined the range of tar yield for light or ultralight cigarettes, the tobacco industry used the ranges shown in the table below (5, 7).

    Industry Terms on PackagesMachine measured Tar Yield (in milligrams)Ultralight or Ultralow tarUsually 7 or lessLight or Low tarUsually 8 14Full flavor or RegularUsually 15 or more

    These ratings were not an accurate indicator of how much tar a smoker might have been exposed to, because people do not smoke cigarettes the same way the machines do and no two people smoke the same way.

    Ultralight and light cigarettes are no safer than full flavor cigarettes. There is no such thing as a safe cigarette (1).

  5. Are machine measured tar yields misleading?

    Yes. The ratings cannot be used to predict how much tar a smoker will actually get because the way the machine smokes a cigarette is not the way a person smokes a cigarette. A rating of 7 milligrams does not mean that you will get only 7 milligrams of tar. You can get just as much tar from a light cigarette as from a full flavor cigarette. It all depends on how you smoke. Taking deeper, longer, and more frequent puffs will lead to greater tar exposure. Also, a smoker s lips or fingers may block the air ventilation holes in the filter, leading to greater tar exposure (7).

  6. Why would someone smoking a light cigarette take bigger puffs than with a regular cigarette?

    Cigarette features that reduce the yield of machine measured tar also reduce the yield of nicotine. Because smokers crave nicotine, they may inhale more deeply take larger, more rapid, or more frequent puffs or smoke extra cigarettes each day to get enough nicotine to satisfy their craving. As a result, smokers end up inhaling more tar, nicotine, and other harmful chemicals than the machine based numbers suggest (1).

    Tobacco industry documents show that companies were aware that smokers of light cigarettes compensated by taking bigger puffs. Industry documents also show that the companies were aware of the difference between machine measured yields of tar and nicotine and what the smoker actually inhaled (8).

  7. How can I get help to quit smoking?

    There are many groups that can help smokers quit

    • Go online to ( ), a Web site created by NCI s Tobacco Control Research Branch, and use the Step by Step Quit Guide.
    • Call NCI s Smoking Quitline at 1 877 44U QUIT (1 877 448 7848) for individualized counseling, printed information, and referrals to other sources.
    • Refer to the NCI fact sheet Where To Get Help When You Decide To Quit Smoking, which is available at on the Internet.