What you need to know about e-cigarettes

As tobacco use continues its inexorable fall from grace, a growing number of people are turning to electronic cigarettes. These nifty electrical inhalers are being seen — and sometimes even marketed — as a "healthier" alternative to smoking tobacco. But are they really a viable alternative to cigarettes, or just a passing fad? What is it like to smoke one? And are they really safer than conventional cigarettes? Here's what you need to know about the e-cigarette.

What is it?

The e-cigarette is meant to mimic the experience of smoking a real one. It looks like a conventional cigarette, and is used in nearly the exact same way — less the fire and smoke. In fact, the experience is so true to traditional smoking that some consider it a viable cessation therapy.

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Each e-cig is powered by a small lithium battery that atomizes a propylene glycol/nicotine solution. The substance that's being inhaled even looks like smoke, but it's a vapor similar to fog — albeit a nicotine drenched fog; the amount of nicotine it produces closely approximates what's found in a conventional cigarette. Starter kits range in price from $40 to $100, and the liquid refills costs about $25 each — what's the equivalent of five packs of cigarettes. Some models even allow for recharging through the USB port of a computer.
Manufacturers say — much to the chagrin of federal regulators — that it's a much cleaner and safer way to inhale nicotine. And unlike cessation patches or gum, the experience is meant to be enjoyed, hence the assortment of flavors that have been made available, like menthol, chocolate and strawberry.
The technology was first conceived by American Herbert Gilbert in 1963, but its modern form took shape back in 2003 owing to the work of China's Hon Lik and his company, Golden Dragon Holding (which has since changed its name to Ruyan, meaning "like smoking"). Though once a lone player, the company now has plenty of rivals — all of whom are vying for space in a potentially lucrative market.

What's the experience like?

To get a better sense of what it's like to smoke an e-cigarette, we spoke to Jayar La Fontaine, a Toronto resident who took up the habit three months ago.
"I'm probably an atypical user of e-cigarettes," he told io9. "I was never a heavy user of tobacco in the first place — but I've always loved the effects of nicotine, what tends to sharpen my thinking." La Fontaine was exposed to e-cigarettes while attending Burning Man in 2011. There, he met a number of users who, like him, were not prior smokers.
For La Fontaine, the initial appeal of e-cigarettes had a lot to do with his asthma. "I would do some casual smoking, but it would make me feel absolutely awful afterward," he said. This was frustrating, as he enjoyed the social aspects — what he calls the "nicotine consumption ritual."
So, with the introduction of the e-cigarette, he felt that he didn't have to worry so much about the harsh toxic chemicals found in tobacco. "It's a safer delivery system for a social drug that I enjoy using every once in awhile," he said.
In terms of the experience itself, La Fontaine describes the effect as a bit muted and not as acute as when smoking traditional cigarettes. He also doesn't get a headrush or dizziness following inhalation.
"But it also doesn't irritate my lungs," he told us, "not the way that regular cigarettes do — though I occasionally feel a tingly sensation."
We asked him if he has any long term concerns about prolonged use. After a slight pause, La Fontaine admitted that he's curious to see what the long term studies will show. "I do have concerns about the overuse of nicotine because it does play with our reward system, he says. "I worry about its addictive qualities — and how it might be affecting my behavior."
And indeed, he's worried that a dependency has already started to take hold.
"I have to admit, even though it's been only three months, when I misplace my e-cigarette I immediately scramble to find out where I left it — and I don't leave home without it. It's something I'm starting to be increasingly aware of."

But is it safe?

As La Fontaine pointed out, there simply isn't enough information yet to prove safety. This has sparked a firestorm of criticism against its use, and even some outright bans.

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As it stands, the sale of e-cigarettes is prohibited in Australia, Canada, Israel, and Hong Kong. Specifically, these products cannot be sold in a retail space, nor can they be marketed. And what's being controlled is not the e-cigarette device itself, but the e-liquid cartridges. Much of the criticism also has to do with claims being made by certain e-cig manufacturers, many of whom claim that it's a safer alternative. While they may eventually be proven right, federal regulators like the U.S. Food and Drug Administration accuse them of making unsubstantiated claims. And indeed, back in 2009 the FDA seized an inbound shipment from China on these very grounds.
Other concerns are that these products are being sold to children, and that there's a heightened chance of nicotine overdose given the ease with which it can be consumed. What's also not known is whether there's a threat to non-users from "second hand vapor."
As for its safety, preliminary tests by the FDA indicated that they do contain some dangerous cancer-causing chemicals, but at lower levels than regular cigarettes.
Actually, as Boston University School of Public Health professor Michael Siegel has pointed out, at much lower levels. Speaking to NPR he said, "It is comparable to what is present in nicotine-replacement products, which are on the market, and, in fact, if you look at the actual levels of the carcinogens in electronic cigarettes, they're about 1,400 times lower than in Marlboros."
Siegel would know. He was involved in a 2010 study published in the Journal of Public Health Policy which indicated that e-cigarettes were in fact safer than cigarettes:

Few, if any, chemicals at levels detected in electronic cigarettes raise serious health concerns. Although the existing research does not warrant a conclusion that electronic cigarettes are safe in absolute terms and further clinical studies are needed to comprehensively assess the safety of electronic cigarettes, a preponderance of the available evidence shows them to be much safer than tobacco cigarettes and comparable in toxicity to conventional nicotine replacement products.

Their survey reviewed 16 laboratory studies that identified the components in electronic cigarette liquid and vapor. The researchers found that carcinogen levels in electronic cigarettes are up to 1,000 times lower than in tobacco cigarettes. Siegel went on to claim that, "The truth is, we know a lot more about what is in electronic cigarettes than regular cigarettes."
At the same time, other studies are showing that e-cigarettes do in fact harm the lungs.
FDA Deputy Commissioner Joshua Sharfstein agrees with the concerns and says consumers should be wary — that it's premature to be jumping on the e-cig bandwagon.
"Some products, which are marketed as exactly the same, have wildly variable amounts of nicotine in them," he told NPR. "One of the products has a poison in it — that is diethylene glycol. And what that indicates is that we don't really know much at all about the way these things are produced."

A lesser evil?

Not surprisingly, tobacco companies are having a fit over e-cigarettes — what's a clear and present danger to their business.
"This is exactly what the tobacco companies have been afraid of all these years, an alternative method of delivering nicotine that is actually enjoyable," said David Sweanor when speaking to the LA Times. He's an adjunct law professor at the University of Ottawa who specializes in tobacco issues. "It took the Chinese, who are very entrepreneurial, and not burdened with all kinds of regulation, to take the risk."
All this said, it's a clear case of vapor-inhaler beware. Not only are the long term impacts of e-cigarette use extremely unclear, it's obvious that nicotine addiction is a necessary part of the equation. As La Fontaine admitted, while he does enjoy the benefits of nicotine, it's a potential problem, one that may already be impacting on his behavior.
Until more is known, it's probably best to exercise caution.