Source: Courier Journal
By: Patrick Howington

Sean Howard smoked cigarettes for 14 years until he found something new — an electronic cigarette that delivers the nicotine he craves but not the deadly toxins from cigarette smoke.

Now Howard, 28, of Lexington, said he breathes better, can exercise again, and “I don’t smell like a cigarette.”

A server at a local country club, Howard said he has gone back and tried cigarettes a couple of times in the year since he quit them, “and now I can’t stand the things. … I actually don’t know how I smoked them.”

Howard is among the growing number of advocates of e-cigarettes — plastic or metal tubes that contain a nicotine solution but no tobacco. A battery heats the liquid into a vapor for inhaling.

Sold under names like “Health E-Cigarettes” and “SmokeAnywhere” that suggest harmlessness and the ability to evade indoor smoking bans, e-cigarettes don’t require matches and don’t emit toxic smoke — but they’ve still drawn plenty of fire.

In court filings and enforcement actions, federal regulators and some states have lined up with medical organizations who say e-cigarettes’ safety hasn’t been proved.

While their sale is legal in most of the U.S., including Kentucky and Indiana, several states have banned e-cigarettes or are considering it. (They are not covered under Louisville and Lexington’s indoor smoking bans, though, and there are no current plans to add them.)

Advocates of the product, and some medical experts, say the devices could save thousands of lives if used instead of cigarettes, which kill more than 400,000 Americans each year.

“I don’t think there’s any question about it,” said Dr. Joel Nitzkin, former chair of the tobacco control task force of the American Association of Public Health Physicians.

If cigarette smokers switched to e-cigarettes, Nitzkin said, “we could eliminate 98 percent of the illness and death” attributed to tobacco use.

Safety, benefits questioned

E-cigarettes emerged several years ago, and sales approached $100 million last year by one estimate. Most are manufactured in China; in the U.S., vendors sell them online or in smoke shops, truck stops and mall kiosks.

They come with various looks — some mimicking cigarettes and others with sleek metal finishes — and in flavors such as cherry, chocolate or banana, prompting fears they could attract teen buyers. An e-cigarette kit, including a battery charger and several nicotine cartridges, can cost from $30 to $90 or more. After that, the main cost is replacement cartridges or, for those who prefer, a nicotine solution that can be poured into the device’s atomizer.

Users choose how strong a nicotine concentration to use. Cartridges also come with no nicotine; they still have appeal for smokers used to the hand-and-mouth ritual of cigarettes.

Because they emit a vapor and not tobacco smoke, some vendors claim the devices can be smoked in places where cigarettes can’t, including airplanes — though the Federal Aviation Administration says airlines generally don’t allow that.

The Food and Drug Administration, meanwhile, considers e-cigarettes unapproved drug-delivery devices and has tried to block their importation. In a case that could decide the fate of e-cigarettes in the U.S., a federal judge in Washington, D.C., ruled against the agency in January. An appeal is pending.

The FDA says it doesn’t want to ban e-cigarettes outright, but wants manufacturers to begin safety studies and stop claiming health benefits. The agency also has moved to stop companies from using e-cigarettes to deliver drugs other than nicotine.

Last month, among other enforcement actions, the agency warned Las Vegas-based E-Cig Technology to stop marketing “E-Cialis,” a product the company said had the same effectiveness as the erectile-dysfunction drug with a similar name. E-Cig Technology also offered a weight-loss drug delivered through its e-cigarettes, the FDA said.

The FDA also has warned e-cigarette vendors not to suggest the product is a better smoking-cessation tool than FDA-approved nicotine patches and gums. Vendors say e-cigarettes aren’t meant as stop-smoking aids — but testimonials on their websites include quotes from users who claim they were able to quit.

At the heart of e-cigarette marketers’ health claims, and some medical authorities’ objections, is nicotine itself.

The highly addictive drug is what hooks smokers on cigarettes, but it’s not what causes smokers to get lung cancer or heart disease. That comes from the chemicals in cigarettes.

E-cigarettes defenders compare nicotine to caffeine — a stimulant that boosts alertness but isn’t very harmful if used properly.

“Caffeine can be concentrated to the point where it will kill us, even though we use it in Coca-Cola and coffee,” said Brad Rodu, a University of Louisville professor and leading proponent of giving nicotine addicts a less dangerous fix.

“I don’t think there’s any question that as a nicotine delivery system, e-cigarettes are vastly safer than continuing to burn tobacco and inhale the smoke,” Rodu said.

But if used in excess, nicotine can cause blood pressure and heart rates to rise, straining the heart. And nicotine inhalation by a pregnant woman may increase the chance of a stillborn baby.

Last year the FDA warned that tests found some electronic cigarettes contained cancer-causing chemicals and that one sample contained diethylene glycol, an ingredient in antifreeze.

The announcement was blasted as misleading by proponents of finding safer nicotine sources than tobacco, including Rodu.

They pointed to what the FDA’s announcement didn’t say — that carcinogens were found only in trace amounts that also can be found in FDA-approved nicotine replacement products.

Still, numerous health organizations, from the American Cancer Society to the Campaign for Tobacco Free Kids, have supported the FDA’s bid to regulate e-cigarettes.

Some of those foes argue that nicotine cravers may use them in addition to tobacco.

“It’s really just keeping people hooked,” said Ellen Hahn, director of the University of Kentucky’s Tobacco Policy Research Program. “More users are realizing, ‘maybe I can use … an e-cigarette when I can’t smoke.’ ”

That was the case for Deanna McGaughey-Summers, a Louisville college instructor who said a smoking ban at the University of Louisville prompted her to try electronic cigarettes late last year.

“I thought it might hold me over until I could have a ‘real’ (cigarette),” said McGaughey-Summers, 38, who smoked for at least 20 years. “I never intended to quit smoking.”

But on New Year’s Eve, with three tobacco cigarettes left, she decided to see how long she could go into 2010 without another.

She hasn’t smoked one since that night, “and I don’t crave or miss them,” McGaughey-Summers said. “It doesn’t even bother me to be around smokers.”

Not many complaints

Hahn said Louisville and Lexington’s smoking bans, passed when e-cigarettes were barely known, don’t apply to them. Bans this year by Bardstown and Glasgow included e-cigarettes, and the Madison County Board of Health is considering taking similar action.

In Louisville, two large employers and one small one said e-cigarette smoking by workers hasn’t become an issue.

And Dave Langdon, spokesman for the Louisville Metro Department of Public Health and Wellness, said his department has no plans to try adding electronic cigarettes to Louisville’s ban.

He said the department has received only one complaint over e-cigarette use in a public place. “We simply told (the complainer) that the ordinance didn’t apply,” he said.