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Health Team

Doctors differ on risk vs. reward of e-cigarettes

Posted May 7
Updated June 6

— Sales of electronic cigarettes in the U.S. boomed from $500 million in 2012 to $1.5 billion in 2013, according to Consumer Reports, but some in the medical community differ on the risks versus possible benefits.

“Vaping,” the act of inhaling the vapors of an e-cigarette’s heated liquid solution, is catching on among smokers hoping to quit the real thing. A battery heats the liquid solution containing nicotine and creates a vapor that users breathe in. What users breathe out disappears quickly and is typically odorless, unless they use flavored oil.

The health risks to those who use e-cigarettes and people around them are largely unknown because the products are not federally regulated, leaving state and municipal governments to create laws to allow or restrict their use.

New York City and Chicago recently banned e-cigarettes in restaurants and bars. In North Carolina, governments, schools and businesses make their own call.

E-cigarettes banned:

Duke University
Town of Chapel Hill
RDU
WakeMed
Rex Hospital
Wake County Schools
Chatham County schools
Durham Public Schools

QVape Juice in Wilson is one of the few facilities of its kind in the country that makes the liquid for e-cigarettes. The liquid is heated to produce a vapor that offers an alternative to traditional cigarette smoking, but contains fewer toxins, according to the company, which offers 40 flavors of liquids.

“That is our focus – delivering a high-quality vapor,” said CEO Sheila Williams, who worked in analytical chemistry for 16 years before starting QVape. “Just based on the chemistry, what we do know is that there are no carcinogens.”

A third of the company's e-cigarette products have no nicotine, and the highest content is labeled as 3 percent of volume. The nicotine is mixed with flavoring, vegetable glycerin and propylene glycol.

“We have our own in-house analytical lab where we test nicotine purity,” Williams said.

QVape’s 9,000-square-foot facility also includes a mixing laboratory, filling/capping laboratory, office space and labeling, packaging and warehouse areas.

The Food and Drug Administration does not regulate how e-cigarettes or the liquid are made, but Williams says she hopes that happens soon.

“There are so many people out right now making it in their basement or garage. That scares me,” she said.

Williams says she created QVape knowing that FDA regulations were inevitable, so she follows GMP, or Good Manufacturing Practices – a standard required for manufacturing food or drug products to assure safety and quality.

“We provide a certificate of analysis for every batch that we prepare and ship out,” she said.

The packaging includes a label that warns about possible birth defects and other reproductive harm. It also says to keep the liquid out of reach of children. If a child drank the candy-flavored nicotine refill bottle, it could be fatal.

QVape will soon double production from 250,000 bottles a month to 500,000. But as sales soar, many questions are still unanswered.

A new study from RTI International, a Research Triangle company, found that e-cigarette vapors contain small particles that could cause or worsen acute respiratory diseases among youth.

Another study published in the International Journal of Hygiene and Environmental Health found that the exhaled vapors worsen indoor air quality-with detectable nicotine and other particulate matter that could be a health concern for users and those close to them.

“What happens if you smoked this thing for 15, 20, 40 years is definitely cause for concern,” said cancer specialist Dr. Neeraj Agrawal, who works at Cancer Centers of North Carolina.

He points to known risks of nicotine, even in vapor, on the heart and in the brain, including the risk of Alzheimer’s and dementia.

“I have patients whose kids are using it,” Agrawal said. “They are getting exposed to nicotine at a very young age.”

The FDA has proposed regulations that restrict e-cigarette sales to the same age required for cigarettes.

Dr. Jed Rose, director of Duke's Center for Smoking Cessation, helped create the first nicotine patch in 1988. He says it’s important to balance concerns about the vapors from e-cigarettes with the smoke of regular cigarettes.

“My greatest concern is that it will be stamped out by excessive fears about fantastic scenarios that ‘might’ happen,” he said. “On the other hand, we do have the known 480,000 deaths per year from cigarette smoking … So, I think that we need innovative and bold new approaches to get cigarette smokers to quit.”

A study published in The Lancet last September showed that, after six months, 7.3 percent of study participants using e-cigarettes stopped smoking versus 5.8 percent using the nicotine patch.

Rose says his staff plans to study e-cigarettes as a smoking cessation tool because other nicotine replacement therapies don't work for most smokers.

“In terms of the long-term effects of inhaling those compounds, that clearly needs to be studied more,” he said.

11 Comments

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  • alto101 May 8, 3:03 p.m.

    ban the things. They are just another health disaster in the making.

    — Posted by Grand Union

    False, false, false. Banning these devices would likely negatively impact the overall health of our society. Do yourself a favor and read up on the peer reviewed science before you post more inaccurate information. I suggest this website as your starting point:
    http://www.casaa.org/Electronic_Cigarettes.html

  • Grand Union May 8, 1:43 p.m.

    ban the things. They are just another health disaster in the making.

  • connied2kids May 8, 10:44 a.m.

    I am a NON-smoker and have to say one of the HUGEST things all studies show with the cigs vs ecig are the decreased levels of carcinogens in ecigs vs filtered cigs. There are insane amounts of poison in regular filtered cigs that smokers don't know about and only in reading the studies show how insane filtered cigs are. Although the ecigs do have nicotine they do not have the laundry list of poisons that filtered manufactured cigs do.
    I would rather see people using the ecigs as most are to reduce the nicotine from there lives than continue to smoke. I know it is hard to stop.
    I also know that a lot of people who smoke do for more than the nicotine needs.

  • amiles1 May 8, 9:37 a.m.

    I've been vaping for a year and a half. Have never missed the Marlboros and never even wanted them since. I do enjoy the relaxation and freedom that vaping offers. My oxygen saturation levels improved so much they are now normal. No asthma attacks or wheezing either. My parents gave me my first kit for Christmas last year and a new one this year. The best present they ever gave me. Most of the griping I hear comes from docs and pharmaceutical reps who aren't getting their kickbacks and bonuses. Those patches, gum, and lozenges are nicotene based...are you going to bash them? As for Chantix...a friend of mine went nuts and almost commited suicide. My coworkers brother died from an anurysm caused by it per the autopsy. Vaping is awesome and if you want to stop smoking, I suggest you pay a visit to Misty Mountain Vapers right here in Raleigh.

  • storm2175 May 8, 9:33 a.m.

    there has been extensive research done already. http://www.ecigarette-research.com/web/index.php
    this is about money and control. all the negativity spouted in the media today is coming from people that have had their palms greased by big pharma and big tobacco. it will be easy to find this information to support this claim. You would think the american lung association would embrace ecigarettes, but look at their top contributors. the fact of the matter is, Vaping is the safer alternative. Marketing towards children? look there are fruity and candy flavored vodka on shelves. nicorette sells yummy flavors. Nicotine is a poison? yes and you wouldn't leave a bottle of bleach out for your kids to get a hold of would you? this is ridiculous regulate for underage sales, regulate the process involved in making eliquid. don't regulate batteries and accesories. if the proposed regulations stick, many people will lose their jobs, and many will die. 4 years vaping and counting, im healthier now

  • nctorwart May 8, 9:32 a.m.

    I have been a "vaper" for about 6 years. Dropped the Marlboros one day for the e-cig and never... View More

    — Posted by Glenn Miller

    Me too. Was a pack to pack and half a day smoker. First month I used an e-cig I also smoked, but maybe 5 cigs a day. Since that first month I have not touched a cig and don't crave one. Each month lowered the nicotine dosage. Biggest thing I have noticed is the spring allergies that destroy my sinuses is non-existent since I stopped smoking. But more research is needed. I agree. But the gubmint will use an excuse like the it harms left handed seagulls on Mars to tax it.

  • read_a_little May 8, 9:30 a.m.

    I smoked for 45 years and "vaping" was the only method worked for me and I have not smoked a cigarette in a year. I am furious and the goverment and the medical establishment. This is projected to be a 2 billion dollar industry, this is clearly a public health issue. Why hasn't the goverment taken my tax dollars and acted in my behalf to investigate and potentially regulate or provide guidelines for consumers. The medical community that are commenting publically is even worse. I think their behaviour is unethical. All I hear from them is FUD (Fear, uncertainty and doubt). Where are the facts? Are they to be conveniently lost while the drum of uncertainty and fear is beaten? Vaping could be safe, could be regulated, could have quality controls and could even be used as treatment because it can deliver vaporized medicines. Why isn't the medical community gathering, interpreting and publishing facts? Why won't the goverment act decisively?

  • ligonmaterial23 May 8, 9:20 a.m.

    I am curious to see if we will turn into walkers in the end from these things but I got one to save money and to use in the house or where I cant smoke . Dr Agrawal treated my mom , good man .

  • cpdtg May 8, 9:12 a.m.

    well almost anything is better than the cigs but I am sure the big cigarette companies are going to spend a LOT of money to make these sound as bad as possible we do not know how bad these are but we know what the cigs are

  • Lightfoot3 May 8, 8:46 a.m.

    "He points to known risks of nicotine, even in vapor, on the heart and in the brain, including the risk of Alzheimer’s and dementia." - article


    Okay, but is it worse than smoking cigarettes? On the surface, it seems that getting nicotine from a vapor is much safer than getting it from something that is set on fire.

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